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According WHO, (2000) Overweight and obesity in many developing countries, not pay most attention is concentrated on famine and under nutrition or malnutrition of children. If preventive measures are not put in place, In these areas the problem may escalate and overburden the health care system. Hence there is require to put measures in place to arrest the problem of overweight and obesity and prevent the negative effect in individuals especially among women.
Balance is defined as the process that maintains the center of gravity within the body’s support base and requires constant adjustments that are provided by muscular activity and joint positioning. Most nervous and musculoskeletal system diseases can alter this balance control.1
Maintaining postural balance requires sensorial detection of the body’s movements, integration of kinaesthesia information into the central nervous system and an appropriate motor response. The position of the body part in relation to environment is determined by somatic sensitive and visual, vestibular functions. Muscular control and dynamic maintenance of balance involve the activity of coordinates of muscular kinetic chains.2
Adipose tissue accumulation and body mass increases can cause a reduction in the body balance and be a major contributing factor regarding falls, especially when combined with low muscular mass, which can generate biomechanical failure of muscular responses and loss of stability mechanisms.3
The susceptibility to weight gain like overweight, as well as produce diseases complication depends on genetic predisposition. For example, the energy consumption rate, ability to store fat distribution as adipose tissue, and the connection between high levels of blood lipids and atherosclerosis show large inter individual variation. Physical inactivity is, however, a crucial factor for every individual, and the disease risk complication is reduced by increased activity, including in overweight individuals.4
Obesity found in boys aged 10–21 there was a significant relationship between percentage of body fat, body weight, body mass index, and total fat mass and a clinical balance score. Obese also showed greater sway areas and variability in the medial/lateral direction when compared with non-obese prepubertal boys.5
Altogether; some studies support the view that overweight can yield poorer balance. More recently, it was reported that in obese teenagers similar results found but only when the postural control was stressed by adding a foam surface. Adding a foam surface presumably provide the lower limbs somatosensory information and requires a greater reliance on the remaining sensory systems. They said that the less stable posture was not only the result of overweight by itself but could be related to sensory integration problems.6,7
Muscle weakness and poor balance have been well established as risk factors for falls in prospective cohort studies in population.8, 9, 10,11,
Postural control is any act of maintaining, achieving or restoring balance in any static or dynamic body position. Balance define is the state of equilibrium whereby the net force or sum of forces, acting on the body is zero. In practice, this means that in order to maintain balance, postural control strategies must be employed to counteract forces that act to move the body out of control equilibrium. Movement and balance deficits may be reflected in impaired ability to stand, transfer motion, lean or reach, and respond to perturbation. The efficacy of these motions is measured through variations in COP or body sway in static balance tests. Since the goal of postural control is to minimize fluctuations in body sway by correcting them quickly, the size and speed of these shifts provides an indication of the efficacy of postural control mechanisms within the body.12
Adipose tissue accumulation and body mass increases can be a major factor contributing to the more chances of falls, which explains why more weighted persons, appear to be at greater risk than normal-weight subjects under daily postural stresses and perturbations 13. In general, the nobility of the postural control system is analyzed, in static posturegraphy, by analyzing the canter of pressure (COP). The effectiveness of the postural control system has been related to the magnitude of transfer of the COP, while the variant related to the velocity of COP is generally associated with posturographic activity to achieve this level of stability 14.
Obesity and overweight: Effects of on musculoskeletal system
Although numerous studies have identified the anthropometric changes associated with overweight and obesity, there is a paucity of research on the effects of adiposity on the musculoskeletal structure in children. Despite several studies indicating that the morphology of connective tissue may primarily be influenced during growth and development, the effects of childhood obesity on the morphology of soft tissue structures, such as muscle tendon and ligament remain unknown15. In animal models, exercise has been shown to augment tendon development during growth, while in children, activity levels have been related to the development of cartilaginous knee joint, addition of low levels of physical activity accompanied by reduced cartilage accumulation 15. Although childhood weight gain is also commonly associated with low levels of physical activity16.
