Low back pain and physical activity – A 6.5 year follow-up among young adults in their transition from school to working life Individuals with low back pain: how do they view physical activity? High-level physical activity in childhood seems to protect against low back pain in early adolescence. Evaluation of a specific home exercise program for low back pain. The Prognosis of Low Back Pain in General Practice Determinants of return-to-work among low back pain patients Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences Psychological aspects of chronic low back pain. A prospective, randomized 5-year follow-up study of functional restoration in chronic low back pain patients Short-term physical risk factors for new episodes of low back pain. Prospective evidence from the South Manchester Back Pain Study. Integrating Mobile health and Physical Activity to reduce the burden of Chronic low back pain Trial (IMPACT): a pilot trial protocol Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain. Physical exercise, body mass index, and risk of chronic pain in the low back and neck/shoulders: longitudinal data from the Nord-Trondelag Health Study. A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial Low back pain in general practice: reported management and reasons for not adhering to the guidelines in The Netherlands. Adding a physical exercise programme to brief intervention for low back pain patients did not increase return to work Comparing physical and behavior therapy for chronic low back pain on physical abilities, psychological distress, and patients' perceptions
Background The association between leisure time physical activity and  low back pain in young adults is unclear and is in the need of prospect ively obtained evidence . This study examined the course of low back pain and the association between low back pain and leisure time physical activity in a cohort of young adults in their transition from school to working life . Methods Both low back pain and leisure time physical activity was monitored over a 6.5 year period in 420 subjects starting out as students within hairdressing , electrical installation and media/ design . The association between physical activity and low back pain was investigated through the follow-up period by using linear mixed models analysis . Results Low back pain was significantly influenced by time and overall there was a decreasing trend of low back pain prevalence throughout the follow-up . Analysis showed a weak trend of decreasing low back pain with moderate/high physical activity levels , but this association was not significant . Conclusions Low back pain decreased during follow-up with baseline as reference . Findings in our study did show non-significant trends of reduced low back pain with increased leisure time physical activity . Still , we could not support the theory of moderate/high levels of physical activity acting protective against low back pain in young adults entering working life . Our results , in combination with previous relevant research , can not support a clear relationship between  physical activity and low back pain for young adults . Thus , recommendations regarding effect of physical activity on reducing low back pain for this group are not clear BACKGROUND Recent guidelines for those with acute low back pain have advocated early resumption of normal activity and increased physical activity . Little is known about the relationship between low back pain and physical activity , and on the impact of that relationship on the promotion of increased levels of physical activity within a general practice population . OBJECTIVES We aim ed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave with their low back pain , and the impact of those perceptions and behaviour on physical activity . METHODS Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who , because of their low back trouble , had been referred by their GPs to a community-based , single-blind , r and omized controlled trial ( RCT ) at the University of York , which is evaluating the effectiveness and cost-effectiveness of a progressive exercise programme . Fifty-four interviews were conducted with this subgroup of the RCT ; four informants were interviewed once , 19 twice and four of them three times . Interviews were transcribed and analysed using manual and computer-aided approaches . RESULTS Physical activity was perceived as ( i ) activities of daily living , ( ii ) activities causing breathlessness that they went out of the way to do and ( iii ) more competitive-type activity . The avoidance of physical activity and fear of pain returning were the two main factors directly associated with informants ' backs and changes in physical activity . These two factors hindered increases in physical activity , even though the majority of informants believed strongly that being physically active helped ease their low back pain . CONCLUSIONS When advocating that individuals with acute low back pain return to or increase physical activity , it is important that clinicians identify avoidance of physical activity and /or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately . If avoidance of activity and fear of pain is identified and clinicians want to encourage patients to take up and sustain increased physical activity , they should explore issues of fear of pain , and avoidance of and confidence to do physical activities , in addition to other factors influencing physical activity BACKGROUND The evidence on the impact of physical activity on  back pain in children and adolescents has been contradicting . It has also been shown that the physical activity can not accurately be estimated in children using question naires . PURPOSE The aim of this study was to establish if physical activity in childhood had any impact on back pain reporting in early adolescence ( 3 years later ) , using an objective instrumental measurement of physical activity . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Representative r and om sample of Danish children from the city of Odense sample d at age 9 years and followed-up at age 12 years . OUTCOME MEASURES The 1-month period prevalence of back pain ( neck pain , mid back pain , and low back pain ) was established using a structured interview . METHODS  Physical activity  was assessed with the MTI-accelerometer . The accelerometer provides a minute-by-minute measure of the physical activity performed . An overall measure of physical activity and time spent in high activity were studied in relation to back pain using logistic regression . The analyses were performed on the total sample and then stratified on back pain ( yes/no ) at baseline . RESULTS High physical activity ( HPA ) levels seem to protect against future low back pain and appear to actually " treat " and reduce the odds of future mid back pain . When comparing the least active children to the most active children , the least active had a multivariate odds ratio of 3.3 of getting low back pain and 2.7 of getting mid back pain 3 years later . When stratified on back pain at baseline , this effect on mid back pain was especially noticeable in children who had had mid back pain already at baseline , with an odds ratio of 7.2 . CONCLUSIONS HPA in childhood seems to protect against low back pain and mid back pain in early adolescence . Larger prospect i ve studies with repetitive follow-ups and preferably intervention studies should be performed , to see if these findings can be reproduced BACKGROUND The prescription of exercise as a conservative treatment for lumbar pain is frequent and seems effective for the chronic cases of nonspecific low back pain . However , there is no evidence favoring one type of exercise over another . Often , exercise programs are prescribed without adequate evaluation of the individual characteristics like posture , muscular force , and extensibility . Patients with totally different causes of low back pain will often be given the same type of exercises . OBJECTIVE Our objective was to compare the effectiveness of 2 home exercise programs in decreasing disability and pain related to subacute and chronic nonspecific low back pain . To do so we compared a specific ( individualized ) exercise program with a program of commonly prescribed exercises for low back pain . METHOD In a control group study , 20 patients with chronic or subacute nonspecific low back pain participated after giving their informed consent . All subjects were evaluated ( physical evaluation of lumbar and pelvic muscles [ 1 ] force and [ 2 ] extensibility , [ 3 ] trunk range of motion ) and then divided in 2 groups : 10 patients received specific exercises ( experimental group ) based on their evaluation , and 10 patients received a commonly prescribed exercise program for low back pain ( control group ) . Six weeks later a second physical evaluation was conducted . Pain ( visual analog pain scale ) and disability ( modified Oswestry ) question naires were also completed by each subject at both evaluations . DESIGN This was a r and omized experimental study . RESULTS Both groups had similar age , weight , and sex characteristics . The experimental group showed significant improvements for some components targeted by the program . The control group significantly had improvement of some physical characteristics not related to their initial deficits . Even if both groups showed some improvements in muscular force and extensibility , only the members of the group who received specific exercises significantly reduced their level of pain and disability . Both groups showed a similar rate of participation in the program . CONCLUSION The results of this study suggest that applying a specific physical evaluation and exercise prescription is an appropriate treatment for people having subacute or chronic nonspecific pain . Thus clinicians should prescribe exercise programs based on individual muscular deficits rather than most commonly prescribed exercise programs Study Design . A prospect i ve cohort study on low back pain in consecutive patients in general practice , in which potential prognostic indicators at baseline and at the 1-year follow-up examination were assessed by means of four weekly question naires . Objectives . To identify prognostic indicators of the duration of low back pain in general practice and the occurrence of a relapse . Background . Little is known about the prognosis of low back pain in general practice . Different design s and different results of preceding studies make drawing conclusions about the prognostic indicators , if any , of the course of low back pain in general practice difficult . Methods . For a period of 2 years , 15 general practitioners from Amsterdam and surrounding areas studied consecutive patients with chronic low back pain and those with a recent onset of low back pain . A large number of potential prognostic indicators were assessed at the initial visit . After the initial visit , each patient was monitored for a period of 12 months . The follow-up assessment was conducted with four weekly postal question naires . The associations among the potential prognostic indicators , the duration of the index episode , and the occurrence of a relapse were analyzed using multivariate Cox regression and logistic regression analysis , respectively . Results . Of the 605 patients identified , 443 were included in the follow-up period of assessment ; the question naires were completed by 269 patients . In general , patients with less severe low back pain participated less often or did not complete the follow-up study . Thirty-five percent of the population still experienced low back pain after 12 weeks , and 10 % still experienced it after 1 year . Approximately three of every four patients whose index episode ended