Frontiers in pediatrics · 2026
The dose-response relationship between physical activity and school scoliosis screening positive in children and adolescents: a preliminary cross-sectional study.
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Chen Chen, Yang Yang, Chen Zhen, Yuan Lingyan
Аннотация
BACKGROUND: While physical inactivity is an established risk factor for adolescent idiopathic scoliosis (AIS), dose-response relationships for physical activity (PA) parameters remain unquantified. This study examined associations between PA dose (amount, duration, frequency, type) and scoliosis screening positive (SSP), exploring optimal thresholds.
METHODS: In this cross-sectional analysis, 1,051 students (mean age 10.69 ± 2.45 years) from 8 Shanghai schools underwent scoliometer screening (ATR ≥5° defined as SSP). PA was assessed via validated The Physical Activity Questionnaire for Older Children(PAQ-C) questionnaire[scores≤2: light PA(LPA), scores2-3: moderate PA(MPA), scores > 3: vigorous PA(VPA)]. Logistic regression modeled scoliosis risk across PA strata. Restricted cubic splines (RCS) characterized dose-response curves. Subgroup analyses explored age-specific effects.
RESULTS: In two multivariable-adjusted models, both LPA and VPA demonstrated significantly elevated risks for SSP compared to MPA (adjusted OR = 3.30, 95% CI 1.92-5.68 and OR = 3.65, 95% CI 2.14-6.24, respectively), revealing a U-shaped dose-response relationship with risk nadir at PAQ-C scores≈2.7(p < 0.05). Exercise frequency <3 sessions/week (OR = 4.68, 95% CI 2.75-7.98), session duration <∼54 min or >90 min (OR = 3.43 and 2.75), and cumulative participation >2 years (OR = 3.37, 95% CI 1.89-6.01) were positively associated with SSP (p < 0.05). Aquatic sports were inversely associated with SSP(OR = 0.29, 95% CI 0.12-0.71)(p < 0.05). In addition,age-stratified analyses further indicated children (6-11y) exhibited heightened vulnerability to LPA(OR = 5.34, 95% CI 2.62-10.89), both age groups faced elevated risks fromVPA (Children OR = 5.03; Adolescents OR = 3.63), and bilateral sports (e.g., basketball) and aquatic activities universally reduced risk (OR = 0.09-0.19)(p < 0.05).
CONCLUSIONS: The amount of physical activity in children and adolescents shows a U-shaped association with SSP, with moderate PA (approximately 54 min/day, 3-4 days/week) being associated with the lowest SSP odds, while low and vigorous PA are associated with higher odds. Participation in water sports and team sports is inversely associated with SSP.These findings highlight potential associations that warrant further longitudinal investigation.
METHODS: In this cross-sectional analysis, 1,051 students (mean age 10.69 ± 2.45 years) from 8 Shanghai schools underwent scoliometer screening (ATR ≥5° defined as SSP). PA was assessed via validated The Physical Activity Questionnaire for Older Children(PAQ-C) questionnaire[scores≤2: light PA(LPA), scores2-3: moderate PA(MPA), scores > 3: vigorous PA(VPA)]. Logistic regression modeled scoliosis risk across PA strata. Restricted cubic splines (RCS) characterized dose-response curves. Subgroup analyses explored age-specific effects.
RESULTS: In two multivariable-adjusted models, both LPA and VPA demonstrated significantly elevated risks for SSP compared to MPA (adjusted OR = 3.30, 95% CI 1.92-5.68 and OR = 3.65, 95% CI 2.14-6.24, respectively), revealing a U-shaped dose-response relationship with risk nadir at PAQ-C scores≈2.7(p < 0.05). Exercise frequency <3 sessions/week (OR = 4.68, 95% CI 2.75-7.98), session duration <∼54 min or >90 min (OR = 3.43 and 2.75), and cumulative participation >2 years (OR = 3.37, 95% CI 1.89-6.01) were positively associated with SSP (p < 0.05). Aquatic sports were inversely associated with SSP(OR = 0.29, 95% CI 0.12-0.71)(p < 0.05). In addition,age-stratified analyses further indicated children (6-11y) exhibited heightened vulnerability to LPA(OR = 5.34, 95% CI 2.62-10.89), both age groups faced elevated risks fromVPA (Children OR = 5.03; Adolescents OR = 3.63), and bilateral sports (e.g., basketball) and aquatic activities universally reduced risk (OR = 0.09-0.19)(p < 0.05).
CONCLUSIONS: The amount of physical activity in children and adolescents shows a U-shaped association with SSP, with moderate PA (approximately 54 min/day, 3-4 days/week) being associated with the lowest SSP odds, while low and vigorous PA are associated with higher odds. Participation in water sports and team sports is inversely associated with SSP.These findings highlight potential associations that warrant further longitudinal investigation.