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Evaluation of the Effects of Physical Activity, Cardiorespiratory Condition, and Neuromuscular Fitness on Direct Healthcare Costs and Sickness-Related Absence Among Nursing Personnel With Recurrent Nonspecific Low Back Pain

Kolu, Päivi, PT, MSc; Tokola, Kari, MSc∗,†; Kankaanpää, Markku, MD, PhD; Suni, Jaana, PT, PhD

doi: 10.1097/BRS.0000000000001922

Study Design. A cross-sectional study, part of a randomized controlled trial.

Objective. To evaluate the association of physical activity, cardiorespiratory fitness, and neuromuscular fitness with direct healthcare costs and sickness-related absence among nursing personnel with nonspecific low back pain.

Summary of Background Data. Low back pain creates a huge economic burden due to increased sick leave and use of healthcare services.

Methods. Female nursing personnel with nonspecific low back pain were included (n = 219). Physical activity was assessed with accelerometry and a questionnaire. In addition, measurements of cardiorespiratory and muscular fitness were conducted. Direct costs and sickness-related absence for a 6-month period were collected retrospectively by questionnaire. Health care utilization and absence from work were analyzed with a general linear model.

Results. The mean total costs were 80.5% lower among women who met physical activity recommendations than inactive women. Those with a higher mean daily intensity level of 10-minute activity sessions showed lower total costs than women in the lowest tertile (middle: 64.0% of the lowest; highest: 54.3% of the lowest). Women with good cardiorespiratory fitness (the highest tertile) as measured with the 6-minute-walk test (based on walking distance) had 77.0% lower total costs when compared with the lowest tertile. Women in the highest third for the modified push-up test had 84.0% lower total costs than those with the poorest results (the bottom tertile).

Conclusion. High cardiorespiratory and muscular fitness and meeting physical activity recommendations for aerobic and muscular fitness were strongly associated with lower total costs among nursing personnel with pain-related disorders of recurrent nonspecific low back pain. Actions to increase physical activity and muscle conditioning may significantly save on healthcare costs and decrease sick-leave costs due to low back pain.

Level of Evidence: 3

UKK Institute for Health Promotion Research, Tampere, Finland

School of Health Sciences, University of Tampere, Tampere, Finland

Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland.

Address correspondence and reprint requests to Päivi Kolu, PT, MSc, UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, FI-33501 Tampere, Finland; E-mail:

Received 2 June, 2016

Revised 25 August, 2016

Accepted 12 September, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Social Insurance Institution of Finland (37/26/2011) and Pirkanmaa Hospital District, Tampere, Finland (9K127 and 9M099) funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.