Sedentary behavior and neck pain in children and adolescents; a systematic review and meta-analysis

Managing pediatric metabolic syndrome: a systematic review of current approaches

BACKGROUND

There are various pharmacological and non-pharmacological approaches in the management and treatment of metabolic syndrome (MetS). We aimed to systematically review the effect of different approaches in the management of pediatric MetS.

METHODS

A systematic search was conducted in Medline, Scopus, Embase, Web of Science, and Google Scholar up to April 15, 2025. All interventional that had assessed the effects of lifestyle modifications in terms of changes in dietary habits, increased physical activity, and pharmacological interventions in the management of pediatrics MetS were included.

RESULTS

Among 1701 records found in the databases, 31 articles were included. Lifestyle modification, physical exercise, and dietary habits alteration were the commonest effective approaches in modulating MetS. The Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets improved the metabolic profile of MetS and reduced its prevalence. Metformin was the most frequently prescribed medication that was prescribed for pediatric MetS. However, its efficacy alone in comparison to lifestyle modifications remains to be determined. The effect of omega-3 supplements on the metabolic profile of MetS cases was inconsistent, but vitamin D supplementation was shown to have some favorable effects. Natural products such as fermented camel milk, grape juice, and pomegranate juice did not show any significant improvement in pediatric MetS.

CONCLUSION

Multidisciplinary lifestyle modification is considered the first recommendation for the prevention and management of MetS in childhood. Metformin can be an effective adjuvant therapy to lifestyle modifications in some cases of MetS, especially in children with other comorbidities.

TRIAL CODE

CRD42024502835.

Screen-based sedentary behavior, physical activity, and the risk of chronic spinal pain: a cross-sectional and cohort study

BACKGROUND

Sedentary behavior (SB) is associated with chronic musculoskeletal pain, but limited evidence exists about its impact on chronic spinal pain (CSP).

AIM

This study aims to explore the relationship between SB, physical activity, and the risk of CSP.

DESIGN

Cross-sectional and cohort study design.

SETTING

United Kingdom (UK).

POPULATION

We included 481872 data collected between 2006 and 2010 for cross-sectional analysis and 45,096 data with the longest follow-up up to 2019 for longitudinal analysis of data from the UK.

METHODS

Screen-based SB was defined as self-reported television (TV) viewing time, computer usage time, and total screen time. CSP was characterized as self-reported neck/shoulder or back pain for more than 3 months.

RESULTS

Cross-sectional analyses suggested that screen-based SB is associated with a high risk of chronic neck/shoulder (OR [95%CI]=1.43 [1.31 to 1.57]) and back pain (OR [95%CI]=1.39 [1.28 to 1.52]). The longitudinal analysis showed that an increase of 1 h in daily screen-based SB was correlated with chronic back pain risk (RR [95% CI]=1.05 [1.03 to 1.07]). Replacing an equivalent amount of TV viewing time with 1 h of walking per day exhibited a connection with a lower potential for chronic neck/shoulder pain (4.82% reduction) and chronic back pain (5.26% reduction). Even replacing 10 min of TV viewing time with 10 min of physical activity demonstrated a similar trend.

CONCLUSIONS

Daily screen-based SB is associated with CSP, but a causal relationship cannot be established. Replacing sedentary TV time with 10 minutes of physical activity per day shows potential benefits for CSP.

CLINICAL REHABILITATION IMPACT

The public should be encouraged to reduce screen-based sedentary behavior and increase physical activity to mitigate the risk of chronic spinal pain.

Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis

OBJECTIVE

To evaluate whether sedentary behaviour is a risk or prognostic factor for spinal pain in children and adolescents. Specifically, to estimate the (1) direction and strength of the association; (2) risk of spinal pain onset and (3) effect on spinal pain prognosis.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Electronic searches of MEDLINE, Embase, CINAHL and Web of Science up to 23 March 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Reports estimating the effect of sedentary behaviour on spinal pain in young people (≤19 years).

RESULTS

We included 129 reports, 14 were longitudinal (n = 8 433) and 115 were cross-sectional (n > 697 590). We incorporated 86 studies into meta-analyses. (1) From cross-sectional data, we found low certainty evidence of a small positive association between sedentary behaviour and spinal pain (adjusted odds ratio 1.25 (95% CI 1.17 to 1.33), k = 44, n > 92 617). (2) From longitudinal data, we found low certainty evidence of no increased risk for the onset of spinal pain due to sedentary behaviour (adjusted risk ratio 1.07 (95% CI 0.84 to 1.35), k = 4, n = 1 292). (3) No studies assessed prognosis.

