Slip on your walking shoes and let’s go!
Reviewed by Dietitian Jessica Ball, M.S., RDReviewed by Dietitian Jessica Ball, M.S., RD
If you’ve ever had low back pain, you know how limiting it can be. And you’re not alone. According to the Centers for Disease Control and Prevention, as of 2019, back pain increases with age—from 28.4% in those aged 18-29 up to 45.6% in those aged 65 and up. Women are more likely to experience back pain than men—40.6% vs. 37.2% respectively.
Related: The 10 Best at-Home Exercises to Reduce Back Pain
And back pain is expensive. According to a 2023 review in BMJ Open, direct medical and indirect costs of low back pain are at least $50 billion per year and upwards of $100 billion in medical costs, lost wages and lost productivity.
But a new study published on June 19, 2024 in The Lancet suggests that back pain recurrence could be prevented—or at least prolonged—by the simple act of walking. Let’s take a closer look.
How Was This Study Conducted?
Participants were chosen based on criteria related to back pain and current exercise status. They had to be at least 18 years old who had recovered from an episode of non-specific back pain within the previous 6 months. Non-specific means that there was not a specific diagnosis for the back pain.
Researchers further defined an episode of non-specific back pain as one that lasted at least 24 hours with a pain intensity of at least a 2 on a 0-10 pain scale. The pain had to be located within the area between the 12th rib and the crease of the buttocks to qualify as low back pain. It also had to have interfered with daily activities, including work.
To be included in the study, participants could not have been exercising regularly prior to the study, since researchers were looking at how exercise influenced the frequency of back pain episodes. They also could not have a condition that prevented them from being able to participate in a walking program.
After dismissing those who did not qualify, there ended up being 701 participants, who were randomly assigned to one of two groups—the intervention group or the control group. The average age of the participants was 54 and the majority of them—81%—were female. Participants were followed for a minimum of 12 months and up to 36 months, depending on when they entered the study.
Baseline data was gathered from both groups, including the number of previous back pain episodes, time since the last episode, levels of physical activity, time spent sitting (sedentary behavior), mental health status (depression, anxiety), stress levels and sleep quality.
Sociodemographic information was also collected, including sex, age, BMI, education level, income level, current work status, smoking status and occupational tasks—like if they had to lift heavy loads or were placed into awkward positions during manual labor.
The control group received no education or training from the research team. They could, however, seek out treatment and prevention strategies on their own during the study period—and many did, in the form of physical therapy, massage and chiropractic care.
The intervention group received education on back pain, as well as individualized training with one of 24 physical therapists. Each participant received a walking program designed specifically for them based on their baseline fitness level, abilities and limitations. The physical therapists were also trained in health coaching methods to help increase adherence to the program and to more effectively coach participants in behavior change. There were six available sessions participants could attend. While these sessions were initially intended to be in-person, the COVID pandemic occurred after the study had begun, so they had to switch to telehealth sessions.
The education component of the program included information about back pain, what current research suggests about pain and coaching to help reduce the fear of movement. This was important, as many who experience back pain fear that exercise will exacerbate the pain and limitations of it.
Each participant in the intervention group also received a pedometer and walking diary. For seven days during the minimal 12-month study period, they wore an accelerometer, which is similar to a pedometer, but it picks up all movement, not just walking.
Related: What Happens to Your Body When You Sit All Day
All participants—both the intervention group and the control group—were required to complete monthly questionnaires to establish whether they had experienced another episode of back pain.
According to the 12-week walking diaries, the intervention group progressively worked up to averaging 4 walking sessions per week for a total of 130 minutes. This is close to the recommended 150 minutes of moderate activity per week recommended in the 2018 Physical Activity Guidelines for Americans.
What Did This Study Find?
The primary outcome researchers were looking at was the number of days between a participant entering the study to their next occurrence of activity-limiting back pain. They wanted to know if the education, training and intentional walking for exercise increased the number of days between back pain episodes.
In the intervention group, the average number of days to recurrence of activity-limiting back pain was 208, and in the control group 112 days.
The researchers concluded that compared to the no-treatment control group, the group that received an individualized, progressive walking program, education and health coaching substantially reduced the recurrence of low back pain. The intervention group also experienced reductions in back pain-related disability (i.e. missing work, not able to perform normal daily activities) for up to 12 months. Researchers also state that taking all things into consideration, including lost work time and wages, and medical expenses due to back pain, the intervention was likely cost-effective.
How Does This Apply to Real Life?
This study shows how walking alone may benefit back pain. Participants were not taught any strength training exercises or stretches for back pain. They simply learned how to make walking a habit.
Related: The 7 Best Walking Shoes, According to Podiatrists
What we know about behavior change is that it takes consistent practice to form new habits. This study drives this home since participants were followed for at least a year (remember, some were followed for as long as three years if they entered the study early on).
While you may have heard that it takes just 21 days to form a new habit, research, like a 2023 study in PNAS suggests that it depends on the complexity of the habit you’re trying to form. In that study, the habit of handwashing took several weeks, whereas forming a new exercise habit can take several months—and that’s if you’re committed and consistent with practicing the new habit.
The reason it takes time for habit formation is because it involves the brain cells and nerve pathways. Your habits are essentially well-worn, frequently used nerve pathways in the brain. That’s why they’re habits—they’re the pathways your brain can automatically go to. So when trying to create new habits, you’re fighting your brain for what it already knows and is familiar with. So to create new pathways—and ultimately habits—it requires consistent practice of the new behavior so that brain cells will wire together to form new pathways. It’s pretty cool and is called neuroplasticity (this is where I geek out!).
If, for example, you’re trying to create a new exercise habit, the first step is to start where you’re at. Too many times we try to start at the end goal and quickly get burnt out. If you’re not currently exercising, then start with fewer sessions per week and fewer minutes per session—even if it sounds like a really small amount of time. Then gradually increase your time and frequency over several weeks.This can help your body adjust to the increase in movement and reduce muscle soreness and the risk of injury.
Simple habits, like hand washing, can be stacked with habits you already have. You probably formed this habit as a child when you were reminded to wash your hands after using the toilet. Boom—new habit formed!
But more complex habits can also be stacked. Going back to the exercise example, what if you stacked going for a walk with eating lunch? So after eating lunch, you’ll go for a 10-minute walk. Eating lunch is your trigger to go for a walk. Or, stack brushing your teeth in the morning with doing a set of push-ups, squats and plank. In this case, brushing your teeth is the trigger for doing some exercises—not necessarily at the same time, although I’ve been known to do squats, leg lifts, heel raises and push-ups off the kitchen counter while doing dishes. It’s the same idea.
Related: How to Do Walking Meditation, According to Experts
The Bottom Line
This study showed that regularly walking for exercise helped to increase the number of days between low back pain episodes. It also highlights the importance of consistently practicing the behaviors you want to become habits. Start slow and gradually increase the number of days and your time to form new habits. Be patient and show yourself some compassion. It can take months to form more complex habits like exercise, so keep practicing consistently and before long it will be a regular part of your lifestyle.
Read the original article on Eating Well.
