{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T11:08:55Z","timestamp":1775819335262,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2019,5,2]],"date-time":"2019-05-02T00:00:00Z","timestamp":1556755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Abnormal excess or lack of body mass can influence gait patterns, but in some cases such differences are subtle and not easy to detect, even with quantitative techniques for movement analysis. In these situations, the study of trunk accelerations may represent an effective way to detecting gait anomalies in terms of symmetry through the calculation of Harmonic Ratio (HR), a parameter obtained by processing trunk accelerations in the frequency domain. In the present study we used this technique to assess the existence of differences in HR during gait in a cohort of 75 healthy children and early adolescents (aged 7\u201314 years) stratified into 3 equally-sized age and gender-matched groups (Underweight: UW; Normal Weight: NW; Overweight: OW). The accelerometric signal, acquired using a single wearable inertial sensor, was processed to calculate stride length, speed, cadence and HR in antero-posterior, vertical and medio-lateral directions. No differences in spatio-temporal parameters were found among groups, while the HR in the medio-lateral direction was found significantly lower in UW children, while OW exhibited the highest values. On the basis of the results obtained, HR appears capable of discriminating gait symmetry in children with different body mass even when conventional gait parameters are unchanged.<\/jats:p>","DOI":"10.3390\/s19092054","type":"journal-article","created":{"date-parts":[[2019,5,7]],"date-time":"2019-05-07T03:15:46Z","timestamp":1557198946000},"page":"2054","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Symmetry of Gait in Underweight, Normal and Overweight Children and Adolescents"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6299-7254","authenticated-orcid":false,"given":"Veronica","family":"Cimolin","sequence":"first","affiliation":[{"name":"Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy"}]},{"given":"Nicola","family":"Cau","sequence":"additional","affiliation":[{"name":"Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Str. L Cadorna 90, 28824 Piancavallo (VB), Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9620-4133","authenticated-orcid":false,"given":"Alessandro","family":"Sartorio","sequence":"additional","affiliation":[{"name":"Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research, Str. L Cadorna 90, 28824 Piancavallo (VB), Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3719-8789","authenticated-orcid":false,"given":"Paolo","family":"Capodaglio","sequence":"additional","affiliation":[{"name":"Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Str. L Cadorna 90, 28824 Piancavallo (VB), Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2772-4837","authenticated-orcid":false,"given":"Manuela","family":"Galli","sequence":"additional","affiliation":[{"name":"Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy"}]},{"given":"Gabriella","family":"Tringali","sequence":"additional","affiliation":[{"name":"Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research, Str. L Cadorna 90, 28824 Piancavallo (VB), Italy"}]},{"given":"Bruno","family":"Leban","sequence":"additional","affiliation":[{"name":"Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d\u2019Armi, 09123 Cagliari, Italy"}]},{"given":"Micaela","family":"Porta","sequence":"additional","affiliation":[{"name":"Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d\u2019Armi, 09123 Cagliari, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9835-3629","authenticated-orcid":false,"given":"Massimiliano","family":"Pau","sequence":"additional","affiliation":[{"name":"Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d\u2019Armi, 09123 Cagliari, Italy"}]}],"member":"1968","published-online":{"date-parts":[[2019,5,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1381\/096089205774512627","article-title":"Gait cinematic analysis in morbidly obese patients","volume":"15","author":"Aparecida","year":"2005","journal-title":"Obes. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/j.1467-789X.2006.00251.x","article-title":"Musculoskeletal disorders associated with obesity: A biomechanical perspective","volume":"7","author":"Wearing","year":"2006","journal-title":"Obes. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Capodaglio, P., Menegoni, F., Vismara, L., Cimolin, V., Grugni, G., and Galli, M. (2011). Characterisation of balance capacity in prader-willi patients. Res. Dev. Disabil., 32.","DOI":"10.1016\/j.ridd.2010.09.002"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1038\/sj.ijo.0801409","article-title":"Sit-to-stand movement analysis in obese subjects","volume":"24","author":"Galli","year":"2000","journal-title":"Int. J. Obes."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/S0268-0033(03)00144-X","article-title":"Biomechanical analysis of sit-to-stand movement in normal and obese subjects","volume":"18","author":"Sibella","year":"2003","journal-title":"Clin. Biomech."