Next Article in Journal
Evolution of the COVID-19 Pandemic after the Introduction of School Referral Nurses in the Province of Granada—A Descriptive Study
Previous Article in Journal
Children of Single Fathers Created by Surrogacy: Psychosocial Adjustment Considerations and Implications for Research and Practice
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Children
Volume 9
Issue 11
10.3390/children9111645
children-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Physical Activity and Recurrent Pain in Children and Adolescents in Germany—Results from the MoMo Study

by
Simon Kolb
1,*,
Alexander Burchartz
1,
Laura Krause
2,
Leon Klos
1,
Steffen C. E. Schmidt
1,
Alexander Woll
1 and
Claudia Niessner
1
1
Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
2
Robert Koch Institute, Department of Epidemiology and Health Monitoring, 12101 Berlin, Germany
*
Author to whom correspondence should be addressed.
Children 2022, 9(11), 1645; https://doi.org/10.3390/children9111645
Submission received: 10 October 2022 / Revised: 20 October 2022 / Accepted: 27 October 2022 / Published: 28 October 2022
Versions Notes

Abstract

:
Recurrent pain can be a significant disruption in the activities of daily life, and is not only a health problem in adults but also in children and adolescents. This study analyzed the prevalence of recurrent pain in the current sample (n = 1516; 11–17 years (meanage = 14.4 ± 2.0 years); 50.8% female) of a nationwide study in Germany, evaluated the association of participants’ device-based physical activity (PA) with the prevalence of recurrent pain, and assessed whether children and adolescents who reported pain for the last three months accumulated less PA than those who did not. A higher prevalence was found in girls for recurrent headaches (42.2% vs. 28.7%), abdominal pain (28.2% vs. 20.1%), and back pain (26.9% vs. 19.5%). We found higher odds for recurrent headaches in girls (OR = 1.54) and in participants that did not reach at least 60 min of moderate to vigorous PA (MVPA) per day (OR = 2.06). Girls who reported recurrent headaches accumulated 4.7 min less MVPA per day than those without. The prevalence of pain remains at a high level in the German youth and underscores the need for interventions to improve the health situations of children and adolescents.

1. Introduction

Recurrent pain is not only a health problem in adults, but also in children and adolescents [1,2,3,4], and can cause significant disruptions in daily activities [3,4,5]. Affected children have more absences from school and participate less frequently in athletic or social activities [3,5]. Furthermore, the utilization of medical care and medications increases in this group [6,7,8]. Additionally, recurrent pain has been shown to affect well-being. This can manifest itself, for example, in a reduced quality of life (HRQoL) or emotional problems such as anxiety and depressiveness [7,9].
Although the scientific evidence is limited, PA and especially aerobic activities are regularly recommended to migraine patients [10,11]. The results of a study by Pilati et al. showed a protective effect in women and support the protective role of exercise with regard to migraines [12]. Others found moderate evidence that aerobic exercise reduces the number of migraine days, but only low evidence for decreased durations of the attacks and intensity of pain [13]. In a qualitative interview study, low-intensity PA was mentioned by adolescents to be helpful in coping with headaches [14]. However, in another study, PA did not show a predictive function for any of the studied headache disorders [15]. A meta-analytic review of the hypoalgesic effects of exercise revealed highly variable magnitudes and directions of the effects in the chronic pain group, depending on the pain condition and the intensity of the exercise [16]. A possible mechanism to explain exercise-induced hypoalgesia is the release of peripheral and central beta-endorphins during exercise, which influence pain sensitivity [16]. In addition to the neurovascular processes, other cardiopulmonary as well as inflammatory processes come into question to explain how improved aerobic fitness affects pain and the perception of it [17].
Part of the conflicting results may be due to the fact that a single dose of physical activity can trigger pain or can cause a pain condition to worsen, while regular physical activity can help relieve pain by increasing serotonin levels and increasing opioids in the central inhibitory pathway [18].
Another point that must be considered in connection with the different results is the recording of PA. Most of the studies assessed PA via self-reports. Some studies ask about the number of days of physical activity without considering duration, type, and intensity [19]. Other studies, especially in the field of therapy, are based on a specific exercise program, the effectiveness of which is tested. In principle, different types and intensities of physical and sporting activity have different effects on the body, and therefore different effects on pain conditions or the perception of pain are to be expected.
Moreover, PA has also been found to be beneficial in the treatment of several conditions commonly associated with migraines (e.g., obesity, hypertension, and depression) [17]. Obesity and low levels of PA also demonstrated an independent as well as a combined association with recurrent headaches in adolescents [19].
Numerous studies from different European countries and other parts of the world have shown an increasing prevalence of headaches, among others, in recent years [3,20,21,22,23,24,25]. For Germany, the prevalence of recurrent pain is assessed by the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) within the framework of health monitoring at the Robert Koch Institute (RKI) [26].
In the KiGGS baseline study (2003–2006), more than half of children and adolescents aged 11 to 17 years reported recurrent pain [6]. Headaches, abdominal pain, and back pain were the most frequently mentioned pain locations [6]. The prevalence was higher in girls compared with boys and in the older group (14–17 years) compared with the younger group (11–13 years) [6]. While only minor changes in prevalence were observed in KiGGS Wave 1 (2009–2012) [9], the following KiGGS Wave 2 (2014–2017) revealed significant increases in the prevalence of recurrent headaches, among other pains [27]. The relation with sociodemographic variables was investigated, but neither stratification by socioeconomic status (SES) nor migrant background revealed consistent differences [9].
Due to the fact that sustainable measures can only be planned and well-founded decisions made on the basis of current data and regular surveillance, one objective of the present study was to update the prevalence of recurrent pain in children and adolescents in Germany based on a current sample of the Motorik-Modul Study (MoMo) Wave 3 (2018–2020) and to compare it with the prevalence reported in previous surveys (i.e., KiGGS Wave 2). Furthermore, the present study assessed the association between PA and recurrent headaches, which, as shown by the previous studies, are the most common type of pain in children and adolescents in Germany. Therefore, PA is captured via accelerometry and evaluated based on the recommendation of the World Health Organization (WHO). Regarding the potential mechanisms linking enhanced cardiovascular fitness and migraines, we would expect an active lifestyle to lower the odds of recurrent headaches. Additionally, the study examined whether self-reported pain in the past three months reduces device-based measured MVPA levels.

