Physical activity levels in adults with chronic low back pain: A national survey in the general Spanish population
Keywords:biopsychosocial model, chronic pain, low back pain, musculoskeletal pain, physical activity
Objective: To identify and compare physical activity levels in the Spanish population with chronic low back pain and their associated factors.
Design: Cross-sectional national study.
Subjects: A total of 3,220 adults with chronic low back pain from the 2017 Spanish National Health Survey.
Methods: Three groups were defined according to physical activity level (low, moderate, and high) assessed with the International Physical Activity Questionnaire. Descriptive analysis and an ordinal regression model were performed.
Results: Thirty percent of the subjects were classed as doing a low level of physical activity, 53% moderate, and 17% high. Females predominated in the low and moderate groups, and the subjects in the high group were younger. Subjects in the low group reported more use of pain-relief, more severe-extreme pain, more functional limitations, and worse quality of life and mental health. Factors more likely to be associated with higher levels of physical activity were: being male, normal body mass index or overweight, better health status, less pain, less physical and cognitive limitations, and more social support.
Conclusion: Different aspects of the biopsychosocial framework were associated with the different levels of physical activity in subjects with chronic low back pain. These findings should be taken into consideration in order to establish suitable public health strategies.
Physical activity benefits subjects with chronic pain, although its performance depends on various factors. This study analysed 3,220 adults with chronic low back pain from the 2017 Spanish National Health Survey, in order to identify and compare levels of physical activity (International Physical Activity Questionnaire) and their associated factors. Thirty percent of subjects were classed as doing low levels of physical activity, 53% moderate, and 17% high. Females predominated in the low and moderate level groups, and subjects with a high level of physical activity were younger. Subjects in the low level of physical activity group reported more consumption of pain-relief, more severe-extreme pain, more functional limitations, and worse quality of life and mental health. Factors associated with more physical activity were being male, normal body mass index (BMI) or overweight, better health status, less pain, less physical and cognitive limitations, and more social support. In conclusion, different biopsychosocial aspects were associated with the different levels of physical activity in subjects with chronic low back pain, and this information should be taken into consideration in order to establish suitable public health strategies.
Cohen SP, Vase L, Hooten WM. Chronic Pain 1 Chronic pain: an update on burden, best practices, and new advances. Lancet 2021; 397: 2082-2097. DOI: 10.1016/S0140-6736(21)00393-7
https://doi.org/10.1016/S0140-6736(21)00393-7 DOI: https://doi.org/10.1016/S0140-6736(21)00393-7
Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73: 968-974. DOI: 10.1136/annrheumdis-2013-204428
https://doi.org/10.1136/annrheumdis-2013-204428 DOI: https://doi.org/10.1136/annrheumdis-2013-204428
Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int 2019; 39: 619-626. DOI: 10.1007/s00296-019-04273-0
https://doi.org/10.1007/s00296-019-04273-0 DOI: https://doi.org/10.1007/s00296-019-04273-0
Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth 2019; 123: 273-283. DOI: 10.1016/j.bja.2019.03.023
https://doi.org/10.1016/j.bja.2019.03.023 DOI: https://doi.org/10.1016/j.bja.2019.03.023
Alonso-García M, Sarría-Santamera A. The economic and social burden of low back pain in spain: a national assessment of the economic and social impact of low back pain in Spain. Spine 2020; 45: 1026-1032. DOI: 10.1097/brs.0000000000003476
https://doi.org/10.1097/BRS.0000000000003476 DOI: https://doi.org/10.1097/BRS.0000000000003476
