Almost all young Australians , including pre-schoolers, are not as physically active as they should be with 9 out of 10 young Australians sitting too much and not moving enough, according to the recommended Australian guidelines [1]. A change towards sedentary lifestyles has happened for many people in many developed countries, including Australia [Australian Institute of Health and Welfare (2004) as cited in 2]. With improved access to mobile phones and the internet, children do not need to leave home to keep in contact with their friends outside of school. Children today are far less likely than children of earlier generations to walk or cycle to get from A to B, or to play outdoors [2].

Instead, children are spending more than the recommended two hours each day using electronic media. The SPANS study in New South Wales found that 61 per cent of boys and 45 per cent of girls in year six (aged approximately 11–12 years) were using more than two hours per day of electronic media. This percentage was higher in older age groups: in year 10, 78 per cent of boys and 67 per cent of girls fell into this group [2].

This increased screen time, combined with a lack of physical activity, can lead to young children being overweight, which often continues into adulthood [3]. In Australia, more than 1 in 4 children and adolescents are overweight or obese and it is predicted that 65 per cent of young Australians will be overweight or obese by 2020 [4]. Increases in the number of overweight and obese children leads to an increasing number of children who suffer with illnesses - including diabetes, asthma and mental health problems -as well as physical pain in muscles and joints, such as back pain [2]. Even type 2 diabetes - a chronic disease traditionally diagnosed only among adults - is now increasingly being detected in Australian children. Research also shows that overweight and obese children are more likely to be overweight or obese adults. Around 80 per cent of Australia’s obese adolescents will become obese adults [4]. This in turn can lead to a number of serious chronic conditions and even premature death [2].

active commute
back health

Keeping children physically active

National guidelines for physical activity recommend infants and preschool children be physically active for at least three hours daily [5] and older children at least one hour [1, 6, 7]. The benefits of physical activity are enhanced further when children are more physically active than these recommended times [7]. The guidelines also provide recommendations for the types of physical activity that are appropriate for children.

National guidelines for sedentary behaviour recommend infants and preschool children should not be sedentary, restrained, or kept inactive for more than one hour at a time [5], and for older children these sedentary activities should be broken up as much as possible [1, 6]. These guidelines also recommend that the amount of time children spend sitting and watching television and using other electronic media (DVDs, computer and other electronic games) should be limited to one hour daily for infants [5] and preschool children and two hours daily for older children [1, 6].

Participation in physical activity

It is widely accepted that being physically active provides numerous health benefits. These have been described in a review by Buhlert-Smith, Hagiliassis [8] whose summary is based on works of the Australian Government Department of Health [6], the Centre for Community Child Health [3] and the World Health Organization [7], including:

Social benefits:

  • creates opportunities for social interaction, making friends and having fun
  • reduces anti-social behaviours
  • develops cooperation and teamwork skills

Emotional and intellectual benefits:

  • improves self-expression
  • improves self-esteem, confidence and independence
  • improves management of anxiety, stress and depression
  • improves concentration
  • promotes relaxation

Health benefits:

  • improves physical fitness by improving heart and lung functions
  • improves balance, coordination and movement skills
  • improves posture
  • improves flexibility
  • builds stronger muscles and bones
  • promotes healthy joint tissues
  • promotes healthy growth and development
  • reduces the risk of unhealthy weight gain by controlling the expenditure of energy 
  • reduces the risk of developing type 2 diabetes and cardiovascular disease


An active commute – walking or riding to school

Increased use of cars and the associated reduction in physical activity participation is a crucial factor in the rise in childhood obesity [4]. An easy way for school children to increase their physical activity participation is to walk or ride to school, but this type of commute is also in significant decline, with the 2015 Active Healthy Kids Australia [11] study finding:

  • 42 per cent decline in children walking or riding a bike or scooter to or from school, in the past 40 years, with no signs of this decline slowing down [11, p.18]
  • only 50 per cent of children and young people in Australia use active transport (bike, scooter) at least once a week to travel to or from school [11, p.11]
  • just 11 per cent of children ride a bike to or from school, however 90 per cent of Australian households have at least one child’s bike in working order [11, p.6]

The Australian Physiotherapy Association (APA) strongly advises parents to encourage their children to walk, ride a bike or scooter to school daily as an easy way for them to increase their physical activity participation. The study also found that active transport (through walking or riding a bike or scooter) provides a key contribution to the overall physical activity levels of children and young people in Australia and is feasible, given it can be easily incorporated into daily routines with minimal planning prior and involves little to no financial cost [11].

Riding and walking to school – avoiding injuries and pain from school bags

Children walking or riding to school need to have the correct school bag to avoid injury, as about 70 per cent of Australian school children may suffer back pain from school bags [12].
To avoid back, neck and shoulder pain, postural changes and injuries, school bags should be backpack style, should not be more than moderately heavy for them and being appropriate for each child’s size with padded and adjusted straps over the shoulders.
As experts in movement and health, physiotherapists can play a vital role in ensuring children using backpacks and undertaking physical activity do these activities safely, to minimise their risk of injury.



Poorly fitting backpacks – what’s the impact on children?

