Relation Between Risk of Back/Neck Pain with Obesity and Exercise

A health study in Norway involving nearly 30,000 men and women was conducted to assess the role of body weight and physical exercise in the risk of chronic musculoskeletal pain, especially in the lower back and neck-shoulder regions. The baseline readings reflected an absence of pain or any physical injury. A follow-up survey measured the pain intensity after 11 years. Results of this study indicated that obesity increased the risk of chronic pain by 20 percent, while moderate exercise reduced the same in both men and women.

Musculoskeletal pain affecting the back from the neck to the lower spine hampers health and productivity, and has an economic cost as well. The magnitude of the problem makes it significant and the feasibility of prevention requires addressing it. Studies have established that weight gain leads to greater incidence of backache, and that exercise could counter this effect to a great extent. A recent study mapped the increase in the risk of musculoskeletal pain with increased obesity. Also, this risk was balanced out by introducing stipulated and consistent exercise modules in a follow-up spanning 11 years. Hence, this study was executed to verify similar effects by correlating neck/shoulder/lower backache to differences in body mass index (BMI) and by incorporating exercises in men and women, starting with a no-pain baseline value.

* The Nord-Trøndelag Health study (HUNT) comprised two surveys, 11 years apart, to assess the association between body weight, exercise and back pain (lower and neck) in approximately 15,000 men and women.
* The intensity, duration and frequency of exercise sessions per week was monitored while BMI, and the persistence and intensity of pain in the affected areas were measured.
* The basic models for age, occupation and smoking, BMI and frequency of physical exercise were mutually adjusted. The combined effect of BMI and exercise was also assessed.

Results/Key Findings
* The initial readings reported no pain while the 11-year follow-up recorded an average incidence of 10 percent low back pain and 20 percent neck pain.
* Compared to inactive people, risk ratios for low backache was 0.84 in women and 0.88 in men who did one to two hours of exercise per week. An increase in exercise lowered the risk of pain.
* Obesity was directly proportional with chronic pain.
* The combined effect analyses revealed that irrespective of baseline BMI, exercise reduced pain and irrespective of the exercise regimen, obesity increased the pain.

Next steps/Shortcomings
One limitation of this study was that the inputs on BMI and exercise were obtained only at baseline; changes during follow-up were not tracked. It has been hypothesized that physiologically, the influence of obesity and exercise on chronic pain is based on systemic inflammation and release of certain biochemicals. This needs further investigation to understand the exact mechanism.

The results of this study are very critical to healthcare industry as this suggest a highly practical solution to the widespread issue of chronic back pain, with medical and economic implications. A moderate exercise regimen of one to two hours/week is sufficient to considerably decrease the risk of developing low back and neck/shoulder pain, most of which are occupation related disorders. Another important highlight of this study is the clear indication that body weight is a potential risk factor of backache. However, this is definitely a controllable factor by working out correct diet patterns in terms of the right type and quantum of nutrition. Thus, physical exercise could be the answer to neutralize the impact of excess body weight on the threat of chronic back pain.

For More Information:
Physical Exercise, Body Mass Index, and Risk of Chronic Pain in the Low Back and Neck/Shoulders: Longitudinal Data From the Nord-Trøndelag Health Study
Publication Journal: American Journal of Epidemiology, June 2011
By Tom Ivar Lund Nilsen, Andreas Holtermann; Norwegian University of Science and Technology, Trondheim, Norway; National Research Centre for the Working Environment, Copenhagen, Denmark

*FYI Living Lab Reports Are Summaries of the Original Research.

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