Palazzo C, Ravaud JF, Papelard A, Ravaud P, Poiraudeau S. The burden of musculoskeletal conditions. PLoS One 2014; 9: 90633. DOI: 10.1371/journal.pone.0090633
https://doi.org/10.1371/journal.pone.0090633 DOI: https://doi.org/10.1371/journal.pone.0090633
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017; 389: 736-747. DOI: 10.1016/s0140-6736(16)30970-9
https://doi.org/10.1016/S0140-6736(16)30970-9 DOI: https://doi.org/10.1016/S0140-6736(16)30970-9
Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. Risk factors for low back pain and sciatica: an umbrella review. Spine J 2018; 18: 1715-1721. DOI: 10.1016/j.spinee.2018.05.018
https://doi.org/10.1016/j.spinee.2018.05.018 DOI: https://doi.org/10.1016/j.spinee.2018.05.018
Ampiah PK, Hendrick P, Moffatt F, Ahenkorah J. Operationalisation of a biopsychosocial approach for the non-pharmacological management of patients with chronic musculoskeletal pain in low- and middle-income countries: a systematic review. Musculoskelet. Care 2020; 18: 227-244. DOI: 10.1002/msc.1462
https://doi.org/10.1002/msc.1462 DOI: https://doi.org/10.1002/msc.1462
Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines. Eur J Pain 2021; 25: 275-295. DOI: 10.1002/ejp.1679
https://doi.org/10.1002/ejp.1679 DOI: https://doi.org/10.1002/ejp.1679
Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: why and when. Best Pract Res Clin Rheumatol 2015; 29: 120-130. DOI: 10.1016/j.berh.2015.04.022
https://doi.org/10.1016/j.berh.2015.04.022 DOI: https://doi.org/10.1016/j.berh.2015.04.022
Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018; 39: 2368-2383. DOI: 10.1016/s0140-6736(18)30489-6
https://doi.org/10.1016/S0140-6736(18)30489-6 DOI: https://doi.org/10.1016/S0140-6736(18)30489-6
Gupta N, Rasmussen CL, Hartvigsen J, Mortensen OS, Clays E, Bültmann U, et al. 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. J Occup Rehabil 2022; 32: 284-294. DOI: 10.1007/s10926-021-10005-8
https://doi.org/10.1007/s10926-021-10005-8 DOI: https://doi.org/10.1007/s10926-021-10005-8
Dueñas M, Munoz JAM, Osuna JP, Salazar A. Differences in physical and psychological health in patients with chronic low back pain : a national survey in general Spanish population. Qual Life Res 2020; 29: 2935-2947. DOI: 10.1007/s11136-020-02553-y
https://doi.org/10.1007/s11136-020-02553-y DOI: https://doi.org/10.1007/s11136-020-02553-y
Ministerio de Sanidad, Servicios Sociales e Igualdad. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad. https://www.mscbs.gob.es/estadEstudios/estadisticas/encuestaNacional/
Román Viñas B, Ribas Barba L, Ngo J, Serra Majem L. Validación en población catalana del cuestionario internacional de actividad física. Gac Sanit 2013; 27: 254-257. DOI: 10.1016/j.gaceta.2012.05.013
https://doi.org/10.1016/j.gaceta.2012.05.013 DOI: https://doi.org/10.1016/j.gaceta.2012.05.013
Jetté M, Sidney K, Blümchen G. Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 1990; 13: 555-565. DOI: 10.1002/clc.4960130809
https://doi.org/10.1002/clc.4960130809 DOI: https://doi.org/10.1002/clc.4960130809
IPAQ Research Committee. Guideline for data processing and analysis of the International Physical Activity Questionnaire (IPAQ)- short and long forms. 2005. https://sites.google.com/site/theipaq/scoring-protocol
Sánchez-López MDP, Dresch V. The 12-item general health questionnaire (GHQ-12): Reliability, external validity and factor structure in the Spanish population. Psicothema 2008; 20: 839-843.
Hamer M, Biddle SJH, Stamatakis E. Weekend warrior physical activity pattern and common mental disorder: a population wide study of 108,011 British adults. Int J Behav Nutr Phys Act 2017; 14: 1-6. DOI: 10.1186/s12966-017-0549-0
https://doi.org/10.1186/s12966-017-0549-0 DOI: https://doi.org/10.1186/s12966-017-0549-0
Bellón Saameño JA, Delgado Sánchez A, Luna del Castillo JD, Lardelli Claret P. Validez y fiabilidad del cuestionario de apoyo social funcional Duke-UNC-11 [Validity and reliability of the Duke-UNC-11 questionnaire of functional social support]. Aten Primaria 1996; 18: 153-163.
