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Posture and body image in individuals with major depressive disorder: A controlled study

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In this study, we aimed to quantify posture and body image in patients with major depressive disorder during episodes and after drug treatment, comparing the results with those obtained for healthy volunteers. Over a 10-week period, we evaluated 34 individuals with depression and 37 healthy volunteers. Posture was assessed based on digital photos of the subjects; CorelDRAW software guidelines and body landmarks were employed. Body image was evaluated using the Body Shape Questionnaire. During depressive episodes (in comparison with the post-treatment period), patients showed increased head flexion (p<0.001), increased thoracic kyphosis (p<0.001), a trend toward left pelvic retroversion (p=0.012) and abduction of the left scapula (p=0.046). During remission, patient posture was similar to that of the controls. At week 1 (during the episode), there were significant differences between the patients and the controls in terms of head flexion (p<0.001) and thoracic kyphosis (p<0.001); at weeks 8-10 (after treatment), such differences were seen only for shoulder position. The mean score on the Body Shape Questionnaire was 90.03 during the depressive episode, compared with 75.82 during remission (p=0.012) and 62.57 for the controls. During episodes of depression, individuals with major depressive disorder experience changes in posture and mild dissatisfaction with body image. The findings demonstrate that the negative impact of depression includes emotional and physical factors.
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original article
375 • Revista Brasileira de Psiquiatria 2010 • vol 32 • nº 4 • dez2010
Posture and body image in individuals with major
depressive disorder: a controlled study
Postura e imagem corporal em indivíduos com depressão: um
estudo controle
Correspondence
Janette Zamudio Canales
Rua Ovídio Pires de Campos 785, 3o. andar, Ala Norte - Cerqueira César
05403-010 São Paulo, SP, Brasil
Phone/fax: (+55 11) 3069-6648
Email: jane_canales@terra.com.br
Janette Zamudio Canales,1 Táki Athanássios Cordás,2 Juliana Teixeira Fiquer,3 André Furtado Cavalcante,1
Ricardo Alberto Moreno1
1 Grupo de Doenças Afetivas (GRUDA), Institute and Department of Psychiatry, Universidade de São Paulo Medical School (FMUSP), São
Paulo, SP, Brazil
2 Eating Disorders Program (AMBULIM), Institute and Department of Psychiatry, Universidade de São Paulo Medical School (FMUSP), São
Paulo, SP, Brazil
3 Department of Experimental Psychology, Institute of Psychology, Universidade de São Paulo (USP), São Paulo, SP, Brazil
Abtract
Objective: In this study, we aimed to quantify posture and body image
in patients with major depressive disorder during episodes and after
drug treatment, comparing the results with those obtained for healthy
volunteers. Method: Over a 10-week period, we evaluated 34 individuals
with depression and 37 healthy volunteers. Posture was assessed based
on digital photos of the subjects; CorelDRAW software guidelines and
body landmarks were employed. Body image was evaluated using the
Body Shape Questionnaire. Results: During depressive episodes (in
comparison with the post-treatment period), patients showed increased
head flexion (p < 0.001), increased thoracic kyphosis (p < 0.001), a
trend toward left pelvic retroversion (p = 0.012) and abduction of the
left scapula (p = 0.046). During remission, patient posture was similar
to that of the controls. At week 1 (during the episode), there were
significant differences between the patients and the controls in terms of
head flexion (p < 0.001) and thoracic kyphosis (p < 0.001); at weeks 8-10
(after treatment), such differences were seen only for shoulder position.
The mean score on the Body Shape Questionnaire was 90.03 during the
depressive episode, compared with 75.82 during remission (p = 0.012)
and 62.57 for the controls. Conclusion: During episodes of depression,
individuals with major depressive disorder experience changes in posture
and mild dissatisfaction with body image. The findings demonstrate that
the negative impact of depression includes emotional and physical factors.
Descriptors: Posture; Depression; Body image; Evaluation; Depressive
disorder, major
Submitted: September 17, 2009
Accepted: January 18, 2010
Resumo
Objetivo: O objetivo deste estudo foi avaliar quantitativamente a postura
e a imagem corporal em pacientes com transtorno depressivo maior, durante
o episódio depressivo e após tratamento medicamentoso, e comparar com
voluntários sadios. Método: Durante o período de dez semanas, foram
avaliados 34 indivíduos com depressão e 37 voluntários sadios. A postura
foi avaliada através de fotos digitais e do software CorelDRAW. A imagem
corporal foi avaliada através do Body Shape Questionnaire. Resultados: No
episódio depressivo (em comparação ao período pós tratamento), os pacientes
apresentaram aumento da flexão da cabeça (p < 0,001), aumento da cifose
(p < 0,001), retroversão pélvica esquerda (p = 0,012) e abdução da escápula
esquerda (p = 0,046). Na remissão, a postura foi similar ao grupo controle.
