Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis

VUORI, ILKKA M.

doi:10.1097/00005768-200106001-00026

Cited by 307Physical Activity and HealthMusculoskeletal pain and rehabilitationLower Extremity Biomechanics and Pathologies

Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis

VUORI, ILKKA M.·2001·Medicine and Science in Sports and Exercise

DOI 10.1097/00005768-200106001-00026

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Abstract

PURPOSE: The purpose of this study was to examine the evidence for causal relationships between physical activity (PA) and low back pain (LBP), osteoarthritis (OA), and osteoporosis (OP), and for dose-response relations involved. METHODS: Computer database searches and personal retrieval systems were used to locate relevant literature. RESULTS: PA can be effective in preventing LBP (Category A) but prolonged, heavy loading can lead to LBP (Category C). Specific exercises have not been found effective in treatment of acute LBP (Category A), but PA can be effective in chronic LBP (Category B), especially for diminishing the effects of deconditioning. No evidence indicates that PA directly prevents OA. Large amounts of intensive PA involving high impacts or torsional loadings or causing injuries increases risk of OA (Category C). Light or moderate PA does not increase the risk of OA (Category C). PA can be effective in the treatment and rehabilitation of OA (Category B). High-intensity loading is osteogenic and possibly useful in prevention of OP (Category A) at the loaded site, but low to moderate loading is not osteogenic (Category D). Static efforts and slow movements are ineffective or less effective than fast application of force (Category B). The types of PA to attain the effects mentioned above are known except in the case of prevention of LBP, but dose-response relationships are poorly known; at best, semiquantitatively on the basis of just a few studies. CONCLUSION: Given the shown primary and/or secondary preventative effectiveness of PA regarding LBP, OA, and OP, research to elucidate the inadequately known dose-response relations should be given high priority.

