Walking can prevent low back pain, a new study shows
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Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly 70% of people who recover from an episode of low back pain will experience a new episode in the following year.
The recurrent nature of low back pain is a major contributor to the enormous burden low back pain places on individuals and the health-care system.
In our new study, published today in The Lancet, we found that a program combining walking and education can effectively reduce the recurrence of low back pain.
The WalkBack trial
We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control).
Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences.
The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls.
The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program.
Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred.
People in the control group received no preventative treatment or education. This reflects what typically occurs after people recover from an episode of low back pain and are discharged from care.
What the results showed
We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services.
The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%.
Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group.
Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group.
This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings.
Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians.
Walking has multiple benefits
We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all previous studies have focused on treating episodes of pain, not preventing future back pain.
A limited number of small studies have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals.
On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care.
Walking also delivers many other health benefits, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases.
While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants reported that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently.
Why is walking helpful for low back pain?
We don’t know exactly why walking is effective for preventing back pain, but possible reasons could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which block pain signals between your body and brain – essentially turning down the dial on pain.
It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, no studies have investigated this.
Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.
Tash Pocovi, Postdoctoral research fellow, Department of Health Sciences, Macquarie University; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Mark Hancock, Professor of Physiotherapy, Macquarie University; Petra Graham, Associate Professor, School of Mathematical and Physical Sciences, Macquarie University, and Simon French, Professor of Musculoskeletal Disorders, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What Melatonin Does To Your DNA
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Spoiler: it’s good
What dreams may come, when we have shuffled off this deoxyribonucleic coil,
…must indeed give us pause!
Researchers (Dr. Umaimah Zanif et al.) did a randomized, placebo-controlled trial of 40 night-shift workers tested whether taking 3mg of melatonin daily for 4 weeks before daytime sleep (because: night-shift workers) could improve the body’s ability to repair oxidative DNA damage.
Why Dr. Zanif and her team investigated melatonin: melatonin normally rises at night and helps regulate sleep and circadian rhythms, but overnight work suppresses melatonin production, which can reduce the body’s capacity to repair oxidative DNA damage, and could be one mechanism linking long-term night-shift work to a higher cancer risk.
Quick note about the participants: all workers had performed at least two consecutive night shifts per week for at least 6 months, with shifts lasting at least 7 hours, and none had sleep disorders or major chronic illnesses.
Of course, that’s not to say it’s only night workers who are affected—it’s relevant for anyone with disrupted sleep. But night workers make for a clear, consistent demographic in which to study these matters.
You may be wondering how DNA repair was measured: the team measured urinary 8-hydroxy-2′-deoxyguanosine (8-OH-dG), a marker of oxidative DNA damage repair capacity, with higher levels interpreted as greater DNA repair activity.
The results, in numbers:
- Main finding: during daytime sleep after night-shift work, the melatonin group showed approximately 1.8 times higher urinary 8-OH-dG levels than the placebo group, suggesting improved oxidative DNA repair capacity.
- Statistical analysis: the increase was described as borderline statistically significant, with a 95% confidence interval of 1.0 to 3.2 and a p-value of 0.06.
- One more thing: no significant difference between groups was observed during the subsequent overnight work period, suggesting the benefit occurred specifically during sleep rather than throughout the entire day.
In other words, restoring melatonin signaling can counter some of the biological stress caused by circadian disruption in general and night work as a top-tier example of that.
You can read the paper in full, here: Melatonin supplementation and oxidative DNA damage repair capacity among night shift workers: a randomised placebo-controlled trial
We’ve also written a bit about melatonin before, including:
Want more options?
Some sleep aids can help, but many are harmful and/or do not really work as such; here’s a rundown of examples of those: Safe Effective Sleep Aids For Seniors?
Want to learn more?
For a much more in-depth treatment of the topic of sleep in general, you might like this book that we reviewed a while back:
Why We Sleep – by Dr Matthew Walker
Basically, if you will read only one book on sleep, that’s the book.
Sweet dreams!
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A Therapeutic Journey – by Alain de Botton
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We’ve often featured The School of Life’s videos here on 10almonds, and most of those are written by (and often voiced by) Alain de Botton.
This book lays out the case for mental health being also just health, that no person is perfectly healthy all the time, and sometimes we all need a little help. While he does suggest seeking help from reliable outside sources, he also tells a lot about how we can improve things for ourselves along the way, whether by what we can control in our environment, or just what’s between our ears.
In the category of limitations, the book is written with the assumption that you are in a position to have access to a therapist of your choice, and in a sufficiently safe and stable life situation that there is a limit to how bad things can get.
The style is… Alain de Botton’s usual style. Well-written, clear, decisive, instructive, compassionate, insightful, thought-provoking.
