Publications by authors named "Paolo Capodaglio"

81 Publications

Kinematics Adaptation and Inter-Limb Symmetry during Gait in Obese Adults.

Sensors (Basel) 2021 Sep 6;21(17). Epub 2021 Sep 6.

Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy.

The main purpose of this study is to characterize lower limb joint kinematics during gait in obese individuals by analyzing inter-limb symmetry and angular trends of lower limb joints during walking. To this purpose, 26 obese individuals (mean age 28.5 years) and 26 normal-weight age- and sex-matched were tested using 3D gait analysis. Raw kinematic data were processed to derive joint-specific angle trends and angle-angle diagrams (synchronized cyclograms) which were characterized in terms of area, orientation and trend symmetry parameters. The results show that obese individuals exhibit a kinematic pattern which significantly differs from those of normal weight especially in the stance phase. In terms of inter-limb symmetry, higher values were found in obese individuals for all the considered parameters, even though the statistical significance was detected only in the case of trend symmetry index at ankle joint. The described alterations of gait kinematics in the obese individuals and especially the results on gait asymmetry are important, because the cyclic uneven movement repeated for hours daily can involve asymmetrical spine loading and cause lumbar pain and could be dangerous for overweight individuals.
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http://dx.doi.org/10.3390/s21175980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434679PMC
September 2021

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity.

J Pers Med 2021 Aug 19;11(8). Epub 2021 Aug 19.

Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, 28824 Verbania, Italy.

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.
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http://dx.doi.org/10.3390/jpm11080810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401554PMC
August 2021

Psychological functioning in survivors of COVID-19: Evidence from recognition of fearful facial expressions.

PLoS One 2021 22;16(7):e0254438. Epub 2021 Jul 22.

Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Piancavallo, Italy.

Evidence about the psychological functioning in individuals who survived the COVID-19 infectious is still rare in the literature. In this paper, we investigated fearful facial expressions recognition, as a behavioural means to assess psychological functioning. From May 15th, 2020 to January 30th, 2021, we enrolled sixty Italian individuals admitted in multiple Italian COVID-19 post-intensive care units. The detection and recognition of fearful facial expressions were assessed through an experimental task grounded on an attentional mechanism (i.e., the redundant target effect). According to the results, our participants showed an altered behaviour in detecting and recognizing fearful expressions. Specifically, their performance was in disagreement with the expected behavioural effect. Our study suggested altered processing of fearful expressions in individuals who survived the COVID-19 infectious. Such a difficulty might represent a crucial sign of psychological distress and it should be addressed in tailored psychological interventions in rehabilitative settings and after discharge.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254438PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297857PMC
August 2021

Body composition assessment using bioelectrical impedance analysis (BIA) in a wide cohort of patients affected with mild to severe obesity.

Clin Nutr 2021 06 28;40(6):3973-3981. Epub 2021 Apr 28.

IRCCS Istituto Auxologico Italiano, Obesity Unit, Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, Milan, Italy. Electronic address:

Background & Aims: Obesity is characterized by fat mass excess (FM), extra cellular water increase (ECW) and, with ageing, decrease in fat free mass (FFM). The validity of body impedance analysis (BIA) in patients with mild to severe obesity is still debated. The purpose of this study is to describe the Resistance (Rz) and Reactance (Xc) values obtained by Body Impedance Analysis (BIA) in a wide cohort of Italian patients with mild to severe obesity. The secondary endpoint is to describe the resulting body composition values (as percentage and indexes) in this population.

Methods: The study enrolled adult in-patients with mild to severe obesity (classified with class I, II and III obesity) undergoing clinical care rehabilitation program for obesity complications and weight loss. BIA values were grouped by sex, BMI and age classes.

Results: A total of 8303 patients with obesity, aged 18 to 90 y, were studied. The Resistance (Rz) and Reactance (Xc) were reported by sex, age and BMI classes. In women and men both, the phase angle (PhA) decreases with increasing BMI (kg/m) and the resulting BIA vector was significantly shifted. The FM index (FMI) was higher (p < 0.0001) in women while FFM index (FFMI) was higher in men (p < 0.0001) and significantly associated with BMI. FFMI decreased with age in both sex (p < 0.0001). Skeletal mass (SM) presents a progressive reduction in relation to age and gender both.

Conclusions: The present BIA-based body composition analysis in a wide cohort of mild to severe obese patients revealed a significantly decreased Rz and Xc values with a consequent significant decrease of PhA in a BMI-dependent manner. The body compartments estimation with available equations was BMI, sex and age dependent. These observational results could be the basis for the development of new equations adapted for patients suffering from obesity.
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http://dx.doi.org/10.1016/j.clnu.2021.04.033DOI Listing
June 2021

Does Kinesiophobia Mediate the Relationship between Pain Intensity and Disability in Individuals with Chronic Low-Back Pain and Obesity?

Brain Sci 2021 May 22;11(6). Epub 2021 May 22.

Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, 28824 Verbania, Italy.

