More walking, less low back pain issues

Walking a longer distance or for a longer time can reduce the risk of developing chronic low back pain (LBP).

In a population-based cohort study from Norway, the risk of chronic LBP was 13-percent lower among participants who walked between 78 and 100 min per day than those who walked <78 min per day (reference group) (risk ratio [RR], 0.87, 95 percent confidence interval [CI], 0.77–0.98). The risk further decreased by 23 percent among those who walked 101–124 min per day (RR, 0.77, 95 percent CI, 0.68–0.87). [JAMA Netw Open 2025;8:e2515592]

The cumulative benefit of the amount of walking on the risk of chronic LBP appeared to level off beyond more than 100 min per day. Notably, participants who walked at least 125 min had a similar risk reduction as those who walked 101–124 min (RR, 0.76, 95 percent CI, 0.67–0.87).

A higher walking intensity also showed a protective association with the risk of chronic LBP. A risk reduction of between 15 percent and 18 percent was observed among participants with a mean walking intensity of 3–3.11 (RR, 0.85, 95 percent CI, 0.75–0.96), 3.12–3.26 (RR, 0.82, 95 percent CI, 0.72–0.93), and ≥3.27 metabolic equivalent of task (MET) per minute (RR, 0.82, 95 percent CI, 0.72–0.93) than those with a lower mean walking intensity (<3 MET per min). However, this association was attenuated after adjusting for the amount walked per day.

“To the best of our knowledge, this is the first prospective population-based cohort study to investigate the association between device-measured volume and intensity of walking and the risk of chronic LBP,” the investigators said. “Our findings suggest that daily walking volume is more important than mean walking intensity in reducing the risk of chronic LBP.”

Similar observations were made in a meta-analysis evaluating total step volume and step intensity (ie, stepping rate) in relation to mortality. Results showed inconsistent evidence that step intensity had an impact on mortality beyond the total step volume. [Lancet Public Health 2022;7:e219-e228]

“However, it is important to note that we only used three cutoffs to classify walking intensity, limiting a more detailed analysis of the association between instantaneous walking intensity and the risk of chronic LBP. Furthermore, participants with higher walking volume tended to exercise more often and reported higher physical work demands,” the investigators acknowledged.

If these findings are confirmed by future research, they could be used to devise public health strategies that promote walking as an easy, accessible, and effective way to prevent chronic LBP, they said.

The study included 11,194 participants (mean age 55.3 years, 58.6 percent female) in the analysis. All of them wore an accelerometer for 7 days, with the resulting data used to measure daily walking volume and walking intensity.

Over a mean follow-up of 4.2 years, chronic LBP occurred in 1,659 participants (14.8 percent). The effect of walking volume on the risk of chronic LBP was more pronounced and consistent among older vs younger participants (≥65 vs <65 years; p=0.01 for interaction). Sex did not modify the effect of either walking volume or walking intensity on the risk of chronic LBP.