Associations of Sedentary Behavior, Physical Activity, Cardiorespiratory Fitness, and Body Fat Content With Pain Conditions in Children: The Physical Activity and Nutrition in Children Study

Lifestyle Factors Associated With Frequent Recurrent Headaches in Children and Adolescents: A Canadian Population-Based Study

BACKGROUND AND OBJECTIVES

Lifestyle behaviors have been postulated to affect headache frequency in youth and are often the primary target of self-management recommendations. Our study aimed to assess the association between various lifestyle factors and frequent recurrent headaches in children and youth.

METHODS

Children and adolescents aged 5-17 years were enrolled in a large cross-sectional Canadian population-based health survey, completed on January 31, 2019. Headache frequency was dichotomized into "approximately once/week or less" or ">once/week" (defined as frequent recurrent headaches). The association between frequent headaches and meal schedules, screen exposure, physical activity, chronotype, and frequent substance use/exposure (alcohol, cigarettes, electronic cigarettes, and cannabis) was assessed using both unadjusted logistic regression models and models adjusted for age/sex. Fully adjusted models examined the odds of frequent headaches according to all exposures. Survey design effects were accounted for using bootstrap replicate weighting.

RESULTS

There were an estimated nweighted = 4,978,370 eligible participants in the population. The mean age was 10.9 years (95% CI 10.9-11.0); 48.8% were female; 6.1% had frequent headaches. Frequent headaches were associated with older age (odds ratio [OR] = 1.31, 95% CI 1.28-1.34, p < 0.001) and female sex (OR = 2.39, 95% CI 2.08-2.75, p < 0.001). In models adjusted for age/sex, the odds of frequent headaches decreased with meal regularity (adjusted OR [aOR] = 0.90, 95% CI 0.89-0.92, p < 0.001) and increased with later chronotype (aOR = 1.10, 95% CI 1.05-1.15, p < 0.001) and excess screen exposure (≥21 hours vs none in past week: aOR = 2.97, 95% CI 1.53-5.77, p = 0.001); there was no significant association with reported physical activity (aOR = 0.95, 95% CI 0.67-1.34, p = 0.77). In 12- to 17-year-olds, frequent headaches were associated with frequent alcohol use (≥1/wk vs never: aOR = 3.50, 95% CI 2.18-5.62, p < 0.001), binge drinking (≥5 times in past month vs never: aOR = 5.52, 95% CI 2.95-10.32, p < 0.001), smoking cigarettes (daily vs never: aOR = 3.81, 95% CI 1.91-7.62, p < 0.001), using e-cigarettes (daily vs never: aOR = 3.10, 95% CI 2.29-4.20, p < 0.001), and cannabis use (daily vs never: aOR = 3.59, 95% CI 2.0-6.45, p < 0.001). In the entire sample, daily exposure to smoking inside the house was associated with frequent headaches (aOR = 2.00, 95% CI 1.23-3.27, p = 0.005).

DISCUSSION

Several lifestyle behaviors were associated with frequent headaches in children and youth, such as meal irregularity, late chronotype, prolonged screen exposure, and frequent substance use/exposure, suggesting that these are potential modifiable risk factors to target in this population.

Feasibility of wearable activity tracking devices to measure physical activity and sleep change among adolescents with chronic pain-a pilot nonrandomized treatment study

Purpose

Personal informatics devices are being used to measure engagement in health behaviors in adults with chronic pain and may be appropriate for adolescent use. The aim of this study was to evaluate the utilization of a wearable activity tracking device to measure physical activity and sleep among adolescents attending a three-week, intensive interdisciplinary pain treatment (IIPT) program. We also assessed changes in physical activity and sleep from baseline to the treatment phase.

Methods

Participants (57.1% female, average age 15.88, SD = 1.27) wore an activity tracking device three weeks prior to starting and during the treatment program.