Na comparação entre controles e transtorno depressivo maior, houve diferença
para postura da cabeça (p < 0,001) e cifose torácica (p < 0,001). Na remissão
houve diferença para a postura do ombro. A média dos escores do Body Shape
Questionnaire foram 90,03 no episódio e 75,82 na remissão (p = 0,012).
O grupo controle apresentou escore 62,57. Conclusão: Houve diferença da
postura e insatisfação da imagem corporal durante o episódio em indivíduos
com transtorno depressivo maior. Os achados destacam que o impacto negativo
da depressão abrange tanto fatores emocionais quanto físicos.
Descritores: Postura; Depressão; Imagem corporal; Avaliação; Transtorno
depressivo maior
Introduction
Depression is one of the most common psychiatric disorders
in adults and is characterized by depressed mood, changes in
appetite, disturbed sleep, reduced energy, tiredness, fatigue,
anxiety and a lack of motivation.1 Clinical observation suggests
that the appearance of patients with depression is distinct and
recognizable, characterized by sad facial expression, furrowed
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Revista Brasileira de Psiquiatria 2010 • vol 32 • nº 4 • dez2010 • 376
brow, curved shoulders and a lack of spontaneous body
movements.2
Posture is defined as the position and relative arrangement of
the body parts. The ideal alignment in the vertical posture allows
the body to maintain its balance with a minimum expense of
energy.3 By analogy, bad (or abnormal) posture means the defective
relation among the multiple parts of the body. Postural problems
typically generate higher tension over the supporting structures
which constitute the musculoskeletal system. Posture is influenced
by a number of conditioning factors: mechanical and emotional
aspects; heredity and race; flexibility; muscle strength; vision;
and habits.4-7 In addition, feelings of excitation, confidence and
satisfaction manifest as an alert attitude and erect posture, whereas
depression typically manifests as a slouching posture.8
Although no standard approach to assessing posture has been
defined, the use of photos has been supported by many studies.9-11
Photogrammetry, defined as the interpretation of obtained values
from a photographic image, is a quantitative technique that allows
the angles and distances between bone references, joints, planes
and axes to be measured, reliably assessing posture and identifying
misalignment.9
Self-awareness of posture is linked to the concept of body
image. Posture and body image are closely related. Body image
determines differences and plasticity of the postural organization.
Due to constant changes in position, tactile and visual perceptions
continuously force the remodeling of the posture.12 Body image is
defined as the mental perception of the size, contour and shape of
our bodies, as well as our feelings related to those characteristics
and to the parts that constitute our body. Therefore, body image
has two major components: a perception component, related to
the self-estimated body size, and an attitude component, related
to affect and cognition.13 Body image disturbances are seen in
neurological and psychiatric disorders.
Most reports on the posture of depressed patients have been
observational. In addition, most studies on this topic have assessed
eating disorders or have evaluated only depressive symptoms.14
To our knowledge, there have been no studies quantitatively
evaluating posture and body image in patients with major
depressive disorder (MDD). Therefore, this study aims to evaluate
the posture and body image in individuals with MDD during
episodes and remission, and we compare the results with those
obtained for a control group consisting of healthy volunteers.
Method
1. Design
This was a 10-week, observational case-control study. Our
sample consisted of 34 individuals with MDD, from 20 to 50
years of age, receiving care at the Mood Disorders Unit of the
Psychiatry Institute of the Universidade de São Paulo Hospital
das Clínicas, a public hospital located in the city of São Paulo,
Brazil. The diagnosis of MDD was made in accordance with the
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV), text revision criteria. A score 18 on the
17-item Hamilton Rating Scale for Depression (HAM-D-17)
was considered indicative of an episode of depression (week 1),
whereas a HAM-D-17 score 14 was considered indicative of
partial or total remission (weeks 8-10).
A control group (n = 37) was composed of age- and gender-
matched healthy individuals, identified from a previous study.15
None of the controls had any family or personal history of
psychiatric disorder as evaluated by the 20-item Self-Reporting
Questionnaire,15 as well as by DSM-IV.15 To rule out clinically
relevant nonpsychiatric disorders, we applied a questionnaire
regarding family history, as well as conducting laboratory tests,
electrocardiograms and physical examinations. The exclusion
criteria were as follows: presenting with a neuromuscular or
musculoskeletal disorder; and exercising regularly (more than
twice a week or more than three hours per week).