Individuals suffering from chronic low-back pain and obesity face severe physical and functional limitations. According to the fear-avoidance model, kinesiophobia might play a crucial role in the relationship between pain intensity and disability. Thus, the purpose of this study was to verify the role of kinesiophobia as a mediator in the association between pain intensity and disability in individuals with both chronic low-back pain and obesity. A total of 213 individuals with chronic low-back pain and obesity were included in the study. The level of kinesiophobia, pain intensity and disability were all assessed using self-reported questionnaires. We verified through a simple mediation analysis that kinesiophobia partially mediated the association between pain intensity and disability in our sample. According to our findings, we emphasize the crucial role of kinesiophobia as a psychological factor that should be addressed in chronic low-back pain rehabilitative protocols to reduce disability in individuals with obesity.
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http://dx.doi.org/10.3390/brainsci11060684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224628PMC
May 2021

Patients with Severe Obesity during the COVID-19 Pandemic: How to Maintain an Adequate Multidisciplinary Nutritional Rehabilitation Program?

Obes Facts 2021 19;14(2):205-213. Epub 2021 Mar 19.

International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy,

Background: The COVID-19 pandemic is spreading all over the world, particularly in developed countries where obesity is also widespread. There is a high frequency of increased BMI in patients admitted to intensive care for SARS-CoV-2 infection with a major severity in patients with an excess of visceral adiposity. Patients at risk of severe SARS-CoV-2 acute respiratory syndrome are characterised by the high prevalence of pre-existing diseases (high blood pressure and cardiovascular disease, diabetes, chronic respiratory disease, or cancer), most of them typically present in severely obese patients. Indeed, the biological role of adipose tissue in sustaining SARS-CoV-2 infection is not completely elucidated.

Summary: The forced isolation due to pandemic containment measures abruptly interrupted the rehabilitation programs to which many patients with severe obesity were enrolled. People affected by obesity, and especially those with severe obesity, should continue clinical rehabilitation programs, taking extra measures to avoid COVID-19 infection and reinforcing the adoption of preventive procedures. In this review, the available data on obesity and COVID-19 are discussed along with evidence-based strategies for maintaining the necessary continuous rehabilitation programs. Key Messages: Greater attention is needed for obese and severely obese patients in the face of the current COVID-19 pandemic, which represents a huge challenge for both patients and healthcare professionals. The adoption of new strategies to guarantee adequate and continuous multidisciplinary nutritional rehabilitation programs will be crucial to control the severity of SARS-CoV-2 infection in high-risk populations as well as the worsening of obesity-linked complications. Health authorities should be urged to equip hospitals with tools for the diffusion of telemedicine to maintain physician-patient communication, which is fundamental in chronic and complicated obese patients.
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http://dx.doi.org/10.1159/000513283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089441PMC
May 2021

Therapeutic cannabis for pain management in a patient with chiari malformation type i during concomitant SARS-COV-2 infection.

J Neurosurg Sci 2021 Mar 11. Epub 2021 Mar 11.

Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.

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http://dx.doi.org/10.23736/S0390-5616.21.05322-4DOI Listing
March 2021

The Reliability and Agreement of the Fibromyalgia Survey Questionnaire in an Italian Sample of Obese Patients.

Front Psychol 2021 9;12:623183. Epub 2021 Feb 9.

Psychology Research Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Ospedale San Giuseppe, Piancavallo, Italy.

The Fibromyalgia Survey Questionnaire (FSQ) was self-administered by a sample of 207 Italian individuals with obesity to screen for fibromyalgia (FM). We aimed to investigate the inter-rater reliability and the agreement in the detection of FM symptomatology between the self-administered FSQ and the clinical interview conducted by a rheumatologist. All the patients were divided randomly into two groups (group A and group B): a rheumatologist first interviewed patients of group A and after 48 h, the patients completed the self-report FSQ. Patients of group B first completed the FSQ and 48 h later were interviewed by a rheumatologist. The agreement between the measurements was good with the Bland-Altman analysis showing low bias scores for the two subscales of the FSQ. Results showed that 33% of the sample satisfied the criteria for a diagnosis of fibromyalgia. The FSQ is a self-reporting measure that showed substantial reliability providing fast screening for FM symptomatology.
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http://dx.doi.org/10.3389/fpsyg.2021.623183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900136PMC
February 2021

The Association of Kinesiophobia and Pain Catastrophizing with Pain-Related Disability and Pain Intensity in Obesity and Chronic Lower-Back Pain.

Brain Sci 2020 Dec 24;11(1). Epub 2020 Dec 24.

Department of Psychology, Catholic University of Milan, 20123 Milan, Italy.

