Association between physical activity and scoliosis: a prospective cohort study

Correlation between physical activity and adolescent idiopathic scoliosis: a systematic review

BACKGROUND

The multifactorial aetiology of scoliosis is well known. Physical activity is considered both a treatment and causative factor for idiopathic scoliosis; however, evidence for a causal relationship between physical activity levels and idiopathic scoliosis in adolescents is conflicting. Therefore, we aimed to summarise the current evidence regarding the association between adolescent idiopathic scoliosis and physical activity and further to assess whether the relationship is dose dependent.

METHODS

PubMed, Cochrane, Scopus, and Web of Science databases were searched from 1991 to July 2022 using the following main keywords: adolescent idiopathic scoliosis, physical activity, and risk factors, supplemented with manual searches, secondary citations, and reference searches. The quality of the included literature was evaluated using the Scale for Reporting Observational Studies in Enhanced Epidemiology guidelines.

RESULTS

Eight studies were included in this review, of which six reported an association between adolescent idiopathic scoliosis and physical activity levels and two reported no association. One British study reported reduced physical function early in life as a new risk factor for scoliosis onset.

CONCLUSIONS

Physical activity is strongly associated with adolescent idiopathic scoliosis. Physical activity should be encouraged as it plays an important role in the prevention of adolescent idiopathic scoliosis. Further research is needed to determine the dose-dependent relationship between physical activity and prevention of adolescent idiopathic scoliosis.

Association between physical activity and body posture: a systematic review and meta-analysis

OBJECTIVE

To estimate the possible associations between posture and physical activity (PA).

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

The search was conducted in seven databases (PubMed, Web of Science, SportDiscus, EMBASE, Scopus, Cochrane Library, and CINAHL) for studies published from inception to January 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were required to meet following criteria: (1) study design: cross-sectional, case control and cohort studies. (2) Participants: people of all ages without any diagnosed diseases. (3) Exposure and outcome: studies that examined the possible effect or correlations between PA, physical inactivity, physical exertion and human body posture.

RESULTS

Sixteen cross-sectional studies, two cohort studies and one case control study involving a total of 16772 participants aged from 6 to 79 years were included. Correlational studies showed that there was a significant relationship between PA and posture (C = 0.100, CI 95% = 0.012-0.186). However, regression studies demonstrated that there was not a significant association between PA and posture (C = 1.00, CI 95% = 0.998-1.002). Three studies investigated the association between PA and the lumbar lordosis and showed that there was not a significant association between the lordosis and PA (CI 95%: -0.253-0.048, P = 0.180). In addition, four studies showed that there were not any associations between scoliosis and PA (CI 95%: 0.819, 1.123, P = 0.607). The evidence of heterogeneity and publication bias was found among all analyzed data (P < 0.05). Also, meta regression was used for age and BMI and the results were not significant.

CONCLUSION

Although a weak correlation was shown to exist between PA and human posture, the odds ratio indicated that there was not a significant association between PA and human posture. The lack of a significant relationship may indicate that multiple biopsychosocial factors may be involved in human posture. In summary, our study highlights the need for caution when interpreting the results of meta-analyses, particularly when there is significant heterogeneity and publication bias in the included studies.

