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Vol. 23. Issue 3.
Pages 257-265 (01 May 2019)
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Vol. 23. Issue 3.
Pages 257-265 (01 May 2019)
Original Research
DOI: 10.1016/j.bjpt.2018.06.004
Is occupational or leisure physical activity associated with low back pain? Insights from a cross-sectional study of 1059 participants
Anita B. Amorima,
Corresponding author

Corresponding author at: Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW 1825, Australia.
, Milena Simica, Evangelos Pappasa, Joshua R. Zadrod, Eduvigis Carrillob,c, Juan R. Ordoñanab,c,1, Paulo H. Ferreiraa,1
a Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
b Murcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia, Murcia, Spain
c Murcia Institute for Biomedical Research (IMIB-Arrixaca), Murcia, Spain
d School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

  • Physical activity is recommended in clinical guidelines for chronic low back pain.

  • Guidelines are silent in regards to which types of physical activity.

  • Leisure physical activity appears to be protective to low back pain.

  • Occupational physical activity appears to be harmful to low back pain.

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Figures (2)
Tables (4)
Table 1. Characteristics of participants at baseline divided by subgroups according to low back pain status.
Table 2. Cross-sectional association between leisure physical activity and low back pain adjusted for confounders.
Table 3. Cross-sectional association between occupational PA (workload variables) and the presence of recent LBP adjusted for confounders.
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Low back pain is a highly prevalent and disabling musculoskeletal disorder. Physical activity is widely used as a prevention strategy for numerous musculoskeletal disorders; however, there is still conflicting evidence as to whether physical activity is a protective or risk factor for low back pain or whether activity levels differ between people with and without low back pain.


To investigate the association between low back pain and different types (occupational and leisure) and intensities (moderate and vigorous) of physical activity.


This is cross-sectional observational study. We included in this study a total of 1059 individuals recruited from a Spanish twin registry with data available on low back pain. Outcome: Self-reported leisure and occupational physical activity were the explanatory variables. The low back pain outcome used in this study was recurrent low back pain.


Our results indicate that leisure physical activity is associated with a lower prevalence of recurrent low back pain. In contrast, occupational physical activity, such as carrying, lifting heavy weight while inclined, awkward postures (e.g. bending, twisting, squatting, and kneeling) are associated with a higher prevalence of recurrent low back pain. There was no statistically significant association between other occupational physical activities, such as sitting or standing, and low back pain.


Leisure and occupational physical activity are likely to have an opposed impact on low back pain. While leisure physical activity appears to be protective, occupational physical activity appears to be harmful to low back pain. Future longitudinal studies should assist in formulating guidelines addressing specific types and intensity of physical activity aimed at effectively preventing low back pain.

Low back pain
Sedentary behavior
Leisure physical activity
Occupational physical activity


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