Individuals affected by chronic lower-back pain and obesity have an increased risk of long-lasting disability. In this study, we aimed to explore the contribution of kinesiophobia and pain catastrophizing in explaining pain intensity and pain-related disability in chronic lower-back pain associated to obesity. A cross-sectional study on 106 participants with obesity and chronic lower-back pain was performed. We assessed pain intensity, pain disability, pain catastrophizing, and kinesiophobia levels through self-reporting questionnaire. Hierarchical regressions were performed to assess the role of pain catastrophizing and kinesiophobia on pain intensity and pain disability. According to the results, kinesiophobia, but not pain catastrophing, significantly explained both pain intensity and pain-related disability. Kinesiophobia might play a significant role in enhancing pain-related disability and the pain intensity in individuals with chronic lower-back pain and obesity. We encourage future studies in which beliefs and cognition towards pain might be a therapeutic target in interdisciplinary pain management interventions.
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http://dx.doi.org/10.3390/brainsci11010011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823580PMC
December 2020

Nerve Compression Injuries After Prolonged Prone Position Ventilation in Patients With SARS-CoV-2: A Case Series.

Arch Phys Med Rehabil 2021 03 25;102(3):359-362. Epub 2020 Nov 25.

Department of Rehabilitation and Functional Recovery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan.

Background: Prone positioning improves oxygenation in adult respiratory distress syndrome. This procedure has been widely used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, this procedure can also be responsible for nerve damage and plexopathy.

Methods: We retrospectively reviewed a series of 7 infectious patients with coronavirus disease 2019 who underwent prone positioning ventilation at the San Raffaele Hospital of Milan, Italy, during the SARS-CoV-2 pandemic.

Results: Clinical and neurophysiological data of 7 patients with nerve compression injuries have been reported.

Conclusions: Health care workers should take into consideration the risk factors for prone positioning-related plexopathy and nerve damage, especially in patients with coronavirus disease 2019, to prevent this type of complication.
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http://dx.doi.org/10.1016/j.apmr.2020.10.131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685952PMC
March 2021

Disability assessment in an Italian cohort of patients with obesity using an International Classification of Functioning, Disability and Health (ICF)-derived questionnaire.

Eur J Phys Rehabil Med 2021 Aug 9;57(4):630-638. Epub 2020 Nov 9.

Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Background: Obesity is a clinical condition that contributes to the development of related disability in different areas (physical, psychological and social). Multidisciplinary treatment calls for specific instruments able to evaluate all related functional problems. We have developed a tool (an ICF-based assessment instrument, the ICF-OB schedule) to evaluate obesity-related disability, composed of an inventory of 71-items from the WHO International Classification of Functioning, Disability and Health (ICF).

Aim: The aim of the present study was to validate this new tool for the definition of obesity-related disability. We also sought to examine the relationship between obesity disability, an index of multimorbidity (Cumulative Illness Rating Scale [CIRS]) and a well-validated score of perceived obesity-related disability (Italian Obesity Society Test for Obesity-Related Disability [TSD-OC]).

Design: Process validation of the ICF-OB schedule.

Setting: Baseline conditions of out- and in-patients.

Population: A large cohort of obese patients recruited from 9 multidisciplinary centers belonging to the Italian Obesity Society (SIO) network, which provide specialized obesity care.

Methods: A total of 353 patients (F: 70%, age: 50.2±12.7yrs, BMI: 41.4±8.3kg/m) were enrolled between January 2017 and June 2018. The ICF-OB was used to define patients' functioning and disability profiles in order to set and appraise rehabilitation goals.

Results: We described the distribution of body functions (BF), body structures (BS) and activities and participations (A&P) categories and the agreement rates were significant for the majority of these. The ICF-OB was more often significantly associated, and with stronger coefficients, with patients' comorbidities as described by the CIRS rather than with Body Mass Index (BMI). The TSD-OC also presented a strong association with A&P indexes.

Conclusions: The complexity of clinical condition, that generates disability in obesity might be well identified with the use of this new instrument that appear significant related to the perceived disability for each patients and also with their multimorbidity.

Clinical Rehabilitation Impact: The ICF-OB shows great promise as a tool for goal setting in the rehabilitation of obese patients.
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http://dx.doi.org/10.23736/S1973-9087.20.06512-0DOI Listing
August 2021

Correction to: Implicit facial emotion recognition of fear and anger in obesity.

Eat Weight Disord 2021 May;26(4):1281

Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, 28824, Piancavallo, VCO, Italy.

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http://dx.doi.org/10.1007/s40519-020-01042-yDOI Listing
May 2021

Implicit facial emotion recognition of fear and anger in obesity.

Eat Weight Disord 2021 May 18;26(4):1243-1251. Epub 2020 Sep 18.

Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, 28824, Piancavallo, VCO, Italy.

Background: Previous evidence about facial emotion recognition capability in obesity is few and not conclusive.

Objective: We investigated the capability of female individuals affected by obesity to recognize the emotions of fear and anger through a facial emotion recognition task grounded on the implicit redundant target effect.

Methods: 20 women affected by obesity and 20 healthy-weight women were enrolled. We administered an implicit facial emotion recognition task. Both reaction time and level of accuracy were computed. Moreover, the level of alexithymia was measured through the standard questionnaire.

