1. Prevalence of Low Back Pain by Physical Activity Domains in the U.S.
Yong Gao1
, Scott Fulkerson1
, Zachary Pope1
, Scott Conger1
, and Haichun Sun2
1
Boise State University, 2
University of South Florida
ABSTRACT
INTRODUCTION
Introduction: Low back pain (LBP) is one of the most commonly reported health problems
worldwide in adults. It is also the major cause of occupational absenteeism and medical
expenses. Increased physical activity (PA) levels have been associated with a decreased
prevalence of LBP. However, the relationship between LBP and the individual PA domains is
not clear.
Purpose: To examine the prevalence of LBP and the relationship between LBP and individual
PA domains using the 2009-2010 National Health and Nutrition Examination Survey (NHANES).
Method: Data were obtained from the 2009-2010 NHANES, where LBP was measured using
the Arthritis Questionnaire (ARQ) specifically designed to collect LBP related information among
the American adults during this one-time data collection effort. 989 adults (48.3% males, 51.7%
females) aged 20 to 69 years completed anthropometric measurements and the ARQ. PA
questionnaire and demographic information were included in the study. SAS survey procedures
(e.g., frequency, means and logistical regression) were used for data analyses to account for
the complex NHANES sampling design as suggested by the NHANES analytic guidelines.
Results: More than 70% of American adults (69.6% males and 70.5% females) reported LBP
on almost every day for 3 or more months in a row at least once in their life. LBP prevalence
varied across different PA domains, with 75.4% of adults engaged in vigorous occupational PA,
70.1% of adults engaged in moderate occupational PA, 64.8% engaged in transportation PA,
63.1% participated in vigorous leisure-time PA, and 70.4% engaged in moderate leisure-time
PA reporting LBP. Logistic regression analysis revealed age (p = 0.021), hours spent on
vigorous occupational PA (p = 0.003), hours spent on leisure-time PA (p = 0.05), and waist
circumference (p = 0.014,) were significantly associated with prevalence of LBP. All other
factors held constant, older respondents (odds ratio [OD] = 1.13), those engaged in more hours
of vigorous occupational PA (OD=1.14) and those with larger waist circumference (OD=1.82)
were more likely to have LBP; Those engaged in more hours of leisure-time PA (OD = 0.68)
were less likely to have LBP.
Conclusion: Results show the likelihood of LBP is higher in older individuals and those
engaged in vigorous occupational PA. However, adults engaged in vigorous leisure-time PA
were less likely to report LBP.
RESULTS
CONCLUSIONS
• LBP was defined in the current study as back pain almost every day
for three or more months in a row. LBP was measured using the
NHANES Arthritis Questionnaire (ARQ) specifically designed to
collect LBP related information among the American adults during this
one-time data collection effort.
• Data regarding participants’ demographic information (e.g., age,
gender), and physical activity participation were obtained through the
NHANES demographic questionnaire and physical activity
questionnaire. The anthropometric measurements (e.g., height,
weight, waist circumference, skinfolds) were also taken from the
participants by the NHANES through its Mobile Examination Center.
