The Facebook page for ActivePosture, a clothing company, seen on 13 January 2019, featured claims in the ‘About’ section which stated “Posture clothing activates muscle memory to help you achieve an improved, upright posture… Posture clothing: can reduce back pain and tension in neck and shoulders (see survey), helps you to achieve aligned posture through posture awareness, activates and stimulates inhibited muscles, decreases tension in overstrained muscles, improves muscle-memory”…Pretty much everyone can improve their posture from wearing posture clothing”.
The complainant challenged whether the efficacy claims in the ad that the device could improve posture and reduce back pain were misleading and could be substantiated.
Active Posture Ltd stated that the product was a medical device and provided a copy of their medical certification and a declaration of conformity setting out each of their products covered by the certification. They provided a definition of an orthosis as being an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system. The definition included what an orthosis may be used for, which included assisting movement and correcting the shape and/ or function of the body to provide easier movement capability or reduction in pain. They provided a copy of the product’s instructions, which set out the recommended usage of the garment. That recommended that the vest should be worn initially for 30‒60 minutes a day and then increasing the duration gradually over time. They also provided copies of six studies in full and two abstracts, which were also linked to their website.
The ASA considered that consumers would understand the efficacy claims in the ad relating to improving posture and reducing back pain to mean that wearing posture clothing would aid in improving posture and would therefore reduce and relieve pain and tension in the areas described in the ad. We also considered that consumers would generally interpret claims relating to posture improvement as implying health benefits. We expected Active Posture to hold robust documentary evidence consisting of clinical trials, to support those claims.
We considered that the claim “reduce back pain” was a medical claim. Under the CAP Code, medical claims could be made for CE-marked medical devices provided they complied with other requirements of the Code, including those relating to substantiation. We understood that the product was classified as Class I medical device. Class I medical devices were generally CE-marked on a self-declaration basis. CE certification in itself did not constitute evidence for medical efficacy claims, and advertisers needed to ensure that they held evidence for such claims.
We reviewed six studies which were provided in full by the advertiser. The first study assessed posture and was based on a user questionnaire that assessed the user’s perception of pain relief after wearing the product over a four-week period. While users self-reported an improvement in posture and productivity in the work place, we noted an absence of a control group and did not consider the methodology to be sufficient to substantiate the claims about improving posture and reducing back pain. The second study looked at the pitching performance and arm blood flow in a group of baseball pitchers. The results stated that the posture garment may have had a positive effect on pitching performance. Another study measured shoulder strength with and without a custom made vest which suggested that those with shoulder injuries may benefit from the garment during rehabilitation. A further study used standardised questionnaires over a period of three weeks to measure knee pain, stiffness and fatigue in skiers while wearing knee support tights and the posture garment. We did not consider that those studies were relevant in substantiating the claims made in the ad about improving posture or reducing back pain. They also provided a copy of a randomised controlled trial on 38 overhead athletes (who commonly used their shoulders and upper arms, such as baseball players) who had poor posture and examined whether a posture vest altered posture and scapular muscle activity in those subjects. They measured posture using lateral-view photography with reflective markers and electronically measured muscle response in the neck, shoulder and back area while doing a series of exercises. These measurements were taken with and without the garment being worn. The results indicated that the garment improved shoulder posture and muscle activity. We considered that the methodology did not reflect the recommended usage of the product and testing was carried out on injury-free athletes in lab conditions. We considered that the garment was likely to be worn by consumers who were not athletes and those who may have injuries, therefore the sample and results of the study was not reflective of the general population. Furthermore, while the study looked at posture there was no reference to reducing back pain. We did not consider, therefore, that the trial was sufficient in substantiating the claims made in the ad.
During the course of the investigation, Active Posture provided a copy of a study which was based on an online user questionnaire which looked at the effects of wearing the garment. Because the study was conducted after the complainant saw the ad, the advertiser therefore did not hold that evidence before the ad was published, which is a requirement of the Code. We nonetheless reviewed whether those tests were sufficient to support future advertising claims. The study asked users about posture, postural awareness and aches and pains before and after wearing the garment. The results found that posture awareness, posture and aches and pains were positively influenced by wearing the garment. We understood that the questionnaire did not provide a definition of “aches and pains” or “posture” and users were incentivised with a discount in order to participate in the study. We considered that there were a number of issues with the methodology used. These included a lack of control group, the user’s experience of pain and posture issues were only ascertained post-purchase and the incentive offered to participants meant there was a potential for bias in the self-reported results. We therefore did not consider the methodology to be sufficient to substantiate the claims about improving posture and reducing back pain.
We concluded that because the advertiser had not provided adequate evidence to substantiate that the posture garment could improve posture and reduce back pain, the ad was misleading.
The ad breached CAP Code (Edition 12) rules 3.1 (Misleading advertising), 3.7 (Substantiation) and 12.1 (Medicines, medical devices, health-related products and beauty products).
The ad must not appear again in the form complained about. We told Active Posture Ltd not to make any claims that their posture clothing could relieve back pain or improve posture unless they held robust documentary evidence to substantiate the claim.