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If you’ve ever had lower back pain, you know how debilitating it can be. And you’re not alone. According to the Centers for Disease Control and Prevention, back pain increases with age in 2019—from 28.4% among 18- to 29-year-olds to 45.6% among those 65 and older.Women suffer from back pain more often than men (40.6% versus 37.2%).

And back pain is expensive. According to a 2023 review in BMJ openedThe direct medical and indirect costs of back pain amount to at least $50 billion per year and over $100 billion in medical costs, lost wages, and lost productivity..

But a new study published on June 19, 2024 in The Lancet suggests that the recurrence of back pain could be prevented or at least delayed by simply walking. Let’s take a closer look.

How was this study conducted?

Participants were selected based on criteria related to back pain and current exercise status. They had to be at least 18 years old and have overcome an episode of non-specific back pain within the last 6 months. Non-specific means that there was no specific diagnosis for the back pain.

Researchers further defined an episode of nonspecific back pain as one that lasted at least 24 hours and had a pain intensity of at least 2 on a pain scale of 0 to 10. The pain had to be in the area between the 12th rib and the gluteal crease to be considered low back pain. It also had to have interfered with daily activities, including work.

To be eligible for the study, participants were not allowed to have exercised regularly before the study, as researchers were studying how exercise affected the frequency of back pain episodes. They were also not allowed to have a medical condition that prevented them from participating in a walking program.

After excluding those who were ineligible, 701 participants remained who were randomly assigned to one of two groups – the intervention group or the control group. The average age of the participants was 54 years and the majority of them – 81% – were female. Participants were followed for at least 12 months and up to 36 months, depending on when they entered the study.

Baseline data were collected from both groups, including the number of previous back pain episodes, the time since the last episode, the level of physical activity, the time spent sitting (sedentary behavior), mental health status (depression, anxiety), stress level and sleep quality.

In addition, sociodemographic information was also collected, including gender, age, BMI, education level, income level, current employment status, smoking habits and job duties – such as whether participants had to lift heavy loads or were placed in uncomfortable positions during physical work.

The control group received no education or training from the research team, but they were able to seek out treatment and prevention strategies themselves during the study period – and many did so in the form of physical therapy, massage and chiropractic care.

The intervention group received education about back pain as well as individualized exercise with one of 24 physical therapists. Each participant received a specifically tailored walking program based on their fitness level, abilities, and limitations. The physical therapists were also trained in health coaching methods to improve adherence to the program and coach participants more effectively on behavior change. There were six available sessions for participants to attend. While these sessions were originally scheduled to take place in person, the COVID pandemic occurred after the study began, so they had to be switched to telehealth sessions.

The educational portion of the program included information about back pain, current research on pain, and coaching to reduce fear of exercise. This was important because many people with back pain fear that exercise will worsen the pain and associated limitations.

Each participant in the intervention group also received a pedometer and a walking diary. For seven days during the minimum 12-month study period, they wore an accelerometer, which is similar to a pedometer but records all movements, not just walking.

All participants – both in the intervention group and the control group – had to complete monthly questionnaires to determine whether they had suffered from back pain again.

According to the 12-week walking diaries, the intervention group gradually increased to an average of 4 walking sessions per week for a total duration of 130 minutes. This is close to the recommended 150 minutes of moderate activity per week recommended in the 2018 Physical Activity Guidelines for Americans..

What did this study find?

The main outcome the researchers looked at was the number of days between the start of the study and the next occurrence of activity-limiting back pain. They wanted to know whether education, training, and targeted walking for exercise increased the number of days between episodes of back pain.

In the intervention group, the average number of days until recurrence of activity-limiting back pain was 208 days and in the control group 112 days.

The researchers concluded that the group that received a personalized, progressive walking program, education, and health coaching significantly reduced the recurrence of low back pain compared to the no-treatment control group. The intervention group also experienced a reduction in back pain-related disability (e.g., missed work, inability to perform normal daily activities) for up to 12 months. The researchers also state that the intervention was likely cost-effective when considering all factors, including lost work time and wages and medical costs due to back pain.

How does this apply to real life?

This study shows how walking alone can relieve back pain. Participants were not taught any strength training or stretching exercises for back pain. They were simply taught how to make walking a habit.

What we know about behavior change is that it takes consistent practice to form new habits. This study underscores this, as participants were followed for at least a year (remember, some were followed for up to three years if they entered the study early).

While you may have heard that it only takes 21 days to develop a new habit, research, such as a 2023 study in PNAS suggests that it depends on the complexity of the habit you want to acquireIn this study, it took several weeks to develop the habit of handwashing, while developing a new exercise habit can take several months—and that’s only if you’re committed and consistent about practicing the new habit.

The reason habit formation takes time is because it involves brain cells and neural pathways. Your habits are essentially well-worn, frequently used neural pathways in the brain. That’s why they’re habits—they’re the pathways your brain can use automatically. So when you try to create new habits, you’re battling with your brain for what it already knows and is comfortable with. So in order to create new pathways—and ultimately habits—the new behavior must be practiced consistently so that the brain cells connect with each other and form new pathways. This is pretty cool, and it’s called neuroplasticity (that’s my thing!).

For example, if you’re trying to develop a new exercise habit, the first step is to start where you are. Too often we try to start with the end goal in mind and quickly burn out. If you’re not currently exercising, start with fewer sessions per week and fewer minutes per session – even though that sounds like a very short period of time. Then gradually increase your time and frequency over several weeks. This can help your body adapt to the increased movement and reduce muscle soreness and risk of injury.

Simple habits like washing your hands can be combined with habits you already have. This habit is one you probably picked up as a child when you were reminded to wash your hands after using the bathroom. Boom – a new habit has been formed!

But more complex habits can also be combined. Going back to the exercise example, what if you combined a walk with lunch? So after lunch, you go for a 10-minute walk. Lunch is your trigger for a walk. Or combine brushing your teeth in the morning with a set of push-ups, squats, and planks. In this case, brushing your teeth is the trigger for some exercise—not necessarily at the same time, although I’ve been known to do squats, leg raises, heel raises, and push-ups on the kitchen counter while doing the dishes. It’s the same idea.

The conclusion

This study showed that regular walking for exercise helps increase the number of days between lower back pain episodes. It also highlights the importance of being consistent in practicing the behaviors you want to make a habit. Start slowly and gradually increase the number of days and time you spend developing new habits. Be patient and show some compassion to yourself. More complex habits like exercise can take months to form, so keep practicing consistently and soon it will be a permanent part of your lifestyle.