Associations of physical activity and sedentary behavior with chronic low back pain in middle-aged and older adults: a cross-sectional study

Objective: To investigate the associations between physical activity levels, sedentary behavior, and the risk of chronic low back pain (CLBP) among middle-aged and older adults. Materials and methods: A cross-sectional survey was conducted among 472 community-dwelling adults aged ≥45 years recruited from communities in Binhai County, Yancheng City, Jiangsu Province, China. Physical activity and sedentary behavior were assessed using the IPAQ-short form. CLBP was defined as low back pain occurring almost daily for ≥3 months. Sociodemographic, lifestyle, and health-related factors were collected as covariates. Associations were examined using chi-square tests and multivariable logistic regression models. Results: The prevalence of CLBP was 16.1%. Individuals who met physical activity guidelines had a significantly lower risk of CLBP (adjusted OR = 0.218, 95% CI: 0.116-0.410). Sedentary behavior was independently associated with a higher risk of CLBP (adjusted OR = 2.720, 95% CI: 1.562-4.738). Stratified analyses showed consistent associations across subgroups defined by sex, residence, marital status, lifestyle factors, and chronic diseases, with no significant interaction effects. Conclusion: Insufficient physical activity and sedentary behavior are major modifiable risk factors for CLBP in middle-aged and older adults. Replacing sedentary time with regular moderate-intensity physical activity and interrupting prolonged sitting may be effective strategies for CLBP prevention and healthy aging.