Results

Of 129 participants contacted, 47 (36.4%) agreed to participate. However, only 30 (64%) complied with the instructions for using the device prior to programming and during program participation. Preliminary analyses comparing averages from 3-weeks pre-treatment to 3-weeks during treatment indicated increases in daily overall activity minutes, daily step counts, and minutes of moderate to vigorous physical activity (by 353%), as well as a corresponding decrease in sedentary minutes. There was more missing data for sleep than anticipated.

Conclusions

Wearable activity tracking devices can be successfully used to measure adolescent physical activity in-person, with more difficulty obtaining this information remotely. Adolescents with chronic pain experience improvements in objective measurements of physical activity over the course of a 3-week IIPT program. Future studies may want to spend more time working with pediatric patients on their understanding of how to use trackers for sleep and physical activity.

Associations between pain, health, and lifestyle factors in 10-year-old boys and girls from a Swedish birth cohort

BACKGROUND

Pain is common in children and its associations with various biopsychosocial factors is complex. Comprehensive pain assessments could contribute to a better understanding of pediatric pain, but these assessments are scarce in literature. The aim of this study was to examine differences in pain prevalence and pain patterns in 10-year-old boys and girls from a Swedish birth cohort and to study associations between pain, health-related quality of life and various lifestyle factors stratified by sex.

METHODS

866 children (426 boys and 440 girls) and their parents from the "Halland Health and Growth Study" participated in this cross-sectional study. Children were categorized into two pain groups, "infrequent pain" (never-monthly pain) or "frequent pain" (weekly-almost daily pain), based on a pain mannequin. Univariate logistic regression analyses, stratified by sex, were performed to study associations between frequent pain and children's self-reports of disease and disability and health-related quality of life (Kidscreen-27, five domains), and parents' reports of their child's sleep (quality and duration), physical activity time, sedentary time, and participation in organized physical activities.

RESULTS

The prevalence of frequent pain was 36.5% with no difference between boys and girls (p = 0.442). Boys with a longstanding disease or disability had higher odds of being in the frequent pain group (OR 2.167, 95% CI 1.168-4.020). Higher scores on health-related quality of life in all five domains for girls, and in two domains for boys, was associated with lower odds of being categorized into the frequent pain group. Frequent pain was associated with poor sleep quality (boys OR 2.533, 95% CI 1.243-5.162; girls OR 2.803, 95% CI 1.276-6.158) and more sedentary time (boys weekends OR 1.131, 95% CI 1.022-1.253; girls weekdays OR 1.137, 95% CI 1.032-1.253), but not with physical activity.

CONCLUSIONS

The high prevalence of frequent pain needs to be acknowledged and treated by school health-care services and the healthcare sector in order to prevent pain from influencing health and lifestyle factors negatively in children.

Narrative review of the prevalence and distribution of acute pain in children in the self-care setting

Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self-care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation-related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real-world setting.

Physical fitness characteristics and neck and shoulder pain incidence in school-aged children-A 2-year follow-up

Background and Aims

Neck and shoulder pain (NSP) is common in school age, but preventative factors have not been identified. The purpose was to study whether a fitness test could be used to predict the incidence of NSP and determine whether good physical fitness characters would be associated with lower NSP incidence in school-aged children at 2-year follow-up.

Methods

After the invitation to nine schools, 970 children (10-15 years old) agreed to participate. Flexibility, fundamental movement skills, musculoskeletal fitness, and cardiorespiratory fitness measurements included in Finnish Schools on the Move! monitoring system for physical functional capacity were measured at baseline in 2013. The NSP incidence was assessed by an online survey during school hours after 1 and 2 years. Logistic regression was used to analyze associations between physical fitness characteristics and NSP incidence.

Results

The mean prevalence of NSP was 26% at baseline. The NSP incidence was 15% in the first and 18% in the second follow-up year. Good physical fitness was not associated with lower NSP incidence in the 2-year follow-up. Successful lower back extension (odds ratio [OR] = 2.83) and good scores in curl-up (OR = 1.80) adjusted with age, gender, and body mass index, were associated with higher NSP incidence between T0 and T2. Throwing-catching combination (OR = 0.55) was associated with a lower NSP incidence in unadjusted analysis, but the association did not remain after adjustments.