The project was approved by the local ethics committee, and the
legal representatives of the subjects gave written informed consent.
2. Procedures
To conduct the postural assessments, we used photos of patients
in the orthostatic position (sagittal and frontal planes), as previously
described by Penha et al.16 Height and weight were measured
before the images were taken, and the body mass index (BMI) was
calculated. A room was reserved for posture evaluation and the
patients were asked to stand on a wood base (40×40cm), which was
positioned in front of a grid (2×1m; grid size, 10×10cm).
A digital camera (Cybershot® DSC, 7.2 Megapixels; Sony
Corporation, Tokyo, Japan) was rotated and locked in the vertical
position (90° from horizontal) in order to capture an image of the
entire body. The camera was positioned at a standardized distance
of 2.70 m from the grid and at a height of 1 m. The upper part
of the wood base coincided with the lowest grid line. The camera
was aligned parallel with the floor through the use of the built-in
bubble level.16
For each subject, the following bone reference points were
marked with adhesive dots: lateral malleoli; head of the fibula;
greater trochanter of the femur; anterior and posterior superior
iliac spine; cervical spine (at C7); thoracic spine (at T3, T6,
T9 and T12); lumbar spine (at L3 and L5); sacral spinous
processes; and inferior scapular angle.5 Some of these reference
points were also marked with small balls (15 cm in diameter):
anterior and posterior superior iliac spine; thoracic spine (at
T3, T6, T9 and T12), lumbar spine (at L3 and L5); cervical
spine (at C7); and acromion.5
Photos were imported into the CorelDRAW program, version
12 (Corel, Ottawa, Canada) and were enlarged in order to identify
the reference points. Sagittal plane photos were used in order to
assess head position, shoulder position, thoracic kyphosis, lumbar
lordosis, pelvic inclination and knee position. Posterior plane
photos were used in order to assess scapula and ankle position.
The Body Shape Questionnaire (BSQ) was used in order to
evaluate subject body image. The BSQ consists of a Likert-type
scale, including 34 questions related to concerns regarding body
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377 • Revista Brasileira de Psiquiatria 2010 • vol 32 • nº 4 • dez2010
shape and weight, as well as affective, cognitive and behavioral
aspects, over the past 4 weeks. Rankings are assigned by ordering
the scores obtained by sum of points and categories: 80 = no
dissatisfaction; 81-110 = mild dissatisfaction; 111-139 = moderate
dissatisfaction; and 140 = strong dissatisfaction.14
3. Data analysis
The angles between bone reference points were quantified in
degrees and calculated using the CorelDraw guidelines. Data
collection and measurements were performed by the same
researcher. Measurements were taken twice (right and left sides)
in the frontal, posterior and sagittal planes.16
Head position - In the sagittal plane, a horizontal line was drawn
at C7 and a diagonal line was drawn from the point where that
horizontal line met the spine to the external auditory meatus. We
measured the angle between those two lines (Figure 1).
Thoracic kyphosis - In the sagittal plane, the angle between the
point of greatest cervical concavity and that of greatest lumbar
concavity was measured, the vertex being the highest point of
thoracic convexity (Figure 1).
Lumbar lordosis - In the sagittal plane, the angle between the
highest points of convexity on the thoracic curve and the gluteus
region was measured, the vertex being the point of greatest lumbar
concavity (Figure 1).
Pelvic inclination - In the sagittal plane, a horizontal line was
drawn at the level of the anterior superior iliac spine, which is
the vertex of the angle formed between that horizontal line and a
second line ending at the posterior superior iliac spine (Figure 1).
Knee position - In the sagittal plane, the angle between the
lateral malleoli, the head of the fibula and the greater trochanter
of the femur was measured in order to identify hyperextension
or semi-flexion (Figure 1).
Scapula position - In the posterior plane, the distance below the
corresponding apophysis angle was measured in centimeters, in
order to estimate abduction or adduction of the scapula.
Shoulder position - In the sagittal plane, the distance from the
acromion to the C7 spinous process was measured in centimeters,
in order to identify shoulder protraction (Figure 1).
Ankle position - In the posterior plane, the angle between a
vertical line running through the Achilles tendon and the vertical
line of the leg to the average midpoint of the calcaneus was
measured.
