Publish in this journal
Journal Information
Share
Share
Download PDF
More article options
Visits
713
Original Research
DOI: 10.1016/j.bjpt.2018.06.004
Full text access
Available online 7 July 2018
Is occupational or leisure physical activity associated with low back pain? Insights from a cross-sectional study of 1059 participants
Visits
713
Anita B. Amorima,
Corresponding author
abar3926@uni.sydney.edu.au

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
Highlights

  • 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.

This item has received
713
Visits
Received 05 February 2018, Accepted 14 June 2018
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
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.
Show moreShow less
Abstract
Background

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.

Objective

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

Methods

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.

Results

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.

Conclusion

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.

Keywords:
Low back pain
Sedentary behavior
Leisure physical activity
Occupational physical activity
Epidemiology
Full Text
Introduction

Low back pain (LBP) is the musculoskeletal disorder responsible for the greatest level of disability worldwide,1,2 with 84% of individuals expected to experience LBP during their lifetime.3 The point-prevalence of chronic LBP is approximately 23%, and about 12% of people will experience activity limitations because of their LBP.4,5 In addition to these impressive figures, the impact of LBP continues to grow.6 According to the latest global burden of disease report, the burden of LBP has increased by 60% between 1990 and 2015 (assessed using disability-adjusted life years).7 It is believed that this growth is partially due to the widespread effect of poor lifestyle choices, including sedentary behavior.8–10

The benefits of physical activity on an individual's social, psychological, and biological health are substantial.11,12 Engagement in regular moderate-intensity physical activity can reduce the risk of morbidity and all-cause mortality,13–17 while physical activity is widely used as a prevention strategy for chronic diseases such as diabetes, osteoporosis, cardiovascular disease, depression, and numerous musculoskeletal disorders, including LBP.18,19 Physical activity has been widely recommended in clinical guidelines for LBP.20 However, the guidelines are silent in regards to which types and intensities of physical activity.21

Despite increasing research investigating the relationship between physical activity and LBP, there is still conflicting evidence as to whether physical activity is a protective or a risk factor for LBP.22 Issues related to the direction of the relationship and strength of association remains unclear.23 For instance, systematic reviews have found contradictory evidence for the association between LBP and leisure physical activity and sports participation.23,24 However, exposure to high occupational workloads and frequent lifting activities appear to be strongly associated with LBP.23 A potential limitation of previous studies is that physical activity is assessed as the sum of all leisure or occupational activities, making it difficult to identify the intensity and type of physical activity that impacts on LBP. The discrepancy in the literature is likely attributed to the different definitions of levels of physical activity.23,25

To our knowledge, no single study has investigated the association between different types (occupational or leisure) and intensities (moderate or vigorous) of physical activity and LBP. The aim of this study is to investigate the association between LBP and different types and intensity of occupational (e.g. twisting, bending, lifting weight), and leisure (walking, moderate, and vigorous-intensity) physical activity.

MethodsDesign, study sample and data collection

A cross-sectional observational design was used. The sample for this study comprised monozygotic (MZ) and dizygotic (DZ) twins registered in the Murcia Twin Registry (MTR), a population-based twin registry of adult multiples born between 1940 and 1966 in the region of Murcia, Spain. The MTR is a joint effort between the University of Murcia and the Regional Health Authority and currently has over 2300 participants. In brief, participants were recruited through the public health system, which keeps up-to-date records of all the residents in the area. People who were born on the same date and had the same family name were contacted and invited to participate in the MTR provided both twins in a pair were alive at the time of enrolment, and neither had any disorder or disability which would limit their voluntary and conscious participation.26

Twin samples are classically used to disentangle the relative effect of genetics and environment on complex phenotypes, but that is not their only utility. A cohort of twins is a great opportunity for epidemiological research as twins can be treated as a regular cohort of individuals; especially when population-based and representative of the general population.27 The MTR sample has shown to adequately represent the reference population in its geographical area.28 Consequently, since the objective of this study was not the determination of the relative effects of genetic and environmental factors on the relationship between LBP and physical activity, data on twin zygosity and subsequent analyses are not provided.

For this cross-sectional study, data were collected in 2013 including demographics, anthropometric data, a basic health history, and self-reported health-related questionnaires, using phone and face-to-face interviews. All registry and data collection procedures involved in the development of the MTR were approved by the University of Murcia ethics committee, Murcia, Spain. All participants included in the MTR were requested to sign an informed consent form. All data collection was conducted by trained assessors who were blinded to the outcomes of the study.