Results: Selective difficulties in recognizing the emotion of fear were observed in participants with obesity, when their performance was contrasted with healthy-weight controls. Instead, they showed the implicit redundant target effect when anger was the target. However, the two groups reported globally similar scores at the standard questionnaire relative to the level of alexithymia.

Conclusions: Our result might agree with the hypothesis about affected individuals' difficulties in being attentive to negative facial emotions, and specifically in the case of fearful expression. This study might encourage future research in which emotional processing will be investigated through subjective judgments and implicit/objective measurements.

Level I: Experimental study.
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http://dx.doi.org/10.1007/s40519-020-01010-6DOI Listing
May 2021

Changes in symmetry during gait in adults with Prader-Willi syndrome.

Comput Methods Biomech Biomed Engin 2020 Nov 3;23(14):1094-1101. Epub 2020 Jul 3.

Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.

Most studies on locomotion of individuals with the Prader-Willi Syndrome (PWS) have been performed in a laboratory setting using quantitative motion analysis. Recently, wireless inertial sensors have been successfully employed for gait analysis in different pathological states with the advantages of reproducing a testing condition very close to those encountered in daily living. Using such devices, it is possible not only to characterize the conventional spatio-temporal parameters, but also extract information on further less conventional metrics, such as the harmonic ratio (HR), a measure of step-to-step symmetry based on trunk acceleration processing. In the present study, this technique was used to quantify gait parameters during level walking in 20 adults with PWS who were compared to 20 unaffected individuals. While no differences between the two groups were found in terms of spatio-temporal parameters, individuals with PWS exhibited significantly reduced values of HR in the antero-posterior and vertical directions. Such results, which indicate a poorer gait symmetry in PWS, suggest that upper body accelerations, as well as HR, provide novel information on gait in people with PWS that could not be extracted from spatio-temporal parameters only.
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http://dx.doi.org/10.1080/10255842.2020.1787999DOI Listing
November 2020

Metabolic Syndromes and Dysmobility: Why Should Physical Medicine and Rehabilitation Care?

Am J Phys Med Rehabil 2021 03;100(3):e32-e33

Istituto Auxologico Italiano IRCCS Piancavallo (Verbania), Italy.

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http://dx.doi.org/10.1097/PHM.0000000000001466DOI Listing
March 2021

ISPRM/ESPRM guidelines on Physical and Rehabilitation Medicine professional practice for adults with obesity and related comorbidities.

Eur J Phys Rehabil Med 2020 Aug 15;56(4):496-507. Epub 2020 Apr 15.

Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, Italy.

Background: The World Health Organization (WHO) has declared obesity as the largest global chronic health problem in adults. In the last years, attention has been drawn to rehabilitative interventions for patients with obesity.

Aim: The aim of this manuscript is to provide Physical and Rehabilitation Medicine (PRM) physicians with evidence-based recommendations for the rehabilitation of patients with overweight or obesity and related comorbidities.

Design: Evidence-based guidelines.

Population: Adults with overweight or obesity.

Methods: Guidelines were based on GRADE and WHO recommendations. A comprehensive search of the available evidence about rehabilitation treatments for obesity was performed, and 17 separate systematic literature reviews were conducted. For each outcome, estimates of the effects of rehabilitation treatments were computed and employed along with an assessment of quality of evidence, desirable and undesirable effects, values and preferences to formulate the recommendations. Recommendations were reviewed by a consensus expert panel using a modified Delphi process.

Results: We strongly recommend providing comprehensive multiprofessional and multidisciplinary interventions including exercise, diet and behavioral or cognitive-behavioral therapy. The nutritional component of these treatments should include diets with either a high-protein or a low-fat content. It is strongly recommended to prescribe frequent moderate aerobic exercise. We strongly recommend providing cognitive-behavioral interventions as the behavioral component of rehabilitation programs.

Conclusions: PRM physicians should lead multidisciplinary teams providing comprehensive and individualized rehabilitation programs for patients with overweight or obesity. These guidelines were endorsed by the International Society of Physical and Rehabilitation Medicine (ISPRM) and by the European Society of Physical and Rehabilitation Medicine (ESPRM).
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http://dx.doi.org/10.23736/S1973-9087.20.06232-2DOI Listing
August 2020

Gait strategy and body composition in patients with Prader-Willi syndrome.

Eat Weight Disord 2021 Feb 4;26(1):115-124. Epub 2019 Dec 4.

Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Piancavallo, Verbania, Italy.

Purpose: Individuals with Prader-Willi syndrome (PWS) exhibit reduced lean body mass and increased fat-lean mass ratio when compared with individuals of normal weight and obese ones. Thus, research on the association of functional limitations during gait and body composition may be of great importance from a rehabilitative viewpoint. In particular, the aim of this study was to compare the gait profile of persons with PWS to that of unaffected individuals and to see if a relationship exists between gait profile and body composition in individuals with PWS.

