European Spine Journal

, Volume 23, Issue 10, pp 2083–2089 | Cite as

Heavy domestic, but not recreational, physical activity is associated with low back pain: Australian Twin low BACK pain (AUTBACK) study

  • Markus HübscherEmail author
  • Manuela L. Ferreira
  • Daniela R. G. Junqueira
  • Kathryn M. Refshauge
  • Chris G. Maher
  • John L. Hopper
  • Paulo H. Ferreira
Original Article



To evaluate the association between domestic and recreational physical activity (PA) and low back pain (LBP) after adjusting for genetic and environmental influences.


Twins were recruited through the Australian twin registry. LBP prevalence and domestic (vigorous gardening/heavy yard work) and recreational (light walking, moderate/vigorous) PA were assessed by a validated questionnaire. Associations were analysed using a cross-sectional analysis of the complete sample of 486 twins, including a matched case–control analysis of 69 twin pairs discordant for LBP. Logistic regression and the lincom post-estimation method were used for the analysis. Odds ratios (OR) with 95 % confidence intervals (CIs) were calculated.


The case–control analysis showed that LBP was significantly associated with heavy domestic PA (OR 2.88, 95 % CI 1.29–6.43), whereas no significant association was found with any form of recreational PA. The results of the lincom command indicated that being engaged in both heavy domestic and recreational PA (light walking or moderate/vigorous) was associated with a significantly increased probability of LBP compared with being engaged only in recreational PA (light walking or moderate/vigorous, ORs 3.48–4.22). Using the whole sample, we found weaker associations but in the same direction.


We found evidence that heavy domestic PA is associated with an increased probability of LBP, and the combination of heavy domestic and recreational PA might increase the probability of LBP more so than heavy domestic or recreational PA alone. Associations being greater when using the co-twin case–control analysis indicate that genetic and environmental factors influence the relationship between PA and LBP, and demonstrate the value of a twin design.


Twin study Low back pain Physical activity Physical workload 



MH is supported by a postdoctoral fellowship from the German Academic Exchange Service (DAAD). CM is supported by a research fellowship from the Australian Research Council. JLH is a Senior Principal Research Fellow of the Australian National Health and Medical Research Council.

