Brazilian Journal of Pain
Brazilian Journal of Pain
Original Article

Correlation between body mass index and joint pain intensity with gait performance in individuals with osteoarthritis

Correlação entre o índice de massa corporal e intensidade da dor articular com o desempenho da marcha em indivíduos com osteoartrite

Sthefany Ellen de Araújo Nascimento; Nyvea Maria de Souza Matias; Ana Isabel da Silva Ferreira; Menberson Santana Souza Lorêdo; Maria Cristina Falcão Raposo; Renato de Souza Melo

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BACKGROUND AND OBJECTIVES: Patients with osteoarthritis (OA) often have joint pain and are overweight or obese. Thus, the objective of this study was to observe whether there is correlation between body mass index and joint pain intensity with gait performance in individuals with OA. 
METHODS: Cross-sectional study, which evaluated 60 volunteers, being 30 with clinical diagnosis of knee osteoarthritis and 30 without the disease, of both sexes and aged between 50-82 years. Joint pain intensity was assessed using the Visual Analog Scale, gait-related functional tasks using the Dynamic Gait Index, and the functional mobility using the Timed Up and Go test. 
RESULTS: There was a correlation between overweight/obesity and high levels of joint pain intensity (p=0.018), with worse performance in gait-related functional tasks (p=0.000) and with worse functional mobility (p=0.034) only for the individuals with OA. High levels of joint pain intensity also correlated with worse performance in the gait-related functional tasks (p=0.000) in the OA group, and also with worse functional mobility in the OA group (p=0.001) and also in the group of individuals without the disease (p=0.032). 
CONCLUSION: This study identified a correlation between overweight/obesity and high levels of joint pain intensity and worse gait performance in individuals with osteoarthritis. High levels of pain intensity also correlated with worse gait performance in individuals with OA.


Accidental falls, Aging, Arthralgia, Knee Osteoarthritis, Overweight, Walking


JUSTIFICATIVA E OBJETIVOS: Indivíduos com osteoartrite (OA) frequentemente apresentam dor articular e sobrepeso ou obesidade. Assim, o objetivo deste estudo foi observar se existe correlação entre o índice de massa corporal e a intensidade da dor articular com o desempenho da marcha em indivíduos com OA. 
MÉTODOS: Estudo de corte transversal, que avaliou 60 indivíduos, sendo 30 com diagnóstico clínico de osteoartrite de joelho e 30 sem a doença, de ambos os sexos e com faixa etária entre 50 e 82 anos. A intensidade da dor articular foi avaliada pela Escala Analógica Visual, as tarefas funcionais relacionadas à marcha pelo Dynamic Gait Index e a mobilidade funcional pelo teste Timed Up and Go. 
RESULTADOS: Houve correlação entre o sobrepeso/obesidade e níveis elevados de intensidade da dor articular (p=0,018), com um pior desempenho nas tarefas funcionais relacionadas à marcha (p=0,000) e com menor mobilidade funcional (p=0,034) apenas para os indivíduos com OA. Os níveis elevados de intensidade de dor articular também mostraram correlação com um pior desempenho nas tarefas funcionais relacionadas à marcha (p=0,000) no grupo com OA, e ainda, com uma menor mobilidade funcional no grupo com OA (p=0,001) e também no grupo de indivíduos sem a doença (p=0,032). 
CONCLUSÃO: Este estudo identificou correlação entre o sobrepeso/obesidade com níveis elevados de intensidade da dor articular e com um pior desempenho na marcha nos indivíduos com OA. Os elevados níveis de intensidade da dor também mostraram correlação com pior desempenho na marcha nos indivíduos com OA.


Acidentes por quedas, Artralgia, Caminhada, Envelhecimento, Osteoartrite do Joelho, Sobrepeso


1 De Rosis, RG, Massabki OS, Kairalla M. Osteoarthritis: clinical and epidemiological assessment of elderly patients in institution of long-stay. Rev Soc Bras Clin Med. 2010;8(2):101-8.