2. Materials and Methods

2.1. Procedure and Participants

The KiGGS core survey is supplemented by different in-depth modules [28]. One of these in-depth modules is the Motorik-Modul Study (MoMo) [29]. The main objectives of MoMo are to analyze the developmental and temporal trends in motor performance (MP), physical fitness (PF), and physical activity (PA), as well as their underlying influencing factors [29,30]. In addition, MoMo assesses the impact of MP/PF and PA on the health development of children and adolescents [29,30]. The selection for the representative cohort of MoMo Wave 3 was conducted according to the established procedure of the former waves. At the first level, the municipalities of the former waves were retained. In the second step, a stratified sample was randomly selected from the addresses submitted. More information about the sampling procedure can be found elsewhere [28]. The selected persons were invited to participate in the study by letter. Participation in the study was voluntary, and written consent was obtained prior to data collection. Under the age of 15, the participants had to be accompanied by a legal guardian. Each participant received an incentive after participating.
The MoMo Wave 3 data collection started in August 2018 and was scheduled to end in June 2020. Due to the COVID-19 lockdown in Germany, MoMo Wave 3 had to be interrupted in March 2020. Therefore, only data collected between August 2018 and March 2020 were used. All tests were carried out by trained personnel.
In total 2,843 participants (48.3% female) were enrolled in MoMo Wave 3. The preliminary response was 25.2% [31]. This results in a sample of 1516 participants, consisting of 770 girls (age = 14.5 ± 2.0 y., MVPA = 34.8 ± 18.3 min/day) and 746 boys (age = 14.3 ± 2.0 y., MVPA = 39.7 ± 20.1 min/day).
The STROBE statement guided the reporting of this study [32].

2.2. Measures and Variables

Except for the device-based measured PA, the data in the current study were self-reported by the participants and collected through a set of questionnaires completed on a PC or online. For information on the conception and the background of the MoMo-PA-Questionnaire (MoMo-AFB) see Schmidt et al. [33]. The reliability and validity of the MoMo-AFB are comparable to other international questionnaires [34].

2.2.1. Demographic Information

Participants were asked for their sex and date of birth. The completed years of life on the day of the examination were used as the participant’s age in years.

2.2.2. Pain

Self-reported pain in the last three months prior to the survey was captured by questionnaire. To ensure comparability with data from previous surveys, the questions about pain were adopted from the KiGGS Wave 2 questionnaire [27,35]. Participants received a list of various pain locations and indicated whether pain had occurred once, recurred, or not occurred in the past 3 months. The list of pain locations included: head, abdomen, back, ears, eyes, lower abdomen, arms/hands, legs/feet, throat, teeth, and thorax. Female participants were also asked about menstrual pain. For the analysis, the responses were dichotomized: pain occurred recurrently vs. no pain occurred or pain occurred only once (see also [27]).
Prevalence was reported for all pain types asked in the questionnaire, while further analysis focused on recurrent headaches, recurrent abdominal pain, and recurrent back pain. In addition to the individual pain variables for the three localizations, a combined dichotomous variable was formed. This variable was set to true as soon as recurrent pain was reported for at least one of the three localizations.

2.2.3. Data Selection

Due to the fact that for participants aged 4 to 10 years the questionnaire and thus the questions about pain were answered by parents, we included only data from participants aged 11 to 17 years in the analysis to avoid bias from possible parental assessment.

2.2.4. Physical Activity

After completion of the PF/MP field tests, participants were asked to wear an accelerometer (GT3X+/wGT3X-BT, ActiGraph) on the right hip during their waking hours for the following week. Before further analyses, the non-wear time was removed from the data using an algorithm implemented by Choi et al. [36]. All days with wear time of 8 h or more after the removal of the non-wear time were considered valid days. Participants needed four or more valid weekdays and at least one valid day of the weekend to be included in the further analyses. The average time (min/day) spent in MVPA was derived from the accelerometer for all valid data sets. Participants who averaged at least 60 min of MVPA per day were considered active according to the WHO recommendation [37].