  • Fatigue (reported by 65.7% Australian children) [12]
  • Muscle strain [13-15]
  • Joint injury [13]
  • Back pain [12-15] (reported by 46.1% Australian children) [12]
  • Neck and shoulder pain [13]
  • Lower back pain lasting into adulthood [16]
  • Postural changes [13-16]
  • Injuries to head/face, hand, wrist/elbow, shoulder, foot/ankle as a result of tripping, wearing and being hit by backpacks [17]

Children’s backpacks - injury warning signs and key recommendations

Injury warning signs

  • Posture changes when backpack on [12, 14]
  • Pain [13, 14]
  • Pins and needles in arms/hands [13, 14, 16] or legs [16]
  • Red marks on shoulders [14] especially at the front [16]
  • Difficulty getting backpack on/off [13, 16]

Choosing the right backpack for your child

  • Appropriate for your child’s size (examples: purchase new as they grow, no wider than child’s chest) [12, 14, 15]
  • Two straps over the shoulders [12-16]
  • Wide straps [13, 15]
  • Hip strap [12-14, 16] and/or moulded frame [12, 14] and/or waist strap [15]
  • Separate compartments for load distribution [12, 14, 16]
  • Padded straps [12, 14, 15]
  • Adjustable straps [12]
  • Padded back [13, 16]
  • Endorsed by a professional association such as the APA [12, 14]
  • Agreed between yourself and your child [12, 14]
  • Comfort and fit over looks [13]

Recommendations for backpack wear

  • Sit just above the waist; don’t hang low over the buttocks [12, 14]
  • Sit no lower than the small of the back [15]
  • Contour snugly to the back/load carried close to the back [12-14]
  • Heavy items placed closest to the spine [12, 14, 16]
  • Items packed snugly to minimise items/load moving [12, 14]
  • Bend knees when lifting to pick up and put on backpack [12, 13, 16], or put on using a bench [14]


Physiotherapists, with their education, training and competence - in physical activity, therapeutic exercise, behaviour change, anatomy and biomechanics - are *ideally suited to assess children’s backpacks and foot health issues and make recommendations to avoid injuries. They can also identify, manage and prevent children’s health conditions associated with physical inactivity and sedentary behaviours.

*The APA has strong partnerships with two companies that specialise in school products. These two companies are Ascent Footwear with the APA endorsing their school shoe range which are exclusively available via The Athletes Foot and Spartan School supplies with the APA endorsing their Primary Physio Pak and Primary Pak which are available via their website:

Physiotherapists play a key role in enhancing children’s physical activity participation and reducing their sedentary behaviours by educating children and their families about the:

  • types of physical activity that are safe and appropriate for their unique needs
  • consequences of physical inactivity and sedentary behaviours
  • levels of physical activity required for their childrens’ health
  • Find out more about how a physiotherapist can help you with your child’s exercise program on

Speak to an APA physio

Find a physiotherapist in your area here.

Help up spread the message

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The APA is grateful to contributors Julianne Pegler and Kirsty Buhlert-Smith.

Physios warn about the dangers of big, bulky school bags ahead of school resuming

7 News Sydney Online  17 January 2016

Reference list


  1. Australian Government Department of Health, Australia's physical activity and sedentary behaviour guidelines 13-17 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  2. Australian Government Australian Institute of Health and Welfare, Australia's health 2006, Australian Institute of Health and Welfare, Editor. 2006, Australian Institute of Health and Welfare: Canberra, Australia.
  3. Centre for Community Child Health. Movement and exercise for kids. 2015; Available from:
  4. Better Health Channel. Obesity in children - causes. 2013; Available from:
  5. Australian Government Department of Health, National physical activity recommendation for children 0-5 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  6. Australian Government Department of Health, Australia's physical activity and sedentary behaviour guidelines 5-12 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  7. World Health Organization, Global recommendations on physical activity for health 5-17 years. 2010, World Health Organization: Geneva, Switzerland.
  8. Buhlert-Smith, K., N. Hagiliassis, and J. Pegler, Move, Play & Thrive. Literature review in preparation. 2016, Scope: Melbourne, Australia
  9. Rimmer, J.H., et al., Physical activity participation among persons with disabilities: barriers and facilitators. American Journal of Preventive Medicine, 2004. 26(5): p. 419-425.
  10. World Health Organization, Global recommendations on physical activity for health. 2010, World Health Organization: Geneva, Switzerland.
  11. Active Healthy Kids Australia, The road less travelled. The 2015 progress report card on active transport for children and young people. 2015, Active Healthy Kids Australia: Adelaide, South Australia.
  12. Better Health Channel. Back pain - school bags. Available from:
  13. American Academy of Orthopaedic Surgeons. Ortho info. Backpack safety. 2015; Available from:
  14. Education Queensland. Health and Safety Fact Sheet. Heavy school bags. 2012; Available from:
  15. Osteopathy Australia. Back(pack) to school - tips on how to pick a backpack for your child. 2014; Available from:
  16. American Occupational Therapy Association. Backpack safety: stats on injuries. 2015; Available from:
  17. Wiersema, B., E. Wall, and S. Foad, Acute backpack injuries in children. Pediatrics, 2003. 111(1): p. 163-166.