Methods: Eighteen individuals with PWS and 20 unaffected individuals (Healthy Group: HG) were assessed. Their gait pattern was quantified with 3D-Gait Analysis (3D-GA). Overall body weight, lean and fat masses were measured by dual-energy X-ray absorptiometry.

Results: Individuals with PWS were found to be characterized by a significantly different (p < 0.05) gait pattern with respect to healthy controls in terms of both kinematic and kinetic parameters. No correlations were found between kinematic parameters and overall mass and lean/fat mass, while some parameters associated with ground reaction force were found to be significantly correlated with overall mass, lean mass and fat mass. Significant regression models were obtained, including impact and propulsive force and loading rate.

Conclusion: Our data suggest that in individuals with PWS, gait is influenced by the overall and lean body mass. Thus, therapeutic strategies should target both weight reduction and lean mass increase to optimize gait, minimize articular stress, and reduce the risk of repetitive strain on the lower limbs.

Level Of Evidence: Level III: Case-control analytic study.
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http://dx.doi.org/10.1007/s40519-019-00825-2DOI Listing
February 2021

Symmetry of Gait in Underweight, Normal and Overweight Children and Adolescents.

Sensors (Basel) 2019 May 2;19(9). Epub 2019 May 2.

Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d'Armi, 09123 Cagliari, Italy.

Abnormal excess or lack of body mass can influence gait patterns, but in some cases such differences are subtle and not easy to detect, even with quantitative techniques for movement analysis. In these situations, the study of trunk accelerations may represent an effective way to detecting gait anomalies in terms of symmetry through the calculation of Harmonic Ratio (HR), a parameter obtained by processing trunk accelerations in the frequency domain. In the present study we used this technique to assess the existence of differences in HR during gait in a cohort of 75 healthy children and early adolescents (aged 7-14 years) stratified into 3 equally-sized age and gender-matched groups (Underweight: UW; Normal Weight: NW; Overweight: OW). The accelerometric signal, acquired using a single wearable inertial sensor, was processed to calculate stride length, speed, cadence and HR in antero-posterior, vertical and medio-lateral directions. No differences in spatio-temporal parameters were found among groups, while the HR in the medio-lateral direction was found significantly lower in UW children, while OW exhibited the highest values. On the basis of the results obtained, HR appears capable of discriminating gait symmetry in children with different body mass even when conventional gait parameters are unchanged.
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http://dx.doi.org/10.3390/s19092054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539288PMC
May 2019

A biomechanical study of gait initiation in Down syndrome.

BMC Neurol 2019 Apr 15;19(1):66. Epub 2019 Apr 15.

Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.

Background: Gait Initiation (GI) is a functional task that challenges the balance control requiring weight shift and a transition from standing to walking. Individuals with Down Syndrome (DS) walk with low velocity, prolonged stance and shorter steps beside an increased support base. However, no studies performed GI analysis on this population. The aim of this study is to quantitatively characterize the GI task in subjects with DS compared with a typically developed control group.

Methods: Seventeen individuals with DS (17 to 40 years) and 19 healthy subjects (17 to 40 years) were enrolled in the study. Data were acquired using an optoelectronic motion capture system and force plates in order to measure the displacement and velocity of Center of Mass (CoM) and the trajectory of Center Of Pressure (CoP). All participants were asked to stand barefoot on the first force platform and received a verbal cue to begin walking for 6 gait initiation trials (three starting with each foot). The CoP duration, velocity, length and excursion were calculated during the anticipatory postural adjustments phases (APAs) and the locomotor (LOC) phase. For the analysis of the CoM, its displacements in antero-posterior (AP) and medio-lateral (ML) during the APAs and LOC phases. Statistical analysis was conducted to compare the two groups.

Results: Regarding CoP measures, when compared to control group, individuals with DS presented higher durations, lower velocities, longer lengths during the second APA and total phases, and shorter lengths during the first APA and LOC phases. The group with DS also presented longer CoP excursion during the second APA, whereas a shorter excursion was present during the first APA and LOC phases. The AP excursion in CoM is reduced in the participants with DS.

Conclusions: Our results could be useful in the rehabilitation of individuals with DS as they suggest to reinforce exercise programs to improve balance in AP and ML directions, which is demonstrated to be impaired in these subjects.
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http://dx.doi.org/10.1186/s12883-019-1288-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466789PMC
April 2019

Slow versus traditional strength training in obese female participants: preliminary results.

Int J Rehabil Res 2019 Jun;42(2):120-125

Istituto Auxologico Italiano, IRCCS, Rehabilitation Unit and Research Lab in Biomechanics and Rehabilitation, S Giuseppe Hospital, Piancavallo.

The aim of this study was to provide comparative data on a slow versus a traditional supervised resistance training in an obese female population. Forty obese female patients admitted to our rehabilitation hospital were assigned randomly to a slow training group (ST group; mean age: 47.44 years, mean BMI: 38.53 kg/m) and a traditional training group (TT group; mean age: 54.34 years, mean BMI: 39.37 kg/m). The ST protocol included five repetitions for five consecutive bouts on the leg press and extension machine. The duration of each repetition (concentric+eccentric phases) was 6 s for leg press and 5 s for leg extension. The initial load was 50% of the one repetition maximum and then gradually reduced by 20% for each bout. The TT protocol included six consecutive repetitions for five bouts on the leg press and leg extension with 80% of the one repetition maximum load. Both groups performed 10 sessions. All of the patients were assessed by a visual analogue scale for pain, a Borg scale for subjective fatigue, and an isokinetic strength test. Statistically significant strength improvements were observed in both groups. In ST group statistically significant improvements in visual analogue scale scores for knee pain were found at post, larger than that observed in TT group. Subjectively perceived fatigue on the Borg scale decreased more at post in ST group in comparison with TT group. Our preliminary data suggest that ST may represent a preferential strengthening method in obese patients as it can lead to significant strength gains with a relatively lower loading effect on the knee, and hence reduced perception of pain.
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http://dx.doi.org/10.1097/MRR.0000000000000335DOI Listing
June 2019

Do wearable sensors add meaningful information to the Timed Up and Go test? A study on obese women.

J Electromyogr Kinesiol 2019 Feb 5;44:78-85. Epub 2018 Dec 5.

Rehabilitation Unit and Research Lab in Biomechanics and Rehabilitation, S Giuseppe Hospital, Istituto Auxologico Italiano, Piancavallo, VB, Italy.

The purpose of this study was to validate Time Up and Go test (TUG) as measured by a single Inertial Measurement Unit (IMU) placed on the lower back to that measured by a stopwatch in obese and normal weight women; in addition, the comparison of the performance of TUG test between obese and healthy women using the instrumented TUG (iTUG). Forty-four severely obese women and 14 age-matched healthy women were assessed simultaneously by IMU and stopwatch. The comparison between manual and instrumented assessment of total time duration showed no significant differences both in the healthy (8.32 ± 0.96 s vs. 8.52 ± 0.97 s, p > 0.05) and in the obese group (9.99 ± 2.28 s vs. 9.81 ± 2.52 s; p > 0.05). The comparison between obese and healthy group exhibited significant differences in terms of total time duration both during manual and iTUG, which is longer in obese women than normal weight women. The duration of the sub-phases in obese group is longer with the exception of sit-to-stand and stand-to-sit phase, with lower turning velocity both in mid- and final turning sub-phase. The results suggest that the iTUG is an objective and fast mobility test and it could add useful information to the manual TUG for clinical practice.
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http://dx.doi.org/10.1016/j.jelekin.2018.12.001DOI Listing
February 2019

ACTonHEALTH study protocol: promoting psychological flexibility with activity tracker and mHealth tools to foster healthful lifestyle for obesity and other chronic health conditions.

Trials 2018 Nov 29;19(1):659. Epub 2018 Nov 29.

Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Verbania, Italy.

Background: Obesity and the state of being overweight are increasing steadily and becoming a global epidemic. Recent research reports 64% of the adult population as overweight in Europe and the USA. The social and economic impacts are increasing, and most of the rehabilitation programs, while effective in the short term, do not produce long-lasting results. An explanatory model from a behavioral perspective can describe the phenomena with the lack of sources of reinforcement related to healthful habits in a daily life context.

Methods/design: A randomized clinical trial combining single-subject studies and a four-arm group design will be conducted to compare the effect of the current standard in obesity treatment to Acceptance and Commitment Therapy (ACT) and wearable technology at different times, before starting intervention, at the end, and at follow-up visits of 3, 6, and 12 months measuring changes over time of physical activity and psychological well-being.

Discussion: The goal of this project, combining ACT and wearable technology, is to develop an effective intervention, efficient and sustainable, which even after discharge can provide adequate contingencies of reinforcement in the natural environment, integrating systematic measurements, continuous feedback, and individualized, values-based objectives. The intervention is aimed to provide a contingent reinforcement for healthful behaviors instead of reinforcing only the achievement of a significant weight loss. The aim of the project, combining Acceptance and Commitment Therapy and Wearable Technology, is to develop an effective, efficient and sustainable intervention able to provide a contingent reinforcement for healthy behaviors. The intervention is aimed to promote adequate healthy behaviors in the natural environment, integrating systematic measurements, continuous feedback and individualized values-based objectives, instead of reinforcing only the achievement of a significant weight loss.

Trial Registration: ClinicalTrials.gov, NCT03351712 . Registered on 24 November 2017.
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http://dx.doi.org/10.1186/s13063-018-2968-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262958PMC
November 2018

Defining the appropriate setting for treating obese patients: do we have the right tools?

Eat Weight Disord 2018 Dec 24;23(6):871-876. Epub 2018 Oct 24.

Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.

Purpose: To allocate obese patients to the correct therapeutic setting, the Italian Obesity Society (SIO) has suggested a new algorithm based on the Edmonton obesity staging system (EOSS). The aim of our study was to apply in two retrospective cohorts of obese patients both the EOSS and the activities of daily life (ADL) scale to identify also their rehabilitation needs.