2.3. Data Analysis

The prevalences of different types of recurrent pain were calculated as the proportion of participants with pain in relation to the total number of participants in the group of interest. The prevalence of each type of pain is reported with 95% confidence intervals (95% CI) for girls and boys separately.
Logistic regression was used to test whether pain could be predicted based on sex, age, and activity status.
Welch tests were used to compare the group means of the PA of participants with pain and those without pain. The Welch test has statistical power comparable to the t test when variances are equal, but unlike the latter, it is robust to unequal variances and skewed distributions [38]. This eliminates the need for a preliminary check of the test assumptions [38]. Multiple Welch tests were used to determine the differences between groups for different pain locations. Due to known differences in MVPA levels in girls and boys, the differences between participants reporting recurrent pain and those who did not were also analyzed separately for both sexes in all analyzes.
The level of significance was set to 0.05 for all statistical analyses. The analyses were performed using R statistical software (v4.1.0, [39]).

3. Results

3.1. Prevalence of Pain

Table 1 and Table 2 show the prevalence rates of the pain locations surveyed in decreasing order for girls and boys, respectively.
The prevalence rates for headache, abdominal pain, back pain, and lower abdominal pain were higher in girls than in boys. Heads, abdomens, and backs were among the most common locations of recurrent pain for both girls and boys.

3.2. Meeting the WHO PA Recommendation and Pain

The logistic regression model for headaches (X2(2) = 13.03, p = 0.001, R²(Nagelkerke) = 0.029) was significant, and it did not improve by including age. The ORs of the final model are presented in Table 3.

3.3. Pain and Physical Activity

In boys, Welch tests did not show significant differences in device-based MVPA between those who reported recurrent headaches and those who did not (Mdiff = 2.4 min, 95% CI [−2.7, 7.4], t(157.75) = 0.93, p = 0.355). There were also no differences between the boys that reported recurrent abdominal pain (Mdiff =4.5 min, 95% CI [−0.7, 9.7], t(95.13) = 1.72, p = 0.088) or back pain (Mdiff = 3.0 min, 95% CI [−3.5, 9.5], t(76.1) = 0.92, p = 0.359) and those who did not.
Girls who reported recurrent headaches in the last three months averaged 4.7 min (95% CI [0.74, 8.66], t(297.29) = 2.33, p = 0.020) less MVPA than girls who reported having no headaches. Among girls who reported recurrent back pain, MVPA was 5.8 min (95% CI [1.58, 10.04]) lower on average (t(156.63) = 2.71, p = 0.007). For abdominal pain, the difference in device-based MVPA was not significant (Mdiff =−1.3 min, 95% CI [−5.5, 3.0], t(171) = −0.58, p = 0.561).

