• Anita B Amorim, Gavin M Levy, Francisco Pérez-Riquelme, Milena Simic, Evangelos Pappas, Amabile B Dario, Manuela L Ferreira, Eduvigis Carrillo, Alejandro Luque-Suarez, Juan R Ordoñana, and Paulo H Ferreira.
• Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: abar3926@uni.sydney.edu.au.
• Spine J. 2017 Jul 1; 17 (7): 933-942.

BackgroundThe relationship between sedentary lifestyle and low back pain (LBP) remains unclear and previous research has not accounted for genetic and early environmental factors.PurposeOur aim was to investigate if sedentary behavior is associated with the lifetime prevalence of persistent LBP and the risk of developing persistent LBP, care-seeking due to LBP, and activity limiting LBP when genetics and early environmental factors are accounted for.Study DesignBoth cross-sectional and longitudinal designs with a within-pair twin case-control were implemented.Patient SampleThere were 2,148 twins included in the cross-sectional analysis whereas 1,098 twins free of persistent LBP at baseline were included in the longitudinal analysis.Outcome MeasuresSedentary behavior was the explanatory variable. Lifetime prevalence of LBP was the outcome variable in the cross-sectional analysis. The incidence of persistent LBP, care-seeking due to LBP, and activity limiting LBP were the outcome variables for the longitudinal analysis.MethodsThis observational study was supported by a grant in 2012. No competing interests were declared.ResultsIn the cross-sectional analysis, sedentary behavior was slightly associated with an increased prevalence of persistent LBP in females but not in males. This association was not apparent when genetics and early environmental factors were accounted for. We acknowledge that the small sample included in the co-twin analyses have yielded wide confidence intervals, and that caution should be exercised when interpreting and an association may not be ruled out. In the longitudinal analysis, sedentary behavior did not significantly increase the risk of persistent LBP, care-seeking due to LBP, or activity limiting LBP.ConclusionsSedentary behavior is associated with concurrent LBP. However, this association is weak; it only appears in females and decreases when accounting for genetics. Future studies using a twin design with larger samples should be conducted to further test these findings.Copyright © 2017 Elsevier Inc. All rights reserved.

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