Table 1. Summary of included studies in the systematic review .
|
First author;
(year) a |
Study design; Study participant | Sample size |
Age
(years) |
Sedentary behavior | Outcome | Assessment of low back pain | Main finding | Adjustment factors | Study quality b | Ref. |
| A. Burdorf (1993)c |
Cross-sectional Sedentary worker in Rotterdam |
275 | 41.5 | Prolong sedentary posture belong work | LBP | Nordic musculoskeletal questionnaire | The adjusted risk for LBP among carne operator and straddle-carrier was significantly higher than office workers who spent lower sedentary daily work time. | Age, Physical activity, whole-body vibration, prolonged sitting, cold and draught in current work, working under severe pressure, and job satisfaction. | Moderate | 50 |
| T. Skov (1996) |
Cross-sectional Danish salespeople |
1306 | 39.3 | Sedentary work (proportion of work time) |
Chronic LBP | Self-reported Nordic questionnaire | Driving and sedentary work were related to neck and low back pain. | - | Moderate | 25 |
| R. Gunzburg (1999)c |
Cohort Belgian students |
392 | 9 | Watching TV and playing video game (> 2 hours/day) | LBP | Questionnaire | More LBP in children who reported playing video games (> 2 hours/day). | - | High | 51 |
| P. R. Croft (1999)c |
Cohort UK general population |
4501 | 46.5 | Watching TV more than 3h/day | Overall LBP | Questionnaire | There is no significant link between watching TV more than 3 hour with risk of overall LBP. | Self-related health and psychological distress | High | 52 |
| C. Thorbjörnsson (1999) c |
Nested case-control Swedish general population |
484 | 26 | Sedentary work | LBP | Interview | Sedentary work was associated with an excess risk of LBP. | Age | High | 68 |
| D. K. Shehab (2003)c |
Cross-sectional Schoolchildren in Kuwait |
400 | 14.4 | Watching TV time. | LBP | Interview | back pain is associated with TV watching time. | - | Moderate | 53 |
| A. N. Sjolie (2004) |
Cross-sectional Norwegian adolescents |
88 | 14.7 | television or computer use | LBP | Self-reported Questionnaire | LBP was associated with the use of television or computer (>15 hours/week). | Gender, distances to school and physical activity | High | 26 |
| V. Yip (2004)c |
Cohort Hong Kong nurses |
144 | 31.1 | Sedentary leisure time activity and prolong setting and standing | New LBP | Face-to-face interview | leisure time sedentariness was not associated with new low back pain. | - | High | 54 |
| S. Andrusaitis (2006)c |
Cross-sectional Brazilian truck drivers |
410 | 40.2 | Number of working hours | LBP | Questionnaire | Working hours were associated with LBP. | Weight, height, number of working hours, ethnic group, age and body mass index. | Moderate | 5 |
| V.M. Mattila (2007) |
Survey; Finland Military |
7040 | 19 | No leisure-time physical activity | lifetime LBP | Visit to a physician | use of smokeless tobacco (OR 1.4) was a risk factor for LBP. | Age | High | 27 |
| P. Spyropoulos (2007) |
Cross-sectional Greek office workers |
648 | 44.5 | Sitting time | Point, one year, two year, and lifetime LBP | Self-reported Questionnaire | Sitting time (>6 hours) is a significant determinant for lifetime LBP. | Gender, age, BMI, Body distance from computer screen, psychosocial factors |
High | 28 |
| J. Auvinen (2008) |
Cross-sectional Finland adolescents |
5999 | 16 | TV viewing, playing or working on a computer, reading books and other sitting activities | LBP | One-item question | Among girls, high amount of sitting associated with consultation or reporting LBP. | Smoking, levels of physical activity and BMI | High | 29 |
| A. Karahan (2008) |
Cross-sectional Turkish hospital staff |
1600 | 28 | Standing and sitting in a working day | LBP | Questionnaire | Overall standing time in a work day was significantly associated with LBP in univariate analysis. | Occupation, gender, working year, Smoking, exercise, Perceived stress level in work environment, performing risky activities as below | High | 30 |
| B. Skoffer (2008) |
Cross-sectional Danish schoolchildren |
546 | 15.5 | Standing talking during school break, hours of watching TV or video | LBP, function-limiting LBP | Self-reported Questionnaire | Homework and TV watching time were associated with LBP. | Age, gender, inactivity indicators, weight, BMI and smoking | Moderate | 31 |
| S. Ahn (2009) |
Cross-sectional Korean postmenopausal women |
143 | 59 | Being inactive during leisure time | LBP | One-item question | leisure time inactivity was a risk for back pain. | health factors related to BMI, parity, osteoarthritis, BMD, drinking coffee and inactivity |
High | 32 |
| F. Tissot (2009) |
Population survey Canadian worker |
7730 | 41.5 | Standing at work without freedom | LBP | Standardized Nordic questionnaire |
Standing at work is associated with low back pain. | - | High | 33 |
| W. Yao (2012)c |
Case-control Chinese adolescents |
