title: How obesity modifies tendons (implications for athletic activities).
abstract: BACKGROUND
  obesity is a well recognized risk factor for dysmetabolic and cardiovascular diseases, but can also be associated to musculo-skeletal disorders.
  
  
  METHODS
  a search of English-language articles was performed using the key search terms "obesity" or "body mass index" combined with "tendon", or "tendinopathy", indipendently.
  
  
  RESULTS
  several studies show that, in obese subjects, tendons frequently undergo to degeneration, which can progress to a symptomatic stage, with pain and functional impairment. The main histopathologic findings are a relative paucity of small collagen fibrils, expression of an impaired remodeling process, deposition of lipid droplets which can abut to tendolipomatosis, and a disorganized architecture in the tension regions. Both load-bearing and non load-bearing tendons can be affected. This suggests that systemic factors play an important pathogenetic role. Indeed, adipose tissue releases several bioactive peptides and hormones (chemerin, lipocalin, leptin and adiponectin), and cytokines responsible of a systemic state of chronic low grade inflammation.
  
  
  CONCLUSIONS
  Physical activity is strongly recommended to stop the progression of weight gain or to bring an obese individual into the normal weight range. Therefore, leisure sport activity is useful in obese subjects, but caution is mandatory, because tendons with sub-clinical damage, when submitted to overload, can easily reach the symptomatic threshold.
authors.affiliation: Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti, Pescara, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Abate
keywords: obesity; sport; tendon