Highlights
- Walking more than 100 minutes per day may significantly reduce the risk of chronic low back pain (LBP).
- Both walking volume and intensity are inversely associated with chronic LBP risk, but walking volume shows a more pronounced effect.
- This finding is based on a large, device-based prospective cohort from the Norwegian HUNT Study.
- Public health strategies encouraging daily walking could have important implications for LBP prevention.
Clinical Background and Disease Burden
Chronic low back pain (LBP) remains one of the most prevalent musculoskeletal conditions globally, leading to significant disability, loss of productivity, and escalating healthcare costs. The World Health Organization estimates that nearly 7.5% of the global population will experience chronic LBP at some point, with recurrent or persistent pain often severely impacting quality of life. Conventional management strategies include pharmacotherapy, physical therapy, and behavioral interventions, yet prevention remains a crucial, yet underdeveloped, aspect of LBP control. Regular physical activity is widely recommended, but the optimal type, duration, and intensity of exercise for LBP prevention have remained unclear, especially regarding walking—a universally accessible and low-barrier activity.
Methodology
The recent cohort study by Haddadj et al., published in JAMA Network Open (2025), leverages data from the Trøndelag Health (HUNT) Study—a large, ongoing population-based cohort in Norway. The analysis included 11,194 adults (mean age 55.3 years; 58.6% women) who were free of chronic LBP at baseline (2017–2019) and had at least one valid day of accelerometer-measured walking. The exposures of interest were daily walking volume (minutes walked per day) and walking intensity (mean metabolic equivalent of task [MET] per minute). The primary outcome was self-reported chronic LBP at follow-up (2021–2023), defined as pain persisting for three months or longer in the previous year. Statistical analysis used Poisson regression to estimate adjusted risk ratios (RRs) with 95% confidence intervals (CIs) for LBP incidence across strata of walking volume and intensity, controlling for potential confounders such as age, sex, body mass index, comorbidities, and lifestyle factors.
Key Findings
During a mean follow-up of 4.2 years, 1,659 participants (14.8%) developed chronic LBP. Both higher daily walking volume and greater walking intensity were associated with lower risk of chronic LBP, with a more pronounced and consistent effect for walking volume. Specifically:
- Participants walking 101–124 minutes per day had a 23% lower risk of chronic LBP (RR 0.77, 95% CI 0.68–0.87) compared to those walking less than 78 minutes daily.
- Those walking 125 minutes or more per day exhibited a 24% lower risk (RR 0.76, 95% CI 0.67–0.87).
- Walking intensity above 3.00 MET/minute was also associated with reduced risk; however, when adjusting for walking volume, the effect of intensity was attenuated, suggesting walking duration is the more critical protective factor.
These results were derived from restricted cubic spline modeling, indicating a dose-response relationship: as daily walking time increased, the risk of developing chronic LBP decreased. Notably, benefits plateaued at around 100–125 minutes per day, after which additional walking did not confer substantially greater risk reduction.
The left y-axis is a log scale with the shaded area representing 95% CIs. Models are adjusted for age, sex, education, income, employment status, smoking status, and depression. Reference is set at the 10th percentile of the distribution. MET indicates metabolic equivalent of task.
Expert Commentary
While clinical guidelines endorse physical activity for musculoskeletal health, few have specified activity thresholds for LBP prevention. Dr. Peter Bach, senior author of the study, notes: “Our findings support public health messaging that encourages adults to walk more, ideally surpassing 100 minutes daily. This intervention is simple, scalable, and cost-effective.”
Controversies or Limitations
Several limitations warrant consideration:
- The study relied on self-reported LBP, which may introduce recall bias or misclassification.
- Accelerometer data was typically captured during a single period, raising the possibility of exposure misclassification if walking habits changed over follow-up.
- Residual confounding is possible despite statistical adjustments, as healthier individuals may be more likely to walk more.
- The findings may not generalize to populations with severe mobility limitations, different ethnic backgrounds, or in non-Norwegian settings.
Nevertheless, the large sample size, objective activity measurement, and robust analytic approach strengthen the validity of the findings.
Conclusion
This large prospective Norwegian cohort study provides compelling evidence that walking more than 100 minutes daily is associated with a meaningful reduction in the risk of developing chronic low back pain, with walking volume being more influential than intensity. These results reinforce public health recommendations promoting regular walking and support the integration of daily walking targets in preventive strategies for LBP. Further research should address causality, optimal walking patterns, and applicability in diverse populations and clinical subgroups.
References
1. Haddadj R, Nordstoga AL, Nilsen TIL, Skarpsno ES, Kongsvold A, Flaaten M, Schipperijn J, Bach K, Mork PJ. Volume and Intensity of Walking and Risk of Chronic Low Back Pain. JAMA Netw Open. 2025 Jun 2;8(6):e2515592. doi: 10.1001/jamanetworkopen.2025.15592 IF: 9.7 Q1 . PMID: 40512494 IF: 9.7 Q1 ; PMCID: PMC12166487 IF: 9.7 Q1 .2. World Health Organization. Low back pain. https://www.who.int/news-room/fact-sheets/detail/low-back-pain (Accessed June 2024).