2 Peat G, Duncan RC, Wood LRJ, Thomas E, Muller S. Clinical features of symptomatic patellofemoral joint osteoarthritis. Arthritis Res Ther. 2012;14(2):R63.

3 Szilagyi IA, Waarsing JH, van Meurs JB, Bierma-Zeinstra MA, Schiphof D. A systematic review of the sex diferences in risk factors for knee osteoarthritis. Rheumatology. 2023;62(6):2037-47.

4 Lemos JF, Araújo LM, Carmo VJ, Cardoso EJ, Raposo MC, Melo RS. Prevalence, affected joints and intensity of the arthralgias in individuals in the chronic phase of Chikungunya fever. BrJP; 2021;4(2):108-12.

5 Rodriguez-Morales AJ, Restrepo-Posada VM, Acevedo-Escalante N, Rodriguez-Muñoz ED, Valencia-Marín M, Castrillón-Spitia JD, et al. Impaired quality of life after chikungunya virus infection: a 12-month follow-up study of its chronic inflammatory rheumatism in La Virginia, Risaralda, Colombia. Rheumatol Int. 2017;37(10):1757-8.

6 Rezende MU, Campos GC, Pailo AF. Current concepts in osteoarthritis. Acta Ortop Bras. 2013;21(2):120-2.

7 Chacur EP, Silva LO, Luz GCP, Silva PL, Baraúna MA, Cheik NC. Obesity and its correlation with knee osteoarthritis in adult women. Fisioter Mov. 2008;21(2):93-8.

8 Hart HF, van Middelkoop M, Stefanik JJ, Crossley KM, Bierma-Zeinstra S. Obesity is related to incidence of patellofemoral osteoarthritis: the cohort hip and cohort knee (CHECK) study. Rheumatol Int. 2020;40(2):227-32.

9 Raud B, Gay C, Guiguet-Auclair C, Bonnin A, Gerbaud L, Pereira B, Duclos M, Boirie Y, Coudeyre E. Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis. Sci Rep. 2020;10(1):3601.

10 Leite AA, Costa AJ, Lima Bde A, Padilha AV, Albuquerque EC, Marques CD. Comorbities in patients with osteoarthritis: frequency and impact n pain and physical function. Rev Bras Reumatol. 2011;51(2):118-23.

11 Ikutomo H, Nagai K, Tagomori K, Miura N, Nakagawa N, Masuhara K. Incidence and risk factors for falls in women with end-stage hip osteoarthritis. J Geriatr Phys Ther. 2019;42(3):161-6.

12 Hoops ML, Rosenblatt NJ, Hurt CP, Crenshaw J, Grabiner MD. Does lower extremity osteoarthritis exacerbate risk factors for falls in older adults. Womens Health. 2012;8(6):685-96.

13 Doré AL, Golightly YM, Mercer VS, Shi XA, Renner JB, Jordan JM, Nelson AE. Lower-extremity osteoarthritis and the risk of falls in a community-based longitudinal study of adults with and without osteoarthritis. Arthritis Care Res (Hoboken). 2015 May;67(5):633-9.

14 Arnold CM, Faulkner RA. The history of falls and the association of the timed up and go test to falls and near-fealls in older adults with hip osteoarthristis. BMC Geriatr. 2007;7:17.

15 Alencar MA, Arantes PM, Dias JM, Kirkwood RN, Pereira LS, Dias RC. Muscular function and functional mobility of faller and non-faller elderly women with osteoarthritis of the knee. Braz J Med Biol Res. 2007;40(2):277-83.

16 Murphy SL, Alexander NB, Levoska M, Smith DM. Relationship between fatigue and subsequent physical activity among older adults with symptomatic osteoarthristis. Arthritis Care Res. 2013;35(10):1617-24.

17 von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9.

18 Malta M, Cardoso LO, Bastos FI, Magnanini MM, Silva CM. STROBE initiative: guidelines on reporting observational studies. Rev Saúde Publica. 2010;44(3):559-65.

19 von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-9.

