European Spine Journal

, Volume 20, Issue 3, pp 464–474 | Cite as

The relationship between physical activity and low back pain outcomes: a systematic review of observational studies

  • Paul Hendrick
  • S. Milosavljevic
  • L. Hale
  • D. A. Hurley
  • S. McDonough
  • B. Ryan
  • G. D. Baxter
Review Article

Abstract

Although clinical guidelines advocate exercise and activity in the management of non-specific low back pain (NSLBP), the link between levels of physical activity and outcomes is unclear. This systematic review investigated the relationships between free living activity levels after onset of low back pain (LBP) and measures of pain, and disability in patients with NSLBP. Cohort and cross-sectional studies were located using OVID, CINAHL, Medline, AMED, Embase, Biomed, PubMed-National Library of Medicine, Proquest and Cochrane Databases, and hand searches of reference lists. Studies were included if a statistical relationship was investigated between measures of free living physical activity (PA) in subjects with LBP and LBP outcome measures. Twelve studies (seven cohort and five cross-sectional) were included. One prospective study reported a statistically significant relationship between increased leisure time activity and improved LBP outcomes, and one cross-sectional study found that lower levels of sporting activity were associated with higher levels of pain and disability. All other studies (n = 10) found no relationship between measures of activity levels and either pain or disability. Heterogeneity of study designs, particularly in terms of activity measurement, made comparisons between studies difficult. These data suggest that the activity levels of patients with NSLBP are neither associated with, nor predictive of, disability or pain levels. Validated activity measurement in prospective research is required to better evaluate the relationships between PA and LBP.

