European Spine Journal

, Volume 25, Issue 4, pp 1226–1233 | Cite as

Does physical activity moderate the relationship between depression symptomatology and low back pain? Cohort and co-twin control analyses nested in the longitudinal study of aging Danish twins (LSADT)

  • Markus HübscherEmail author
  • Jan Hartvigsen
  • Matthew Fernandez
  • Kaare Christensen
  • Paulo Ferreira
Original Article



To investigate whether depression symptomatology is associated with low back pain (LBP) in twins aged 70+ and whether this effect depends on a person’s physical activity (PA) status.


This prospective cohort and nested case–control study used a nationally representative sample of twins. Data on depression symptomatology (modified Cambridge Mental Disorders Examination) and self-reported PA were obtained from the Longitudinal Study of Aging Danish Twins using twins without LBP at baseline. Associations between depression symptomatology (highest quartile) at baseline and LBP two years later were investigated using logistic regression analyses adjusted for sex. To examine the moderating effect of PA, we tested its interaction with depression. Associations were analysed using the complete sample of 2446 twins and a matched case–control analysis of 97 twin pairs discordant for LBP at follow-up. Odds ratios (OR) with 95 % confidence intervals (CI) were calculated.


Using the whole sample, high depression scores were associated with an increased probability of LBP (OR 1.56, 95 % CI 1.22–1.99, P ≤ 0.01). There was no statistically significant interaction of light PA and depression symptomatology (OR 0.78, 95 % CI 0.46–1.35, P = 0.39) and strenuous PA and depression symptomatology (0.84, 95 % CI 0.50–1.41, P = 0.51). The case–control analysis showed similar ORs, although statistically insignificant.


High depression symptomatology predicted incident LBP. This effect is supposedly not attributable to genetic or shared environmental factors. Physical activity did not moderate the effect of depression symptomatology on LBP.


Low back pain Depression symptomatology Spinal pain Physical activity Twins 



M.H. was supported by a postdoctoral fellowship from the German Academic Exchange Service (DAAD), Bonn, Germany. The authors thank Prof Kathryn Refshauge, Prof Chris Maher and Assoc. Prof Manuela Ferreira for their advice on the concept of this study.

Compliance with ethical standards

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Markus Hübscher
    • 1
    Email author
  • Jan Hartvigsen
    • 2
  • Matthew Fernandez
    • 3
  • Kaare Christensen
    • 4
  • Paulo Ferreira
    • 3
  1. 1.Neuroscience Research AustraliaThe University of New South WalesSydneyAustralia
  2. 2.Department of Sports Science and Clinical Biomechanics and Nordic Institute of Chiropractic and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
  3. 3.Faculty of Health SciencesThe University of SydneySydneyAustralia
  4. 4.Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark

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