20 Campbell WI, Lewis S. Visual analogue measurement of pain. Ulster Med J. 1990;59(2):149-54.

21 Ludington E, Dexter F. Statistical analysis of total labor pain using the visual analog scale and application to studies of analgesic effectiveness during childbirth. Anesth Analg. 1998;87(3):723-7.

22 Castro SM, Perracini MR, Ganança FF. Dynamic gait index - Brazilian Version. Braz J Otorhinolaryngol. 2006;72(6):817-25.

23 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8.

24 Melo RS, Silva PWA, Tassitano RM, Macky CFTS, Silva LVC. Balance and gait evaluation: comparative study between deaf and hearing students. Rev Paul Ped. 2012;30(3):385-91.

25 Monteiro ET, Albuquerque SP, Melo RS. Organ and tissue donation in a public hospital of Pernambuco. Rev Bioét. 2020;28(1):69-75.

26 Santos RA, Raposo MC, Melo RS. Prevalence and associated factors with musculoskeletal pain in professionals of the Mobile Emergency Care Service. BrJP. 2021;4(1):20-5.

27 Araújo LMC, Guimarães-do-Carmo VJ, Andrade TGVS, Claudino SC, Soares DM, Melo RS. Musculoskeletal pain and quality of life in mothers of children with microcephaly due to congenital Zika virus syndrome. Child Care Health Dev. 2023;49(2):268-80.

28 Mukaka MM. A guide to appropriate use of correlation coeficiente in medical research. Malawi Med J. 2012;24(3):69-71.

29 Duffell LD, Southgate DFL, Gulati V, McGregor AH. Balance and gait adaptations in patients with early knee osteoarthritis. Gait Posture. 2014;39(4):1057-61.

30 Lazaridou A, Martel MO, Cornelius M, Franceschelli O, Campbell C, Smith M, Haythornthwaite JA, Wright JR, Edwards RR. The associations between daily physical activity and pain among patients with knee osteoarthritis: the moderating role of pain catastrophizing. Pain Med. 2019;20(5):916-24.

31 Tonelli SM, Rakel BA, Cooper NA, Angstom WL, Sluka KA. Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement. Biol Sex Differ. 2011;2:12.

32 Tadano S, Takeda R, Sasaki K, Fujisawa T, Tohyama H. Gait characterization for osteoarthritis patients using wearable gait sensors (H-Gait systems). J Biomech. 2016;49(5):684-90.

33 Constatinou M, Loureiro A, Carty C, Mills P, Barrett R. Hip joint mechanics during walking in individuals with mild-to-moderate hip osteoarthritis. Gait Posture. 2017;53(3):162-7.

34 Naili JE, Esbjoensson AC, Iversen MD, Schwartz MH, Hedstrom M, Hager CK, Broström EW. The impact of symptomatic knee osteoarthritis on overall gait pattern deviations and its association with performance-based measures and patient-reported outcomes. Knee. 2017;24(3):536-46.

35 King LK, March L, Anandacoomarasamy A. Obesity & Osteoarthritis. Indian J Med Res. 2013;138(2):185-93.

36 Kulkarni K, Karssiens T, Kumar V, Pandit H. Obesity and osteoarthritis. Maturitas. 2016; 89(7):22-8.

37 Park JM. Association between obesity and osteoarthritis in the South Korean older population: a nationwide-population-based study. Medicine (Baltimore). 2023;102(14):e33455.

38 Harding GT, Dunbar MJ, Hubley-Kozey CL, Stanish WD, Astephen Wilson JL. Obesity is associated with higher absolute tibiofemoral contact and muscle forces during gait with and without knee osteoarthritis. Clin Biomech. 2016;31(1):79-86.

39 Jinks C, Jordan K, Croft P. Disabling knee pain-another consequence of obesity: results from a prospective cohort study. BMC Public Health. 2006;6:258.

40 Alfieri FM, Silva NCOV, Battistella LR. Study of the relation between body weight and functional limitations and pain in patients with knee osteoarthritis. Einstein (São Paulo). 2017;15(3):307-12.

