Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association

Reducing Daily Sitting Time By 40 Minutes May Help Prevent Worsening Back Pain

Back pain is a common experience that can be chronic and lead to challenges in living everyday life.

Researchers are interested in finding the most successful strategies to help people who experience back pain.

A recent study indicated that increasing daily activity could help keep back pain from getting worse, compared to continuing a sedentary lifestyle.

The results show that as little as 40 minutes of less sedentary time could improve back pain.

In the United States, back pain is a widespread problem. Someone's risk for back pain can increase if they are overweight, older, or have stress-related conditions. Experts want to understand what lifestyle interventions could be most effective for people with back pain.

A study published in BMJ Open explored how reducing sedentary behavior for simply an hour a day could help with back pain.

Over six months, participants who, on average, increased their moderate to vigorous activity by 20 minutes a day and decreased their sedentary behavior by 40 minutes a day saw less increase in back pain than the control group who continued their sedentary behavior.

The results highlight how simple changes in daily activities could likely help people who experience back pain.

Researchers of the current study wanted to understand more about the relationship between back pain, reducing sedentary behavior, insulin sensitivity, disability, and paraspinal muscle fat fraction. Fat in the paraspinal muscles and insulin resistance are both related to back pain.

The study was a secondary analysis of a randomized controlled trial. The trial involved 64 adults. All participants had a body mass index that indicated having obesity or overweight, and participants reported less than two hours of moderate to vigorous physical activity each week. Measured with accelerometers, participants were also sedentary for 10 hours or more or at least 60% of the accelerometer wear time. Participants also had metabolic syndrome, which put the group at an increased risk for diabetes and heart disease.

Researchers excluded participants who already had diabetes, consumed excessive alcohol, or used tobacco products.

Before starting the trial, researchers measured participants' physical activity and sedentary behavior using accelerometers for about one month. Researchers divided participants into a control and intervention group. The intervention lasted for six months.

The intervention group tried to decrease sedentary behavior by one hour each day. The control group continued with their normal lifestyle. On average, participants in the intervention group increased moderate to vigorous physical activity by 20 minutes a day and decreased their sedentary behavior by 40 minutes a day.

The researchers conducted PET and MRI scans on a subsample of forty-four participants to examine paraspinal muscle glucose uptake and fat fraction.

Overall, the intervention group did not see changes in back pain, while the control group saw a statistically significant increase in back pain.

The researchers also found an association between increased daily steps and better paraspinal muscle glucose uptake. Both groups saw an increase in pain-related disability, but there wasn't a significant difference in pain-related disability between the two groups.

The researchers did not find an association between changes in back pain intensity and changes in paraspinal muscle fat fraction, glucose uptake, physical activity, sedentary behavior, or pain-related disability.

The results add to evidence that even simple changes in activity could benefit people who experience back pain.

Study author, doctoral researcher, and physiotherapist Jooa Norha highlighted the following findings to Medical News Today:

"Back pain is a common and sometimes disabling complaint. Previous research has suggested that prolonged sitting might be a risk factor for back pain, but our study was among the first to actually investigate what happens if you start sitting less."

"And indeed, we did find that limiting your daily sitting time helps to prevent back pain. No single threshold for a 'safe' amount of sitting can be given for many reasons, but the main idea is to change your normal sitting habits for the better – be it reducing from 10 to eight hours per day or from eight to seven hours per day," he added.

Back pain remains a challenging problem that doctors and specialists address. The results point to how a simple intervention could improve outcomes in clinical practice and individuals' lives.

Medhat Mikhael, MD, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study, highlighted the following about back pain to Medical News Today:

"Back pain is very common, about 80-90% of people in the U.S. Will have back pain at some point during their life. Pain tends to increase with age and the statistics showed that the percentage would range from 28% for age 18-29, 35% among age 30-45, 45% among age 45-64 and 46% for those ages 65 and above. That is because of the progress of the degenerative disease, lack of exercise and physical activity plus developments of chronic diseases."

All people with back pain should work with doctors to develop individualized treatment plans. However, the study results add to evidence that increasing activity can be beneficial. Michael Wheeler, MD, an orthopedic spine surgeon with Texas Orthopaedic Associates, who was also not involved in the study, noted the following to MNT:

"For healthcare providers, the study suggests that recommending less sitting could help prevent worsening back pain, particularly in patients with mild symptoms. However, to achieve better results, reducing sitting should be combined with other strategies like increasing physical activity, strength training, and managing emotional responses."

"A well-rounded approach is key to addressing both pain and function. The body is designed to move, and by reducing sedentary time there will be additional health benefits beyond decreased back pain," he said.