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Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association
(2007) · Circulation · doi:10.1161/circulationaha.107.185649 · Cited by 6,545 · see citing works
Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity)
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Physical Activity and Bone Health
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Updating the evidence that physical activity is good for health: an epidemiological review 2000–2003
Bauman, A. E. (2004) · Journal of Science and Medicine in Sport · doi:10.1016/s1440-2440(04)80273-1 · Cited by 768 · see citing works
Physical activity and older adults: a review of health benefits and the effectiveness of interventions
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Effects of the DASH Diet Alone and in Combination With Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women With High Blood Pressure
Blumenthal, J. A. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.470 · Cited by 592 · see citing works
Chapter 2 European guidelines for prevention in low back pain
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Exercise comes of age: rationale and recommendations for a geriatric exercise prescription
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Physical activity and low back pain: A U-shaped relation?
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Physical activity and low back pain: a systematic review of recent literature
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Exercise and chronic low back pain: what works?
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Measuring the full economic costs of diet, physical activity and obesity‐related chronic diseases
Popkin, B. M., Kim, S., Rusev, E. R., Du, S., & Zizza, C. A. (2006) · Obesity Reviews · doi:10.1111/j.1467-789x.2006.00230.x · Cited by 299 · see citing works
STRESS, FATIGUE, HEALTH, AND RISK OF ROAD TRAFFIC ACCIDENTS AMONG PROFESSIONAL DRIVERS: The Contribution of Physical Inactivity
Taylor, A. H., & Dorn, L. (2005) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.27.021405.102117 · Cited by 285 · see citing works
Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS)
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Prevalence of Back Pain in Sports: A Systematic Review of the Literature
Trompeter, K., Fett, D., & Platen, P. (2016) · Sports Medicine · doi:10.1007/s40279-016-0645-3 · Cited by 250 · see citing works
Benefits of 2 Years of Intense Exercise on Bone Density, Physical Fitness, and Blood Lipids in Early Postmenopausal Osteopenic Women
KEMMLER, W. K., Lauber, D., Weineck, J., Hensen, J., Kalender, W. A., & Engelke, K. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.10.1084 · Cited by 245 · see citing works
Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease
Thompson, P. D. (2003) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.0000087143.33998.f2 · Cited by 232 · see citing works
Exercise interventions for cancer patients: systematic review of controlled trials
Stevinson, C. D., Lawlor, D. A., & Fox, K. R. (2004) · Cancer Causes & Control · doi:10.1007/s10552-004-1325-4 · Cited by 199 · see citing works
Exercise and nonspecific low back pain: A literature review
Henchoz, Y., & Kai-Lik So, A. (2008) · Joint Bone Spine · doi:10.1016/j.jbspin.2008.03.003 · Cited by 170 · see citing works
Smartphone app in self-management of chronic low back pain: a randomized controlled trial
Chhabra, H. S., Sharma, S., & Verma, S. (2018) · European Spine Journal · doi:10.1007/s00586-018-5788-5 · Cited by 166 · see citing works
Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women
KEMMLER, W. K. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.499 · Cited by 161 · see citing works
Associations between different types of physical activity and teachers’ perceived mental, physical, and work-related health
Bogaert, I., De Martelaer, K., Deforche, B., Clarys, P., & Zinzen, E. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-534 · Cited by 157 · see citing works
Evidence-based risk assessment and recommendations for physical activity clearance: Consensus Document 2011<sup>1</sup>This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.
Warburton, D. E. R., Gledhill, N., Jamnik, V. K., Bredin, S. S. D., McKenzie, D. C., Stone, J., Charlesworth, S., & Shephard, R. J. (2011) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/h11-062 · Cited by 156 · see citing works
Back pain in elite sports: A cross-sectional study on 1114 athletes
Fett, D., Trompeter, K., & Platen, P. (2017) · PLoS ONE · doi:10.1371/journal.pone.0180130 · Cited by 151 · see citing works
Exercise maintains bone density at spine and hip EFOPS: a 3-year longitudinal study in early postmenopausal women
Engelke, K., Kemmler, W., Lauber, D., Beeskow, C., Pintag, R., & Kalender, W. A. (2006) · Osteoporosis International · doi:10.1007/s00198-005-1938-9 · Cited by 148 · see citing works
Walking ability during daily life in patients with osteoarthritis of the knee or the hip and lumbar spinal stenosis: a cross sectional study
Winter, C., Brandes, M., Müller, C., Schubert, T., Ringling, M., Hillmann, A., Rosenbaum, D., & Schulte, T. L. (2010) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-11-233 · Cited by 141 · see citing works
Muscle training for bone strength
Suominen, H. (2006) · Aging Clinical and Experimental Research · doi:10.1007/bf03327422 · Cited by 139 · see citing works
Sedentary Lifestyle and Nonspecific Low Back Pain in Medical Personnel in North-East Poland
Citko, A., Górski, S., Marcinowicz, L., & Górska, A. (2018) · BioMed Research International · doi:10.1155/2018/1965807 · Cited by 137 · see citing works
Musculoskeletal disorder prevalence and psychosocial risk exposures by age and gender in a cohort of office based employees in two academic institutions