During normal growth and development the head and neck of the femur undergo relative internal rotation with respect to the femoral condyles, such that the femoral head moves from a position of approximately 30 of anteversion to about 13 anteversion by adulthood 17,18. This reduction in femoral anteversion with maturation has been attributed to several factors including bone growth, tension within soft tissue structures about the hip and biomechanical
and weight-bearing forces 19,20.
The effect of obesity on the alignment of the knee has been sparsely reported within the literature. Severe obesity has been clinically linked with Blount’s disease or idiopathic tibial Vera in infants, juveniles and adolescents 21–22.
Although little is known regarding the pathogenesis of the condition, biomechanical overload of the proximal tibial physis secondary to static varus alignment and excessive body weight has been touted to suppress varus stress growth and disrupt endochondral ossification of the bone in small children21, 23 .In the late-onset form, however, an underlying static abnormal varus alignment of the knee might not be a prerequisite for its development.
Despite the potential negative consequences of obesity on lower limb structure, only limited research has considered the effects of obesity on the anthropometry of the foot.23
Appropriately targeted exercise programmes of sufficient intensity will increase and improve, balance, and cardiovascular fitness, muscle strength in older people25,24 Exercises to improve strength and balance have therefore been central to most fall prevention programmes.25
Balance training can be defined as a training regimen that aims at an improved postural control 26. Balance training has been used in different age and patient groups to enhance various neuromuscular capacities (e.g., balance ability, maximal and explosive force production etc.27, for the rehabilitation of sports injuries 28, and in studies aiming at fall prevention. When conducting BT, it is assumed that the neuromuscular system adapts specifically and progressively to the applied training intensity 27. It has frequently been shown that a reduced base of support or deprived visual control results in a larger postural sway 29.
Enhanced balance training exercises are designed to improve confidence, mobility, and functioning in a day-today context.12 Balance training includes equilibrium control exercises that are repetitive and graded in complexity that enhance balance by improving sway control and inhibiting inappropriate motor responses.30,31
However, whether enhanced balance training has any advantages over balance training undertaken as a part of conventional physiotherapy remains open to question. The objective of thisfortuitous trial was to evaluate the effectiveness of enhanced balance training in improving mobility and function in elderly people with impaired balance.31
Multisensory balance programs
Programs which combine multisensory training and specific balance activities are more effective for improving balance when compared to traditional exercise programs that consist only of aerobics, strengthening, or flexibility exercises.56
A study said, a multisensory balance program, which required subjects to bend, turn, and reach, while maintaining balance on various surfaces, was compared to a balance program various traditional training, which exists of typical balance activities, such as marching in place, gentle stretching activities, arm movement and stepping to the side. The multisensory balance program provided additional vestibular stimulation and encouraged participants to increase their speed and size of movements to maintain balance, which resulted in increased endurance, strength, and reaction time in individuals. After the intervention, both groups had a significant reduction in falls and significant improvements on the TGUG; however, the multisensory balance group had more improvements in functional skills, measures of balance, and a reduced fear of falling.56
A conventional therapy program, which consisted of various motility skills, was compared to an motivate balance program, which required participants to maintain a narrow base of support, while moving the centre of gravity outside of the base of support. The amplify therapy program also consisted of repetition of graded balance activities and participants received visual feedback from the Balance Performance observed which provided an objective evaluate of balance by measuring a participant‘s postural sway and all the balance. Both the convention balance group and the enhanced therapy group showed improvements in balance, walking speed number of falls, quality of life, independence for activities of daily living, and social participation; however the enhanced therapy group showed more improvements in walking speed, stability, and quality of life.31
Athletic trainers and other allied health care professions have begun to use interactive gaming systems and technology to help rehabilitate patients with musculoskeletal and neurologic conditions.32–35
Interactive games, such as Dance Dance Revolution and gaming environmental systems, such as Play Station 2 and Wii can be seen in physical therapy and sports medicine competence. The growing demand of interactive gaming partially is due to the belief that playing interactive video games during a rehabilitation session can direct a patient’s focus away from the repetitive and mundane nature of rehabilitation exercises and toward the fun and competitive aspects of the video game.35–38
Thus, interesting gaming technology subjectively improves adherence rates for rehabilitation programs36 and presents allied health care providers with an adjunct to traditional rehabilitation exercises.
