Effects of a school-based physical activity implementation program to reduce musculoskeletal pain frequency in children aged 9 to 12: a randomised clinical trial

ObjectiveTo estimate the effect of scheduling physical activity during the school day on pain outcomes (frequency, severity, and impact), quality of life, physical activity and sedentary time in school children with musculoskeletal pain. Design, setting, and participantsA preplanned secondary analysis of a cluster randomised trial in private elementary schools from Australia. Eligible participants were students aged 9 to 12 (grades 4 to 6) who reported having previous MSK pain. InterventionsIntervention schools received support to increase the scheduling of physical activity during the school day (with and without nutrition strategies). Control schools received either support to implement nutrition strategies or no active support. Main outcomes and measuresPain frequency reported at 9-months after randomisation over the last six months. Secondary outcomes: quality of life (PedsQL 4.0), pain severity (FSP-R), physical activity and sedentary times, the prevalence of recent pain, and pain-related impact on physical activity, usual activities, school absenteeism, and health care utilisation. ResultsWe included 633 students (mean age 10.5 years). Of those, 33% of students reported previous frequent pain at follow-up. We found no difference in pain frequency between groups (OR 1.0, 95% CI: 0.6 to 1.6). The intervention group had slightly higher physical activity levels (mean difference: 3.1 min/day, 95% CI: -0.02 to 6.2) and lower pain impact in usual activities (OR 0.7, 95% CI: 0.4 to 1.0). Conclusion and relevanceIncreased scheduling of physical activity in schools did not improve pain outcomes in children with MSK pain. However, results suggest that children can improve physical activity levels during school time despite experiencing pain. Trial registrationACTRN12616001228471 SUMMARY BOXO_ST_ABSWhat is already known on this topicC_ST_ABSMusculoskeletal (MSK) pain is prevalent among children and adolescents. The relationship between physical activity and pain is complex, with evidence indicating that physical inactivity can contribute to MSK pain, but pain may also serve as a barrier to engaging in physical activities. What this study addsWe found that scheduling physical activity during school time did not improve pain outcomes of school-aged children with MSK pain. However, there appears to be a small benefit to improving physical activity levels and impact on usual activities in students with prior MSK pain. How this study might affect research, practice or policyThis study highlights that children with MSK pain might need a more comprehensive approach to school-based physical activity programs, combining strategies that not only promote physical activity but also address the unique challenges posed by MSK pain in this age group.