41 Vasconcelos KKS, Dias JMD, Dias RC. Relationship between pain intensity and functional capacity of obese individuals with knee osteoarthritis. Braz J Phys Ther. 2006;10(2):213-8.

42 Gomes-Neto M, Araujo AD, Junqueira IDA, Oliveira D, Brasileiro A, Arcanjo FL. Comparative study of functional capacity and quality of life among obese and non-obese elderly people with knee osteoartrhritis. Rev Bras Reumatol. 2016;56(2):126-30.

43 Vasconcelos KSS, Dias JMD, Dias RC. Functional difficulties in obese women with knee osteoarthritis: relationships between subjective perception and motor performance. Fisioter Pesq. 2007;14(3):55-61.

44 Kim BS, Lee SY, Kim BR, Choi JH, Kim SR, Lee HJ, Lee SJ. Associations between obesity with low muscle mass and physical function in patients with end-stage knee osteoarthritis. Geriatr Orthop Surg Rehabil. 2021;12:21514593211020700.

45 Adegoke BOA, Boyinde OH, Odole AC, Akosile CO, Bello AI. Do self-efficacy, body mass index, duration of onset and pain intensity determine performance on selected physical tasks in individuals with unilateral knee osteoarthritis. Musculoskelet Sci Pract. 2017;32(12):1-6.

46 Amiri P, Hubley-Kozey CL, Landry SC, Stanish WD, Astephen Wilson JL. Obesity is associated with prolonged activity of the quadríceps and gastrocnemius during gait. J Electromyogr Kinesiol. 2015;25(6):951-8.

47 Runhaar J, Koes BW, Clockaserts S, Bierma-Zeinstra SMA. A systematic review on changed biomechanics of lower extremities in obese individuals: a possible role in development of osteoarthritis. Obes Rev. 2011;12(12):1071-82.

48 Messier SP. Osteoarthritis of the knee and associated factors of age and obesity: effects on gait. Med Sci Sports Exerc. 1994;26(12):1446-52.

49 Hurwitz DE, Hulet CH, Andriacchi TP, Rosenberg AG, Galante JO. Gait compensations in patients with osteoarthritis of the hip and their relationship to pain and passive hip motion. J Orthop Res. 1997;15(4):629-35.

50 O’Connell M, Farrokhi S, Fitzgerald GK. The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis. Clin Biomech. 2016;31(1):40-6.

51 Harding GT, Hubley-Kozey CL, Dunbar MJ, Stanish WD, Astephen Wilson JL. Body mass index affects knee joint mechanics during gait differently with and without moderate knee osteoarthritis. Osteoarthritis Cartilage. 2012;20(11):1234-42.

52 Pereira D, Severo M, Ramos E, Branco J, Santos RA, Costa L, Lucas R, Barros H. Potential role of age, sex, body mass index and pain to identify patients with knee osteoarthritis. Int J Rheum Dis. 2017;20(2):190-8.

53 Harato K, Iwama Y, Kaneda K, Kobayashi S, Niki Y, Nagura T. Pain detect questionnaire and pain catastrophizing scale affect gait pattern in patients with knee osteoarthritis. J Exp Orthop. 2022;9:52.

54 Marriott KA, Birmingham TB, Leitch KM, Pinto R, Giffin JR. Strong independent associations between gait biomechanics and pain in patients with knee osteoarthritis. J Biomech. 2019;94(9):123-9.

55 Silva NC, Cardoso TS, Andrade EA, Battistella LR, Alfieri FM. Pain, disability and catastrophizing in individuals with knee osteoarthritis. BrJP. 2020;3(4):322-7.

56 Alumona CJ, Adegoke BOA. Contributions of pain intensity, body mass index and balance to physical function in individuals with bilateral knee osteoarthritis. Eur J Physiother. 2021;23(4):254-8.

57 Suzuki Y, Iiijima H, Aoyama T. Pain catastrophizing affects stair climbing ability in individuals with knee osteoarthritis. Clin Rehabil. 2020;39(4):1257-64.