The Impact of Physical Activity on Adolescent Idiopathic Scoliosis

The prevalence of adolescent idiopathic scoliosis (AIS) is increasing, partly due to a lack of physical activity. In a cross-sectional study with 18,216 pupils (5th, 6th, and 8th grades) from four Croatian counties using the forward bend test (FBT; presumed AIS), the prevalence of AIS and its correlation with physical activity were evaluated. Pupils with presumed AIS were less physically active than their peers without scoliosis (p < 0.001). Abnormal FBT was more prevalent among girls than boys (8.3% vs. 3.2%). Boys were more physically active than girls (p < 0.001). Pupils with presumed AIS were less physically active than their peers without scoliosis (p < 0.001). A higher prevalence of presumed AIS was found among inactive or just recreationally active schoolchildren than among those engaged in organized sports (p = 0.001), girls especially. Pupils with presumed AIS were less active and had fewer weekly sports sessions than their peers without scoliosis (p < 0.001). Notably low prevalence of AIS was detected among pupils engaged in soccer (2.8%, p < 0.001), handball (3.4%, p = 0.002), and martial arts (3.9%, p = 0.006), while it was higher than expected in swimming (8.6%, p = 0.012), dancing (7.7%, p = 0.024), and volleyball (8.2%, p = 0.001) participants. No difference was detected for other sports. A positive correlation was found between time spent using handheld electronic devices and the prevalence of scoliosis (r_s = 0.06, p < 0.01). This study confirms the increasing prevalence of AIS, particularly among less athletic girls. Further, prospective studies in this field are required to explain whether the higher prevalence of AIS in these sports is due to referral or other aspects.

Associations Between Physical Activity and Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the associations between adolescent idiopathic scoliosis (AIS) and physical activity (PA).

DATA SOURCES

MEDLINE, EMBASE, AMED, SPORTDiscus, Cochrane Library, and CINAHL electronic databases were searched from inception to August 2022/plus citation tracking.

STUDY SELECTION

Observational studies of participants with radiographically confirmed AIS with ≥10° lateral spinal curvature (Cobb method) and comparator groups without AIS that measured PA were selected by 2 reviewers.

DATA EXTRACTION

Data were extracted independently and cross-checked by 2 reviewers. Risk of bias was evaluated using Newcastle Ottawa Scales and overall confidence in the evidence using the GRADE approach.

DATA SYNTHESIS

Sixteen studies with 9627 participants (9162, 95% women) were included. A history of vigorous PA significantly reduced the odds of being newly diagnosed with AIS by 24% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.65-0.89) (high certainty). Moderate PA reduced odds by 13% (moderate certainty) and light PA increased odds by 9% (low certainty), but neither analysis was statistically significant. Ballet or gymnastics (OR 1.47, 95% CI 3.08 (1.90, 5.00) were the only individual sports significantly associated with AIS diagnosis (moderate certainty). Case-control studies of people with and without AIS provided greater evidence that having AIS reduces vigorous PA and sports participation, and less evidence light PA and walking are affected.

CONCLUSION

Adolescents who participate in more vigorous PA are less likely to be diagnosed with AIS. Ballet and gymnastics are associated with AIS diagnosis, but the direction of this association is uncertain. People with AIS are likely to do less vigorous physical and sporting activity compared with those without AIS, which could negatively affect health and quality of life. Further research is warranted into the inter-relations between PA and AIS, studies need to be of sufficient size, include men, and evaluate vigorous including higher-impact PA compared with moderate or light PA.

Risk factors associated with low bone mineral density in children with idiopathic scoliosis: a scoping review

BACKGROUND

Children with idiopathic scoliosis (IS) have a high risk of osteoporosis and IS with low bone mineral density (BMD) are susceptible to curve progression. This review aims to explore the risk factors of low BMD in children with IS.

METHODS

Studies were retrieved from 5 databases that were published up to January 2022. Search terms are keywords in titles or abstracts, including subject headings related to "Scoliosis", "Bone Mineral Density", and "Risk Factors". Observational studies on risk factors of low BMD in children with IS were enrolled in this review. The number of studies, sample size, outcome measures, research type, endocrine, and lifestyle-related factors, gene/signal pathway, and other contents were extracted for qualitative analysis.

RESULTS

A total of 56 studies were included in this scoping review. Thirty studies involved genetic factors that may affect BMD, including the Vitamin-D receptor gene, RANK/RANKL signal pathway, the function of mesenchymal stem cells, Runx2, Interleukin-6 (IL-6), and miR-145/β-catenin pathway. Eight studies mentioned the influence of endocrine factors on BMD, and the results showed that serum levels of IL-6, leptin and its metabolites, and ghrelin in children with IS were different from the age-matched controls. In addition, there were 18 articles on lifestyle-related factors related to low BMD in children with IS, consisting of physical activity, calcium intake, Vitamin D level, and body composition.

