Is Objectively Measured Sitting Time Associated with Low Back Pain? A Cross-Sectional Investigation in the NOMAD study

Background Studies on the association between sitting time and low back pain (LBP) have found contrasting results. This may be due to the lack of objectively measured sitting time or because socioeconomic confounders were not considered in the analysis. Objectives To investigate the association between objectively measured sitting time (daily total, and occupational and leisure-time periods) and LBP among blue-collar workers. Methods Two-hundred-and-one blue-collar workers wore two accelerometers (GT3X+ Actigraph) for up to four consecutive working days to obtain objective measures of sitting time, estimated via Acti4 software. Workers reported their LBP intensity the past month on a scale from 0 (no pain) to 9 (worst imaginable pain) and were categorized into either low (≤5) or high (>5) LBP intensity groups. In the multivariate-adjusted binary logistic regression analysis, total sitting time, and occupational and leisure-time sitting were both modeled as continuous (hours/day) and categorical variables (i.e. low, moderate and high sitting time). Results The multivariate logistic regression analysis showed a significant positive association between total sitting time (per hour) and high LBP intensity (odds ratio; OR=1.43, 95%CI=1.15-1.77, P=0.01). Similar results were obtained for leisure-time sitting (OR=1.45, 95%CI=1.10-1.91, P=0.01), and a similar but non-significant trend was obtained for occupational sitting time (OR=1.34, 95%CI 0.99-1.82, P=0.06). In the analysis on categorized sitting time, high sitting time was positively associated with high LBP for total (OR=3.31, 95%CI=1.18-9.28, P=0.03), leisure (OR=5.31, 95%CI=1.57-17.90, P=0.01), and occupational (OR=3.26, 95%CI=0.89-11.98, P=0.08) periods, referencing those with low sitting time. Conclusion Sitting time is positively associated with LBP intensity among blue-collar workers. Future studies using a prospective design with objective measures of sitting time are recommended.

[1]  Christiane,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2004, Journal international de bioethique = International journal of bioethics.

[2]  A. Burdorf,et al.  Positive and negative evidence of risk factors for back disorders. , 1997, Scandinavian journal of work, environment & health.

[3]  H. Morgenstern,et al.  Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain , 2004, Occupational and Environmental Medicine.

[4]  J Dul,et al.  The relationship between leisure time, physical activities and musculoskeletal symptoms and disability in worker populations , 2000, International archives of occupational and environmental health.

[5]  J. Shaw,et al.  Breaks in Sedentary Time , 2008, Diabetes Care.

[6]  C. Tudor-Locke,et al.  Adult self-reported and objectively monitored physical activity and sedentary behavior: NHANES 2005–2006 , 2013, International Journal of Behavioral Nutrition and Physical Activity.

[7]  George Papathanasiou,et al.  Prevalence of low back pain in greek public office workers. , 2007, Pain physician.

[8]  H. P. van der Ploeg,et al.  The prevalence and correlates of sitting in European adults - a comparison of 32 Eurobarometer-participating countries , 2013, International Journal of Behavioral Nutrition and Physical Activity.

[9]  D. Harrison,et al.  Effects of lifestyle and work-related physical activity on the degree of lumbar lordosis and chronic low back pain in a Middle East population. , 2002, Journal of spinal disorders & techniques.

[10]  M I Jayson,et al.  Employment and Physical Work Activities as Predictors of Future Low Back Pain , 1997, Spine.

[11]  A. Silman,et al.  Short-term physical risk factors for new episodes of low back pain. Prospective evidence from the South Manchester Back Pain Study. , 1999, Spine.

[12]  W. Chiou,et al.  Risk factors for low back pain, and patient-handling capacity of nursing personnel , 1994 .

[13]  Andreas Holtermann,et al.  Validity of the Acti4 software using ActiGraph GT3X+accelerometer for recording of arm and upper body inclination in simulated work tasks , 2014, Ergonomics.

