title: Healthy Physical Activity Levels Below Recommended Thresholds Two Years After Lumbar Spine Surgery.
abstract: METHODS
  Prospective analysis.
  
  
  OBJECTIVE
  To quantify physical activity after lumbar surgery and identify spine-related variables associated with not meeting recommended activity thresholds.
  
  
  BACKGROUND
  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. Spine-related 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.
  
  
  CONCLUSIONS
  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 long-term adverse health outcomes due to inactivity.
  
  
  METHODS
  3.
authors.affiliation: Weill Cornell Medical College, Hospital for Special Surgery, New York, NY.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Roland
authors.initials: R
authors.lastname: Duculan
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome