Körperliche Inaktivität und Rückenschmerz

 

 Buy Article Permissions and Reprints

Zusammenfassung

Körperliche Inaktivität ist ein unabhängiger Risikofaktor für erhöhte kardiovaskuläre Mortalität, begünstigt das Entstehen diverser Krebserkrankungen und gilt auch als Risikofaktor für die Entwicklung von chronischen Schmerzen. Langanhaltende körperliche Inaktivität führt zu einem Abbau der Kraft und der (Rücken-)Muskulatur. Schwache Rückenmuskulatur ist aber nur ein Faktor, der zur Entstehung von lumbalen Rückenschmerzen (Low Back Pain, LBP) beitragen kann, da viele biopsychosoziale Faktoren dabei eine Rolle spielen.

Regelmäßiges Training und körperliche Aktivität reduzieren zwar das Risiko, einschränkenden LBP zu erfahren, aber ein Therapieerfolg wird bei LBP nicht vorrangig durch eine Verbesserung physischer Faktoren erreicht. Vielmehr spielen andere Einflussfaktoren, wie ein reduziertes Angstvermeidungsverhalten und bessere schmerzbezogene Selbstwirksamkeit, ebenso eine wichtige Rolle im Genesungsprozess.

Das Ziel dieses Artikels ist es, den Zusammenhang von körperlicher (In-)Aktivität und Rückenschmerzen darzustellen und die Risiken eines eindimensionalen, biomedizinischen Verständnisses, unabhängig von der Profession, zu diskutieren.

Abstract

Physical inactivity is an independent risk factor for increased cardio-vascular mortality, promotes the emergence of various cancers and is also regarded as a risk factor for the development of chronic pain. Long lasting physical inactivity leads to a loss in strength and (back) muscles. However, weak back muscles are only one element that may contribute to the emergence of low back pain (LBP), since many bio-psycho-social factors play a role here.

While regular training and physical activity do reduce the risk of experiencing restricting LBP, successful LBP therapy is not primarily the result of improving physical factors. The influence of other factors, such as reduced fear avoidance behaviors and improved pain-related self-efficacy, is just as important for the recovery process.

It is the aim of this article to show the connection between physical (in-)activity and back pain – and to discuss the inherent risks of a one-dimensional biomedical understanding, regardless of profession.

Publication History

Received: 07 November 2022

Accepted: 07 December 2022

Article published online:
07 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• Literatur

