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Schools on the move: how a strategic approach to promoting exercise can prevent musculoskeletal disorders

Around one third of school children and young people are already suffering from musculoskeletal disorders (MSDs), which may become worse once they join the work force. Early prevention and adopting a lifelong approach to good musculoskeletal health is therefore paramount for good occupational safety and health (OSH) and healthy ageing. Schools are an ideal setting for early and long-term prevention of MSDs, but a coherent strategy - serving both OSH and educational goals - is needed for successful implementation.


Photo by Spikeball on Unsplash

According to the World Health Organization (WHO) it is not only important that children and young people exercise often, but equally important that they do seated work as rarely as possible. Active playing and transport (cycling or walking) and participating in sports are the most important elements of promoting exercise in children. However, not even every fifth young person meets the WHO recommendations of at least 60 minutes of moderate to vigorous physical activity per day.

Exercise and physical activity can effectively prevent MSDs and involving schools in strengthening and boosting health-promoting and preventive activities seems like the next logical step. Early prevention is necessary as the majority of health issues occur or have their foundations laid in childhood or adolescent years, not in adulthood. Similarly, good OSH can only be achieved if children and young people acquire health competences during their school education.

But despite these facts we still witness a lack of integrating MSD prevention in the school curriculum. In that respect, Heinz Hundeloh, former head of the educational institutions department of the German social accident insurance (DGUV), highlights that “What is now standard for topics such as diet, tobacco, illegal drugs, violence and mental health is not (yet) the case for MSDs.”


What are the success factors to promoting exercise in schools?

To enable the most effective implementation, a variety of success factors should be considered.

Promoting physical activity is to be rooted in a school’s pedagogical concept. Speaking the language of the school and taking into account its characteristics and needs is key here.

Goals that are beneficial and realistic while also challenging can contribute to establishing the necessary willingness to change amongst school members.

Any measures should be implemented in cooperation with the education sector. This means coordination in the design, planning, implementation and evaluation with the national education ministry, regional or local school authorities or the schools involved. Cooperation with the community and other partnerships, for example with sport and health organisations can form synergies and increase acceptance in schools.

The availability of sufficient, suitable resources and support also plays a key role. Teachers need to be adequately prepared and have the right skill set (social, communicative, subject-specific and didactic-methodological) or receive adequate training. Rooms and equipment for exercise and physical activity must be safe and well maintained.


How can we ensure long-term effectiveness?

Experience shows that many school interventions to promote physical activity and prevent MSDs fail in the long-term. Lasting effectiveness of measures can be positively influenced by these principles:

Firstly, exercise- and health-related behavioural skills should be taught in a structured way and practised, considering the didactic and methodological design of the sports classes. Students that are competent in physical activity and health also develop the skills, confidence and understanding to continue exercise over the course of their lives. Measures should also address the general health competence and exercise skills of teachers and support them in their acquisition.

Another aspect is that any measure should look at as many fields of action in the school system as possible, such as the school sports policy, teacher training, curriculum development, teaching materials, infrastructure, lesson development and school culture. Similarly, measures should not be limited to physical exercise classes, but span all subjects.

Lastly, measures should not be planned as a one-off initiative, but as a long-term intervention within the school development process. This method also takes into account that every school is unique and there is no intervention that works for every school. Every school should be the driver of its own change.

Examples of good and comprehensive concepts, recommended by the European Network Education and Training in Occupational Safety and Health (ENETOSH), include the German ‘Good Healthy School concept’ as well as the ‘Schools for Health in Europe’ approach.

More details on the strategic approach can be found in the report Better Schools by Promoting Musculoskeletal Health.

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