Assessment of LBP

LBP was comprehensively assessed in 2013 from questions derived from standardized definitions aimed to facilitate uniformity across epidemiological studies.29 The LBP outcome used in this study was recurrent LBP. We selected the cases with a more recent presentation of LBP to more efficiently synchronize the assessment of LBP with participants’ report of physical activity engagement in the past week. Initially, the presence of lifetime chronic LBP was assessed by the following question: (i) “Have you ever suffered from chronic LBP?” Chronic LBP was described as pain in the lower back lasting for six months or longer, including seasonal and recurrent episodes. Participants responding ‘yes’ were asked a follow-up question: (ii) When was the last time you experienced LBP?” This question was followed by (iii) “How long has it been since you have had a whole month pain free?” Participants indicating they have suffered from chronic LBP (i), experienced LBP ‘within the past 4 weeks’ (ii), and have had a pain free month within the last ‘3 months’ (iii), were considered to have a history of chronic LBP, experiencing current symptoms consistent with a new recurrent episode.

Assessment of leisure physical activity

Leisure physical activity was assessed with questions adapted from the Active Australia Survey,30 which has been proved to be valid and reliable for accessing physical activity in large-scale population-based studies.31–34 First, participants were asked about their engagement in walking during the past week. The variable walking was created based on the participant's response to the following questions: (i) “In the last week, how many times have you walked continuously, for at least 10min for recreation, exercise, or to get to or from places?”; (ii) “What do you estimate was the total time that you spent walking in this way in the last week?”

Second, participants were asked about their engagement in vigorous-intensity physical activity. The variable vigorous physical activity was determined by participants’ response to the following questions: (i) “In the last week, how many times did you do any vigorous physical activity for at least 10min which made you breathe harder or puff and pant? (e.g. jogging, cycling, aerobics, competitive tennis)”, (ii) “What do you estimate was the total time that you spent doing this vigorous physical activity in the last week?”

Finally, participants were asked about their engagement in moderate-intensity physical activity:

(i) “In the last week, how many times did you do any other more moderate physical activities for at least 10min that you have not already mentioned? (e.g. gentle swimming, social tennis, golf)”; (ii) “What do you estimate was the total time that you spent doing these activities in the last week?”

Since it is likely walking is a common form of exercise in the Spanish population, we included walking as a type of moderate-intensity physical activity despite being unable to assess intensity.

We also created a total physical activity category combining the total time spent in vigorous-intensity physical activity, plus moderate-intensity physical activity and walking, in the last week, considering that many people may not engage in only one type of physical activity but a combination of different types. We used as variables, the total time in minutes of each category: moderate (including walking), vigorous, and total physical activity.

Assessment of occupational physical activity

A detailed assessment of occupational physical activity was performed with questions adapted from the Hollmann questionnaire,35 which is a reliable and valid instrument for assessing physical workload. Participants were asked how often they work in a specific position on their current job (e.g. trunk upright, trunk twisted, squatting, etc.) and whether they lift or carry light or heavy weight while working (Appendix 1). We used the data from 17 different work postures, with some variables being created through the combination of different postures.

Assessment of co-variables

We performed univariate logistic regression to explore potential confounders that should be adjusted for in the multivariate models. Investigation of potential confounders such as age, gender, Body Mass Index (BMI), sleep quality, and symptoms of depression or anxiety was based on previous studies in the field.36,37 If the univariate association between co-variables, the outcome and the predictor, reached a significance of <0.2, these variables were adjusted for in the multivariate logistic regression models.

Data analysis

Data analysis was performed using STATA statistical software (version 13.0, STATA Corp., College Station, TX). We conducted descriptive analyses for all study variables to summarize the data. Our outcome variable was recurrent LBP. Our explanatory variables were leisure physical activity and occupational physical activity. We conducted an unadjusted univariate total sample analysis to explore the association between LBP and the different types of physical activity. In addition, we performed multivariate analysis including the pre-selected confounders as described above. We set the α level for all the final regression models at <0.05. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated.

ResultsSample characteristics

There were 1059 twins (384 MZ, 675 DZ) with data available on LBP from the 2013 data collection wave. The mean age [standard deviation (SD)] of participants in the total sample was 56.7 (7.1), and 884 (55%) were females. Of those that responded the follow-up wave, only 4% reported recurrent LBP. Further details regarding sample characteristics can be found in Table 1.

Table 1.

Characteristics of participants at baseline divided by subgroups according to low back pain status.

