Should physical activity recommendation depend on state of low back pain?

National Research Centre for the Working Environment, Copenhagen, Denmark.
European Journal of Pain (Impact Factor: 2.93). 04/2014; DOI: 10.1002/j.1532-2149.2013.00403.x
Source: PubMed


Leisure time physical activity is recommended for preventing long-term sickness absence (LTSA). Although low back pain (LBP) is a risk factor for sickness absence and physical activity is recommended for people with LBP, it is unknown if leisure time physical activity prevents LTSA among persons with different levels of LBP.
Prospective cohort study among 8655 Danish female healthcare workers responding to a questionnaire in 2004-2005 on leisure time physical activity and LBP, and subsequently followed for 1 year on periods with LTSA ∼2 consecutive weeks or more of sickness absence in a national register of social transfer payments (DREAM). Multi-adjusted Cox regression analysis was used to model risk estimates for LTSA associated with low, moderate, high and very high leisure time physical activity at baseline among healthcare workers with no LBP (0 days past 12 months, n = 2761), non-chronic LBP (1-30 days the past 12 months, n = 3942) and persistent LBP (>30 days the past 12 months, n = 1952).
A strongly reduced risk for LTSA from high leisure time physical activity was found among healthcare workers with no LBP [hazard ratio (HR): 95% confidence interval (CI) 0.47:0.23-0.97 for low vs. very high activity] and non-chronic LBP (HR: 95%CI 0.43:0.23-0.84 of low vs. very high activity), but not among healthcare workers with persistent LBP (HR: 95%CI 1.15:0.55-2.44 of low vs. very high activity).
Leisure time physical activity is a strong predictive factor on LTSA among female healthcare workers with no and non-chronic LBP, but not among those with more persistent LBP.

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    ABSTRACT: Objective: To analyse attitudes and beliefs about movement and physical activity in people with low back pain (LBP) and compare these beliefs between people with acute and chronic LBP. Design: Qualitative inductive analysis of data collected via face-to-face semi-structured interviews. Setting: Twelve participants with acute LBP (<6 weeks) and eleven participants with chronic LBP (>3 months) were purposively recruited from one region of New Zealand. Interviews were audio-recorded and transcribed verbatim. Interventions: Not-applicable. Main outcome measure: Themes which emerged from participant interview transcripts using analysis based on Interpretative Description. Results: Participants with acute and chronic LBP made judgements about physical activity and rest using the same conceptual model. Concerns about creating more pain, tissue damage, or impairment influenced the physical activity judgements of most participants with acute and chronic LBP. These perceived risks were balanced against the perceived benefits, the most important of which were psychological or social rather than physical. Judgements made by those with acute and chronic LBP were context dependent and influenced by the nature and duration of pain, the type of physical activity, the importance of the activity, and the participant's previous experience. Participants with acute pain who had not experienced back pain previously often expressed more uncertainty whereas those with chronic LBP appeared to have developed cognitive rules which determined physical activity decisions. Conclusions: Exploring the perceived risks, benefits, and contextual factors which influence decisions about physical activity and rest may help clinicians to understand the behaviour of patients with acute and chronic LBP. Clinicians may best support their patients to engage in physical activity by providing an informed assessment of risks and explanation about the range of potential benefits.
    Full-text · Article · Oct 2015 · Archives of physical medicine and rehabilitation