before the end of the follow-up period had one or more relapses within a year . The analysis result ed in a model with four variables predicting the duration of the low back pain , including " the duration of the low back pain preceding the initial visit , " " receiving physical therapy , " " pain intensity , " and " history of back surgery . " Daily functioning appeared to be the only variable that was significantly associated with the occurrence of a relapse . Conclusions . Only a few variables appear to be related to the clinical course of low back pain seen in general practice . In particular , the duration preceding the initial visit and , unexpectedly , receiving physical therapy were both associated with a longer duration of low back pain & NA ; This prospect i ve study identifies physical , behavioral , and psychosocial correlates of subsequent employment status in a sample of low back pain patients . The sample of 150 subjects was drawn from 2 population s of persons with chronic low back pain : 87 individuals who were receiving care at a university low back pain clinic , and 63 individuals who had applied for ( but not yet received ) Social Security compensation on the basis of low back pain . All subjects had worked at least 3 months prior to their latest unemployment period and were currently out of work . Initial assessment included a medical history , physical examination , biomechanical testing , psychiatric interview , and MMPI testing .  All subjects were followed up 6 months later to determine whether they had returned to work . Cross‐sectional group comparisons at the time of initial assessment showed that , after controlling for the effects of age , the two sample s differed on several physical and biomechanical measures , the Social Security group reflecting a more chronic picture . Group differences on physical variables were found , but most significant differences disappeared when adjusted for length of time out‐of‐work . Longitudinal analyses showed that few objective physical or biomechanical measures were associated with return‐to‐work at 6 months , while a number of psychosocial variables were significant predictors of 6‐month work status . The data suggest that exclusive reliance on the physical examination to determine level of disability , without consideration of psychosocial conditions , and without adjusting for the confounding effects of age and length of time out‐of‐work , is not empirically justified . Logistic regression analysis was used to ascertain the relative contribution of each predictor to outcome and to illustrate the hypothetical effects of changes in the levels of selected risk factors on the likelihood of return‐to‐work . Implication s for interventions with low back pain patients are discussed and future research directions suggested Abstract Objective : To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities . Design : R and omised controlled trial of progressive exercise programme compared with usual primary care management . Patients ' preferences for type of management were elicited independently of r and omisation . Participants : 187 patients aged 18 - 60 years with mechanical low back pain of 4 weeks to 6 months ' duration . Interventions : Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups , stretching exercises , relaxation session , and brief education on back care . A cognitive-behavioural approach was used . Main outcome measures : Assessment s of debilitating effects of back pain before and after intervention and at 6 months and 1 year later . Measures included Rol and disability question naire , Aberdeen back pain scale , pain diaries , and use of healthcare services . Results : At 6 weeks after r and omisation , the intervention group improved marginally more than the control group on the disability question naire and reported less distressing pain . At 6 months and 1 year , the intervention group showed significantly greater improvement in the disability question naire score ( mean difference in changes 1.35 , 95 % confidence interval 0.13 to 2.57 ) . At 1 year , the intervention group also showed significantly greater improvement in the Aberdeen back pain scale ( 4.44 , 1.01 to 7.87 ) and reported only 378 days off work compared with 607 in the control group . The intervention group used fewer healthcare re sources . Outcome was not influenced by patients ' preferences . Conclusions : The exercise class was more clinical ly effective than traditional general practitioner management , regardless of patient preference , and was cost effective . Key messages Patients with back pain need to return to normal activities as soon as possible but are often afraid that movement or activity may be harmful An exercise programme led by a physiotherapist in the community and based on cognitive-behavioural principles helped patients to cope better with their pain and function better even one year later Patients ' preferences for type of management did not affect outcome Patients in the intervention group tended to use fewer healthcare re sources and took fewer days off work This type of exercise programme should be more widely BACKGROUND Patients with chronic low back pain present physicians with diagnostic and therapeutic problems . Physical treatments tend to have low success rates and it is postulated that this may be because low back pain can be a manifestation of abnormal illness behaviour . METHODS A structured prospect i ve study determined the prevalence of somatization in a sample of 131 adult patients with chronic low back pain using the Illness Behaviour Question naire ( IBQ ) and the Modified Somatic Perception Question naire ( MSPQ ) . The scores on these psychological question naires were compared with the blind interpretation of pain distribution drawings and with the results of a mechanical classification of the patient 's symptoms and signs . RESULTS