CONCLUSIONS

Genetic, endocrine, and lifestyle-related factors might relate to low BMD and even osteoporosis in IS. To prevent osteoporosis, the effectiveness of regular screening for low BMD risk factors in children with IS needs to be investigated. Additionally, clear risk factors suggest strategies for bone intervention. Future studies should consider the effectiveness of calcium and vitamin D supplements and physical activity in BMD improvement.

Associations of physical activity and screen time with adolescent idiopathic scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is the most common type of idiopathic scoliosis, affecting approximately 0.61%-6.15% adolescents worldwide. To date, the results on the relationship between moderate-to-vigorous physical activity (MVPA) and AIS were inconsistent, and the association between screen time (ST) and AIS remained unclear. This study aimed to describe MVPA and ST among adolescents, and to explore the independent and joint associations between PA, ST, and AIS.

METHODS

A frequency-matched case-control study based on the 2021 Chinese School-based Scoliosis Screening Program in Shenzhen city, south China, was conducted. The research involved 494 AIS patients (aged 9-17 years) and 994 sex- and age-matched healthy controls. MVPA and ST were measured using a self-administered questionnaire. Logistic regression models estimated associations between PA, ST, and AIS.

RESULTS

Compared to subjects meeting the recommended 60-min daily of MVPA, adolescents reporting daily MVPA time less than 60 min had 1.76 times higher odds of experiencing AIS (95% CI: 1.32-2.35) and adolescents reporting daily MVPA in inactive status had 2.14 times higher odds of experiencing AIS (95% CI: 1.51-3.03). Moreover, participants reporting ST for 2 hours or more had 3.40 times higher odds of AIS compared with those reporting ST less than 2 hours (95% CI: 2.35-4.93). When compared with the adolescents reporting both ST and MVPA meeting the guidelines recommended times (ST < 2 h and MVPA ≥ 60 min/day), those reporting both ST ≥ 2 h and MVPA in inactive status are 8.84 times more likely to develop AIS (95% CI: 3.99-19.61).

CONCLUSIONS

This study reported that the insufficient MVPA, especially MVPA in inactive status, and excessive ST were risk factors for AIS. Additionally, the joint effects of insufficient MVPA and excessive ST probably increase the risk of AIS.

Bone Health in Adults With Prader-Willi Syndrome: Clinical Recommendations Based on a Multicenter Cohort Study

CONTEXT

Prader-Willi syndrome (PWS) is a rare complex genetic syndrome, characterized by delayed psychomotor development, hypotonia, and hyperphagia. Hormone deficiencies such as hypogonadism, hypothyroidism, and growth hormone deficiency are common. The combination of hypotonia, low physical activity, and hypogonadism might lead to a decrease in bone mass and increase in fracture risk. Moreover, one would expect an increased risk of scoliosis due to hypotonia and low physical activity.

OBJECTIVE

To study the prevalence and risk factors for skeletal problems (reduced bone mineral density, fractures, and scoliosis) in adults with PWS.

METHODS

We retrospectively collected patient characteristics, medical history, medication, biochemical measurements, dual-energy X-ray absorptiometry scans, and spinal X-rays and reviewed the current literature.

RESULTS

We included 354 adults with PWS (median age 31 years; 43% males), of whom 51 (14%) had osteoporosis (T-score below -2.5) and 143 (54%) had osteopenia (T-score -1 to -2.5). The most prevalent modifiable risk factors for osteoporosis were hypogonadism, insufficient dairy intake, sedentary lifestyle, and corticosteroid use. Male sex was associated with osteoporosis (P = .005). Growth hormone treatment was not associated with osteoporosis. A history of vertebral fractures was present in 10 (3%) and nonvertebral fractures in 59 (17%). Scoliosis was present in 263 (80%), but no modifiable risk factors were identified.