Bottom line: this isn’t a book for absolutely everyone, but if your problems are moderate and your resources are comfortable, then this book has a lot of insights that can make your life more easy-going and joyful, without dropping the seriousness when appropriate.
Click here to check out A Therapeutic Journey, and perhaps begin one of your own!
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Struggle to Get Up? The Strength Many People Lose First (Not Your Legs)
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Dr. Alyssa Kuhn, arthritis expert, explains:
Pressing on
For most people, getting up off the floor relies heavily on upper-body pushing strength (chest, triceps, and shoulders), not just your legs.
Ideally, you will be able to get up without using your hands at all (see the “learn more” section below for several ways of doing that) as being able to do so is a good predictor of healthy longevity. However, if you’re not able to comfortably do that all the time, it pays to be able to get up “by any means necessary”.
So, with this in mind, here’s how to be strong enough in upper-body pushing movements, starting with the easiest exercise and building up to the harder exercises:
- Wall push-ups: stand an arm’s length from a wall and bring your forehead towards it, then press away while keeping your body in a straight line and your elbows close.
- Counter push-ups: use a stable surface like a kitchen counter, bring your chest all the way down, then push back up with control while maintaining a straight body and full range of motion.
- Floor push-ups: hold a plank position with your hands under your shoulders, lower your chest fully, then press up while keeping your hips aligned and your elbows close.
Note that this is a good place to leave your ego aside, especially if you’re a man (men being broadly expected to have upper body strength). There are a lot of people who cannot really do a single good form push-up, but they will balk at the idea of doing easier versions, which they see as being beneath them. To this we say… Nobody’s watching. Train in secret if you like. It’s fine. Just start with what you can do, and work up. You’ll find the progress comes quickly with a progressive approach. However, if you do nothing because full push-ups are too hard and the others are “too easy”, then of course you’ll never progress.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
- 4 Tips To Stand Without Using Hands
- How To Stand Up From The Floor Without Kneeling (3 Simple Methods)
- How To Get Out Of Any Low Chair Without Help
Take care!
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The Connection Cure – by Julia Hotz
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You may recognize some of the things in the subtitle as being notable elements of the Blue Zones supercentenarians’ lifestyles, but this book looks at numerous quite diverse countries, and people from many walks of life.
What they have in common—and this is mostly a very person-centered book, relying a lot on case studies, with additional references coming from wider sociological data—is social prescribing.
What is social prescribing? That’s what the author (a journalist by general profession) answers comprehensively here, and it’s about looking at the ways medical problems can often have nonmedical solutions. It doesn’t necessarily mean that walking will cure your cancer or art will cure your diabetes, but it does mean that very often a key part of an unhealthy lifestyle is fundamentally something that can be fixed by one or more of: movement, nature, art, service, and belonging.
She looks at social prescribing in its birthplace (the UK, where cheap solutions that are nevertheless evidence-based are very much prioritized), in big countries like Canada and Australia, in aging countries like Singapore and South Korea, and yes, also in the #1 country of pill prescribing, the US.
The structure of the book is interesting, we first have 5 person-centered chapters addressing each of the social prescribing aspects and how they helped in two example case studies for each one, then 5 country-by-country epidemiological chapters looking at the big picture, then 5 person-centered chapters again, this time looking at personalizing social prescribing for oneself (this section of the book being headed “Social Prescribing For You And Me”), looking at what is going on in one’s life and health, which of the 5 elements might be missing, and what tangible goal-oriented benefits can—according to the evidence—be obtained by tending to what one actually needs in terms of social prescribing.
The style is narrative and journalistic, with very little hard science, but very little that’s wishy-washy either. It is, in short, a pleasant and informative read that helps the reader really understand social prescribing, the better to implement it in our own lives.
Bottom line: if you like having extra nonmedical approaches to avoid or alleviate medical problems, then this book will really help you achieve that.
Click here to check out The Connection Cure, and get social prescribing!
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Acid Reflux After Meals? Here’s How To Stop It Naturally
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Harvard-trained gastroenterologist Dr. Saurabh Sethi advises:
Calming it down
First of all, what it actually is and how it happens: acid reflux occurs when the lower esophageal sphincter (LES) doesn’t close properly, allowing stomach acid to flow back into the esophagus. Chronic acid reflux is known as gastroesophageal reflux disease (GERD). Symptoms can include heartburn, an acid taste in the mouth, belching, bloating, sore throat, and a persistent cough—but most people do not get all of the symptoms, usually just some.
Things that help it acutely (as in, you can do them today and they will help today): consider skipping certain foods/substances like peppermint, tomatoes, chocolate, alcohol, and caffeine, which can worsen acid reflux. Eating smaller, more frequent meals instead of large ones and leaving a gap of 3–4 hours before lying down after meals can also help manage symptoms.
