Elsevier

The Spine Journal

Volume 9, Issue 2, February 2009, Pages 134-141
The Spine Journal

Clinical Studies
High-level physical activity in childhood seems to protect against low back pain in early adolescence

https://doi.org/10.1016/j.spinee.2008.02.003Get rights and content

Abstract

Background

The evidence on the impact of physical activity on back pain in children and adolescents has been contradicting. It has also been shown that the physical activity cannot accurately be estimated in children using questionnaires.

Purpose

The aim of this study was to establish if physical activity in childhood had any impact on back pain reporting in early adolescence (3 years later), using an objective instrumental measurement of physical activity.

Patient sample

Representative random sample of Danish children from the city of Odense sampled at age 9 years and followed-up at age 12 years.

Outcome measures

The 1-month period prevalence of back pain (neck pain, mid back pain, and low back pain) was established using a structured interview.

Methods

Physical activity was assessed with the MTI-accelerometer. The accelerometer provides a minute-by-minute measure of the physical activity performed. An overall measure of physical activity and time spent in high activity were studied in relation to back pain using logistic regression. The analyses were performed on the total sample and then stratified on back pain (yes/no) at baseline.

Results

High physical activity (HPA) levels seem to protect against future low back pain and appear to actually “treat” and reduce the odds of future mid back pain. When comparing the least active children to the most active children, the least active had a multivariate odds ratio of 3.3 of getting low back pain and 2.7 of getting mid back pain 3 years later. When stratified on back pain at baseline, this effect on mid back pain was especially noticeable in children who had had mid back pain already at baseline, with an odds ratio of 7.2.

Conclusions

HPA in childhood seems to protect against low back pain and mid back pain in early adolescence. Larger prospective studies with repetitive follow-ups and preferably intervention studies should be performed, to see if these findings can be reproduced.

Section snippets

Background

Evidence & Methods

Context

The currently available literature is unclear as to the relationship between physical activity and back pain in childhood. In the United States, physical activity levels in children are generally low: less than 50% of Californian public schools provide the minimum opportunity for 20 minutes of exercise per day.

Contribution

Using a prospective cohort design, the authors’ findings suggest that high physical activity levels might protect against the development of back pain in children (aged

Basic design

The design and methods of the baseline study of back problems in children and adolescents have been extensively described elsewhere [19] and are summarized together with the relevant measurements performed in the follow-up study in Table 1. The follow-up study was performed on children aged 12 to 13 years, 3 years after the baseline study. Of the original 481 children, 364 children (191 girls and 173 boys) and their parents agreed to participate in the follow-up study.

The proportion of

Sample description and comparison between 1998 and 2001

Back pain was reported considerably more often in 2000 to 2001 (57%) than in 1998 (30%). The anatomic locations of the back pain in 1997 to 1998 and in 2000 to 2001 are shown in Table 2. The pattern of reporting changed from being mainly in the mid back at the time of the first survey to being mainly in the low back 3 years later. At baseline, it was rare that subjects reported pain in more than one area, whereas this was more common at follow-up. There was no difference in proportions of the

Main findings

The main findings of this study were that 9-year-old children with low levels of physical activity had higher probability and odds of having back pain anywhere, low back pain, and mid back pain 3 years later. There was a clear significant trend in predicted probabilities; with no significant difference between observed and predicted outcome, and in most cases a moderate-to-good fit (Table 6). The multivariate probability of low back pain as function of HPA showed a difference between the

Conclusion

The finding that HPA in childhood seems to protect against back pain in early adolescence highlights yet another reason to promote physical activity in the young. Furthermore, our study implies that not only moderate activity, but also high activity should be promoted. Larger prospective studies and preferably intervention studies should be performed, to see if our findings can be reproduced, and also to establish whether very high amounts of physical activity will have detrimental effects on

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