Conclusion

Good physical fitness characteristics were not consistently associated with a lower NSP incidence in school-aged children in a 2-year follow-up. The role of general field-based physical fitness test as a screening tool for NSP incidence remains unconfirmed. More longitudinal studies are needed to detect the factors underlying NSP incidence in school-aged children.

Reducing the Weight of Spinal Pain in Children and Adolescents

Spinal pain in adults is a significant burden, from an individual and societal perspective. According to epidemiologic data, spinal pain is commonly found in children and adolescents, where evidence emerging over the past decade has demonstrated that spinal pain in adults can, in many cases, be traced back to childhood or adolescence. Nevertheless, very little focus has been on how to best manage spinal pain in younger age groups. The purpose of this article is to put the focus on spinal pain in children and adolescents and highlight how and where these problems emerge and how they are commonly dealt with. We will draw on findings from the relevant literature from adults to highlight potential common pathways that can be used in the management of spinal pain in children and adolescents. The overall focus is on how healthcare professionals can best support children and adolescents and their caregivers in making sense of spinal pain (when present) and support them in the self-management of the condition.

Parents' Perspectives on Adaptive Sports in Children with Profound Intellectual and Multiple Disabilities

Children with profound intellectual and multiple disabilities (PIMD) need adaptations to participate in sports and it is more difficult for them to access these activities. We investigated the effects of adaptive sports in children with PIMD as perceived by their parents. The parents answered a postal questionnaire exploring the effects of adaptive sports during the 3 days following an activity. The questionnaire explored twelve domains of children’s daily lives, such as sleep and appetite. We calculated a composite score, including all of these domains, to assess whether the children globally benefited from adaptive sports. Of the families, 27/63 responded (participation 42.9%). Four domains improved after the sports activity in an important proportion of children (improvement in 64.0% of children for wellbeing, 57.6% for mood, 56.0% for comfort and 48.1% for sleep). Among the majority of children, the other eight domains remained mostly stable. Three quarters of parents reported a globally positive effect of adapted physical activities on their child. These findings support the further development and provision of adaptive sports for children with severe neurological impairments.

Association of Temporomandibular Disorder Symptoms with Physical Fitness among Finnish Conscripts

Studies on the role of physical fitness, physical activity and obesity as risk factors for temporomandibular disorders (TMD) are scarce. The aim of the present study was to evaluate the association of TMD symptoms with physical fitness, physical activity and body mass index (BMI) among Finnish conscripts. The study sample consisted of 8685 Finnish conscripts. Data on self-reported TMD symptoms were used as outcome variables. Physical activity (questionnaire), physical fitness (measured with physical tests: Cooper test, push-ups, sit-ups and standing long jump) and body mass index (BMI) were used as explanatory variables. The associations between TMD symptoms and explanatory variables were evaluated using Chi-squared test and logistic regression analysis. The prevalence of all TMD symptoms was significantly higher among those who exercised more rarely than weekly. Pain-related TMD symptoms were also significantly more frequent among those who were overweight (BMI ≥ 25). Poor push-up results and overweight (BMI ≥ 25) were significantly associated with jaw pain and TMJ pain at jaw rest. The present study showed that good physical fitness may be a protective factor against TMD pain. Dentists should also be prepared to motivate TMD patients to physical activity and regular exercise as part of the treatment.

