Walking effective for low back pain recurrence: Lancet


By Siobhan Calafiore

24 Jun 2024

Adults with a history of low back pain who walk at least three times a week can double the amount of time in respite until back pain recurrence, according to a pioneering Australian trial.

Researchers say the findings from the first randomised controlled trial on the topic showed walking was a cost-effective and accessible intervention for back pain.

The Sydney-based team followed 701 adults who had recovered from a recent episode of non-specific low back pain lasting at least 24 hours.

Participants – who were mostly female (81%), had a mean age of 54 and weren’t regularly active – were randomly allocated 1:1 to either an individualised walking program and six physiotherapist-guided education sessions over six months or to a no treatment control group.

They were followed for 1-3 years depending on date of enrolment.

Findings published in The Lancet [link here] showed that the intervention group had fewer occurrences of activity-limiting pain versus the control group (hazard ratio 0.72), and a longer period before recurrence (median 208 days vs 112 days).

The intervention also reduced the risk of any recurrences of low back pain and care-seeking episodes related to recurrences of low back pain compared with the control group (HR 0.80 and 0.57 respectively).

The incremental cost per quality-adjusted life-year (QALY) gained was $7802 AUD, with the intervention having a high (94%) probability of being cost-effective compared with no treatment, at a willingness-to-pay of $28,000 per QALY.

Although the number of participants experiencing at least one adverse event over 12 months was similar between the intervention and control groups (52% and 54%, respectively), there was a greater number of adverse events related to the lower extremities in the intervention group than in the control group (100 vs 54).

“The focus on empowering patients with back pain to self-manage their condition is strongly aligned with guideline recommendations,” wrote the authors from Macquarie University, The University of Sydney and Western Sydney University.

“Future research should assess the implementation of this intervention, ideally as part of discharge planning following an acute episode of low back pain.”

Senior author physiotherapist Professor Mark Hancock from Macquarie University said walking was low-cost, widely accessible and suitable for almost everyone.

“We don’t know exactly why walking is so good for preventing back pain, but it is likely to include the combination of the gentle oscillatory movements, loading and strengthening the spinal structures and muscles, relaxation and stress relief, and release of ‘feel-good’ endorphins. And of course, we also know that walking comes with many other health benefits, including cardiovascular health, bone density, healthy weight, and improved mental health,” Professor Hancock said.

Lead author Dr Natasha Pocovi, also a physiotherapist and researcher at Macquarie University, said walking was also cost-effective in other ways, such as reduced healthcare support seeking and halving the amount of time off work.

“The exercise-based interventions to prevent back pain that have been explored previously are typically group-based and need close clinical supervision and expensive equipment, so they are much less accessible to the majority of patients.”

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