4. Statistics
Data were analyzed using descriptive statistics and summary
tables. The statistical analysis was performed using the following:
Pearson’s chi-square test to compare proportions between groups
(e.g., gender); the t-test to compare age; the exact chi-square test
for race; and the Mann-Whitney test for BMI. For quantitative
variables, the Kolmogorov-Smirnov test was employed in order
to determine the goodness of fit for normality; the paired t-test
was performed for variables with normally distributed data within
a group; and the Wilcoxon test for paired samples was used for
variables with non-normally distributed data. In the comparison
between groups for postural variables, ANOVA was performed for
normally distributed data and the Mann-Whitney test was used
for non-normally distributed data. The Statistical Package for the
Social Sciences, version 14.0 (SPSS Inc., Chicago, IL, USA) was
used for statistical calculations.
Results
Our sample consisted of 34 individuals with MDD and 37
healthy controls. Females predominated in both groups (76.5%
and 78.4%). The mean age was 37.62 ± 8.20 years in those with
MDD and 34.78 ± 6.21 years in the control group. At weeks 8-10,
mean BMI was 24.85 ± 5.18kg/m2 in the MDD group, compared
with 23.90 ± 2.76kg/m2 in the control group. In terms of age,
gender and BMI, the differences between the two groups were
not significant (p = 0.10, p = 0.848 and p = 0.23, respectively).
At enrollment, 55.9% of the individuals with MDD were
experiencing a severe recurrent episode, 11.8% were experiencing a
moderate recurrent episode; 17.6% were experiencing a moderate
first episode and 14.79% were experiencing a severe first episode.
The mean HAM-D-17 score for the group was 26.65 ± 4.24 at
week 1 and 6.91 ± 3.80 at weeks 8-10.
Comparing week 1 with weeks 8-10 in terms of the postural
variables in the MDD group, we observed significant differences
for left side pelvic position (p = 0.012), left scapular position (p =
0.046), right thoracic kyphosis (p < 0.001), left thoracic kyphosis
(p < 0.001) and sagittal head position (p < 0.001), as can be seen
in Table 1 and Figure 1.
Table 1 shows that there were significant differences between
the MDD group at week 1 and the control group in terms of
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this was attenuated during remission.
The posterior cervical, trapezius and paraspinal muscles
counterbalance the weight of the head, and anterior head
carriage can therefore cause tenderness in the neck region.17
Using the Penha et al. methodology,16 Miranda18 found the
mean head position in a group of 37 healthy women to be
52.0 ± 6.5°. Using the same methodology, Ferreira found the
mean head position to be 47.06 ± 4.77° for a group composed
of both genders.19 These values are similar to those obtained
for our control group.
Patients presenting depressive episodes showed a marked
increase in kyphosis, which was also reduced during remission.
Kyphosis affects the muscles, reducing the flexibility of anterior
thorax (intercostal) muscles, upper limb muscles originating
from the thorax (minor and major pectoralis, latissimus dorsi
and anterior serratus muscles) and cervical spine muscles (levator
scapulae and trapezius muscles).17 In the study conducted by
Miranda,18 the mean kyphosis angle was found to be 143.4 ±
7.1°, similar to that found for our control group.
right sagittal head position (p < 0.001), left sagittal head position
(p < 0.001), right thoracic kyphosis (p < 0.001) and left thoracic
kyphosis (p < 0.001), whereas, at weeks 8-10, such differences
were seen only for position of the right and left shoulders (p =
0.022 and p = 0.012, respectively).
As can be seen in Table 2, the mean BSQ score in the MDD
group was 90.03 ± 38.46 at week 1 and 75.82 ± 35.30 at weeks
8-10 (p = 0.012). In the control group, the mean BSQ score was
62.57 ± 23.04. In terms of the BSQ score, there were no significant
differences between the MDD group at weeks 8-10 and the control
group (p = 0.127).
Discussion
1. Postural variables
Although there have been studies evaluating posture in various
pathologies, few have done so in individuals with MDD, making
it difficult to contextualize our results.
We found that, during episodes, patients with MDD showed
marked anterior head carriage, tend to look at the floor, and that
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193 young adult female students of nutrition, 59.9% expressed no
dissatisfaction with their body image, and there was a significant
association between BSQ and BMI (p = 0.026).24 In a review
of the literature on body image,25 it was concluded that current
investigations are increasingly focusing on physical appearance,
particularly body shape and weight. For men, body image is
less clear, because there have been fewer studies. For women,
dissatisfaction with body size and weight is well documented,
showing that the body image concept must be extended. Most
studies on adults evaluated student populations within a narrow
age range of 18-25 years, and those populations were typically
homogeneous in terms of race, socioeconomic status and level
of education.25
Conclusion
Patients with MDD showed changes in body posture during
their episodic depressive exacerbation and expressed dissatisfaction
with their body image. These alterations were not finding during
the remission phase. These findings highlight the role of body
posture and body image in the expression and communication
of mood disorders and support the hypothesis that depression
is related to impairments in both emotional and physical health
domains.
