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Causal relationship between leisure sedentary behaviors and low back pain risk: a Mendelian randomization study

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Abstract

Purpose

This study aims to assess the causal associations of leisure sedentary behaviors with low back pain (LBP).

Methods

A Mendelian randomization (MR) study was carried out utilizing genetic instruments to determine whether leisure sedentary behaviors (including leisure television watching, leisure computer use, and driving) are causally associated with LBP. All instrumental variables were selected from publicly available genetic summary data. The inverse variance weighted (IVW) was used as the main method to conduct univariable MR analyses. Further sensitivity analyses were utilized to test the stability of the results. Moreover, multivariable MR was performed to evaluate the independent causal relationship between leisure sedentary behaviors and LBP when body mass index (BMI), waist circumference, smoking initiation, and vigorous physical activity were taken into account.

Results

The MR analyses showed evidence that television watching increased the risk for LBP (OR: 1.97, 95% CI 1.45, 2.66; P = 1.19 × 10–5). Genetically determined computer use is causally associated with a decreased risk of LBP (OR: 0.53, 95% CI 0.41, 0.68; P = 4.79 × 10–7). However, no evidence was found of a causal relationship between driving and LBP (OR: 2.27, 95% CI 0.75, 6.81; P = 0.145). After adjusting for BMI, waist circumference, smoking initiation, and vigorous physical activity, only television maintained its causal effect on LBP.

Conclusions

This study indicated that genetically predicted television watching was a risk factor for LBP independent of BMI, waist circumference, smoking initiation, and vigorous physical activity. This finding may be helpful for the diagnosis and management of LBP.

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References

  1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M (2018) What low back pain is and why we need to pay attention. Lancet 391(10137):2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X

    Article  PubMed  Google Scholar 

  2. Stevans JM, Delitto A, Khoja SS, Patterson CG, Smith CN, Schneider MJ, Freburger JK, Greco CM, Freel JA, Sowa GA, Wasan AD, Brennan GP, Hunter SJ, Minick KI, Wegener ST, Ephraim PL, Friedman M, Beneciuk JM, George SZ, Saper RB (2021) Risk factors associated with transition from acute to chronic low back pain in us patients seeking primary care. JAMA Netw Open 4(2):e2037371. https://doi.org/10.1001/jamanetworkopen.2020.37371

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T (2021) Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396(10267):2006–2017. https://doi.org/10.1016/S0140-6736(20)32340-0

    Article  PubMed  Google Scholar 

  4. Dieleman JL, Cao J, Chapin A, Chen C, Li Z, Liu A, Horst C, Kaldjian A, Matyasz T, Scott KW, Bui AL, Campbell M, Duber HC, Dunn AC, Flaxman AD, Fitzmaurice C, Naghavi M, Sadat N, Shieh P, Squires E, Yeung K, Murray C (2020) US health care spending by payer and health condition, 1996–2016. JAMA 323(9):863–884. https://doi.org/10.1001/jama.2020.0734

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, Chastin S, Altenburg TM, Chinapaw M (2017) Sedentary behavior research network (SBRN) - Terminology consensus project process and outcome. Int J Behav Nutr Phys Act 14(1):75. https://doi.org/10.1186/s12966-017-0525-8

    Article  PubMed  PubMed Central  Google Scholar 

  6. Park SM, Kim HJ, Jeong H, Kim H, Chang BS, Lee CK, Yeom JS (2018) Longer sitting time and low physical activity are closely associated with chronic low back pain in population over 50 years of age: a cross-sectional study using the sixth Korea National Health and Nutrition Examination Survey. Spine J 18(11):2051–2058. https://doi.org/10.1016/j.spinee.2018.04.003

    Article  PubMed  Google Scholar 

  7. Alzahrani H, Alshehri MA, Alzhrani M, Alshehri YS, Al AW (2022) The association between sedentary behavior and low back pain in adults: a systematic review and meta-analysis of longitudinal studies. PeerJ 10:e13127. https://doi.org/10.7717/peerj.13127

    Article  PubMed  PubMed Central  Google Scholar 

  8. Parry SP, Coenen P, Shrestha N, O’Sullivan PB, Maher CG, Straker LM (2019) Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012487.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  9. Schwertner DS, Oliveira R, Koerich M, Motta AF, Pimenta AL, Gioda FR (2020) Prevalence of low back pain in young Brazilians and associated factors: sex, physical activity, sedentary behavior, sleep and body mass index. J Back Musculoskelet Rehabil 33(2):233–244. https://doi.org/10.3233/BMR-170821

