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Effectiveness of Multidisciplinary Inpatient and Outpatient Rehabilitation on Functional Outcomes in Obese Patients with Orthopedic Comorbidities

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Disabling Obesity

Abstract

Outpatient and inpatient rehabilitation programs are designed to minimize or abolish disability associated with obesity, which may be predominantly due to cardiorespiratory and musculoskeletal issues, and general deconditioning. This chapter discusses the efficacy of outpatient multidisciplinary rehabilitation in obese patients, and presents emerging evidence of the effects of inpatient rehabilitation on functional outcomes in obese patients with disabling orthopedic conditions. In inpatient setting, obesity and its related comorbidities may prolong or complicate hospital stays and reduce efficiency of functional gain. Because of the relative scarcity of data regarding inpatient rehabilitation programs, we performed a large prospective investigation on obese patients with orthopedic conditions (N = 464). Intensive rehabilitation administered to obese patients with orthopedic conditions and motor difficulties consisted of a 4-week multidisciplinary program covering nutritional, motor, and psychological aspects. Our data provide initial evidence that multidisciplinary intensive rehabilitation is effective in minimizing the obesity-related disability and enhancing functional capacities in obese patients with motor disability. Outpatient rehabilitation programs in obese patients focus on chronic musculoskeletal conditions resulting from obesity, specifically joint misalignment, balance and postural issues, and osteoarthritis. Common goals include decreasing body weight, reducing metabolic disease risk and musculoskeletal pain severity, and improving functional strength and mobility. The chapter discusses the randomized controlled trials which have previously examined the efficacy of a variety of outpatient exercise programs using variations of resistance and/or aerobic exercise modalities at achieving these goals.

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References

  • Anton SD, Manini TM, Milsom VA et al (2011) Effects of a weight loss plus exercise program on physical function in overweight, older women: a randomized controlled trial. Clin Interv Aging 6:141–149

    Article  PubMed  Google Scholar 

  • Avila JJ, Gutierres JA, Sheehy ME, Lofgren IE, Delmonico MJ (2010) Effect of moderate intensity resistance training during weight loss on body composition and physical performance in overweight older adults. Eur J Appl Physiol 109(3):517–525

    Article  PubMed  Google Scholar 

  • Balducci S, Zanuso S, Nicolucci A et al (2010) Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian diabetes and exercise study (IDES). Arch Intern Med 170(20):1794–1803

    Article  PubMed  Google Scholar 

  • Bouchard DR, Soucy L, Sénéchal M, Dionne IJ, Brochu M (2009) Impact of resistance training with or without caloric restriction on physical capacity in obese older women. Menopause 16(1):66–72

    Article  PubMed  Google Scholar 

  • Bouchard DR, Soucy L, Sénéchal M, Dionne IJ, Brochu M (2010) Changes in objective and self-reported measures of physical capacity after an intervention in obese older women. J Women Aging 22(1):34–36

    Article  PubMed  Google Scholar 

  • Buchner DM, de Lateur BJ (1991) The importance of skeletal muscle strength to physical function in older adults. Ann Behav Med 13:91–98

    Google Scholar 

  • Capodaglio P, Capodaglio EM, Facioli M, Saibene F (2006) Long-term strength training for community-dwelling people over 75: impact on muscle function, functional ability and life style. Eur J Appl Physiol. doi:10.1007/s00421-006-0195-8

    PubMed  Google Scholar 

  • Capodaglio P, Castelnuovo G, Brunani A, Vismara L, Villa V, Capodaglio EM (2010) Functional limitations and occupational issues in obesity. Int J Occup Saf Ergon 16:507–523

    PubMed  Google Scholar 

  • Cimolin V, Vismara L, Galli M, Zaina F, Negrini S, Capodaglio P (2011) Effects of obesity and chronic low back pain on gait. J Neuroeng Rehabil 26(8):55

    Article  Google Scholar 

  • Davidson LE, Hudson R, Kilpatrick K et al (2009) Effects of exercise modality on insulin resistance and functional limitation in older adults: a randomized controlled trial. Arch Intern Med 169(2):122–131

    Article  PubMed  Google Scholar 

  • Davison KK, Ford ES, Cogswell ME, Dietz WH (2002) Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III. J Am Geriatr Soc 50(11):1802–1809

