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Advising a nurse who walks 20,000 steps during the workday to walk more in her free time may not help her back pain.

Increased activity not always the best advice for neck and back pain

The Norwegian Directorate for Health and Human Affairs recommends more physical activity and less time sitting still. But that isn’t the right approach to managing neck and back pain for everyone, according to research from NTNU.

The NTNU study primarily includes industrial workers and employees in jobs with a lot of physical activity, such as nurses, cleaners and people in service professions who are required to stand a lot.

Moving more and sitting less has been the ongoing mantra, but this study comes to some different conclusions.

“Regular physical activity is still an important key to good health and disease prevention. Our message is that people who have physical work may benefit from taking rest breaks during the work day,” says Cecilie K. Øverås. She is a PhD candidate in NTNU’s Department of Public Health and at the University of Southern Denmark’s Department of Sports Science and Clinical Biomechanics.

“This could reduce the risk of neck and back pain, which is one of the leading causes of disability and impaired quality of life,” she says.

Pain that costs

About 90 per cent of us experience one or more neck or back pain episodes in life. Some people experience protracted pain. Lower back pain is the leading cause of sick leave and disability in Europe.

The study at NTNU is part of the EU’s Back-UP project, which is aimed at finding better and more individualized methods for treating neck and back pain.

Fooling ourselves

Øverås and study co-authors did a systematic review of research in a field that has previously shown some inconsistent results. The literature search yielded ten articles which used objective measurements of physical activity. These were included in the study.

Lower back pain is the leading cause of sick leave and disability in Europe.

“Self-reporting of physical behaviour has proven to be unreliable. As a rule, we think that we sit less than we actually do. In the studies we looked at, objective measurements were taken in people’s daily lives and included both work and leisure activity. The equipment used included pedometers and accelerometers that can measure energy consumption for various types of activities – like sitting, standing, or walking,” says Øverås.

Finding the balance

Other research results have shown that a high level of physical activity at work is associated with increased sick leave. Øverås therefore believes it is important to find a good balance between activity and rest.

A nurse who’s walked 20,000 steps during the workday may not need advice on taking a walk to help with her back pain in her time off. But perhaps strength training would be beneficial for her back? Health care professionals who advise patients on activity have to talk to the patient so that recommendations are nuanced for the individual and take the overall burden into account.

PhD candidate Cecilie K. Øverås.

The type of physical activity is key. A lot activities are good for the back, but others can put a strain on it.

“We’re seeing that physical activity at work doesn’t necessarily reduce the risk of neck and back pain – on the contrary. On the other hand, physical activity in people’s leisure time seems to have a positive effect,” says Øverås.

This discrepancy can be explained by the type of physical activity people do at work and in their leisure time.

“In jobs with a lot of physical activity, the pattern of movement is often repetitive and the intensity low – like repeated lifting, or standing and walking for long, continuous periods. Leisure activity often has greater variety, it’s fun-filled, and you have control over the duration and intensity,” she says.

“In order to safeguard our health, it’s important to find the right balance between physical activity at work and in our free time,” says Øverås, who is the lead author of the article.

The literature study included one article on workers with sedentary jobs. It showed that walking more in the course of a day to some extent reduced the risk of neck pain.

The HUNT 4 (the fourth health study in Nord-Trøndelag/Trøndelag county) includes objective measurements of physical activity, but the results from this round of the study are not yet available.


Association between objectively measured physical behaviour and neck‐ and/or low back pain: A systematic review. European Journal of Pain. Cecilie K. Øverås, Morten Villumsen, Iben Axén, Miriam Cabrita, Charlotte Leboeuf‐Yde, Jan Hartvigsen, Paul J. Mork

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