1214 | 15.1 | Prolong TV watching, computer using, and homework time | LBP | - | There was no significant association between sedentary activity and LBP. | - | High | 55 |
| N. Aggarwal (2013)c |
Cross-sectional Indian undergraduate medical students |
160 | 20.6 | Regular watching TV, and working on PC/laptop | LBP | Questionnaire | No associations between watching television or computer use with LBP. | - | High | 62 |
| M. Mohseni Bandpei (2014) |
Cross-sectional Iranian teacher |
586 | 37.9 | Standing or sitting time, computer working hours | Lifetime LBP | Oswestry LBP and disability questionnaire | Greater risk of LBP was observed in participants with prolonged sitting and standing, higher computer working hours and correcting examination. | General health, years of teaching, do exercise, pain intensifiers, sex, age, BMI, and job satisfaction | High | 34 |
| P. Mikkonen (2015)c |
Cohort Finland Students |
1625 | 16 | working on a computer, watching television, reading books, and other sedentary activities |
Chronic LBP | Self-reported or consultation-reported | No association between the sedentary behavior and LBP | - | High | 66 |
| J. Fernandes (2015) |
Cross-sectional Brazilian schoolchildren |
1461 | 12.6 | Watching TV/ week | Chronic LBP | Nordic Questionnaire | Low back pain was associated with watching TV (>3 times/week and 3 hours/day) | Age, gender | High | 35 |
| G. Inoue (2015) |
Cross-sectional Japanese sitting worker |
1329 | 40 | Routine standing work | LBP | RDQ | standing was not a significant risk factor for LBP. | working status, height, age, gender, BMI, smoking habit, and frequency of exercise | High | 36 |
| N. Gupta (2015)c |
Cross-sectional Danish blue-collar workers |
201 | 44.7 | Total sitting time (hour per day) | Intensity of LBP | Standardized Nordic questionnaire | Positive association between total sitting time and high LBP intensity (OR = 1.43) was found. | Age, gender, smoking, BMI, occupational time, sitting time in the opposite domain | High | 63 |
| J. Stričević (2015) |
Cross-sectional Nursing personnel in Slovenia |
659 | - | Working with computer or watching TV ≥ 2 h per day |
LBP | Questionnaire | Work with the computer reduced the risk for LBP (OR = 0.6) | Preventive exercises, Duration of employment, Frequent manual lifting | Moderate | 37 |
| M. Dolphens (2016) |
Cross-sectional Belgian adolescents |
842 | 11.6 | screen time, homework time and reading outside of school. | LBP | Questionnaire | Sedentary behaviors were not associated with LBP. | - | High | 38 |
| S. Hussain (2016)c |
Cohort Australian adults |
5058 | - | Total time spent watching Television ≥ 2h/day | disability of LBP LBP intensity |
Self-administered Chronic Pain Grade Questionnaire | ≥ 2 hours/day TV watching was associated with greater prevalence of LBP in women | Age, smoking status, dietary index score, BMI, education, | High | 65 |
| M. Ardahan (2016) |
Cross-sectional Turkish computer-using office workers |
395 | 45 | Daily working hours at computer | LB disorder | Turkish-Cornell Musculoskeletal Discomfort Questionnaire | Using a computer (> 7 hours/day) was associated with LB disorder. | - | High | 39 |
| L. Lunde (2017)c |
Cohort Norwegian construction and healthcare workers |
124 | 42.2 | sitting and standing during work | LBP intensity | - | The duration of sitting during work and leisure time was associated with LBP intensity. | Age, gender, smoking, BMI, heavy lifting, and sitting or standing time | High | 56 |
| S. Şimşek (2017) |
Cross-sectional healthcare workers (Turkey) |
1682 | 37.9 | Prolong standing & siting at work & using computer for more than 4 hours |
Lifetime; Recent and previous year LBP |
SNMA Questionnaire Pain level with visual analogue scale |
Working for more than 4 hours (standing or sitting at desk) and using computer for more than 4 hours were associated with low back pain. | - | High | 49 |
| Y. Yabe (2017) |
Cross-sectional Japanese school-aged athletes |
6441 | 11 | Video playing and TV viewing time | LBP | Self-reported questionnaire | Long video playing time/day was associated with low back pain. | Gender, age, BMI, TV-viewing time per day, and video playing time per day | High | 40 |
| S. Ganesan (2017)c |
Cross-sectional Indian young adult |
1355 | 24.5 | Study time more than 5h/day | LBP score | Questionnaire | LBP is triggered by >5 hours studying. | - | Moderate | 57 |
| M. Balling (2017)c |
Cohort Danish adults |
76438 | 47.6 | Total sitting time 6h/day or more | LBP | National Patient Register | No statistically significant association between total sitting time and low back pain was found. | Sex, age, smoking, BMI and physical activity at work | High | 58 |
| S. Ye (2017)c |
Cross-sectional Chicness office workers |
417 | 29.1 | Computer use ≥8 hours/day | LBP | Oswestry Low Back Pain Disability Index | Computer use (>8 hours/day) was not associated with high LBP. | - | High | 64 |
| H. Yang (2018) |
