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The association of previous and current non-chronic low back pain with daily physical activity in middle- and older-aged adults

成人头条 volume听25, Article听number:听396 (2025) Cite this article

Abstract

Background

Low back pain (LBP) is a leading cause of years lived with disability. However, the association of non-chronic LBP with levels of daily physical activity (PA) remains poorly explored. This study investigated the association between previous and current non-chronic LBP with daily PA and compliance with PA recommendations in middle and older-aged adults.

Methods

This is a cross-sectional analysis including volunteers from the Baltimore Longitudinal Study of Aging who answered questions about LBP and wore an Actiheart accelerometer for 7days. Generalized linear models and logistic models were used and adjusted for potential confounders.

Results

662 volunteers were included (50.8% women, 68.1% white), aged 68.0 (卤鈥�11.4) years. Previous non-chronic LBP was reported by 240 (36.3%) participants with mean pain intensity of 3.5鈥�卤鈥�2.0 (ranging from 0 to 10). Current non-chronic LBP was reported by 5.7% (n鈥�=鈥�38) with mean pain intensity of 4.1鈥�卤鈥�2.3. Participants reporting current non-chronic LBP had lower levels of total (尾 -0.18, 95% CI -0.34 to -0.02) and vigorous (尾 -0.29, 95% CI -0.56 to -0.007) daily PA and lower odds of meeting PA recommendations (OR 0.20, 95% CI 0.05 to 0.92) compared to those reporting no LBP. No association was observed for LBP intensity. Conversely, previous non-chronic LBP showed no statistically significant association with daily PA levels.

Conclusion

The presence of current non-chronic LBP seems to be negatively associated with PA levels driven mainly by lower engagement in vigorous PA. No association was observed for pain intensity.

Peer Review reports

Background

Low back pain (LBP) is a leading cause of years lived with disability and disability-adjusted life-years [1,2,3]. The aetiology of LBP is multifactorial including biological, psychological, and social components that may affect physical function and quality of life and decrease the ability to perform daily activities [3,4,5,6,7]. Previous studies suggested that individuals with chronic LBP (persistent LBP for 鈮モ��12 weeks) may develop fear-avoidance behaviour due to the belief that movement would be harmful, potentially worsening injury and increasing pain [8]. Despite this behaviour may initially provide a short-term pain relief, it can decrease participation on overall daily activities, exacerbating muscle deconditioning, promoting disability, and facilitating pain chronification [9,10,11]. However, despite the evidence of an association between chronic LBP and reduced participation in daily activities, studies examining this relationship in individuals with non-chronic LBP (LBP lasting鈥�<鈥�12 weeks) are scarce [12].

Physical activity (PA) is any bodily movement produced by skeletal muscles that result in energy expenditure, and commonly classified according to the intensity as light, moderate, and vigorous [13, 14]. The World Health Organization (WHO) published in 2020 a new guideline on PA suggesting all adults to undertake 150鈥�300听min of moderate-intensity, or 75鈥�150听min of vigorous-intensity PA per week [15] in order to improve health and increase longevity. Moreover, numerous studies have demonstrated a beneficial effect of increased PA levels on prevention and management of LBP [16, 17]. PA has been described as a pivotal intervention strategy for managing chronic LBP, to improve physical function and decrease pain, breaking up this deleterious vicious cycle [17, 18]. However, the other direction of this association, in which LBP may impact different levels of daily PA, particularly including objective measurements of PA, is underreported. The few studies that examined this direction of association mostly included individuals with chronic LBP, presenting inconclusive results [19,20,21,22,23]. The investigation of this relationship in non-chronic LBP is scarce and of special importance since low levels of PA increases the risk of pain chronification, disability, incidence of chronic diseases and death [14, 24, 25]. The purpose of this study is to investigate the association between previous and current non-chronic LBP with daily PA levels and compliance with PA recommendation in middle and older-aged adults. We hypothesized that both previous and current non-chronic LBP would be negatively associated with daily PA.

