The Effect of Classroom-Based Interventions on Sedentary Behavior and Spinal Health in Schoolchildren: Systematic Review

BACKGROUND: Multifaceted school-based interventions involving many stakeholders show promise toward the reduction of sedentary behavior (SB) and improved musculoskeletal conditions in schoolchildren. In resource-limited contexts, where schools face multiple, complex demands, broad school-based interventions may not be possible. In these settings, less complex, resource-efficient interventions are more likely to be adopted and implemented. Interventions that are limited to classrooms and that do not require broader stakeholder participation may be more appropriate to lower-resource settings. OBJECTIVE: The aim of this study was to systematically search for, identify, and summarize the literature on the effectiveness of classroom-based interventions on SB and spinal health in schoolchildren. METHODS: PubMed, EBSCOhost CINAHL, Web of Science, and Scopus were searched between January 1, 2021, and April 30, 2021. We included experimental studies conducted exclusively in school classrooms that objectively measured classroom SB and spinal health. The search terms related to SB, classroom sitting, and classroom neck and back pain. Studies that reported on objectively measured classroom physical activity and instrumented observation of healthy spinal behavior were included in the review. The included studies were critically appraised using the McMaster critical review form for quantitative studies. The study findings were summarized in tables, and a meta-analysis of homogeneous review outcome data was conducted. RESULTS: Overall, 12 experimental studies from high-income countries were included: 9 (75%) studies focused on SB, and 3 (25%) focused on spinal health. Of the 9 SB studies, 8 (89%) reported decreases in classroom sitting time. The pooled medium-term effects of a subset of SB interventions showed statistically significant decreases in sitting time (P=.03), whereas short-term effects and long-term effects were not significantly reduced (P=.13 and P=.23, respectively). A meta-analysis of spinal health studies demonstrated statistically significant improvements in spinal behavior during functional tasks (P=.005). CONCLUSIONS: Classroom-based interventions aimed at reducing SB and improving spinal health may be effective without placing an additional burden on teachers and parents. SB interventions must include strategies to overcome teachers’ and learners’ hedonic motivation to sit during class time. Standardized outcomes for school-based SB are encouraged so that findings from various settings may be pooled to determine the overall effect across studies. The use of standardized functional outcomes in spinal health studies will aid in determining the effectiveness of spinal health interventions across studies. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020176080; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020176080