Fifty-four per cent of patients had four or more ( out of five ) abnormal illness indicators . The MSPQ values for the group were significantly above the control values in the literature . Thirty-two per cent of pain diagrams were thought to be incompatible with an organic cause when assessed by an orthopaedic surgeon and sixty-two per cent when assessed by a psychiatrist . CONCLUSIONS Psychosocial factors are dominant in the presentation of chronic low back pain in adults and the disorder is not primarily a musculoskeletal one Abstract A functional restoration ( FR ) program , dealing with a combination of intensive physical and ergonomic training , psychological pain management , and patient education , was tested in two r and omized , parallel group studies . In one of these patients following the FR program were compared with a non-treated control group ( project A ) , and in the other with patients on two less intensive treatment programs ( project B ) . A total of 238 chronic low back pain patients participated in the two studies , 106 entering project A and 132 project B. Patients from the two projects were comparable except that the patients in project A were recruited from all over the country , whereas patients in project B all were living in and around Copenhagen . Thirteen patients never started any treatment , and 20 patients ( 9 % ) dropped out during the treatment period . Of the 207 who completed treatment , 89 % returned a mailed question naire 5 years later . This was the case for 55 % of the drop-outs . The questions referred to work situation , pain level , activities of daily living , days of sick leave , contact with health care professionals , physical activity , use of medication , and a subjective overall assessment . The results show that in project A the treated group reported significantly fewer contacts with the health care system and significantly fewer days of sick leave over the 5-year follow-up period compared to the control group . In all other parameters , including work ability , there was no statistically significant difference between the two groups . In project B , patients treated in the FR program did significantly better in most measured parameters , except in leg pain , use of pain medication and sport activity , where no significant differences were found between groups . The overall result shows a positive long-term effect of the FR program , but it also shows the necessity of testing a given treatment in different projects and design s , among other things due to statistical variations STUDY DESIGN A prospect i ve population -based cohort study performed in South Manchester , United Kingdom . OBJECTIVES To determine whether nonoccupational physical activity and indicators of physical stress on the spine predict low back pain in the short term . SUMMARY OF BACKGROUND DATA There is evidence that physical activity outside the workplace helps to protect against low back pain in the long term . However , such activity may injure or stress the spine in the short term . METHODS A baseline survey question naire identified 2715 adults , aged 18 - 75 years , with no low back pain at the time of the survey . Information on potential predictors of low back pain also was obtained . New episodes of back pain were identified during the subsequent year . RESULTS A new low back pain episode occurred in 34 % of men and 37 % of women . Poor general health at baseline was the strongest predictor of a new episode of pain ( men : relative risk ( RR ) 1.5 , 95 % confidence intervals ( CI ) 0.8 , 2.7 ; women : RR 2.2 , 95 % CI 1.2 , 4.0 ) . High weight was associated with subsequent low back pain in women ( RR 1.4 ; 95 % CI 1.0 , 2.0 ) , but neither height nor weight predicted low back pain in men . A self-rated low level of physical activity  was not consistently linked with subsequent low back pain , nor were specific nonoccupational physical activities , apart from home-improvement work in men and regular sports in women . CONCLUSION Although some specific activities may be hazardous to the back , physical activity outside the workplace does not increase the short-term risk of low back pain overall . Leisure-time physical activity is not a hazard to the back , whereas poor physical health in both genders and heavier weight in women do increase the risk of new low back pain episodes in the short term Background It is well recognised that low back pain is a significant public health problem and engagement in moderate levels of physical activity is associated with positive outcomes .Conservative active care , such as exercise , is effective in reducing pain and disability associated with chronic low back pain . However , a rapid decline in clinical outcomes is commonly seen after discharge from treatment . Methods / Design We will conduct a r and omised controlled trial to investigate the effectiveness of a mobile health supported physical activity intervention ( compared to st and ard care ) in care-seeking , pain and disability in people with chronic low back pain after discharge from treatment . We will recruit 68 patients with chronic low back pain following discharge from an outpatient hospital program , who will be r and omly allocated to the physical activity intervention ( n = 34 ) or the st and ard care group ( n = 34 ) and monitored for 6 months . The physical activity intervention will involve a physical activity advice booklet , a face-to-face health coaching session and 12 fortnightly follow-up telephone-based health coaching sessions . This intervention will be supported by provision of a specifically design ed web app and a physical activity monitoring device ( FitBit ) . The st and ard care group will receive the physical activity advice booklet only . Discussion This pilot trial will investigate a new model to prevent clinical decline in people following conservative treatment for chronic low