Methods

Study design

This is a cross-sectional analysis that included volunteers from the Baltimore Longitudinal Study of Aging (BLSA - ), a continuously enrolled cohort study of normative human aging run by the National Institute on Aging (NIA) Intramural Research Program that began in 1958 and has been described in detail previously [26]. For the current study, participants underwent clinical evaluation between January 2007 and August 2015 (period when the Actiheart accelerometer was used). BLSA participants are community-dwelling adults who must be free of major chronic conditions and cognitive and functional impairment and must undergo 2.5 days of comprehensive health and functional screening evaluations at the time of the enrolment [26]. The Internal Review Board of the National Institutes of Health Intramural Research Program approved the study protocol. All participants provided informed consent at each study visit.

Eligibility criteria

For the present study, those who underwent a clinical evaluation and performed accelerometer measurement were selected to participate. Participants with missing values in exposure variables (presence of LBP), younger than 40 years, those who did not achieve a minimum of three valid days of accelerometer measurements, and those who reported chronic LBP (lasting more than 12 consecutive weeks) were excluded from the analysis. The exclusion of participants with chronic LBP was due to their specific characteristics, particularly in terms of pain sensitization mechanisms [27].

Exposure

LBP

The presence and intensity of LBP over the preceding year and at the moment of the study evaluation were assessed using an interviewer-administered questionnaire. The question referring to the presence of LBP over the preceding year was 鈥淚n the past year, have you had any LBP?鈥�, with a yes/no answer options. Those who answered 鈥測es鈥� to this question were asked to rate the previous LBP intensity as follow: 鈥淧lease rate your usual back pain over the past year using a scale from 0 to 10, where 0 indicates no pain and 10 indicates extremely intense pain鈥� [28]. The question referring to presence of LBP at the moment of study evaluation was 鈥淒o you currently have LBP?鈥� with a yes/no answer options. Participants who answered 鈥測es鈥� to this question were asked to rate current LBP as follow: 鈥淧lease rate your pain over the past week, using the scale below (from 0 to 10, where 0 indicates no pain and 10 indicates extremely intense pain)鈥� [28].

Participants were classified into categories based on their experiences with LBP as follows: No LBP (who had no episodes in the previous year); Previous LBP (who reported experiencing LBP in the past year but not at the time of the interview); Current LBP (who reported experiencing LBP at the moment of the study interview).

Outcomes

Physical activity was captured by a unidirectional chest worn Actiheart accelerometer (CamNtech, Cambridge, UK). On the last day of the BLSA clinical visit participants were fitted with this device positioned horizontally at the chest (at the third intercostal space) using two standard electrocardiogram electrodes. Participants were asked to wear the device at all times for the next seven days in a free-living environment. The equipment was returned to the clinic by express mail and data was transferred to the computer using commercial software (Actiheart version 4.0.32) to derive activity counts in 1-minute epochs. Days with more than 5% of data missing were considered invalid and excluded, and for inclusion in this analysis, a minimum of three valid days was required. Missing values were imputed with the average activity count per minute (cpm) for each participant (during the same time period of the others complete days for the remaining valid days) [29]. To calculate the average counts per minute for every minute of the day (12:00 am to 11:59 pm), a minute-level activity count was averaged across all valid days. For each participant, a log transformed total volume activity count was created due to highly skewed distribution of the original variable (鈥淟TAC鈥�- log of total daily activity counts) [29, 30].

The sum of the accumulated counts was generated according to minute-level activity counts and classified as light (10 cpm鈥�<鈥塴ight鈥夆墹鈥�95听cpm ), moderate (95 cpm鈥�<鈥塵oderate鈥夆墹鈥�234听cpm) and vigorous (>鈥�234听cpm). Those cut-off points to determine whether an individual was engaged in, light, moderate, or vigorous intensity activities for each minute of the day were generated according to the distribution of activity counts in the BLSA population and using the Karvonen formula for heart rate reserve [(maximum heart rate - resting heart rate) x % effort] [30, 31].

A dichotomic variable was calculated based on the recommendation of the WHO 2020 physical activity guidelines: performing at least 150听min of moderate or 75听min of vigorous or 150听min of a combination of moderate and vigorous activity during the week.