• 1 World Health Organization (WHO). Global status report on physical activity 2022. Geneva (Licence: CC BY-NC-SA 3.0 IGO). Im Internet: https://apps.who.int/iris/handle/10665/363607; Stand: 12.12.2022
• 2 Bull FC, Al-Ansari SS, Biddle S. et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. BR J Sports Med 2020; 54: 1451-1462 DOI: 10.1136/bjsports-2020-102955.
  CrossrefPubMedGoogle Scholar
• 3 Hallal PC, Andersen LB, Bull FC. et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 380: 247-257 DOI: 10.1016/S0140-6736(12)60646-1.
  CrossrefPubMedGoogle Scholar
• 4 Haskell W, Blair SN, Hill JO. Physical activity: health outcomes and importance for public health policy. Prev Med 2009; 49: 280-282 DOI: 10.1016/j.ypmed.2009.05.002.
  CrossrefPubMedGoogle Scholar
• 5 Moholdt T, Skarpsno ES, Moe B. et al. It is never too late to start: adherence to physical activity recommendations for 11-22 years and risk of all-cause and cardiovascular disease mortality. The HUNT Study. Br J Sports Med 2020; DOI: 10.1136/bjsports-2020-102350.
  CrossrefPubMedGoogle Scholar
• 6 Han M, Qie R, Shi X. et al. Cardiorespiratory fitness and mortality from all causes, cardiovascular disease and cancer: dose-response meta-analysis of cohort studies. Br J Sports Med 2022; 56: 733-739 DOI: 10.1136/bjsports-2021-104876.
  CrossrefPubMedGoogle Scholar
• 7 Minihan AK, Patel AV, Flanders WD. et al. Proportion of Cancer Cases Attributable to Physical Inactivity by US State, 2013-2016. Med Sci Sports Exerc 2022; 54: 417-423 DOI: 10.1249/MSS.0000000000002801.
  CrossrefPubMedGoogle Scholar
• 8 Dixon-Suen SC, Lewis SJ, Martin RM. et al. Physical activity, sedentary time and breast cancer risk: a Mendelian randomisation study. Br J Sports Med 2022; 56: 1157-1170 DOI: 10.1136/bjsports-2021-105132.
  CrossrefPubMedGoogle Scholar
• 9 Friedenreich CM, Ryder-Burbidge C, McNeil J. Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms. Mol Oncol 2021; 15: 790-800 DOI: 10.1002/1878-0261.12772.
  CrossrefPubMedGoogle Scholar
• 10 Katzmarzyk PT, Friedenreich CM, Shiroma EJ. et al. Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries. Br J Sports Med 2022; 56: 101-106 DOI: 10.1136/bjsports-2020-103640.
  CrossrefPubMedGoogle Scholar
• 11 Chow LS, Gerszten RE, Taylor JM. et al. Exerkines in health, resilience and disease. Nat Rev Endocrinol 2022; 18: 273-289 DOI: 10.1038/s41574-022-00641-2.
  CrossrefPubMedGoogle Scholar
• 12 Laube W. Sensomotorik und Schmerz. Wechselwirkungen von Bewegungsreizen und Schmerzempfinden. Berlin, Heidelberg: Springer; 2020
  CrossrefGoogle Scholar
• 13 Verbunt JA, Seelen HA, Vlaeyen JW. et al. Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. Eur J Pain 2003; 7: 9-21 DOI: 10.1016/s1090-3801(02)00071-x.
  CrossrefPubMedGoogle Scholar
• 14 Koop MA, Lutke Schipholt IJ, Scholten-Peeters GGM. et al. Identifying the most important confounders when assessing the association between low-grade systemic inflammation and musculoskeletal pain: A modified Delphi study. Pain Med 2021; 22: 2661-2669 DOI: 10.1093/pm/pnab243.
  CrossrefPubMedGoogle Scholar
• 15 Robinson WH, Lepus CM, Wang Q. et al. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol 2016; 12: 580-592 DOI: 10.1038/nrrheum.2016.136.
  CrossrefPubMedGoogle Scholar
• 16 Bloomfield SA. Changes in musculoskeletal structure and function with prolonged bed rest. Med Sci Sports Exerc 1997; 29: 197-206 DOI: 10.1097/00005768-199702000-00006.
  CrossrefPubMedGoogle Scholar
• 17 Di Girolamo FG, Fiotti N, Milanović Z. et al. The Aging Muscle in Experimental Bed Rest: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8: 633987 DOI: 10.3389/fnut.2021.633987.