4. Discussion

The present study aimed to describe the prevalence of recurrent pain in a German sample of children aged 11–17 years and to assess whether PA is associated with the occurrence of recurrent pain in children and adolescents.
We found differences between girls and boys in the prevalence of recurrent pain in several locations. Recurrent pain was observed more frequently in girls than in boys for headaches, abdominal pain, back pain, and lower abdominal pain. The most pronounced difference observed was for headaches. The analysis showed increased odds of recurrent headaches if the analyzed participant was a girl or if the participant failed to achieve the recommended average of 60 min of MVPA per day. We only found reduced PA levels in girls reporting recurrent pain, but not in boys.
For the most part, the prevalence observed in the present study did not differ from that reported in KiGGS Wave 2 [27]. Only the prevalence of recurrent abdominal pain in girls’ pain was higher (KiGGS Wave 2: 34.5%, 95% CI [31.9, 37.2]) than in the present study (MoMo Wave 3: 28.2%, 95% CI [25.1, 31.5]). Regarding this, we have to keep in mind that the survey in the KiGGS study was supplemented by medical examinations that do not require physical exertion on the part of the participant, while a considerable part of MoMo consists of motor test tasks. Therefore, it is possible for those, especially girls with acute complaints due to menstrual or abdominal pain, to refrain from participating in the latter. All in all, the prevalence of recurrent headaches and back pain in children and adolescents in Germany seems to remain constant on a high level over the last 5 to 10 years. Especially with regard to recurrent headaches, it seems important to take action against the high prevalence, as previous studies have shown that headaches in adolescents leads to significant impairments in HRQoL [24,40]. The fact that recurrent headaches were the most frequently cited pain in both sexes in the present data underscores the urgency of action. At the same time, the current figures indicate that either no steps have been initiated so far or that previous steps have not led to an improvement compared with the figures from KiGGS Wave 2 (2014–2017).
The Norwegian HUNT study found that recurrent headaches were associated with an unfavorable lifestyle among adolescents. The study addressed being overweight and low PA, among other factors [19]. Their analysis showed an elevated OR of recurrent headaches for overweight (OR = 1.4, 95% CI [1.2, 1.6], p < 0.001) and low PA (OR = 1.2, 95% CI [1.1, 1.4], p= 0.002) adolescents [19]. The association with being overweight was not tested in the current analysis, but higher odds were also found for the low-active group (OR (low PA) = 2.06, 95% CI [1.1, 4.17], p = 0.001). Different definitions of the threshold for low activity or the underlying metric probably explain the different magnitudes, but the direction of the effect shows a consistent picture that PA could lower the odds of recurrent headaches. The association of headaches with an unhealthy lifestyle has also been observed in other studies [41,42,43]. The lack of PA was often used as part of an expression of an unhealthy lifestyle. Therefore, the lack of PA showed an increased risk of migraines (OR = 4.2, 95% CI [2.2, 7.9]) and tension-type headaches (OR = 1.7, 95% CI [1.1, 2.7]) [42]. In addition, social stress factors such as family conflicts, school, or bullying experiences have also been identified as possible causes of headaches [44,45]. The current results underline the importance of promoting a healthy lifestyle in children and adolescents, including adequate levels of physical activity. In addition, further steps may be also beneficial, e. g., to reduce stress in the family or at school.
The difference in the prevalences of recurrent pain between girls and boys that was found in our analyses is in line with the results of KiGGS [9,27] and several international studies [23,24,46]. Various reasons are discussed as explanations. On the one hand, it is assumed that girls perceive their bodies differently than boys, and that they are more sensitive and more willing to communicate their feelings [47]. On the other hand, different pain processing in the brain and hormonal differences could play a role [48,49].
In our results, we found lower MVPA in girls with recurrent headaches or back pain compared with those who reported no pain. This suggests that the presence of pain may have a negative impact on PA, which in turn would support the findings of another population-based survey that also reported reduced MVPA in the presence of pain [50].
In summary, the results confirm the high prevalence rates reported in previous surveys of German youth. Logistic regression shows that only a small part of the variance in our sample can be explained by the factors examined. At the same time, it should be kept in mind that both physical activity and pain are very complex constructs. However, the results show a consistent picture and indicate that being female and having a low activity status are associated with a higher prevalence of recurrent pain, especially headaches and abdominal pain.
One strength of the MoMo study data set is its representative sample [28,29]. Although data collection in the current wave ended prematurely due to the pandemic, data was collected in about two-thirds of the test sites according to the preestablished protocol. On the other hand, the MoMo study uses proven methods on the different waves, which allows for comparability between the different waves of the study.
Nevertheless, there are some limitations to consider. The representativeness of the sample is compromised by the discontinuation of the study due to the pandemic. Due to the fact that the results of the study are on the same level as those of KiGGS Wave 2, it can be assumed that the impact due to early termination is manageable. Pain data were collected by questionnaire, and therefore may be biased by recall error or incorrect information due to social desirability [51,52,53]. In particular, with regard to the questions on pain, it can be seen that the recall period of three months is relatively long. To prevent misperceptions of health statuses by parents from becoming a problem, only data from children 11 years and older were analyzed. From this age, the participants fill out the questionnaire themselves. In addition, it is possible that children and adolescents currently suffering from pain may not participate in the study at all or refuse to wear the accelerometer, resulting in exclusion from the analysis due to missing data.
Last but not least, based on the cross-sectional data, we can only make statements about the correlations, but cannot draw conclusions about causal effects.

5. Conclusions

The prevalence of pain, especially of recurrent headaches, abdominal pain, and back pain, remains at a high level in girls as well as in boys in Germany, and therefore underscores the need for interventions to improve the health situation of children and adolescents. First, more research is needed to find the reasons for such a high pain prevalence while also considering sex differences in frequencies and types of pain. Lifestyle recommendations play an important role in the treatment and prevention of pain in childhood, and especially in adolescence [54]. Therefore, it is important to further investigate the effects of lifestyle factors, such as PA, to gain a better understanding and therefore make more targeted recommendations. This also needs longitudinal data to investigate causal effects between PA and pain. Furthermore, it should be considered that PA, in addition to the presumed preventive effect against pain, can also be a trigger of the same. Finally, the presence of pain can influence PA levels, and thus should therefore be considered when assessing PA to avoid bias.

Author Contributions

Conceptualization, S.K. and C.N.; Data curation, A.B.; Formal analysis, S.K.; Funding acquisition, A.W. and C.N.; Methodology, S.K.; Project administration, A.B., A.W., and C.N.; Visualization, S.K.; Writing—original draft, S.K.; Writing—review & editing, S.K., A.B., L.K. (Laura Krause), L.K. (Leon Klos), S.C.E.S., A.W. and C.N. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the Federal Ministry of Education and Research [01ER1503] within the research program ‘long-term studies’ in public health research. It has been developed within the Motorik-Modul Longitudinal Study (MoMo) (2009–2022): Physical fitness and physical activity as determinants of health development in children and adolescents. The funding source did not play a role in study design, data collection, analysis, or interpretation, but agreed to submit this manuscript.

