title: Encouraging healthy spine habits to prevent low back pain in children: an observational study of adherence to exercise.
abstract: BACKGROUND
  Low back pain (LBP) in adolescence is a predictor of adult LBP. Strategies to educate children and encourage healthy spine habits may prevent LBP. Poor adherence to health programmes can be a barrier to their success. This study addresses the potential for habitualisation of a short daily exercise programme that draws attention to factors thought to keep the spine healthy.
  
  
  OBJECTIVE
  To describe adherence to a 9-month exercise programme, and analyse factors that may influence adherence.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Four primary schools in New Zealand.
  
  
  METHODS
  Outcomes included self-evaluation of adherence to exercise, and self-reported incidence and severity of LBP.
  
  
  METHODS
  Children (n=469) aged 8 to 11 years.
  
  
  METHODS
  Participants were taught four simple spine movements for daily practice as part of a health programme that emphasised 'back awareness' and self-care of the spine. Strategies to encourage adherence were implemented. Data on self-reported adherence and episodes of LBP during the previous week were collected through an online survey completed on trial days 7, 21, 49, 105, 161 and 270 over a 9-month period.
  
  
  RESULTS
  Daily exercise adherence was 34% on day 7 and dropped to 9% by day 270. Exercise adherence of at least once per week was 84% on day 7 and 47% by day 270. Frequency of exercise was not associated with episodes of LBP [odds ratio (OR) 1.16, 95% confidence interval (CI) 0.92 to 1.47, P=0.21], previous history of LBP (OR 0.97, 95% CI 0.77 to 1.23, P=0.77), lifetime first episode of LBP (defined as the first episode of LBP in the study period for participants with no previous history of LBP) (OR 0.39, 95% CI 0.15 to 1.34, P=0.14) or severity of LBP (OR 1.59, 95% CI 0.99 to 2.52, P=0.05).
  
  
  CONCLUSIONS
  This study applied a comprehensive set of strategies considered to be important in encouraging adherence, but was not successful in sustaining the interest of more than half of the cohort. Innovative strategies are needed to develop new exercise habits in children.
  
  
  BACKGROUND
  ACTRN12611000551998.
authors.affiliation: Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia. Electronic address: jjhil2@student.monash.edu.
authors.forename: J J
authors.initials: JJ
authors.lastname: Hill
authors.affiliation: Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia.
authors.forename: J L
authors.initials: JL
authors.lastname: Keating
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D005081:Exercise Therapy; D017116:Low Back Pain / Q000517:prevention & control; D010349:Patient Compliance; D010353:Patient Education as Topic; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Adherence; Children; Exercise; Habit; Low back pain; Prevention