Picorelli AMA, Pereira LSM, Pereira DS, Felício D, Sherrington C. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. J Physiother 2014; 60: 151-156. DOI: 10.1016/j.jphys.2014.06.012
https://doi.org/10.1016/j.jphys.2014.06.012 DOI: https://doi.org/10.1016/j.jphys.2014.06.012
Jalayondeja C, Jalayondeja W, Suttiwong J, Sullivan PE, Consultants PT, Centre M, et al. Physical activity, self-esteem, and quality of life among people with physical disability. Southeast Asian J Trop Med Public Heal 2016; 47: 546-558.
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017; 2020. DOI: 10.1002/14651858.cd011279.pub3
https://doi.org/10.1002/14651858.CD011279.pub3 DOI: https://doi.org/10.1002/14651858.CD011279.pub3
Lin CWC, McAuley JH, MacEdo L, Barnett DC, Smeets RJ, Verbunt JA. Relationship between physical activity and disability in low back pain: a systematic review and meta-analysis. Pain 2011; 152: 607-613. DOI: 10.1016/j.pain.2010.11.034
https://doi.org/10.1016/j.pain.2010.11.034 DOI: https://doi.org/10.1016/j.pain.2010.11.034
Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med 2007; 147: 492-504. DOI: 10.7326/0003-4819-147-7-200710020-00007
https://doi.org/10.7326/0003-4819-147-7-200710020-00007 DOI: https://doi.org/10.7326/0003-4819-147-7-200710020-00007
Van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011; 20: 19-39. DOI: 10.1007/s00586-010-1518-3
https://doi.org/10.1007/s00586-010-1518-3 DOI: https://doi.org/10.1007/s00586-010-1518-3
Tucker HR, Scaff K, McCloud T, Carlomagno K, Daly K, Garcia A, et al. Harms and benefits of opioids for management of non-surgical acute and chronic low back pain: a systematic review. Br J Sports Med 2020; 54: 664. DOI: 10.1136/bjsports-2018-099805
https://doi.org/10.1136/bjsports-2018-099805 DOI: https://doi.org/10.1136/bjsports-2018-099805
de Campos TF. Low back pain and sciatica in over 16s: assessment and management NICE Guideline [NG59]. J Physiother 2017; 63: 120. DOI: 10.1016/j.jphys.2017.02.012
https://doi.org/10.1016/j.jphys.2017.02.012 DOI: https://doi.org/10.1016/j.jphys.2017.02.012
Maynou L, Hernández-Pizarro HM, Rodríguez ME. The association of physical (In)activity with mental health. differences between elder and younger populations: a systematic literature review. Int J Environ Res Public Health 2021; 18: 4771. DOI: 10.3390/ijerph18094771
https://doi.org/10.3390/ijerph18094771 DOI: https://doi.org/10.3390/ijerph18094771
Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas 2017; 106: 48-56. DOI: 10.1016/j.maturitas.2017.09.003
https://doi.org/10.1016/j.maturitas.2017.09.003 DOI: https://doi.org/10.1016/j.maturitas.2017.09.003
Deslandes A, Moraes H, Ferreira C, Veiga H, Silveira H, Mouta R, et al. Exercise and mental health: many reasons to move. Neuropsychobiology 2009; 59: 191-198. DOI: 10.1159/000223730
https://doi.org/10.1159/000223730 DOI: https://doi.org/10.1159/000223730
Baumgartner NW, Walk AM, Edwards CG, Covello AR, Chojnacki MR, Reeser GE, Taylor AM, Holscher HD, Khan NA. Relationship between physical activity, adiposity, and attentional inhibition. J Phys Act Health 2018; 15: 191-6. DOI: 10.1123/jpah.2017-0181
https://doi.org/10.1123/jpah.2017-0181 DOI: https://doi.org/10.1123/jpah.2017-0181
Engeroff T, Ingmann T, Banzer W. Physical activity throughout the adult life span and domain-specific cognitive function in old age: a systematic review of cross-sectional and longitudinal data. Sport Med 2018; 48: 1405-1436. DOI: 10.1007/s40279-018-0920-6