Things that can help it chronically (as in, you do them in an ongoing fashion and they will help in an ongoing fashion): lifestyle changes like quitting smoking, reducing alcohol intake, and wearing loose clothing can strengthen the LES. Maintaining a healthy weight and avoiding large meals, especially close to bedtime, can also reduce symptoms. Elevating the upper body while sleeping (using a wedge pillow or raising the bed by 10–20°) can make a big difference.
Medications to avoid, if possible, include: aspirin, ibuprofen, and calcium channel blockers.
Some drinks you can enjoy that will help: drinking water can quickly dilute stomach acid and provide relief. Herbal teas like basil tea, fennel tea, and ginger tea are also effective. But notably: not peppermint tea! Since, as mentioned earlier, peppermint is a known trigger for acid reflux (despite peppermint’s usual digestion-improving properties).
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Coughing/Wheezing After Dinner? Here’s How To Fix It ← this is about acid reflux and more
Take care!
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Blood Glucose & Your Brain
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Two facts worth considering:
- Your brain runs on glucose, and if there’s not enough, it won’t work well
- Blood sugar levels are definitely something where it’s entirely possible to have too much of a good thing
This much is not too tricky to reconcile.
After all, your car might run on gasoline, but filling the tank to overflowing and dowsing your car in it will not improve its performance, to put it mildly.
So, when it comes to blood glucose and the brain, where does the danger zone lie? When does it stop being a “extra fuel” and start being “we dowsed it in fuel and now it’s a burning wreck”?
It’s about the big picture
Recently, researchers (Dr. Lina Jin et al.) analyzed neuroimaging, metabolomic, and genetic data from the UK Biobank and found that higher blood glucose levels were strongly associated with faster brain aging.
How much data is that, you ask?
The best-performing model was applied to 37,458 UK Biobank participants to calculate the brain age gap (BAG), which measures how much older or younger a person’s brain is (according to epigenetic clocks) compared with their chronological age:
❝Using 1,079 imaging-derived phenotypes (IDPs) from 4,333 healthy participants, we trained and validated machine learning models for brain age prediction, with a least absolute shrinkage and selection operator (LASSO) regression model achieving the best performance (mean absolute error = 3.26 years, R² = 0.68). Brain age gap (BAG) was then estimated in 37,458 participants. Association analyses in 21,780 individuals identified nine plasma metabolites significantly linked to BAG after Bonferroni correction, with glucose showing the strongest effect (β = 0.32, P = 9.90 × 10⁻¹²).❞
And as for how much this matters: the brain usually shrinks after your 30s or 40s, but accelerated brain aging is linked to earlier memory loss, cognitive decline, and a higher risk of neurological, psychiatric, and neurodegenerative disorders.
In fewer words: higher blood glucose levels were associated with an increased risk of all-cause dementia, Alzheimer’s disease, vascular dementia, Parkinson’s disease, stroke, depression, and anxiety.
And in particular, higher glucose concentrations were linked to poorer cognitive performance, reduced movement function, and worse mental health outcomes.
Structurally, the study saw consistent results too: elevated blood glucose was associated with smaller brain volumes across 80 cortical, subcortical, and cerebellar regions, indicating widespread structural changes rather than effects confined to a few brain areas. That’s a lot, and there are not many worse things you can do in this regard (if you do want ideas for doing worse, though, options include Don’t Shrink Your Brain With This Habit and How Does Alcohol Cause Blackouts?).
The effects of chronically elevated blood sugar levels are thus also quite related to what we talked about in: The Surprising Place Fat Can Accumulate To Shrink Your Brain ← since that also pertained, ultimately, to metabolic mishaps.
As for what all this means in practical terms: all these findings strongly suggest (do not outright prove, because the study was associative, but it seems very clear) that glucose metabolism can be a modifiable pathway influencing brain aging, reinforcing the idea that maintaining healthy blood glucose levels can help preserve brain health and reduce the risk of age-related brain disorders.
If you’d like to read the paper in full for yourself, here it is: Metabolomic signatures of brain aging: A multimodal and genetic study
Want to learn more?
To learn more about how to most easily and effectively manage your blood sugar levels, do swing by these previous main features of ours:
- Improve Your Insulin Sensitivity!
- 10 Ways To Balance Blood Sugars
- Eating For Energy (In Ways That Actually Work)
- Glycemic Index vs Glycemic Load vs Insulin Index
- Which Sugars Are Healthier, And Which Are Just The Same?
And to learn much more deeply about this, check out this excellent book that we reviewed:
Why We Get Sick – by Dr. Benjamin Bikman ← this is about insulin resistance, and, importantly, the invisible insulin resistance that precedes blood sugar imbalances by many years (it goes unnoticed because the pancreas will dutifully keep cranking out more and more insulin to keep the blood sugars stable, until one day it just can’t keep up anymore, and then and only then does prediabetes get diagnosed).
Take care!
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