{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T21:11:47Z","timestamp":1788297107956,"version":"build-2803163510"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Introduction<\/jats:title>\n Daily schoolbag carriage represents a common mechanical load in school-aged children and has been associated with alterations in gait mechanics, postural control, and plantar pressure distribution. However, evidence regarding the effectiveness of structured exercise programs in reducing these biomechanical alterations during schoolbag carriage remains limited. Therefore, identifying effective intervention strategies is important for promoting musculoskeletal health during growth.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the effects of a 16-week structured exercise program on maximum plantar pressure and weight-bearing symmetry during walking with a schoolbag in school-aged children.<\/jats:p>\n <\/jats:sec>\n \n Research methodology<\/jats:title>\n \n A controlled non-randomized experimental study was conducted involving 147 school-aged children (experimental:\n n<\/jats:italic>\n \u202f=\u202f74; control:\n n<\/jats:italic>\n \u202f=\u202f73). Pre- and post-intervention assessments were performed using the T&amp;T Medilogic\n \u00ae<\/jats:sup>\n plantar pressure system during walking with a standardized schoolbag load. Maximum plantar pressure and weight-bearing symmetry were analyzed using repeated-measures ANOVA, paired-, and independent-samples\n t<\/jats:italic>\n -tests, with effect sizes estimated using Cohen\u2019s\n d<\/jats:italic>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The experimental group demonstrated a significant reduction in maximum plantar pressure during walking with a schoolbag (\n p<\/jats:italic>\n \u202f=\u202f0.010;\n d<\/jats:italic>\n \u202f=\u202f\u22120.31), whereas no significant change was observed in the control group (\n p<\/jats:italic>\n \u202f=\u202f0.37). Between-group comparisons confirmed a significant intervention effect (\n p<\/jats:italic>\n \u202f=\u202f0.016). The reduction in plantar pressure was accompanied by improved weight-bearing symmetry, indicating a more favorable distribution of plantar loads during functional load carriage.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The structured exercise program reduced maximum plantar pressure and improved weight-bearing symmetry during walking with a schoolbag, supporting better postural control under functional loading conditions. These findings support the implementation of targeted school-based exercise programs to promote musculoskeletal health and reduce the biomechanical demands associated with daily schoolbag carriage in children.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1887693","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T05:35:30Z","timestamp":1786426530000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Load-carrying biomechanics in children: programed exercise enhances postural resilience and reduces plantar pressure under backpack load"],"prefix":"10.3389","volume":"14","author":[{"given":"Aida","family":"Bendo","sequence":"first","affiliation":[{"name":"Department of Movement and Health, Faculty of Physical Activity and Recreation, Sports University of Tirana","place":["Tirana, Albania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Nuriu","sequence":"additional","affiliation":[{"name":"Department of Physical Activity and Health, Institute of Scientific Research in Sport, Sports University of Tirana","place":["Tirana, Albania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1007\/s00421-020-04592-2","article-title":"The development of mature gait patterns in children during walking and running","volume":"121","author":"Bach","year":"2021","journal-title":"Eur J Appl Physiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"740509","DOI":"10.3389\/fnhum.2021.740509","article-title":"Development of the relationships among dynamic balance control, inter-limb coordination, and torso coordination during GAIT in children aged 3\u201310 years","volume":"15","author":"Mani","year":"2021","journal-title":"Front Hum Neurosci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e0281037","DOI":"10.1371\/journal.pone.0281037","article-title":"Developmental changes in straight gait in childhood","volume":"18","author":"Miyagishima","year":"2023","journal-title":"PLoS One"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"7598","DOI":"10.1109\/EMBC.2015.7320151","article-title":"Dependence of gait parameters on height in typically developing children","volume":"2015","author":"Agostini","year":"2015","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.math.2015.05.001","article-title":"The effects of training and detraining after an 8-month resistance and stretching training program on forward head and protracted shoulder postures in adolescents: randomised controlled study","volume":"21","author":"Ruivo","year":"2016","journal-title":"Man Ther"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1532035","DOI":"10.3389\/fped.2025.1532035","article-title":"Are school-based behavioural interventions an effective strategy for improving physical activity and sedentary behaviour in children and adolescents? 