However, Nintendo recently released the Wii Balance Board (Nintendo of America Inc) as a controller for games such as Wii Fit (Nintendo of America Inc) and Wii Fit Plus (Nintendo of America Inc). The Wii Balance Board have characteristics similar to a research-grade force plate and contains transducers used to assess force distribution and the subsequent movements of an individual’s centre of pressure (COP). Thus, the Wii Balance Board combines current force-platform technology with the entertainment value of gaming while completing activities related fitness, yoga and balance. Furthermore, the Wii Fit and Wii Fit Plus games include personalized settings to track an individual’s improvement over time. The completion of these activities allegedly gain balance, and some health care providers have provide that components of attractive games, such as balance scores and player ratings, might be related to sensorimotor function.37
Thus, using the Wii Balance Board while playing Wii Fit or Wii Fit Plus could be an effective assessment tool for athletic trainers and other allied health care providers because the board and games have the potential to improve balance and provide objective measures of balance over time to monitor rehabilitation progress. Some author said compared COP data from a research-grade force plate with COP data from a Wii Balance Board. To do this, the authors integrate the Wii Balance Board with a laptop computer using mechanical made software, bypassing game software and scores. The results produce that a Wii Balance Board produced raw COP means that were similar to the means that the force plate produced, and it had good to best test-retest reliability.39
Furthermore, doubt exists about the validity and reliability of the balance scores that arise from the software implemented in the Wii Fit and Wii Fit Plus games. Until this information is evolve, clinicians using balance scores result from the Wii Fit or Wii Fit Plus games to monitor progress during rehabilitation might be making clinical decisions based on inaccurate or not reliable data. Therefore, the purpose of this investigation was to determine the concurrent validity and the intrasession and intersession reliability of balance scores the Wii Fit game produces39.
The degree to which a person is overweight is generally described bybody mass index(BMI). Overweight is defined as a BMI of 25 or more, thus it includes pre-obesity defined as a BMI between 25 and 30 andobesityas defined by a BMI of 30 or more.Pre obese and overweight however are often used interchangeably thus giving overweight a common definition of a BMI of between 25 -29.9.42
Balance is define as the ability to stay upright or stay in control manner of body movement, and coordination is the ability to move two or more body parts under control, smoothly and efficiently.
Balance classified in: static and dynamic. Static balance is maintaining equilibrium when stationary, while dynamic balance is maintaining equilibrium when moving. We use our eyes, ears and 'body sense' to help retain our balance. Coordination is a taught skill that requires not only good balance, but good category of other fitness components such strength and agility. Balance and coordination can be improved through lot of practice and training within specific sports.43
Virtual realityis a video game designed byNintendo's Hiroshi Matsunaga44for theWiihomevideo game console.45It is anexercise game consisting of activities using theWii Balance Boardperipheral. As of March 2012, Wii Fithas held the position ofthird best selling console gamenot packaged with a console, with 22.67 million copies sold. 46
The game uses a unique platform peripheral called theWii Balance Board, on which the player stands during exercise. The game featuresyoga,strength training,aerobics, andbalancegames. Matsunaga described the game as a "way to help get families exercising together"47.Wii Fithas been used for physiotherapy rehabilitation48,49and has been adopted by varioushealth clubs around the world. Additionally, the game has been used in nursing homes to improveposturein the elderly. The game has received generally positive reviews, despite criticism over the lack of intensity in some of its workout activities.50