Variables  Recent LBP
  YesNo
  n  Mean (SD) or %  n  Mean (SD) or % 
Age (years)  43  53.7 (7.3)  1016  53.4 (7.2) 
Gender (male)  43  23.2  1016  46.8 
Zigosity (MZ)  15  3.9  369  96.0 
Moderate PA  43  46.5  1009  68.9 
Vigorous PA  43  2.3  1000  21.0 
Always upright  14  92.8  352  92.0 
Any inclination  14  71.4  354  54.8 
Any awkward posture  14  50.0  362  22.6 
No load  14  92.8  362  97.5 
Straight upright  14  64.2  374  49.1 
Slightly inclined  14  64.2  377  48.5 
Strongly inclined  14  14.2  369  15.7 
Twisted  14  21.4  366  15.2 
Sitting  14  14.2  373  39.9 
Standing  14  14.2  317  26.5 
Squatting  13  7.6  233  3.4 
Kneeling  13  7.6  234  3.8 
Walking  14  14.2  340  31.1 
BMI (kg/m240  27.1 (5.4)  951  27.1 (4.2) 

LBP, low back pain; PA, physical activity; BMI, Body Mass Index; n, number of participants; SD, standard deviation; MZ, monozygotic; DZ, dizygotic.

Leisure physical activity

The results showed a strong inverse association between moderate (OR=0.44, 95% CI: 0.25 to 0.78, p=0.006), vigorous (OR=0.12, 95% CI: 0.01 to 0.91, p=0.041), and total physical activity and LBP (OR=0.36, 95% CI: 0.20 to 0.65, p=0.001) (Table 2) (Fig. 1). These analyses were adjusted for age, gender, and symptoms of depression or anxiety.

Table 2.

Cross-sectional association between leisure physical activity and low back pain adjusted for confounders.

Multivariate models  OR (95% CI)  p-Value  R2 
Moderate PAa,b (n=1052)  0.44 (0.25–0.78)  0.01  0.06 
Vigorous PAa,b (n=1043)  0.12 (0.01–0.91)  0.04  0.07 
Total Leisure PAa,b (n=1010)  0.36 (0.20–0.65)  0.00  0.06 

PA, physical activity; OR, odds ratio; CI, confidence interval; n, number of participants.

a

Adjusted for age and sex;

b

Adjusted for depression/anxiety levels.

Figure 1.

Influence of different dosages of leisure physical activity (moderate, vigorous and total) in the prevalence of recent LBP based on odds ratio (OR) and 95% confidence intervals.

(0.04MB).
Occupational physical activity

The results showed a strong association between lifting or carrying heavy weight on trunk while inclined and LBP (OR=5.0, 95% CI: 1.3 to 18.7, p=0.02). Likewise, any awkward posture at work was strongly associated with LBP (OR=3.1, 95% CI: 1.0 to 9.0, p=0.04). For the other variables (e.g. sitting or standing). There was no statistically significant association between the remaining occupational physical activity variables (e.g. sitting, standing) and LBP (Table 3) (Fig. 2). These analyses were also adjusted for age, sex, and symptoms of depression or anxiety were included in these multivariate models.

Table 3.

Cross-sectional association between occupational PA (workload variables) and the presence of recent LBP adjusted for confounders.

Multivariate models  n  OR (95% CI)  p-Value  R2 
Straight uprighta,b  338  2.39 (0.77–7.39)  0.13  0.06 
Always uprighta,b  366  1.07 (0.13–8.22)  0.95  0.01 
Slightly inclineda,b  391  1.75 (0.58–5.25)  0.31  0.05 
Strongly inclineda,b  383  0.95 (0.20–4.41)  0.95  0.04 
Trunk twisteda  380  1.43 (0.34–6.01)  0.62  0.04 
Sittinga,b  387  0.28 (0.05–1.38)  0.12  0.07 
Standinga  332  0.53 (0.11–2.58)  0.44  0.05 
Squattinga  246  2.37 (0.26–20.99)  0.44  0.01 
Kneelinga  247  2.08 (0.24–17.97)  0.50  0.01 
Walkinga  354  0.40 (0.08–1.96)  0.26  0.05 
Light weight on trunk uprighta,b  390  0.54 (0.15–1.96)  0.35  0.01 
Heavy weight on trunk uprighta,b  374  1.16 (0.12–11.01)  0.89  0.01 
Light weight on trunk while inclineda  390  0.51 (0.06–4.13)  0.53  0.01 
Heavy weight on trunk while inclineda  377  4.99 (1.33–18.74)  0.02  0.04 
Any inclinationa  368  1.98 (0.63–6.24)  0.24  0.02 
Any awkward posture at worka,b  376  3.08 (1.05–9.07)  0.04  0.07 

OR, odds ratio; CI, confidence interval; n, number of participants.

a

Adjusted for age and sex.

b

Adjusted for depression/anxiety levels.