    Article  PubMed  Google Scholar 

  10. Damato TM, Christofaro D, Pinheiro MB, Morelhao PK, Pinto RZ, De Oliveira SD, Tebar WR, Grande G, Oliveira CB (2022) Does sedentary behaviour contribute to the development of a new episode of low back pain? A systematic review of prospective cohort studies. Eur J Pain 26(7):1412–1423. https://doi.org/10.1002/ejp.1977

    Article  PubMed  Google Scholar 

  11. Sekula P, Del GMF, Pattaro C, Köttgen A (2016) Mendelian randomization as an approach to assess causality using observational data. J Am Soc Nephrol 27(11):3253–3265. https://doi.org/10.1681/ASN.2016010098

    Article  PubMed  PubMed Central  Google Scholar 

  12. Momen MM, Hakim F, Bandhan IH, Razzaque MA, Zahid-Al-Quadir A, Ahmed S, Choudhury MR, Haq SA, Zaman MM (2022) Low back pain in the Bangladeshi adult population: a cross-sectional national survey. BMJ Open 12(9):e59192. https://doi.org/10.1136/bmjopen-2021-059192

    Article  Google Scholar 

  13. Mosabbir A (2022) Mechanisms behind the development of chronic low back pain and its neurodegenerative features. Life (Basel) 13(1):84. https://doi.org/10.3390/life13010084

    Article  CAS  PubMed  Google Scholar 

  14. Richmond RC, Davey SG (2022) Mendelian randomization: concepts and scope. Cold Spring Harb Perspect Med 12(1):a040501. https://doi.org/10.1101/cshperspect.a040501

    Article  PubMed  Google Scholar 

  15. Sheehan NA, Didelez V, Burton PR, Tobin MD (2008) Mendelian randomisation and causal inference in observational epidemiology. Plos Med 5(8):e177. https://doi.org/10.1371/journal.pmed.0050177

    Article  PubMed  PubMed Central  Google Scholar 

  16. Davey SG, Hemani G (2014) Mendelian randomization: genetic anchors for causal inference in epidemiological studies. Hum Mol Genet 23(R1):R89–R98. https://doi.org/10.1093/hmg/ddu328

    Article  CAS  Google Scholar 

  17. Davies NM, Holmes MV, Davey SG (2018) Reading Mendelian randomisation studies: a guide, glossary, and checklist for clinicians. BMJ 362:k601. https://doi.org/10.1136/bmj.k601

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zhou J, Mi J, Peng Y, Han H, Liu Z (2021) Causal associations of obesity with the intervertebral degeneration, low back pain, and sciatica: a two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 12:740200. https://doi.org/10.3389/fendo.2021.740200

    Article  PubMed  Google Scholar 

  19. You Q, Jiang Q, Li D, Wang T, Wang S, Cao S (2022) Waist circumference, waist-hip ratio, body fat rate, total body fat mass and risk of low back pain: a systematic review and meta-analysis. Eur Spine J 31(1):123–135. https://doi.org/10.1007/s00586-021-06994-y

    Article  PubMed  Google Scholar 

  20. Lv Z, Cui J, Zhang J (2022) Smoking, alcohol and coffee consumption and risk of low back pain: a Mendelian randomization study. Eur Spine J 31(11):2913–2919. https://doi.org/10.1007/s00586-022-07389-3

    Article  PubMed  Google Scholar 

  21. Grooten WJA, Boström C, Dedering Å, Halvorsen M, Kuster RP, Nilsson-Wikmar L, Olsson CB, Rovner G, Tseli E, Rasmussen-Barr E (2022) Summarizing the effects of different exercise types in chronic low back pain - a systematic review of systematic reviews. BMC Musculoskelet Disord 23(1):801. https://doi.org/10.1186/s12891-022-05722-x

    Article  PubMed  PubMed Central  Google Scholar 

  22. van de Vegte YJ, Said MA, Rienstra M, van der Harst P, Verweij N (2020) Genome-wide association studies and Mendelian randomization analyses for leisure sedentary behaviours. Nat Commun 11(1):1770. https://doi.org/10.1038/s41467-020-15553-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Burgess S, Thompson SG (2011) Avoiding bias from weak instruments in Mendelian randomization studies. Int J Epidemiol 40(3):755–764. https://doi.org/10.1093/ije/dyr036

    Article  PubMed  Google Scholar 

  24. Kamat MA, Blackshaw JA, Young R, Surendran P, Burgess S, Danesh J, Butterworth AS, Staley JR (2019) PhenoScanner V2: an expanded tool for searching human genotype-phenotype associations. Bioinformatics 35(22):4851–4853. https://doi.org/10.1093/bioinformatics/btz469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hartwig FP, Davey SG, Bowden J (2017) Robust inference in summary data Mendelian randomization via the zero modal pleiotropy assumption. Int J Epidemiol 46(6):1985–1998. https://doi.org/10.1093/ije/dyx102

