Background

Muscle strength is associated with metabolic health and other important health outcomes. Grip strength and long jump measurement have been used to assess muscular strength in children with overweight and obesity (OO). Very few studies have reported on a comprehensive assessment of total body strength in children with OO, or examined changes in strength after lifestyle intervention. The Bruininks-Oseretsky Test of Motor Proficiency (BOT2) assesses functional strength of major muscle groups. Our hypotheses were: [1] Children with OO have decreased functional strength compared to age related norms. [2] Physical therapist (PT) assessment and intervention as part of a multidisciplinary weight management program (MWMP) results in improved functional strength.

Methods

The functional strength of pediatric patients in a MWMP was assessed by a PT, using the strength subtest of the (BOT2). The BOT2 was repeated at follow-up visits. At each visit, individualized activity recommendations were given, in addition to nutrition, medical, and behavioral health interventions. Chart review was used to obtain strength scores and other clinical data. BOT2 scale scores were compared to age related norms, and change in strength over time was calculated.

Results

Baseline data were collected for 192 subjects. The mean BMI z-score was 2.4 ± 0.4 (SD). BOT2 strength scale scores for subjects were in the below average range and significantly lower than population norms (9.35 ± 3.3 vs population mean 11, p<0.001). There was a significant inverse association between BMI z-score and BOT2 strength scale score (r = -0.29, p < 0.001). Thirty-five patients were re-assessed with scores improving to an average of 10.31, indicating an improvement in functional strength (t=2.79, p<.0089).

Conclusions

Children with OO have decreased functional strength as measured by the BOT2. Physical therapy intervention and education as part of a MWMP resulted in improved functional strength.