Covariates

Sociodemographic, clinical, and lifestyle covariates were considered to characterize the study population and to address the potential confounding for the associations between non-chronic LBP and PA. Age (years) was used as continuous variable and self-reported race was dichotomized into white or non-white. Obesity was classified based on body mass index (BMI鈥�鈮�鈥�30听kg/m2). History of smoking was self-reported and categorized as 鈥渆ver鈥� or 鈥渘ever鈥� smoker. Self-reported depression was categorized as a dichotomous variable. Any pain or discomfort on different body sites including head, neck, shoulder, wrists, hands, legs, hip, knee, feet, toes and ankles was used to generate the number of painful sites and this sum was categorized as 0, 1, 2 and 鈮モ��3 painful sites.

Data analyses

Descriptive statistics for categorical variables comprised frequency distribution and for continuous variables, means and standard deviations. Association between presence and intensity of previous and current non-chronic LBP were analyzed separately as different exposures with the following outcomes: [1] log of total daily physical activity counts (LTAC) [2], time spent in light (min/day) [3], moderate (min/day) and vigorous (min/day) daily PA, and [4] compliance with PA guidelines. Unadjusted models were generated and then adjusted by age, sex, race, obesity, number of painful body sites, smoking history, and self-reported depression. Generalized linear models (GLM) with identity link with gaussian distribution were performed for LTAC outcome, GLM with log link and gamma distribution were utilized for the continuous outcomes to account for potentially skewed distributions, and logistic models were performed for the dichotomic outcome meeting PA guidelines. Statistical significance was set at a 2-tailed p-value of <鈥�0.05 for all analyses. All analyses were performed using Stata 13.0.

Results

Between January 2007 and August 2015, 867 volunteers underwent clinical evaluation and were fitted with the accelerometer. Of those, 13 participants were excluded due to missing values in exposure variables: 33 due to age鈥�<鈥�40 years, 109 having鈥�<鈥�3 valid days of accelerometer data, and 50 due to presence of chronic LBP (鈮�鈥�12 weeks) (Fig.听1). Therefore, 662 participants were included in the data analysis and their characteristics, overall and stratified by non-chronic LBP status, are presented in Table听1. Participants鈥� mean age was 68.0鈥�卤鈥�11.4 years, 50.8% were female and white (68.1%), with an average of 17.5鈥�卤鈥�2.7 years of education. Obesity was observed in 23.3% of the participants, history of smoking was reported by 37.0%, self-reported depression by 15.6%, and one site of pain in the body (other than LBP) by 25.5%. Previous non-chronic LBP was reported by 36.3% of participants, with a mean pain intensity of 3.5鈥�卤鈥�2.0, and current non-chronic LBP was reported by 5.7%, with a mean pain intensity of 4.1鈥�卤鈥�2.3. Participants without LBP were older (68.9鈥�卤鈥�11.7) than participants with previous non-chronic LBP (66.5鈥�卤鈥�10.7). Those who reported previous non-chronic LBP had a more frequently history of smoking (43.9%) and self-reported depression (21.7%) than participants without LBP (32.6% and 11.8%, respectively). Participants with either previous non-chronic LBP (29.5%) and current non-chronic LBP (42.1%) reported a higher number of painful sites in the body than the ones without LBP (10.8%). Percentage of participants meeting PA recommendations was higher for those without LBP (96.5%) and with previous non-chronic LBP (97.5%) when compared to those with current non-chronic LBP (89.5%) (Fig.听2).

Fig. 1
figure 1

Participant flow diagram

BLSA鈥� Baltimore Longitudinal Study of Aging; LBP鈥� low back pain

Full size image
Table 1 Characteristics of participants according to low back Pain status in the past 12 months.
Full size table
Fig. 2
figure 2

Percentage of participants meeting physical activity recommendations by LBP status (p-value -*No LBP X Current LBP鈥�=鈥�0.037; 色 Previous LBP X Current LBP鈥�=鈥�0.014)

LBP鈥� low back pain; PA鈥� physical activity

Full size image

Table听2 shows the association between presence of previous and current non-chronic LBP with LTAC, light PA, moderate PA, vigorous PA and meeting PA recommendations. Current non-chronic LBP was inversely associated with LTAC (尾 -0.18, 95% CI -0.34 to -0.017), minutes per day in vigorous PA (尾 -0.29, 95% CI -0.56 to -0.007), and with a lower odd of meeting the PA recommendations (OR 0.20, 95% CI 0.05 to 0.92) (Table听2). No statistically significant association for the presence of previous non-chronic LBP with LTAC, light PA, moderate PA, vigorous PA and meeting PA recommendations and for current non-chronic LBP with light PA and moderate PA were observed.