Figure 2.

Influence of different occupational physical activity in the prevalence of recent LBP based on odds ratios and 95% confidence intervals.

(0.18MB).
DiscussionSummary of findings

In this cross-sectional study, we investigated the relationship between different types and intensity of leisure and occupational physical activity, and recurrent LBP among people with a history of chronic LBP. Our findings demonstrate that leisure physical activity is associated with a lower prevalence of LBP. Likewise, because of the cross-sectional nature of our study, the results also show that people with recurrent LBP are engaging less in leisure physical activity. In contrast, some postures that people adopt in the occupational setting, such as carrying, lifting heavy weight while inclined, or adopting awkward postures (e.g. bending, twisting, squatting, and kneeling) are associated with a higher prevalence of recurrent symptoms of LBP. However, less complex postures such as sitting, standing, or walking are not associated with the prevalence of recurrent LBP.

Comparison of findings with previous research

In regards to the relationship between leisure physical activity and LBP, our findings are consistent with the results of recent systematic reviews.22,38 Shiri and Falah-Hassani22 concluded that leisure physical activity might reduce the risk of chronic LBP by 11%–16%. Another systematic review38 investigating the relationship between physical activity and LBP concluded that people with chronic LBP with high levels of disability are likely to have low levels of physical activity. Other studies investigating the effect of physical activity intervention on a chronic pain population have suggested that physical activity may improve pain severity, physical function, as well as quality of life.39,40

Likewise, our results are in agreement with previous prospective studies investigating the effects of occupational physical activity for LBP. Heuch et al.41 conducted a longitudinal study with 14,915 adults aged 20 years or older and concluded that heavy physical workload increases the risk of chronic LBP. Another study42 showed that early exposure to heavier physical workload might have a long-lasting effect on the risk of LBP. Esquirol et al.43 also concluded that occupational factors have an important influence on the incidence of LBP. Whereas other studies,44,45 found that sitting or standing were not independently associated with LBP. However, a recently published systematic review could not confirm a causal relationship between occupational physical activity and LBP because there is still a lack of high-quality research investigating a causation pathway that can confirm this relationship.46

To date, the literature has provided insufficient evidence as to the extent which types and intensities of physical activity may increase or decrease the risk of developing LBP.47 The discrepancy in the literature is likely attributed to the different definitions of levels of physical activity and the lack of clarification on the type of physical activities investigated. Activities such as long walks and bike riding have been defined as strenuous physical activity in a longitudinal study identifying a protective effect,25 whereas the same types of physical activities were considered as of moderate intensity in another study that did not find any association with chronic LBP.23 A design limitation of previous studies is that comparisons across different types of physical activities are rarely performed in the same study.

Implications of study findings

Clinicians should consider promoting the engagement in leisure physical activity in this population, such as encouraging walking as a leisure activity on a daily basis,48–50 especially through behavioral change techniques as there is growing evidence in the field suggesting that this approach might increase participation and adherence.51,52 However, the effects of such strategies should still be investigated in future prospective studies. Furthermore, given that some postures and loads adopted at work are more common in individuals with recurrent LBP, clinicians should consider performing a detailed assessment of an individual's occupational physical activities given these will probably have different effects on LBP.

Clinicians should also discuss the potential negative effect of frequent exposure to heavy lifting while inclined or awkward postures such as twisting, bending, squatting and kneeling in patients who frequently adopt these activities at work. Moreover, ergonomic advice regarding the use of body posture as a tool that can be changed to meet the job demands with minimum stress on the muscles, ligaments, bones and joints should be emphasized. A study looking at workplace prevention and musculoskeletal injuries in nurses showed that nurses with lifting devices and lifting teams in their workplace were significantly less likely to report neck or back pain.53 Another study investigating a multifaceted intervention consisting of participatory ergonomics, physical training, and cognitive behavior therapy showed a reduction in LBP among workers in eldercare.54 Therefore, multifaceted interventions aiming at reducing workers’ engagement in some occupational postures adopted at work, such as twisting, bending or lifting heavy weights, as well as encouragement to incorporate the practice of leisure physical activity while at work, may be relevant for improving LBP in a working population.

According to the latest global burden of disease report, occupational ergonomic factors are responsible for 31% of disability-adjusted life years due to LBP.7 The highest occupational risk is found in service industries and manual labor, especially agriculture. However, the management of most LBP cases remains mostly focused on pain relief and prevention of worsening outcomes through conservative care. Taking into consideration the great burden and the related economic consequences of lost work time, identification of effective preventive measures for LBP should be a priority for research.