https://doi.org/10.1007/s40279-018-0920-6 DOI: https://doi.org/10.1007/s40279-018-0920-6
Stenling A, Eriksson Sörman D, Lindwall M, MacHado L. Bidirectional within- and between-person relations between physical activity and cognitive function. J Gerontol - Ser B Psychol Sci Soc Sci 2022; 77: 704-709. DOI: 10.1093/geronb/gbab234
https://doi.org/10.1093/geronb/gbab234 DOI: https://doi.org/10.1093/geronb/gbab234
Zhu W, Wadley VG, Howard VJ, Hutto B, Blair SN, Hooker SP. Objectively measured physical activity and cognitive function in older adults. Med Sci Sports Exerc 2017; 49: 47-53. DOI: 10.1249/mss.0000000000001079
https://doi.org/10.1249/MSS.0000000000001079 DOI: https://doi.org/10.1249/MSS.0000000000001079
Erickson KI, Hillman C, Stillman CM, Ballard RM, Bloodgood B, Conroy DE, et al. Physical activity, cognition, and brain outcomes: a review of the 2018 physical activity guidelines. Med Sci Sport Exerc 2019; 51: 1242-1251. DOI: 10.1249/mss.0000000000001936
https://doi.org/10.1249/MSS.0000000000001936 DOI: https://doi.org/10.1249/MSS.0000000000001936
Lewis ZH, Swartz MC, Martinez E, Lyons EJ. Social support patterns of middle-aged and older adults within a physical activity app: secondary mixed method analysis. JMIR Aging 2019; 2: 12496. DOI: 10.2196/12496
https://doi.org/10.2196/12496 DOI: https://doi.org/10.2196/12496
Eynon M, Foad J, Downey J, Bowmer Y, Mills H. Assessing the psychosocial factors associated with adherence to exercise referral schemes: a systematic review. Scand J Med Sci Sport 2019; 29: 638-650. DOI: 10.1111/sms.13403
https://doi.org/10.1111/sms.13403 DOI: https://doi.org/10.1111/sms.13403
Swartz MC, Lewis ZH, Swartz MD, Martinez E, Lyons EJ. Brief report: active ingredients for adherence to a tracker-based physical activity intervention in older adults. J Appl Gerontol 2019; 38: 1023-1034. DOI: 10.1177/0733464817739350
https://doi.org/10.1177/0733464817739350 DOI: https://doi.org/10.1177/0733464817739350
de Looze M, Elgar FJ, Currie C, Kolip P, Stevens GWJM. Gender inequality and sex differences in physical fighting, physical activity, and injury among adolescents across 36 countries. J Adolesc Heal 2019; 64: 657-663. DOI: 10.1016/j.jadohealth.2018.11.007
https://doi.org/10.1016/j.jadohealth.2018.11.007 DOI: https://doi.org/10.1016/j.jadohealth.2018.11.007
Molanorouzi K, Khoo S, Morris T. Motives for adult participation in physical activity: type of activity, age, and gender health behavior, health promotion and society. BMC Public Health 2015; 15: 66. DOI: 10.1186/s12889-015-1429-7
https://doi.org/10.1186/s12889-015-1429-7 DOI: https://doi.org/10.1186/s12889-015-1429-7
Zhang TT, Liu Z, Liu YL, Zhao JJ, Liu DW, Tian QB. Obesity as a risk factor for low back pain. Clin Spine Surg 2018; 31: 22-27. DOI: 10.1097/bsd.0000000000000468
https://doi.org/10.1097/BSD.0000000000000468 DOI: https://doi.org/10.1097/BSD.0000000000000468
Fernandes IM da C, Pinto RZ, Ferreira P, Lira FS. Low back pain, obesity, and inflammatory markers: exercise as potential treatment. J Exerc Rehabil 2018; 14: 168-174. DOI: 10.12965/jer.1836070.035
https://doi.org/10.12965/jer.1836070.035 DOI: https://doi.org/10.12965/jer.1836070.035
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