Table 2 Regression analyses on the association between presence of previous and current LBP in the last 12 months with physical activity outcomes
Full size table

Table听3 presents the association between previous and current non-chronic LBP intensity with LTAC, minutes per day in light PA, moderate PA and vigorous PA. No significant associations were found between non-chronic LBP intensity and these outcomes.

Table 3 Regression models on the association between LBP intensity with PA outcomes
Full size table

Discussion

The present study found that participants reporting current non-chronic LBP had lower levels of objectively measured total and vigorous daily PA and also lower odds of complying with the PA recommendation compared to those without LBP, with no association with pain intensity. Conversely, non-chronic LBP in the previous year was not found to be associated with daily PA levels. These results partially confirm our hypotheses and indicates that the presence of current non-chronic LBP seems to be inversely associated with PA levels, making it difficult to comply with the PA guidelines recommendation. The lower total PA levels seem to be driven by lower levels of vigorous PA, with no association with moderate and light PA.

While some studies suggested that individuals with chronic LBP tend to have lower total PA levels compared to those without pain, other studies have not confirmed these findings [12, 32]. A cross-sectional study involving 30 adults (15 with chronic LBP and 15 healthy controls matched for age, gender, and occupation) found that participants with chronic LBP had lower levels of PA compared to the healthy controls [33]. Moreover, a large cross-sectional study of 1,588 twins with chronic LBP, who self-reported their pain status and PA levels, found that recent LBP (over the last month) was significantly associated with a 30% lower odds of meeting PA guidelines compared to those without LBP. Although these results were primarily observed in a population with chronic LBP, they are consistent with our findings in a non-chronic LBP population, demonstrating that a reduction in daily activities, especially those requiring vigorous intensity, can be a short-term adaptive behaviour or a coping strategy to the pain onset. The lack of association between pain intensity and PA levels may suggest that adaptive strategies are primarily initiated in response to the pain onset, regardless of intensity, as a strategy to minimize spinal movements rather than interfering with the amount of PA performed during the day, confirming the results from previous studies [34, 35]. Studies including measures of fear-avoidance behaviour could provide a deeper understanding of the mechanisms by which non-chronic LBP is associated with PA levels.

Besides the potential impact of current LBP on daily activities, studies have shown that individuals with previous episodes of LBP may also develop fear-avoidance behaviour, potentially leading to a decrease in their PA levels [24, 36,37,38]. However, contrary to our hypothesis, no significant associations between previous LBP and lower PA levels were observed among those with previous LBP in our study. Similarly, a cross-sectional study enrolling 13 middle-aged participants found no significant difference in total energy expenditure (assessed using doubly-labelled water) between those with chronic LBP and healthy controls [21]. These results are consistent with those observed in a larger cohort study demonstrating that participants returned to their previous self-reported PA levels after an acute episode of LBP 12 months earlier [39]. Moreover, a systematic review with meta-analysis including seven observational studies found no differences in total PA levels of adolescents and adults with chronic LBP in comparison to controls without pain. However, contrary to our study - which primarily included older adults (approximately 65% of our sample) - the review found evidence that older adults with LBP were less active than controls [19].

A possible explanation for the lack of association between previous LBP and PA levels is the exclusion of chronic LBP participants, since chronic pain has specific characteristics regarding pain sensitization, which may have reduced the influence of the fear avoidance behaviour in our sample. In addition, considering that the fear avoidance behaviour is associated with several aspects of health, the inclusion of BLSA participants that are a relatively healthy sample may partially explain the lack of association between previous LBP and PA levels [26, 40, 41].

