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The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study

https://doi.org/10.1016/j.semarthrit.2012.09.002Get rights and content

Objective

To study the effects of obesity, physical activity, and change in physical activity on the incidence of low back pain and explore whether obesity modifies the effects of physical activity.

Methods

As part of the ongoing Young Finns Study, 1224 subjects aged 24–39 years free from low back pain during the preceding 12 months at baseline in 2001 were included. Obesity was defined based on the body mass index (BMI) and waist circumference, and physical activity was assessed by the metabolic equivalent of task (MET) index in 2001 and 2007.

Results

Abdominal obesity, defined by an increased waist circumference, was associated with an increased incidence of radiating low back pain (adjusted odds ratio (OR) = 1.7 and 95% confidence interval (CI) 1.1–2.7), while it had no effect on non-specific low back pain. BMI was associated neither with the incidence of radiating low back pain nor with non-specific low back pain. Compared with subjects who stayed active during follow-up, those with a low level of physical activity (adjusted OR = 2.0 and 95% CI 1.1–3.5) and active subjects who further increased their physical activity during follow-up (OR = 3.1 and 95% CI 1.5–6.7) had a higher incidence of radiating low back pain. Low level of physical activity was associated with an increased incidence of radiating low back pain in obese (OR = 3.3 and 95% 1.1–10.4), but not in non-overweight subjects (OR = 1.1 and 95% CI 0.6–1.9). Physical activity was not associated with non-specific low back pain.

Conclusions

Our findings indicate that both obesity and low level of physical activity are independent risk factors of radiating low back pain. The current findings propose a U-shaped relation between physical activity and radiating low back pain. Moderate level of physical activity is recommended for the prevention of low back pain, especially in obese individuals. In all, our findings imply that obese individuals should stay physically active, even if they may not lose weight.

Section snippets

Population

This study is a part of an ongoing follow-up study, the Young Finns Study. In 1980, children and adolescents aged 3, 6, 9, 12, 15, or 18 years (N = 4320) were invited to participate in the study. Of them, 3596 (83%) participated (Fig. 1) [32]. The study was carried out in five Finnish university cities. The follow-up studies were carried out in 1983, 1986, 2001, and 2007, the two latest follow-ups included questions on low back pain. A total of 2620 (73% of those who participated at baseline)

Background characteristics

The mean age of the study population at baseline (2001) was 31.4 years (Table 1). BMI increased by about one unit and waist circumference by almost 5 cm during the follow-up. A quarter of the study population participated in organized physical activity and a third commuted to work by walking or biking at baseline. Eighteen per cent of the subjects reduced and 12% increased their physical activity during 2001–2007 (Table 1).

Table 2 shows the baseline and follow-up physical activity (MET) scores

Discussion

Our findings show that obesity and low levels of physical activity independently increase the risk of radiating low back pain in young to middle-aged adults, but not non-specific low back pain. Increased incidence of radiating low back pain was observed in those with sustained low level of physical activity and in those active individuals who further increased their activity. Furthermore, the current study indicates that obese individuals who stay inactive are at the highest risk of radiating

Source of funding

This study was financially supported by the Academy of Finland (Grants 121584, 129378, and 129364), the Social Insurance Institution of Finland, government grants to Tampere and Turku University Hospitals, the Turku University Foundation, the Juho Vainio Foundation, the Finnish Foundation of Cardiovascular Research, the Lydia Maria Julin Foundation, Research Foundation of Orion Corporation, and the Finnish Cultural Foundation.

Author contributions

All authors were involved in the designing of the study. R. Shiri carried out the statistical analyses and drafted the manuscript. He had full access to the data and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors critically revised the manuscript and approved the final version to be submitted for publication.

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