Effects of a School-based Exercise Program on Posture, Trunk Range of Motion, and Musculoskeletal Pain

Study Overview
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Brief Summary
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The objective of this study was to evaluate the effects of a school-based exercise program on posture, trunk range of motion and musculoskeletal pain in schoolchildren. This study was a Randomized controlled trial. The hypothesis was that the exercise group would have the postural deviations corrected, would have the trunk range of motion increased and would have the prevalence of pain decreased, while the control group would have not. Three schools from Brazil participated. The students that have been included (n=300) were randomly allocated to experimental (EG) or control group (CG). The intervention for EG consisted in a program based on stretching and strengthening exercises, applied twice a week, for eight weeks, with group sessions of 50 minutes. CG did not perform any intervention. Qualitative and quantitative postural evaluation (PAS/SAPO), musculoskeletal pain (self-report) and trunk mobility were collected.

Official Title
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Effects of a School-based Exercise Program on Posture, Trunk Range of Motion, and Musculoskeletal Pain - A Randomized, Controlled Trial

Conditions
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Musculoskeletal and Connective Tissue Disorders

Intervention / Treatment
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* Other: School-based exercise program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: to attend elementary school and deliver the consent term signed by the parents. - Exclusion Criteria: presence of disability on musculoskeletal or neurological system, exercise intolerance or attendance less than 50% in the exercise sections -

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control group<br>Control group | |
| Experimental: School-based exercise program<br>School-based exercise program | Other: School-based exercise program<br>* The exercise program was applied, twice a week, for 8 weeks, with sessions of 50 minutes, in groups of 10 students. The exercise program was elaborate to restore muscular balance through flexibility, endurance and muscular strength. To promote flexibility stretching exercises for rotator neck muscles, lateral neck flexors, levator scapulae, upper trapezius, erector spinae, major and minor pectoralis, rhomboids, spinal lateral flexors, column rotators, piriformis, hamstrings, quadriceps, hip adductors and abductors were applied. Strengthening exercises were applied for the development of strength, endurance and control of deep flexor muscles of the cervical spine, stabilizers of the glenohumeral joint and scapula, abdominals, spine extensors and hip extensors.<br>* Other names: Program based on stretching and strengthening exercises;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the qualitative postural assessment from the baseline | Qualitative postural assessment was performed by a physiotherapist through the photographic records. The photos were recorded with the students in swimsuits and no shoes. The subject was positioned over the gyratory platform to avoid reposition for the photographic record, besides the plumb line, with the feet lined and separated by hip width. The records were performed in the frontal and sagittal planes, in the anterior, posterior and lateral view. According to the positioning of the structures in relation to the plumb line, the presence of postural changes was classified by the physiotherapist. Lateral tilt and forward head, shoulder protrusion, cervical lordosis, thoracic kyphosis, and lumbar lordosis were evaluated. | Two time points: baseline and 9 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the quantitative postural assessment from the baseline | Postural Assessment Software (PAS/SAPo) was used to quantitatively assess posture. Reflective markers were placed by a trained physiotherapist on the anatomical landmarks of the subject. The subject was positioned over the gyratory platform, and photographic records were performed in the frontal and sagittal planes, in the anterior, posterior and lateral view. The analysis followed the guidelines of PAS/SAPo. The photos were aligned and calibrated. The reflective markers were identified and the protocol of measures of the PAS/SAPo was used, providing the following parameters: horizontal alignment of the acromions, horizontal alignment of the ASIS, angle between acromions and ASIS, vertical alignment of the trunk, horizontal alignment of the pelvis, horizontal alignment of the head, vertical alignment of the head. | Two time points: baseline and 9 weeks | 
| Changes in trunk range of motion from baseline | A photogrammetric technique was used to measure the trunk flexion angle. This angle is formed between the line joining the markers attached on anterior superior iliac spine (ASIS) and greater trochanter and the line joining the marker fixed on the spinous process of the C7 vertebra and the one fixed on the ASIS. Two photographs were recorded; one in the upright position and the other in maximum trunk flexion. The trunk mobility was estimated by the difference between the values obtained in the two photographs. This procedure was performed in PAS/SAPo software. | Two time points: baseline and 9 weeks | 
| Changes in the prevalence of musculoskeletal pain from baseline | The presence of pain was evaluated by self-report. The Nordic Questionnaire of Musculoskeletal Symptoms body map was used to provide pain localization and data from musculoskeletal pain during the last 7 days. The pain intensity was also investigated by asking to the children about their pain in a 11-point scale, in which 0 is lack of pain and 10 is the greatest pain that the children had ever experienced. | Two time points: baseline and 9 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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posture, child, prevention, muscle strength, muscle stretching exercises, exercise therapy, disease management, musculoskeletal pain, adolescent, spinal curvatures