Load-carrying biomechanics in children: programed exercise enhances postural resilience and reduces plantar pressure under backpack load

Introduction 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. Objective 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. Research methodology A controlled non-randomized experimental study was conducted involving 147 school-aged children (experimental: n = 74; control: n = 73). Pre- and post-intervention assessments were performed using the T&T Medilogic ® 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 t -tests, with effect sizes estimated using Cohen’s d . Results The experimental group demonstrated a significant reduction in maximum plantar pressure during walking with a schoolbag ( p = 0.010; d = −0.31), whereas no significant change was observed in the control group ( p = 0.37). Between-group comparisons confirmed a significant intervention effect ( p = 0.016). The reduction in plantar pressure was accompanied by improved weight-bearing symmetry, indicating a more favorable distribution of plantar loads during functional load carriage. Conclusion 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.