Association between physical activity, sedentary behaviour and the trajectory of low back pain

• Updated on: 2023-06-18
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Association between physical activity, sedentary behaviour and the trajectory of low back pain
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Meiyi Huo 1
ABSTRACT
Background
Low back pain (LBP) is one of the world's most prevalent health issues. Patients with LBP experience various intensities and durations of symptoms, which can lead to distinctive course patterns commonly described as symptom trajectories.
Purpose
This study aimed to investigate the association between different amounts of physical activity and sedentary behavior and the trajectory of LBP, in people with a lifetime history of LBP.
Study design
The study involved a secondary analysis of observational longitudinal data collected from the AUstralian Twin low BACK pain (AUTBACK) study.
Method
A total of 329 individual twins met the inclusion criteria for analysis. Latent Class Growth Analysis was used to identify distinct patterns of LBP and select the primary outcome (probability of having a severe LBP trajectory, 0-100%). Linear regression models were used to investigate the association between different amounts of physical activity or sedentary behavior at baseline, and the probability of having a severe LBP trajectory. Results were expressed as β coefficients and 95% confidence intervals (CI).
Results
Moderate-to-vigorous intensity physical activity was significantly associated with the probability of having a severe LBP trajectory (unadjusted β -0.0276; 95%CI -0.0456 to -0.0097, p=0.003). For every one-minute increase in moderate-to-vigorous intensity physical activity per week, there was a 2.8%-point reduction in a participant's probability of having a severe LBP trajectory. No significant associations were identified between sedentary behavior or light intensity physical activity, and the probability of having a severe LBP trajectory.
Conclusion
In people with a lifetime history of LBP, engagement in higher volumes of moderate to vigorous intensity physical activity at baseline was associated with a lower probability of developing a severe trajectory of LBP over one year.
Introduction
Low back pain (LBP) is one of the most common health problems around the world [1], with an age-standardized point prevalence of 7.5% globally (i.e., 577 million people) [2], and an estimated lifetime prevalence of 40% [1]. LBP is the highest contributor to years lived with disability (YLDs) – approximately 64.9 million –representing an increase of 52.7% in YLDs from 1990 to 2017 [2]. Society bears a heavy economic burden from LBP. In Western countries, the societal costs attributable to LBP are estimated to be 1% to 2% of the gross national product [3,4]. In Australia, the estimated cost of LBP to the healthcare system is approximately AU$392.9 million each year [5]. Greater attention to preventive and management strategies for LBP are needed to ease the burden of the condition on individuals and society.
Overall, physical activity (PA) and exercise have been widely recommended in clinical guidelines for LBP [6]. However, studies have shown that different volumes and intensities of PA affect LBP differently [7], [8], [9]. For instance, a meta-analysis of seven cohort studies revealed that people's engagement in medium levels of PA (defined as PA with an intensity level of >4.5 metabolic equivalent of task [METs]) had a 10% lower risk of developing an initial episode of LBP, compared to those engaged in low levels of PA (≤4 METs) [7]. In contrast, it has been shown that the risk for developing chronic LBP is higher among those engaged in strenuous PA (≥6.5 METs intensities), compared to those engaged in lower moderate intensity PA (4 to 6.5 METs) (Odds Ratio [OR] 1.22, 95% Confidence Interval [CI] 1.00 to 1.49) [8]. Sedentary behavior is another important measure of PA and is commonly defined as prolonged sitting or activities that involve energy expenditure less than 1.5 METs and below 600 MET-minutes/week, both at work and during leisure time. It has been shown that compared to engagement in moderate levels of PA (defined as between 600 to 1500 MET-minutes/week), a sedentary lifestyle (i.e., less than 600 MET-minutes/week) is associated with a three-fold increase in the odds of recurrent non-specific LBP (OR 3.58, 95% CI 2.54 to 5.03) [9].
As the clinical pattern of LBP (i.e., trajectories of recovery, fluctuations, or persistent pain) can vary between individuals over time [10], it can be beneficial to map variations in LBP course patterns to assist clinicians and patients in identifying the most appropriate prevention or management strategies. LBP course patterns can be mapped using repeated measures of LBP symptoms and outcomes. This has been done in a previous study which showed that people with LBP are likely to experience trajectories of either persistent or episodic pain rather than one well-defined episode, suggesting that describing LBP from a single time point is oversimplistic [11].
Despite the vast number of studies investigating factors that predispose individuals to have different trajectory patterns, including previous history of LBP, activity limitation, presence of leg pain, patients’ participation in work, a diagnosis of depression or anxiety, and patients’ expectations of recovery [12], [13], [14], [15], no study to date has considered PA or sedentary behavior as factors which could influence the trajectory of LBP. Therefore, this study aimed to explore the association between different amounts of PA and sedentary behavior and the trajectory of LBP.
Section snippets
Study design
This study involved a secondary analysis of observational longitudinal data collected from the Australian Twin low BACK pain (AUTBACK) [16,17]. The AUTBACK study was conducted between 2015 to 2020 in Australia and aimed to investigate the association between PA and LBP outcomes. The University of Sydney Human Research Ethics Committee (HREC) approved the AUTBACK study (Project Number 2015/407), and all participants gave written informed consent. In the current study, we utilized data on LBP
Sample characteristics
The baseline descriptive characteristics of the total sample (n=329) are presented in Table 1. Most of the sample were female (73%) and non-smokers (81%), and the median sample age was 56.6 years (IQR 45.2 to 62.3). Median BMI was 24.6 kg/m2 (IQR 22.2 to 28.2 kg/m2). Although 47% of the sample reported a recent episode of LBP at baseline, baseline levels of pain intensity were low, with the median NPRS score being 3 (IQR 2 to 4). Sleep quality was poor, with the median PSQI score being 6 (IQR 4
DISCUSSION
This study aimed to explore the relationship between different amounts of PA as well as sedentary behavior at baseline, and the trajectory of LBP. Our study found that there was a statistically significant association between baseline volumes of MVPA and the probability of people having a severe LBP trajectory with or without adjustment for age, sex, BMI, baseline pain intensity and a history of a recent episode of LBP. We identified that the higher the volume of MVPA performed over a one-week
Conclusion
This study highlights that, in people with a history of LBP, higher baseline levels of engagement in MVPA, but not light PA or sedentary behavior, is likely to be associated with a lower probability of having a severe LBP trajectory. These findings may be useful to support clinicians with providing more tailored recommendations regarding PA to support patients with LBP to experience less severe LBP.
Funding Disclosure(s) Statement
This study was funded by a Sydney University National Health and Medical Research Council (NHMRC) bridging grant (APP1086738). PHF is funded by a National Health and Medical Research Council of Australia Research Fellowship.
Data availability