Spinal pain is prospectively associated with cardiovascular risk factors in girls but not boys (CHAMPS study-DK)

Associations between cardiovascular disease risk factors and spinal pain may be moderated by sex and health-related physical activity (CHAMPS Study-DK)

BACKGROUND

Spinal pain has been previously linked with cardiovascular disease risk factors in children. This study investigated the prospective associations between cardiovascular disease risk factors and non-traumatic spinal pain occurrences in children, and examined the moderating role of sex and health-related physical activity in these relationships.

METHODS

We used prospective data from the Childhood Health, Activity, and Motor Performance School Study Denmark (CHAMPS Study-DK). The exposure variables were a clustered cardiovascular risk score and homeostasis assessment model-estimated insulin resistance (HOMA-IR) score collected in 2008 and 2010. The spinal pain outcome comprised the number of weeks of non-traumatic spinal pain from 2008-2010 and 2010-2012. Potential confounders included age, sex, and time spent in moderate-to-vigorous intensity physical activity. We constructed age-adjusted mixed negative binominal regression models to investigate the prospective associations of cardiovascular disease risk factors and non-traumatic spinal pain, while considering the potential moderating roles of sex and physical activity in these relationships.

RESULTS

Girls with low HOMA-IR scores and boys with low clustered cardiovascular disease risk scores, who engaged in higher levels of moderate-to-vigorous physical activity, reported more weeks of spinal pain, compared to girls with high HOMA-IR scores (p = 0.001) and boys with high clustered cardiovascular disease risk scores (p = 0.024). whereas boys with higher clustered cardiovascular disease risk who had less time in moderate-to-vigorous physical activity reported more weeks of spinal pain than boys with low clustered cardiovascular disease risk score (p = 0.024).

CONCLUSION

Our results show that cardiovascular disease risk factors are related to future occurrences of non-traumatic spinal pain. However, these relationships appear complex and dependent on the nature of the interactions with sex and physical activity.

Motor performance and back pain in children and adolescents: A systematic review

BACKGROUND AND OBJECTIVE

Motor performance during childhood and adolescence is recognized as a relevant determinant of present and future health, but its effects on back pain (BP) remain unclear. In this systematic review, we aimed to identify the association between motor performance and BP in children and adolescents.

DATABASES AND DATA TREATMENT

A literature search was performed in the MEDLINE, Scopus, Embase, SPORTDiscus and CINAHL databases. We included cross-sectional, cohort, case-control and controlled clinical trials (data from control groups). The inclusion criteria were as follows: (a) participants aged 6-19 years; (b) assessment motor performance components; (c) assessment of BP and (d) reported measures of association. The risk of bias was assessed by the Downs and Black instrument and the quality of evidence by the grading of recommendations, assessment, development and evaluation (GRADE).

RESULTS

A total of 2360 articles were identified, 25 of which were included in our systematic review. Of the 25 studies, 19 were evaluated as having a low risk of bias. GRADE indicated that 20 studies presented low or very low quality. Most of the studies evaluated flexibility (n = 16), muscle endurance (n = 18) and muscle strength (n = 9). Aerobic capacity, balance and speed were also examined in some studies (n < 5). Overall, motor performance (flexibility, muscle endurance, muscle strength, aerobic capacity, balance and speed) was not associated with BP. Most of the results were inconsistent because of the lack of studies, risk of bias and low quality of evidence. Only trunk extensor muscle endurance was associated with decreased BP with moderate quality of the supporting evidence. Prospective studies with a low risk of bias are warranted to further clarify this relationship in childhood and adolescence and findings may support more targeted and effective health promotion interventions.

SIGNIFICANCE

This systematic review shows that motor performance (flexibility, muscle endurance, muscle strength, aerobic capacity, balance and speed) was not associated with BP in children and adolescents. Most of the results were inconsistent because of the lack of studies, risk of bias and low quality of evidence. Only trunk extensor muscle endurance was associated with decreased BP with moderate quality of supporting evidence.

Motor performance and back pain in children and adolescents: a systematic review and meta-analysis protocol

BACKGROUND

The relationship between motor performance and back pain in children and adolescents remains unclear. This article describes the protocol for a systematic review to summarize the knowledge about the association between motor performance, such as agility, flexibility, balance, strength, muscle endurance, and cardiorespiratory fitness, and back pain. Thus, our aim is to identify the influence of motor performance on back pain among children and adolescents.

METHODS

Two independent researchers will search MEDLINE, Scopus, Embase, SPORTDiscus, and CINAHL databases, with no period or language restrictions. We will include cross-sectional, cohort, case-control, and controlled clinical trial studies based on the following criteria: (a) participants from 6 to 19 years of age, (b) assessment of motor performance, (c) assessment of back pain, and (d) report measures of associations between motor performance and back pain. Study quality and risk of bias will be assessed using an adapted version of the Downs and Black instrument. Grading of Recommendations, Assessment, Development, and Evaluations will be used to assess the strength of the body of evidence. Meta-analyses of association measures will be performed for each type of motor performance, separately for different study types. The results will be reported using forest to show the pooled effect of findings and funnel plots to assess precision of the data. If studies are not homogeneous, results from the meta-analyses will not be reported. Associations will then be synthesized descriptively using a pragmatic approach.

DISCUSSION

This systematic review will provide critical insights into the association between motor performance and back pain among children and adolescents; this information may help support clinical practice guidelines as well as public health programs.

ETHICS AND DISSEMINATION

Protocol was written according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020178496.

Spinal pain is prospectively associated with cardiovascular risk factors in girls but not boys (CHAMPS study-DK)

PURPOSE

To examine the prospective associations between spinal pain exposures and risk factors for cardiovascular disease in children and explore the mediating role of health-related physical activity.

METHODS

Students were recruited from ten public primary schools. Each week from November 2008 to October 2010, parents reported spinal pain occurrences in their children via text messaging. Clustered cardiovascular risk was estimated with a composite score comprising fasting serum triglycerides, homeostasis assessment model-estimated insulin resistance (HOMA-IR), total to high-density lipoprotein cholesterol ratio, and systolic blood pressure. Additional outcomes were fasting serum insulin and glucose concentrations and body mass index categories. Associations were explored with multilevel mixed regression models and reported with beta coefficients (β) and percent difference scores. All models were adjusted for potential confounders.

RESULTS

Data from 1022 children (53% female) with mean ± SD age of 8.4 ± 1.4 years were included. Girls with spinal pain had greater clustered cardiovascular risk (β [95% CI]; percent difference [95% CI] = .41 [.02-.80]; 3.3% [.2-6.4%]) than those without spinal pain. Similar outcomes were observed for log insulin (percent difference [95% CI] = 3.4% [.6-6.2%]) and log HOMA-IR = (percent difference [95% CI] = 3.8% [.4-7.3%]). Remaining associations between spinal pain and cardiovascular risk in girls were nonsignificant. There were no associations between spinal pain and cardiovascular risk in boys. Moderate-to-vigorous-intensity physical activity did not appear to mediate this relationship.

CONCLUSION

These findings suggest a potentially important link between spinal pain and cardiovascular risk in girls that may be independent of health-related physical activity. These slides can be retrieved under Electronic Supplementary Material.