Document Type : Systematic Review


1 Department Department of Health and Sports Medicine, Faculty of Physical Education and Sports Sciences, University of Tehran, Tehran, Iran

2 Department of corrective exercise & Sport injury, Faculty of physical education and sport sciences, Allameh Tabataba’i University, Tehran, Iran


Context: Carrying a backpack with an inappropriate weight and non-optimal postures play a pivotal role in developing musculoskeletal pain. Studies have shown that school bags affect muscle activity and biomechanical variables in children and adolescents. Accordingly, the present study aimed to systematically review the effect of school bags on electromyographic activity of muscles and kinematic and kinetic parameters during walking in Iranian students.
Methods: Relevant articles were searched through Scopus, PubMed, Web of Science, MagIran, and SID databases. Original articles in Persian and English published in peer-review journals were selected without time limitation. Eligible studies were divided based on various biomechanical factors that were examined.
Results: A total of 1975 articles were found in the mentioned databases. Twelve studies were eligible based on the inclusion criteria in this study. In general, it seems as though weight, type, the height of placement of schoolbag, slope of the surface, and the manner of carrying the schoolbag had significant effects on the trunk, neck, ankle, and knee angles, length and frequency of steps, symmetry index, and vertical forces. Additionally, the weight and type of the bag had significant effects on the electromyographic activity of rectus abdominus, paraspinal, and lower limb muscles.
Conclusions: Factors such as weight, the slope of the surface, method of carrying, and schoolbag height of placement could affect the kinetic and kinematic variables whereas the weight of the bag and the type of school bag could affect the electromyographic activity of the muscles in Iranian students.