Impact of Sedentary Behavior on Bodily Pain While Staying at Home in COVID-19 Pandemic and Potential Preventive Strategies

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Musculoskeletal pain in 6-year-old children: the Generation R Study

Musculoskeletal (MSK) pain is frequently reported among adolescents and children and is a common reason for consultation in primary care. Our aim is to examine its prevalence in 6-year-old children in a general population and to assess associations with physical and psychosocial factors. Data from the Generation R Study, a population-based cohort, was used. Prevalence and characteristics of MSK pain were assessed with parent-reported questionnaires at 6 years of age (N = 6200). Demographics and data on physical activity, sedentary behaviors, previous reported MSK pain, and behavioral problems were extracted from questionnaires. The body mass index SD score was calculated from objectively measured weight and height. A 3-month prevalence of 10.0% was found for MSK pain in children, of which one-third was chronic, and 44.6% experienced together with pain at other sites. Univariate analyses showed that boys and children with lower socioeconomic status reported MSK pain more frequently compared to other pain and no pain. Although no associations were found between MSK pain and children's body mass index and physical activity level, children with MSK pain were more likely to watch television ≥2 hours/day. Multivariable analysis showed significant associations for MSK pain at 3 years of age (odds ratio 5.10, 95% confidence interval 3.25-7.98) and behavioral problems (odds ratio 2.10, 95% confidence interval 1.19-3.72) with the presence of MSK pain. So, MSK pain is already common in young children and is often chronic or recurrent. Previous reported MSK pain and behavioral problems are independently associated with MSK pain in the studied population.

Home-Based Exergaming on Preschoolers' Energy Expenditure, Cardiovascular Fitness, Body Mass Index and Cognitive Flexibility: A Randomized Controlled Trial

PURPOSE

The effects of exergaming-based physical activity (PA) interventions on preschoolers' health outcomes and cognition remain largely unexplored. Therefore, we conducted a randomized controlled trial to discern the effectiveness of a home-based educational exergaming intervention on preschoolers' energy expenditure, fitness, body mass index, and cognition.

METHODS

Participants were 32 preschoolers (16 girls; 59.4% Asian; M_age = 4.72, SD = ±0.73) recruited from the Twin Cities area in Minnesota. During baseline testing, we measured preschooler's daily energy expenditure (EE), cardiovascular fitness, body mass index, and cognitive flexibility using validated instruments. Participants were then randomly assigned to one of two conditions: (1) the exergaming intervention condition; or (2) control condition. The intervention program requested children participate in home-based educational exergaming using the LeapTV gaming console for at least 30 min/session 5 times/week. The control condition asked children to maintain regular PA patterns without any exergaming gameplay. Each condition lasted 12 weeks. We conducted identical outcome assessments for all children at baseline and post-intervention.

RESULTS

Analysis of covariance with repeated measures yielded significant time x group interaction effects for cognitive flexibility, Wilks' Lambda = 0.81, F(1, 29) = 6.98, p = 0.01, η² = 0.19, suggesting children in the exergaming group demonstrated significantly greater increases in cognitive flexibility as compared to those in the control group over time. There were no significant differences for time x group changes between the two groups for EE, Wilks' Lambda = 0.92, F(1, 29) = 2.29, p = 0.14, η² = 0.08; cardiovascular fitness, Wilks' Lambda = 0.96, F(1, 29) = 1.07, p = 0.31, η² = 0.04; and BMI, Wilks' Lambda = 0.99, F(1, 29) = 0.05, p = 0.82, η² = 0.01. However, our data did suggest a marginal effect of time for EE, Wilks' Lambda = 0.89, F(1, 29) = 3.26, p = 0.08, η² = 0.08, indicating that children's daily EE increased from baseline to post-intervention.

CONCLUSIONS

Home-based educational exergaming may positively impact cognitive flexibility in preschoolers. Studies with larger sample sizes in multiple geographic locations are needed, with our study suggesting a longer intervention period might also be warranted.

Associations between number of pain sites and sleep, sports participation, and quality of life: a cross-sectional survey of 1021 youth from the Midwestern United States

BACKGROUND

Musculoskeletal pain in youth is common but little is known about the influence of the number of pain sites on pain characteristics. The objective of this study was to compare pain characteristics, quality of life, sleep, sport participation between adolescents without pain, those with single site pain, and those with multi-site pain and investigate the relationship between pain duration and number of pain sites.