Cross-sectional USA adult population |
122,337 | 51.5 | Leisure time physical activity |
Chronic LBP | Self-reported LBP | Higher prevalence of LBP among inactive people in leisure time. | Gender, age, ethnicity, socioeconomic status, and serious psychological distress | High | 41 |
| Sh. Sen Sribastav (2018) |
Cross-sectional; Patient with LBP (Chi na) |
1046 | 37.2 | Long time driving | Non-specific LBP and pain level | Self-assessment questionnaire | Smoking, long driving time, and higher BMI were associated with LBP pain. | Gender, age, BMI, smoking habits, duration of driving or riding, drinking habits | High | 42 |
| S. Park (2018) |
Cross-sectional General Korean population |
5364 | 65.4 | sitting time | Chronic LBP | Self-reported LBP | Sitting time more than 7 hours/day was notably associated with LBP. | Age, socioeconomic factors, sex, BMI, smoking history, alcohol consumption, and physical activity | High | 43 |
| M. Korshøj (2018)c |
Cross-sectional | 704 | 45 | Sitting at work | Intensity of LBP | Nordic Questionnaire | No significant associations were found between total duration and temporal patterns of sitting with LBP. | Interaction between sitting and BMI | High | 13 |
| A. Citko (2018) |
Survey Poland medical personnel |
609 | 41 | Sedentary lifestyle | Recurrent and chronic LBP | Nordic musculoskeletal questionnaire | Sedentary lifestyle associated with a 3.5-fold increase in the incidence of LBP. | - | High | 19 |
| S. Çelik (2018)c |
Cross-sectional Office worker |
528 | 38.6 | Time spent standing and continuously sitting in workplace | LBP | Questionnaire | There is no significant association time spent standing and sitting with risk of LBP. | - | High | 59 |
| R. Shiri (2018)c |
Cohort Finnish population |
3505 | - | Sitting hours/day | LBP | Questionnaire | No significant associations between sitting time/day and LBP for more than 7 or 30 days. | Age, sex | High | 67 |
| S. Kulandaivelan (2018) |
Cross-sectional HISAR urban population |
1540 | 48.2 | Long sitting or watching TV time (> 2h/day) | LBP | Modified Nordic musculoskeletal questionnaire | No statistically significant association between long sitting and sleeping time and LBP | - | High | 44 |
| C. Tavares (2018)c |
Cross-sectional Brazilian medical students |
629 | 23 | Sitting hours per day | LBP | Questionnaire | The number of sitting hours was not associated with LBP. | - | High | 60 |
| Q. Zhang (2019) |
Cross-sectional Emergency ambulance workers (driver). (China) |
1560 (543 drivers) |
38.4 | Sitting time | Chronic LBP | Nordic Musculoskeletal Questionnaire | BMI and sitting time were associated with chronic LBP study sample. | Age, BMI, sex, Psychosocial factors | High | 45 |
| B. Minghelli (2019) |
Cross-sectional Portuguese students |
304 | 13.7 | Sedentary habits (Watching television, Mobile phones use, Console/computer games) | Lifetime and 6- and 12-month LBP | Self-Questionnaire | Mobile use more than 10 hours/week is associated with LBP in adolescents. | Sex, sedentary habits, physical activity |
High | 46 |
| T. Bento (2019) |
Cross-sectional Brazilian students |
1628 | 15 | Daily use time of TV/day, cell phone, tablet more than 3 h | Chronic LBP | Nordic Questionnaire | Daily TV use, cell phone use and tablet use (>3 hours) were significantly associated with LBP. | Sex, TV watching hours, daily use time of cell-phone and tablet | High | 47 |
| H. Ayed (2019) |
Cross-sectional Tunisia schoolchildren |
1221 | 15.6 | Watching TV more than 12h/week and playing video game for more than 2h/week | LBP | Nordic Questionnaire | Playing videogames (≥2 hours/day), and watching TV (≥12 hours/week) were significant risk factors for LBP. | - | High | 20 |
| F. Hanna (2019) |
Cross-sectional Qatari University Employees |
479 | - | Prolong sitting hour | LBP | ALBPSQ | Too much sitting was significantly associated with LBP or UBP | Age, gender, and profession. | High | 48 |
| D. Schwertner (2019)c |
Cross-sectional Brazilian young |
330 | 16 | TV watching time and computer use | LBP | Oliveira Questionnaire on Low Back Pain in Youths | No association of LBP with sedentary lifestyle was found. | Sex, age and BMI | High | 61 |
| C. Bontrup (2019)c |
Cross-sectional Swedish call-center employees |
70 | 43 | Occupational sitting habits | LBP | CPG questionnaire and BPI | Small association between general sitting behavior and chronic LBP was found. | - | High | 1 |
Abbreviations: STROBE; STrengthening the Reporting of OBservational studies in Epidemiology; BMI, body mass index; BMD, bone mass density; LBP, low back pain; RDQ, Roland-Morris Disability Questionnaire; CPG, Chronic Pain Grade;
BPI, Brief Pain Inventory; ALBPSQ, Acute Low Back Pain Screening Questionnaire.
aArranged chronologically.
b Mean STROBE score ≥ 16.5 (from two reviewers) was considered as high quality and 11 to 16.5 was considered as moderate quality.
c Not included in metanalyses.