CONCLUSION

Besides scoliosis, osteoporosis is common in adults with PWS. Based on the literature and the risk factors for osteoporosis found in our cohort, we provide practical clinical recommendations to avoid skeletal complications in these vulnerable patients.

Regional disparity in epidemiological characteristics of adolescent scoliosis in China: Data from a screening program

Objective

We investigated regional disparities in rates of scoliosis among adolescents in western and eastern China and the dominant factors underlying these disparities.

Methods

This cross-sectional study used data from a school scoliosis screening program conducted in two typical areas: Yangpu District of Shanghai (eastern China) and Tianzhu Tibetan Autonomous County of Gansu Province (western China), during October 2020 to February 2021. Participants included adolescents aged 12-16 years (4,240 in Shanghai and 2,510 in Gansu Province). School scoliosis screening data were obtained on age, sex, height, weight and BMI, and region as well. We screened angles of trunk rotation in level of proximal thoracic (T1-T4), main thoracic (T5-T12), and lumbar (T12-L4) by the forward bend test with scoliometer. An angle of trunk rotation ≥5° was used as the criterion to identify suspected scoliosis.

Results

The proportion of suspected scoliosis was lower in Shanghai (6.9%) than in Gansu (8.6%). Angle of trunk rotation tended to increase with age in Shanghai, peaking at 15 years, but decreased with age in Gansu, and bottomed at 15 years. The angle of trunk rotation in the proximal thoracic, main thoracic, and lumbar part of the spine appeared to be larger in Gansu adolescents and in Shanghai female adolescents. Age was a relevant factor in angle trunk rotation in regression models and interacted with region as well.

Conclusion

We found regional and age- and sex-related disparities in rates of suspected scoliosis.

Sport improved medium-term results in a prospective cohort of 785 adolescents with idiopathic scoliosis braced full time. SOSORT 2018 award winner

PURPOSE

The association between idiopathic scoliosis (IS) and sports activities remains vague. We aimed to analyse their effect on full-time braced adolescents with IS.

METHODS

We retrospectively recruited all the consecutive patients of a tertiary referral Institute of age ≥ 10 (adolescents), with a juvenile (JIS) or adolescent (AIS) IS diagnosis, Risser 0-2, TLSO brace prescription and self-reported adherence ≥ 20 h per day, and follow-up out-of-brace X-rays 18 months after brace prescription. We divided participants into two groups: SPORT (sport twice or more per week) and CONTROL (sport once per week or less). We calculated odds ratio (OR) to compare the outcome of subjects performing to those not performing sport. We ran a logistic regression with covariate adjustment to assess if sports frequency affected the outcomes.

RESULTS

Out of 33,311 participants assessed for eligibility, 785 satisfied the inclusion criteria (693 females, age 12.7 ± 1.3 and 40 ± 11° Cobb). The SPORT group consisted of 290 participants and the CONTROL group of 495. The SPORT group showed higher odds of improvement (OR = 1.59, 95%CI = 1.17-2.16, p = 0.0018). The odds of improving increased with the frequency of sports activity (OR = 1.20, 95%CI 1.08-1.34).

CONCLUSION

This study shows that sports activities increase the odds of improvement at 18-month follow-up in adolescents with IS treated with a full-time brace. The odds of improvement increase with sports week frequency.

Postural habits and lifestyle factors associated with adolescent idiopathic scoliosis (AIS) in China: results from a big case-control study

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is the most prevalent type of scoliosis affecting children between the ages of 10-16 years. However, risk factors for AIS, particularly the modifiable ones, are still largely unknown. This study aims to investigate the associations of lifestyle and social environment factors with AIS in Chinese schoolchildren.

METHODS

This is a matched case-control study based on survey data collected from school-based scoliosis screening program. We used conditional logistic regression models to describe the relative risk of AIS incidence for each variable in the analyses. To examine the independent effect of each factor on developing AIS, a multivariate conditional logistic regression was conducted and odds ratios (ORs) were adjusted for age and other significant variables.