Institutional Review Board Statement

The study was carried out according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committees of the Charité Universitätsmedizin Berlin (Baseline Study), the University of Konstanz (Wave 1), and the Karlsruhe Institute of Technology (KIT) (Wave 2 and 3, a positive ethics vote was given on 23 September 2014 by the Ethics Committee of the KIT).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Original data can be derived from the corresponding author on request.

Acknowledgments

We acknowledge the support from the KIT-Publication Fund of the Karlsruhe Institute of Technology.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Perquin, C.W.; Hazebroek-Kampschreur, A.A.; Hunfeld, J.A.; Bohnen, A.M.; van Suijlekom-Smit, L.W.; Passchier, J.; van der Wouden, J.C. Pain in children and adolescents: A common experience. Pain 2000, 87, 51–58. [Google Scholar] [CrossRef]
  2. Roth-Isigkeit, A.; Raspe, H.H.; Stöven, H.; Thyen, U.; Schmucker, P. Schmerzen bei Kindern und Jugendlichen—Ergebnisse einer explorativen epidemiologischen Studie. Schmerz 2003, 17, 171–178. [Google Scholar] [CrossRef] [PubMed]
  3. Nieswand, V.; Richter, M.; Gossrau, G. Epidemiology of Headache in Children and Adolescents-Another Type of Pandemia. Curr. Pain Headache Rep. 2020, 24, 62. [Google Scholar] [CrossRef] [PubMed]
  4. Nieswand, V.; Richter, M.; Berner, R.; von der Hagen, M.; Klimova, A.; Roeder, I.; Koch, T.; Sabatowski, R.; Gossrau, G. The prevalence of headache in German pupils of different ages and school types. Cephalalgia 2019, 39, 1030–1040. [Google Scholar] [CrossRef] [PubMed]
  5. Palermo, T.M. Impact of Recurrent and Chronic Pain on Child and Family Daily Functioning: A Critical Review of the Literature. J. Dev. Behav. Pediatr. 2000, 21, 58–69. [Google Scholar] [CrossRef]
  6. Ellert, U.; Neuhauser, H.; Roth-Isigkeit, A. Schmerzen bei Kindern und Jugendlichen in Deutschland: Prävalenz und Inanspruchnahme medizinischer Leistungen. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsblatt Gesundh. Gesundh. 2007, 50, 711–717. [Google Scholar] [CrossRef] [Green Version]
  7. Krause, L.; Mauz, E. Kopf-, Bauch- und Rückenschmerzen bei Kindern und Jugendlichen in Thüringen: Repräsentative Ergebnisse einer regionalen Modulstudie in KiGGS Welle 1. Schmerz 2018, 32, 105–114. [Google Scholar] [CrossRef]
  8. Du, Y.; Ellert, U.; Zhuang, W.; Knopf, H. Analgesic use in a national community sample of German children and adolescents. Eur. J. Pain 2012, 16, 934–943. [Google Scholar] [CrossRef]
  9. Krause, L.; Neuhauser, H.; Hölling, H.; Ellert, U. Kopf-, Bauch- und Rückenschmerzen bei Kindern und Jugendlichen in Deutschland—Aktuelle Prävalenzen und zeitliche Trends. Mon. Kinderheilkd 2017, 165, 416–426. [Google Scholar] [CrossRef]
  10. Hammond, N.G.; Colman, I. The Role of Positive Health Behaviors in the Relationship between Early Life Stress and Migraine. Headache 2020, 60, 1111–1123. [Google Scholar] [CrossRef]
  11. Busch, V.; Gaul, C. Exercise in migraine therapy--is there any evidence for efficacy? A critical review. Headache 2008, 48, 890–899. [Google Scholar] [CrossRef] [PubMed]
  12. Pilati, L.; Battaglia, G.; Di Stefano, V.; Di Marco, S.; Torrente, A.; Raieli, V.; Firenze, A.; Salemi, G.; Brighina, F. Migraine and Sport in a Physically Active Population of Students: Results of a Cross-Sectional Study. Headache 2020, 60, 2330–2339. [Google Scholar] [CrossRef] [PubMed]
  13. Lemmens, J.; de Pauw, J.; van Soom, T.; Michiels, S.; Versijpt, J.; van Breda, E.; Castien, R.; de Hertogh, W. The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: A systematic literature review and meta-analysis. J. Headache Pain 2019, 20, 16. [Google Scholar] [CrossRef] [PubMed]
  14. Skogvold, L.; Magnussen, L.H. Chronic tension-type headache and coping strategies in adolescents: A qualitative interview study. Physiother. Res. Int. 2019, 24, e1778. [Google Scholar] [CrossRef] [PubMed]