  CrossrefPubMedGoogle Scholar
• 18 Alley DE, Koster A, Mackey D. et al. Hospitalization and change in body composition and strength in a population-based cohort of older persons. J Am Geriatr Soc 2010; 58: 2085-2091 DOI: 10.1111/j.1532-5415.2010.03144.x.
  CrossrefPubMedGoogle Scholar
• 19 Welch C, Hassan-Smith ZK, Greig CA. et al. Acute Sarcopenia Secondary to Hospitalisation – An Emerging Condition Affecting Older Adults. Aging Dis 2018; 9: 151-164 DOI: 10.14336/AD.2017.0315.
  CrossrefPubMedGoogle Scholar
• 20 Inouye SK, Bogardus ST, Baker DI. et al. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc 2000; 48: 1697-1706 DOI: 10.1111/j.1532-5415.2000.tb03885.x.
  CrossrefPubMedGoogle Scholar
• 21 Zisberg A, Shadmi E, Sinoff G. et al. Low mobility during hospitalization and functional decline in older adults. J Am Geriatr Soc 2011; 59: 266-273 DOI: 10.1111/j.1532-5415.2010.03276.x.
  CrossrefPubMedGoogle Scholar
• 22 Teichtahl AJ, Urquhart DM, Wang Y. et al. Physical inactivity is associated with narrower lumbar intervertebral discs, high fat content of paraspinal muscles and low back pain and disability. Arthritis Res Ther 2015; 17: 114 DOI: 10.1186/s13075-015-0629-y.
  CrossrefPubMedGoogle Scholar
• 23 Verbunt JA, Smeets RJ, Wittink HM. Cause or effect? Deconditioning and chronic low back pain. Pain 2010; 149: 428-430 DOI: 10.1016/j.pain.2010.01.020.
  CrossrefPubMedGoogle Scholar
• 24 Parreira P, Maher CG, Steffens D. et al. Risk factors for low back pain and sciatica: an umbrella review. Spine J 2018; 18: 1715-1721 DOI: 10.1016/j.spinee.2018.05.018.
  CrossrefPubMedGoogle Scholar
• 25 Macedo LG, Battié MC. The association between occupational loading and spine degeneration on imaging – a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20: 489 DOI: 10.1186/s12891-019-2835-2.
  CrossrefPubMedGoogle Scholar
• 26 Vallance JK, Gardiner PA, Lynch BM. et al. Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking?. Am J Public Health 2018; 108: 1478-1482 DOI: 10.2105/AJPH.2018.304649.
  CrossrefPubMedGoogle Scholar
• 27 Chen S-M, Liu M-F, Cook J. et al. Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health 2009; 82: 797-806 DOI: 10.1007/s00420-009-0410-0.
  CrossrefPubMedGoogle Scholar
• 28 Alzahrani H, Alshehri MA, Alzhrani M. et al. The association between sedentary behavior and low back pain in adults: A systematic review and meta-analysis of longitudinal studies. PeerJ 2022; 10: e13127 DOI: 10.7717/peerj.13127.
  CrossrefPubMedGoogle Scholar
• 29 Foster NE, Anema JR, Cherkin D. et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018; 391: 2368-2383 DOI: 10.1016/S0140-6736(18)30489-6.
  CrossrefPubMedGoogle Scholar
• 30 Wittink H, Hoskins Michel T, Wagner A. et al. Deconditioning in patients with chronic low back pain: fact or fiction?. Spine (Phila Pa 1976) 2000; 25: 2221-2228 DOI: 10.1097/00007632-200009010-00013.
  CrossrefPubMedGoogle Scholar
• 31 Hamberg-van Reenen HH, Ariëns GAM, Blatter BM. et al. A systematic review of the relation between physical capacity and future low back and neck/shoulder pain. Pain 2007; 130: 93-107 DOI: 10.1016/j.pain.2006.11.004.
  CrossrefPubMedGoogle Scholar
• 32 Wilson F, Ardern CL, Hartvigsen J. et al. Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis. Br J Sports Med 2020; DOI: 10.1136/bjsports-2020-102537.
  CrossrefPubMedGoogle Scholar
• 33 Pinto SM, Cheung JPY, Samartzis D. et al. Are Morphometric and Biomechanical Characteristics of Lumbar Multifidus Related to Pain Intensity or Disability in People With Chronic Low Back Pain After Considering Psychological Factors or Insomnia. Front Psychiatry 2022; 13: 809891 DOI: 10.3389/fpsyt.2022.809891.
