Obesity: A Clinical Trial Observing the Use of Pedometers
Guest: Catherine Ling - Research & Sponsored Programs, MUSC
Host: Dr. Linda Austin – College of Medicine / Dean’s Office, MUSC
Dr. Linda Austin: Catherine Ling is a PhD candidate in the College of Nursing here at MUSC. Catherine, I understand that you have been working on your PhD for four years in, which area?
Catherine Ling: In nursing, specifically in the area of obesity and physical activity.
Dr. Linda Austin: In this podcast, we’re going to be talking about a very interesting clinical trial that you’re doing. Tell us about that trial.
Catherine Ling: That trial is looking at walking and how your gait seems to match up with how you’re active in your everyday life, and your participation in everyday activities. What we really don’t know is whether or not the way people walk affects what they’re doing in everyday life. We’re looking, specifically, at people who have about one and a half to two times the recommended body weight for height, which we also call class III obesity. For those folks, what is the impact of the way they walk? How does it correlate with how they go through their everyday life, the activities they engage in, and their level of participation?
Dr. Linda Austin: When you say the way they walk, what characteristics of walking are you studying?
Catherine Ling: How fast they walk; the speed at which they walk, how far apart their steps are, the ease in which they’re able to turn around or get up from a chair, and walk in a straight line.
Dr. Linda Austin: So, you’re interested in the impact of those characteristics on weight gain?
Catherine Ling: We’re actually looking at how those characteristics match self-reported activity and participation levels. So, we’re really trying to look at those walking characteristics along with what their everyday life looks like to see if there are any correlations.
Dr. Linda Austin: How did get you interested in this? What’s your hypothesis? Something, clearly, triggered you to think, gosh, there’s something about people who walk this way that seems to result in that.
Catherine Ling: Well, actually, I did a pre-dissertation study, funded and sponsored by the American Nurses Foundation and the Southern Nursing Research Society, looking at pedometer use by people who have that one and a half to two times the recommended body weight. What I found was that people did not feel that using a pedometer was applicable to them. So, I started thinking: well, am I assuming that they’re comfortable walking? Maybe that’s not the case. The more I read, the more I found that there are a lot of assumptions about the activity level they can engage in.
We have some data indicating that how they walk is similar to people who have had a stroke or who have Parkinson’s disease, and we don’t tell them to go out and walk. We give them physical rehabilitation. So, that was the genesis of this study.
Dr. Linda Austin: So, is your thought, then, that people with class III obesity are, maybe, not walking, or it’s just not realistic to think that walking will be an exercise that they have an interest in or feels comfortable to them?
Catherine Ling: It may be that it doesn’t feel comfortable to them, or it may be that they need some rehabilitation to be able to walk efficiently. It takes an enormous amount of energy to move against gravitational pull and some of the friction, especially in an environment that’s not friendly for your body type. So, when we ask people to walk, when we ask them to engage in activity, we really need to know what is their possibilities are. What can they do?
If somebody isn’t able to be active, I think we’re going to see a very strong correlation between the type of walking patterns they have and what they’re able to do. And then we can begin to design population-specific interventions: how can we help you be more active? How can we make walking less of chore and something you enjoy?
Dr. Linda Austin: You are now soliciting people to come in and be subjects in your trial. Specifically, what are the characteristics of the folks you’re interested in having?
Catherine Ling: We’re looking for people who have the one and a half to two times the recommended body weight for their height. If you know what your BMI is, that’s a BMI of 40 or higher. We need adults, so folks need to be 18 years or older. We are excluding people who are pregnant. Also, we have a screening questionnaire. If someone has been told by a health care provider not to engage in physical activity because of a heart condition, if they’ve had any kind of loss of consciousness, or chest pain when they walk, those are folks that we don’t want to be asking to walk around; we’re excluding them. Primarily, if you’re an adult and have a BMI of 40, or think you might be in that range, we’re absolutely interested in talking with you.
Dr. Linda Austin: So, Catherine, tell us what a participant can expect if they decide to participate in this trial?
Catherine Ling: We’ll ask them to come into the Research Center, which is in the main body of the hospital. I will sit down with them initially and we’ll talk, and give them another opportunity to look at the study and the consent process. And if at that point they’re ready to go on, we have some questionnaires that we’ll ask them to fill out. Those questionnaires look at what your everyday looks like, what you do, the kinds of activities you’re engaged in.
Then we’ll take some measurements: height, weight, hips, waist, and blood pressure. We’re also going to measure something called an RMR, or a resting metabolic rate. That tells us your baseline use of oxygen, which gives us an idea of what your cardiovascular fitness is.
Then we move on to the more active and final component. And those are the walking components. There’s a test in which we ask you to sit in a chair and then stand up, walk around a cone, and then walk back to the chair and sit down. Then we’ll ask you to walk for six minutes. Both of those walking tests are done once, and then you get some rest before doing them again. All of the walking tests are videotaped.
Dr. Linda Austin: What do you, as a researcher, hope to gain from this study? What do you think will be the practical contribution of this information?
Catherine Ling: My hope, and certainly what my driving goal, is to take the data from this study and create very individualized programs for people who have class III obesity, for physical activity or rehabilitation, because right now, they don’t exist. They’re being asked to participate in physical activity at the same level of someone with a much lower weight to height ratio. From talking with patients during my career as a nurse practitioner and observations through the studies I’ve been a part of, that’s not necessarily the case. There’s data which shows that people aren’t as physically active at that level. My purview is that we need to find out where and how they’re not able to be physically active, and then let’s give them the tools and the support to be able to do so, so that they can fully be in their lives, and fully participate.
Dr. Linda Austin: In a realistic exercise program, that will work for them. And it sounds like, realistically, the suspicion is that a walking program may not be the best suited.
Catherine Ling: Absolutely.
Dr. Linda Austin: Even though we think of it as a pretty basic form of exercise.
Catherine Ling: And, we don’t ask people with strokes to go out there or say that physical activity is going to make you feel better; go do it. We give them tools on how to work with what they have to be as active as possible. And I think that same principle should be applied to people who have class III obesity.
Dr. Linda Austin: Thank so much and good luck to you. Now, if somebody wanted to participate in this research, how would they contact you?
Catherine Ling: They can contact me via e-mail: firstname.lastname@example.org. This is really the best way to get in touch with me. That way, I can give you a lengthy response and answer all your questions.
Dr. Linda Austin: Thank you very much for sharing this.
Catherine Ling: Thank you.
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