The associations of body composition, fitness, and physical activity with balance in children: The Arkansas Active Kids study

Authors: DINIZ-SOUSA, FLORÊNCIO - University Arkansas For Medical Sciences (UAMS); EDWARDS, TIMOTHY - Arkansas Children'S Nutrition Research Center (ACNC); DIAZ, EVA - Arkansas Children'S Nutrition Research Center (ACNC); WEBER, JUDITH - Arkansas Children'S Nutrition Research Center (ACNC); BØRSHEIM, ELISABET - Arkansas Children'S Nutrition Research Center (ACNC)

Submitted to: Gait and Posture
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/30/2025
Publication Date: 2/6/2025
Citation: Diniz-Sousa, F., Edwards, T., Diaz, E., Weber, J.L., Børsheim, E. 2025. The associations of body composition, fitness, and physical activity with balance in children: The Arkansas Active Kids study. Gait and Posture. 118:61-68. https://doi.org/10.1016/j.gaitpost.2025.01.081.
DOI: https://doi.org/10.1016/j.gaitpost.2025.01.081

Interpretive Summary: Balance is essential for children to develop motor skills. However, the factors that influence children's balance are not well understood. In a study involving 219 children aged 7-11 years (average age 9), researchers measured balance, body composition, physical fitness, and daily physical activity. They discovered that higher body weight, larger waist circumference, and more body fat were linked to poorer balance. On the other hand, stronger leg muscles and better cardiovascular fitness were associated with better balance. Importantly, the negative effects of higher body weight and body fat on balance could be mitigated by higher levels of physical fitness and physical activity. These findings highlight the importance of physical fitness and physical activity in improving children's balance. Exercise programs focusing on weight management, muscle strength, and cardiovascular fitness could be key strategies in helping children develop better balance.

Technical Abstract: Background: Balance plays an important role in children's motor development. However, the factors that are associated with balance in children are not yet fully understood. Research question: We aimed to investigate the association of body composition, physical fitness, and daily physical activity on balance in children. Methods: The sample was composed of 219 children (53% females), aged 9.0 (IQR = 2.2) years with a body mass index (BMI)-percentile of 74.9 (IQR = 48.7). Balance was evaluated through a force platform in the upright bipedal stance under different sensory conditions. Anthropometry, body composition (dual-energy x-ray absorptiometry), knee maximal strength (isokinetic dynamometer), aerobic capacity (indirect calorimetry), and daily physical activity (accelerometry and questionnaires) were also assessed. Results: Higher levels of body mass, waist circumference, and fat mass were associated with worse balance, whereas greater knee extension strength and peak oxygen uptake were linked to enhanced balance. Among those, fat mass percentage and waist circumference were the most important factors associated with balance performance. Moreover, it was observed that the associations between the identified anthropometric and body composition measures with balance could be counteracted by physical fitness and physical activity levels. Significance: Our findings revealed that anthropometric measures, body composition, and physical fitness levels are associated with children's balance. Furthermore, physical fitness and physical activity may be especially relevant, as they could help mitigate the detrimental effect of excess fat mass on postural control.