  CrossrefPubMedGoogle Scholar
• 34 Ranger TA, Cicuttini FM, Jensen TS. et al. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J 2017; 17: 1729-1748 DOI: 10.1016/j.spinee.2017.07.002.
  CrossrefPubMedGoogle Scholar
• 35 Seyedhoseinpoor T, Taghipour M, Dadgoo M. et al. Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Spine J 2022; 22: 660-676 DOI: 10.1016/j.spinee.2021.10.018.
  CrossrefPubMedGoogle Scholar
• 36 Goubert D, van Oosterwijck J, Meeus M. et al. Structural Changes of Lumbar Muscles in Non-specific Low Back Pain: A Systematic Review. Pain Physician 2016; 19: E985-E1000
  PubMedGoogle Scholar
• 37 Saragiotto BT, Maher CG, Yamato TP. et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev 2016; CD012004 DOI: 10.1002/14651858.CD012004.
  CrossrefPubMedGoogle Scholar
• 38 Pourahmadi M, Delavari S, Hayden JA. et al. Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials. Br J Sports Med 2022; DOI: 10.1136/bjsports-2021-104926.
  CrossrefPubMedGoogle Scholar
• 39 Alzahrani H, Mackey M, Stamatakis E. et al. The association between physical activity and low back pain: a systematic review and meta-analysis of observational studies. Sci Rep 2019; 9: 8244 DOI: 10.1038/s41598-019-44664-8.
  CrossrefPubMedGoogle Scholar
• 40 Steffens D, Maher CG, Pereira LSM. et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med 2016; 176: 199-208 DOI: 10.1001/jamainternmed.2015.7431.
  CrossrefPubMedGoogle Scholar
• 41 de Campos TF, Maher CG, Fuller JT. et al. Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis. Br J Sports Med 2021; 55: 468-476 DOI: 10.1136/bjsports-2019-101436.
  CrossrefPubMedGoogle Scholar
• 42 Fancourt D, Steptoe A.. Physical and Psychosocial Factors in the Prevention of Chronic Pain in Older Age. J Pain 2018; 19: 1385-1391 DOI: 10.1016/j.jpain.2018.06.001.
  CrossrefPubMedGoogle Scholar
• 43 Manderlier A, de Fooz M, Patris S. et al. Modifiable lifestyle-related prognostic factors for the onset of chronic spinal pain: A systematic review of longitudinal studies. Ann Phys Rehabil Med 2022; 65: 101660 DOI: 10.1016/j.rehab.2022.101660.
  CrossrefPubMedGoogle Scholar
• 44 Dansie EJ, Turk DC, Martin KR. et al. Association of chronic widespread pain with objectively measured physical activity in adults: findings from the National Health and Nutrition Examination survey. J Pain 2014; 15: 507-515 DOI: 10.1016/j.jpain.2014.01.489.
  CrossrefPubMedGoogle Scholar
• 45 Coenen P, Huysmans MA, Holtermann A. et al. Do highly physically active workers die early? A systematic review with meta-analysis of data from 193 696 participants. Pr J sports Med 2018; 52: 1320-1326 DOI: 10.1136/bjsports-2017-098540.
  CrossrefPubMedGoogle Scholar
• 46 Feinberg JB, Møller A, Siersma V. et al. Physical activity paradox: could inflammation be a key factor?. Br J Sports Med 2022; DOI: 10.1136/bjsports-2022-105429.
  CrossrefPubMedGoogle Scholar
• 47 Holtermann A, Hansen JV, Burr H. et al. The health paradox of occupational and leisure-time physical activity. Br J Sports Med 2012; 46: 291-295 DOI: 10.1136/bjsm.2010.079582.
  CrossrefPubMedGoogle Scholar
• 48 Cheng W, Zhang Z, Cheng W. et al. Associations of leisure-time physical activity with cardiovascular mortality: A systematic review and meta-analysis of 44 prospective cohort studies. Eur J Prev Cardiol 2018; 25: 1864-1872 DOI: 10.1177/2047487318795194.
  CrossrefPubMedGoogle Scholar
