Physical Activity Advice for Prevention and Rehabilitation of Low Back Pain- Same or Different? A Study on Device-Measured Physical Activity and Register-Based Sickness Absence

Nidhi Gupta,Els Clays,Jan Hartvigsen,Ute Bültmann,Ole Steen Mortensen,Charlotte Lund Rasmussen,Andreas Holtermann

doi:10.1007/s10926-021-10005-8

Abstract

Purpose We lack knowledge on whether the advice of “being physically active” should be the same for prevention and rehabilitation of low back pain (LBP). Sickness absence is a key outcome for LBP prevention and rehabilitation. We investigated the associations between physical activity and long-term sickness absence (LTSA) among employees with and without LBP. Methods Between 2011 and 2013, 925 Danish employees wore a Actigraph GTX3 accelerometer for 1–5 workdays to measure physical activity and reported LBP in past 7 days. Employees were followed for 4 years to determine their first register-based LTSA event (≥ 6 consecutive weeks). Results Among employees with LBP, increasing moderate-to-vigorous-intensity physical activity at work by 20 min and decreasing the remaining behaviors at work (ie., sitting, standing and light-intensity activity) by 20 min was associated with 38% (95% CI 17%; 63%) higher LTSA risk. Increasing light-intensity activity at work by 20 min and decreasing 20 min from the remaining behaviors was associated with 18% (95% CI 4%; 30%) lower risk. During leisure, increasing moderate-to-vigorous-intensity activity by 20 min or standing by 40 min was associated with 26% (95% CI 3%; 43%) lower and 37% (95% CI 0%; 87%) higher risk, respectively. Among employees without LBP, we found no such associations. Conclusions The physical activity advice ought to be different for LBP prevention and rehabilitation to reduce LTSA risk, and specified by domain and activity intensity. At work, employees with LBP should be advised to spend time on light-intensity physical activity and limit their time on moderate-to-vigorous-intensity physical activity. During leisure, employees should spend time on moderate-to-vigorous-intensity physical activity.

Highlights

Low back pain (LBP) is the leading global cause of work disability, imposing a large burden on employees, workplaces and societies [1]
Among employees with LBP, increasing moderate-to-vigorous-intensity physical activity at work by 20 min and decreasing the remaining behaviors at work by 20 min was associated with 38% higher long-term sickness absence (LTSA) risk
The physical activity advice ought to be different for LBP prevention and rehabilitation to reduce LTSA risk, and specified by domain and activity intensity

Summary

Introduction

Low back pain (LBP) is the leading global cause of work disability, imposing a large burden on employees, workplaces and societies [1]. A key driver of the economic burden of LBP is sickness absence. In the EU, LBP is responsible for almost 50% of all sickness absence (more than three consecutive days) and the societal burden of LBP in Europe amounted to 441 billion EUR in 2016 [2, 3]. The burden of LBP is shown to be similar in the remaining part of the world [4]. Evidence-based knowledge on prevention and rehabilitation of LBP is urgently needed [5]. Advice to “be physically active (as tolerated)” plays a key role in the prevention and rehabilitation of LBP [6, 7]. There is uncertainty on the validity of this advice [8] and the evidence is not clear on whether the advice should

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