General Spine

Healthy lifestyle behavior and risk of long duration troublesome neck pain or low back pain among men and women: results from the Stockholm Public Health Cohort.

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Study Review

This Karolinska Institute of Stockholm study  utilized the Stockholm Public Health Cohort.  The Stockholm County Council established public health surveys of the Swedish population and has participants filled in baseline questions that addressed various aspects of health,  lifestyle and social outcomes.

The authors used data sets from respondents from 2006, between the ages of 18 and 84 years old, and reviewed followup questionnaires in 2010,  collecting 4 years of data.

The details of the study are in the article,  but two groups were established.

Group 1 (n= 12,483)  had participants who had no back pain in the past 6 months.  Group 2 (n=10,539) had participants who had no neck pain in the past 6 months.

Each of participant answered questions to determine whether they exhibited healthy lifestyle behavior in the categories of 1. physical activity 2. alcohol intake 3. diet  and 4.smoking.

Each lifestyle component was stratified into either a Healthy,  or not health category.

Healthy physical activity was defined as 150 minutes of moderate intensity physical activity a week,  or 75 minutes of high intensity physical activity a week.

Health Smoking status was defined as a person who does NOT smoke on a daily basis.

Healthy alcohol consumption was less than 168 grams of Pure alcohol a week for men.  Less than 108 grams of Pure alcohol for women.  As a reference,  a standard drink in the US is .6 ounces of alcohol, or 14 grams.   That is about 12 drinks a week for men, and 8 drinks a week for women.

Healthy diet was considered consuming 4 or more portions of fruits or vegetables a day.

Participants who reported three of four of these components in the healthy  category were stratified into the healthy lifestyle behavior (HLB) group.

Over the four year period of the review,  approximately 75% responded to the followup questionaire.

In terms of HLB,  each group had appoximately 31% of women and 25% of men with at least 3 healthy components.  Each group had approximately 11% women and 4% men with 4 healthy components.



In the initial no back pain group,  after 4 years,  men with 3 or 4 healthy behaviors had a .63 relative risk of low back pain compare to those with none or only one healthy behavior.   In others words,  about 1/3 less incidence of back pain for those with HLB compared to those with none or only one healthy behavior.

In the initial no neck pain group,  after 4 years,  women who had HLB had a .52 relative risk for neck pain compared to those with none or only one healthy behavior.  An almost 50% decrease of incidence of neck pain for the HLB group.



This is an epidemiologic study based on questionnaire surveys of a relatively homogeneous population of Sweden.  There are others do identify potential confounding variables, and acknowledge that this Information is based on review of surveys and not specific individual examination of subject.  Nevertheless, with large participation numbers, and reasonable follow-up Ratios,  the conclusions drawn have merit.

Further dissection of data do indicate Swedish Woman in general, Made healthier lifestyle choices than Men.  Interestingly, there is sex segregation of the effects of healthy life style behaviors, In terms of development of low back pain versus neck pain.

The conclusion supports medical professionals biases to promoting healthy lifestyles as a way to decrease incidences of spinal pain.  Unfortunately, at least in the Swedish population, the majority do not practice  healthy behaviors.

As a clinician, it is always good when the data is aligned with our recommendations to our patients.  It would be in the interest of public health to promote these healthy behaviors.   Long-term, the potential to reduce costly treatments for neck and back pain needs to be studied.  Instead of spending large resources to manage spine pain, we should consider spending justifiable resources to prevent the development of spine pain.





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