• 49 Li J, Loerbroks A, Angerer P.. Physical activity and risk of cardiovascular disease: what does the new epidemiological evidence show?. Curr Opin Cardiol 2013; 28: 575-583 DOI: 10.1097/HCO.0b013e328364289c.
  CrossrefPubMedGoogle Scholar
• 50 Hayden JA, Ellis J, Ogilvie R. et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev 2021; CD009790 DOI: 10.1002/14651858.CD009790.pub2.
  CrossrefPubMedGoogle Scholar
• 51 Kamper SJ, Apeldoorn AT, Chiarotto A. et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015; 350: h444 DOI: 10.1136/bmj.h444.
  CrossrefPubMedGoogle Scholar
• 52 Booth J, Moseley GL, Schiltenwolf M. et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care 2017; 15: 413-421 DOI: 10.1002/msc.1191.
  CrossrefPubMedGoogle Scholar
• 53 Steiger F, Wirth B, de Bruin E. et al. Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review. Eur Spine J 2012; 21: 575-598 DOI: 10.1007/s00586-011-2045-6.
  CrossrefPubMedGoogle Scholar
• 54 Mannion AF, Caporaso F, Pulkovski N. et al. Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function. Eur spine J 2012; 21: 1301-1310 DOI: 10.1007/s00586-012-2155-9.
  CrossrefPubMedGoogle Scholar
• 55 Lee H, Hübscher M, Moseley GL. et al. How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain 2015; 156: 988-997 DOI: 10.1097/j.pain.0000000000000146.
  CrossrefPubMedGoogle Scholar
• 56 Costa Lda C, Maher CG, McAuley JH. et al. Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. Eur J Pain 2011; 15: 213-219 DOI: 10.1016/j.ejpain.2010.06.014.
  CrossrefPubMedGoogle Scholar
• 57 Woby SR, Urmston M, Watson PJ.. Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients. IEur J Pain 2007; 11: 711-718 DOI: 10.1016/j.ejpain.2006.10.009.
  CrossrefPubMedGoogle Scholar
• 58 Bialosky JE, Beneciuk JM, Bishop MD. et al. Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther 2018; 48: 8-18 DOI: 10.2519/jospt.2018.7476.
  CrossrefPubMedGoogle Scholar
• 59 Burns JW.. Mechanisms, mechanisms, mechanisms: it really does all boil down to mechanisms. Pain 2016; 157: 2393-2394 DOI: 10.1097/j.pain.0000000000000696.
  CrossrefPubMedGoogle Scholar
• 60 Corrêa LA, Mathieson S, Meziat-Filho NAM. et al. Which psychosocial factors are related to severe pain and functional limitation in patients with low back pain. Braz J Phys Ther 2022; 26: 100413 DOI: 10.1016/j.bjpt.2022.100413.
  CrossrefPubMedGoogle Scholar
• 61 Vlaeyen JWS, Crombez G, Linton SJ.. The fear-avoidance model of pain. Pain 2016; 157: 1588-1589 DOI: 10.1097/j.pain.0000000000000574.
  CrossrefPubMedGoogle Scholar
• 62 Vlaeyen JWS, Linton SJ.. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 2012; 153: 1144-1147 DOI: 10.1016/j.pain.2011.12.009.
  CrossrefPubMedGoogle Scholar
• 63 Stenberg G, Fjellman-Wiklund A, Ahlgren C.. 'I am afraid to make the damage worse'--fear of engaging in physical activity among patients with neck or back pain--a gender perspective. Scand J Caring Sci 2014; 28: 146-154 DOI: 10.1111/scs.12043.
  CrossrefPubMedGoogle Scholar
• 64 Bunzli S, Smith A, Schütze R. et al. Making Sense of Low Back Pain and Pain-Related Fear. J Orthop Sports Phys Ther 2017; 47: 628-636 DOI: 10.2519/jospt.2017.7434.
  CrossrefPubMedGoogle Scholar
• 65 Jay K, Thorsen SV, Sundstrup E. et al. Fear Avoidance Beliefs and Risk of Long-Term Sickness Absence: Prospective Cohort Study among Workers with Musculoskeletal Pain. Pain Res Treat 2018; 2018: 8347120 DOI: 10.1155/2018/8347120.
  CrossrefPubMedGoogle Scholar
• 66 Hoegh M.. Pain Science in Practice: What Is Pain Neuroscience? Part 1. J Orthop Sports Phys Ther 2022; 52: 163-165 DOI: 10.2519/jospt.2022.10995.
  CrossrefPubMedGoogle Scholar
