Volume and Intensity of Walking and Risk of Chronic Low Back Pain

Chronic low back pain (LBP) is a prevalent and costly condition, and regular physical activity may reduce its risk. Walking is a common and accessible form of physical activity, but its association with the risk of chronic LBP is unclear.

To examine whether accelerometer-derived daily walking volume and walking intensity are associated with the risk of chronic LBP.

This prospective population-based cohort study used data from the Trøndelag Health (HUNT) Study in Norway, with a baseline in 2017 to 2019 and follow-up in 2021 to 2023. The study included individuals without chronic LBP at baseline and with at least 1 valid day of device-measured walking.

Daily walking volume (minutes per day) and walking intensity, expressed as metabolic equivalent of task (MET) per minute.

The primary outcome was self-reported chronic LBP at follow-up, defined as pain lasting 3 months or longer in the past 12 months. Poisson regression was used to estimate adjusted risk ratios (RRs) with 95% CIs of chronic LBP according to daily walking volume and mean walking intensity.

A total of 11 194 participants aged 20 years or older (mean [SD] age, 55.3 [15.1] years; 6564 women [58.6%]) were included in the analysis. At follow-up (mean [SD] follow-up time, 4.2 [0.3] years), 1659 participants (14.8%) reported chronic LBP. Continuous measures of both walking volume and walking intensity were inversely associated with the risk of chronic LBP using restricted cubic splines models. Compared with participants walking less than 78 minutes per day, those walking 78 to 100 minutes per day had an RR for chronic LBP of 0.87 (95% CI, 0.77-0.98), those walking 101 to 124 minutes per day had an RR of 0.77 (95% CI, 0.68-0.87), and those walking 125 minutes or more per day had an RR of 0.76 (95% CI, 0.67-0.87). Compared with a mean walking intensity of less than 3.00 MET per minute, participants with walking intensity of 3.00 to 3.11 MET per minute had an RR for chronic LBP of 0.85 (95% CI, 0.75-0.96), those with walking intensity of 3.12 to 3.26 MET per minute had an RR of 0.82 (95% CI, 0.72-0.93), and those with walking intensity greater than or equal to 3.27 MET per minute had an RR of 0.82 (95% CI, 0.72-0.93). After mutual adjustment, the association remained largely similar for walking volume but was attenuated for walking intensity.

In this cohort study, daily walking volume and walking intensity were inversely associated with the risk of chronic LBP. The findings suggest that walking volume may have a more pronounced benefit than walking intensity.