sedentary behaviour

Association between sedentary behaviour and low back pain

Goal of the Study?

In this qualitative systematic review and meta-analysis article from the Journal of Health Promotion Perspectives 1 the authors investigated existing studies to determine if consistent correlations exist between various types of sedentary behaviour and low back pain in both children and adults.


Why are they doing this study about sedentary behaviour?

Low Back Pain (LBP) is a universal public health concern contributing to self-perceived disability and a high economic burden worldwide.  It is estimated that about 80% of the population has experienced an episode of LBP in their lives.  Sedentary behaviours are a substantial risk for many chronic diseases, including LBP, but the relationship between sitting time and LBP in current literature is inconsistent. This is due to the differences in study design, measurement methods and occupational groups.  



What was done?

A systematic search using PubMed, Embase, Web of Science and Scopus databases were searched and 3,406 articles were initially found.  After removing duplicates, non-full text, non-english and inappropriate studies, 27 articles were fully analyzed using a variety of meta-analysis tools, looking for correlations between sedentary behaviours and LBP.  Factors included in the meta-analysis were correlation between body mass, age groups (adults and children/adolescents), coffee consumption, smoking and hours spent in sedentary behaviour (screen,  driving and sitting time). Various meta-analysis statistical tools such as Odds Ratio, Cochran’s Q and inconsistency index, STROBE scores and Forest Plots were applied to the 27 articles.


What did they find?

Using the pooled effect sizes obtained from the meta-analysis studies of children/adolescents, the authors determined that LBP was significantly correlated with body mass and two sedentary behaviours; prolonged TV watching and screen playing time. Among the adult population, obesity, sitting time and driving time were significantly correlated with LBP, whereas correlations with smoking and coffee consumption were inconsistent, and only moderately associated with LBP.  It appears that body mass and smoking interact with sitting and LBP.  It was suspected that sedentary behaviour decreases the level of water supply to the vertebral disc, which in turn leads to degenerative changes and disk herniation. Smoking seems to have both a direct and indirect effect on LBP.  Smoking is a risk factor for osteoporosis and also alters the blood supply of vertebral disks by impairing vasoconstriction and atherosclerosis. Excessive coffee consumption tends to flush magnesium from the body, resulting in increasing painful contractions of the paraspinal muscles.


Why do these findings matter?

There are many inconsistencies in the definition and measurement of LBP and sedentary behaviour in current research articles.  Very few studies used any type of objective measurements to determine LBP or sitting time.  LBP is a complex disorder with many interacting risk factors.  Given the increasing trend of sedentary behaviour worldwide, especially in this era of the COVID pandemic, increased health education is necessary to avoid sedentariness in early childhood to prevent future musculoskeletal consequences such as LBP.