back pain . If proven to be effective , this approach will constitute a major advance in the management of low back pain . Chronic patients who experience recurrent pain and disability after treatment are prone to seek additional care in the form of physiotherapy , medication , emergency department attendance , specialist consultation or spinal surgery . This model aims to maintain functional levels and reduce care-seeking empowering patients to self-manage their low back pain by offering them a contemporary patient-centred physical activity program with the support of mobile health technology . The outcomes of this trial will have immediate implication s for clinical practice .Trial registration ACTRN12615000189527 ( 26 - 02 - 2015 ) OBJECTIVE To evaluate a progressive fitness programme for patients with chronic low back pain . DESIGN Single blind r and omised controlled trial . Assessment s were carried out before and after treatment by an observer blinded to the study and included a battery of vali date d measures . All patients were followed up by postal question naire six months after treatment . SETTING Physiotherapy department of orthopaedic hospital . SUBJECTS 81 patients with chronic low back pain referred from orthopaedic consultants for physiotherapy . The patients were r and omly allocated to a fitness programme or control group . INTERVENTION Both groups were taught specific exercises to carry out at home and referred to a back-school for education in back care . Patients allocated to the fitness class attended eight exercise classes over four weeks in addition to the home programme and backschool . RESULTS Significant differences between the groups were shown in the changes before and after treatment in scores on the Oswestry low back pain disability index ( P < 0.005 ) , pain reports ( sensory P < 0.05 and affective P < 0.005 ) , self efficacy reports ( P < 0.05 ) , and walking distance ( P < 0.005 ) . No significant differences between the groups were found by the general health question naire or question naire on pain locus of control . A benefit of about 6 percentage points on the disability index was maintained by patients in the fitness group at six months . CONCLUSION There is a role for supervised fitness programmes in the management of moderately disabled patients with chronic low back pain . Further clinical trials , however , need to be established in other centres to confirm these findings Chronic musculoskeletal pain constitutes a large socioeconomic challenge , and preventive measures with documented effects are warranted . The authors ' aim in this study was to prospect ively investigate the association between physical exercise , body mass index ( BMI ) , and risk of chronic pain in the low back and neck/shoulders . The study comprised data on approximately 30,000 women and men in the Nord-Trøndelag Health Study ( Norway ) who reported no pain or physical impairment at baseline in 1984 - 1986 . Occurrence of  chronic musculoskeletal pain  was assessed at follow-up in 1995 - 1997 . A generalized linear model was used to calculate adjusted risk ratios . For both females and males , hours of physical exercise per week were linearly and inversely associated with risk of chronic pain in the low back ( women : P-trend = 0.02 ; men : P-trend < 0.001 ) and neck/shoulders ( women : P-trend = 0.002 ; men : P-trend < 0.001 ) . Obese women and men had an approximately 20 % increased risk of chronic pain in both the low back and the neck/shoulders . Exercising for 1 or more hours per week compensated , to some extent , for the adverse effect of high BMI on risk of chronic pain . The authors conclude that physical inactivity and high BMI are associated with an increased risk of chronic pain in the low back and neck/shoulders in the general adult population & NA ; The aim of this study was to assess the long‐term effect of a supervised fitness programme on patients with chronic low back pain . The design of the study was a single blind r and omised controlled trial with follow‐up , by postal question naire , 2 years after intervention . The Oswestry Low Back Pain Disability Index was used as the outcome measure to assess daily activity affected by back pain . Eighty‐one patients with chronic low back pain , who were referred to the physiotherapy department of a National Health Service orthopaedic hospital , were r and omised to either a supervised fitness programme or a control group . Patients in the intervention group and control group were taught specific exercises to be continued at home and referred to a backschool for back care education . In addition , the intervention group attended eight sessions of a supervised fitness programme .  Sixty‐two patients ( 76 % ) with a mean age of 37 years , returned the Oswestry Low Back Pain Disability Index question naire . Of these , 29 were in the intervention group and 31 in the control group . Patients in the intervention group demonstrated a mean reduction of 7.7 % in the Oswestry Low Back Pain Disability Index score ( 95 % confidence interval of mean paired difference 3.9 , 11.6 P<0.001 ) , compared with only 2.4 % in the control group ( 95 % confidence interval of mean paired difference −2.0 , 6.9 P>0.05 ) . Between group comparisons demonstrated a statistically significant difference in disability scores between the treatment and control group ( mean difference 5.8 , 95 % confidence interval 0.3 , 11.4 P<0.04 ) . This study supports the current trend towards a more active treatment approach to low back pain . We have demonstrated clinical effectiveness of a fitness programme 2 years after treatment but this needs to be replicated in a larger study which should include a cost effectiveness analysis , further analysis of objective functional status and a placebo intervention group BACKGROUND Although guidelines for the management of low back pain have been published