  15. Kröner-Herwig, B.; Gassmann, J. Headache disorders in children and adolescents: Their association with psychological, behavioral, and socio-environmental factors. Headache 2012, 52, 1387–1401. [Google Scholar] [CrossRef]
  16. Naugle, K.M.; Fillingim, R.B.; Riley, J.L. A meta-analytic review of the hypoalgesic effects of exercise. J. Pain 2012, 13, 1139–1150. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  17. Irby, M.B.; Bond, D.S.; Lipton, R.B.; Nicklas, B.; Houle, T.T.; Penzien, D.B. Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes. Headache 2016, 56, 357–369. [Google Scholar] [CrossRef]
  18. Lima, L.V.; Abner, T.S.S.; Sluka, K.A. Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. J. Physiol. 2017, 595, 4141–4150. [Google Scholar] [CrossRef] [Green Version]
  19. Robberstad, L.; Dyb, G.; Hagen, K.; Stovner, L.J.; Holmen, T.L.; Zwart, J.-A. An unfavorable lifestyle and recurrent headaches among adolescents: The HUNT study. Neurology 2010, 75, 712–717. [Google Scholar] [CrossRef]
  20. Wilkes, M.J.; Mendis, M.D.; Bisset, L.; Leung, F.T.; Sexton, C.T.; Hides, J.A. The prevalence and burden of recurrent headache in Australian adolescents: Findings from the longitudinal study of Australian children. J. Headache Pain 2021, 22, 49. [Google Scholar] [CrossRef]
  21. Albers, L.; von Kries, R.; Heinen, F.; Straube, A. Headache in school children: Is the prevalence increasing? Curr. Pain Headache Rep. 2015, 19, 4. [Google Scholar] [CrossRef] [PubMed]
  22. Jacobsena, B.A.; Dyb, G.; Hagen, K.; Stovner, L.J.; Holmen, T.L.; Zwart, J.-A. The Nord-Trøndelag Health Study shows increased prevalence of primary recurrent headaches among adolescents over a four-year period. Scand. J. Pain 2011, 2, 148–152. [Google Scholar]
  23. Torres-Ferrus, M.; Vila-Sala, C.; Quintana, M.; Ajanovic, S.; Gallardo, V.J.; Gomez, J.B.; Alvarez-Sabin, J.; Macaya, A.; Pozo-Rosich, P. Headache, comorbidities and lifestyle in an adolescent population (The TEENs Study). Cephalalgia 2019, 39, 91–99. [Google Scholar] [CrossRef]
  24. Philipp, J.; Zeiler, M.; Wöber, C.; Wagner, G.; Karwautz, A.F.K.; Steiner, T.J.; Wöber-Bingöl, Ç. Prevalence and burden of headache in children and adolescents in Austria—A nationwide study in a representative sample of pupils aged 10-18 years. J. Headache Pain 2019, 20, 101. [Google Scholar] [CrossRef] [Green Version]
  25. Holstein, B.E.; Andersen, A.; Denbaek, A.M.; Johansen, A.; Michelsen, S.I.; Due, P. Short communication: Persistent socio-economic inequality in frequent headache among Danish adolescents from 1991 to 2014. Eur. J. Pain 2018, 22, 935–940. [Google Scholar] [CrossRef]
  26. Hölling, H.; Schlack, R.; Kamtsiuris, P.; Butschalowsky, H.; Schlaud, M.; Kurth, B.M. Die KiGGS-Studie. Bundesweit repräsentative Längs- und Querschnittstudie zur Gesundheit von Kindern und Jugendlichen im Rahmen des Gesundheitsmonitorings am Robert Koch-Institut. Bundesgesundheitsblatt Gesundh. Gesundh. 2012, 55, 836–842. [Google Scholar] [CrossRef]
  27. Krause, L.; Sarganas, G.; Thamm, R.; Neuhauser, H. Kopf-, Bauch- und Rückenschmerzen bei Kindern und Jugendlichen in Deutschland: Ergebnisse aus KiGGS Welle 2 und Trends. Bundesgesundheitsblatt Gesundh. Gesundh. 2019, 62, 1184–1194. [Google Scholar] [CrossRef]
  28. Kurth, B.-M.; Kamtsiuris, P.; Hölling, H.; Schlaud, M.; Dölle, R.; Ellert, U.; Kahl, H.; Knopf, H.; Lange, M.; Mensink, G.B.; et al. The challenge of comprehensively mapping children’s health in a nation-wide health survey: Design of the German KiGGS-Study. BMC Public Health 2008, 8, 196. [Google Scholar] [CrossRef] [Green Version]
  29. Woll, A.; Albrecht, C.; Worth, A. Motorik-Modul (MoMo)—Das Modul zur Erfassung der motorischen Leistungsfähigkeit und der körperlich-sportlichen Aktivität in KiGGS Welle 2. J. Health Monit. 2017, 2, 66–73. [Google Scholar] [CrossRef]
  30. Bös, K. Motorik-Modul: Eine Studie zur motorischen Leistungsfähigkeit und körperlich-sportliche Aktivität von Kindern und Jugendlichen in Deutschland, 1st ed.; Abschlussbericht zum Forschungsprojekt; Nomos-Verl.: Baden-Baden, Germany, 2009; ISBN 978-3-8329-4498-8. [Google Scholar]