Acknowledgements
This study was supported in part by the Coordenação de Aperfeiçoamento
de Pessoal de Nível Superior (CAPES, Coordination of the Advancement
of Higher Education).
In the present study, depressive patients tended to present with
pelvic retroversion, which decreased during remission. The pelvis
is the key to correct posture of the dorsal region, and the mean
pelvic inclination in normal subjects is 11 ± 4°.17 Miranda found
the mean pelvic position to be 11.3 ± 5.7° on both sides,18 again
similar to that found for our control group.
During the depressive episode, our patients showed mild
left scapular abduction, which decreased during remission. It
is known that changes in the position of the scapula adversely
affect the shoulder, predisposing to injury and chronic pain.5 In
the study conducted by Miranda,18 the mean scapular position
was 2.4 ± 0.5°, comparable to that found for our control group.18
In our study, patients with depression showed mild left scapular
abduction, which is likely related to the increased kyphosis, since
the scapula is located in the same region. There were no significant
differences between the MDD group and the control group in
terms of the other postural variables.
We found that, during episodes, there are measurable changes
in the posture of individuals with MDD. Such changes included
significant increases in head flexion, thoracic kyphosis, a trend
toward pelvic retroversion and an increase in scapular distance,
all of which interfere with the proper functioning of the skeletal
muscles. During remission, these aspects improved (Figure 1).
Such alterations, in addition to having consequences such as pain,
tension and shortness of breath, are often part of the spectrum
of symptoms observed in MDD, characterizing a depressive
posture.”
2. Body image
During depressive episodes, the patients in the MDD group
were mildly dissatisfied with their body image, and this was
primarily attributable to sadness and discouragement. During
remission, there was no apparent dissatisfaction with body image,
probably due to a lessening of the depressive symptoms. Control
subjects did not express any dissatisfaction with their body image.
Therefore, in this aspect, the controls were no different than the
patients during remission. Several studies have associated poor
body image with eating disorders and depressive symptoms.20,21
One such study evaluated patients with class III obesity, analyzing
periodic episodes of compulsive eating, anxiety, depression and
body image distortion.21 In that study, all of the participants
were found to have depressive symptoms, and 76% expressed
concerns regarding body image. In our study, care was taken to
study only patients with a specific diagnosis of MDD, rather
than all patients with depressive symptoms, which increases the
relevance of our findings.
In a study involving a sample of the young adult female
population of Sweden, the mean BSQ score was 74.50 ± 29.50,
similar to that found for our controls.22 A study conducted in
Brazil showed that, in a group of 582 female and male university
employees, most (90.2%) expressed no dissatisfaction with their
body image, the mean BSQ score being 65.06 ± 31.66,23 which is
also in agreement with our findings. In another study evaluating
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Art.04_RBP822.indd 380 1/6/11 10:14 PM
... MDD represents a severe form of depression, presenting significant challenges in terms of treatment and profoundly impacting patients' emotional, physical well-being, daily functioning, learning, and work (1,2). Previous research has not only demonstrated its adverse effects on cardiovascular and metabolic diseases (3), but also indicated its significant role in specific postural changes in the human body (4), highlighting the close relationship between depression and the occurrence of musculoskeletal diseases (5,6). ...
... The increased risk of CS and KOA among individuals with depression may be closely linked to poor posture. Research indicates that individuals with depression often exhibit poor posture, which can lead to neck muscle tension and alterations in spinal structure, potentially contributing to the development of CS (4)(5)(6). Moreover, individuals with depression often engage in decreased physical activity, leading to muscle atrophy, reduced joint stability, and potentially adverse effects on knee function and outcomes (24). ...
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Background The association between depression and musculoskeletal diseases has long been a subject of contentious debate. However, the causal relationship between the two remains uncertain. This study employs a two-sample Mendelian randomization (MR) analysis to investigate the causality between depression and six musculoskeletal diseases. Methods In this study, we performed MR analysis to systematically explore the causal relationship between depression and six musculoskeletal disorders. Single nucleotide polymorphisms (SNPs) that are linked to depression were employed as instrumental variables. To ensure robust and reliable conclusions, multiple analytical approaches were utilized, including inverse variance weighting(IVW), weighted median, and MR-Egger regression. Additionally, sensitivity analysis methods such as the MR-Egger intercept test, Cochran’s Q test, leave-one-out analysis, and funnel plot were employed. Results Our MR analysis revealed a significant association between depression and cervical spondylosis (depression: OR 1.003, 95% CI 1.002–1.005, P = 8.32E-05; major depressive disorder: OR 1.003, 95% CI 1.001–1.005, P = 0.0052). Furthermore, a strong correlation was noted between major depressive disorder (MDD) and knee osteoarthritis (KOA) (OR 1.299, 95% CI 1.154–1.463, P = 1.50E−5). Sensitivity analysis confirmed the robustness of these findings. Our independent validation study also corroborated these results. Conclusion The MR analysis conducted in this study provides evidence supporting a genetic link between depression and cervical spondylosis, as well as KOA. Targeted interventions to manage depression in susceptible populations may contribute to lowering the risk of cervical spondylosis and KOA in these cohorts.
