Monitoring BMI-dependent gait adaptations through smart insole technology: implications for musculoskeletal health

BACKGROUND: This study aims to identify differences in specific gait parameters (spatiotemporal kinematics, plantar pressure, and center of plantar pressure indicators) among young adults with different body mass index (BMI) levels, clarify their linear and nonlinear correlation patterns with BMI, provide a theoretical basis for the prevention and intervention of musculoskeletal injuries associated with abnormal BMI, and verify the practical value of a self-developed smart insole in gait monitoring. METHODS: A total of 62 college students aged 18-28 years were enrolled and categorized into four groups (underweight, normal-weight, overweight, obese) based on the 2024 Guidelines for the Prevention and Control of Overweight and Obesity in Chinese Adults. All participants wore smart insoles and completed a 10-meter walking test. Twenty-one key gait parameters were extracted, including general gait parameters, gait cycle-related indicators, ankle angle indicators, five-division peak plantar pressure (PPP), and center of plantar pressure (COP)-related indicators. Inter-group differences were compared using one-way ANOVA or Kruskal-Wallis H test with Bonferroni correction, and correlations between gait parameters and BMI were analyzed via Spearman correlation analysis. Nonlinear relationships were explored using parabolic regression for parameters without significant linear correlation. Effect sizes (f = 0.40 for ANOVA, ε² = 0.398 for Kruskal-Wallis H test) were calculated based on primary outcome variables. RESULTS: Analysis of 21 gait parameters revealed that 12 indicators were linearly correlated with BMI, while 6 showed a nonlinear (curvilinear) relationship with BMI. Significant inter-group differences (p < 0.05) were observed in relative stride speed (RSS), percentage of single support time (%SST), percentage of swing-phase time (%SPT), and peak pressures at the medial metatarsal (PPP-M), arch (PPP-A), and heel (PPP-H) regions, with large effect sizes indicating substantial practical differences. Specifically, RSS, %SST, and %SPT progressively decreased, while PPP-M, PPP-A, and PPP-H progressively increased across the four BMI groups (p < 0.001 after Bonferroni correction). The smart insole system accurately captured these differential parameters with high sensitivity and dynamic response performance. CONCLUSION: This study reveals the specific gait adaptation mechanisms of young people at different body mass index (BMI) levels. The self-developed smart insole can effectively capture these key differential parameters, providing a feasible quantitative technical method for the preliminary screening of gait abnormalities related to BMI and the monitoring of the musculoskeletal and motor health status of young people similar to the study cohort. TRIAL REGISTRATION: This study was registered at the Chinese Clinical Trial Registry (Registration number: MR-34-23-032327) on September 8, 2023.