Programs of Postural Education with Physical Activity in School Settings: A Systematic Review

The aim of the study was to investigate scientific evidence related to the protocols and effects of PEPs using theoretical and practical approaches and physical activity in school environments.

This systematic review was conducted according to the PRISMA guidelines and registered on the PROSPERO platform. The search was conducted in five electronic databases until December 2024. Randomized controlled clinical trials, non-randomized clinical trials, and quasi-experimental, interventional, and longitudinal studies published over the last 10 years were included. The studies involved children and adolescents with typical development, participating in postural education interventions in school environments that involved physical activity. Methodological quality was assessed using the PEDro Scale, and the risk of bias was evaluated using ROB 2_cluster and ROBINSI.

From 1,147 identified records, 11 studies met the eligibility criteria, involving 35-4,695 participants aged 5-16 years. While most studies reported improvements in postural knowledge and health education, findings on postural habits, pain reduction, and muscular endurance were inconsistent. Randomized clinical trials and most other studies exhibited good and reasonable methodological qualities, respectively. High and moderate risks of bias were prevalent.

Variability in assessment methods, interventions, and physical activity components limits standardization, yet studies aim to prevent postural changes and promote postural care to improve health in children and adolescents.

PEPs incorporating physical activity show promise in improving postural knowledge, though evidence on long-term benefits for low back pain and postural behaviors remains inconclusive. Future research should standardize protocols and assess sustained outcomes.