Methods: 288 out-patients and 298 in-patients were recruited. All patients were evaluated with a multidisciplinary approach and the mental, mechanical, and metabolic comorbidities were scored.

Results: The 2 groups differed for gender (28.8% men in out-patients, p = 0.001), age (> 60 years in in-patients, p = 0.03), BMI (40.8 ± 6.3 kg/m in in-patients, p < 0.001), and ADL (44.0 ± 16.0 in in-patients, p < 0.001). EOSS distribution was significant different: stages 0 and 1 were more present in out-patients and stages 3 and 4 in in-patients. In both groups, BMI increased significantly in EOSS category [95% CI + 1.4 (+ 0.5; + 2.2) for out-patients and + 1.7 (+ 0.7; + 2.6) for in-patients] and ADL were positively correlated with EOSS [95% CI + 5.0 (+ 2.5; + 7.4) for out-patients and + 9.9 (+ 7.7; + 12.2) for in-patients]. Mean ADL difference between the two groups, adjusted for age (over/under 60 years), BMI category, and EOSS was 24.8 (p < 0.0001).

Conclusions: SIO algorithm seems an effective tool for staging obesity in relation to the clinical impairment. To better define the correct rehabilitative allocation of obese patients, we suggest to integrate the SIO algorithm with the ADL score.

Level Of Evidence: Level III, retrospective case-control analytic study.
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http://dx.doi.org/10.1007/s40519-018-0595-xDOI Listing
December 2018

Whole-body vibration training in obese subjects: A systematic review.

PLoS One 2018 5;13(9):e0202866. Epub 2018 Sep 5.

Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano-Italy.

Objective: (i) to determine the outcomes of whole-body vibration training (WBVT) on obese individuals, and the intervention settings producing such effects; (ii) identify potential improper or harmful use of WBVT.

Design: Systematic review.

Data Sources: Medline, Scopus, Web of Science, PEDro and Scielo until July 2018.

Eligibility Criteria: Full papers evaluating the effect of WBVT on body composition, cardiovascular status and functional performance in obese adults. Papers with PEDro score<4 were excluded.

Study Appraisal And Synthesis: Risk of bias and quality of WBVT reporting were assessed with PEDro scale (randomized controlled trials) or TREND checklist (non-randomized studies) and a 14-items checklist, respectively. Weighted acceleration, daily exposure and Hedges' adjusted g were computed.

Results: We included 18 papers published 2010-2017. Typical interventions consisted in three sessions/week of exercises (squats, calf-raises) performed on platforms vibrating at 25-40 Hz (amplitude: 1-2 mm); according to ISO 2631-1:1997, daily exposure was "unsafe" in 7/18 studies. Interventions lasting ≥6 weeks improved cardiac autonomic function and reduced central/peripheral arterial stiffness in obese women; 10 weeks of WBVT produced significant weight/fat mass reduction, leg strength improvements as resistance training, and enhanced glucose regulation when added to hypocaloric diet. No paper evidenced losses of lean mass. Isolated cases of adverse effects were reported.

Summary: To date, WBVT is a promising adjuvant intervention therapy for obese women; long-term studies involving larger cohorts and male participants are required to demonstrate the associated safety and health benefits. The therapeutic use of WBVT in the management of obese patients is still not standardised and should be supported by an extensive knowledge on the causality between vibration parameters and outcomes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202866PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124767PMC
February 2019

Prevalence and burden of obesity in Rehabilitation Units in Italy: a survey.

Eur J Phys Rehabil Med 2019 Feb 27;55(1):137-139. Epub 2018 Aug 27.

Rehabilitation Unit, Istituto Auxologico Italiano, Piancavallo, Pordenone, Italy.

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http://dx.doi.org/10.23736/S1973-9087.18.05393-5DOI Listing
February 2019

What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation? Clinical Implications From the Italian Consensus Conference on Pain in Neurorehabilitation.

Front Neurol 2018 18;9:310. Epub 2018 May 18.

Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, Italy.

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use.

Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form.

Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results.

Clinical Implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.
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http://dx.doi.org/10.3389/fneur.2018.00310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968866PMC
May 2018

Range of motion limitations of the upper body in obese female workers.

Med Lav 2017 12 14;108(6):455-465. Epub 2017 Dec 14.

.

Background: The prevalence of obesity is increasing worldwide, and the economic consequences of an increased percentage of obese workers are relevant in terms of health costs and absences from work. Obesity is associated with reduced participation in the workforce, increased absence from work, disability and health costs, lower salaries and reduced productivity.

Objectives: We aimed at quantifying the limitations in range of motion (ROM) of the upper limb and the trunk of obese workers during basic occupational tasks.

