Reducing sedentary time may prevent worsening

• Back pain is a common experience that can be chronic and lead to challenges in living everyday life.
• Researchers are interested in finding the most successful strategies to help people who experience back pain.
• A recent study indicated that increasing daily activity could help keep back pain from getting worse, compared to continuing a sedentary lifestyle.
• The results show that as little as 40 minutes of less sedentary time could improve back pain.

In the United States, back pain is a widespread problem. Someone’s risk for back pain can increase if they are overweight, older, or have stress-related conditions. Experts want to understand what lifestyle interventions could be most effective for people with back pain.

A study published in BMJ Open explored how reducing sedentary behavior for simply an hour a day could help with back pain.

Over six months, participants who, on average, increased their moderate to vigorous activity by 20 minutes a day and decreased their sedentary behavior by 40 minutes a day saw less increase in back pain than the control group who continued their sedentary behavior.

The results highlight how simple changes in daily activities could likely help people who experience back pain.

Researchers of the current study wanted to understand more about the relationship between back pain, reducing sedentary behavior, insulin sensitivity, disability, and paraspinal muscle fat fraction. Fat in the paraspinal muscles and insulin resistance are both related to back pain.

The study was a secondary analysis of a randomized controlled trial. The trial involved 64 adults. All participants had a body mass index that indicated having obesity or overweight, and participants reported less than two hours of moderate to vigorous physical activity each week. Measured with accelerometers, participants were also sedentary for 10 hours or more or at least 60% of the accelerometer wear time. Participants also had metabolic syndrome, which put the group at an increased risk for diabetes and heart disease.

Researchers excluded participants who already had diabetes, consumed excessive alcohol, or used tobacco products.

Before starting the trial, researchers measured participants’ physical activity and sedentary behavior using accelerometers for about one month. Researchers divided participants into a control and intervention group. The intervention lasted for six months.

The intervention group tried to decrease sedentary behavior by one hour each day. The control group continued with their normal lifestyle. On average, participants in the intervention group increased moderate to vigorous physical activity by 20 minutes a day and decreased their sedentary behavior by 40 minutes a day.

The researchers conducted PET and MRI scans on a subsample of forty-four participants to examine paraspinal muscle glucose uptake and fat fraction.

Overall, the intervention group did not see changes in back pain, while the control group saw a statistically significant increase in back pain.

The researchers also found an association between increased daily steps and better paraspinal muscle glucose uptake. Both groups saw an increase in pain-related disability, but there wasn’t a significant difference in pain-related disability between the two groups.

The researchers did not find an association between changes in back pain intensity and changes in paraspinal muscle fat fraction, glucose uptake, physical activity, sedentary behavior, or pain-related disability.

The results add to evidence that even simple changes in activity could benefit people who experience back pain.

Study author, doctoral researcher, and physiotherapist Jooa Norha highlighted the following findings to Medical News Today:

“Back pain is a common and sometimes disabling complaint. Previous research has suggested that prolonged sitting might be a risk factor for back pain, but our study was among the first to actually investigate what happens if you start sitting less.”

“And indeed, we did find that limiting your daily sitting time helps to prevent back pain. No single threshold for a ‘safe’ amount of sitting can be given for many reasons, but the main idea is to change your normal sitting habits for the better – be it reducing from 10 to eight hours per day or from eight to seven hours per day,” he added.

Back pain remains a challenging problem that doctors and specialists address. The results point to how a simple intervention could improve outcomes in clinical practice and individuals’ lives.

Medhat Mikhael, MD, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, highlighted the following about back pain to Medical News Today:

“Back pain is very common, about 80-90% of people in the U.S. will have back pain at some point during their life. Pain tends to increase with age and the statistics showed that the percentage would range from 28% for age 18-29, 35% among age 30-45, 45% among age 45-64 and 46% for those ages 65 and above. That is because of the progress of the degenerative disease, lack of exercise and physical activity plus developments of chronic diseases.”

All people with back pain should work with doctors to develop individualized treatment plans. However, the study results add to evidence that increasing activity can be beneficial. Michael Wheeler, MD, an orthopedic spine surgeon with Texas Orthopaedic Associates, who was also not involved in the study, noted the following to MNT:

“For healthcare providers, the study suggests that recommending less sitting could help prevent worsening back pain, particularly in patients with mild symptoms. However, to achieve better results, reducing sitting should be combined with other strategies like increasing physical activity, strength training, and managing emotional responses.”

“A well-rounded approach is key to addressing both pain and function. The body is designed to move, and by reducing sedentary time there will be additional health benefits beyond decreased back pain,” he said.

This research does have limitations, such as the small size and relatively short time frame of the original trial. Future research could include more diversity, as the trial focused on Finnish participants. Researchers also did not pick the sample based on pain status, which could have decreased statistical power.

Some data that researchers relied on was self-reported by participants, and it is important to consider this with these sorts of studies. The researchers note that many participants in the control group were disappointed that they weren’t in the intervention group, and the negative emotions could have impacted pain intensity. It’s also possible that the benefits of increased physical activity could have played a role in the observed results.

Overall, the researchers acknowledge that participants’ pain perceptions could have been affected by assignment to the control or intervention group. The trial also did not take into account pain history in its exclusion or inclusion criteria and only assessed pain and disability at baseline and at the end of the six months. The researchers also used some non-validated questions in back pain assessment, which could have affected the results.

The researchers acknowledge that they didn’t apply specific back pain-related eligibility criteria. Also, since this current paper was a secondary analysis, the authors did not do power calculations for disability or back pain.

Norha noted the following areas for continued research:

“The participants in our study had mostly only mild pain in the beginning of the study. Future research should investigate whether reducing sitting time also helps individuals who have more severe pain. My hypothesis would be that individuals with moderate or severe pain would have to reduce their sitting by a bit more than 1 h/day and additionally include some more strenuous activities or strengthening exercises as well.”