RESULTS

Overall, 2538 participants from 49 schools were included in this study, comprising 1269 AIS cases and 1269 controls. Mean age of the study population was 13.4 years ± 1.06 (range 10-18). One thousand five hundred and fifty (61.1%) of the study subjects were girls. After adjusting for other significant factors, inappropriate desk heights, either too low (OR = 1.40, 95% CI 1.04-1.90) or too high (OR = 1.61, 95% CI 1.09-2.38), standing with anterior pelvic tilt (OR = 2.73, 95% CI 1.41-5.28), and sleeping on the right side (OR = 1.38, 95% CI 1.00-1.91), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.69 (95% CI 0.50-0.96) for sitting normally, and 0.72 (95% CI 0.53-0.98) for sitting positions change.

CONCLUSIONS

This is the first study to address the associations between desk heights and AIS and showed inappropriate desk heights were related to increased AIS risks. To protect school children from developing AIS, stakeholders are advised to consider introducing height-adjustable desks in the class, changing students' sitting positions in the classroom on a regular basis, and implementing educational programs to help students maintain correct sitting postures.

Kinesiophobia and its association with treatment choice in individuals with idiopathic scoliosis

BACKGROUND

Previous studies have reported increased kinesiophobia in adults with degenerative scoliosis or adolescents who have undergone spinal surgery. However, little is known about the phenomenon of kinesiophobia among adolescents with idiopathic scoliosis (IS).

OBJECTIVES

The aim of this study was to investigate levels of kinesiophobia and its association with treatment choice in IS.

METHODS

The study included 98 IS patients with a mean age of 14 years and 20 healthy controls. Participants with IS were divided into groups based on treatment conditions, as follows: (1) untreated (n= 33); (2) treated with exercise (n= 32); and (3) treated with a brace (n= 33). Kinesiophobia was measured using the Tampa Scale for Kinesiophobia (TSK). Comparisons were made between four groups.

RESULTS

Untreated participants with IS were found to have greater kinesiophobia than healthy controls (p< 0.001). Participants treated with a brace (p= 0.046) and exercise (p= 0.064) had similar kinesiophobia levels as the healthy control group.

CONCLUSIONS

Kinesiophobia was found to be higher in adolescents with IS compared to healthy peers. Brace or exercise treatment both had a positive impact on kinesiophobia. These findings should be considered when organizing rehabilitation programs to achieve the best results for adolescents with IS.

Scoliosis incidence and treatment methods

Scoliosis is defined as a three-dimensional deformity of the spine that is of particular interest to the lateral curvature of the spine. Various types of treatment approaches have been recommended for patients with scoliosis. The aim of this study was to provide an up-to-date review of scoliosis, focusing on issues such as its incidence and treatment methods. The ISI-Thomson Web Of Science International Virtual Library was accessed for this review. The search criteria selected were 'title', 'abstract' and 'keywords'. In the ISI Thomson Web of Science virtual library platforms, the keywords in the articles search were "scoliosis incidence" and "scoliosis treatment". Over the years, different therapeutic strategies have been addressed for patients with scoliosis, they differ depending on the type of scoliosis, the patient's age and the available therapeutic means. Keywords: Scoliosis, Incidence, Physical Treatment;

Ethnic Disparity in the Incidence of Scoliosis Among Adolescents in Tianzhu Tibetan Autonomous County, China

Objectives

To determine the influence of ethnic disparities, socioeconomic status (SES) and hukou on the incidence of scoliosis.

Methods

We enrolled 2,445 junior high school students (Han: 1,153; ethnic minorities: 1,292) aged 12–16 years from two schools in Tianzhu Tibetan Autonomous County, Gansu Province from November 2020 to February 2021. We measured the angle of trunk rotation (ATR) using a scoliometer. Two-factor analysis of variance was used to comparatively analyze differences in the ATR according to ethnicity, age, sex, body mass index (BMI), and SES between the groups. Associations between risk factors and scoliosis were estimated using odds ratios and 95% confidence intervals with an unconditional multivariate logistic regression model for the two groups.

