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Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies
  1. Rahman Shiri1,
  2. Kobra Falah-Hassani2
  1. 1 Finnish Institute of Occupational Health, Helsinki, Finland
  2. 2 Western University, London, Canada
  1. Correspondence to Dr Rahman Shiri, Finnish Institute of Occupational Health, P.O. Box 40, Helsinki FI-00251, Finland; rahman.shiri{at}


Background There are plausible mechanisms whereby leisure time physical activity may protect against low back pain (LBP) but there have been no quality systematic reviews and meta-analyses of the subject.

Objective This review aims to assess the effect of leisure time physical activity on non-specific LBP.

Methods Literature searches were conducted in PubMed, Embase, Web of Science, Scopus and Google Scholar databases from their inception through July 2016. Methodological quality of included studies was evaluated. A random-effects meta-analysis was performed, and heterogeneity and publication bias were assessed.

Results Thirty-six prospective cohort studies (n=158 475 participants) qualified for meta-analyses. Participation in sport or other leisure physical activity reduced the risk of frequent or chronic LBP, but not LBP for > 1 day in the past month or past 6–12 months. Risk of frequent/chronic LBP was 11% lower (adjusted risk ratio (RR)=0.89, CI 0.82 to 0.97, I2=31%, n=48 520) in moderately/highly active individuals, 14% lower (RR=0.86, CI 0.79 to 0.94, I2=0%, n=33 032) in moderately active individuals and 16% lower (RR=0.84, CI 0.75 to 0.93, I2=0%, n=33 032) in highly active individuals in comparison with individuals without regular physical activity. For LBP in the past 1–12 months, adjusted RR was 0.98 (CI 0.93 to 1.03, I2=50%, n=32 654) for moderate/high level of activity, 0.94 (CI 0.84 to 1.05, I2=3%, n=8549) for moderate level of activity and 1.06 (CI 0.89 to 1.25, I2=53%, n=8554) for high level of activity.

Conclusions Leisure time physical activity may reduce the risk of chronic LBP by 11%–16%. The finding, however, should be interpreted cautiously due to limitations of the original studies. If this effect size is proven in future research, the public health implications would be substantial.

  • Back pain
  • epidemiology
  • exercise
  • hospitalisation
  • incidence
  • leisure activities
  • sport
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  • Contributors RS developed the review protocol and conducted the literature searches. Both authors screened the eligible studies and rated the quality of included studies. RS extracted the data, performed the meta-analyses, interpreted the results and drafted the manuscript.

  • Funding The Finnish Ministry of Education and Culture (grant no 253715).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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