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lin Z, Deng Y, Pan W (2021) Combining the strengths of inverse-variance weighting and Egger regression in Mendelian randomization using a mixture of regressions model. Plos Genet 17(11):e1009922. https://doi.org/10.1371/journal.pgen.1009922

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Bowden J, Davey SG, Haycock PC, Burgess S (2016) Consistent estimation in Mendelian randomization with some invalid instruments using a weighted median estimator. Genet Epidemiol 40(4):304–314. https://doi.org/10.1002/gepi.21965

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bowden J, Davey SG, Burgess S (2015) Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression. Int J Epidemiol 44(2):512–525. https://doi.org/10.1093/ije/dyv080

    Article  PubMed  PubMed Central  Google Scholar 

  29. Burgess S, Thompson SG (2015) Multivariable Mendelian randomization: the use of pleiotropic genetic variants to estimate causal effects. Am J Epidemiol 181(4):251–260. https://doi.org/10.1093/aje/kwu283

    Article  PubMed  PubMed Central  Google Scholar 

  30. Yang L, Cao C, Kantor ED, Nguyen LH, Zheng X, Park Y, Giovannucci EL, Matthews CE, Colditz GA, Cao Y (2019) Trends in sedentary behavior among the US population, 2001–2016. JAMA 321(16):1587–1597. https://doi.org/10.1001/jama.2019.3636

    Article  PubMed  PubMed Central  Google Scholar 

  31. Prince SA, Melvin A, Roberts KC, Butler GP, Thompson W (2020) Sedentary behaviour surveillance in Canada: trends, challenges and lessons learned. Int J Behav Nutr Phys Act 17(1):34. https://doi.org/10.1186/s12966-020-00925-8

    Article  PubMed  PubMed Central  Google Scholar 

  32. Husu P, Suni J, Vähä-Ypyä H, Sievänen H, Tokola K, Valkeinen H, Mäki-Opas T, Vasankari T (2016) Objectively measured sedentary behavior and physical activity in a sample of Finnish adults: a cross-sectional study. BMC Public Health 16(1):920. https://doi.org/10.1186/s12889-016-3591-y

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kang SH, Joo JH, Park EC, Jang SI (2020) Effect of sedentary time on the risk of orthopaedic problems in people aged 50 years and older. J Nutr Health Aging 24(8):839–845. https://doi.org/10.1007/s12603-020-1391-7

    Article  CAS  PubMed  Google Scholar 

  34. Diaz KM, Howard VJ, Hutto B, Colabianchi N, Vena JE, Safford MM, Blair SN, Hooker SP (2017) Patterns of sedentary behavior and mortality in US middle-aged and older adults: a national cohort study. Ann Intern Med 167(7):465–475. https://doi.org/10.7326/M17-0212

    Article  PubMed  PubMed Central  Google Scholar 

  35. Bontrup C, Taylor WR, Fliesser M, Visscher R, Green T, Wippert PM, Zemp R (2019) Low back pain and its relationship with sitting behaviour among sedentary office workers. Appl Ergon 81:102894. https://doi.org/10.1016/j.apergo.2019.102894

    Article  PubMed  Google Scholar 

  36. Chun SW, Lim CY, Kim K, Hwang J, Chung SG (2017) The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J 17(8):1180–1191. https://doi.org/10.1016/j.spinee.2017.04.034

    Article  PubMed  Google Scholar 

  37. Proskura P, Rutkowska-Kucharska A, Sobera M (2023) Evaluation of the effects of a novel exercise program in the treatment of low back pain in women working in a seated position: a randomized trial. J Back Musculoskelet Rehabil. https://doi.org/10.3233/BMR-210349

    Article  PubMed  Google Scholar 

  38. Vandercappellen EJ, Koster A, Savelberg H, Eussen S, Dagnelie PC, Schaper NC, Schram MT, van der Kallen C, van Greevenbroek M, Wesselius A, Schalkwijk CG, Kroon AA, Henry R, Stehouwer C (2022) Sedentary behaviour and physical activity are associated with biomarkers of endothelial dysfunction and low-grade inflammation-relevance for (pre)diabetes: the Maastricht study. Diabetologia 65(5):777–789. https://doi.org/10.1007/s00125-022-05651-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Henson J, Yates T, Edwardson CL, Khunti K, Talbot D, Gray LJ, Leigh TM, Carter P, Davies MJ (2013) Sedentary time and markers of chronic low-grade inflammation in a high risk population. PLoS One 8(10):e78350. https://doi.org/10.1371/journal.pone.0078350

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Goode AP, Cleveland RJ, Kraus VB, Taylor KA, George SZ, Schwartz TA, Renner J, Huebner JL, Jordan JM, Golightly YM (2023) Biomarkers and longitudinal changes in lumbar spine degeneration and low back pain: the Johnston County Osteoarthritis Project. Osteoarthr Cartilage. https://doi.org/10.1016/j.joca.2023.02.005

    Article  Google Scholar 

  41. Chastin SF, Mandrichenko O, Skelton DA (2014) The frequency of osteogenic activities and the pattern of intermittence between periods of physical activity and sedentary behaviour affects bone mineral content: the cross-sectional NHANES study. BMC Public Health 14:4. https://doi.org/10.1186/1471-2458-14-4

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hussain SM, Urquhart DM, Wang Y, Dunstan D, Shaw JE, Magliano DJ, Wluka AE, Cicuttini FM (2016) Associations between television viewing and physical activity and low back pain in community-based adults: a cohort study. Medicine (Baltimore) 95(25):e3963. https://doi.org/10.1097/MD.0000000000003963

    Article  PubMed  Google Scholar 

  43. Santos M, Gabani FL, Dias DF, de Andrade SM, González AD, Loch MR, Mesas AE (2020) Longitudinal associations of changes in physical activity and TV viewing with chronic musculoskeletal pain in Brazilian schoolteachers. Plos One 15(6):e234609. https://doi.org/10.1371/journal.pone.0234609

    Article  CAS  Google Scholar 

  44. Swain C, Bassett JK, Hodge AM, Dunstan DW, Owen N, Yang Y, Jayasekara H, Hébert JR, Shivappa N, MacInnis RJ, Milne RL, English DR, Lynch BM (2022) Television viewing time and all-cause mortality: interactions with BMI, physical activity, smoking, and dietary factors. Int J Behav Nutr Phys Act 19(1):30. https://doi.org/10.1186/s12966-022-01273-5

    Article  PubMed  PubMed Central  Google Scholar 

  45. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, Bauman A, Lee IM (2016) Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 388(10051):1302–1310. https://doi.org/10.1016/S0140-6736(16)30370-1

    Article  PubMed  Google Scholar 

  46. Frydenlund G, Jørgensen T, Toft U, Pisinger C, Aadahl M (2012) Sedentary leisure time behavior, snacking habits and cardiovascular biomarkers: the Inter99 Study. Eur J Prev Cardiol 19(5):1111–1119. https://doi.org/10.1177/1741826711419999

    Article  PubMed  Google Scholar 

  47. Lyons EJ, Tate DF, Ward DS, Wang X (2012) Energy intake and expenditure during sedentary screen time and motion-controlled video gaming. Am J Clin Nutr 96(2):234–239. https://doi.org/10.3945/ajcn.111.028423

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Elgaeva EE, Tsepilov Y, Freidin MB, Williams FMK, Aulchenko Y, Suri P (2020) ISSLS Prize in Clinical Science, 2020. Examining causal effects of body mass index on back pain: a Mendelian randomization study. Eur Spine J 29(4):686–691. https://doi.org/10.1007/s00586-019-06224-6

    Article  PubMed  Google Scholar 

  49. Castro O, Bennie J, Vergeer I, Bosselut G, Biddle S (2020) How sedentary are university students? a systematic review and meta-analysis. Prev Sci 21(3):332–343. https://doi.org/10.1007/s11121-020-01093-8

    Article  PubMed  Google Scholar 

  50. Wilson R, Pryymachenko Y, Abbott JH, Dean S, Stanley J, Garrett S, Mathieson F, Dowell A, Darlow B (2023) A guideline-implementation intervention to improve the management of low back pain in primary care: a difference-in-difference-in-differences analysis. Appl Health Econ Health Policy 21(2):253–262. https://doi.org/10.1007/s40258-022-00776-3

    Article  PubMed  Google Scholar 

  51. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF (2020) World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 54(24):1451–1462. https://doi.org/10.1136/bjsports-2020-102955

    Article  PubMed  Google Scholar 

  52. Owen N, Healy GN, Matthews CE, Dunstan DW (2010) Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev 38(3):105–113. https://doi.org/10.1097/JES.0b013e3181e373a2

    Article  PubMed  PubMed Central  Google Scholar 

  53. O’Hagan ET, Cashin AG, Traeger AC, McAuley JH (2023) Person-centred education and advice for people with low back pain: making the best of what we know. Braz J Phys Ther 27(1):100478. https://doi.org/10.1016/j.bjpt.2022.100478

    Article  PubMed  Google Scholar 

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  1. School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053, China

    Qianyin Zhu, Lingshan Chen & Cuizhen Shen

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Zhu, Q., Chen, L. & Shen, C. Causal relationship between leisure sedentary behaviors and low back pain risk: a Mendelian randomization study. Eur Spine J 32, 3300–3308 (2023). https://doi.org/10.1007/s00586-023-07839-6

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