High prevalence of inadequate sitting and sleeping postures: a three-year prospective study of adolescents

Exercise Selection and Common Injuries in Fitness Centers: A Systematic Integrative Review and Practical Recommendations

Weight resistance training (RT) is an essential component of physical conditioning programs to improve the quality of life and physical fitness in different ages and populations. This integrative review aimed to analyze the scientific evidence on the relationship between exercise selection and the appearance of musculoskeletal injuries in physical fitness centers (PFC). The PubMed or Medline, EMBASE or Science Direct, Google Scholar and PEDro databases were selected to examine the available literature using a Boolean algorithm with search terms. The review process was performed using the five-stage approach for an integrative review and it was reported according to the PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSiST) guidelines. A total of 39 peer-reviewed articles (Price index = 71.7%) met the inclusion criteria and evaluated the link between exercise selection and the incidence of injuries in exercisers who regularly attend PFC. Most injuries occur to the shoulders, elbows, vertebrae of the spine, and knees. Although the injury etiologies are multifactorial, the findings of the reviewed articles include the impacts of overuse, short post-exercise recovery periods, poor conditioning in the exercised body areas, frequent use of heavy loads, improper technique in certain exercises, and the abuse of performance- and image-enhancing drugs. Practical recommendations addressed to clinical exercise physiologists, exercise professionals, and health professionals are given in this paper. The exercise selection in RT programs requires professional supervision and adhering to proper lifting techniques and training habits that consider the anatomical and biomechanical patterns of the musculoskeletal structures, as well as genetic, pedagogical, and methodological aspects directly related to the stimulus-response process to mitigate the occurrence of RT-related injuries in PFC.

Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA): Expansion, Content Validation, and Reliability

The Back Pain and Body Posture Evaluation Instrument (BackPEI) was created in 2013 to assess back pain and its risk factors in school children. However, it does not assess neck pain or the habits of mobile device usage, which are aspects that are often part of school children’s lives. Therefore, we aimed to update the BackPEI questionnaire to include new questions assessing aspects related to neck pain and the use of mobile devices and to test the content validity and reliability of the new questions. The updated questionnaire was named Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA). The content was validated by eight experts using the content validity index (CVI). To assess reliability, the BackPEI-CA questionnaire was applied at two different times in 105 school children, and Cohen’s kappa (k) and intraclass correlation coefficient (ICC) were calculated. All aspects assessed regarding content validity had a CVI higher than 0.8. The new questions presented moderate and good kappa values and excellent ICC values. The updated version of BackPEI-CA can be used as a clinic tool for assessing the presence, frequency, and intensity of back and neck pain and their risk factors.

Incidence and factors associated with low back pain in adolescents: A prospective study

BACKGROUND

Low back pain (LBP) is a common complaint among children and adolescents and can negatively impact their physical and mental health. Although previous studies investigating the incidence of low back pain (LBP) in children and adolescents have been performed in high income countries, it is unclear whether countries such as Brazil would show similar incidence rates.

OBJECTIVE

To determine the incidence and to identify predictors of new episodes of LBP in high school students.

METHODS

This is a 1-year longitudinal study of high school students from public schools in the city of Bauru, Sao Paulo. Collected clinical data were: demographic and socioeconomic factors, information on the use of electronic devices, mental health status (the Strengths and Difficulties Questionnaires), level of habitual physical activity (Baecke Physical Activity Questionnaire), and incidence of LBP (measured with question about LBP in the past 12 months and the Nordic Musculoskeletal Questionnaire). Descriptive analysis and bivariate and multivariate logistic regressions were performed.

RESULTS

The cumulative incidence of new LBP episodes for the total cohort of 757 high school students was 18.9% (95% CI: 16.2, 21.8). The cumulative incidence was 14.8% (95% CI: 11.7, 18.5) for male students and 24.1% (95% CI: 19.8, 29.9) for female students. Being a female student (OR = 1.78; 95% CI: 1.23, 2.59), sitting posture while using tablet (OR = 4.34; 95% CI: 1.19, 16.60), daily time spent on tablet (OR = 3.21; 95% CI: 1.41, 7.30), daily time spent on mobile phone (OR =1.49; 95% CI: 1.11, 2.00), lying posture while using mobile phone (OR = 1.49; 95% CI: 1.05, 2.12), and mental health status (OR = 2.81; 95% CI: 1.76, 4.48) were identified as predictor variables.

CONCLUSION

Our findings showed that one in five high school students reported having a LBP episode over the last year. The predictors found to be associated with low back pain include those related to sex, time and posture while using electronic devices, and mental health status.

Effect of 9-month Pilates program on sagittal spinal curvatures and hamstring extensibility in adolescents: randomised controlled trial

The percentage of spine misalignment increases during the childhood and adolescence stages. The Pilates method has been associated with an improvement in the sagittal spine disposition, but no studies have been conducted on adolescents. Therefore, the present study aimed to evaluate the effectiveness of a 9-month Pilates exercise program (PEP) on hamstring extensibility and sagittal spinal curvatures on adolescents. This randomised controlled trial included 236 adolescents. The experimental group (EG) received a PEP (9 months, 2 sessions/week, 15 minutes/session). The control group (CG) did not receive any intervention. Hamstring extensibility was measured with the passive and active straight leg raise and toe-touch tests. Sagittal spinal curvatures and pelvic tilt was assessed in relaxed standing, active alignment and toe-touch test positions. The EG had significant changes in hamstring extensibility, lumbar curvature and pelvic tilt in standing sagittal curvature. The CG became significantly worse in thoracic kyphosis in standing. This study provides evidence of nine-months of a PEP increased the hamstring extensibility; averted the increase of the thoracic curvature, and decreased the curvature of the lumbar lordosis and pelvic tilt in standing position; avoided a greater increase of thoracic curvature in active alignment in standing position; and avoided the increase of thoracic curvature in trunk flexion.

