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Several barriers to exercise are present that need to be addressed. Morbidly obese individuals experience more skin friction, urinary stress incontinence, knee pain, low back pain, and hip arthritis than the lean population, which may significantly impair their ability to adhere to an exercise regimen (6). Obesity and overweight also contribute to greater perceived effort, oxygen uptake, and less pleasure during treadmill exercise sessions (7). Recent theories suggest that a negative experience associated with exercise can significantly reduce the likelihood of engaging in future exercise sessions (8). Therefore, tools to reduce these barriers may improve outcomes for exercise-based interventions for morbid obesity.
The Alter-G, an antigravity treadmill that alleviates body weight while subjects exercise, has potential to reduce pain and exertion during exercise. Overall, these treadmills have been found to be effective for weight loss in obese populations (10). However, although evidence suggests that the Alter-G would reduce pain and exertion, the effect of the Alter-G treadmill on exercise adherence in morbidly obese populations has not been studied.
The hypothesis is that the adherence to and progression of the exercise routine of participants walking at a reduced percentage of their body weight will increase relative to those who must exercise at 100% of their body weight.
A secondary hypothesis is that participants who use the Alter-G with the anti-gravity function will experience less pain and perceived exertion during exercise compared to those who exercise at 100% of their body weight.
Finally, the investigators hypothesize that increased exercise adherence in those using the anti-gravity function of the Alter-G will lead to increased fitness and improved muscle function.
Full description
Screening
III.) Exercise Protocol:
Scheduling:
Before beginning phases of the program, participants will be shown a physical calendar that will be located in the same room as the treadmill. They will be able to come in and select time slots in which they are available. Once a time slot has been filled it may not be reserved by another participant. If a schedule change is needed the participants will be allowed to come in and change it on the calendar and reserve an open time slot, while removing their name from the one they will be missing, or email the study coordinator and have a student or faculty member on the project change it for them.
Participants will take part in information and orientation session before scheduling begins. Informed consent will be obtained during this time, and this information session will serve as an overview of the program, and will introduce them to the Alter-G antigravity treadmill. They will be informed on how this exercise program will proceed, and will be told what to expect. Orientation Session During the orientation session, first measure blood pressure and resting heart rate as a final screening measure, and make sure it is not above 140/90 or heart rate (HR) of 90. The investigator will then review the study brochure with participants and complete informed consent. Once informed consent is obtained, participants will randomize them perform the sit-to-stand assessment followed by the 6 minute walk assessment then introduce them to the treadmill according to the following protocols:
Unweighting group:
Control Group:
Goals:
Begin program
Explain and emphasize the individualized goals for each participant
Record resting BP, HR, age-predicted max heart rate
Start with a 5-10 minute warm up
Monitor HR, rate of perceived excretion (RPE), and McGill Pain Inventory throughout exercise session
o During the first session, as participants are walking on treadmill, the investigator will be recording these measurements.
Allow participants to self-select an intensity that is comfortable for each subject individually while encouraging them to come in at least 3 days a week and work for at least 30 minutes a day.
Should aim to reach a moderate intensity during the active part of the program (~50-70 % age-predicted max heart rate, 12-13 RPE on a Borg Scale, 2.0-4.0 mph).
Reduce intensity for a 5-10 minute cool-down at the end
Treatment:
* The treatment group should walk at individualized percentage of body weight that was established during their orientation session for at least 30 minutes where there is reduced pain, or an absence of pain. Phase II [Weeks 2 - 16]
Goals:
Continue program
Start with a 5-10 minute warm up.
Record HR, RPE, every session, and BP, and McGill Pain Inventory once per week.
Meet with each participant individually every two weeks to:
o Encourage participants to increase workload intensity and aim for longer and more frequent sessions on the treadmill.
For those who met the 30 minutes for 3 days, they will be encouraged to increase their speed, duration, and/or incline.
For those who were unable to meet the 30 min/3 day minimum they will be given advice on how to meet this minimum time. These meetings will serve as troubleshooting sessions.
o Answer any questions the participants may have.
Address any questions, comments, concerns, and complaints.
Reduce intensity for a 5-10 minute cool-down at end of each session.
Final Session:
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26 participants in 2 patient groups
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Data sourced from clinicaltrials.gov
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