Methods: One group of 15 obese female subjects (BMI: 42.10±9.10 kg/m2) and one control group of 13 normal-weight female subjects were recruited. Three group of tasks were selected as representative of basic occupational movements: 1) upper limb movements (reaching, abduction-adduction, frontal elevation); 2) trunk movements (lateral bending, rotation); 3) whole body movement (target task).

Results: We observed significant range of motion limitations in lateral and frontal upper arm elevation. Statistically significant difference in terms of center of pressure (the point of application of the ground reaction force measured by means of force platform) excursions was observed for lateral bending and trunk rotation tasks.

Conclusions: Our results show that obese subjects have significant range of motion limitations of the upper body during basic occupational activities. This study provides quantitative evidence of these limitations of obese workers and may serve occupational specialists to allocate them to adequate jobs and reduce the rate of work-related musculoskeletal disorders.
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http://dx.doi.org/10.23749/mdl.v108i6.6339DOI Listing
December 2017

Body-scaled action in obesity during locomotion: Insights on the nature and extent of body representation disturbances.

J Psychosom Res 2017 11 4;102:34-40. Epub 2017 Sep 4.

Research Laboratory in Biomechanics and Rehabilitation, Orthopedic Rehabilitation Unit, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Piancavallo (VCO), Italy.

Objective: Conscious perception of our own body, also known as body image, can influence body-scaled actions. Certain conditions such as obesity are frequently accompanied by a negative body image, leaving open the question if body-scaled actions are distorted in these individuals.

Methods: To shed light on this issue, we asked individuals affected by obesity to process dimensions of their own body in a real action: they walked in a straight-ahead direction, while avoiding collision with obstacles represented by door-like openings that varied in width.

Results: Participants affected by obesity showed a body rotation behavior similar to that of the healthy weighted, but differences emerged in parameters such as step length and velocity.

Conclusion: When participants with obesity walk through door-like openings, their body parts rotation is scaled according to their physical body dimensions; however, they might try to minimize risk of collision. Our study is in line with the hypothesis that unconscious body-scaled actions are related to emotional, cognitive and perceptual components of a negative body image.
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http://dx.doi.org/10.1016/j.jpsychores.2017.09.004DOI Listing
November 2017

Effects of nanotechnology-based devices on postural control in healthy subjects.

J Sports Med Phys Fitness 2018 Oct 5;58(10):1418-1422. Epub 2017 Sep 5.

Unit of Rehabilitation, Research Lab of Biomechanics and Rehabilitation, S. Giuseppe Hospital, Istituto Auxologico Italiano, Piancavallo, Verbania, Italy.

Background: The aim of the present preliminary randomized controlled study was to ascertain whether the use of newly developed nanotechnologies-based patches can influence posture control of healthy subjects.

Methods: Thirty healthy female subjects (age 39.4 years, BMI 22.74 kg/m2) were randomly assigned to two groups: one with active patches and a control group with sham patches. Two patches were applied with a tape: one on the subject's sternum and the other on the C7 apophysis. Body sway during quiet upright stance was recorded with a dynamometric platform. Each subject was tested under two visual conditions, eyes open and closed. We used a blocked stratified randomization procedure conducted by a third party.

Results: Subjects wearing the sham patches showed a significant increase of the center of pressure sway area after 4 hours when they performed the habitual moderate-intensity work activities. In the active patch group, a decrease of the sway path was evident, providing evidence of an enhanced balance control.

Conclusions: Our preliminary findings on healthy subjects indicate that nanotechnological devices generating ultra-low electromagnetic fields can improve posture control.
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http://dx.doi.org/10.23736/S0022-4707.17.07530-2DOI Listing
October 2018

GH Responsiveness to Combined GH-Releasing Hormone and Arginine Administration in Obese Patients with Fibromyalgia Syndrome.

Int J Endocrinol 2017 28;2017:3106041. Epub 2017 Jun 28.

Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan and Verbania, Italy.

Reportedly, fibromyalgia (FM) is frequently associated with reduced IGF-1 levels and GH hyporesponsiveness to different GH stimulation tests. Since there is a high prevalence of obesity in FM, and obesity itself is characterized by hyposomatotropism, the aim of this study was to assess IGF-1 levels and GH responsiveness in sixteen severely obese women suffering from FM, who, subdivided into two subgroups on the basis of their age-dependent IGF-1 values (> or <-2 SDS), underwent the combined GHRH plus arginine test. Four out of 16 obese women with FM (25%) had low IGF-1 SDS values, 2 cases of this subgroup (12.5%) failing also to normally respond to the test. Among patients with normal GH responses, 4 showed a delayed GH peak. The subgroup with low IGF-1 SDS values had higher BMI than that with normal IGF-1 SDS. GH peak and area under the curve were not correlated with CRP, ESR, or tender point score, while significant correlations were found with fat-free mass and fat mass. In conclusion, this study shows the existence of a high prevalence of GH-IGF-1 dysfunction in patients with both FM and obesity, presumably as a consequence of the obese rather than fibromyalgic condition.
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http://dx.doi.org/10.1155/2017/3106041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506478PMC
June 2017
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