Researchers tracking over 11,000 adults have revealed that simply walking longer each day, rather than faster, may help protect against chronic low back pain, one of the world’s leading causes of disability. This finding is part of a study titled “Volume and Intensity of Walking and Risk of Chronic Low Back Pain” published in JAMA Network Open.
Millions globally suffer from chronic low back pain, yet regular physical activity could offer relief. The study examines the potential benefits of daily walking volume and intensity in reducing the risk of developing this condition.
Understanding Chronic Low Back Pain
Chronic low back pain is the most common type of chronic pain and the leading cause of functional disability worldwide. It is also the single largest contributor to years lived with disability. With cases expected to rise, identifying modifiable risk factors is crucial for framing preventive interventions and policies.
Physical activity is recognized as a key factor in managing chronic low back pain, although the specific type and amount of activity remain debated. Recent evidence suggests that walking can reduce the risk of recurrence in nonspecific chronic low back pain. The current study investigates whether walking is associated with a lower risk of chronic low back pain, acknowledging the limitations of observational research in proving causality.
The Study: Methodology and Participants
The prospective study involved 11,194 participants aged 20 and above, part of the Norwegian Trøndelag Health (HUNT) Study, with approximately 60% being women. Baseline measurements were collected between 2017 and 2019, with follow-up assessments from 2021 to 2023. All participants were free of chronic low back pain at the study’s outset, defined as pain lasting three or more months over the past year.
Walking parameters included daily walking volume in minutes per day and intensity measured as metabolic equivalent of task (MET) per minute. Accelerometers were utilized to gather this data, ensuring accuracy in tracking physical activity.
Key Findings: Volume vs. Intensity
Walking Volume
Participants initially wore accelerometers for an average of 5.7 days, with a mean walking volume of approximately 104 minutes per day. During the follow-up period, averaging 4.2 years, about 15% experienced one or more episodes of chronic low back pain.
Those who walked more than 100 minutes daily had a 23% lower risk of developing chronic low back pain compared to those walking less than 78 minutes per day. Walking 78-100 minutes daily was associated with a 13% lower risk. The effect was particularly pronounced among older adults (65 years or above), although both men and women benefited.
Walking Intensity
Higher-intensity walking also correlated with a reduced risk of chronic low back pain. Compared to a reference intensity of less than 3 MET per minute, walking at 3-3.1 MET/minute was linked to a 15% lower risk. The risk decreased 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 weakened when walking volume was considered.
The reduction in low back pain risk increased with walking volume up to about 100 minutes per 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 less pronounced when adjusted for walking volume.
When both walking volume and intensity were considered together, increased walking intensity did not provide additional benefits for those walking more than 125 minutes daily. However, below this threshold, more intense walking was associated with a greater reduction in low back pain risk.
Implications and Future Directions
“These findings indicate that policies and public health strategies promoting walking may help to reduce the burden of chronic low back pain,” the study authors noted. They emphasized that daily walking volume appeared more significant than walking intensity. However, they cautioned that the study design does not establish causation and that residual confounding is possible. Limitations such as reliance on a single baseline measurement and potential recall bias in pain reporting were also acknowledged.
Given 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. As the world grapples with increasing cases of chronic pain, simple lifestyle changes like walking could offer a practical solution to a complex problem.