METHODS

An online survey was sent via email to 7177 possible middle- and high-school students. The students completed a survey containing questions about their pain (including location, duration, intensity, frequency), health-related quality of life, sleep quantity and quality, and sports participation. Quantitative variables were analysed with one-way ANOVAs or t-tests and qualitative variables were analysed with Pearson Chi-squared tests. Relationships were investigated with a Pearson Correlation.

RESULTS

Of the respondents (n = 1021), 52.9% reported no pain, 17.2% reported pain in a single-site, and 29.9% reported pain in multiple sites. Those with multi-site pain reported significantly lower quality of life than both pain-free youth (p < 0.001) and those with single-site pain (p < 0.001); those with single-site pain had lower quality of life than pain-free youth (p < 0.001). Those with pain reported worse sleep than those without pain (P < 0.05). No differences in sport participation were found (p > 0.10). Those with multi-site pain reported greater intensity (p = 0.005) and duration (p < 0.001) than those with single-site pain. A positive, moderate, and significant correlation (r = 0.437, p < 0.001) was found between the pain duration and number of pain sites.

CONCLUSIONS

A large percentage of youth experience regular pain that affects their self-reported quality of life and sleep, with greater effects in those with multi-site pain.

Prevalence of TMD and level of chronic pain in a group of Brazilian adolescents

AIMS

To determine the prevalence of temporomandibular disorders and associated factors in an adolescent sample from Recife, Brazil.

MATERIALS AND METHODS

A cross-sectional study was conducted with 1342 adolescents aged 10-17 years. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used by calibrated examiners to evaluate the presence and levels of chronic pain. To evaluate the socioeconomic conditions, the subjects answered the Brazilian Economic Classification Criteria (CCEB) questionnaire. Data were analyzed by means of binary logistic regression in SPSS.

RESULTS

The results showed that 33.2% of the subjects had TMD irrespective of age (p = 0.153) or economic class (p = 0.653). Statistically significant associations were found between TMD and female gender (p = 0.017), headache/migraine in the past six months (p<0.001), chronic pain (p<0.001) and chronic pain level (p<0.001). In the final model, logistic regression showed that the level of chronic pain and the headache/migraine in the past six months were related to the presence of TMD.

CONCLUSIONS

The prevalence of TMD was considered high (33.2%) and adolescents with chronic pain and headache in the past six months were more likely to have TMD.

CLINICAL RELEVANCE

The data contribute to the understanding of TMD among adolescents and to the development of preventive measures and polices to identify the dysfunction promptly.

Playing video games for more than 3 hours a day is associated with shoulder and elbow pain in elite young male baseball players

BACKGROUND

The effect of lifestyle factors on elbow or shoulder pain in young baseball players remains unclear. This study examined the association of game playing and television viewing with elbow or shoulder pain among elite young baseball players.

METHODS

Study participants were young baseball players (age, 9-12 years) who participated in the National Junior Sports Clubs Baseball Festival in 2017. The national tournament invited 16 teams (totaling 210 players) selected based on the results of the regional qualifying tournaments. Self-reported questionnaires were mailed to all players before the tournament. Multiple logistic regression analyses were used to assess the association of video game playing and television viewing behavior with elbow or shoulder pain.

RESULTS

Among the 210 players polled, 200 male players were included in the analysis. The prevalence of elbow or shoulder pain was 30.0%. Playing video games for ≥3 hours/day was significantly associated with elbow or shoulder pain vs. spending <1 hour/day playing video games (odds ratio, 5.59; 95% confidence interval, 1.44-21.64; P = .013). The amount of time spent watching television was not significantly associated with the prevalence of elbow or shoulder pain.

CONCLUSIONS

Playing video games for ≥3 hours/day was associated with elbow or shoulder pain among elite young male baseball players. These findings highlight the effect of lifestyle on elbow and shoulder pain and should be taken into consideration by players, coaches, parents, and clinicians for the prevention of elbow and shoulder pain.