Collins, J. D., & O'Sullivan, L. W. (2015) · International Journal of Industrial Ergonomics · doi:10.1016/j.ergon.2014.12.013 · Cited by 126 · see citing works
Perioperative exercise training in elderly subjects
Jack, S., West, M. A., & Grocott, M. P. W. (2011) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2011.07.003 · Cited by 123 · see citing works
Exercise and aging
Singh, M. A. F. (2004) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2004.03.003 · Cited by 119 · see citing works
Progressive High-Intensity Resistance Training and Bone Mineral Density Changes Among Premenopausal Women
James, M. M., & Carroll, S. (2006) · Sports Medicine · doi:10.2165/00007256-200636080-00005 · Cited by 108 · see citing works
Testing a model of physical activity and obesity tracking from youth to adulthood: the cardiovascular risk in young Finns study
Yang, X., Telama, R., Leskinen, E., Mansikkaniemi, K., Viikari, J. S. A., & Raitakari, O. T. (2006) · International Journal of Obesity · doi:10.1038/sj.ijo.0803459 · Cited by 107 · see citing works
Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study
Morken, T., Magerøy, N., & Moen, B. E. (2007) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-8-56 · Cited by 104 · see citing works
Resistance Training as a Tool for Preventing and Treating Musculoskeletal Disorders
Ciolac, E. G., & da Silva, J. M. R. (2016) · Sports Medicine · doi:10.1007/s40279-016-0507-z · Cited by 97 · see citing works
Muscle energy technique for non-specific low-back pain
Franke, H., Fryer, G., Ostelo, R., & Kamper, S. J. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009852.pub2 · Cited by 95 · see citing works
Workplace stress, lifestyle and social factors as correlates of back pain: a representative study of the German working population
Schneider, S. O., Schmitt, H., Zoller, S., & Schiltenwolf, M. (2005) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-004-0576-4 · Cited by 93 · see citing works
Comparison of a high-intensity and a low-intensity lumbar extensor training program as minimal intervention treatment in low back pain: a randomized trial
Helmhout, P. H., Harts, C. C., Staal, J. B., Candel, M. J. J. M., & de Bie, R. A. (2004) · European Spine Journal · doi:10.1007/s00586-004-0671-y · Cited by 93 · see citing works
Beneficios de la actividad física y riesgos del sedentarismo
Cenarruzabeitia, J. J. V., Hernández, J. A. M., & Martínez‐González, M. Á. (2003) · Medicina Clínica · doi:10.1016/s0025-7753(03)74054-8 · Cited by 91 · see citing works
Correlates of time spent walking and cycling to and from work: baseline results from the commuting and health in Cambridge study
Panter, J., Griffin, S. J., Jones, A., Mackett, R. L., & Ogilvie, D. (2011) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/1479-5868-8-124 · Cited by 90 · see citing works
Building healthy bones throughout life: an evidence‐informed strategy to prevent osteoporosis in Australia
Ebeling, P. R., Daly, R. M., Kerr, D. A., & Kimlin, M. G. (2013) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2013.tb04225.x · Cited by 89 · see citing works
Exercise, Manual Therapy, and Education with or Without High-Intensity Deep-Water Running for Nonspecific Chronic Low Back Pain
Cuesta‐Vargas, A., García-Romero, J., Arroyo‐Morales, M., Diego-Acosta, Á. M., & Daly, D. J. (2011) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e31821a71d0 · Cited by 89 · see citing works
A Study of Exercise Modality and Physical Self-esteem in Breast Cancer Survivors
Musanti, R. M. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31822cb5f2 · Cited by 88 · see citing works
Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass
Liu-Ambrose, T. Y. L., Khan, K. M., Eng, J. J., Lord, S. R., Lentle, B. C., & McKay, H. A. (2005) · Osteoporosis International · doi:10.1007/s00198-005-1842-3 · Cited by 86 · see citing works
Acute Effects of 2 Hours of Moderate-Intensity Cycling on Serum Parathyroid Hormone and Calcium
Barry, D. W., & Kohrt, W. M. (2007) · Calcified Tissue International · doi:10.1007/s00223-007-9028-y · Cited by 82 · see citing works
The effect of physical activity in leisure time on neck and upper limb symptoms
van den Heuvel, S. G., Heinrich, J., Jans, M. P., van der Beek, A. J., & Bongers, P. M. (2004) · Preventive Medicine · doi:10.1016/j.ypmed.2004.11.006 · Cited by 82 · see citing works
Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease
Thompson, P. D., Büchner, D. M., Piña, I. L., Balady, G. J., Williams, M. A., Marcus, B. H., Berra, K. A., Blair, S. N., Costa, F., Franklin, B. A., et al. (2003) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.0000089628.63625.d4 · Cited by 81 · see citing works
Preventing chronic back pain: Evaluation of a theory-based cognitive-behavioural training programme for patients with subacute back pain
Göhner, W., & Schlicht, W. M. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2005.11.018 · Cited by 72 · see citing works
The Medical College of Georgia FitKid Project: the relations between program attendance and changes in outcomes in year 1
Yin, Z., Moore, J. B., Johnson, M. H., Barbeau, P., Cavnar, M. M., Thornburg, J., & Gutin, B. (2005) · International Journal of Obesity · doi:10.1038/sj.ijo.0803061 · Cited by 69 · see citing works
Exercise Decreases the Risk of Metabolic Syndrome in Elderly Females
KEMMLER, W. K., von Stengel, S., Engelke, K., & Kalender, W. A. (2009) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31818844b7 · Cited by 68 · see citing works
Effects of exercise on functional aerobic capacity in lower limb osteoarthritis: A systematic review
Escalante, Y., García‐Hermoso, A., & Saavedra, J. M. (2010) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2010.10.004 · Cited by 68 · see citing works