58 Oliveira LAS, Pontes-Silva A, Damasceno KLB, Apahaza GHS, Oliveira AR, Dibai-Filho AV, Avila MA, Fidelis-de-Paula-Gomes CA. Comparison between pain intensity, functionality, central sensitization, and self-efficacy in individuals with unilateral or bilateral knee osteoarthritis: a cross-sectional study. Rev Assoc Med Bras (1992). 2022;68(8):1048-52.

59 Henriksen M, Graven-Nielsen T, Aaboe J, Andriacchi TP, Bliddal H. Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain. Arthritis Care Res. 2010;62(4):501-9.

60 Bindawas SM. Relationship between frequent knee pain, obesity, and gait speed in older adults: data from the osteoarthritis iniciative. Clin Interv Aging. 2016;11:237-44.

61 Paradowski PT, Englund M, Lohmander LS, Roos EM. The effect of patient characteristics on variability in pain and function over two years in early knee osteoarthritis. Health Qual Life Outcomes. 2005;3:59.

62 Higgins DM, Buta E, Heapy AA, Driscoll MA, Kerns RD, Masheb R, Becker WC, Hausmann LRM, Bair MJ, Wandner L, Janke EA, Brandt CA, Goulet JL. The Relationship Between Body Mass Index and Pain Intensity Among Veterans with Musculoskeletal Disorders: Findings from the MSD Cohort Study. Pain Med. 2020;21(10):2563-72.

63 Santos JPM, Andraus RAC, Pires-Oliveira DAA, Fernandes MTP, Frâncica MC, Poli-Frederico RC, et al. Analysis of functional status of elderly with osteoarthritis. Fisioter Pesq. 2015;22(2):161-8.

64 Oliveira RCS, Inocêncio AVM, Shirahige L, Rodrigues MAB, Vasconcelos CR, Pedrosa MAC. Gait speed and functional performance in elderly women with knee osteoarthritis. Fisioter Mov. 2021;34:e34120.

65 Zasadzka E, Borowicz AM, Roszak M, Pawlaczyk. Assessment of the risk of falling with the use of timed up and go test in the elderly with lower extremity osteoarthritis. Clin Interv Aging. 2015;10:1289-98.

66 Ko SU, Ling SM, Schreiber C, Nesbitt M, Ferrucci L. Gait patterns during diferente walking conditions in older adults with and without knee osteoarthritis - results from the Baltimore longitudinal study of aging. Gait Posture. 2011;33(2):205-10.

67 Alshahrani MS, Reddy RS, Tedla JS, Asiri F, Alshahrani A. Association between kinesiophobia and knee pain, joint position sense, and functional performance in individuals with bilateral knee Osteoarthritis. Healthcare (Basel). 2022;10(1):120.

68 Busse AL. A importância da prevenção de quedas em idosos. Geriatr Gerontol Aging. 2015;9(2): 41.

69 Alexandre TS, Meira DM, Rico NC, Mizuta SK. Accuracy of Timed Up and Go test for screening risk of falls among community-dwelling elderly. Braz J Phys Ther. 2012;16(5):381-8.

70 Wamser EL, Valderramas SR, Paula JA, Schieferdecker MEM, Amarante TP, Pinotti F, et al. Best performance in the Timed Up and Go is associated to best functional performance in community-dwelling older adults. Geriatr Gerontol Aging. 2015;9(4):138-43.

71 Tanaka R, Ozawa J, Kito N, Moriyama H. Efficacy of strengthening or aerobic exercise on pain relief in people with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2013;27(12):1059-71.

72 Onwunzo CN, Igwe SE, Umunnah J O, Uchenwoke CI, Ezugwu UA. Effects of isometric strengthening exercises on pain and disability among patients with knee osteoarthritis. Cureus. 2021;13(10):e18972.

73 Nascimento MM. Fall in older adults: considerations on balance regulation, postural strategies, and physical exercise. Geriatr Gerontol Aging. 2019;13(2):103-10.

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