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Schoolchildren's perceptions of load, associations with back pain and factors determining the load","volume":"27","author":"Negrini","year":"2002","journal-title":"Spine"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1139\/H08-020","article-title":"Canadian Society for Exercise Physiology position paper: resistance training in children and adolescents","volume":"33","author":"Behm","year":"2008","journal-title":"Appl Physiol Nutr Metab"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1007\/s40279-019-01215-5","article-title":"Efficacy of school-based interventions for improving muscular fitness outcomes in adolescent boys: a systematic review and meta-analysis","volume":"50","author":"Cox","year":"2020","journal-title":"Sports Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"S60","DOI":"10.1519\/JSC.0b013e31819df407","article-title":"Youth resistance training: updated position statement paper from the National Strength and conditioning association","volume":"23","author":"Faigenbaum","year":"2009","journal-title":"J Strength Cond Res"},{"key":"ref20","volume-title":"WHO Guidelines on Physical Activity and Sedentary Behaviour","year":"2020"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1194779","DOI":"10.3389\/fpubh.2023.1194779","article-title":"Comparative effectiveness of school-based exercise interventions on physical fitness in children and adolescents: a systematic review and network meta-analys","volume":"11","author":"Wu","year":"2023","journal-title":"Front Public Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1038\/s41598-025-31557-2","article-title":"The effect of school-based functional training for physical fitness and postural health among children: a school-based cluster intervention trial","volume":"16","author":"Zhu","year":"2025","journal-title":"Sci Rep"},{"key":"ref23","volume-title":"Discovering Statistics using IBM SPSS Statistics","author":"Field","year":"2018"},{"key":"ref24","first-page":"56","volume-title":"Structural Equation Modeling: Concepts, Issues, and Applications","author":"West","year":"1995"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1007\/s13312-010-0130-2","article-title":"Effect of backpack weight on postural angles in preadolescent children","volume":"47","author":"Ramprasad","year":"2010","journal-title":"Indian Pediatr"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1080\/00140130500070921","article-title":"The effect of backpack load on the gait of normal adolescent girls","volume":"48","author":"Chow","year":"2005","journal-title":"Ergonomics"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/s0966-6362(02)00050-4","article-title":"Gait and posture responses to backpack load during level walking in children","volume":"17","author":"Hong","year":"2003","journal-title":"Gait Posture"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5539\/gjhs.v7n2p1","article-title":"Evaluation of limb load asymmetry using two new mathematical models","volume":"7","author":"Kumar","year":"2014","journal-title":"Global J Health Sci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"45","DOI":"10.7205\/milmed.169.1.45","article-title":"Soldier load carriage: historical, physiological, biomechanical, and medical aspects","volume":"169","author":"Knapik","year":"2004","journal-title":"Mil Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.apergo.2004.10.007","article-title":"The effect of simulated school load carriage configurations on shoulder strap tension forces and shoulder interface pressure","volume":"36","author":"Mackie","year":"2005","journal-title":"Appl Ergon"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"13777","DOI":"10.1038\/s41598-024-63745-x","article-title":"The effect of body weight on the knee joint biomechanics based on subject-specific finite element\u2013musculoskeletal approach","volume":"14","author":"Adouni","year":"2024","journal-title":"Sci Rep"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1080\/00140130701194850","article-title":"Evaluation of the effect of backpack load and position during standing and walking using biomechanical, physiological and subjective measures","volume":"50","author":"Devroey","year":"2007","journal-title":"Ergonomics"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/00024720-200402000-00008","article-title":"Correlation between backpack weight and way of carrying, sagittal and frontal spinal curvatures, athletic activity, and dorsal and low back pain in schoolchildren and adolescents","volume":"17","author":"Korovessis","year":"2004","journal-title":"J Spinal Disord 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