Strengths and limitations

This study has several strengths. First, occupational physical activity examined the combination of different body postures at work, which reflects a more realistic scenario, compared to the adoption of single plane movement. Second, both the outcome and the explanatory variables referred to a close and synchronized time point. Our outcome of recurrent LBP referred to pain within the past four weeks, while leisure physical activity and occupational physical activity, referred to activities within the last week.

When interpreting the findings of our analyses we also need to take into account some general study limitations. First, our study employed a cross-sectional design which limits the possibility of identifying a causal relationship between physical activity and LBP (or eliminating reverse causation). Second, we could not run any within-pair twin case-control analysis as there was a dramatic decrease in the sample size when discordant twin pairs were identified, and therefore the effects of genetics on the LBP-physical activity relationship could not be explored. Lastly, data on leisure and occupational physical activity were self-reported, and it is known that participants are likely to overestimate or underestimate their engagement in physical activity.55 However, the detailed description of different types of physical activities that we employed could only be assessed via self-reported tools as the MTR is a large population-based study.

Future high-quality longitudinal research is needed to identify whether a specific type and intensity of physical activity increase the risk of developing LBP. This may be challenging due to difficulties in obtaining accurate, objective measurements of intensity, duration, frequency, and type of physical activity performed.56 However, advancements in technology are gradually assisting in overcoming this barrier, evident by many studies making the transition from self-reported measurements of physical activity to pedometers57 and accelerometers.58,59 Accelerometers have been identified to be a more accurate tool for measuring physical activity compared to pedometers60 and self-reported measurements,61 although they still present limitations regarding calibration and structural modeling.62 Future methods are required to obtain more accurate physical activity objective measurements.

Conclusion

Our study highlights that leisure and occupational physical activities are likely to have a different and divergent influence on LBP. Our results suggest the relationship between physical activity and LBP is highly dependent on how it is defined and assessed. Clinicians may support their patients to engage in leisure physical activity with the support of informed assessment of risks and explanation of the range of potential benefits.

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgements

The Murcia Twin Registry is supported by the Seneca Foundation, Regional Agency for Science and Technology, Murcia, Spain (08633/PHCS/08 & 15302/PHCS/10) and Ministry of Science and Innovation, Spain (PSI11560 – 2009). This study has been supported by a grant from the Fundación MAPFRE, Spain (2012). ABA holds the International Post-graduate Research Scholarship “Science without Borders” award from the Brazilian Government.

Appendix 1
Definition of the occupational physical activity variables

Study variables  Original variables 
Always upright  Straight, upright
Standing
Walking
Light weight, lifted/carried while upright trunk
Medium weight, lifted/carried while upright trunk
Heavy weight, lifted/carried while upright trunk 
Any awkward posture at work  Trunk twisted
trunk laterally bent
squatting
kneeling with one or both knees 
Any inclination  Slightly inclined
Strongly inclined
Light weight, lifted/carried while inclined trunk
Medium weight, lifted/carried while inclined trunk
Heavy weight, lifted/carried while inclined trunk 
No load  Straight upright
Slightly inclined
Strongly inclined
Twisted
Laterally bent
Sitting
Squatting
Kneeling
Standing
Walking 
Straight upright  Straight, upright 
Slightly inclined  Slightly inclined 
Strongly inclined  Strongly inclined 
Trunk twisted  Twisted 
Sitting  Sitting 
Standing  Standing 
Squatting  Squatting 
Kneeling  Kneeling 
Walking  Walking 
Light weight on trunk upright  Light weight, lifted/carried while upright trunk 
Heavy weight on trunk upright  Heavy weight, lifted/carried while upright trunk 
Light weight on trunk while inclined  Light weight, lifted/carried while inclined trunk 
Heavy weight on trunk while inclined  Heavy weight, lifted/carried while inclined trunk 

OR, odds ratio; CI, confidence interval; n, number of participants. aAdjusted for age and sex; bAdjusted for depression/anxiety levels.