... These same changes in head posture were identified in individuals who underwent treatment for depression, in which an increase in head flexion and thoracic kyphosis was observed. Depressive individuals tend to experience significant changes in posture and manifest mild dissatisfaction with body image 19 . A study of marathon runners indicated that the group with depressed mood had significantly higher scores on anger, confusion, fatigue, tension with lower vigor, and perceived readiness. ...
... In the present study, it was observed that the means of anger and depression were the ones that presented the lowest means in women, which may explain the absence of association between these emotions and changes in the pelvis and shoulder blades, as reported in other studies. Anger may be related to shoulder strain 25 , while depressive symptoms have been associated with poor posture, including abnormal spinal curvatures and episodes of low back pain 19,26 . In addition, one study identified an association between subjective expression of anger and chronic low back pain 27 . ...
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In the clinical practice of health professionals, it is observed that body posture can reveal the current emotional state. Emotional states can generate habitual gestures and postures that continue even after the emotion has ceased. The objective was to identify postural changes and variables found in the mood state in women. After project submission and approval to the CEP of the Lutheran University of Brazil (ULBRA), 15 women with a mean age of 39.6 years, regardless of color, race, or social class participated in the study. The sample was by convenience, being recruited through invitations on social networks. The research was carried out at the Walk Clinic of Exercise, in Charqueadas/RS. The instruments used were a sociodemographic and clinical questionnaire to characterize the sample, the Brunel Mood Scale (Brums), and the DIPA v13 (Digital Image based Postural Assessment) to assess posture. The results were presented in the form of descriptive statistics. It was found that increased tension and mental confusion for women with head changes in the sagittal plane and who also showed decreased vigor. In this study, it was verified that for women with low vigor, there is head alteration and that they present tension and mental confusion. More studies should be carried out with different methodologies in larger samples to enable the mapping and delineation of most postural changes related to emotional states and mood disorders, with due application in the clinical practice of health professionals.
... The transition to the digital age has increased sedentary behavior among individuals, resulting in heightened concerns regarding the prevalence of lower back pain due to decreased physical activity levels [1,2]. The early symptoms of lower back pain can present as minor discomfort and mild aches; if left untreated, it can progress to chronic musculoskeletal disorders, circulatory deficiencies, and psychological complications [3][4][5]. Only 10% of individuals experiencing lower back pain need surgical intervention [6]. ...
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This study investigates design and evaluation of an intelligent vest integrating Marginal Absolute Relative Gradient (MARG) sensors for posture correction. The research aims to enhance ergonomic interventions through a lightweight, aesthetic garment that provides real-time feedback, addressing both functional and design in wearable technology. The vest incorporates Adafruit FLORA microcontroller boards and MARG sensors to monitor neck and shoulder movements. Experimental setups involved recording roll and pitch angles during various postures. A sample of 10 female participants was recruited for usability testing, and quantitative analyses of sensor data were performed to validate the vest's performance. Moreover, user feedback on the vest's visual (LED) and tactile (vibration) feedback, comfort, and posture correction effectiveness was collected. Data revealed distinct posture patterns, including a mean neck pitch of −61.80° during forward tilts and synchronized neck-shoulder movements when leaning right (correlation coefficient of 0.46 for pitch). Conversely, independent movements were observed in leftward tilts (correlation coefficients of 0.07 for roll and −0.18 for pitch). User feedback indicated high ratings for comfort (mean = 4.4) and LED feedback effectiveness (mean = 4.3), while haptic feedback received moderate scores (mean = 3.6). The intelligent vest successfully integrates posture correction functionality with user-friendly design, providing detailed real-time feedback and maintaining wearability. This study highlights its potential in health-related applications and underscores the importance of aesthetics in wearable technology for enhanced adoption and usability.
... Canales et al found that depressed patients exhibited changes in body posture during depressive episodes, such as neck, and chest kyphosis and neck stiffness. 39 Rosario et al found that long-term postural inaccuracy led to cone structure remodeling and osteophyte formation. Depressed patients with long-term postural inaccuracy due to various factors lead to poor development of the shoulder and neck and eventually become deformities. ...
