Low-back pain is a pervasive and debilitating condition, affecting nearly 800 million people worldwide. Recurrence is highly common, with 70% of individuals who recover from an episode experiencing a relapse within a year. Helping clients manage this condition effectively has long been a priority for health and exercise professionals. While many strategies have been explored, a recent study led by Macquarie University sheds new light on an accessible and low-cost intervention: walking. This groundbreaking research offers valuable insights into preventing the recurrence of low-back pain through a progressive walking and education program, which could revolutionize the way we approach treatment and prevention for millions.

Overview of the Study: The WalkBack Trial

The WalkBack trial, published in The Lancet, aimed to investigate the clinical and cost-effectiveness of a simple walking program combined with education for preventing the recurrence of non-specific low-back pain. The trial followed 701 adults who had recently recovered from an episode of low-back pain. Participants were split into two groups: one received an individualized, progressive walking regimen along with educational sessions facilitated by physiotherapists, while the other group did not receive any intervention.

Participants in the intervention group were encouraged to build up to walking five times a week for approximately 30 minutes over six months. Their progress was tracked over a period ranging from one to three years, with particular focus given to the time to their next episode of activity-limiting back pain. The results were promising—those in the walking group lasted nearly twice as long without a recurrence, with a median of 208 days compared to just 112 days in the control group.

After three months, explains Dr. Mark Hancock, professor of physiotherapy at Macquarie University and senior author of the study, most of the people who took part were walking three to five days a week for an average of 130 minutes in total across the week. “You don’t need to be walking five or 10 kilometers [3.1 to 6.2 miles] every day to get these benefits.”

Why Walking Works: The Mechanisms Behind Its Success

Walking is a form of low-impact, accessible exercise that brings several physiological benefits, including improved cardiovascular health, muscle strengthening, stress relief and the release of endorphins. For individuals with a history of low-back pain, walking provides gentle oscillatory movements that help load and strengthen the spine and surrounding musculature, says Dr. Hancock. This may be a key factor in reducing the recurrence of low-back pain, as stronger muscles and spinal structures provide better support and resilience against future episodes.

Moreover, the study highlighted the holistic benefits of walking. In addition to preventing recurrences of back pain, walking promotes overall health, contributing to weight management, improved mental health and increased bone density. These broader health benefits make walking a powerful tool not only for individuals with low-back pain but for general wellness as well.

Cost-Effectiveness and Accessibility

One of the standout findings from the WalkBack trial is the cost-effectiveness of the intervention. In a healthcare system burdened by the high costs of treating recurrent low-back pain, this walking and education program presents a highly scalable and affordable solution.

“It not only improved people’s quality of life,” explains lead research Natasha Pocovi, PhD, “but it reduced their need both to seek healthcare support and the amount of time taken off work by approximately half.”

Walking is a particularly attractive intervention because it is accessible to a wide demographic. Unlike more expensive or time-intensive exercises that require specialized equipment or supervision, walking can be done almost anywhere and at any time. This makes it ideal for individuals from all socioeconomic backgrounds and geographic locations.

How to Apply These Findings as a Health and Exercise Professional

For health and exercise professionals, the implications of this study are significant. Walking, when combined with proper education on posture, pacing and progression, offers a simple yet effective way to help clients prevent the recurrence of low-back pain. Here’s how you can incorporate these findings into your work with clients:

1. Educate clients on the benefits of walking. Ensure your clients understand why walking is beneficial, especially for those with a history of low-back pain. Explain how it strengthens the muscles that support the spine, promotes overall cardiovascular health, and helps manage stress and body weight, which are often contributing factors to back pain.

2. Create individualized walking programs. Tailor the walking program to each client’s fitness level and physical capacity. The WalkBack trial encouraged participants to build up to walking 30 minutes a day, five times a week. However, start with shorter sessions if necessary, and gradually increase the duration and frequency. Monitor progress and adjust based on the client’s feedback and ability.

3. Incorporate walking as part of a broader exercise program. While walking alone has demonstrated clear benefits for preventing back pain recurrence, it can be even more effective when combined with strength training. For example, exercises that target the core, hips and lower-back muscles can complement walking by further stabilizing the spine. Incorporate exercises like planks, bridges or hip extensions to enhance the benefits.

4. Use education to empower clients. The WalkBack trial didn’t just involve physical activity—it also included six educational sessions facilitated by physiotherapists. Consider how you can provide ongoing education to your clients about the mechanics of walking, proper posture and how to listen to their bodies to avoid overexertion. This education empowers clients to manage their own health more effectively and reduces the need for ongoing supervision.

5. Offer continuous support and adjustments. For clients with recurring low-back pain, long-term success depends on consistency and adherence to the walking regimen. Provide regular check-ins to assess their progress, adjust the walking program as needed and ensure that they are staying motivated. Encouragement and small adjustments can go a long way in helping clients stay committed.

Conclusion: Walking as a Preventive Tool

The WalkBack trial shows that a progressive, individualized walking program, combined with education, significantly reduces the recurrence of low-back pain. As a health and exercise professional, this provides a valuable, evidence-based tool that can be easily implemented with your clients. Walking is not only accessible and cost-effective, but it also offers broad health benefits that extend beyond back pain prevention. By incorporating walking into your clients’ exercise routines, you can help them manage their pain, improve their overall well-being and reduce the risk of future recurrences.

Expand Your Knowledge

Low-back Health Begins With the Core

Generalized low-back pain can be debilitating, as well as challenging to solve. But just because you have back pain now, that doesn’t mean it’ll be with you forever. In this webinar, you’ll learn the steps you can help your clients take to alleviate low-back pain and get back to doing the activities they love.

Fundamentals of Spine, Neck and Hip Health

Do your clients experience pain in their hips, neck or spine? Help them improve their health and function in these areas with this course focused on kinetic chain training. This course focuses on three areas of learning: safe cervical training for optimal neck health; hip, pelvic and spinal anatomy and their joint movements; and the musculoskeletal chain reactions that occur with a lateral pelvic tilt combined with an anterior pelvic tilt or posterior pelvic tilt. Furthermore, you will learn how to apply your theoretical knowledge to movement and create amazing programs that are client-specific and goal-driven.