    Article  PubMed  Google Scholar 

  • Donini LM, Brunani A, Sirtori A et al (2010) Assessing disability in morbidly obese individuals: the Italian society of obesity test for obesity-related disabilities. Disabil Rehabil 1–10 (Early Online). doi:10.3109/09638288.2011.575529

  • Duvigneaud N, Matton L, Wijndaele K et al (2008) Relationship of obesity with physical activity, aerobic fitness and muscle strength in flemish adults. J Sports Med Phys Fitness 48(2):201–210

    PubMed  CAS  Google Scholar 

  • Farrell RT, Gameli RL, Aleem RF, Sinacore DR (2008) The relationship of body mass index and functional outcomes in patients with acute burns. J Burn Care Res 29:102–108

    PubMed  Google Scholar 

  • Frimel TN, Sinacore DR, Villareal DT (2008) Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults. Med Sci Sports Exerc 40(7):1213–1219

    Article  PubMed  Google Scholar 

  • Grant S, Todd K, Aitchison TC, Kelly P, Stoddart D (2004) The effects of a 12-week group exercise programme on physiological and psychological variables and function in overweight women. Public Health 118(1):31–42

    Article  PubMed  CAS  Google Scholar 

  • Hamilton BB, Laughlin JA, Fiedler RC, Granger CV (1994) Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehabil Med 26(3):115–119

    PubMed  CAS  Google Scholar 

  • Heo M, Pietrobelli A, Wang D, Heymsfield SB, Faith MS (2010) Obesity and functional impairment: influence of comorbidity, joint pain, and mental health. Obesity (Silver Spring) 18(10):2030–2038

    Article  Google Scholar 

  • Jensen GL, Hsiao PY (2010) Obesity in older adults: relationship to functional limitation. Curr Opin Clin Nutr Metab Care 13:46–51

    Article  PubMed  CAS  Google Scholar 

  • Kelly KR, Haus JM, Solomon TP et al (2011) A low-glycemic index diet and exercise intervention reduces TNF(alpha) in isolated mononuclear cells of older, obese adults. J Nutr 141(6):1089–1094

    Article  PubMed  CAS  Google Scholar 

  • Lebrun CE, van der Schouw YT, de Jong FH, Grobbee DE, Lamberts SW (2006) Fat mass rather than muscle strength is the major determinant of physical function and disability in postmenopausal women younger than 75 years of age. Menopause 13(3):474–481

    Article  PubMed  Google Scholar 

  • Lim JY, Tchai E, Jang SN (2010) Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial. PMR 2(8):723–731

    Google Scholar 

  • Macfarlane GJ, de Silva V, Jones GT (2011) The relationship between body mass index across the life course and knee pain in adulthood: results from the 1958 birth cohort study. Rheumatology (Oxford) 50(12):2251–2256

    Article  Google Scholar 

  • Manini TM, Newman AB, Fielding R et al (2010) Effects of exercise on mobility in obese and nonobese older adults. Obesity (Silver Spring) 18(6):1168–1175

    Article  Google Scholar 

  • Mathias S, Nayak USL, Isaacs B (1986) Balance in elderly patients: the ‘Get up and go’ test. Arch Phys Med Rehabil 67:387–389

    PubMed  CAS  Google Scholar 

  • Menegoni F, Galli M, Tacchini E, Vismara L, Cavigioli M, Capodaglio P (2009) Gender-specific effect of obesity on balance. Obesity (Silver Spring) 16(2):232–239

    CAS  Google Scholar 

  • Messier SP, Loeser RF, Miller GD et al (2004) Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the arthritis, diet, and activity promotion trial. Arthr Rheumatol 50(5):1501–1510

    Article  Google Scholar 

  • Miller GD, Nicklas BJ, Davis C, Loeser RF, Lenchik L, Messier SP (2006) Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. Obesity (Silver Spring) 14(7):1219–1230

    Article  Google Scholar 

  • Ministero della Salute. Quaderni, del, Ministero, della. Marzo-Aprile 2011 Roma: Istituto Poligrafico e Zecca dello Stato;vol 8

