Association of Activity with the Risk of Developing Neck and Low Back Pain in the All of Us Research Program

Introduction: Daily physical activity is recommended to prevent chronic disease, but its benefits and optimal targets remain unclear. In spine surgery, research tracking patient activity primarily focuses on surgical outcomes, leaving a gap in understanding physical activity as a risk factor for chronic spine conditions. This study uses All of Us Research Program (AoURP) data to investigate the association between physical activity and spinal pain development.

Methods: Adults participants who shared both their Fitbit and electronic health record (EHR) data and had at least 6 months of Fitbit usage were included. Daily step counts and three levels of activity intensity (light, moderate, and vigorous) were analyzed using time-dependent Cox proportional hazard models to examine associations between physical activity and incident neck or back pain. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated adjusting for age, sex, and BMI. Outcomes were identified using Concept ID codes for neck and back pain.

Results: Of 8,419 participants (median age 51.1 [IQR 25.3], 72% female) with Fitbit and EHR data, 419 developed low back pain and 92 developed neck pain. Higher overall physical activity, including mean daily steps, was associated with reduced risk of both low back (HR 0.82 [0.71-0.94]) and neck pain (HR 0.48 [0.34-0.68]). Higher activity intensity also reduced risk. For low back pain, HRs for light, fair, and vigorous activity were 1.00 [0.92-1.10], 0.94 [0.86-1.04], and 0.80 [0.72-0.93], respectively. For neck pain, HRs were 0.76 [0.57-1.01], 0.70 [0.53-0.94], and 0.43 [0.28-0.66]. Increasing age and BMI were linked to higher low back pain risk, while black race was protective.

Conclusion : We found that increased physical activity, particularly at higher intensity levels, is associated with a reduced risk of both low back and neck pain. These results highlight the potential benefits of promoting physical activity as a preventive measure for spinal pain.