Background & Aims

Disability-related to low back pain (LBP) is associated with work absence and inability to perform activities of daily life1. In Brazil, the impact of LBP results, on average, 100 days per year of sick leave2. Exercise is defined as planned, structured, and repeated physical activity (PA) with the aim of either to keep or increase fitness, while PA encompasses all human movement that increases energy expenditure beyond the resting state3. Although moderate-quality evidence supports exercise’s beneficial effects on LBP, questions remain on the relationship between incidental PA and LBP, including the ideal volume, intensity, and type.4. The literature lacks consistency regarding LBP outcomes, including pain intensity and daily activity limitation, with studies reporting conflicting results5–7. Thus, we aimed to prospectively evaluate the association of leisure-time physical activity (LTPA) and pain intensity and daily activity limitation in people with LBP.

Methods

We analyzed data from the PAMPA (Prospective Study About Mental and Physical Health in Adults) cohort on baseline (June 2020) and four waves of data collection (December 2020, June 2021 and June 2022). Participants were adults (18 or older) who had experienced LBP (n=991). We asked participants about LBP-related activity limitation (yes/no) and pain intensity during the last six months (0-10 scale) at each time point. We classified participants as active and inactive based on the World Health Organization physical activity recommendation (i.e., 150 min/week or more)8. We used generalized linear models to investigate the interaction between PA and daily activity limitation and pain intensity along the cohort waves. All analyses were adjusted for age, sex, education, income, body mass index, and chronic diseases. We used the Gaussian distribution for pain intensity and the Poisson distribution for daily activity limitation.

Results

Participants who reported LBP-related activity limitation were older (41.1 vs. 37.8; p<0.001) and more likely to report at least one chronic disease (72.5% vs. 55.2%; p<0.001) when compared to those with no daily activity limitation. Inactive participants at baseline showed a higher incidence rate ratio (IRR) (1.06; 95%CI: 1.02, 1.12) of daily activity limitation compared to active counterparts. Physical inactivity at wave one was associated with a higher probability of activity limitation at waves two (IRR 1.77; 95%CI 1.27; 2.46), three (IRR: 1.63; 95%CI: 1.17, 2.29), and four (IRR: 1.74; 95%CI: 1.20, 2.50). However, inactive participants in wave one showed no increased risk of LBP-related activity limitation. Physically inactive participants at wave one reported higher pain intensity in waves one (?: 0.54; 95%CI: 0.23, 0.86), three (?: 0.38; 95%CI: 0.02, 0.75), and four (?: 0.48; 95%CI: 0.06, 0.90). However, on active participants, no association in pain intensity was observed.

Conclusions

Being inactive increased pain levels and the likelihood of experiencing daily activity limitation in people with LBP. Patterson et al. found no association between moderate-to-vigorous PA (MVPAP and activity limitation5. Conversely, Pinto et al. reported decreased pain intensity and activity limitation regardless of PA intensity 6. Thus, the impact of sustained PA on LBP outcomes remains to be determined. We recently showed that people who remained inactive during the initial months of the COVID-19 pandemic reported higher pain levels and activity limitations 9. In addition to our previous data on the short-term effect of PA on LBP outcomes, our current data indicate a mid-/long-term impact of PA on pain intensity and daily activity limitation. Future studies should concentrate on identifying variables mediating this relationship, such as barriers to PA, frequency of LBP episodes, and the chronicity of LBP.

References

1. Grabovac I, Dorner TE. Association between low back pain and various everyday performances?: Activities of daily living, ability to work and sexual function. Wien Klin Wochenschr [Internet]. 2019 Nov 1 [cited 2023 Jul 2];131(21–22):541–9. Available from: https://pubmed.ncbi.nlm.nih.gov/31493101/
2. Carregaro RL, Tottoli CR, da Silva Rodrigues D, Bosmans JE, da Silva EN, van Tulder M. Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016. PLoS One [Internet]. 2020 [cited 2023 May 28];15(4). Available from: https://pubmed.ncbi.nlm.nih.gov/32236113/
3. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public health reports. 1985;100(2):126.
4. A Q, TJ W, RM M, MA F, TD D, MJ B, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med [Internet]. 2017 Apr 4 [cited 2023 May 28];166(7):514–30. Available from: https://pubmed.ncbi.nlm.nih.gov/28192789/
5. Patterson TG, Beckenkamp PR, Ferreira M, Bauman A, Carvalho-e-Silva AP, Ferreira LC, et al. The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: A prospective cohort study with a one-year followup. Eur J Pain [Internet]. 2022 Sep 1 [cited 2023 May 14];26(8):1636–49. Available from: https://pubmed.ncbi.nlm.nih.gov/35642334/
6. Pinto RZ, Ferreira PH, Kongsted A, Ferreira ML, Maher CG, Kent P. Self-reported moderate-to-vigorous leisure time physical activity predicts less pain and disability over 12 months in chronic and persistent low back pain. Eur J Pain [Internet]. 2014 [cited 2023 May 14];18(8):1190–8. Available from: https://pubmed.ncbi.nlm.nih.gov/24577780/
7. Feter N, Caputo EL, Doring IR, Leite JS, Cassuriaga J, Reichert FF, et al. Longitudinal study about the impact of COVID-19 pandemic in a southern Brazilian state: the PAMPA cohort. An Acad Bras Cienc [Internet]. 2022 Jun 13 [cited 2023 May 18];94(2):e20201718. Available from: https://www.scielo.br/j/aabc/a/Fc7mdXtcXg9GTjsTd5XKmjg/?lang=en
8. Organization WH. WHO guidelines on physical activity and sedentary behaviour. 2020;
9. Caputo EL, Ferreira PH, Feter N, Doring IR, Leite JS, Alt R, et al. Short-term impact of COVID-19 pandemic on low back pain: data from the PAMPA Cohort, Brazil. BMC Public Health [Internet]. 2023 Dec 1 [cited 2023 May 14];23(1). Available from: https://pubmed.ncbi.nlm.nih.gov/36609256/

Presenting Author

Eduardo Caputo

Poster Authors

Eduardo Caputo

PhD

Lead Author

Natan Feter

PhD

Lead Author

Jayne Feter

PhD

Lead Author

Felipe Delpino

PhD

Lead Author

Luisa S da Silva

Universidade Federal de Pelotas

Lead Author

Natália Schröeder

MsC

Lead Author

Carine da Silva

MsC

Lead Author

Yohana Vieira

MsC

Lead Author

Juliana Rocha

MsC

Lead Author

Júlia Cassuriaga

MsC

Lead Author

Isabel Paz

MsC

Lead Author

Airton Rombaldi

PhD

Lead Author

Felipe Reichert

PhD

Lead Author

Marcelo da Silva

PhD

Lead Author

Topics

  • Epidemiology