  31. Schmidt, S.C.E.; Anedda, B.; Burchartz, A.; Eichsteller, A.; Kolb, S.; Nigg, C.; Niessner, C.; Oriwol, D.; Worth, A.; Woll, A. Physical activity and screen time of children and adolescents before and during the COVID-19 lockdown in Germany: A natural experiment. Sci. Rep. 2020, 10, 21780. [Google Scholar] [CrossRef]
  32. Vandenbroucke, J.P.; von Elm, E.; Altman, D.G.; Gøtzsche, P.C.; Mulrow, C.D.; Pocock, S.J.; Poole, C.; Schlesselman, J.J.; Egger, M. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration. Epidemiology 2007, 18, 805–835. [Google Scholar] [CrossRef] [PubMed]
  33. Schmidt, S.C.E.; Will, N.; Henn, A.; Reimers, A.; Woll, A. Der Motorik-Modul Aktivitätsfragebogen MoMo-AFB: Leitfaden zur Anwendung und Auswertung. In Kit Scientific Working Papers; Karlsruher Institut für Technologie (KIT): Karlsruhe, Germany, 2016; p. 53. [Google Scholar] [CrossRef]
  34. Jekauc, D.; Wagner, M.O.; Kahlert, D.; Woll, A. Reliabilität und Validität des MoMo-Aktivitätsfragebogens für Jugendliche (MoMo-AFB). Diagnostica 2013, 59, 100–111. [Google Scholar] [CrossRef] [Green Version]
  35. RKI. Neue Daten für Taten. Die Datenerhebung zur KiGGS Welle 2 ist Beendet; RKI: Berlin, Germany, 2017.
  36. Choi, L.; Liu, Z.; Matthews, C.E.; Buchowski, M.S. Validation of accelerometer wear and nonwear time classification algorithm. Med. Sci. Sport. Exerc. 2011, 43, 357–364. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  37. World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour; World Health Organization: Geneva, Switzerland, 2020; ISBN 9789240015128. [Google Scholar]
  38. Rasch, D.; Kubinger, K.D.; Moder, K. The two-sample t test: Pre-testing its assumptions does not pay off. Stat. Papers 2011, 52, 219–231. [Google Scholar] [CrossRef]
  39. R Core Team. R: A Language and Enviranment for Statistical Computing; R Core Team: Vienna, Austria, 2021; Available online: www.R-Project.org (accessed on 13 August 2022).
  40. Hunfeld, J.A.; Passchier, J.; Perquin, C.W.; Hazebroek-Kampschreur, A.A.; van Suijlekom-Smit, L.W.; van der Wouden, J.C. Quality of life in adolescents with chronic pain in the head or at other locations. Cephalalgia 2001, 21, 201–206. [Google Scholar] [CrossRef] [PubMed]
  41. Hagen, K.; Åsberg, A.N.; Stovner, L.; Linde, M.; Zwart, J.-A.; Winsvold, B.S.; Heuch, I. Lifestyle factors and risk of migraine and tension-type headache. Follow-up data from the Nord-Trøndelag Health Surveys 1995–1997 and 2006–2008. Cephalalgia 2018, 38, 1919–1926. [Google Scholar] [CrossRef] [Green Version]
  42. Milde-Busch, A.; Blaschek, A.; Borggräfe, I.; Heinen, F.; Straube, A.; von Kries, R. Associations of diet and lifestyle with headache in high-school students: Results from a cross-sectional study. Headache 2010, 50, 1104–1114. [Google Scholar] [CrossRef]
  43. Queiroz, L.P.; Peres, M.F.P.; Piovesan, E.J.; Kowacs, F.; Ciciarelli, M.C.; Souza, J.A.; Zukerman, E. A nationwide population-based study of migraine in Brazil. Cephalalgia 2009, 29, 642–649. [Google Scholar] [CrossRef]
  44. Sansone, R.A.; Sansone, L.A. Bully victims: Psychological and somatic aftermaths. Psychiatry 2008, 5, 62–64. [Google Scholar]
  45. Straube, A.; Heinen, F.; Ebinger, F.; von Kries, R. Headache in school children: Prevalence and risk factors. Dtsch. Arztebl. Int. 2013, 110, 811–818. [Google Scholar] [CrossRef] [Green Version]
  46. Gobina, I.; Villberg, J.; Villerusa, A.; Välimaa, R.; Tynjälä, J.; Ottova-Jordan, V.; Ravens-Sieberer, U.; Levin, K.; Cavallo, F.; Borraccino, A.; et al. Self-reported recurrent pain and medicine use behaviours among 15-year olds: Results from the international study. Eur. J. Pain 2015, 19, 77–84. [Google Scholar] [CrossRef] [PubMed]
  47. Moré, A. Zur Geschlechtsspezifik bei (neuro) psychologischen und psychosomatischen Störungen aus der Sicht der pädiatrischen Psychologie. In Gender Medizin: Geschlechtsspezifische Aspekte Fur Die Klinische Praxis; Rieder, A., Lohff, B., Eds.; Springer: Dordrecht, The Netherlands, 2007; pp. 89–106. ISBN 978-3-211-68289-0. [Google Scholar]