CONCLUSION

Cross-sectional data suggest minimally higher odds of spinal pain for children and adolescents who engage in greater sedentary behaviours. However, longitudinal data do not support a causal relationship, indicating that sedentary behaviour does not increase the risk for onset of spinal pain. Due to the low certainty of evidence, these findings must be interpreted with caution. We found no evidence of the effect sedentary behaviour has on spinal pain prognosis in children and adolescents, highlighting a considerable gap in the literature.

Magnitude, temporal trend and inequality in burden of neck pain: an analysis of the Global Burden of Disease Study 2019

BACKGROUND

This study aimed to comprehensively assess the magnitude, temporal trends, and inequalities associated with socioeconomic development in neck pain (NP) based on the Global Burden of Disease Study 2019.

METHODS

An assessment of incidence and years of life with disability (YLD) at the global, regional, and country levels by age, sex and year was conducted for NP. Joinpoint regression (JPR) was used to analyze trends between 1990 and 2019. Decomposition analysis was used to explore the extent to which population growth, aging, and epidemiological changes influenced the changes in incidence and YLD. A Bayesian Age-Period-Cohort (BAPC) model was constructed to predict trends over the next 25 years. Concentration curve and concentration index were used to examine the cross-country relative inequality of the burden of NP at the socio-demographic index (SDI) level.

RESULTS

In 2019, the global ASIR and ASDR of NP were 579.085 and 267.348 per 100,000 individuals, respectively. JPR analysis showed that the global ASIR and ASDR have decreased slightly over the past 30 years, although an increase was observed between 2011 and 2019. The BAPC model predicted that this upward trend would continue over the next 25 years. Decomposition analysis showed that the global increase in incidence and YLD in 2019 compared to 1990 was mainly driven by population growth. The burden of NP was higher in the middle-aged, old-age, and female groups, with differences in regional distribution. The analysis of cross-country inequality showed that the burden of NP was disproportionately concentrated in countries with a high SDI, and this phenomenon continued to increase over the 30-year study period.

CONCLUSIONS

Globally, NP remains an important public health problem, and governments are urgently required to raise public awareness about NP and its risk factors, implement targeted prevention and control policies, and deliver the necessary health services.

The associations between sedentary behavior and neck pain: a systematic review and meta-analysis

BACKGROUND

This study aimed to systematically evaluate the associations between sedentary behavior (SB) in daily life and the risk of neck pain (NP), and to investigate the dose-response relationships between these variables across different populations, including variations in age, sex, occupation, and lifestyle practices.

METHODS

We conducted a systematic literature search of PubMed, Web of Science, Scopus, and Embase for cross-sectional, cohort and case-control studies examining the association between SB and NP risk. The National Institute of Health (NIH) quality assessment tool was utilized to evaluate study quality. Odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs) were used to assess the association between SB and NP. Due to significant heterogeneity among the studies, a random-effects model was employed for the meta-analysis to obtain pooled estimates.

RESULTS

A total of 25 studies with 43,184 participants met the eligibility criteria. Overall, the meta-analysis revealed a significant relationship between SB and NP (OR = 1.46, 95%CI: 1.33, 1.60). Subgroup analyses revealed that the risk of NP was greater in female (OR = 1.43, 95%CI: 1.22, 1.67) than in male (OR = 1.13, 95%CI: 1.01, 1.27) and was greater in employees (OR = 1.97, 95%CI: 1.70, 2.28) than in students (OR = 1.26, 95%CI: 1.15, 1.39). Among screen-based SB, using mobile phones conferred the greatest risk of NP (OR = 1.82, 95%CI: 1.27, 2.61), followed by using computers (OR = 1.23, 95%CI: 1.08, 1.40), whereas watching TV was not a significant risk (OR = 1.20, 95%CI: 0.99, 1.44). Moreover, SB ≥ 4 h per day (h/d) increased the risk of NP (OR = 1.60, 95%CI: 1.38, 1.87), and the risk further increased with SB ≥ 6 h/d (OR = 1.88, 95%CI: 1.42, 2.48). The risk of NP increased with a screen-based SB dose ≥ 1 h/d (OR = 1.28, 95%CI: 1.17, 1.44), ≥ 2 h/d (OR = 1.35, 95%CI: 1.18, 1.55), and ≥ 4 h/d (OR = 1.45, 95%CI: 1.26, 1.67).