References
[1]
C. Maher, M. Underwood, R. Buchbinder
Non-specific low back pain
[2]
D. Hoy, L. March, P. Brooks
The global burden of low back pain: estimates from the Global Burden of Disease 2010 study
Ann Rheum Dis, 73 (2014), pp. 968-974 http://dx.doi.org/10.1136/annrheumdis-2013-204428
[3]
F. Balague, A.F. Mannion, F. Pellise, C. Cedraschi
Non-specific low back pain
[4]
C.J. Itz, J.W. Geurts, M. van Kleef, P. Nelemans
Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care
[5]
O. Airaksinen, J.I. Brox, C. Cedraschi
Chapter 4. European guidelines for the management of chronic nonspecific low back pain
Eur Spine J, 15 (2006), pp. S192-S300 http://dx.doi.org/10.1007/s00586-006-1072-1
[6]
J. Hartvigsen, M.J. Hancock, A. Kongsted
What low back pain is and why we need to pay attention
[7]
Collaborators GBDCoD
Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016
[8]
G.J. Egger, N. Vogels, K.R. Westerterp
Estimating historical changes in physical activity levels
Med J Aust, 175 (2001), pp. 635-636
[9]
A.D. Woolf, B. Pfleger
Burden of major musculoskeletal conditions
Bull World Health Organ, 81 (2003), pp. 646-656
[10]
A.B. Amorim, G.M. Levy, F. Perez-Riquelme
Does sedentary behavior increase the risk of low back pain? A population-based co-twin study of Spanish twins
[11]
P. Das, R. Horton
Physical activity-time to take it seriously and regularly
[12]
H. Arem, S.C. Moore, A. Patel
Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship
JAMA Intern Med, 175 (2015), pp. 959-967 http://dx.doi.org/10.1001/jamainternmed.2015.0533
[13]
H.A. King, J.M. Gierisch, J.W. Williams Jr., M.L. Maciejewski
Effects of health plan-sponsored fitness center benefits on physical activity, health outcomes, and health care costs and utilization: a systematic review. Washington (DC)
(2012)
[14]
K. Abu-Omar, A. Rutten
Physical activity and health. Evidence for the health benefits of different physical activity promotion concepts
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 49 (2006), pp. 1162-1168 http://dx.doi.org/10.1007/s00103-006-0078-5
[15]
D.E. Warburton, C.W. Nicol, S.S. Bredin
Health benefits of physical activity: the evidence
CMAJ, 174 (2006), pp. 801-809 http://dx.doi.org/10.1503/cmaj.051351
[16]
P. Kokkinos
Physical activity, health benefits, and mortality risk
ISRN Cardiol, 2012 (2012), pp. 718789 http://dx.doi.org/10.5402/2012/718789
[17]
U. Ekelund, J. Steene-Johannessen, W.J. Brown
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
[18]
C.E. Garber, B. Blissmer, M.R. Deschenes
American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise
Med Sci Sports Exerc, 43 (2011), pp. 1334-1359 http://dx.doi.org/10.1249/MSS.0b013e318213fefb
[19]
A. Bauman, D. Merom, F.C. Bull, D.M. Buchner, M.A. Fiatarone Singh
Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “Active Aging”
Gerontologist, 56 (2016), pp. S268-S280 http://dx.doi.org/10.1093/geront/gnw031
[20]
N.E. Foster, J.R. Anema, D. Cherkin
Prevention and treatment of low back pain: evidence, challenges, and promising directions
[21]
Excellence NIfHaC
Low back pain and sciatica in over 16s: assessment and management
(2016)
[22]
R. Shiri, K. Falah-Hassani
Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies
Br J Sports Med, 51 (2017), pp. 1410-1418 http://dx.doi.org/10.1136/bjsports-2016-097352
[23]
H. Heneweer, F. Staes, G. Aufdemkampe, M. van Rijn, L. Vanhees
Physical activity and low back pain: a systematic review of recent literature
Eur Spine J, 20 (2011), pp. 826-845 http://dx.doi.org/10.1007/s00586-010-1680-7
[24]
W.E. Hoogendoorn, M.N. van Poppel, P.M. Bongers, B.W. Koes, L.M. Bouter
Physical load during work and leisure time as risk factors for back pain
Scand J Work Environ Health, 25 (1999), pp. 387-403
[25]
J. Hartvigsen, K. Christensen
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
[26]
J.R. Ordoñana, F. Pérez-Riquelme, I. Rebollo-Mesa
The Murcia Twin Registry: a population-based registry of adult multiples in Spain
Twin Res Hum Genet, 16 (2013), pp. 302-306 http://dx.doi.org/10.1017/thg.2012.66
