Background
The benefits of regular physical activity on general health is well established. Organizations such as the World Health Organization and The American College of Sports Medicine has stated that regular physical activity provides many health benefits, however this has mainly been studied in an adult population. Very little information exists on how activity levels can affect a child’s overall health. This study aims to evaluate the association of a validated activity scale, the HSS Pedi-FABS, with global health scores in a pediatric population.
Methods
A retrospective review of youth athletes age 6 to 19 presenting for evaluation at a single pediatric sports medicine clinic between April 2016 and July 2020 was performed. Participants were included if they completed a pre-visit intake questionnaire, the HSS Pedi-FABS, and the PROMIS® Pediatric Global Health 7 (PGH7) with Fatigue (PGHF) and Pain Interference (PGHPI) components as part of standard of care treatment. Patient demographics, sport, level of competition, frequency of sport participation, HSS Pedi-FABS Quartiles, PROMIS® PGH T-scores and HSS Pedi-FABS scores were compared utilizing a Kruskal-Wallis test followed by the Dwass, Steel, and Critchlow-Flinger method for multiple comparisons. Spearman’s Correlations were calculated to evaluate HSS Pedi-FABS score association with patient reported participation in sport (level, hours, weeks) and PROMIS® PGH T-scores.
Results
1049 sports medicine patients (mean age 14.7 ± 2.4 years; 52.1% females) reported participating in sports for 9.3 ± 7.0 hours per week during 30.6 ± 15.9 weeks per year with 6.3 ± 3.4 years of participation in their primary sport. The mean PGH7 score was 50.9 ± 8.6, while PGHF was 49.2 ± 6.5 and PGHPI was 51.1 ± 6.9. All three PGH components correlated significantly with the HSS Pedi-FABS (PGH7: r=0.27, p<0.01 / PGHF: r=-0.15, p<0.01 / PGHPI: r=-0.11, p<0.01).
The mean PGH7 score in the bottom quartile (47.7 ± 8.9) of HSS Pedi-FABS scores was significantly lower than in the top three quartiles (p<0.01). There was no significant difference between the second and third quartile means (50.9 ± 8.1 vs. 52.1 ± 8.0, p<0.30), while the fourth quartile (54.0 ± 7.7) was higher than the rest (p<0.01). The first quartile had significantly higher PGH Fatigue (Q1=50.5 ± 6.7 vs Q2=49.1 ± 6.3 vs Q3=48.7 ± 6.3 vs Q4=48.1 ± 6.2; p<0.05) and PGH Pain Interference scores (Q1=52.3 ± 7.1 vs Q2=50.5 ± 6.9 vs Q3=50.6 ± 6.9 vs Q4=50.6 ± 6.4; p<0.05).
Conclusion
The correlation between HSS Pedi-FABS and PROMIS® Pediatric Global Health Scores indicates an association between increased activity with increased global health. Pediatric patients with the lowest activity level, according to the HSS Pedi-FABS, report the lowest PROMIS® Global Health scores and the highest Fatigue and Pain Interference scores. This association suggests that higher childhood and adolescent activity levels are associated with improved global health scores and may serve as a basis for future research supporting public health initiatives promoting increased physical activity for pediatric wellbeing.