CONCLUSION

SB is a notable risk factor for NP, with the risk escalating with longer durations of sedentary time. Targeted preventative measures, particularly for high-risk groups like female and employees, are necessary. Public health initiatives should encourage the reduction of sedentary behaviors and the promotion of physical activity to enhance neck health and alleviate the global prevalence of NP.

Establishing consensus on biopsychosocial factors associated with pediatric chronic pain: A modified Delphi study

A variety of factors are associated with the development and maintenance of chronic pain in children. Identifying modifiable factors associated with pediatric chronic pain is important to use them as target outcomes in the development and evaluation of interventions for the prevention and management of chronic pain. This study aimed to reach expert consensus on factors associated with pediatric chronic pain and their modifiability and population-level effect. Pediatric pain experts were questioned using a web-based two-round modified Delphi method. Two rounds of questions with Likert scaling were used to identify influencing factors (Round 1) and to reach consensus on each factor (Round 2) in terms of: 1) strength of association with chronic pain in children; 2) modifiability; and 3) population-level effect. An inductive approach was used to derive categories (ranging from 'very low' to 'very high') and subcategories (ranging from 'low' to 'high'). In total, 48 experts from 14 different countries completed Round 1, and 31 completed Round 2. A list of 47 factors was considered to be associated with pediatric chronic pain. Four factors (physical activity (PA), sedentary behavior (SB), pain-related school absence, and pain concept/knowledge of the child) were considered highly modifiable and three factors having a high population-level effect (PA, SB, and the child's depressive or negative emotional feelings). Expert consensus was established about modifiable and population-level factors associated with pediatric chronic pain through this web-based modified Delphi study, guiding target outcomes for its prevention and management. PERSPECTIVE: This article presents the results of a modified Delphi study with pediatric pain experts to gain consensus on factors associated with pediatric chronic pain. Relationship strength, modifiability, and population-level effect of associated factors were rated to identify areas of research priority and interventions aiming to reduce the development and maintenance of chronic pain in children.

Effects of flexible learning spaces, active breaks, and active lessons on sedentary behaviors, physical activity, learning, and musculoskeletal health in school-aged children: a scoping review

BACKGROUND

Children aged 6 to 17 spend long periods of sitting at school. Reducing these behaviors and increasing physical activity has been linked to improvements in cognitive functions and decreased musculoskeletal issues. The purpose of this scoping review was to describe interventions implementing flexible learning spaces, active breaks, and active lessons and their effects on sedentary behaviors as well as on physical activity, learning, and musculoskeletal health.

METHODS

A search on databases (EDUCATION SOURCE, ERIC, SPORTDISCUS, MEDLINE, EMBASE, and WEB OF SCIENCE) was carried out in April 2021 and updated in June 2022 according to the guidelines of the "PRISMA-ScR". Studies on flexible learning spaces and physical activity in elementary and secondary school classes were retained. These also had to measure the effects of the interventions on sedentary behaviors, physical activity, learning (e.g., academic achievement), and musculoskeletal health outcomes.

RESULTS

Ninety-two articles were identified; twenty-four from the initial screening, thirty-two from the update, and thirty-six were manually included. Among these 92 articles, twenty-one studies used only flexible learning spaces, twenty-three used only active breaks, thirty-six used only active lessons, four used both flexible learning spaces and active breaks separately in different classes, five combined active breaks and active lessons, and three combined flexible learning spaces and active breaks. Analyses show positive changes in sedentary behaviors (32 articles/40) and physical activity (52 articles/74) including sitting time, sit-to-stand transitions, number of steps, and moderate-to-vigorous physical activity. Positive effects were also observed on learning (13 articles/26) or musculoskeletal health outcomes (3 articles/8). Although many studies found no effect of these interventions, no studies report harmful interventions on these variables. The most effective strategy to reduce sedentary behaviors seems to be flexible learning spaces with adapted teaching approaches.

CONCLUSIONS

Results indicate that flexible learning spaces, active breaks, and active lessons effectively reduce sedentary behaviors and increase physical activity without negatively influencing academic achievement. Further studies are needed to understand better the effects of combining these interventions and their effects on children's learning and musculoskeletal health outcomes.

The lasting influence of parenting intervention on child behavior: findings from a randomized clinical trial using care for child development guidelines

BACKGROUND

Studies have investigated the role of different parenting intervention programs in the early development of children. Here we aimed to determine the long-term efficacy of Care for Child Development (CCD) guideline interventions on behavioral dimensions of children's development.

