Healthy Physical Activity Levels Below Recommended Thresholds Two Years After Lumbar Spine Surgery

Study Design. Prospective analysis. Objective. To quantify physical activity after lumbar surgery and identify spine-related variables associated with not meeting recommended activity thresholds. Summary of Background Data. National guidelines recommend >= 150 minutes/week of moderate-intensity activity; however, only 52% of the general population meets this threshold. For patients not participating in exercise/sports, >= 1400 kcal/week of energy expenditure, including from walking, is another threshold. Potential spine-related variables associated with not meeting these thresholds after lumbar surgery have not been described. Methods. Clinical data were collected pre-and intraoperatively for 422 patients. Patients were contacted 2.2 years postoperatively to measure several patient-reported outcomes, including physical activity with the Paffenbarger Physical Activity and Exercise Index. The Paffenbarger Physical Activity and Exercise Index encompasses blocks walked, stairs climbed, and exercise/ sports. Minutes/week of activity and total kcal/week were calculated and compared to recommended thresholds. Spinerelated variables associated with not meeting thresholds were assessed in multivariable analyses. Results. Mean age was 57 years, 55% were men, 80% had degenerative diagnoses, and 63% had multilevel surgery. Only 35% met >= 1400 kcal/week; in multivariable analysis, not meeting this threshold was associated with revision surgery (OR 0.53, CI 0.30-0.95), surgery at >= 3 levels (OR 0.51, CI 0.31-0.84), and more postoperative back pain (OR 0.38, CI 0.24-0.59) (P<0.05 for all variables). Only 26% met >= 150 minutes/week; in multivariable analysis, not meeting this threshold was associated with degenerative diagnoses (OR 0.53, CI 0.31-0.92), subsequent spine surgery (OR 0.17, CI 0.05-0.58), and more postoperative back pain (OR 0.41, CI 0.25-0.67) (P<0.05 for all variables). All multivariable associations persisted after controlling for demographic characteristics. Conclusion. Physical activity is below population norms after lumbar surgery and is associated with spine-related variables. Patients with stable spine conditions should be encouraged to engage in prudent physical activity to decrease their risk of longterm adverse health outcomes due to inactivity.