    Google Scholar 

  • Padwal RS, Wang X, Sharma AM, Dyer D (2012) The impact of severe obesity on post-acute rehabilitation efficiency, length of stay, and hospital costs. J Obes 2012:972365(Epub 2012 Feb 22)

    Google Scholar 

  • Peytremann-Bridevaux I, Santos-Eggimann B (2008) Health correlates of overweight and obesity in adults aged 50 years and over: results from the survey of health, ageing and retirement in europe (SHARE). Obesity and health in europeans aged > or = 50 years. Swiss Med Wkly 138(17-18):261–266

    PubMed  Google Scholar 

  • Podeszwa DA, Stanko KJ, Mooney JFr, Cramer KE, Mendelow MJ (2006) An analysis of the functional health of obese children and adolescents utilizing the PODC instrument. J Pedatric Orthop 26(1):140–143

    Article  Google Scholar 

  • Precilios H, Brunani A, Cimolin V, Tacchini E, Donini LM, Fabris De Souza S, Capodaglio P (2012) Measuring changes after multidisciplinary rehabilitation of obese individuals. J Endocrinol Invest (Jan 31 2012). [Epub ahead of print]

    Google Scholar 

  • Ramsay SE, Whincup PH, Shaper AG, Wannamethee SG (2006) The relations of body composition and adiposity measures to ill health and physical disability in elderly men. Am J Epidemiol 164(5):459–469

    Article  PubMed  Google Scholar 

  • Riddiford-Harland DL, Steele JR, Baur LA (2006) Upper and lower limb functionality: are these compromised in obese children? Int J Pediatr Obes 1(1):42–49

    Article  PubMed  Google Scholar 

  • Ropka ME (2002) Symptom status and functional status outcomes: humanistic outcomes in obesity disease management. Obes Res 10(suppl 1):42S–49S

    Article  PubMed  Google Scholar 

  • Schlenk EA, Lias JL, Sereika SM, Dunbar-Jacob J, Kwoh CK (2011) Improving physical activity and function in overweight and obese older adults with osteoarthritis of the knee: a feasibility study. Rehabil Nurs 36(1):32–42

    Article  PubMed  Google Scholar 

  • Sjolie AN (2004) Low-back pain in adolescents is associated with poor hip mobility and high body mass index. ScandJ Med Sci Sports 14(3):168–175

    Article  Google Scholar 

  • Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L (2008) Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care 11(6):693–700

    Article  PubMed  Google Scholar 

  • Sternfeld B, Ngo L, Satariano WA, Tager IB (2002) Associations of body composition with physical performance and self-reported functional limitation in elderly men and women. Am J Epidemiol 156(2):110–121

    Article  PubMed  Google Scholar 

  • Stickles B, Phillips L, Brox WT, Owens B, Lanzer WL (2001) Defining the relationship between obesity and total joint arthroplasty. Obes R` 9(3):219–223

    Article  CAS  Google Scholar 

  • Suri P, Morgenroth DC, Hunter DJ (2012) Epidemiology of osteoarthritis and associated comorbidities. PMR 4(5 Suppl):S10–S19

    Google Scholar 

  • Taylor ED, Theim KR, Mirch MC et al (2006) Orthopedic complications of overweight in children and adolescents. Pediatrics 117(6):2167–2174

    Article  PubMed  Google Scholar 

  • Thomas DR (2007) Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia. Clin Nutr 26(4):389–399

    Article  PubMed  Google Scholar 

  • Villareal DT, Banks M, Sinacore DR, Siener C, Klein S (2006) Effect of weight loss and exercise on frailty in obese older adults. Arch Intern Med 17(2):172–173

    Google Scholar 

  • Villareal DT, Chode S, Parimi N et al (2011) Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med 364(13):1218–1229

    Article  PubMed  CAS  Google Scholar 

  • Vincent HK, Vincent KR (2008) Obesity and inpatient rehabilitation outcomes following knee arthroplasty: a multicenter study. Obesity (Silver Spring) 16(1):130–136

    Article  Google Scholar 

  • Vincent KR, Vincent HK, Lee LW, Alfano AP (2006a) Inpatient rehabilitation outcomes in primary and revision total knee arthroplasty patients. Clin Orthop Rehabil 446:201–207