The present study has some limitations. Although PA was measured in the week after the interview, the cross-sectional study design precluded us from establishing temporal associations, specially between current LBP and PA. There is a possibility that low levels of PA are causing deconditioning and subsequent pain. Moreover, the number of participants that reported current LBP was small, which may raise the possibility of spurious association. Despite we included all eligible participants, the lack of a sample size calculation could impact the statistical robustness of the findings. Recall bias may have influenced participants鈥� self-reports of previous LBP (in the last 12 months) and its intensity, potentially increasing the risk of measurement errors. In addition, the lack of detailed information on the moment and frequency of LBP pain episodes in the previous 12 months may have introduced some residual confounding. Strengths of this study includes the high-quality of BLSA data, the objectively measured levels of PA, and the measurement of LBP intensities.

Conclusion

Results indicate that current non-chronic LBP, but not pain intensity, was associated with decreased levels of PA, mostly in vigorous activities, and a lower odd of complying the WHO鈥檚 PA recommendations in a healthy middle- and older-aged adults. This underscores the importance of addressing LBP early, even when non-chronic, to maintain PA levels and potentially prevent the cascade of health issues associated with low levels of PA in aging populations.

Data availability

The data that support the findings of this study are available from the BLSA website [https://www.blsa.nih.gov/blsa-data-use] but restrictions apply to the availability of these data, which were used under license for the current study, and are not publicly available. Data are available from the corresponding author upon reasonable request, and with permission of the BLSA Data Sharing Proposal Review Committee.

Abbreviations

LBP:

Low back pain

PA:

Physical activity

WHO:

World Health Organization

BLSA:

Baltimore Longitudinal Study of Aging

NIA:

National Institute on Aging

LTAC:

Log of total daily activity counts

cpm:

Count per minute

BMI:

Body mass index

GLM:

Generalized linear models

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Acknowledgements

The authors would like to thank all the participants in the Baltimore Longitudinal Study of Aging during the conduction of this research.

Funding

This research was supported by the Research Program of the National Institute of Aging (NIA) of the National Institutes of Health (NIH)鈥� USA, by grant R21AG053198. The first author in this study received a doctoral scholarship from the National Council for Scientific and Technological Development鈥� CNPq.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Institute of Social Medicine H茅sio Cordeiro, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Tatiana Rehder Gon莽alves听&听Diana Barbosa Cunha

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Tatiana Rehder Gon莽alves,听Mauro Felippe Felix Mediano,听Amal A. Wanigatunga听&听Jennifer A. Schrack

  3. Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil

    Mauro Felippe Felix Mediano

  4. National Institute on Aging, National Institutes of Health, Baltimore, MD, USA

    Eleanor M. Simonsick

  5. Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA

    Amal A. Wanigatunga听&听Jennifer A. Schrack

Authors
  1. Tatiana Rehder Gon莽alves

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  2. Diana Barbosa Cunha

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  3. Mauro Felippe Felix Mediano

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  4. Amal A. Wanigatunga

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  5. Eleanor M. Simonsick

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  6. Jennifer A. Schrack

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Contributions

TRG, DBC, MFFM, and JAS contributed to the conception and design of the work. AAW, SEM, and JAS contributed to the acquisition of the dataset. TRG, DBC, MFFM, and JAS performed the analysis, and TRG, DBC, MFFM, AAW, EMS, and JAS participated in the interpretation of the data. TRG wrote the original draft, and all authors鈥擳RG, DBC, MFFM, AAW, EMS, and JAS鈥攕ubstantively revised it. All authors approved the submitted version, agreed to be personally accountable for their contributions, and ensured that any questions related to the accuracy or integrity of any part of the work would be appropriately investigated, resolved, and documented in the literature.

Corresponding author

Correspondence to Tatiana Rehder Gon莽alves.

Ethics declarations

Ethics approval and consent to participate

The data used in the analyzes of this manuscript were obtained and approved for use by the Baltimore Longitudinal Study of Aging (BLSA), a study carried out by the National Institute on Aging (NIA). The BLSA study protocol was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and approved by the National Institutes of Health Intramural Institutional Review Board.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Gon莽alves, T.R., Cunha, D.B., Mediano, M.F.F. et al. The association of previous and current non-chronic low back pain with daily physical activity in middle- and older-aged adults. 成人头条 25, 396 (2025). https://doi.org/10.1186/s12889-025-21453-9

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  • DOI: https://doi.org/10.1186/s12889-025-21453-9

Keywords

成人头条

ISSN: 1471-2458

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