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Background Previous observational studies have suggested a potential link between depression and cervical spondylosis (CS). While it is known that depression and CS can coexist, the specific relationship between them is not fully understood. We hypothesize that there may be connections between the two conditions, but the independent causal relationship of depression as a risk factor for CS, remains uncertain. This particular study has important implications for the future clinical treatment of depression and cervical spondylosis because Mendelian randomization has not been widely used in this field. We obtained valuable results through big data analysis and have guiding significance for future research. Methods We conducted a two-sample Mendelian randomization (MR) study using data from genome-wide association studies to investigate the causal relationship between depression and CS in individuals of European ancestry. Additionally, we examined the impact of CS on susceptibility to depression using large population-level genetic data (number of depression SNPs: 9,761,853; number of CS SNPs: 9,851,867). The primary approach for data analysis was the inverse-variance weighted (IVW) method to estimate potential causal effects. Furthermore, we performed sensitivity analyses utilizing methods such as Manhattan plot (CMplot), linkage disequilibrium (LD), F-filtering, removal of phenoscanner, MR-Egger, weighted median, MR-PRESSO simple mode weighted mode MR pleiotropy test MR heterogeneity assessment leave-one-out analysis to ensure result robustness. Results Our findings indicated that an elevated likelihood of CS was linked to depression [IVW odds ratio (OR): 1.322, 95% confidence interval (CI): 1.205–1.441, P=0.01243]. There was reciprocal evidence of causation, with the genetic predisposition to depression significantly heightening susceptibility to CS [IVW odds ratio (OR): 1.426, 95% confidence interval (CI): 1.236–1.651, P=0.01775]. Conclusion This investigation provides genetic support for a bidirectional causal association between depression and CS. Specifically, individuals with depression are at greater risk of developing CS. Addressing depression may serve as an effective approach in mitigating or preventing the burden of CS and vice versa.
... This method is characterized by noninvasiveness, repeatability and measurement sensitivity [32]. In the reports of other authors, digital photography was used for evaluating the body posture of both children and adults with various dysfunctions and disorders [30,32,33]. In our own research, the use of modern software (FreeSTEP) allowed for precise calculation and analysis of the selected parameters, which is significant from the perspective of objectifying the obtained results [34]. ...
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Patients with cervical spondylosis are often accompanied by a series of mental disorders, but there is no direct evidence of causal relationship and the mediation factors are not clear. Our purpose is to use the aggregated data of the large-scale genome-wide association study (GWAS) to explore the causal relationship between mental disorders and cervical spondylosis by using Mendelian randomization analysis, and further explore the mediation factors, to provide theoretical basis for the prevention and treatment of cervical spondylosis. Data on cervical spondylosis, mental disorders (depression, anxiety and schizophrenia), and living habits (smoking, insomnia, drinking, exercise, and time spent watching TV) were collected from the aggregated data of GWAS. In the univariable MR, inverse variance weighted (IVW) method was adopted as the main method, MR-Egger-based regression method, weighted median (WME) method, simple mode method, and weighted mode (WM) method were adopted as the complementary methods to evaluate the causal relationship between mental disorders and cervical spondylosis. Cochran's Q test, MR-Egger intercept test, and MR pleiotropy residual sum and outlier (MR-PRESSO)test were used to verify the reliability of the analysis results as sensitivity analysis. In the multivariable MR, IVW was used to analyze the causal relationship between the three mental disorders and cervical spondylosis after adjustment. In the mediation MR analysis, according to the steps of exposure to mediation and mediation to outcome, the qualified mediation factors in living habits were screened out, and the P-value of mediation effect was calculated by coefficient product test. The confidence interval was estimated by Delta method, and the proportion mediated was calculated. The univariable analysis (OR=1.398, 95%CI:1.085-1.803, P=0.010) indicated that depression was a risk factor for cervical spondylosis. The multivariable analysis showed that depression still has positive causal relationship with cervical spondylosis after adjustment for anxiety and schizophrenia (OR=1.343, 95%CI:1.06-1.70, P=0.013). The mediation MR analysis showed that from depression to living habits, “time spent watching TV” was excluded. From living habits to cervical spondylosis, “exercise” was excluded. Drinking was also excluded by the results of coefficient product test. The mediation MR analysis showed that the causal relationship between depression and cervical spondylosis was partly mediated by smoking and insomnia, and the proportion mediated was 15.98% and 41.70%. Our study shows that there is a positive causal relationship between depression and cervical spondylosis, which is partly mediated by smoking and insomnia, and the finding may be helpful for the prevention and treatment of cervical spondylosis.
