Outcomes/Effectiveness Research

Recreational physical activities improve symptoms in patients with low back pain

Specific back exercises may be counterproductive for patients who suffer from low back pain. Instead, a research study, supported in part by the Agency for Healthcare Research and Quality (HS07755), indicates they should focus on low-stress recreational physical activities such as walking and swimming as recommended by current guidelines.

Researchers interviewed 681 patients with low back pain at 3 primary care sites, nearly half of whom had been in pain for more than a year. The patients were asked about their participation in recreational physical activities and use of back exercises, as well as intensity of low back pain, related disability, and psychological distress at baseline, at 6 weeks, and at 6, 12, and 18 months. A metabolic equivalent task (MET) value was assigned to each activity. For example, walking briskly for at least 3 hours per week is equal to 10.5 METs.

Patients in the top quartile of recreational physical activity (26 or more METs per week) were 48 percent less likely to suffer from severe back pain than those reporting no physical activity, half as likely to suffer from significant low back disability, and 40 percent less likely to be psychologically distressed. They were also 28 percent, 31 percent, and 25 percent less likely, respectively, to suffer from subsequent low back pain, disability, and psychological distress.

In contrast, patients who performed back exercises 4 to 7 days per week were twice as likely as those who never did back exercises to suffer from severe pain and 61 percent more likely to suffer from back disability, but were no more likely to experience psychological distress. Also, doing frequent back exercises increased the odds of subsequent appreciable low back pain and disability by 64 percent and 44 percent, respectively, but reduced the odds of subsequent psychological distress by 22 percent.

More details are in "Effects of recreational physical activity and back exercises on low back pain and psychological distress: Findings from the UCLA low back pain study," by Eric L. Hurwitz, D.C., Ph.D., Hal Morgenstern, Ph.D., and Chi Chiao, M.S., Ph.D., in the October 2005 American Journal of Public Health 95(10), pp. 1817-1824.

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