Daily Walking Volume Linked to Reduced Risk of Chronic Low Back Pain: JAMA

Chronic low back pain is a common condition that poses a significant burden on individuals and healthcare systems around the world. Physical activity to manage and prevent LBP has been suggested, but few studies have objectively quantified walking habits in daily life to examine their actual preventive effects. Walking is an easy and commonly performed type of exercise, but the relationship between its volume and intensity and the risk of LBP has been unclear. This research bridges this gap by employing accelerometer-based data to measure the influence of walking on the subsequent growth of chronic LBP.

This population-based cohort study with large-scale prospective design was performed within the Trøndelag Health (HUNT) Study in Norway. The authors recruited 11,194 participants at least 20 years of age (mean age: 55.3 years, SD: 15.1), of whom 58.6% were women (n=6564). All participants were chronic LBP free at baseline (2017–2019) and had ≥1 valid day of accelerometer-measured walking data. They were followed up in 2021–2023, with a median follow-up time of 4.2 years.

Walking volume was ascertained in minutes a day, and walking intensity in metabolic equivalent of task (MET) per minute. Self-reported chronic LBP was the main outcome and was defined as three or more months of back pain within the past year. Poisson regression models were used to estimate the risk ratios (RRs) adjusted and 95% confidence intervals (CIs).

Key Findings

• At follow-up, 14.8% (n=1659) of the participants reported chronic LBP.

Restricted cubic spline analyses revealed that heightened walking volume and intensity were inversely related to risk of chronic LBP:

• Walking Volume and LBP Risk

Relative to those walking fewer than 78 minutes per day:

• 78–100 minutes/day: RR = 0.87 (95% CI: 0.77–0.98)

• 101–124 minutes/day: RR = 0.77 (95% CI: 0.68–0.87)

• 125 minutes or more/day: RR = 0.76 (95% CI: 0.67–0.87)

• Walking Intensity and LBP Risk

Relative to walking intensity of <3.00 MET/min:

• 3.00–3.11 MET/min: RR = 0.85 (95% CI: 0.75–0.96)

• 3.12–3.26 MET/min: RR = 0.82 (95% CI: 0.72–0.93)

• ≥3.27 MET/min: RR = 0.82 (95% CI: 0.72–0.93)

This systematic review concludes that higher daily walking volume is linked with a significantly reduced risk of acquiring chronic low back pain, and walking intensity also has a secondary protective effect. Use of accelerometer-derived data offers strong, objective evidence supporting encouragement of regular walking as part of public health interventions. Walking more daily, particularly in excess of 100 minutes may be an easy and effective means of preventing chronic back pain in the general population.

Reference:

Haddadj R, Nordstoga AL, Nilsen TIL, et al. Volume and Intensity of Walking and Risk of Chronic Low Back Pain. JAMA Netw Open. 2025;8(6):e2515592. doi:10.1001/jamanetworkopen.2025.15592