Back education in elementary schoolchildren: the effects of adding a physical activity promotion program to a back care program.

Promoting a physically active lifestyle whilst optimizing the spinal load at a young age seems to be advocated within the scope of early back pain prevention efforts. The present study aimed at evaluating the effects of combining a back care program with a physical activity promotion program in elementary schoolchildren. In a pre-post design over two school years, back care knowledge, back care behavior, fear avoidance beliefs and back pain reports were evaluated in children classified into three categories--those who received a back care and a physical activity promotion program (n=190), those who received only a back care program (n=193) and those in a control group (n=172) (mean age at baseline: 9.7 years+/-0.7). Physical activity levels were evaluated in a sub-sample of 26 pupils in each group. The back care program and the physical activity promotion program were both comprehensive ones. In both intervention groups, the scores for back care related knowledge and back care behavior were significantly higher than the control group. The increase in the sum score for back care behavior was significantly higher in the back care group than in the back care plus physical activity promotion group. Significant interaction effects showed an increase in fear-avoidance beliefs between pre- and post-tests in the control group, significantly different from the better scores in both intervention groups. Interaction effects were not significant for pain reports. In the back care plus physical activity promotion group, the daily moderate to vigorous physical activity levels decreased by 8 min per day while a decrease by 31 min per day was found in the back care group and a decrease by 36 min per day in the control group. However, group differences were not significant. The present study findings favor the addition of a physical activity promotion program to a back care program in elementary schools within the scope of early back pain prevention efforts. However, the findings also emphasize the disadvantages of implementing both programs simultaneously in a school curriculum that is already full.