Physical Activity, Sitting Duration, and Posture Associated with Low Back Pain: A Systematic Review

Abstract

Background: Low back pain (LBP) is increasingly prevalent among adolescents and is associated with modifiable lifestyle factors such as physical inactivity, prolonged sitting, and poor posture. Sedentary behavior in school settings may contribute significantly to the development of musculoskeletal complaints.

Objective: This study aimed to systematically evaluate the association between physical activity, sitting duration, and sitting posture with the incidence of LBP in adolescents.

Methods: A systematic review was conducted following PRISMA 2020 guidelines. Literature was retrieved from Scopus, Google Scholar, and Semantic Scholar databases between 2015 and 2025. Observational studies examining the relationship between physical activity, sitting duration, posture, and LBP were included. Six studies met the eligibility criteria after screening and full-text assessment. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist.

Results: Six cross-sectional studies were included, with sample sizes ranging from approximately 500 to 7,000 participants. Low physical activity was consistently associated with increased risk of LBP. Prolonged sitting duration and non-ergonomic posture were also significantly associated with higher prevalence of LBP across studies. Methodological quality ranged from moderate to high (JBI scores 8–10). However, heterogeneity in study design and outcome measures limited quantitative synthesis.

Conclusion: Low physical activity, prolonged sitting, and poor posture are key modifiable risk factors for LBP in adolescents. Preventive strategies targeting these factors are recommended, although the overall strength of evidence remains limited due to predominantly cross-sectional designs.