Keywords

Physical activity Low back pain Systematic review Outcomes Guidelines 

References

  1. 1.
    Ainslie P, Reilly T, Westerterp K (2003) Estimating human energy expenditure: a review of techniques with particular reference to doubly labelled water. Sports Med 33:683–698PubMedCrossRefGoogle Scholar
  2. 2.
    Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gotzsche PC, Lang T (2001) The revised CONSORT statement for reporting randomised trials: explanation and elaboration. Ann Intern Med 134:663–695PubMedGoogle Scholar
  3. 3.
    Arnau JM, Vallano A, Lopez A, Pellise F, Delgado MJ, Prat N (2006) A critical review of guidelines for low back pain treatment. Eur Spine J 15:543–553PubMedCrossRefGoogle Scholar
  4. 4.
    Basler HD, Luckmann J, Wolf U, Quint S (2008) Fear-avoidance beliefs, physical activity, and disability in elderly individuals with chronic low back pain and healthy controls. Clin J Pain 24:604–610PubMedCrossRefGoogle Scholar
  5. 5.
    Bassett DR, Cureton AL, Ainsworth BE (2000) Measurement of daily walking distance—questionnaire versus pedometer. Med Sci Sports Exerc 32:1018–1023PubMedCrossRefGoogle Scholar
  6. 6.
    Bekkering GE, Hendriks HJM, Koes BW, Oostendorp RAB, Ostelo RWJG, Thomassen JMC, van Tulder MW (2003) Dutch physiotherapy guidelines for low back pain. Physiotherapy 89:82–96CrossRefGoogle Scholar
  7. 7.
    Bouchard C, Blair SN, Haskell WL (2007) Physical activity and health. Human Kinetics, ChampaignGoogle Scholar
  8. 8.
    Bousema EJ, Verbunt JA, Seelen HAM, Vlaeyen JWS, Andre Knottnerus J (2007) Disuse and physical deconditioning in the first year after the onset of back pain. Pain 130:279–286PubMedCrossRefGoogle Scholar
  9. 9.
    Cole DA, Maxwell SE (2003) Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. J Abnorm Psychol 112:558–577PubMedCrossRefGoogle Scholar
  10. 10.
    Cunha IT, Simmonds MJ, Protas EJ, Jones S (2002) Back pain, physical function, and estimates of aerobic capacity: what are the relationships among methods and measures? Am J Phys Med Rehabil 81:913–920CrossRefGoogle Scholar
  11. 11.
    Di Iorio A, Abate M, Guralnik JM, Bandinelli S, Cecchi F, Cherubini A, Corsonello A, Foschini N, Guglielmi M, Lauretani F, Volpato S, Abate G, Ferrucci L (2007) From chronic low back pain to disability, a multifactorial mediated pathway: the InCHIANTI study. Spine 32:E809–E815PubMedCrossRefGoogle Scholar
  12. 12.
    Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384PubMedCrossRefGoogle Scholar
  13. 13.
    Frey I, Berg A, Grathwohl DK, Keul J (1999) Freiburger questionnaire on physical activity—design, validation and application. Soz Praventivmed 44:55–64PubMedGoogle Scholar
  14. 14.
    Hammill RR, Beazell JR, Hart JM (2008) Neuromuscular consequences of low back pain and core dysfunction. Clin Sports Med 27:449–462PubMedCrossRefGoogle Scholar
  15. 15.
    Hartvigsen J, Bakketeig LS, Leboeuf-Yde C, Engberg M, Lauritzen T (2001) The association between physical workload and low back pain clouded by the “healthy worker” effect: population-based cross-sectional and 5-year prospective questionnaire study. Spine 26:1788–1792PubMedCrossRefGoogle Scholar
  16. 16.
    Hartvigsen J, Frederiksen H, Christensen K (2006) Physical and mental function and incident low back pain in seniors: a population-based two-year prospective study of 1387 Danish Twins aged 70 to 100 years. Spine 31:1628–1632PubMedCrossRefGoogle Scholar
  17. 17.
    Hayden JA, van Tulder MW, Tomlinson G (2005) Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 142:776–785PubMedGoogle Scholar
  18. 18.
    Heneweer H, Vanhees L, Picavet HSJ (2009) Physical activity and low back pain: a U-shaped relation? Pain 143:21–25PubMedCrossRefGoogle Scholar
  19. 19.
    Hlobil H, Staal JB, Twisk J, Koke A, Ariens G, Smid T, van Mechelen W (2005) The effects of a graded activity intervention for low back pain in occupational health on sick leave, functional status and pain: 12-month results of a randomized controlled trial. J Occup Rehabil 15:569–580PubMedCrossRefGoogle Scholar
  20. 20.
    Hoppe DJ, Schemitsch EH, Morshed S, Tornetta P, Bhandari M (2009) Hierarchy of evidence: where observational studies fit in and why we need them. J Bone Joint Surg Am 91(Suppl 3):2–9PubMedCrossRefGoogle Scholar
  21. 21.
