Jeffrey J. Hebert, Heidi Klakk, Claudia Franz, Martin Sénéchal, Neil Manson, Niels Wedderkopp

November 2019, Volume 28, Issue 11, pp 2452 - 2461 Original Article Read Full Article 10.1007/s00586-019-06034-w

First Online: 19 June 2019


To examine the prospective associations between spinal pain exposures and risk factors for cardiovascular disease in children and explore the mediating role of health-related physical activity.


Students were recruited from ten public primary schools. Each week from November 2008 to October 2010, parents reported spinal pain occurrences in their children via text messaging. Clustered cardiovascular risk was estimated with a composite score comprising fasting serum triglycerides, homeostasis assessment model-estimated insulin resistance (HOMA-IR), total to high-density lipoprotein cholesterol ratio, and systolic blood pressure. Additional outcomes were fasting serum insulin and glucose concentrations and body mass index categories. Associations were explored with multilevel mixed regression models and reported with beta coefficients (β) and percent difference scores. All models were adjusted for potential confounders.


Data from 1022 children (53% female) with mean ± SD age of 8.4 ± 1.4 years were included. Girls with spinal pain had greater clustered cardiovascular risk (β [95% CI]; percent difference [95% CI] = .41 [.02–.80]; 3.3% [.2–6.4%]) than those without spinal pain. Similar outcomes were observed for log insulin (percent difference [95% CI] = 3.4% [.6–6.2%]) and log HOMA-IR = (percent difference [95% CI] = 3.8% [.4–7.3%]). Remaining associations between spinal pain and cardiovascular risk in girls were nonsignificant. There were no associations between spinal pain and cardiovascular risk in boys. Moderate-to-vigorous-intensity physical activity did not appear to mediate this relationship.


These findings suggest a potentially important link between spinal pain and cardiovascular risk in girls that may be independent of health-related physical activity.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

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