METHODS

This randomized clinical trial took place at an outpatient public Pediatrics clinic in Isfahan, Iran from February 2020 to May 2024. Pregnant women between the ages of 18 and 45 in their third trimester were included in the study, and their children were followed for 48 months. The intervention group participated in 5 educational group sessions, each session lasting approximately 45 min. The control group underwent routine education on childcare, as suggested by WHO. The main outcome was the children's socio-emotional behavior problems using the Children Behavior Checklist (CBCL) at 18, 36, and 48 months. The comparisons between groups were done using independent two-sample t-tests, or the Mann-Whitney test and the Chi-square test. Statistical software SPSS 22 was utilized for data analysis.

RESULTS

Finally, the data of 166 participants (70 in the intervention group and 96 in the control group) were included in the current study. The adjusted mean differences between the intervention and control groups significantly differed in some scales after follow-up. After 36 months of follow-up, the scores in the following aspects were significantly lower in the intervention group: emotional problems, anxiety, seclusion problems, sleep disorders, aggressive behavior, and the total problem. After 48 months, only sleep problems were significantly lower in the intervention group.

CONCLUSION

According to the results of this intervention, delivering parenting interventions through group sessions according to the CCD recommendation indicated weak efficacy during long-term follow-ups. Further trials are needed to assess the effects of these programs on parents.

TRIAL REGISTRATION

IRCT20190128042533N2, Date of Registration: 16 January 2020, www.irct.ir .

Assessing the Impact of Smartphone Use on Neck Pain and Related Symptoms Among Residents in Jeddah, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

The widespread adoption of smartphones has transformed global communication but raised health concerns like Text Neck Syndrome - a musculoskeletal condition arising from prolonged device use, causing discomfort in the cervical spine. This study investigates its prevalence and associated factors among smartphone users in Jeddah, Saudi Arabia, focusing on usage patterns, symptoms, and awareness.

METHODS

This cross-sectional online survey was conducted from June 1 to June 30, 2024. Data on demographics, smartphone habits, symptoms, and Text Neck Syndrome awareness were collected using a structured questionnaire. Statistical analysis involved descriptive statistics and chi-square tests.

RESULTS

The study included 421 participants, predominantly female (279, 66.3%) and Saudi nationals (397, 94.3%). The largest age group was 21-40 years (308, 73.2%), and most were single (251, 59.6%) with a college degree (236, 56.1%). Over 42.0% of participants used smartphones for more than five hours daily, with 39.4% adopting a 30-degree neck posture. The most prevalent symptoms reported were neck pain (272, 64.6%), headaches (203, 48.2%), and shoulder pain (178, 42.3%). Awareness of Text Neck Syndrome was reported by 197 participants (46.8%), but only 60 (14.3%) had been diagnosed. Concerns about long-term complications such as osteoporosis (105, 24.9%) and prolapsed intervertebral disc (120, 28.5%) were expressed. Despite these concerns, 97.9% of participants hesitated to reduce smartphone usage due to reported symptoms.

CONCLUSION

This study highlights the significant musculoskeletal impact of smartphone use in Jeddah, underscoring the need for interventions promoting ergonomic practices and increasing awareness about associated risks. Public health strategies should focus on promoting ergonomic practices and educating users about preventive measures.

Associations between exposure to common technology devices and reported neck pain among Iranian school-age adolescents: a cross sectional study

BACKGROUND

The advancement of technology has contributed to a more sedentary lifestyle, and the extensive use of handheld devices among adolescents may potentially result in neck pain. This study aimed to assess the association between exposure to common technology devices and self-reported neck pain in Iranian school-age adolescents.

METHODS

This cross-sectional study was conducted between June and October 2021, employing a randomized multi-stage cluster sampling approach. We enrolled 808 adolescent students aged 11 to 19 years old. We asked participants about any neck pain they experienced in the week leading up to the study. Additionally, we gathered demographic information and assessed participants' use of electronic devices using a questionnaire.

RESULTS

Our study comprised 73.5% female participants with an average age of 15.1 ± 1.7 years and 26.5% male participants with an average age of 14.5 ± 1.5 years. In the regression model, the female gender (p = 0.038), using mobile for more than 6 h (p = 0.04), and using electronic devices while sitting on the floor (p = 0.02) were associated with a higher prevalence of neck pain among participants.