    Huijnen IPJ, Verbunt JA, Roelofs J, Goossens M, Peters M (2009) The disabling role of fluctuations in physical activity in patients with chronic low back pain. Eur J Pain 13:1076–1079PubMedCrossRefGoogle Scholar
  22. 22.
    Hurwitz EL, Morgenstern H, Chiao C (2005) Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study. Am J Public Health 95:1817–1824PubMedCrossRefGoogle Scholar
  23. 23.
    Jacob T, Baras M, Epstein L (2001) Low back pain: reliability of a set of pain measurement tools. Arch Phys Med Rehabil 82:735–742PubMedCrossRefGoogle Scholar
  24. 24.
    Jacob T, Baras M, Zeev A, Epstein L (2004) A longitudinal, community-based study of low back pain outcomes. Spine 29:1810–1817PubMedCrossRefGoogle Scholar
  25. 25.
    Jacob T, Baras M, Zeev A, Epstein L (2004) Physical activities and low back pain: a community-based study. Med Sci Sports Exerc 36:9–15PubMedCrossRefGoogle Scholar
  26. 26.
    Johansson E, Lindberg P (1998) Subacute and chronic low back pain. Reliability and validity of a Swedish version of the Roland Morris Disability Questionnaire. J Rehabil Med 30:139–140CrossRefGoogle Scholar
  27. 27.
    Kamper SJ, Rebbeck TJ, Maher CG, McAuley JH, Sterling M (2008) Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain 138:617–629PubMedCrossRefGoogle Scholar
  28. 28.
    Karmisholt K, Gotzsche PC (2005) Physical activity for secondary prevention of disease. Systematic reviews of randomised clinical trials. Dan Med Bull 52:90–94PubMedGoogle Scholar
  29. 29.
    Kent PM, Keating JL (2008) Can we predict poor recovery from recent-onset nonspecific low back pain? A systematic review. Man Ther 13:12–28PubMedCrossRefGoogle Scholar
  30. 30.
    Koes BW, van Tulder MW, Ostelo R, Kim Burton A, Waddell G (2001) Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine 26:2504–2513PubMedCrossRefGoogle Scholar
  31. 31.
    Kuukkanen T, Malkia E, Kautiainen H, Pohjolainen T (2007) Effectiveness of a home exercise programme in low back pain: a randomized five-year follow-up study. Physiother Res Int 12:213–224PubMedCrossRefGoogle Scholar
  32. 32.
    Leonhardt C, Keller S, Chenot JF, Luckmann J, Basler HD, Wegscheider K, Baum E, Donner-Banzhoff N, Pfingsten M, Hildebrandt J, Kochen MM, Becker A (2008) TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting—a cluster-randomized controlled trial. Patient Educ Couns 70:50–60PubMedCrossRefGoogle Scholar
  33. 33.
    Levangie PK (1999) Association of low back pain with self-reported risk factors among patients seeking physical therapy services. Phys Ther 79:757–766PubMedGoogle Scholar
  34. 34.
    Liddle SD, Gracey JH, Baxter GD (2007) Advice for the management of low back pain: a systematic review of randomised controlled trials. Man Ther 12:310–327PubMedCrossRefGoogle Scholar
  35. 35.
    Majid K, Truumees E (2008) Epidemiology and natural history of low back pain. Semin Spine Surg 20:87–92CrossRefGoogle Scholar
  36. 36.
    Merlin T, Weston A, Tooher R (2009) Extending an evidence hierarchy to include topics other than treatment: revising the Australian ‘levels of evidence’. BMC Med Res Methodol 9:34Google Scholar
  37. 37.
    Mortimer M, Pernold G, Wiktorin C (2006) Low back pain in a general population. Natural course and influence of physical exercise—a 5-year follow-up of the Musculoskeletal Intervention Center-Norrtalje Study. Spine 31:3045–3051PubMedCrossRefGoogle Scholar
  38. 38.
    Motl RW, McAuley E, Snook EM, Gliottoni RC (2009) Physical activity and quality of life in multiple sclerosis: Intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychol Health Med 14:111–124PubMedCrossRefGoogle Scholar
  39. 39.
    Oleske DM, Lavender SA, Andersson GBJ, Morrissey MJ, Zold-Kilbourn P, Allen C, Taylor E (2006) Risk factors for recurrent episodes of work-related low back disorders in an industrial population. Spine 31:789–798PubMedCrossRefGoogle Scholar
  40. 40.
    Perruccio AV, Power JD, Badley EM (2005) Arthritis onset and worsening self-rated health: a longitudinal evaluation of the role of pain and activity limitations. Arthritis Care Res 53:571–577CrossRefGoogle Scholar
  41. 41.
    Plasqui G, Westerterp KR (2007) Physical activity assessment with accelerometers: an evaluation against doubly labeled water. Obesity 15:2371–2379PubMedCrossRefGoogle Scholar
  42. 42.
    Pols MA, Peeters PHM, Bueno De-Mesquita HB, Ocke MC, Wentink CA, Kemper HCG, Collette HJA (1995) Validity and repeatability of a modified Baecke questionnaire on physical activity. Int J Epidemiol 24:381–388PubMedCrossRefGoogle Scholar
