Reducing Sedentary Behavior to Decrease Low Back Pain: Stand Back Study

Low back pain (LBP) is prevalent, debilitating and costly. Though exercise is a recommended
treatment for LBP, outcomes are variable and adherence is often poor due to barriers such as
time, sedentary jobs, and fear-avoidance of movement. Thus, the management of LBP must
include a biobehavioral lifestyle treatment approach. Preliminary evidence suggests that
prolonged sitting at work can exacerbate LBP, LBP is relieved shortly after prolonged sitting
ends, and standing more at work can relieve pain. Thus, this proposal will examine an
innovative intervention to decrease pain in patients with chronic LBP (cLBP) through a
reduction in sedentary behavior. The target population will be University of Pittsburgh
(UPitt) employees with cLBP who are inactive and sit at their desk for ≥20 hours/week. Over 6
months, individuals will be provided with a workstation that allows for standing while
performing work duties, a wrist-worn activity device that vibrates after prolonged
sedentariness, and a behavioral intervention including an initial orientation and monthly
follow-up telephone contacts. This is a novel pain reduction approach that is easily
incorporated into the workplace and targets a timeframe during which prolonged sitting is
common. A unique aspect of the approach is that individuals with cLBP who avoid movement due
to pain may especially benefit from this emerging strategy of more frequent, lifestyle
activity facilitated by newly-available devices. The investigators hypothesize that this
intervention will reduce pain intensity thereby leading to increased work productivity,
decreased healthcare utilization, improved health-related quality of life, and improved
physical function in LBP sufferers. If effective, this scalable intervention could be
implemented broadly to enhance employee health.

Inclusion Criteria:

1. Have chronic low back pain defined as a back pain problem that has persisted at least
3 months and has resulted in pain on at least half the days in the past 6 months

2. Oswestry low back pain index >20% to ensure a moderate level of disability is present,
thus minimizing a potential floor effect

3. Currently perform deskwork at least 20 hours per week at a desk compatible with the
sit-stand attachment

4. Stable employment (at least 3 months at current job and plan to stay at current job
for the next 6 months)

5. Ability to obtain approval to install sit-stand workstation (i.e., from supervisor)

6. Access to internet connection and email to complete assessment surveys

Exclusion Criteria:

1. Unable to provide informed consent

2. Cardiovascular event in the last 6 months (e.g. heart attack, stoke, heart failure,
revascularization procedure)

3. Presence of a comorbid condition that would limit ability to reduce sedentary behavior
(e.g. currently undergoing treatment for cancer)

4. Back surgery in the past 3 months or planned in the next year

5. Presence of a medical "red flag" for a serious spinal condition (cancer, compression
fracture, signs or symptoms of root compression, infection)

6. Inability to tolerate standing for any reason

7. Currently using a sit-stand desk, standing desk, or wearable activity monitor

8. Currently pregnant or planned pregnancy in the next 6 months

9. Blood pressure >159/100 mmHg