CONCLUSION

In our study, we observed a relatively high prevalence of neck pain, which was linked to extended daily mobile phone usage and body posture during electronic device use. Policymakers may consider interventions aimed at reducing mobile phone usage and promoting proper body posture while using electronic devices as potential strategies to alleviate the burden of neck pain among Iranian adolescents.

Screen Time and Its Health Consequences in Children and Adolescents

Nowadays, children and adolescents are exposed to digital media (DM) from an early age. Therefore, specific guidelines have been published by the World Health Organization, whose aim is to limit daily screen time (ST) viewing. However, during the COVID-19 pandemic, a rise in DM use, and consequently ST viewing, was observed. More and more aspects of modern life are thought to be affected by excessive ST viewing. Accordingly, the aim of this review is to document the health effects of excessive ST viewing on children and adolescents. A narrative review was performed in searchable databases. In total, 43 original articles were considered. Excessive ST viewing was correlated with increased risk for obesity and other cardiometabolic risk factors, mental health, unhealthy dietary habits and eating disorders, and problems in development and child-parent relationships. Sleep, physical activity, eyesight, headaches, and the musculoskeletal system were negatively affected as well. However, the effect of ST was weighted by the type of media used and the way types of media were used. Other confounding factors were reported. There is evidence to suggest a negative correlation between excessive ST and youth health exists. Nevertheless, more research is needed if this correlation is to be established.

Sedentary behavior and neck pain in adults: A systematic review and meta-analysis

Sedentary lifestyle is an imperative risk for musculoskeletal pain. We sought to investigate the association between different types of sedentary behaviors (SBs) and neck pain (NP) among adults. A systematic search was conducted in PubMed, Web of Science, Embase, Scopus, and Google Scholar up to the end of April 2023. The odds ratio (95% CI) was considered as the desired effect size for the association between SBs and the NP. Among 1881 records found by primary search, 46, and 27 reports were included in the qualitative and quantitative analysis respectively. All included studies qualified as good or fair. Our results indicated that SB is a risk factor for NP among adults (OR = 1.5, [1.29, 1.76]). Computer and mobile phone use were also found to be considerable risk factors for NP (OR = 1.3, [1.12, 1.53], and OR = 2.11, [1.32, 3.42] respectively). However, sitting time showed an insignificant association with NP (OR = 1.33, [0.86, 2.07]). Subgroup analysis revealed that SBs are a significant risk factor for NP among university students (OR = 1.58, [1.27, 1.97]), but the association among office workers was marginally insignificant (OR = 1.36, [0.98, 1.89]). According to the meta-regression results, the male gender was found to increase the risk of NP. Meanwhile, Egger's test revealed the presence of publication bias (p-value <0.0001). A sedentary lifestyle as well as computer and mobile phone use is associated with a considerable risk of NP among adults, especially university students. Further, longitudinal studies are needed to better clarify the causality relationships.

Determinants of cervical spine disorders in military pilots: a systematic review

BACKGROUND

Neck pain and cervical spine disorders are widespread among military cockpit aircrew pilots and are often recognized as occupational stressors.

AIMS

This systematic review aimed to identify significant determinants for military pilot neck pain and cervical spine disorders determined through multivariable logistic regression studies.

METHODS

This systematic review was conducted according to the recommendations of the Statement of Systematic Review and Meta-analysis Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA]-P). The following databases were searched for literature: Medline and Embase. We included studies that studied neck pain, cervical spine disorders, and/or radiological abnormalities and associated exposures (adjusted odds ratios, ORadj) in military cockpit aircrew. The trustworthiness, relevance and results of the published papers were evaluated using the Joanna Briggs Institute critical checklist.

RESULTS

A total of three studies quantified the strength of the correlations between exposures and outcomes. Significant determinants/risk factors of neck pain, cervical spine disorders and radiological abnormalities were identified as age (ORadj: 1.092 [95% CI 1.054, 1.132]), fighter type (ORadj: 3.9 [95% CI 1.1, 13.9]) and absolute rotation angle of C2-7 (ARA) (ORadj: 0.91 [CI 0.85, 0.98]). The following variables were unable to demonstrate statistical significance: flying hours, body height and body mass index.

CONCLUSIONS

Military cockpit aircrew's frequent neck pain after a flight raises concerns about cervical spine disorders. Age, fighter type and ARA C2-7 are strong predictors of neck pain and cervical spine disorders. More research is needed on occupational determinants and risk factors for neck pain and cervical spine disorders in military cockpit aircrew.