This research does have limitations, such as the small size and relatively short time frame of the original trial. Future research could include more diversity, as the trial focused on Finnish participants. Researchers also did not pick the sample based on pain status, which could have decreased statistical power.

Some data that researchers relied on was self-reported by participants, and it is important to consider this with these sorts of studies. The researchers note that many participants in the control group were disappointed that they weren't in the intervention group, and the negative emotions could have impacted pain intensity. It's also possible that the benefits of increased physical activity could have played a role in the observed results.

Overall, the researchers acknowledge that participants' pain perceptions could have been affected by assignment to the control or intervention group. The trial also did not take into account pain history in its exclusion or inclusion criteria and only assessed pain and disability at baseline and at the end of the six months. The researchers also used some non-validated questions in back pain assessment, which could have affected the results.

The researchers acknowledge that they didn't apply specific back pain-related eligibility criteria. Also, since this current paper was a secondary analysis, the authors did not do power calculations for disability or back pain.

Norha noted the following areas for continued research:

"The participants in our study had mostly only mild pain in the beginning of the study. Future research should investigate whether reducing sitting time also helps individuals who have more severe pain. My hypothesis would be that individuals with moderate or severe pain would have to reduce their sitting by a bit more than 1 h/day and additionally include some more strenuous activities or strengthening exercises as well."

7 Reasons To Exercise Outdoors And How To Get Started

Outdoor exercise offers many upsides for mental and physical health. Here are several.

1. Outdoor Workouts May Reduce Stress and Anxiety

Have you ever noticed you feel better after spending time in nature? It's not just you. One study found that when young adults with obesity began walking in the park or gym, the park group felt less stress and more enjoyment than the gym group.

The reason is that walking in nature lowers levels of the stress hormone cortisol (as measured by salivary cortisol concentration) more than walking in an urban environment does, according to one study.

Those who walked in a green environment also reported improved stress levels and general mood, leading the researchers to conclude that being in nature has a therapeutic effect.

"Being in nature can leave individuals refreshed and rejuvenated because it gives them a sense of being away from the stress and demands of their 'normal' life,'" says Todd Buckingham, PhD, a visiting professor of exercise science at Grand Valley State University and an exercise physiologist at PTSportsPRO in Grand Rapids, Michigan.

2. Going Outside May Extend the Time Spent Exercising

An older study found that older adults spent significantly more time being physically active outdoors than indoors, as measured by self-reported survey data and an accelerometer (step counter) they wore for one week to track their physical activity.

"The enjoyment of a beautiful day or fresh air can cause us to lose track and spend more time working out than expected," Bernard explains.

3. Exercise Outdoors May Improve Sleep

Any exercise can help you sleep soundly. But taking it outdoors may amplify that benefit. "Daily exposure to natural light helps regulate sleep-wake cycles and your circadian rhythm," Dr. Buckingham says. "So exercising outdoors is better for your sleep than [either] exercising or spending time outdoors alone." But he adds, it's not yet known whether this improvement is significant.

4. Outdoor Workouts May Boost Vitamin D Levels

Vitamin D is a fat-soluble vitamin important for bone and immune health, muscle function, and brain activity. It's found in fatty fish, fish oils, and fortified dairy products, but your body also produces vitamin D (the "sunshine vitamin") when exposed to the sun. Exercising outdoors in the sunshine may help you get more vitamin D.

You still need to protect your skin from the sun when you go outside, which you can do by applying sunscreen. Sunscreen only slightly lowers vitamin D production.

5. Outdoor Exercise May Boost Self Esteem

Exercising in nature can improve self-esteem and lessen feelings of anger, tension, and depression. The researchers behind an older review found these mental health improvements come through after just five minutes of outdoor exercise.

6. Activity Outside May Improve Memory

A small study found outdoor exercise led to greater attention and memory benefits than indoor exercise. And it didn't take long to see benefits — all it took was a 15-minute outdoor walk.

The researchers behind the study suggest that these effects come from increases in blood flow to the brain's prefrontal cortex (the front portion of the frontal lobe that affects problem-solving and emotions).

Blood flow is boosted during exercise, which can help increase attention to the task at hand. In addition, outdoor natural environments prevent the brain from focusing on unimportant stimuli.

"The outdoors is known as a 'restorative environment' where people don't have to focus on a particular piece of information or have distractions that may take their focus and attention away," Buckingham says. "Therefore, it could allow us to recover from mental fatigue and help focus our attention."