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cau, N., Cimolin, V., Galli, M., Precilios, H., Tacchini, E., Santovito, C., and Capodaglio, P. (2014). Center of pressure displacements during gait initiation in individuals with obesity. J. Neuroeng. Rehabil., 11.","DOI":"10.1186\/1743-0003-11-82"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Cimolin, V., Vismara, L., Galli, M., Grugni, G., Cau, N., and Capodaglio, P. (2014). Gait strategy in genetically obese patients: A 7-year follow up. Res. Dev. Disabil., 35.","DOI":"10.1016\/j.ridd.2014.04.005"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cimolin, V., Cau, N., Galli, M., Santovito, C., Grugni, G., and Capodaglio, P. (2017). Gait initiation and termination strategies in patients with prader-willi syndrome. J. Neuroeng. Rehabil., 14.","DOI":"10.1186\/s12984-017-0257-7"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cimolin, V., Capodaglio, P., Cau, N., Galli, M., Santovito, C., Patrizi, A., Tringali, G., and Sartorio, A. (2017). Computation of spatio-temporal parameters in level walking using a single inertial system in lean and obese adolescents. Biomed. Tech., 62.","DOI":"10.1515\/bmt-2015-0180"},{"key":"ref_10","first-page":"335","article-title":"Balance in patients with anorexia and bulimia nervosa","volume":"45","author":"Fontana","year":"2009","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_11","first-page":"122","article-title":"Gait analysis in anorexia and bulimia nervosa","volume":"11","author":"Cimolin","year":"2013","journal-title":"J. Appl. Biomater. Funct. Mater."},{"key":"ref_12","first-page":"1","article-title":"Childhood obesity: A global public health crisis","volume":"3","author":"Karnik","year":"2012","journal-title":"Int. J. Prev. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.gaitpost.2013.02.002","article-title":"Mass affects lower extremity muscle activity patterns in children\u2019s gait","volume":"38","author":"Blakemore","year":"2013","journal-title":"Gait Posture"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1053\/mr.2000.3782","article-title":"Gait and postural stability in obese and nonobese prepubertal boys","volume":"81","author":"McGraw","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_15","first-page":"403","article-title":"Gait characteristics of obese children","volume":"72","author":"Hills","year":"1991","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.humov.2016.08.003","article-title":"Human movement science profiling movement quality and gait characteristics according to body-mass index in children (9\u201311 y)","volume":"49","author":"Clark","year":"2016","journal-title":"Hum. Mov. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.rehab.2015.04.001","article-title":"Collection of normative data for spatial and temporal gait parameters in a sample of french children aged between 6 and 12","volume":"58","author":"Thevenon","year":"2015","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_18","unstructured":"Brochu, N.J., and Prince, F. (2016). Locomotor strategies in obese and non\u00adobese children. Obesity, 14."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Molina-Garcia, P., Migueles, J.H., Cadenas-Sanchez, C., Esteban-Cornejo, I., Mora-Gonzalez, J., Rodriguez-Ayllon, M., Plaza-Florido, A., Vanrenterghem, J., and Ortega, F.B. (2019). A systematic review on biomechanical characteristics of walking in children and adolescents with overweight\/obesity: Possible implications for the development of musculoskeletal disorders. Obes. Rev.","DOI":"10.1111\/obr.12848"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.humov.2014.05.002","article-title":"The role of excess mass in the adaptation of children\u2019s gait","volume":"36","author":"Shultz","year":"2014","journal-title":"Hum. Mov. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.gaitpost.2011.09.019","article-title":"Age-and speed-related differences in harmonic ratios during walking","volume":"35","author":"Lowry","year":"2012","journal-title":"Gait Posture"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.jbiomech.2012.12.008","article-title":"Harmonic ratios: A quantification of step to step symmetry","volume":"46","author":"Bellanca","year":"2013","journal-title":"J. Biomech."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1093\/gerona\/glq170","article-title":"Validation of a measure of smoothness of walking","volume":"66","author":"Brach","year":"2011","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.humov.2018.11.010","article-title":"Dynamic balance assessment during gait in children with down and prader-willi syndromes using inertial sensors","volume":"63","author":"Belluscio","year":"2019","journal-title":"Hum. Mov. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Cimolin, V., and Galli, M. (2014). Summary measures for clinical gait analysis: A literature review. Gait Posture, 39.","DOI":"10.1016\/j.gaitpost.2014.02.001"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S0966-6362(02)00159-5","article-title":"Acceleration patterns of the head and pelvis when walking on level and irregular surfaces","volume":"18","author":"Menz","year":"2003","journal-title":"Gait Posture"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.apmr.2003.06.015","article-title":"Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy","volume":"85","author":"Menz","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.gaitpost.2017.08.023","article-title":"Gait & posture smoothness of gait detects early alterations of walking in persons with multiple sclerosis without disability","volume":"58","author":"Pau","year":"2017","journal-title":"Gait Posture"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/mds.22352","article-title":"Walking stability using harmonic ratios in Parkinson\u2019 s disease","volume":"24","author":"Lowry","year":"2019","journal-title":"Mov. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chen, X., Liao, S., Cao, S., Wu, D., and Zhang, X. (2017). An acceleration-based gait assessment method for children with cerebral palsy. Sensors, 17.","DOI":"10.3390\/s17051002"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.gaitpost.2012.10.005","article-title":"Age-related changes in spatiotemporal characteristics of gait accompany ongoing lower limb linear growth in late childhood and early adolescence","volume":"38","author":"Froehle","year":"2013","journal-title":"Gait Posture"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1136\/bmj.39238.399444.55","article-title":"Body mass index cut offs to define thinness in children and adolescents: International survey","volume":"335","author":"Cole","year":"2007","journal-title":"Br. Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmj.320.7244.1240","article-title":"Establishing a standard definition for child overweight and obesity worldwide: International survey","volume":"320","author":"Cole","year":"2000","journal-title":"Br. Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/14733280701791827","article-title":"Ethics in child research: Rights, reason and responsibilities","volume":"6","author":"Bell","year":"2008","journal-title":"Child. Geogr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jelekin.2014.11.006","article-title":"Short-term effects of backpack carriage on plantar pressure and gait in schoolchildren","volume":"25","author":"Pau","year":"2015","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.gaitpost.2018.01.031","article-title":"Trunk rotation alters postural sway but not gait in female children and early adolescents: Results from a school-based screening for scoliosis","volume":"61","author":"Pau","year":"2018","journal-title":"Gait Posture"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jbiomech.2017.01.005","article-title":"Overcoming the limitations of the harmonic ratio for the reliable assessment of gait symmetry","volume":"53","author":"Pasciuto","year":"2017","journal-title":"J. Biomech."},{"key":"ref_38","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1111\/ggi.12839","article-title":"Association between gait abnormality and malnutrition in a community-dwelling elderly population","volume":"17","author":"Misu","year":"2017","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1152\/jn.00131.2009","article-title":"Direction-dependent control of balance during walking and standing","volume":"102","author":"Connor","year":"2019","journal-title":"J. Neurophysiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1249\/mss.0b013e318076b54b","article-title":"Effects of obesity on the biomechanics of walking at different speeds","volume":"39","author":"Browning","year":"2007","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.jbiomech.2003.06.002","article-title":"Mechanical and metabolic requirements for active lateral stabilization in human walking","volume":"37","author":"Donelan","year":"2004","journal-title":"J. Biomech."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1590\/2446-4740.180017","article-title":"Biomechanical alterations of gait on overweight subjects biomechanical alterations of gait on overweight subjects","volume":"34","author":"Silva","year":"2018","journal-title":"Res. Biomed. Eng."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1159\/000362836","article-title":"Good lateral harmonic stability combined with adequate gait speed is required for low fall risk in older people","volume":"61","author":"Brodie","year":"2015","journal-title":"Gerontology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12984-016-0211-0","article-title":"The Association between fear of falling and smoothness of lower trunk oscillation in gait varies according to gait speed in community-dwelling older adults","volume":"14","author":"Asai","year":"2017","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_46","first-page":"9482373","article-title":"Gender differences in joint biomechanics during walking: Normative study in young adults","volume":"77","author":"Kerrigan","year":"2019","journal-title":"Am. J. Phys. Med. Rehabil."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/19\/9\/2054\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:48:50Z","timestamp":1760186930000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/19\/9\/2054"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,2]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,5]]}},"alternative-id":["s19092054"],"URL":"https:\/\/doi.org\/10.3390\/s19092054","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,2]]}}}