• SAS survey procedures were used for data analyses to account for
the complex NHANES sampling design as suggested by the NHANES
analytic guidelines
Variable
Male Female
n Mean SEM n Mean SEM
Had LBP 3 months in a row
Age (yr) 307 47.35 0.84 368 44.61 0.66
Weight (kg) 306 91.23 1.35 367 82.17 1.71
Height (cm) 306 176.55 0.49 367 163.31 0.60
BMI (kg/m2
) 305 29.25 0.43 367 30.82 0.64
Waist Circumference (cm) 300 103.13 1.04 342 100.17 1.44
Sum of Skinfolds (cm) 294 33.29 0.94 328 45.31 1.19
Total PA Participation (hr/w) 307 16.66 1.32 368 8.74 0.93
Daily Sedentary Activities (hr/d) 306 5.88 0.29 367 6.05 0.31
Lumbar flexion test length (cm) 287 3.78 0.06 326 3.76 0.08
Didn't have LBP 3 months in a row
Age (yr) 147 42.24 0.96 150 41.48 1.32
Weight (kg) 146 91.84 1.70 150 80.71 2.19
Height (cm) 145 175.56 0.66 150 163.10 0.80
BMI (kg/m2
) 145 29.81 0.58 150 30.21 0.66
Waist Circumference (cm) 141 103.01 1.57 144 99.18 1.63
Sum of Skinfolds (cm) 138 35.18 1.51 139 42.91 1.28
Total PA Participation (hr/w) 147 14.13 1.45 150 8.77 1.59
Daily Sedentary Activities (hr/d) 145 6.12 0.27 150 6.03 0.52
Lumbar flexion test length (cm) 140 4.03 0.09 138 3.87 0.08
Variable Beta SE t Value p Value
95% Confidence
Interval
Gender 4.40 2.70 2.65 0.10 0.41
BMI (kg/m2) -2.14 1.11 3.76 0.054 0.01 1.02
Age (yr) 0.12 0.05 5.31 0.021 1.02 1.26
Vigorous Work Place PA (hr/w) 0.13 0.04 8.61 0.003 1.04 1.23
Moderate Work Place PA (hr/w) 0.08 0.16 0.22 0.64 0.79 1.48
Transportation PA (hr/w) -0.37 0.22 2.78 0.10 0.45 1.07
Vigorous Leisure Time PA (hr/w) -0.39 0.20 3.76 0.05 0.45 1.00
Moderate Leisure Time PA (hr/w) 0.12 0.10 1.54 0.21 0.93 1.38
Daily Sedentary Activities (hr/d) -0.03 0.15 0.03 0.86 0.73 1.31
LBP Started Age (yr) -0.07 0.10 0.49 0.49 0.77 1.13
Lumbar flexion test length (cm) 3.10 2.40 1.66 0.20 0.20
Waist Circumference (cm) 0.60 0.24 6.02 0.014 1.13 2.93
The likelihood of LBP is higher in older individuals and those
engaged in vigorous occupational PA. However, adults engaged
in vigorous leisure-time PA were less likely to report LBP.
METHODS
Table 1: Sample Characteristics.
• More than 70% of American adults reported LBP on almost every day
for 3 or more months in a row at least once in their life. LBP
prevalence varied across different PA domains, with 75.4% of adults
engaged in vigorous occupational PA, 70.1% of adults engaged in
moderate occupational PA, 64.8% engaged in transportation PA,
63.1% participated in vigorous leisure-time PA, and 70.4% engaged in
moderate leisure-time PA reporting LBP. See Figure 1 for details.
Figure 1: LBP Prevalence Across Gender, BMI category and PA Domain
Table 2: Significant Predictors of LBP
• Logistic regression analysis revealed when all other factors held
constant, older respondents (odds ratio [OD] = 1.13), those engaged
in more hours of vigorous occupational PA (OD=1.14) and those with
larger waist circumference (OD=1.82) were more likely to have LBP;
Those engaged in more hours of leisure-time PA (OD = 0.68) were
less likely to have LBP. See Table 2 for details.
• LBP: Low Back Pain
• VOPA: Vigorous Occupational PA
• MOPA: Moderate Occupational PA
• VLPA: Vigorous Leisure-time PA
• MLPA: Moderate Leisure-time PA
• Low back pain (LBP) is one of the most common health problems,
affecting up to 54% of adults at least once in their lifetime.
• Factors such as age, gender, BMI, waist circumference, and intensity
of occupational physical activity have previously been associated with
LBP.
• Leisure time physical activity has been shown to be an effective
method for treatment and prevention of LBP.
• However, the relationship between LBP and physical activity across
all four activity domains (Occupational, leisure time, domestic, and
transportation) is less clear.
• Therefore, the purpose of this study was to examine the prevalence of
LBP and the relationship to PA domains using the 2009-2010
NHANES data.
• The 2009-2010 National Health and Nutrition Examination Survey
(NHANES) data were used for the analysis (unweighted N = 989, aged
20 to 69).