7. Outdoor Workouts May Lower Chronic Disease Risk

A study found that adults who spent more time outdoors during the week engaged in more moderate to vigorous physical activity. More active adults also had a lower risk of chronic disease than those who were less active and spent more time indoors. The researchers say these findings are partially explained by activity levels. Still, more research is needed to explain how being outdoors may lower chronic disease risk.

Chronic Disease Report Reflects Unhealthy Habits Among Alaskans

The Providence Imaging Center's Mammography Mobile Unit is parked at Bartlett High School on May 18 at the start area for the all-female Gold Nugget Triathlon. The state Division of Public Health's annual chronic disease brief report says that, according to its most recent data, 40% of women 40 and older had failed to get mammograms within the recommended two-year interval. The report listed some other health shortcomings, including obesity and lack of regular exercise for a significant portion of the population. (Photo by Yereth Rosen/Alaska Beacon)

Seven out of 10 Alaska adults are overweight or obese, and large percentages of adults in the state have chronic conditions like high blood pressure and high cholesterol that are linked to the leading causes of death, according to a new report released by the state Department of Health.

The 2024 Alaska Chronic Disease Facts summary, published by the department's Division of Public Health, also showed that 33% of Alaska high school students were overweight or obese.

Large percentages of adults and teenagers are sedentary, according to the report. Among adults, 22% engaged in no regular physical activity, and among high school students, 82% failed to have the recommended 60 minutes of daily physical activity, the report said.

The report is based mostly on statistics from 2022, a year in which COVID-19 was the fourth-leading cause of death, after cancer, heart disease and unintentional injuries.

The annual chronic disease report does not show trends, though trends are monitored by the department in other reporting projects.

"It's really meant as a snapshot," said Andrea Fenaughty, a department public health scientist. Additionally, the report is meant to educate the public, she said. "Sometimes people don't really know what chronic disease is, so it's a way of getting that message out."

Along with obesity, common chronic conditions in Alaska listed in the report include high blood pressure, high cholesterol, arthritis and asthma. Chronic diseases to which they are linked — diseases that last for long periods — include heart disease, stroke, cancer, diabetes and liver disease.

In all, seven of the top 10 causes of death in Alaska are linked to chronic conditions, Fenaughty said.

While cancer is Alaska's leading cause of death, large percentages of Alaskans have missed the recommended screenings to detect the disease and treat it early.

Among women aged 40 and older, 40% had failed to get a mammogram in the prior two years. Among adults aged 50 to 75, 44% had failed to get recommended colorectal cancer screenings.

Cancer causes about a fifth of Alaska's deaths, the report said. The most common causes of cancer deaths in Alaska as of 2022 were lung cancer, colorectal cancer, pancreatic cancer and prostate cancer, the report said. The most commonly diagnosed cancers in Alaska, as of 2020, were breast cancer, lung cancer, prostate cancer and colorectal cancer, the report said. Those four cancers represent about half of Alaska's cancer cases, the report said.

Most of the statistics are similar to those in the chronic disease report issued by the division last year, which reflected data from 2021 and earlier.

However, there were a few signs of improvement.

Among high school students, the report said that 17% regularly use electronic cigarettes, also known as vapes, down from the 26% level in the previous report. Among adults without diabetes, 27% had not gotten the recommended blood-sugar tests within the prior three years, as recommended. That is significantly lower than the 54% who had missed those recommended tests in 2020, as reported in last year's chronic disease brief.

The report concludes with some recommendations, including for individuals to make lifestyle changes to ward off the chronic conditions linked to poor health and fatal diseases. To help people do that, the Division of Public Health has a program, Fresh Start, that provides guidance and coaching.

Reflecting Alaska's aging population, a new part of the Fresh Start program concerns dementia, Fenaughty said.

"Right now, it's largely focused on awareness of dementia and the fact that there are really lots of things you could do to reduce your chances of getting dementia. People don't often think of it as being preventable," she said.

Additionally, the Division of Public Health has a Play Every Day program that encourages fitness and healthy habits among youth.

The report also recommends some community actions and policies to help people pursue healthier lifestyles and habits. In sum, said the report: "Make the healthy choice the easier choice." Examples of helpful policies listed by the report are tobacco-free workplaces, easier access to safe places to walk and otherwise exercise, good physical education programs at schools and disease-prevention programs at workplaces.

Reducing chronic health problems through public policy is a long-term effort, Fenaughty said. She pointed to decades of tobacco-cessation policies that led to current smoking rates being much lower than they were in the past.

"It did take a couple of decades, and something like that involves all kinds of people at the community level, at the statewide level, all different partners," she said.

Originally published by the Alaska Beacon, an independent, nonpartisan news organization that covers Alaska state government.

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