BACKGROUND: Potential physiological mechanisms contributing to reduced physical activity in children with obesity or at risk for obesity include poor neuromuscular performance. Children with obesity demonstrate poorer neuromuscular performance, particularly in activities that involve simultaneous body movement and control (dynamic balance) compared to more static object-control tasks. However, the relationship between adiposity and dynamic balance in children is unknown. Emerging evidence in adults suggests that muscle stiffness positively contributes to dynamic balance, but whether this applies to children remains unclear. Understanding these factors can provide insights into the physiological mechanisms influencing a child's level of physical activity. Therefore, the aim of this study was to examine the relationships between body composition, musculo-tendon stiffness, and dynamic balance in children. METHODS: Nine children aged 5 to 16, consisting of 2 males and 7 females, participated in the study. Height and weight were assessed using standard clinical procedures. Body mass index (BMI) percentile was determined using the CDC reference data. Measures of adiposity such as percent total body fat and leg fat (g) were estimated via a total body Dual energy X-ray absorptiometry (DXA) scan. A handheld device (Myoton) was used to assess musculo-tendon stiffness (N/m) in a relaxed state, at the gluteus maximus, vastus lateralis, lateral head of the gastrocnemius, quadriceps tendon, patellar tendon, and Achilles tendon. Dynamic balance was evaluated by the Four-square step test (FSST), which is a multi-directional, timed clinical test of balance, where a greater time taken to complete FSST depicts poor performance. RESULTS: FSST was positively related to percent total body fat (r=0.77, p=0.01), BMI percentile (r=0.78, p=0.01), and leg fat (r=0.75, p=0.02). Stiffness of the quadriceps tendon was negatively related to BMI percentile (r=-0.84, p < 0.01) and leg fat (r=-0.72, p=0.03) while showing a negative trend with percent total body fat (r=-0.61, p=0.08). Additionally, the FSST was negatively related to the quadriceps tendon stiffness (r=-0.84, p=0.005) only. CONCLUSIONS: We provide preliminary evidence that adiposity is negatively related to dynamic balance and musculo-tendon stiffness in children. Specifically, our results suggest that poor dynamic balance in children may be partially explained by the negative relationship between adiposity and stiffness of the quadriceps tendon.

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