Research Summary

Greater Daily Walking Duration Linked to Lower Risk of Chronic Low Back Pain

Miranda Manier, BA

Key Highlights:

  • Walking more than 100 minutes per day was associated with a 23% lower risk of chronic low back pain.
  • Walking intensity showed a weaker association with chronic low back pain risk than walking volume.
  • The relationship between walking volume and low back pain was nonlinear and inverse.

In a prospective, population-based cohort study of 11,194 adults in Norway, greater daily walking volume was significantly associated with a lower risk of developing chronic low back pain. Participants who walked more than 100 minutes per day experienced a 23% reduced risk compared with those walking less than 78 minutes per day. Walking intensity also showed an inverse association with chronic low back pain risk, but its effect was less pronounced and attenuated when adjusted for walking volume.

Chronic low back pain is a leading global cause of disability and health care utilization. While physical activity is broadly recommended for secondary prevention, there is limited evidence to guide primary prevention strategies, particularly regarding walking, a widely accessible form of physical activity. Prior research has primarily focused on structured exercise interventions, with few studies evaluating the preventive role of daily walking in asymptomatic populations.

Researchers used data from the Trøndelag Health (HUNT) Study in Norway, collecting baseline data between 2017 and 2019 and follow-up data from 2021 to 2023. Participants aged 20 years or older without chronic low back pain at baseline wore thigh and back-mounted accelerometers to quantify daily walking volume and intensity over an average of 5.7 days. Walking intensity was calculated using metabolic equivalents (MET) per minute. Chronic low back pain at follow-up was defined as self-reported pain in the lower back lasting three or more consecutive months in the past year.

Among the 11,194 participants (mean age 55.3 years; 58.6% women), 14.8% reported chronic low back pain at follow-up. Risk ratios showed a graded, inverse association between walking volume and pain risk. Compared with those walking less than 78 minutes per day, participants walking 78–100 minutes, 101–124 minutes, and 125 minutes or more per day had adjusted risk ratios of 0.87, 0.77, and 0.76, respectively. Walking intensity also showed a reduced risk, with participants walking at intensities 3.27 MET/min or more having a risk ratio of 0.82 compared with those walking at fewer than 3.00 MET/min. However, after adjusting for both volume and intensity, walking volume remained a stronger independent predictor of lower risk.

Limitations include reliance on a single measurement of walking behaviors at baseline, potential residual confounding, and self-reported pain outcomes. Misclassification of low back pain and a lack of follow-up data on new risk factors may have influenced the results. The observational design precludes causal inference, though sensitivity analyses helped mitigate concerns about reverse causation.

“In this cohort study, daily walking volume and walking intensity were inversely associated with the risk of chronic low back pain,” the study authors concluded. “The findings suggest that walking volume may have a more pronounced benefit than walking intensity.”

Reference:
Haddadj R, Nordstoga AL, Nilsen TIL, et al. Volume and intensity of walking and risk of chronic low back pain. JAMA Netw Open. 2025;8(6):e2515592. doi:10.1001/jamanetworkopen.2025