[27]
L. Calais-Ferreira, V.C. Oliveira, J.M. Craig
Twin studies for the prognosis, prevention and treatment of musculoskeletal conditions
Braz J Phys Ther, 22 (2018), pp. 184-189 http://dx.doi.org/10.1016/j.bjpt.2017.12.004
[28]
J.R. Ordonana, J.F. Sanchez Romera, L. Colodro-Conde
The Murcia Twin Registry. A resource for research on health-related behaviour
[29]
C.E. Dionne, K.M. Dunn, P.R. Croft
A consensus approach toward the standardization of back pain definitions for use in prevalence studies
Spine (Phila Pa 1976), 33 (2008), pp. 95-103
[30]
W.B.A. Brown, A. Timperio, J. Salmon, S. Trost
Measurement of adult physical activity: reliability, comparison and validity of self-report surveys for population surveillance. Summary and recommendations
Unpublished report to the Department of Health and Ageing, (2002)
[31]
W.J. Brown, N.W. Burton, A.L. Marshall, Y.D. Miller
Reliability and validity of a modified self-administered version of the Active Australia physical activity survey in a sample of mid-age women
Aust N Z J Public Health, 32 (2008), pp. 535-541 http://dx.doi.org/10.1111/j.1753-6405.2008.00305.x
[32]
K.C. Heesch, R.L. Hill, J.G. van Uffelen, W.J. Brown
Are Active Australia physical activity questions valid for older adults?
J Sci Med Sport, 14 (2011), pp. 233-237 http://dx.doi.org/10.1016/j.jsams.2010.11.004
[33]
W.J. Brown, S.G. Trost, A. Bauman, K. Mummery, N. Owen
Test-retest reliability of four physical activity measures used in population surveys
J Sci Med Sport, 7 (2004), pp. 205-215
[34]
V.T.M. Rocha, T.M. Soares, A.A.O. Leopoldino
Cross-cultural adaptation and reliability of the Active Australia Questionnaire for the elderly
Rev Bras Med Esporte, 23 (2017),
[35]
S. Hollmann, F. Klimmer, K.H. Schmidt, H. Kylian
Validation of a questionnaire for assessing physical work load
Scand J Work Environ Health, 25 (1999), pp. 105-114
[36]
A.B. Dario, M.L. Ferreira, K. Refshauge
Are obesity and body fat distribution associated with low back pain in women?. A population-based study of 1128 Spanish twins
Eur Spine J, 25 (2016), pp. 1188-1195 http://dx.doi.org/10.1007/s00586-015-4055-2
[37]
M.B. Pinheiro, M.L. Ferreira, K. Refshauge
Symptoms of depression and risk of low back pain: a prospective co-twin study
Clin J Pain, (2016),
[38]
C.W. Lin, J.H. McAuley, L. Macedo, D.C. Barnett, R.J. Smeets, J.A. Verbunt
Relationship between physical activity and disability in low back pain: a systematic review and meta-analysis
[39]
J. Marley, M.A. Tully, A. Porter-Armstrong
The effectiveness of interventions aimed at increasing physical activity in adults with persistent musculoskeletal pain: a systematic review and meta-analysis
BMC Musculoskelet Disord, 18 (2017), pp. 482 http://dx.doi.org/10.1186/s12891-017-1836-2
[40]
L.J. Geneen, R.A. Moore, C. Clarke, D. Martin, L.A. Colvin, B.H. Smith
Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews
Cochrane Database Syst Rev, 4 (2017), pp. CD011279 http://dx.doi.org/10.1002/14651858.CD011279.pub3
[41]
I. Heuch, I. Heuch, K. Hagen, J.A. Zwart
Physical activity level at work and risk of chronic low back pain: a follow-up in the Nord-Trondelag Health Study
[42]
T. Lallukka, E. Viikari-Juntura, J. Viikari
Early work-related physical exposures and low back pain in midlife: the Cardiovascular Risk in Young Finns Study
Occup Environ Med, 74 (2017), pp. 163-168 http://dx.doi.org/10.1136/oemed-2016-103727
[43]
Y. Esquirol, M. Niezborala, M. Visentin, A. Leguevel, I. Gonzalez, J.C. Marquie
Contribution of occupational factors to the incidence and persistence of chronic low back pain among workers: results from the longitudinal VISAT study
Occup Environ Med, 74 (2017), pp. 243-251 http://dx.doi.org/10.1136/oemed-2015-103443
[44]
M. Korshoj, D.M. Hallman, S.E. Mathiassen, M. Aadahl, A. Holtermann, M.B. Jorgensen
Is objectively measured sitting at work associated with low-back pain?. A cross sectional study in the DPhacto cohort
Scand J Work Environ Health, 44 (2018), pp. 96-105 http://dx.doi.org/10.5271/sjweh.3680
[45]
