Researchers tracking over 11,000 adults reveal that simply walking longer each day, rather than faster, may help protect against one of the world’s leading causes of disability.
Study: Volume and Intensity of Walking and Risk of Chronic Low Back Pain. Image credit: Chay_Tee/Shutterstock.com
Millions of people worldwide suffer from chronic low back pain, but regular physical activity could reduce it. A recent study in JAMA Network Open examines the potential benefit of daily walking volume and intensity in lowering the risk of chronic low back pain.
Introduction
Chronic low back pain is the most common type of chronic pain and the leading cause of functional disability, as well as the single largest contributor to years lived with disability. With the number of cases only set to increase, it is essential to identify modifiable risk factors and frame suitable preventive interventions and policies.
Physical activity is key to managing chronic low back pain, but the type and amount remain unclear. Recent evidence suggests that walking reduces the risk of recurrence in nonspecific chronic low back pain. The current study examined whether walking is associated with a lower risk of chronic low back pain, but it cannot prove causality as an observational study.
About the study
The current prospective study was based on a group of 11,194 participants at least 20 years old, who were part of the Norwegian Trøndelag Health (HUNT) Study. About 60% were women.
Baseline measurements were obtained between 2017 and 2019, with follow-up assessments in 2021-2023. All participants were free of chronic low back pain at baseline. Chronic low back pain was defined as pain that had lasted for three or more months during the last 12 months.
The walking parameters used in this study were daily walking volume in minutes per day and walking intensity measured as metabolic equivalent of task (MET) per minute. Accelerometers were used to collect this data.
Study findings
At the beginning of the study, the participants wore accelerometers for an average of 5.7 days, with a mean walking volume of ~104 minutes/day. During the follow-up period (4.2 years on average), about 15% developed one or more episodes of chronic low back pain.
Walking volume
Those who walked more had a lower risk of chronic low back pain. On average, walking for more than 100 minutes/day was linked to a 23% lower risk of chronic low back pain, compared with <78 minutes of walking per day. Those who walked 78-100 minutes/day also had a 13% lower risk.
The effect was stronger and more consistent among older adults (65 years or above) than among younger people, but both men and women showed comparable benefits.
Walking intensity
Again, higher-intensity walking was associated with a lower risk of chronic low back pain. Compared to the reference intensity of <3 MET per minute, a higher intensity of 3-3.1 MET/minute was linked to a 15% lower risk of low back pain.
The risk dropped by 16% and 18% at walking intensities of 3.12-3.26 MET/minute and 3.27 MET/minute or higher, respectively. However, these associations were weaker once walking volume was considered.
The reduction in low back pain risk increased with increased walking volume until about 100 minutes/day, with a more gradual increase thereafter. Similarly, walking intensity was linked to a reduced back pain risk until about 3.2 MET/minute, though this was much weaker when adjusted for walking volume.
When both were considered together, there was no apparent benefit with increased walking intensity among those who walked more than 125 minutes daily. Below this, those who walked more intensely had a greater reduction in low back pain risk.
Conclusion
“These findings indicate that policies and public health strategies promoting walking may help to reduce the burden of chronic low back pain.”
The authors emphasized that daily walking volume appeared more important than walking intensity. Still, they cautioned that the study design does not establish cause and effect and that residual confounding is possible. They also noted limitations such as reliance on a single baseline measurement and potential recall bias in pain reporting.
With its ease, universal availability, and numerous benefits, walking could be widely encouraged as a preventive measure for chronic low back pain, pending confirmation in future studies.
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