Results

Adolescents with Han ethnicity were more likely to have scoliosis than their ethnic minority counterparts (10.8% vs. 7.1%, P < 0.05). The ATR value in the Han group decreased with age whereas the minority group showed an upward trend (P < 0.05). The difference between ethnic groups was not significant, only at level 3. In particular, the ATR values among Han girls were significantly higher than those of ethnic minority girls (P < 0.05). Compared with Han adolescents, the BMI of ethnic minorities had a greater impact on the ATR. A statistically significant difference in SES was found between the two ethnic groups (P < 0.05). Hukou and parents' occupation had an important influence on the onset of scoliosis.

Conclusions

Han adolescents had higher ATR values and were more likely to have scoliosis than ethnic minority adolescents in our study. Growth and development indicators (height and BMI) and differences in SES between the two groups played an important role.

The Utility of Anti-Covid-19 Desks in Italy, Doubts and Criticism

As of the 14th of September, Italy has been considered one of the more susceptible nations in terms of risk of increase for Sars-Cov-2 contagion [...].

Accelerometer based assessment of daily physical activity and sedentary time in adolescents with idiopathic scoliosis

BACKGROUND

Studies have shown a positive correlation between higher physical activity (PA) and health benefits. However, device-based assessment of PA and sedentary time (ST) in people with adolescent idiopathic scoliosis (AIS) has not been deeply investigated.

OBJECTIVE

Analysis and comparison of weekend and weekdays PA and ST using multiple accelerometers in people with AIS with different curvature severity compared to healthy controls.

METHODS

24 participants with AIS divided into 2 groups of 12 with Cobb angles < 40° and > 40°, along with 12 age and BMI matched healthy controls. Daily PA and ST during four consecutive days were measured using four tri-axial accelerometers. Clinical functional assessment was performed using the scoliosis research society (SRS-22) questionnaire.

RESULTS

The combined weekend and weekdays average daily step count was found to be 22% and 29% lower in the AIS groups with Cobb angle < 40° and > 40°, respectively, compared to the controls. The average ST was also reported to be 5% and 7% higher in the AIS groups with Cobb angle < 40° and > 40°, respectively, compared to the controls. The reported differences were significant in the AIS group with higher Cobb angle (p≤0.05). No significant differences in PA or ST were reported between the AIS groups based on curvature severity.

CONCLUSIONS

Decreased PA and increased ST observed in patients with AIS may have long term health implications and may play a role in the disease process. The device-based assessment of PA to understand potential benefits in clinical practice is recommended.

Identifying Scoliosis in Population-Based Cohorts: Automation of a Validated Method Based on Total Body Dual Energy X-ray Absorptiometry Scans

Scoliosis is a 3D-torsional rotation of the spine, but risk factors for initiation and progression are little understood. Research is hampered by lack of population-based research since radiographs cannot be performed on entire populations due to the relatively high levels of ionising radiation. Hence we have developed and validated a manual method for identifying scoliosis from total body dual energy X-ray absorptiometry (DXA) scans for research purposes. However, to allow full utilisation of population-based research cohorts, this needs to be automated. The purpose of this study was therefore to automate the identification of spinal curvature from total body DXA scans using machine learning techniques. To validate the automation, we assessed: (1) sensitivity, specificity and area under the receiver operator curve value (AUC) by comparison with 12,000 manually annotated images; (2) reliability by rerunning the automation on a subset of DXA scans repeated 2-6 weeks apart and calculating the kappa statistic; (3) validity by applying the automation to 5000 non-annotated images to assess associations with epidemiological variables. The final automated model had a sensitivity of 86.5%, specificity of 96.9% and an AUC of 0.80 (95%CI 0.74-0.87). There was almost perfect agreement of identification of those with scoliosis (kappa 0.90). Those with scoliosis identified by the automated model showed similar associations with gender, ethnicity, socioeconomic status, BMI and lean mass to previous literature. In conclusion, we have developed an accurate and valid automated method for identifying and quantifying spinal curvature from total body DXA scans.