L.K. Lunde, M. Koch, S. Knardahl, K.B. Veiersted
Associations of objectively measured sitting and standing with low-back pain intensity: a 6-month follow-up of construction and healthcare workers
Scand J Work Environ Health, 43 (2017), pp. 269-278 http://dx.doi.org/10.5271/sjweh.3628
[46]
B.K. Kwon, D.M. Roffey, P.B. Bishop, S. Dagenais, E.K. Wai
Systematic review: occupational physical activity and low back pain
Occup Med (Lond), 61 (2011), pp. 541-548
[47]
E. Sitthipornvorakul, P. Janwantanakul, N. Purepong, P. Pensri, A.J. van der Beek
The association between physical activity and neck and low back pain: a systematic review
Eur Spine J, 20 (2011), pp. 677-689 http://dx.doi.org/10.1007/s00586-010-1630-4
[48]
D.A. Hurley, M.A. Tully, C. Lonsdale
Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092)
[49]
S.L. Krein, R. Kadri, M. Hughes
Pedometer-based internet-mediated intervention for adults with chronic low back pain: randomized controlled trial
J Med Internet Res, 15 (2013), pp. e181 http://dx.doi.org/10.2196/jmir.2605
[50]
S.R. O’Connor, M.A. Tully, B. Ryan
Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis
Arch Phys Med Rehabil, 96 (2015), pp. 724-734 http://dx.doi.org/10.1016/j.apmr.2014.12.003
e723
[51]
N. Ben-Ami, G. Chodick, Y. Mirovsky, T. Pincus, Y. Shapiro
Increasing recreational physical activity in patients with chronic low back pain: a pragmatic controlled clinical trial
J Orthop Sports Phys Ther, 47 (2017), pp. 57-66 http://dx.doi.org/10.2519/jospt.2017.7057
[52]
A.B. Amorim, E. Pappas, M. Simic
Integrating Mobile health and Physical Activity to reduce the burden of Chronic low back pain Trial (IMPACT): a pilot trial protocol
BMC Musculoskelet Disord, 17 (2016), pp. 36 http://dx.doi.org/10.1186/s12891-015-0852-3
[53]
A.M. Trinkoff, B. Brady, K. Nielsen
Workplace prevention and musculoskeletal injuries in nurses
J Nurs Adm, 33 (2003), pp. 153-158
[54]
C.D. Rasmussen, A. Holtermann, H. Bay, K. Sogaard, M. Birk Jorgensen
A multifaceted workplace intervention for low back pain in nurses’ aides: a pragmatic stepped wedge cluster randomised controlled trial
[55]
R. Rzewnicki, Y. Vanden Auweele, I. De Bourdeaudhuij
Addressing overreporting on the International Physical Activity Questionnaire (IPAQ) telephone survey with a population sample
Public Health Nutr, 6 (2003), pp. 299-305 http://dx.doi.org/10.1079/PHN2002427
[56]
A.G. Bonomi, A.H. Goris, B. Yin, K.R. Westerterp
Detection of type, duration, and intensity of physical activity using an accelerometer
Med Sci Sports Exerc, 41 (2009), pp. 1770-1777 http://dx.doi.org/10.1249/MSS.0b013e3181a24536
[57]
R.L. Freak-Poli, M. Cumpston, A. Peeters, S.A. Clemes
Workplace pedometer interventions for increasing physical activity
Cochrane Database Syst Rev, (2013), pp. CD009209
[58]
M. Skatrud-Mickelson, J. Benson, J.C. Hannon, E.W. Askew
A comparison of subjective and objective measures of physical exertion
J Sports Sci, 29 (2011), pp. 1635-1644 http://dx.doi.org/10.1080/02640414.2011.609898
[59]
R.C. Colley, D. Garriguet, I. Janssen
The association between accelerometer-measured patterns of sedentary time and health risk in children and youth: results from the Canadian Health Measures Survey
BMC Public Health, 13 (2013), pp. 200 http://dx.doi.org/10.1186/1471-2458-13-200
[60]
S. Duncan, K. White, L. Sa’ulilo, G. Schofield
Convergent validity of a piezoelectric pedometer and an omnidirectional accelerometer for measuring children's physical activity
Pediatr Exerc Sci, 23 (2011), pp. 399-410
[61]
C.A. Celis-Morales, F. Perez-Bravo, L. Ibanez, C. Salas, M.E. Bailey, J.M. Gill
Objective vs. self-reported physical activity and sedentary time: effects of measurement method on relationships with risk biomarkers
[62]
P.L. Walter
Accelerometer limitations for pyroshock measurements
Sound Vib, 43 (2009), pp. 17-19

Share senior authorship.

Copyright © 2018. Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia
Idiomas
Brazilian Journal of Physical Therapy

Subscribe to our newsletter

Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.