Self-reported physical activities in patients with adolescent idiopathic scoliosis-A cross-sectional observational study

ABSTRACT

Introduction: The impact of idiopathic scoliosis on exercise and activities of affected adolescents are not well-documented. The aim of this study was to assess the self-reported physical activity (PA) of patients with Adolescent Idiopathic Scoliosis (AIS) in Hong Kong. Materials and Methods: This was an observational, cross-sectional study conducted at a scoliosis clinic in a tertiary referral centre in Hong Kong. Patients referred from the Hong Kong Scoliosis School Screening Programme were consecutively recruited and asked to fill in the Chinese-translated version of the Paffenbarger Physical Activity Questionnaire (PPAQ) online. Details included flights of stairs climbed, city blocks walked, and frequency, duration and intensity of sporting activities were recorded, from which a Physical Activity Index (PAI) in kilocalories/week (kcal/week) was calculated. The PAI provides an estimate of the total energy expenditure of the subject. Radiographic data including Cobb angles and region of major curve, and anthropometric data was collected from routine clinical examinations. Results: 33 male (mean age = 14.6 ± 1.84) and 102 female (mean age = 13.2 ± 1.46) were included in the study. The mean BMI of male patients was 17.3 ± 2.2 kg/m2, and that of females was 18.0 ± 3.06 kg/m2, both of which are classified as underweight. 64 patients had a mild Cobb angle (10°-24.9°), 52 had a moderate Cobb angle (25°-39.9°) and 17 had a severe Cobb angle (>40°). In terms of PA, 72 patients (53%) reported participation in yearly PA activity excluding physiotherapy and mandatory physical education classes, and 55 (40.7%) in weekly PA that caused sweating, increased heart rate and shortness of breath. The 80 patients that did not participate in any PA were asked to provide reasons for their lack of physical activity. 30% of patients reported "lack of time" and 16.3% reported "laziness". Other reasons include lack of interest (6.3%), the COVID pandemic (2.5%) and being unfit (5%). A Physical Activity Index (PAI) in kcal/week was calculated based on subjects' answers to flights of stairs climbed, city blocks walked and sporting activities. Patients that were unable to provide a numerical answer to such questions were excluded from the PAI calculations. 113 PAIs were calculated, with a mean of 2611.2 ± 5009.4 kcal/week, and a median of 1128.4 kcal/week. 48 patients (42.5%) expended under 1000 kcal/week, 30 patients (26.5%) expended 1000-2000 kcal/week, 21 patients (18.6%) expended 2000-4000 kcal/week, and 14 patients (12.4%) expended over 4000kcal/week. According to the WHO guidelines on Physical Activity and Sedentary Behavior, PA recommendations for children and adolescents include 60 minutes of moderate-to-vigorous-intensity PA per day, which totals to 365 hours per week. Only 2 patients fulfilled this criterion. Conclusion: Adolescents with AIS in Hong Kong exhibited a wide range of PA levels. However, the majority of AIS patients in this study did not participate adequate physical activity according to WHO guidelines. Further studies are required to correlate if AIS negatively impacted on their motivation to participate in physical activities and exercises.