  43. 43.
    Rasmussen-Barr E, Lundqvist L, Nilsson-Wikmar L, Ljungquist T (2008) Aerobic fitness in patients at work despite recurrent low back pain: a cross-sectional study with healthy age- and gender-matched controls. J Rehabil Med 40:359–365PubMedCrossRefGoogle Scholar
  44. 44.
    Refshauge KM, Maher CG (2006) Low back pain investigations and prognosis: a review. Br J Sports Med 40:494–498PubMedCrossRefGoogle Scholar
  45. 45.
    Smeets RJEM, Wittink H (2007) The deconditioning paradigm for chronic low back pain unmasked? Pain 130:201–202PubMedCrossRefGoogle Scholar
  46. 46.
    Smeets RJE, Wittink H, Hidding A, Knottnerus JA (2006) Do patients with chronic low back pain have a lower level of aerobic fitness than healthy controls? Are pain, disability, fear of injury, working status, or level of leisure time activity associated with the difference in aerobic fitness level? Spine 31:90–98PubMedCrossRefGoogle Scholar
  47. 47.
    Smeets RJ, van Geel KD, Verbunt JA (2009) Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain? Arch Phys Med Rehabil 90:109–117PubMedCrossRefGoogle Scholar
  48. 48.
    Smith MD, Russell A, Hodges PW (2006) Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother 52:11–16PubMedGoogle Scholar
  49. 49.
    Steenstra IA, Verbeek JH, Heymans MW, Bongers PM (2005) Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med 62:851–860PubMedCrossRefGoogle Scholar
  50. 50.
    Steenstra IA, Anema JR, Bongers PM, de Vet HC, Knol DL, van Mechelen W (2006) The effectiveness of graded activity for low back pain in occupational healthcare. Occup Environ Med 63:718–725PubMedCrossRefGoogle Scholar
  51. 51.
    Storheim K, Ivar Brox J, Holm I, Bø K (2005) Predictors of return to work in patients sick listed for sub-acute low back pain: a 12-month follow-up study. J Rehabil Med 37:365–371PubMedCrossRefGoogle Scholar
  52. 52.
    van den Berg-Emons RJ, Schasfoort FC, de Vos LA, Bussmann JB, Stam HJ (2007) Impact of chronic pain on everyday physical activity. Eur J Pain 11:587–593PubMedCrossRefGoogle Scholar
  53. 53.
    van Tulder M, Malmivaara A, Esmail R, Koes B (2000) Exercise therapy for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 25:2784–2796PubMedCrossRefGoogle Scholar
  54. 54.
    van Tulder M, Becker A, Bekkering T, Breen A, Del Real MTG, Hutchinson A, Koes B, Laerum E, Malmivaara A (2006) Chapter 3: European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15:S169–S191PubMedCrossRefGoogle Scholar
  55. 55.
    van Weering MGH, Vollenbroek-Hutten MMR, Tonis TM, Hermens HJ (2008) Daily physical activities in chronic lower back pain patients assessed with accelerometry. Eur J Pain 13:649–654PubMedCrossRefGoogle Scholar
  56. 56.
    Verbunt JA, Westerterp KR, van der Heijden GJ, Seelen HA, Vlaeyen JW, Knottnerus JA (2001) Physical activity in daily life in patients with chronic low back pain. Arch Phys Med Rehabil 82:726–730PubMedCrossRefGoogle Scholar
  57. 57.
    Verbunt JA, Sieben JM, Seelen HA, Vlaeyen JW, Bousema EJ, van der Heijden GJ, Knottnerus JA (2005) Decline in physical activity, disability and pain-related fear in sub-acute low back pain. Eur J Pain 9:417–425PubMedCrossRefGoogle Scholar
  58. 58.
    Warburton DER, Nicol CW, Bredin SSD (2006) Health benefits of physical activity: the evidence. Can Med Assoc J 174:801–809CrossRefGoogle Scholar
  59. 59.
    Wessels T, Van Tulder M, Sigl T, Ewert T, Limm H, Stucki G (2006) What predicts outcome in non-operative treatments of chronic low back pain? A systematic review. Eur Spine J 15:1633–1644PubMedCrossRefGoogle Scholar
  60. 60.
    Wittink H, Hoskins Michel T, Wagner A, Sukiennik A, Rogers W (2000) Deconditioning in patients with chronic low back pain: fact or fiction? Spine 25:2221–2228PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Paul Hendrick
    • 1
  • S. Milosavljevic
    • 1
  • L. Hale
    • 1
  • D. A. Hurley
    • 2
  • S. McDonough
    • 3
  • B. Ryan
    • 1
  • G. D. Baxter
    • 1
  1. 1.Centre for Physiotherapy Research, School of PhysiotherapyUniversity of OtagoDunedinNew Zealand
  2. 2.School of Public Health, Physiotherapy and Population Science, College of Life SciencesUniversity College DublinDublinIreland
  3. 3.Health and Rehabilitation Research InstituteUniversity of UlsterUlsterUK

Personalised recommendations