Modifiable Lifestyle Factors (Smoking, Weight Loss, Exercise) May Contribute to Chronic Lower Back Pain
Many risk factors appear to contribute to the development of chronic lower back pain (CLBP), including lifestyle factors, such as smoking, weight, and exercise. These modifiable risk factors are considered to be an integral component for the prevention and treatment of CLBP.
The authors of this article write that the information available regarding exercise and CLBP suggests that both too little and too much exercise plays a role in CLBP. For example, some physical activity can be too demanding on the lower back in twisting and lifting. However, according to the Centers for Disease Control and Prevention, "regular, moderate-intensity activity is sufficient to produce health benefits in those who are sedentary." Recommendations are that healthy adults participate in 30 minutes of moderate-intensity five days per week or 20 minutes of vigorous-intensity activity three days per week.
Smoking cessation is a healthy choice for the entire body, not just CLBP, however smoking does also play a role in CLBP. Some hypothesis include repeated microtrauma from chronic cough leading to disc herniation, reduced blood flow to the discs and vertebral bodies that lead to early degeneration, or decreased bone mineral density.
The American Cancer Society has put forth four steps required for a patient to move ahead with smoking cessation: making the decision to quit, setting a quit date and quitting plan, dealing with the withdrawal, and remaining smoke-free. To encourage patients to quit smoking, they must learn the health benefits and they must believe that they are able to do this.
Weight loss is also encouraged for many health issues, although a systemic review of epidemiologic studies only found a 32 percent positive association between obesity and lower back pain. However, weight loss is still of benefit to patients who have CLBP.
The Weight-control Information Network mentions two main categories of weight-loss programs: nonclinical and clinical. The clinical programs are supervised by licensed healthcare professionals while nonclinical are the "do it yourself" weight loss programs.
Upon reviewing studies that investigated the results of smoking cessation, increased physical activity, and weight loss, the authors of this article found that systemic reviews suggest that exercise does have a positive effect on CLBP, while randomized control trials had varying results, ranging from better results in the treatment groups to no difference between treatment and control groups.
One study of 20,332 employees of a large manufacturing company found that total medical charges, including for CLBP, were significantly lower among the former smokers, compared with current smokers.
In conclusion, the authors write that there was "moderate evidence that physical activity with general aerobic an strengthening exercises or aquafitness was more effective than nonactive controls for long-term reductions in disability." There was limited evidence with home aerobics, and moderate evidence with other types of physical activity. The efficacy of smoking cessation and/or weight loss was not determined. However, the authors caution that further research is needed in this area because of the known benefits of the three lifestyle factors.
Eugene K. Waid, MD, MSc, et al. Evidence-informed management of chronic low back pain with physical activity, smoking cessation, and weight loss. In The Spine Journal. January/February 2008. Vol. 8. Issue 1. Pp. 195-202.
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