Adults Who Took Up Walking After Back Pain Went Longer Without a Relapse

CATEGORY: EXERCISE & MOVEMENT

Adults who built a walking habit after a bout of low back pain stayed well nearly twice as long. In an Australian trial of 701 people who had just recovered from an episode, those given a structured walking program went a median of 208 days before back pain limited their activities again. Those given nothing lasted a median of 112 days. Over the full follow-up, that worked out to a 28% lower risk of recurrence (hazard ratio 0.72, 95% CI 0.60 to 0.85).¹ Think of it as the difference between staying well from New Year’s until midsummer, and only until late April.

Six Physio Sessions to Build the Habit

Everyone enrolled had recently gotten over nonspecific low back pain, the everyday kind with no single identified cause. Most were women, and the average age was 54. A coin-flip style draw put half into the program and left half without any treatment, so the groups started out alike. The program itself was modest: six sessions with a physiotherapist spread over six months, used to design a personal walking plan that ramped up gradually, plus education about why a sore back usually isn’t a damaged one. After that, the walking was up to them. For one to three years, everyone reported monthly on whether their back pain had returned.¹

Walking Postponed Trouble More Than It Prevented It

The honest version of this finding is a delay, not a shield. Even among the walkers, half had a recurrence within about seven months. A follow-up analysis of the same trial found that when pain did return, it was a little briefer (a median of 3 days against 4) and slightly less intense at its worst, differences the authors themselves call small and of uncertain clinical relevance.² Two limits are worth knowing. Participants knew which group they were in, and recurrences were self-reported. And because the program paired walking with coaching, the trial can’t say how much the walking alone did.

A Few More Sore Feet, at a Modest Price

Side effects looked like what you’d expect from more time on the pavement. Overall adverse events were even between groups, at 52% and 54%, but leg and foot complaints were nearly twice as common among the walkers, 100 against 54.¹ The economics came out well: about AU$7,800 per quality-adjusted year of health gained, with a 94% chance of being cost-effective by Australian standards.¹ A prevention program built on sneakers rather than equipment is the kind of result that health systems notice.

Key Takeaways

• The benefit was a postponement: median time to the next activity-limiting episode roughly doubled, from 112 days to 208, and recurrence risk over follow-up was 28% lower.
• Walking didn’t make back pain a thing of the past; half the walkers still relapsed within about seven months, and returning episodes were only slightly shorter and milder.
• Because people knew their group and the program bundled walking with coaching, the trial can’t separate the walking from the education that came with it.

References

1. Pocovi NC, Lin CWC, French SD, et al. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. The Lancet. 2024;404(10448):134–144. link
2. Pocovi NC, Graham PL, Pisharody G, et al. Effect of a walking plus education program on the duration and severity of recurrences of low back pain: a secondary exploratory analysis of the WalkBack trial. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(9):596–601. link