# Effects of Physical Activities on Pain and Functional Recovery in Low Back Pain

> **NIH VA I01** · VA PUGET SOUND HEALTHCARE SYSTEM · 2021 · —

## Abstract

Low back pain (LBP) is the #1 cause of disability worldwide and a leading cause among Veterans. LBP has a
recurrent course for most individuals, involving the periodic occurrence of new episodes that patients must
manage. New LBP episodes therefore are critical juncture points where interventions hold promise for
optimizing functional recovery, promoting return to work (RTW), and averting a cascade of downstream
consequences such as opioid use, mental health problems, and even the risk of suicide and death.
 The general advice to remain active during a new LBP episode is a key part of clinical practice guidelines.
However, existing guidelines provide no specific recommendations about the types of activity (e.g., lifting,
bending, etc.) that should be engaged in or avoided (“Which?”) or the duration/intensity of such activities
should they be performed (“How?”). The guidelines therefore do not address a major concern of patients with
LBP, which is that certain activities may have short-term effects on pain exacerbations or “flares”, or cause
sustained detrimental effects on pain or function. The distinctions between healthy, benign, and detrimental
activities are also important to clinicians, who are often called upon to complete “work restriction forms” as part
of the RTW process. An ideal set of work restrictions after a new LBP episode would limit only those activities
that are likely to cause flares of pain (short-term effects) or poor overall functional recovery in the longer term
(overall effects). However, there exist no empirically derived data concerning the short-term vs. overall
effects of specific activities during a new episode of LBP, with which to guide work restrictions.
Instead, in standard practice, clinicians’ recommendations to engage in or avoid specific activities rely on their
personal practice style and may limit functional recovery if overly restrictive. The proposed research will use a
novel approach to distinguish the short-term effects of activities from the overall effects of such activities, by
conducting a longitudinal case-crossover study nested within a cohort study. This design accounts for
measured and unmeasured confounds by using each case as his/her own control, analogous to a crossover
experiment, capitalizing on modern mobile health and actigraphy technology.
 Aim 1: Estimate the short-term effects (24 hours) of specific physical activities on pain flares in
Veterans with LBP. A longitudinal case-crossover study will be conducted to identify activities that trigger
flares among 550 Veterans of working age (18-65 yrs) seen for a new LBP episode in VA primary care. The
primary outcome is a validated flare definition characterized by pain and functional impact. Analyses will use a
biopsychosocial framework accounting for potential confounders and moderators, such as pain characteristics,
work-related factors, catastrophizing, fear of movement, depression, post-traumatic stress, and opioid use.
 Aim 2: Estimate...

## Key facts

- **NIH application ID:** 10128207
- **Project number:** 5I01RX003248-02
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Pradeep Suri
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-04-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10128207

## Citation

> US National Institutes of Health, RePORTER application 10128207, Effects of Physical Activities on Pain and Functional Recovery in Low Back Pain (5I01RX003248-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10128207. Licensed CC0.

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