• 67 Pincus T, Holt N, Vogel S. et al. Cognitive and affective reassurance and patient outcomes in primary care: a systematic review. Pain 2013; 154: 2407-2416 DOI: 10.1016/j.pain.2013.07.019.
  CrossrefPubMedGoogle Scholar
• 68 Pincus T, McCracken LM.. Psychological factors and treatment opportunities in low back pain. Best Pract Res Clin Rheumatol 2013; 27: 625-635 DOI: 10.1016/j.berh.2013.09.010.
  CrossrefPubMedGoogle Scholar
• 69 Moseley GL.. Reconceptualising pain according to modern pain science. Physical Therapy Reviews 2007; 12: 169-178 DOI: 10.1179/108331907X223010.
  CrossrefGoogle Scholar
• 70 Linton SJ, Buer N, Vlaeyen J. et al. Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study. Psyhol Health 2000; 14: 1051-1059 DOI: 10.1080/08870440008407366.
  CrossrefPubMedGoogle Scholar
• 71 Smith JA, Russo L, Santayana N. et al. Fear Avoidance Predicts Persistent Pain in Young Adults With Low Back Pain: A Prospective Study. J Orthop Sports Phys Ther 2021; 51: 1-27 DOI: 10.2519/jospt.2021.9828.
  CrossrefPubMedGoogle Scholar
• 72 Labrenz F, Woud ML, Elsenbruch S. et al. The Good, the Bad, and the Ugly-Chances, Challenges, and Clinical Implications of Avoidance Research in Psychosomatic Medicine. Front Psychiatry 2022; 13: 841734 DOI: 10.3389/fpsyt.2022.841734.
  CrossrefPubMedGoogle Scholar
• 73 Glogan E, Meulders M, Pfeiffer L. et al. Alike, But Not Quite: Comparing the Generalization of Pain-Related Fear and Pain-Related Avoidance. J Pain 2022; 23: 1616-1628 DOI: 10.1016/j.jpain.2022.04.010.
  CrossrefPubMedGoogle Scholar
• 74 Nolan D, O'Sullivan K, Newton C. et al. Are there differences in lifting technique between those with and without low back pain? A systematic review. Scand J Pain 2020; 20: 215-227 DOI: 10.1515/sjpain-2019-0089.
  CrossrefPubMedGoogle Scholar
• 75 Karayannis NV, Smeets RJEM, van den Hoorn W. et al. Fear of Movement Is Related to Trunk Stiffness in Low Back Pain. PLoS One 2013; 8: e67779 DOI: 10.1371/journal.pone.0067779.
  CrossrefPubMedGoogle Scholar
• 76 Balasch-Bernat M, Willems T, Danneels L. et al. Differences in myoelectric activity of the lumbar muscles between recurrent and chronic low back pain: a cross-sectional study. BMC Musculoskelet Disord 2021; 22: 756 DOI: 10.1186/s12891-021-04623-9.
  CrossrefPubMedGoogle Scholar
• 77 Wernli K, Smith A, Coll F. et al. From protection to non-protection: A mixed methods study investigating movement, posture and recovery from disabling low back pain. Eur J Pain 2022; 26: 2097-2119 DOI: 10.1002/ejp.2022.
  CrossrefPubMedGoogle Scholar
• 78 Gifford, Louis. Aches and Pains. First published 2014, reprinted 2015, 2016 (thrice). Falmouth: CNS Press; 2014
  Google Scholar
• 79 Hanel J, Owen PJ, Held S. et al. Effects of Exercise Training on Fear-Avoidance in Pain and Pain-Free Populations: Systematic Review and Meta-analysis. Sports Med 2020; 50: 2193-2207 DOI: 10.1007/s40279-020-01345-1.
  CrossrefPubMedGoogle Scholar
• 80 Kamonseki DH, Christenson P, Rezvanifar SC. et al. Effects of manual therapy on fear avoidance, kinesiophobia and pain catastrophizing in individuals with chronic musculoskeletal pain: Systematic review and meta-analysis. Musculoskelet Sci Pract 2021; 51: 102311 DOI: 10.1016/j.msksp.2020.102311.
  CrossrefPubMedGoogle Scholar
• 81 Matheve T, de Baets L, Bogaerts K. et al. Lumbar range of motion in chronic low back pain is predicted by task-specific, but not by general measures of pain-related fear. Eur J Pain 2019; 23: 1171-1184 DOI: 10.1002/ejp.1384.
  CrossrefPubMedGoogle Scholar
