An experimental and simulation based approach toward understanding the effects of obesity on balance recovery from a postural perturbation

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Virginia Tech


Obesity is associated with an increased risk of falls and subsequent injury. Most falls result from some type of postural perturbation. As such, it is important to understand how obesity influences balance recovery from a postural perturbation. There is limited information on the effects of obesity on balance recovery, and the limited available information is ambiguous. Therefore, the purpose of the research within this dissertation was to investigate the effects of obesity on balance recovery after a postural perturbation in young adults to better understand how obesity contributes to fall risk.

Four separate studies make up this dissertation. The purpose of the first study was to investigate the effects of obesity on balance recovery ability using an ankle strategy in young adults. Normal-weight and obese participants recovered balance using an ankle strategy after three types of postural perturbations: an initial angular displacement, an initial angular velocity from the natural stance, and an initial angular velocity from a prescribed position. Obese participants were unable to recover balance using an ankle strategy as well as normal-weight participants when perturbations involved an initial angular velocity. However, no differences between obese and normal-weight participants were found when perturbations only involved an initial angular displacement. The effect of obesity on balance recovery in young adults was dependent on the perturbation characteristics, and may be explained by a possible beneficial effect of increased inertia on balance recovery after perturbations with little or no initial angular velocity.

The purpose of the second study was to examine the effects of obesity on balance recovery by stepping in young adults. The ankle strategy has the benefit of simplifying the mechanics of balance recovery, but limits generalizability to more realistic fall scenarios where stepping to extend the base of support and recover balance is desired. Similar to the first study, participants attempted to recover balance following two types of postural perturbations: an initial angular displacement from an upright stance (by releasing participants from a static forward lean), and an initial angular velocity while in an upright stance (using a translating platform). In contrast to the first study, the ability to recover balance with a single-step did not differ between young normal-weight and obese adults. These results suggest that the reported increase in fall risk in obese adults is not a result of impaired balance recovery ability (at least among young adults that were tested here).

The third study examined the effects of obesity on body kinematics immediately following a trip-like perturbation in young adults. Obesity was found to increase body angular velocity the perturbation, and that increases in body angular velocity were associated with an increased probability of a failed recovery. These results suggest that when a young obese and young normal-weight individual trip while walking at similar speeds, the young obese individual may be at a greater risk of falling following a trip because the young obese individual will experience a greater body angular velocity. This detrimental effect of obesity on the difficulty of recovering from a trip-like perturbation in young adults is most likely due to how mass is distributed throughout the body and not the amount of mass itself.

The final study examined the relationship between relative strength and functional capability in young adults, and how obesity influences this relationship. To compare relative strength used during a functional task (i.e. balance recovery from a forward fall), the obese and normal-weight individual should complete the task with identical kinematics. Forward dynamic simulations were used to address this research question, instead of human subjects testing, to achieve identical kinematics. Differences in peak relative torques were found between the normal-weight and obese model, with the largest differences seen at the hip. These findings suggest that young obese individuals use greater relative strength at some joints than young normal-weight individuals to perform the time-critical task of balance recovery, and that these differences in relative strength demands may limit functional capability in young individuals who are obese.



falls, balance recovery, Obesity, forward dynamic modeling