Conflict of interest



  1. 1.
    Burton AK, Balague F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Muller G, van der Beek AJ (2005) How to prevent low back pain. Best Pract Res Clin Rheumatol 19:541–555PubMedCrossRefGoogle Scholar
  2. 2.
    Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147(7):478–491PubMedCrossRefGoogle Scholar
  3. 3.
    Heneweer H, Vanhees L, Picavet HS (2009) Physical activity and low back pain: a U-shaped relation? Pain 143(1–2):21–25PubMedCrossRefGoogle Scholar
  4. 4.
    Hildebrandt VH, Bongers PM, Dul J, van Dijk FJ, Kemper HC (2000) The relationship between leisure time, physical activities and musculoskeletal symptoms and disability in worker populations. Int Arch Occup Environ Health 73(8):507–518PubMedCrossRefGoogle Scholar
  5. 5.
    Heneweer H, Staes F, Aufdemkampe G, van Rijn M, Vanhees L (2011) Physical activity and low back pain: a systematic review of recent literature. Eur Spine J 20(6):826–845PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Sitthipornvorakul E, Janwantanakul P, Purepong N, Pensri P, van der Beek AJ (2011) The association between physical activity and neck and low back pain: a systematic review. Eur Spine J 20(5):677–689PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Hartvigsen J, Christensen K (2007) Active lifestyle protects against incident low back pain in seniors: a population-based 2-year prospective study of 1387 danish twins aged 70-100 years. Spine 32(1):76–81PubMedCrossRefGoogle Scholar
  8. 8.
    Schiltenwolf M, Schneider S (2009) Activity and low back pain: a dubious correlation. Pain 143(1–2):1–2PubMedCrossRefGoogle Scholar
  9. 9.
    Livshits G, Popham M, Malkin I, Sambrook PN, Macgregor AJ, Spector T, Williams FM (2011) Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK twin spine study. Ann Rheum Dis 70(10):1740–1745PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Ferreira PH, Beckenkamp P, Maher CG, Hopper JL, Ferreira ML (2013) Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples. Eur J Pain 20(10):1532–2149Google Scholar
  11. 11.
    Hopper JL, Treloar SA, de Klerk NH, Morley R (2006) Australian twin registry: a nationally funded resource for medical and scientific research, incorporating match and watch. Twin Res Hum Genet 9(6):707–711PubMedCrossRefGoogle Scholar
  12. 12.
    Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, Wyatt M, Cassidy JD, Rossignol M, Leboeuf-Yde C, Hartvigsen J, Leino-Arjas P, Latza U, Reis S, Gil Del Real MT, Kovacs FM, Oberg B, Cedraschi C, Bouter LM, Koes BW, Picavet HS, van Tulder MW, Burton K, Foster NE, Macfarlane GJ, Thomas E, Underwood M, Waddell G, Shekelle P, Volinn E, Von Korff M (1976) A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 33(1):95–103CrossRefGoogle Scholar
  13. 13.
    Brown WJ, Trost SG, Bauman A, Mummery K, Owen N (2004) Test-retest reliability of four physical activity measures used in population surveys. J Sci Med Sport 7(2):205–215PubMedCrossRefGoogle Scholar
  14. 14.
    Timperio A, Salmon JO, Rosenberg M, Bull FC (2004) Do logbooks influence recall of physical activity in validation studies? Med Sci Sports Exerc 36:1181–1186PubMedCrossRefGoogle Scholar
  15. 15.
    Kopec JA, Sayre EC, Esdaile JM (2004) Predictors of back pain in a general population cohort. Spine 29(1):70–77PubMedCrossRefGoogle Scholar
  16. 16.
    Lee IM, Paffenbarger RS Jr (2000) Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard alumni health study. Am J Epidemiol 151:293–299PubMedCrossRefGoogle Scholar
  17. 17.
    Kraigher-Krainer E, Lyass A, Massaro JM, Lee DS, Ho JE, Levy D, Kannel WB, Vasan RS (2013) Association of physical activity and heart failure with preserved vs. reduced ejection fraction in the elderly: the Framingham heart study. Eur J Heart Fail 15:742–746PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Walker BF, Muller R, Grant WD (2004) Low back pain in Australian adults: prevalence and associated disability. J Manipulative Physiol Ther 27(4):238–244PubMedCrossRefGoogle Scholar
  19. 19.
    Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R (2012) A systematic review of the global prevalence of low back pain. Arthritis Rheum 64(6):2028–2037PubMedCrossRefGoogle Scholar
  20. 20.
    Hu FB, Goldberg J, Hedeker D, Henderson WG (1998) Modelling ordinal responses from co-twin control studies. Stat Med 17(9):957–970PubMedCrossRefGoogle Scholar
  21. 21.
    Boomsma D, Busjahn A, Peltonen L (2002) Classical twin studies and beyond. Nat Rev Genet 3(11):872–882PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Markus Hübscher
    • 1
    • 2
    • 6
    Email author
  • Manuela L. Ferreira
    • 3
  • Daniela R. G. Junqueira
    • 1
    • 4
  • Kathryn M. Refshauge
    • 1
  • Chris G. Maher
    • 3
  • John L. Hopper
    • 5
  • Paulo H. Ferreira
    • 1
  1. 1.Faculty of Health SciencesThe University of SydneySydneyAustralia
  2. 2.Neuroscience Research Australia and The University of New South WalesSydneyAustralia
  3. 3.The George Institute for Global Health, Sydney Medical SchoolThe University of SydneySydneyAustralia
  4. 4.Centro de Estudos Do Medicamento (Cemed), Departamento de Farmácia Social, Faculdade de FarmáciaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  5. 5.Centre for Molecular, Environmental, Genetic, and Analytic EpidemiologyThe University of MelbourneMelbourneAustralia
  6. 6.LidcombeAustralia

Personalised recommendations