• 82 Crombez G, Eccleston C, Vlaeyen JWS. et al. Exposure to physical movement in low back pain patients: Restricted effects of generalization. Health Psychol 2002; 21: 573-578 DOI: 10.1037//0278-6133.21.6.573.
  CrossrefGoogle Scholar
• 83 Hedman-Lagerlöf M, Andersson E, Hedman-Lagerlöf E. et al. Approach as a key for success: Reduced avoidance behaviour mediates the effect of exposure therapy for fibromyalgia. Behav Res Ther 2019; 122: 103478 DOI: 10.1016/j.brat.2019.103478.
  CrossrefPubMedGoogle Scholar
• 84 Klaber Moffett JA, Carr J, Howarth E.. High fear-avoiders of physical activity benefit from an exercise program for patients with back pain. Spine (Phila Pa 1976) 2004; 29: 1167-72 discussion 1173 DOI: 10.1097/00007632-200406010-00002.
  CrossrefPubMedGoogle Scholar
• 85 Ferrari S, Chiarotto A, Pellizzer M. et al. Pain Self-Efficacy and Fear of Movement are Similarly Associated with Pain Intensity and Disability in Italian Patients with Chronic Low Back Pain. Pain Pract 2016; 16: 1040-1047 DOI: 10.1111/papr.12397.
  CrossrefPubMedGoogle Scholar
• 86 Smeets RJEM, Wade D, Hidding A. et al. The association of physical deconditioning and chronic low back pain: a hypothesis-oriented systematic review. Disabil Rehabil 2006; 28: 673-693 DOI: 10.1080/09638280500264782.
  CrossrefPubMedGoogle Scholar
• 87 Caneiro JP, Roos EM, Barton CJ. et al. Infographic. Roadmap to managing a person with musculoskeletal pain irrespective of body region. Br J Sports Med 2020; 54: 554-555 DOI: 10.1136/bjsports-2019-101681.
  CrossrefPubMedGoogle Scholar
• 88 George SZ, Wittmer VT, Fillingim RB. et al. Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain. J Orthop Sports Phys Ther 2010; 40: 694-704 DOI: 10.2519/jospt.2010.3396.
  CrossrefPubMedGoogle Scholar
• 89 Hutting N, Caneiro JP, Ong'wen OM. et al. Person-centered care for musculoskeletal pain: Putting principles into practice. Musculoskelet Sci Pract 2022; 62: 102663 DOI: 10.1016/j.msksp.2022.102663.
  CrossrefPubMedGoogle Scholar
• 90 Hanssen H, Boardman H, Deiseroth A. et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cadriol 2022; 29: 205-215 DOI: 10.1093/eurjpc/zwaa141.
  CrossrefPubMedGoogle Scholar
• 91 Pescatello LS, Wu Y, Gao S. et al. Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review. BMJ Open Sport Exerc Med 2021; 7: e000895 DOI: 10.1136/bmjsem-2020-000895.
  CrossrefPubMedGoogle Scholar
• 92 Williams B, Mancia G, Spiering W. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart 2018; 39: 3021-3104 DOI: 10.1093/eurheartj/ehy339.
  CrossrefPubMedGoogle Scholar
• 93 Nieman DC, Wentz LM.. The compelling link between physical activity and the body's defense system. J Sport Health Sci 2019; 8: 201-217 DOI: 10.1016/j.jshs.2018.09.009.
  CrossrefPubMedGoogle Scholar
• 94 Ezzatvar Y, Ramírez-Vélez R, Izquierdo M. et al. Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose-response meta-analysis of data from 1 853 610 adults. Br J Sports Med 2022; DOI: 10.1136/bjsports-2022-105733.
  CrossrefPubMedGoogle Scholar
• 95 Dishman RK, McDowell CP, Herring MP.. Customary physical activity and odds of depression: a systematic review and meta-analysis of 111 prospective cohort studies. Br J Sports Med 2021; 55: 926-934 DOI: 10.1136/bjsports-2020-103140.
  CrossrefPubMedGoogle Scholar
• 96 Bridle C, Spanjers K, Patel S. et al. Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2012; 201: 180-185 DOI: 10.1192/bjp.bp.111.095174.
  CrossrefPubMedGoogle Scholar
• 97 Cooney GM, Dwan K, Greig CA. et al. Exercise for depression. Cochrane Database Syst Rev 2013; 2013: CD004366 DOI: 10.1002/14651858.CD004366.pub6.
  CrossrefPubMedGoogle Scholar
