100 Minutes a Day for Chronic Low Back Pain: What a Large Norwegian Study Shows

Walking is the most accessible form of activity, but how much does it really protect against chronic low back pain? A new study in JAMA Network Open on 11,194 adults in Norway provides a simple guide: the more you walk per day, the lower your risk – and a noticeable threshold appears at about 100 minutes. Those who spent more than 100 minutes on their feet daily had a 23% lower risk of chronic low back pain than those who walked less than 78 minutes. Step intensity is also important, but its contribution is lower than that of the overall “volume” of walking.

Background of the study

Chronic low back pain is one of the main causes of years of life lost with disability in the world and an “expensive” problem for healthcare systems: frequent exacerbations, loss of ability to work, comorbid anxiety/depression, polypharmacy. Most clinical guidelines agree that physical activity is better than rest, but there is less evidence of primary prevention (how to prevent the transition to chronic pain) than data on the treatment of existing symptoms. Especially when it comes to the most accessible type of activity, regular walking: how much is needed, is “long” or “faster” more important, is there a “threshold” of minutes per day - these questions have so far been answered mainly by small observational studies and questionnaires, vulnerable to memory errors and reverse causality (“I walk less because it already hurts”).

Hence the interest in large prospective cohorts with objective activity recording (accelerometers/trackers), where it is possible to separate the two key components of walking - volume (minutes per day) and intensity (average pace, METs) - and look at the dose-response relationship with the risk of chronic pain in the future for several years, adjusting for age, gender, smoking, mental health, education, etc. Walking is an ideal candidate for public health: it requires almost no equipment, is easily "broken down" into short episodes during the day and theoretically affects many links in the pathogenesis of low back pain - mechanical (moderate load as training of tissues and discs), metabolic (body weight, insulin resistance), inflammatory (myokines, anti-inflammatory effect of regular activity), neuropsychological (stress, sleep, mood). But without clear numbers and thresholds, it is difficult to turn general calls to "move more" into specific recommendations.

The work on the Norwegian sample addresses several methodological weaknesses of the past: it uses wearable sensors to measure walking at the start, clearly defines the outcome (self-report of chronic pain ≥3 months after years of observation), separates the contribution of volume and intensity, and constructs dose-response curves. Against this background, it is possible to discuss practically important things - whether there is a "reasonable lower limit" of daily walking, after which the risk is significantly reduced, and how significant is the increase in pace compared to the banal "walk longer".

What exactly did the scientists do?

• Design and sample. Prospective cohort study within the Trøndelag Health Study (HUNT, Norway): baseline activity assessment 2017–2019, pain survey 2021–2023. The analysis included 11,194 individuals without chronic low back pain at baseline (mean age 55.3 years; 58.6% women).
• How walking was measured. Wearable sensors were used to determine minutes of walking per day (volume) and average intensity (metabolic equivalents, METs/min). The primary outcome was self-reported chronic low back pain (≥3 months in the past year) at the follow-up visit.
• Statistics: Odds ratios (RR) were estimated in Poisson models with adjustments for age, sex, education, income, employment, smoking, and depression; dose-response splines were also constructed.

An important detail: the relationship was dose-dependent - up to a certain plateau. Compared with those who walked <78 min/day, the risk of chronic pain was lower at 78-100 min/day (RR 0.87), even lower at 101-124 min/day (RR 0.77) and ≥125 min/day (RR 0.76). That is, the “magic” of walking fast without minutes did not happen: the duration of walks mattered more than the pace.

What about the walking pace?

• Intensity was measured as average METs/min. Compared with <3.00 METs/min, the 3.00–3.11 and 3.12–3.26 groups showed RRs of 0.85 and 0.82, while ≥3.27 METs/min also showed RRs of 0.82. However, when simultaneously adjusting for walking volume, the contribution of intensity was attenuated, with volume remaining the “leading” factor.

In a popular retelling, it sounds like this: if you currently walk less than an hour a day, every extra 10-20 minutes already noticeably improves the prognosis. And after ~100 minutes/day, the benefit curve becomes flatter - further growth gives a smaller effect. Comments from authors and independent experts agree: walking is a cheap, accessible, mass means of preventing lower back pain, although this design cannot prove causality.

Key numbers at a glance

• 11,194 participants; 4.2 years of follow-up; 1659 (14.8%) reported chronic pain at follow-up.
• >100 min/day walking ↘ 23% risk relative to <78 min/day.
• Intensity is important (up to ~0.82 RR in the upper categories), but volume is more important.

Of course, the study has its limitations: activity was recorded by a short window of wearable sensors at the start, and the outcome (chronic pain) was self-reported several years later; behavior may have changed during this time, and an observational design does not prove cause and effect. Nevertheless, similar findings in popularization reviews and press releases reinforce a simple public health recommendation: walk longer, and your back will thank you.

What to do today

• Start with a minimum plank: increase your total walking to ~80-100 minutes/day (not necessarily all at once - add up “pieces” of 10-20 minutes throughout the day).
• If comfortable, increase the tempo to moderate/vigorous - this will give an additional, but less pronounced, contribution.
• Build walking into your routine: “walk one stop,” “take the stairs instead of the elevator,” walk for lunch. Small doses of time add up. (This reflects the WHO’s general “every move counts” approach.)
• If pain is already present, discuss your regimen with your doctor/physiotherapist: walking often relieves symptoms, but acute conditions require an individual plan.

Conclusion

Regular walking – especially about 100 minutes a day – is associated with a lower risk of chronic low back pain; walking faster is good, but walking longer is more important. It’s a rare “over-the-counter pill” for health systems: cheap, widespread, and potentially impactful for the population.

Research source: Haddadj R., Nordstoga AL, Nilsen TIL, et al. Volume and Intensity of Walking and Risk of Chronic Low Back Pain. JAMA Network Open. 2025;8(6):e2515592. doi:10.1001/jamanetworkopen.2025.15592