Importance: Chronic low back pain (LBP) is a prevalent and costly condition, and regular physical activity may reduce its risk. Walking is a common and accessible form of physical activity, but its association with the risk of chronic LBP is unclear.

Objective: To examine whether accelerometer-derived daily walking volume and walking intensity are associated with the risk of chronic LBP.

Design, setting, and participants: This prospective population-based cohort study used data from the Trøndelag Health (HUNT) Study in Norway, with a baseline in 2017 to 2019 and follow-up in 2021 to 2023. The study included individuals without chronic LBP at baseline and with at least 1 valid day of device-measured walking.

Exposure: Daily walking volume (minutes per day) and walking intensity, expressed as metabolic equivalent of task (MET) per minute.

Main outcomes and measures: The primary outcome was self-reported chronic LBP at follow-up, defined as pain lasting 3 months or longer in the past 12 months. Poisson regression was used to estimate adjusted risk ratios (RRs) with 95% CIs of chronic LBP according to daily walking volume and mean walking intensity.

Results: A total of 11 194 participants aged 20 years or older (mean [SD] age, 55.3 [15.1] years; 6564 women [58.6%]) were included in the analysis. At follow-up (mean [SD] follow-up time, 4.2 [0.3] years), 1659 participants (14.8%) reported chronic LBP. Continuous measures of both walking volume and walking intensity were inversely associated with the risk of chronic LBP using restricted cubic splines models. Compared with participants walking less than 78 minutes per day, those walking 78 to 100 minutes per day had an RR for chronic LBP of 0.87 (95% CI, 0.77-0.98), those walking 101 to 124 minutes per day had an RR of 0.77 (95% CI, 0.68-0.87), and those walking 125 minutes or more per day had an RR of 0.76 (95% CI, 0.67-0.87). Compared with a mean walking intensity of less than 3.00 MET per minute, participants with walking intensity of 3.00 to 3.11 MET per minute had an RR for chronic LBP of 0.85 (95% CI, 0.75-0.96), those with walking intensity of 3.12 to 3.26 MET per minute had an RR of 0.82 (95% CI, 0.72-0.93), and those with walking intensity greater than or equal to 3.27 MET per minute had an RR of 0.82 (95% CI, 0.72-0.93). After mutual adjustment, the association remained largely similar for walking volume but was attenuated for walking intensity.

Conclusions and relevance: In this cohort study, daily walking volume and walking intensity were inversely associated with the risk of chronic LBP. The findings suggest that walking volume may have a more pronounced benefit than walking intensity.

重要性：慢性下背痛（LBP）是一种常见且昂贵的疾病，定期进行体育活动可能可以降低其风险。步行是一种常见的、易于访问的身体活动形式，但其与慢性下背痛风险之间的关系尚不清楚。

目的：探讨加速度计记录的日均步数和步行强度是否与慢性下背痛的风险相关。

设计、地点及参与者：这项前瞻性队列研究使用了挪威特隆赫姆健康（HUNT）研究的数据，基线调查时间为2017年至2019年，随访时间为2021年至2023年。该研究包括在基线时没有慢性下背痛且至少有一个有效设备测量步行日的个体。

暴露因素：每日步数（每天分钟数）和以代谢当量（MET）每分钟表示的步行强度。

主要结果及措施：主要结局是随访时自报的慢性下背痛，定义为过去12个月内持续3个月或更长时间的疼痛。采用泊松回归分析计算根据日均步数和平均步行强度调整的风险比（RRs）及其95%置信区间。

结果：共有11,194名年龄在20岁及以上的参与者（平均[标准差]年龄为55.3 [15.1] 岁，女性6564人[58.6%]）纳入分析。随访时（平均[标准差]随访时间，4.2 [0.3] 年），有1,659名参与者（14.8%）报告了慢性下背痛。连续测量的步行量和步行强度均与慢性下背痛的风险呈负相关。与每天步行少于78分钟的人相比，每天步行78至100分钟的人患慢性下背痛的风险比为0.87（95％置信区间，0.77-0.98），每天步行101至124分钟的人风险比为0.77（95%置信区间，0.68-0.87），而每天步行125分钟或更多的人风险比为0.76（95％置信区间，0.67-0.87）。与平均步行强度小于3.00 MET/分钟的参与者相比，具有3.00至3.11 MET/分钟步行强度的参与者的慢性下背痛的风险比为0.85（95%置信区间，0.75-0.96），而具有3.12至3.26 MET/分钟步行强度的人风险比为0.82（95％置信区间，0.72-0.93），并且那些具有大于或等于3.27 MET/分钟的步行强度的人风险比也为0.82（95%置信区间，0.72-0.93）。在相互调整后，步数与慢性下背痛的风险关联保持大致相同，而步行强度的关联有所减弱。

结论及意义：在这项队列研究中，每日行走量和步行强度均与慢性下背痛风险呈负相关。这些发现表明，步行量可能比步行强度带来更显著的好处。