    Article  Google Scholar 

  • Vincent HK, Alfano AP, Lee L, Vincent KR (2006b) Sex and age effects on outcomes of total hip arthroplasty after inpatient rehabilitation. Arch Phys Med Rehabil 84(4):461–467

    Article  Google Scholar 

  • Vincent HK, Bourguignon C, Vincent KR (2006c) Resistance training lowers exercise-induced oxidative stress and homocysteine levels in overweight and obese older adults. Obesity (Silver Spring) 14(11):1921–1930

    Article  CAS  Google Scholar 

  • Vincent HK, Dejong G, Mascarenhas D, Vincent KR (2009) The effect of body mass index and hip abductor brace use on inpatient rehabilitation outcomes after total hip arthroplasty. Am J Phys Med Rehabil 88:201–209

    Article  PubMed  Google Scholar 

  • Vincent HK, Lamb KM, Day TI, Tillman SM, Vincent KR, George SZ (2010a) Morbid obesity is associated with fear of movement and lower quality of life in patients with knee pain-related diagnoses. PMR 2(8):713–722

    Google Scholar 

  • Vincent HK, Omli MR, Day TI, Hodges M, Vincent KR, George S (2010b) Fear of movement, quality of life and self-reported disability in obese patients with chronic lumbar pain. Pain Med 12(1):154–164

    Article  PubMed  Google Scholar 

  • Vincent HK, Seay AN, Vincent KR, Atchison JW, Sadasivan K (2012a) Effects of obesity on rehabilitation outcomes after orthopedic trauma. Am J Phys Med Rehabil (Jun 3 29, Epub ahead of print)

    Google Scholar 

  • Vincent HK, Raiser SN, Vincent KR (2012b) The aging musculoskeletal system and obesity-related considerations with exercise. Ageing Res Rev (in press)

    Google Scholar 

  • Visser M, Langlois J, Guralnik JM et al (1998a) High body fatness, but not low fat-free mass, predicts disability in older men and women: the Cardiovascular Health Study. Am J Clin Nutr 68(3):584–590

    PubMed  CAS  Google Scholar 

  • Visser M, Harris TB, Langlois J et al (1998b) Body fat and skeletal muscle mass in relation to physical disability in very old men and women of the Framingham Heart Study. J Gerontol A Biol Sci Med Sci 53(3):M214–M221

    Google Scholar 

  • Ware JJ, Kosinski M, Keller SD (1996) A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233

    Article  PubMed  Google Scholar 

  • Wilson AC, Samuelson B, Palermo TM (2010) Obesity in children and adolescents with chronic pain: associations with pain and activity limitations. Clin J Pain 26(8):705–711

    PubMed  Google Scholar 

  • World health organization (2008) The global burden of disease: 2004 update. World Health Organization, Geneva

    Google Scholar 

  • Xu X, Mirka GA, Hsiang SM (2008) The effects of obesity on lifting performance. Appl Ergon 39:93–98

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano IRCCS, Piancavallo, Verbania, Italy

    Paolo Capodaglio

  2. Human Performance Laboratory, Department of Orthopaedics and Rehabilitation, Divisions of Research and Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA

    Heather K. Vincent

  3. College of Medicine, University of Florida, Gainesville, FL, USA

    Jason Ludlow

Authors
  1. Paolo Capodaglio
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  2. Heather K. Vincent
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  3. Jason Ludlow
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Correspondence to Paolo Capodaglio .

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Editors and Affiliations

  1. Istituto Auxologico Italiano IRCCS, Via Cadorna 90, Piancavallo (VB), 28824, Italy

    Paolo Capodaglio

  2. , Department of Gastroenterology, Sao Paulo University Medical School, Avenida Eneias C. Aguiar 255, Sao Paulo, 05403-900, Brazil

    Joel Faintuch

  3. Ospedale San Giuseppe, Via Cadorna 90, Piancavallo (Oggebbio – VCO), 28824, Italy

    Antonio Liuzzi

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Capodaglio, P., Vincent, H.K., Ludlow, J. (2013). Effectiveness of Multidisciplinary Inpatient and Outpatient Rehabilitation on Functional Outcomes in Obese Patients with Orthopedic Comorbidities. In: Capodaglio, P., Faintuch, J., Liuzzi, A. (eds) Disabling Obesity. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35972-9_6

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