  48. Vincent, K.; Tracey, I. Hormones and their Interaction with the Pain Experience. Rev. Pain 2008, 2, 20–24. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  49. de Leeuw, R.; Albuquerque, R.J.C.; Andersen, A.H.; Carlson, C.R. Influence of estrogen on brain activation during stimulation with painful heat. J. Oral Maxillofac. Surg. 2006, 64, 158–166. [Google Scholar] [CrossRef] [PubMed]
  50. Swain, M.S.; Henschke, N.; Kamper, S.J.; Gobina, I.; Ottová-Jordan, V.; Maher, C.G. Pain and Moderate to Vigorous Physical Activity in Adolescence: An International Population-Based Survey. Pain Med. 2016, 17, 813–819. [Google Scholar] [CrossRef] [Green Version]
  51. Jekauc, D.; Reimers, A.; Woll, A. Methoden der Aktivitätsmessung bei Kindern und Jugendlichen. BG Beweg. Gesundh. 2014, 30, 79–82. [Google Scholar] [CrossRef]
  52. Kahlert, D.; Brand, R. Comparing Self-Report and Accelerometry Data. A Contribution to the Validation of the MoMo-Physical Activity Questionnaire for Children and Adolescents. Dtsch. Z. Sportmed. 2011, 62, 36. [Google Scholar]
  53. Müller, C.; Winter, C.; Rosenbaum, D. Current Objective Techniques for Physical Activity Assessment in Comparison with Subjective Methods. Dtsch. Z. Sportmed. 2010, 61, 11–18. [Google Scholar]
  54. Raucci, U.; Boni, A.; Evangelisti, M.; Della Vecchia, N.; Velardi, M.; Ursitti, F.; Terrin, G.; Di Nardo, G.; Reale, A.; Villani, A.; et al. Lifestyle Modifications to Help Prevent Headache at a Developmental Age. Front. Neurol. 2020, 11, 618375. [Google Scholar] [CrossRef]
Table
Table 1. Prevalence and 95% CI of recurrent pain in girls.
Table 1. Prevalence and 95% CI of recurrent pain in girls.
Pain LocationNPrevalence (in %)Lower 95% CI (in %)Upper 95% CI (in %)
head75642.7 *39.246.3
menstrual pain 151041.437.245.7
abdomen75228.2 *25.131.5
back75526.9 *23.830.2
legs/feet61321.918.825.3
lower abdomen61420.0 *17.123.4
throat61412.710.315.6
arms/hands6128.56.511.0
thorax7515.54.07.3
teeth6115.23.77.3
eyes6144.12.85.9
ears6132.31.43.8
* different from prevalence in boys, p < 0.05, 1 menstrual pain was only analyzed for girls.
Table
Table 2. Prevalence and 95% CI of recurrent pain for boys.
Table 2. Prevalence and 95% CI of recurrent pain for boys.
Pain LocationNPrevalence (in %)Lower 95% CI (in %)Upper 95% CI (in %)
head72928.7 *25.532.1
legs/feet61222.719.626.2
abdomen72820.1 *17.323.1
back72819.5 *16.822.5
throat61311.69.314.4
arms/hands6127.55.79.9
thorax7245.13.77.0
teeth6124.73.36.7
ears6142.11.23.6
eyes6143.42.25.2
lower abdomen7081.6 *0.93.0
* different from prevalence in girls, p < 0.05.
Table
Table 3. Logistic regression model for recurrent headaches.
Table 3. Logistic regression model for recurrent headaches.
OR (95% CI)p
(Intercept)0.21 (0.11–0.39)<0.001
Sex
MaleRef.
Female1.54 (1.09–2.18)0.014
Meeting the recommendation
YesRef.
No2.06 (1.1–4.17)0.033
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Kolb, S.; Burchartz, A.; Krause, L.; Klos, L.; Schmidt, S.C.E.; Woll, A.; Niessner, C. Physical Activity and Recurrent Pain in Children and Adolescents in Germany—Results from the MoMo Study. Children 2022, 9, 1645. https://doi.org/10.3390/children9111645

AMA Style

Kolb S, Burchartz A, Krause L, Klos L, Schmidt SCE, Woll A, Niessner C. Physical Activity and Recurrent Pain in Children and Adolescents in Germany—Results from the MoMo Study. Children. 2022; 9(11):1645. https://doi.org/10.3390/children9111645

Chicago/Turabian Style

Kolb, Simon, Alexander Burchartz, Laura Krause, Leon Klos, Steffen C. E. Schmidt, Alexander Woll, and Claudia Niessner. 2022. "Physical Activity and Recurrent Pain in Children and Adolescents in Germany—Results from the MoMo Study" Children 9, no. 11: 1645. https://doi.org/10.3390/children9111645

APA Style

Kolb, S., Burchartz, A., Krause, L., Klos, L., Schmidt, S. C. E., Woll, A., & Niessner, C. (2022). Physical Activity and Recurrent Pain in Children and Adolescents in Germany—Results from the MoMo Study. Children, 9(11), 1645. https://doi.org/10.3390/children9111645

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop