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Pain and Spine Medicine

Session: Factors associated with activity level in adults with chronic low back pain

Factors Associated with Activity Level in Adults with Chronic Low Back Pain

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Disclosure(s):
Natalie Curley, DO: No financial relationships to disclose
Carol M. Greco, PhD: No financial relationships to disclose
Aileen Chou, PhD, PT: No financial relationships to disclose
Zakiy Alfikri, PhD: No financial relationships to disclose
Gwendolyn Sowa, MD, PhD: No relevant disclosure to display
Background and/or Objectives: Physical activity and exercise are commonly recommended for patients with chronic pain. This study aims to identify relationships between biopsychosocial factors and activity in persons with chronic low back pain (cLBP).

Design: Observational cross-sectional study

Setting : Real-world community setting

Participants : 778 adults with cLBP recruited by the overarching Low Back Pain Biological, Biomechanical, Behavioral Phenotypes (LB3P) study of 1007 participants were included (excluding those missing data for tested variables). The cohort aged 18-95 years (mean 61 ± 16) and consisted of 316 males (41%) and 462 females (59%).

Interventions: N/A

Main Outcome Measures: Average daily step count (SC) and average daily minutes of moderate to vigorous physical activity (MVPA) were measured by take-home activity monitors worn for 4-7 days. Negative binomial regression was used for modeling SC, and logistic regression for identifying predictors of MVPA < 5 minutes versus MVPA>=5 minutes based on distribution.

Results: The median SC was 3,397 steps (IQR = 1,860-5,243) and median MVPA was 6.4 minutes (IQR=1.8-17.0). Higher SC and odds of MVPA>=5 minutes were seen in males compared to females (SC: Incidence Rate Ratio [95% CI] (IRR)=1.17[1.07-1.29]; MVPA: Odds Ratio [95% CI] (OR)=1.94[1.36-2.78]), and in employed compared to unemployed persons (SC: IRR=1.13[1.02-1.25]; MVPA: OR=1.75[1.20-2.55]). Both measures of activity were inversely associated with age (SC: IRR=0.99[0.98-0.99]; MVPA: OR=0.93[0.92-0.95]), BMI (SC: IRR=0.97[0.96-0.98]; MVPA: OR=0.93[0.91-0.96]), and pain interference score (SC: IRR=0.99[0.98-0.995]; MVPA: OR=0.94[0.91-0.98]). Odds of MVPA>=5 minutes were additionally inversely associated with fear-avoidance beliefs about physical activity (FABQ-PA) (OR=0.95[0.92-0.98]). Activity levels were not significantly associated with pain intensity, sleep disturbance, anxiety, depression, self-efficacy, positive outlook, pain acceptance, pain catastrophizing, education level, or financial stress.

Conclusions: Physical activity in adults with cLBP is multifaceted. Older age, female sex, higher BMI, and unemployment were associated with lower activity. While higher pain interference scores and FABQ-PA were associated with lower activity, there was not a significant relationship between pain intensity and activity.