1. Hammami A, Harrabi B, Mohr M, Krustrup P. Physical Activity and Coronavirus Disease 2019 (COVID-19): Specific Recommendations for Home-Based Physical Training. Managing Sport and Leisure. 2020. doi: 10.1080/ 23750472.2020.1757494. ## 2. Gobbi E, Maltagliati S, Sarrazin P, di Fronso S, Colangelo A, Cheval B, et al. Promoting Physical Activity during School Closures Imposed by the First Wave of the COVID-19 Pandemic: Physical Education Teachers’ Behaviors in France, Italy and Turkey. Int J Environ Res Public Health. 2020;17(24):9431. doi: 10.3390/ijerph17249431. PubMed PMID: 33339228; PubMed Central PMCID: PMC7767079. ## 3. Roe A, Blikstad-Balas M, Dalland CP. The Impact of COVID-19 and Homeschooling on Students’ Engagement with Physical Activity. Front Sports Act Living. 2021;2:589227. doi: 10.3389/fspor.2020.589227. PubMed PMID: 33585811; PubMed Central PMCID: PMC7873937. ## 4. Gul M, Demirci E. Psychiatric Disorders and Symptoms in Children and Adolescents During the COVID-19 Pandemic: A Review. EJMO. 2021;5(1):20-36. doi: 10.14744/EJMO.2021.14105. ## 5. Dunton GF, Do B, Wang SD. Early Effects of the COVID-19 Pandemic on Physical Activity and Sedentary Behavior in Children Living in the U.S. BMC Public Health. 2020;20(1):1351. doi: 10.1186/s12889-020-09429-3. PubMed PMID: 32887592; PubMed Central PMCID: PMC7472405. ## 6. Tulchin-Francis K, Stevens Jr W, Gu X, Zhang T, Roberts H, Keller J, et al. The Impact of the Coronavirus Disease 2019 Pandemic on Physical Activity in US Children. J Sport Health Sci. 2021;10(3):323-332 doi: 10.1016/j.jshs.2021.02.005. PubMed PMID: 33657464; PubMed Central PMCID: PMC8167336. ## 7. Lahart I, Darcy P, Gidlow C, Calogiuri G. The Effects of Green Exercise on Physical and Mental Wellbeing: A Systematic Review. Int J Environ Res Public Health. 2019;16(8):1352. doi: 10.3390/ijerph16081352. PubMed PMID: 30991724; PubMed Central PMCID: PMC6518264. ## 8. Malm C, Jakobsson J, Isaksson A. Physical Activity and Sports-Related Health Benefits: A Review with Insight into the Public Health of Sweden. Sports. 2019;7(5):127. doi: 10.3390/sports7050127. PubMed PMID: 31126126; PubMed Central PMCID: PMC6572041. ## 9. Huotari P, Nupponen H, Mikkelsson L, Laakso L, Kujala U. Adolescent Physical Fitness and Activity as Predictors of Adulthood Activity. J Sports Sci. 2011;29(11):1135-41. doi: 10.1080/02640414.2011.585166. PubMed PMID: 21777154. ## 10. Telama R, Yang X, Viikari J, Välimäki I, Wanne O, Raitakari O. Physical Activity from Childhood to Adulthood: A 21-year Tracking Study. Am J Prev Med. 2005;28(3):267-73. doi: 10.1016/j.amepre.2004.12.003. PubMed PMID: 15766614. ## 11. Hosseini FB, Ghorbani S, Rezaeshirazi R. Effects of Perceived Autonomy Support in the Physical Education on Basic Psychological Needs Satisfaction, Intrinsic Motivation and Intention to Physical Activity in High-School Students. Int J School Health. 2020;7(4), 39-46. doi: 10.30476/intjsh.2020.88171.1106. ## 12. Filiz B, Konukman F. Teaching Strategies for Physical Education during the COVID-19 Pandemic. Journal of Physical Education Recreation & Dance. 2020;91(9):948-50. doi: 10.1080/07303084.2020.1816099. ## 13. Ryan RM, Deci EL. Brick by Brick. The Origins, Development, and Future of Self-Determination Theory. In: Elliot AJ, editors. Advances in Motivation Science. Cambridge, MA: Elsevier Inc; 2019. pp. 111-156. ## 14. Ryan RM, Bradshaw EL, Deci EL. A History of Human Motivation Theories in Psychology. In: Sternberg RJ & Pickren WE. Cambridge, UK: Cambridge University Press; 2019. pp. 391-411. ## 15. Vansteenkiste M, Ryan RM, Soenens B. Basic Psychological Need Theory: Advancements, Critical Themes, and Future Directions. Motivation and Emotion. 2020;44:1-31. doi: 10.1007/s11031-019-09818-1. ## 16. Mohammad Gholinezhad P, Hojjati H, Ghorbani S. The effect of aerobic exercise on body composition and muscle strength of female students at elementary schools of Ali Abad Katoul in 2018. Int J School Health. 2019;6(4):27-33. doi: 10.30476/intjsh.2019.45892. ## 17. Baard PP, Deci EL, Ryan RM. Intrinsic Need Satisfaction: A Motivational Basis of Performance and Wellbeing in Two Work Settings. Journal of Applied Social Psychology. 2004;34(10):2045-2068. doi: 10.1111/j.1559-1816.2004.tb02690.x. ## 18. Pelletier LG, Rocchi MA, Vallerand RJ, Deci EL, Ryan RM. Validation of the Revised Sport Motivation Scale (SMS-II). Psychology of Sport and Exercise. 2013;14(3):329-341. doi: 10.1016/j.psychsport.2012.12.002. ## 19. Hagger MS, Chatzisarantis NLD, Culverhouse T, Biddle SJH. The Process by Which Perceived Autonomy Support in Physical Education Promote Leisure-Time Physical Activity Intentions and Behavior: A Trans-Contextual Model. Journal of Educational Psychology. 2003;95:784-795. doi: 10.1037/0022-0663.95.4.784. ## 20. Meng How W, Whipp P, Dimmock J, Jackson B. The Effects of Choice on Autonomous Motivation, Perceived Autonomy Support, and Physical Activity Levels in High School Physical Education. Journal of Teaching in Physical Education. 2013;32(2):131-148. doi: 10.1123/jtpe.32.2.131-148. ## 21. Holt A, Smedegaard S, Pawlowski CS, Skovgaard T, Christiansen LB. Pupils’ Experiences of Autonomy, Competence and Relatedness in ‘Move for Well-being in Schools’: A Physical Activity Intervention. European Physical Education Review. 2019;25(3):640-658. doi: 10.1177/1356336X18758353. ## 22. Sfandyari B, Ghorbani S, Rezaeeshirazi R, Noohpisheh S. The Effectiveness of an Autonomy-Based Exercise Training on Intrinsic Motivation, Physical Activity Intention, and Health-Related Fitness of Sedentary Students in Middle School. Int J School Health. 2020;7(1):40-47. doi: 10.30476/intjsh.2020.84678.1046. ## 23. Sevil-Serrano J, Aibar A, Abós A, Generelo E, García-González L. Improving Motivation for Physical Activity and Physical Education through a School-Based Intervention. Journal of Experimental Education. 2020. doi: 10.1080/00220973.2020.1764466. ## 24. Cheon SH, Reeve J, Song YG. A Teacher-Focused Intervention to Decrease PE Students’ Amotivation by Increasing Need Satisfaction and Decreasing Need Frustration. J Sport Exerc Psychol. 2016;38(3):217-235. doi: 10.1123/jsep.2015-0236. PubMed PMID: 27385730. ## 25. Su YL, Reeve J. A Meta-Analysis of the Effectiveness of Intervention Programs Designed to Support Autonomy. Educational Psychology Review. 2011;23:159-188. doi: 10.1007/s10648-010-9142-7. ## 26. Moreno-Murcia JA, Sánchez-Latorre F. The Effects of Autonomy Support in Physical Education Classes. RICYDE. 2016;43:79-89. doi: 10.5232/ricyde2016.04305. ## 27. Gholidahaneh MG, Ghorbani S, Esfahaninia A. Effects of Basic Psychological Needs Satisfaction in the Physical Education on Leisure-Time Physical Activity Behavior of Primary School Students: Mediating Role of Autonomous Motivation. Int J School Health. 2020;7(2):46-53. doi: 10.30476/intjsh.2020.86028.1068. ## 28. Ghorbani S, Noohpisheh S, Shakki M. Gender Differences in the Relationship between Perceived Competence and Physical Activity in Middle School Students: Mediating Role of Enjoyment. Int J School Health. 2020;7(2):14-20. doi: 10.30476/intjsh.2020.85668.1056. ##