Chronic non-cancer pain in children: we have a problem, but also solutions

Chronic non-cancer pain in children and adolescents has been described as "a modern public health disaster" that has generated significant medical and economic burdens within society. Seen as a disease in its own right, chronic pain has short and long-term consequences that impact not only the patient's health but also that of friends and families, due to significant parenting stress and disruptions in family life and structure. The evidence supporting pharmacological treatments and interventional procedures is limited, and no single strategy has been shown to be completely effective in children with chronic non-cancer pain. Therefore, considering the multifactorial nature of chronic pain, these patients should be treated with a multidisciplinary, balanced approach that seeks a primary outcome of improved functioning rather than of pain reduction. Using a bio-psycho-social approach, a multidisciplinary team, including a physiotherapist, nurse, social worker, psychologist, and physician, has been effective in achieving this outcome of improved functioning in children and adolescents with chronic pain. In this review, we discuss the impact, associated conditions, and evolution of chronic pain, along with the crucial role of every member of a multidisciplinary chronic pain clinic involved in the care of the children and adolescents with chronic non-cancer pain.

Self-Rated Health Status and Cardiorespiratory Fitness in a Sample of Schoolchildren from Bogotá, Colombia. The FUPRECOL Study

To evaluate the relationship between Self-Rated Health (SRH) and cardiorespiratory fitness (CRF) in a sample of children and adolescents enrolled in official schools in Bogotá, Colombia. A cross-sectional study was performed with 7402 children and adolescents between 9 and 17 years of age. Participants were asked to rate their health based on eight validated questions, addressing the participants propensity for headache, stomach-ache, backache, feeling-low, irritability/bad mood, nervousness, sleeping-difficulties, and dizziness. The choices were "rarely or never", "almost every month", "almost every week", and "more than once a week/about every day". Participants performed the international course-navette shuttle run test to estimate CRF, and cut-off points for age and gender were used to categorize the healthy/unhealthy fitness zone according to the FITNESSGRAM® criteria. Overall, 16.4% of those surveyed reported a perception of irritability/bad mood "more than once a week/about every day", followed by feeling-low and nervousness (both with 9.9%). Dizziness had the lowest prevalence with a percentage of 6.9%. Unhealthy CRF in boys increased the likelihood of headaches by 1.20 times, stomach aches by 1.31 times, feeling-low by 1.29 times, nervousness by 1.24 times, and dizziness by 1.29 times. In girls, unhealthy CRF increased the likelihood of headaches by 1.19 times, backache by 1.26 times, feeling-low by 1.28 times, irritability/bad mood by 1.17 times, sleeping-difficulties by 1.20 times, and dizziness by 1.27 times. SRH was associated with CRF in both genders. Early identification of children and adolescents with low CRF levels will permit interventions to promote healthy behaviors and prevent future diseases during adulthood.

Modest Amounts of Voluntary Exercise Reduce Pain- and Stress-Related Outcomes in a Rat Model of Persistent Hind Limb Inflammation

Aerobic exercise improves outcomes in a variety of chronic health conditions, yet the support for exercise-induced effects on chronic pain in humans is mixed. Although many rodent studies have examined the effects of exercise on persistent hypersensitivity, the most used forced exercise paradigms that are known to be highly stressful. Because stress can also produce analgesic effects, we studied how voluntary exercise, known to reduce stress in healthy subjects, alters hypersensitivity, stress, and swelling in a rat model of persistent hind paw inflammation. Our data indicate that voluntary exercise rapidly and effectively reduces hypersensitivity as well as stress-related outcomes without altering swelling. Moreover, the level of exercise is unrelated to the analgesic and stress-reducing effects, suggesting that even modest amounts of exercise may impart significant benefit in persistent inflammatory pain states.

PERSPECTIVE

Modest levels of voluntary exercise reduce pain- and stress-related outcomes in a rat model of persistent inflammatory pain, independently of the amount of exercise. As such, consistent, self-regulated activity levels may be more relevant to health improvement in persistent pain states than standardized exercise goals.