THE ROLE OF PHYSICAL ACTIVITY IN LOW BACK PAIN PREVENTION AND MANAGEMENT

Abstract

Thesis Abstract

Low back pain (LBP) remains a major health problem globally, and it is the leading cause of years lived with disability, imposing a great burden on society. The prevention and intervention strategies currently used in LBP management are failing to reduce this burden. Further research is needed to improve outcomes for people with LBP. Current clinical guidelines recommend people with LBP remain active, but it is unclear whether this means maintaining normal activities or being physically active. The overarching aim of this thesis was to examine the role of physical activity (PA) in prevention and management of LBP. Chapter Two found an inverse association between medium-high level PA and LBP. The results also indicated that people who engaged in medium-level, leisure-time PA had a lower risk of LBP. Chapter Three showed that people who met the current PA guidelines were less likely to report a chronic back condition (CBC). In addition, there were beneficial associations of some specific activities (e.g. high-level sport/exercise, medium-level domestic activity or any participation in football/rugby or in running/jogging with CBCs. Conversely, high-level manual domestic work was associated with higher prevalence of CBCs. Chapter Four found a positive association between moderate- to vigorous-intensity PA and health-related quality of life in people with back pain. Chapter Five provided evidence supporting the clinically beneficial role of incidental PA in reducing disability at intermediate and long-term follow-up in people with chronic LBP. The pilot trial conducted in Chapter Six demonstrated the feasibility and potential efficacy of adding a wearables-based walking intervention to usual care for people with medium to high risk of chronicity of LBP. There were also clinically important improvements in pain at 26 weeks and greater improvements in light and moderate-intensity PA and walking steps immediately post-intervention (8 weeks) for those in the wearables-based program.