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A. Angarita Fonseca1,2, C. Trask3, P. Pahwa1,3, D. Fuller4, B. Bath5
1University of Saskatchewan, Community Health and Epidemiology, Saskatoon, Canada, 2Universidad de Santander, Physiotherapy, Bucaramanga, Colombia, 3University of Saskatchewan, Canadian Centre for Health and Safety in Agriculture, Saskatoon, Canada, 4Memorial University, School of Human Kinetics and Recreation, St. John's, Newfoundland and Labrador, Canada, 5University of Saskatchewan, School of Rehabilitation Science, Saskatoon, Canada
Background: Longitudinal studies investigating the relationship between physical activity [PA] and chronic back disorders [CBD] in the general adult population show an inconsistent relationship.
Purpose: To investigate the association between PA variables and CBD within the same survey cycle [concurrent analysis]; and PA variables within the previous survey cycle and subsequent CBD adjusted for previous CBD and other covariates [time-lagged analysis].
Methods: We included 13,929 Canadians aged ≥18 years from Statistics Canada’s National Population Health Survey, consisting of nine repeated measures collected between 1994 and 2011. Individuals were categorized into three leisure-time PA [LTPA] levels: 1) active [>3 kcal/kg/day]; 2) moderately active [1.5-3.0 kcal/kg/day]; and 3) inactive [<1.5 kcal/kg/day]. Utilitarian walking [UW] and cycling [UC] were collected as ‘time per week usually spent walking and cycling to work or to school, or while doing errands.’ CBD was defined as self-reported back problems, with at least a six-month duration. Two final models were obtained using generalized estimating equation marginal models (concurrent analysis) and generalized estimating equation transition models (time-lagged analysis).
Results: CBD prevalence ranged from 15% in 1994-95 to 20% in 2010-11. In the concurrent multivariable model, there was an interaction between UC and sex [>5hours/week*female OR=1.77, 95% CI 1.02, 3.09], as well as UW and body mass index [<1 hour/week*overweight OR=0.79, 95% CI 0.66, 0.93; <1 hour/week*pregnant OR=0.43, 95% CI:0.20, 0.95; >5 hours/week*overweight OR=0.86, 95% CI:0.75, 0.99]. In the time-lagged multivariable model, LTPA in the previous survey cycle was associated with reduced CBD in the subsequent cycle [active versus inactive OR=0.89, 95% CI:0.8, 0.95].
Conclusion(s): In conclusion, previous PA during leisure time is associated with subsequent reporting of CBD [up to two years later] in Canadian adults followed from 1994-95 to 2010-11 when controlling for a range of bio-psychosocial factors. Conversely, there was no association between leisure-time PA and CBD when these were studied concurrently. Further research is needed to better understand this relationship and the potential of LTPA and utilitarian PA strategies to prevent CBD.
Implications: Currently, Canada has not implemented widespread national or regional public policies or strategies to prevent or manage CBD. However, as a first step before the creation of a national policy for prevention and management of chronic pain, the Canadian Pain Task Force, [i.e. a group of eight experts supported by an advisory panel: 2019], published a document reporting on the current state of chronic pain in Canada. Such policies could incorporate specific guidelines about the importance of being physically active during free time to prevent CBD. However, since there are not yet clear parameters of PA associated to back health benefits, more studies are recommended to identify those parameters including possible new thresholds of PA.
Funding, acknowledgements: This work was supported by the Canada Research Chairs program [#228136], the University of Saskatchewan, and the Universidad de Santander.
Keywords: back pain, prevalence, physical activity
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: University of Saskatchewan
Committee: Behavioral Research Ethics Board
Ethics number: BIO: 17-253
All authors, affiliations and abstracts have been published as submitted.