Tai Chi Improves Physical Function in Older Chinese Women With Knee Osteoarthritis
Ni, G., Song, L., Yu, B., Huang, C., & Lin, J. (2010) · JCR Journal of Clinical Rheumatology · doi:10.1097/rhu.0b013e3181cf344f · Cited by 68 · see citing works
Retracted
Predicting the transition from acute to persistent low back pain
Melloh, M., Elfering, A., Presland, C. E., Roder, C., Hendrick, P. A., Darlow, B. J. S., & Theis, J. C. (2011) · Occupational Medicine · doi:10.1093/occmed/kqq194 · Cited by 61 · see citing works
Physical activity of Estonian family doctors and their counselling for a healthy lifestyle: a cross-sectional study
Suija, K., Pechter, Ü., Maaroos, J., Kalda, R., Rätsep, A., Oona, M., & Maaroos, H. (2010) · BMC Family Practice · doi:10.1186/1471-2296-11-48 · Cited by 58 · see citing works
Bundesärztekammer Kassenärztliche Bundesvereinigung Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften
VersorgungsLeitlinie, N. (2011) · Cited by 58 · see citing works
Physical Exercise Interventions to Improve Disability and Return to Work in Low Back Pain: Current Insights and Opportunities for Improvement
Staal, J. B., Rainville, J., Fritz, J. M., van Mechelen, W., & Pransky, G. (2005) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-005-8030-3 · Cited by 57 · see citing works
Long-Term Leisure Time Physical Activity and Properties of Bone: A Twin Study
Ma, H., Leskinen, T., Alén, M., Cheng, S., Sipilä, S., Heinonen, A. O., Kaprio, J. A., Suominen, H., & Kujala, U. M. (2009) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.090309 · Cited by 56 · see citing works
Effectiveness of a home exercise programme in low back pain: a randomized five‐year follow‐up study
Kuukkanen, T., Mälkiä, E., Kautiainen, H., & Pohjolainen, T. (2007) · Physiotherapy Research International · doi:10.1002/pri.378 · Cited by 56 · see citing works
Self-reported domain-specific and accelerometer-based physical activity and sedentary behaviour in relation to psychological distress among an urban Asian population
Chu, A. H. Y., van Dam, R. M., Biddle, S., Tan, C. S., Koh, D. S. Q., & Müller‐Riemenschneider, F. (2018) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-018-0669-1 · Cited by 55 · see citing works
Occupational health problems and injuries among Quebec's physical educators
Lemoyne, J., Laurencelle, L., Lirette, M., & Trudeau, F. (2006) · Applied Ergonomics · doi:10.1016/j.apergo.2006.06.004 · Cited by 55 · see citing works
Physical activity of depressed patients and their motivation to exercise: Nordic Walking in family practice
Suija, K., Pechter, Ü., Kalda, R., Tähepõld, H., Maaroos, J., & Maaroos, H. (2009) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0b013e32831e44ef · Cited by 54 · see citing works
Exercise and the Preservation of Bone Health
Barry, D. W., & Kohrt, W. M. (2008) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/01.hcr.0000320065.50976.7c · Cited by 53 · see citing works
Predicting physical activity and general health perception among patients with rheumatoid arthritis.
Eurenius, E., Brodin, N., Lindblad, S., & Opava, C. H. (2007) · PubMed · Cited by 53 · see citing works
Exercise and Osteoporosis-Related Fractures: Perspectives and Recommendations of the Sports and Exercise Scientist
KEMMLER, W. K., & von Stengel, S. (2011) · The Physician and Sportsmedicine · doi:10.3810/psm.2011.02.1872 · Cited by 48 · see citing works
Physical inactivity is a cause and physical activity is a remedy for major public health problems
VUORI, I. M. (2004) · University of Zagreb University Computing Centre (SRCE) · Cited by 47 · see citing works
Self-citation
Healthy aging: health promotion and disease prevention
TOPP, R. V., FAHLMAN, M. M., & Boardley, D. (2004) · Nursing Clinics of North America · doi:10.1016/j.cnur.2004.01.007 · Cited by 47 · see citing works
the American College of Sports Medicine and the American Heart Association Physical Activity and Public Health. Updated Recommendation for Adults From
Bauman, A. E., Franklin, B. A., Macera, C. A., Heath, G. W., Thompson, P. D., Haskell, W. L., Lee, I.-M. M., Pate, R. R., Powell, K. E., & Blair, S. N. (2007) · Cited by 46 · see citing works
Musculoskeletal Fitness: The Keystone in Overall Well-Being and Injury Prevention
Hunt, A. P. (2003) · Clinical Orthopaedics and Related Research · doi:10.1097/01.blo.0000057787.10364.4e · Cited by 46 · see citing works
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Authors: VUORI, I. M.
Affiliations: Urho Kaleva Kekkonen Institute (FI)
Corresponding author: VUORI, ILKKA M.
ORCID: VUORI, ILKKA M.
Venue: Medicine and Science in Sports and Exercise
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2001-06
Volume: 33
Issue: Supplement
Pages: S551-S586
ISSN: 0195-9131 (ISSN-L)
DOI: 10.1097/00005768-200106001-00026
OpenAlex: W2007560309
Cited by: 306
References: 268
Citations by year: 2026: 2 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 10 · 2021: 14 · 2020: 8 · 2019: 9 · 2018: 19 · 2017: 9 · 2016: 16 · 2015: 13 · 2014: 15 · 2013: 8 · 2012: 11
FWCI: 1.79
Type: journal article
Language: en
Open access: closed
Locations: Medicine & Science in Sports & Exercise (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Keywords: physical activity, low back pain, osteoarthritis, osteoporosis, dose-response relationship, exercise therapy, chronic low back pain, high-impact loading, musculoskeletal injuries, prevention, rehabilitation
MeSH terms: Adult, Aged, Exercise Therapy, Female, Humans, Male, Middle Aged, Osteoarthritis, Osteoporosis, Physical Fitness, Preventive Medicine, Exercise, Low Back Pain

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Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis

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