Research is clear that positive lifestyle behaviors (smoking cessation, improvements in sleep quality, engagement in moderate to high physical activity, healthy BMI, and moderate to low alcohol consumption) are beneficial for our health and lower the risk of developing chronic low back pain. These lifestyle behaviors help people build resilience. Resilience facilitates adaptation and adjustment to adversity leading to recovery or sustainability. Recovery is the resolution of LBP (and continued resolution for at least 3 months, according to this study) while sustainability pertains to the level of pain interference in physical or work activities. This study (PMID: 36208321) explored the potential relationship between positive lifestyle behaviors and emotional health factors and low back pain resilience.
The study included 1065 participants (487 individual twin members of an incomplete pair and 578 twin members of a complete pair) who had a history of LBP. Twins were used to minimize the influence of genetics and childhood environmental factors. Assessed lifestyle factors included BMI, smoking status, leisure time physical activity, sleep quality, and alcohol consumption. Assessed emotional health factors included depressed mood, perceived stress, and active coping. The researchers found no relationship between either the combined lifestyle behavior score or the cumulative emotional health score and the likelihood of people recovering from LBP at follow-up. There was, however, a positive relationship between levels of sustainability in LBP and healthy lifestyle behaviors (adequate sleep and physical activity, optimal BMI, non-smoking, and minimal alcohol consumption) and healthy emotional factors (lack of depressive thoughts, low perceived stress, and resilient coping).
Although, the beta coefficient values for healthy lifestyle behaviors and healthy emotional behaviors were low (0.2 and 0.22). The data suggests there is a small positive effect of these behaviors on sustainability, meaning patients with a healthy lifestyle and emotional behaviors are more likely to adapt to their pain and maintain higher levels of activity. This paper does not provide a hierarchy of importance within those behaviors. When assessing the likelihood of someone remaining active in the presence of pain, these lifestyle and emotional factors are worth assessing.