Relationship between seat surface shape and pressure distribution in school seat models

BACKGROUND

Students remain in a sedentary position inside classrooms for 60% to 80% of their school day. As such, research has associated students' prolonged seated posture on school furniture with their discomfort and musculoskeletal pain. The correlation between the shape of the seat surface and the zones of the body making contact with these surfaces constitutes an essential factor in determining comfort-enhancing seat design.

OBJECTIVE

This study's primary aim lies in contrasting the standard, current school chair against two seat prototypes, both designed and built from digital models, comparing seat-user pressure distribution and contact area during students' performance of different school tasks.

METHODS

Participants (n = 13), ages 7 to 19, performed school tasks sitting on three different chairs' seat surfaces during the test: the current seat used in schools and two seat prototypes, each designed based on body anatomy. The seats were evaluated through a force-sensing array pressure-mapping system.

RESULTS

The measurements from designed seat prototypes provide a better distribution of pressures and greater contact area with the students' anatomical areas (buttocks and thighs) than the seat currently used in the specified schools. The improvement in pressure values and contact area as seen in the second designed seat prototype is due to its inclination angle and contact with students' sacral zone.

CONCLUSIONS

This research work found that a seat's shape based on human anatomical features (buttocks and thighs), compared to a completely flat seat, creates a higher reduction of body pressures and an increase in the body contact area, with the intent to increase comfort and reduce musculoskeletal pain.

Back pain and its risk factors in Brazilian adolescents: a longitudinal study

Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11-16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% (n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% (n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys (p = 0.002) and girls (p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.

Examining the validity and reliability of a portable sleep posture assessment protocol, using infrared cameras, under a variety of light and bed cover situations in the home environment

BACKGROUND

Spinal symptoms of pain and stiffness on waking have been linked to sleep posture. Sleep posture is commonly classified as supine, side lying and prone. It is clinically postulated that sleeping postures with sustained end of range rotation and extension may influence pain sensitive spinal tissues. However, the lack of a valid and reliable method of assessing sleep posture, means clinicians are unable to provide corrective advice based upon evidenced based research.

OBJECTIVE

To determine the validity and reliability of a sleep posture recording protocol in the home environment.

METHOD

Twenty health professionals viewed a pre-recorded video recording of randomised sleep postures under natural and infrared light situations, with a variety of bed coverings, to represent the habitual environment. Sleep postures were classified into six categories including two intermediate postures (supported side lying and provocative side lying). Viewing was repeated after two days.

RESULTS

Intra-and inter-rater reliability were excellent; Cohen's Kappa = .93 (95% CI 0.80 to 1.0) and Fleiss Kappa = 0.83 (95% CI 0.82 to 0.84) respectively. Validity, determined as concordance between the health professionals' classifications and the known postures, was also excellent Cohen's Kappa = .91 (95% CI 0.77 to 1.0).

CONCLUSIONS

Reliable and valid assessment of sleep posture, including intermediate postures, could be achieved using low cost, portable, infrared video recording equipment, under a variety of lighting conditions and a variety of bed cover situations typical of the home environment.

Implementation of Distracted Estimation System based on Sensor Fusion through Correlation Analysis with Concentration

Sitting for an extended time may cause a serious chronic disease such as a musculoskeletal disorder, or a cardiovascular disease, diabetes, or obesity. Because a consistently improper posture from early childhood to adolescence can have a number of undesirable effects on the formation of the musculoskeletal structure, learning to maintain a correct posture should be emphasized. A consistently improper posture can not only cause physical problems, it may also lead to emotional issues such as distractions, an attention deficit, and hyperactivity, and the possibility of a low efficiency and performance on assignments is high when the students have a low concentration. The present study implemented a distracted estimation system based on sensor fusion through correlation analysis with concentration that could estimate the level of distraction and prevent musculoskeletal diseases caused by poor sitting posture habits in daily life. The implemented system was designed in the form of a sitting cushion to reflect the ethological movements and characteristics of a sitting position that modern people spend a large amount of time in, and can be easily applied to existing chairs. Both algorithms installed in the system detected the center of gravity of the seated person and displayed positional changes that occurred based on the intensity of the postural changes when moving; thus, simultaneous determination of posture and impulsive behavior was possible. To evaluate the system performance, a posture determination evaluation was conducted, along with distraction estimation according to the rate of changes in posture that occur in everyday life. In addition, to evaluate performance in daily life, a movie-watching scenario was set up, and the distracted-limit estimation and concentration indices according to the rate of changes in posture were comparatively evaluated by reviewing a video of the subjects. The results of the posture determination performance evaluation through 100 posture repetitions on 10 subjects showed a high detection performance of 99.04%. The Pearson's correlation coefficient results showed a high correlation coefficient (inverse) of r = -0.975076 and a P-VALUE =   1.654 × 10 - 6 . This experiment objectively confirmed the correlation between the DLE Index (based on postural change) and the CI Index (based on EEG).