• 98 Izquierdo M, Merchant RA, Morley JE. et al. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25: 824-853 DOI: 10.1007/s12603-021-1665-8.
  CrossrefPubMedGoogle Scholar
• 99 Recchia F, Leung CK, Chin EC. et al. Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials. Br J Sports Med 2022; 56: 1375-1380 DOI: 10.1136/bjsports-2022-105964.
  CrossrefPubMedGoogle Scholar
• 100 Kvam S, Kleppe CL, Nordhus IH. et al. Exercise as a treatment for depression: A meta-analysis. J Affect Disord 2016; 202: 67-86 DOI: 10.1016/j.jad.2016.03.063.
  CrossrefPubMedGoogle Scholar
• 101 Allen MD, Dalton BH, Gilmore KJ. et al. Neuroprotective effects of exercise on the aging human neuromuscular system. Exp Gerontol 2021; 152: 111465 DOI: 10.1016/j.exger.2021.111465.
  CrossrefPubMedGoogle Scholar
• 102 Iso-Markku P, Kujala UM, Knittle K. et al. Physical activity as a protective factor for dementia and Alzheimer's disease: systematic review, meta-analysis and quality assessment of cohort and case-control studies. Br J Sports Med 2022; 56: 701-709 DOI: 10.1136/bjsports-2021-104981.
  CrossrefPubMedGoogle Scholar
• 103 Kluding PM, Bareiss SK, Hastings M. et al. Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift. Phys Ther 2017; 97: 31-43 DOI: 10.2522/ptj.20160124.
  CrossrefPubMedGoogle Scholar
• 104 Thomas DE, Elliott EJ, Naughton GA.. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2006; 2006: CD002968 DOI: 10.1002/14651858.CD002968.pub2.
  CrossrefPubMedGoogle Scholar
• 105 Nolan D, O'Sullivan K, Stephenson J. et al. What do physiotherapists and manual handling advisors consider the safest lifting posture, and do back beliefs influence their choice?. Musculoskelet Sci Pract 2018; 33: 35-40 DOI: 10.1016/j.msksp.2017.10.010.
  CrossrefPubMedGoogle Scholar
• 106 Korakakis V, O'Sullivan K, O'Sullivan PB. et al. Physiotherapist perceptions of optimal sitting and standing posture. Musculoskelet Sci Pract 2019; 39: 24-31 DOI: 10.1016/j.msksp.2018.11.004.
  CrossrefPubMedGoogle Scholar
• 107 O'Sullivan K, O'Sullivan P, O'Sullivan L. et al. What do physiotherapists consider to be the best sitting spinal posture?. Man Ther 2012; 17: 432-437 DOI: 10.1016/j.math.2012.04.007.
  CrossrefPubMedGoogle Scholar
• 108 Krug RC, Silva MF, Lipp OV. et al. An investigation of implicit bias about bending and lifting. Scand J Pain 2021; 22: 336-347 DOI: 10.1515/sjpain-2021-0145.
  CrossrefPubMedGoogle Scholar
• 109 Rialet-Micoulau J, Lucas V, Demoulin C. et al. Misconceptions of physical therapists and medical doctors regarding the impact of lifting a light load on low back pain. Braz J Phys ther 2022; 26: 100385 DOI: 10.1016/j.bjpt.2021.100385.
  CrossrefPubMedGoogle Scholar
• 110 Slater D, Korakakis V, O'Sullivan P. et al. “Sit Up Straight”: Time to Re-evaluate. J Orthop Sports Phys ther 2019; 49: 562-564 DOI: 10.2519/jospt.2019.0610.
  CrossrefPubMedGoogle Scholar
• 111 Roffey DM, Wai EK, Bishop P. et al. Causal assessment of awkward occupational postures and low back pain: results of a systematic review. Spine J 2010; 10: 89-99 DOI: 10.1016/j.spinee.2009.09.003.
  CrossrefPubMedGoogle Scholar
• 112 Wai EK, Roffey DM, Bishop P. et al. Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J 2010; 10: 554-566 DOI: 10.1016/j.spinee.2010.03.033.
  CrossrefPubMedGoogle Scholar
• 113 Mawston G, Holder L, O'Sullivan P. et al. Flexed lumbar spine postures are associated with greater strength and efficiency than lordotic postures during a maximal lift in pain-free individuals. Gait Posture 2021; 86: 245-250 DOI: 10.1016/j.gaitpost.2021.02.029.
  CrossrefPubMedGoogle Scholar