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Objective: To investigate body image perceptions among students of nutrition in the city of Rio de Janeiro. Methods: Sectional study among female nutrition students. The prevalence of distortion in body image perception was assessed by using the Body Shape Questionnaire (BSQ), Portuguese version, adopting the confidence interval of 95%. To study the associations, the chi-square test was used. Results: The sample consisted of 193 students; average age 20.9 years (± 2). The median score of the BSQ was of 81.2 points (± 33.6), corresponding to the light concern with the corporal self-image. Among these students the prevalence of serious distortion of body image was 6.2% (IC 95%; 3.2%-10.6%). A significant statistical association ( p < 0,026) between BSQ and the categorized body mass index (BMI) was observed. Also the association between moderate or serious BSQ and body weight dissatisfaction was significant ( p < 0,001). Conclusion: The results evidence that the ideal body image prevalent in our society influenced the practices of this group; therefore women with adequate weight presented dissatisfaction with their body image, desiring to modify it in order to adjust to social standards. Since this study deals with future nutritionists, the impact of this finding is still more relevant.
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Postural alterations are often found in children and teenagers. In this stage of development, the posture undergoes many adjustments and adaptations due to changes of the body and to demanding psychosocial factors. To identify which postural alterations occur most often in students between 7 and 10 years of age, to identify preventive measures, and to provide information to parents and teachers about the problem of bad posture. Thirty three girls in each of 4 age groups between 7 and 10 years of age were assessed, resulting in a sample of 132 subjects. Photos of each girl in the sagittal and frontal planes were examined for postural deviations. The main postural deviations found were knock-knee, medial rotation of the hip, antepulsion, pelvic anteversion, knee hyperextension, lumbar hyperlordosis, valgus ankle, imbalanced shoulders, lateral pelvic inclination, scoliosis, trunk rotation, thoracic hyperkyphosis, winged scapula, shoulder protraction, abducted scapula, medial rotation of shoulders, and head tilt. High incidences of postural alterations occur in children of school age. Some of these reflect normal postural development, and get corrected during the child's growth. On the other hand, some alterations are asymmetries that can be caused by daily demands on the body and can result in negative impacts on the quality of life during childhood and adulthood. We emphasize the importance of providing information to parents and teachers about the problem of bad posture.
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Many practitioners have found that posture training has a positive impact on temporomandibular, or TMD, symptoms. The authors conducted a study to evaluate its effectiveness. Sixty patients with TMD and a primary muscle disorder were randomized into two groups: one group received posture training and TMD self-management instructions while the control group received TMD self-management instructions only. Four weeks after the study began, the authors reexamined the subjects for changes in symptoms, pain-free opening and pressure algometer pain thresholds. In addition, pretreatment and posttreatment posture measurements were recorded for subjects in the treatment group. Statistically significant improvement was demonstrated by the modified symptom severity index, maximum pain-free opening and pressure algometer threshold measurements, as well as by the subjects' perceived TMD and neck symptoms. Subjects in the treatment group reported having experienced a mean reduction in TMD and neck symptoms of 41.9 and 38.2 percent, respectively, while subjects in the control group reported a mean reduction in these symptoms of 8.1 and 9.3 percent. Within the treatment group, the authors found significant correlations between improvements in TMD symptoms and improvements in neck symptoms (P < .005) as well as between TMD symptom improvement and the difference between head and shoulder posture measurements at the outset of treatment (P < .05). Posture training and TMD self-management instructions are significantly more effective than TMD self-management instructions alone for patients with TMD who have a primary muscle disorder. Patients with TMD who hold their heads farther forward relative to the shoulders have a high probability of experiencing symptom improvement as a result of posture training and being provided with selfmanagement instructions.
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Psychometric properties of the Swedish version of the Body Shape Questionnaire (BSQ) were examined using data from three samples: (1) a sample from the general population (n= 1157), (2) a student sample (n= 124) and (3) a clinical sample (n= 90). Analyses showed that a single factor solution might be a reasonable solution as 32 of the 34 items loaded heavily on the first factor. The derived short 14-item version of the BSQ also showed a coherent structure with all the items loading on one single factor. The BSQ showed high test-retest reliability, very high internal consistency, ranging from 0.94 to 0.97, and high split-half reliability (above 0.93). Furthermore, it showed high validity by correlating highly with the body dissatisfaction subscale of the Eating Disorders Inventory (r= 0.72 and higher), and high discriminant validity. Thus, the Swedish version of the BSQ showed good concurrent and discriminant validity as well as high reliability.