A 16-week structured exercise program significantly reduced maximum plantar pressure (p=0.010; d=-0.31) and improved weight-bearing symmetry during walking with a schoolbag in school-aged children, supporting better postural control under functional loading conditions.
Key Findings
Results
The experimental group demonstrated a significant reduction in maximum plantar pressure during walking with a schoolbag following a 16-week structured exercise program.
Within-group comparison for the experimental group yielded p=0.010 with effect size d=-0.31 (small effect)
No significant change was observed in the control group (p=0.37)
Between-group comparisons confirmed a significant intervention effect (p=0.016)
Plantar pressure was measured using the T&T Medilogic® plantar pressure system during walking with a standardized schoolbag load
Results
The reduction in maximum plantar pressure was accompanied by improved weight-bearing symmetry in the experimental group.
Improved weight-bearing symmetry indicated a more favorable distribution of plantar loads during functional load carriage
Weight-bearing symmetry was analyzed using repeated-measures ANOVA, paired-, and independent-samples t-tests
Effect sizes were estimated using Cohen's d
No corresponding improvement in weight-bearing symmetry was reported for the control group
Methods
The study involved 147 school-aged children assigned to experimental and control groups in a controlled non-randomized experimental design.
Experimental group: n=74; control group: n=73
The study was a controlled non-randomized experimental design
Pre- and post-intervention assessments were performed at both time points
The intervention duration was 16 weeks
Assessments were conducted during walking with a standardized schoolbag load
Background
Daily schoolbag carriage in school-aged children has been associated with alterations in gait mechanics, postural control, and plantar pressure distribution.
Evidence regarding the effectiveness of structured exercise programs in reducing these biomechanical alterations during schoolbag carriage was described as 'limited' prior to this study
The authors identified this gap as motivation for evaluating structured exercise as an intervention strategy
Musculoskeletal health during growth was identified as the primary health concern
Conclusions
The structured exercise program supported better postural control under functional loading conditions in children carrying schoolbags.
The authors concluded that findings support 'the implementation of targeted school-based exercise programs to promote musculoskeletal health'
The program was described as reducing 'the biomechanical demands associated with daily schoolbag carriage in children'
Improvements were observed specifically under functional load carriage conditions, not just unloaded conditions
What This Means
This research suggests that a 16-week structured exercise program can meaningfully change how children's feet bear weight when they carry a schoolbag. The study measured maximum plantar pressure — essentially how much force is concentrated on the feet — and how evenly that force is distributed between feet while children walked with a standardized backpack load. Children who participated in the exercise program showed a statistically significant reduction in peak plantar pressure and more balanced weight distribution compared to children who did not participate, who showed no meaningful change over the same period.
The study included 147 school-aged children split into an exercise group (74 children) and a comparison group (73 children). The effect size was small (Cohen's d = -0.31), meaning the difference, while statistically significant, was modest in magnitude. Nevertheless, both the within-group and between-group comparisons supported the conclusion that the exercise program had a genuine effect on how children's bodies managed the mechanical stress of carrying a schoolbag.
This research matters because millions of children carry heavy schoolbags daily, and uneven or excessive plantar pressure during growth has been associated with musculoskeletal concerns. The findings suggest that school-based exercise programs — which are relatively accessible and low-cost to implement — could be a practical tool for reducing the physical strain children experience from everyday backpack carriage, potentially supporting healthier musculoskeletal development during childhood.
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Bendo A, Nuriu D. (2026). Load-carrying biomechanics in children: programed exercise enhances postural resilience and reduces plantar pressure under backpack load.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1887693