[14]  Y. Xu,et al.  Work environment and low back pain: the influence of occupational activities. , 1997, Occupational and environmental medicine.

[15]  Svend Erik Mathiassen,et al.  Musculoskeletal health and work ability in physically demanding occupations: study protocol for a prospective field study on construction and health care workers , 2014, BMC Public Health.

[16]  Jørgen Skotte,et al.  Detection of physical activity types using triaxial accelerometers. , 2014, Journal of physical activity & health.

[17]  S. Linton,et al.  Risk factors for neck and back pain in a working population in Sweden , 1990 .

[18]  Wolzt,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2003, The Journal of the American College of Dentists.

[19]  T. Skov,et al.  Psychosocial and physical risk factors for musculoskeletal disorders of the neck, shoulders, and lower back in salespeople. , 1996, Occupational and environmental medicine.

[20]  Maria Hagströmer,et al.  The repeatability and validity of questionnaires assessing occupational physical activity--a systematic review. , 2011, Scandinavian journal of work, environment & health.

[21]  Andreas Holtermann,et al.  A prospective cohort study on musculoskeletal risk factors for long-term sickness absence among healthcare workers in eldercare , 2012, International Archives of Occupational and Environmental Health.

[22]  Jack P Callaghan,et al.  Effects of prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine. , 2005, The spine journal : official journal of the North American Spine Society.

[23]  Svend Lings,et al.  Review Article: Is sitting-while-at-work associated with low back pain? A systematic, critical literature review , 2000 .

[24]  G. Cardon,et al.  Objectively measured sedentary time and physical activity time across the lifespan: a cross-sectional study in four age groups , 2012, International Journal of Behavioral Nutrition and Physical Activity.

[25]  D Coggon,et al.  Occupational causes of low-back pain. , 1989, Scandinavian journal of work, environment & health.

[26]  W. E. Hoogendoorn,et al.  High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study , 2002, Occupational and environmental medicine.

[27]  P. Kong.  Changes in Perceived Comfort, Strength and Electromyographic Response in Lower Back, Hip and Leg Muscles during 8-Hour Prolonged Sitting , 2010 .

[28]  Ulf Ekelund,et al.  Objectively measured physical activity in four-year-old British children: a cross-sectional analysis of activity patterns segmented across the day , 2014, International Journal of Behavioral Nutrition and Physical Activity.

[29]  Vera Yin Bing Yip,et al.  New low back pain in nurses: work activities, work stress and sedentary lifestyle. , 2004, Journal of advanced nursing.

[30]  M. Nordin,et al.  Association between sitting and occupational LBP , 2007, European Spine Journal.

[31]  Chris Jensen,et al.  Computer users' risk factors for developing shoulder, elbow and back symptoms. , 2004, Scandinavian journal of work, environment & health.

[32]  E N Corlett,et al.  Background to sitting at work: research-based requirements for the design of work seats , 2006, Ergonomics.

[33]  Bronwyn K. Clark,et al.  Validity of self-reported measures of workplace sitting time and breaks in sitting time. , 2011, Medicine and science in sports and exercise.

[34]  K. Søgaard,et al.  Comparison of Objectively Measured and Self-reported Time Spent Sitting , 2013, International Journal of Sports Medicine.

[35]  Jill Cook,et al.  Sedentary lifestyle as a risk factor for low back pain: a systematic review , 2009, International archives of occupational and environmental health.

[36]  Paulien M. Bongers,et al.  A systematic review of the relation between physical capacity and future low back and neck/shoulder pain , 2007, PAIN.

[37]  H. Riihimäki,et al.  Low-back pain, its origin and risk indicators. , 1991, Scandinavian journal of work, environment & health.

[38]  W. Brown,et al.  Validity of two self-report measures of sitting time. , 2012, Journal of physical activity & health.

[39]  A. J. van der Beek,et al.  A worksite vitality intervention to improve older workers' lifestyle and vitality-related outcomes: results of a randomised controlled trial , 2012, Journal of Epidemiology & Community Health.

[40]  D. Ward,et al.  Validity of self-reported leisure-time sedentary behavior in adolescents , 2011, Journal of Negative Results in BioMedicine.

[41]  N. Owen,et al.  Sedentary behaviour and biomarkers of cardiometabolic health risk in adolescents: an emerging scientific and public health issue. , 2010, Revista espanola de cardiologia.

[42]  Genevieve N. Healy,et al.  Conducta sedentaria y biomarcadores del riesgo cardiometabólico en adolescentes: un problema científico y de salud pública emergente , 2010 .

[43]  Svend Erik Mathiassen,et al.  Diversity and variation in biomechanical exposure: what is it, and why would we like to know? , 2006, Applied ergonomics.

[44]  S. Pocock,et al.  Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration , 2007, PLoS medicine.

[45]  Hidde P van der Ploeg,et al.  Cross-sectional associations between occupational and leisure-time sitting, physical activity and obesity in working adults. , 2012, Preventive medicine.

[46]  A. Holtermann,et al.  Independent Effect of Physical Workload and Childhood Socioeconomic Status on Low Back Pain Among Health Care Workers in Denmark , 2013, Spine.

[47]  J W Frymoyer,et al.  The Relationship Between Work History, Work Environment and Low-Back Pain in Men , 1984, Spine.

[48]  P. Freedson,et al.  Amount of time spent in sedentary behaviors in the United States, 2003-2004. , 2008, American journal of epidemiology.

[49]  A Magora,et al.  Investigation of the relation between low back pain and occupation. VII. Neurologic and orthopedic condition. , 1975, Scandinavian journal of rehabilitation medicine.

[50]  Matthew Rockloff,et al.  Associations between occupational indicators and total, work-based and leisure-time sitting: a cross-sectional study , 2013, BMC Public Health.

[51]  J. Freburger,et al.  The rising prevalence of chronic low back pain. , 2009, Archives of internal medicine.

[52]  C. Leboeuf‐Yde,et al.  Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies. , 2004, Occupational and environmental medicine.

[53]  A. Leclerc,et al.  Low-back pain in commercial travelers. , 1992, Scandinavian journal of work, environment & health.

[54]  A. Breen,et al.  A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. , 2008, Arthritis and rheumatism.

[55]  A. Nachemson.  Disc Pressure Measurements , 1981, Spine.

[56]  H. Hall,et al.  Evidence-informed management of chronic low back pain with physical activity, smoking cessation, and weight loss. , 2008, The spine journal : official journal of the North American Spine Society.

[57]  Allard J van der Beek,et al.  Gender differences in the relations between work-related physical and psychosocial risk factors and musculoskeletal complaints. , 2004, Scandinavian journal of work, environment & health.

[58]  J. Caro,et al.  A systematic review of low back pain cost of illness studies in the United States and internationally. , 2008, The spine journal : official journal of the North American Spine Society.

[59]  Douglas G Altman,et al.  Dichotomizing continuous predictors in multiple regression: a bad idea , 2006, Statistics in medicine.

[60]  Jakob B. Bjorner,et al.  The second version of the Copenhagen Psychosocial Questionnaire , 2010, Scandinavian journal of public health.

[61]  H. Savelberg,et al.  Interrupting long periods of sitting: good STUFF , 2013, International Journal of Behavioral Nutrition and Physical Activity.

[62]  C. Hildingsson,et al.  Low back pain, lifestyle factors and physical activity: a population based-study. , 2008, Journal of rehabilitation medicine.

[63]  Carlos Salas,et al.  Objective vs. Self-Reported Physical Activity and Sedentary Time: Effects of Measurement Method on Relationships with Risk Biomarkers , 2012, PloS one.

[64]  A. Leclerc,et al.  Individual and occupational determinants of low back pain according to various definitions of low back pain , 2000, Journal of epidemiology and community health.

[65]  S. Linton.  Occupational Psychological Factors Increase the Risk for Back Pain: A Systematic Review , 2001, Journal of Occupational Rehabilitation.

[66]  Shenglan Tang,et al.  On residents’ satisfaction with community health services after health care system reform in Shanghai, China, 2011 , 2012, BMC Public Health.

[67]  J. Coste,et al.  Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice , 1994, BMJ.

[68]  M. Hagberg,et al.  To what extent do current and past physical and psychosocial occupational factors explain care-seeking for low back pain in a working population? Results from the Musculoskeletal Intervention Center-Norrtälje Study. , 2000, Spine.

[69]  D. Wegman,et al.  Increase of chronic low back pain prevalence in a medium-sized city of southern Brazil , 2013, BMC Musculoskeletal Disorders.

[70]  Catrine Tudor-Locke,et al.  Accelerometer-determined steps per day in US adults. , 2009, Medicine and science in sports and exercise.

[71]  A. Silman,et al.  Predictors of low back pain in British schoolchildren: a population-based prospective cohort study. , 2003, Pediatrics.

[72]  Liping Li,et al.  Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors , 2012, BMC Public Health.

[73]  J Malchaire,et al.  Low back pain. Epidemiologic aspects and work-related factors in the steel industry. , 1994, Spine.

[74]  B. Walker,et al.  The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. , 2000, Journal of spinal disorders.

[75]  S Lings,et al.  Is sitting-while-at-work associated with low back pain? A systematic, critical literature review. , 2000, Scandinavian journal of public health.

[76]  B. Kwon,et al.  Causal assessment of awkward occupational postures and low back pain: results of a systematic review. , 2010, The spine journal : official journal of the North American Spine Society.

[77]  G B Andersson,et al.  The Relationship of Low-Back Pain, Work History, Work Environment, and Stress: A Retrospective Cross-Sectional Study of 38- to 64-Year-Old Women , 1989, Spine.

[78]  F. Omokhodion,et al.  Risk factors for low back pain among office workers in Ibadan, Southwest Nigeria. , 2003, Occupational medicine.

[79]  M. Nordin,et al.  A 2-year prospective longitudinal study on low back pain in primary school children , 2002, European Spine Journal.

[80]  Ulrik Hesse,et al.  Sundhed og sygelighed i Danmark & udviklingen siden 1987 , 2007 .

[81]  L. Bouter,et al.  A cost-of-illness study of back pain in The Netherlands , 1995, Pain.

[82]  Kheng Lim Goh,et al.  Spine ergonomics. , 2002, Annual review of biomedical engineering.

[83]  P. Froom,et al.  Prevalence of low back pain in employees of a pharmaceutical company. , 1992, Israel journal of medical sciences.

[84]  B. Jonsson,et al.  Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. , 1987, Applied ergonomics.

[85]  S M McGill,et al.  Lumbar erector spinae oxygenation during prolonged contractions: implications for prolonged work , 2000, Ergonomics.

[86]  C. Leboeuf‐Yde.  Back pain--individual and genetic factors. , 2004, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[87]  Lau Caspar Thygesen,et al.  Total sitting time and risk of myocardial infarction, coronary heart disease and all-cause mortality in a prospective cohort of Danish adults , 2014, International Journal of Behavioral Nutrition and Physical Activity.

[88]  P K Levangie.  Association of low back pain with self-reported risk factors among patients seeking physical therapy services. , 1999, Physical therapy.

[89]  A. N. Sjolie,et al.  Persistence and Change in Nonspecific Low Back Pain Among Adolescents: A 3-Year Prospective Study , 2004, Spine.

[90]  C. Chang,et al.  Understanding the link between psychosocial work stressors and work-related musculoskeletal complaints. , 2012, Applied ergonomics.

[91]  J. Winkel,et al.  Self-assessed and directly measured occupational physical activities--influence of musculoskeletal complaints, age and gender. , 2004, Applied ergonomics.