in the past decade , there is potential for further improvement in back pain care . AIM To document the management of non-specific low back pain by general practitioners ( GPs ) in the Netherl and s , to determine how this management of care is related to patient and physician factors , and to explore possible reasons for not adhering to the guidelines . METHOD A prospect i ve study was set up in which 57 GPs in 30 general practice s completed a computerised question naire after each consultation for low back pain during a four-month period . RESULTS Of 1640 back pain contacts , 1180 referred to non-specific low back pain . Diagnostic tests were ordered in 2 % of first consultations and in 7 % of follow-up consultations within one episode . The advice to  stay active  despite  pain  was given in 76 % and 69 % of these cases respectively . Patients were prescribed an  analgesic  in 53 % and 41 % of cases respectively ( mainly NSAIDs [ 80 % ] ) . Patients were referred to a physiotherapist in 22 % of first and in 50 % of follow-up consultations . Older patients were physically examined less often , prescribed analgesics more often , and were told less often that staying active could benefit them . The advice to remain active was omitted more often when symptoms lasted longer . Only a small part of the variance in management was accounted for by patient characteristics or by differences between practice s. CONCLUSION The management of low back pain met the guidelines to a large extent . Management decisions were often related to characteristics in which the guidelines lack differentiation . Important reasons for non-adherence were perceived patients ' preferences . Further implementation of guidelines will be difficult unless doctors ' and patients ' views are more explicitly known Aims : To investigate if a st and ardised physical exercise programme given in addition to a brief intervention at a spine clinic had an effect on return to work . Methods : A total of 246 patients sick-listed 8—12 weeks for non-specific low back pain were offered a brief intervention programme at the spine clinic with examination , information , reassurance , and encouragement to engage in physical activity as normal as possible , before they were r and omised into an intervention group ( n = 124 ) and a control group ( n = 122 ) . Patients in the intervention group participated in a physical exercise programme at the spine clinic . Results : During the 2-year follow-up , there were no significant differences between the groups on sick leave , pain , use of analgesics , psychological distress , coping strategies , fear-avoidance beliefs , self-reported disability , or walking distances . However , both groups increased return to work , reported less pain and better function , and reduced fear-avoidance beliefs for physical activity during the follow-up period . Fear-avoidance beliefs for work were not changed . Conclusions : A physical exercise programme for low back pain patients given after a brief intervention at a spine clinic did not have any additional effect on sick leave or fear-avoidance beliefs . Both groups reported less pain , better physical function , and increased return to work during follow-up . The treatment at the spine clinic did not contain a vocational rehabilitation programme directed towards individual work-related problems , which might explain no change in fear-avoidance beliefs for work A treatment- outcome study was conducted to study the impact of behavior and physical therapy on components of the chronic low back pain syndrome . Eighteen patients received behavior therapy and 15 patients received physical therapy . All patients had at least a 6-month history of seeking treatment for chronic low back pain . Prior to treatment patients were assessed in four principal areas of functioning : ( 1 ) physical abilities ; ( 2 ) current physical functioning ; ( 3 ) psychological and psychosocial functioning ; and ( 4 ) pain intensity and pain perception . Treatments were conducted in a group ( five to eight patients ) outpatient setting . Both behavior therapy and physical therapy groups met for 10-weekly sessions , each lasting 2 hr . Behavior therapy was design ed to address the environmental , social , and emotional components of the low back pain syndrome as well as the depression and decreased activity that result from chronic low back pain . Physical therapy was based upon traditional rehabilitation theory and was design ed to improve low back function . Patients were reevaluated at posttreatment , 6 months , and 1 year . The results showed a general improvement for patients in both groups and a few treatment-specific differences in outcome measures
Pooled data revealed no significant difference in the overall activity level of adults or adolescents with CLBP , however there is evidence that older adults with chronic low back pain are less active than controls .
The results suggest that patients exhibit an altered pattern of physical activity over the course of a day compared to controls .
There is no conclusive evidence that patients with chronic low back pain are less active than healthy individuals .
Based on a limited number of studies , there is some evidence that the distribution of activities over the course of a day is different between patients with chronic low back pain and controls
BACKGROUND It is commonly assumed that patients with chronic low back pain are less active than healthy individuals .
There has been a recent increase in the number of studies published comparing the physical activity levels of patients with chronic low back pain and healthy individuals .
OBJECTIVES The aim of this systematic review was to determine , based on the current body of evidence , if patients with chronic low back pain have a lower level and /or altered pattern of physical activity compared with asymptomatic , healthy individuals .