Maximal oxygen consumption and disability in nonspecific chronic low back pain: a retrospective cross-sectional study - 05/11/26

Doi : 10.1016/j.rehab.2026.102191

Louis Jacob ^a,^b,^c,^⁎ , Louis Chevassut ^a, Charlotte Logiou ^a,^d, David Petrover ^e, Jean-François Vergnol ^f, Guy Amah ^g, Augustin Latourte ^d,^f, Johann Beaudreuil ^a,^d

^a AP-HP, Université Paris Cité, Lariboisière–Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, 2 rue Ambroise Paré, 75010 Paris, France

^b Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases (EpiAgeing), 10 avenue de Verdun, 75010 Paris, France

^c Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain

^d Université Paris Cité, Inserm U1132, Bioscar, 2 rue Ambroise Paré, 75010 Paris, France

^e Centre Imagerie Médicale Bachaumont Paris Centre (IMPC Bachaumont-Blomet Ramsay GDS), 12 rue Bachaumont, 75002 Paris, France

^f AP-HP, Université Paris Cité, Lariboisière Hospital, Department of Rheumatology, 2 rue Ambroise Paré, 75010 Paris, France

^g AP-HP, Université Paris Cité, Lariboisière Hospital, Department of Clinical Physiology and Functional Investigations, 2 rue Ambroise Paré, 75010 Paris, France

^⁎ Corresponding author: Louis Jacob, Associate Professor, Université Paris Cité, AP-HP, Lariboisière–Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, 2 rue Ambroise Paré, 75010 Paris, France, Tel: +33 6 27 88 37 06 Associate Professor, Université Paris Cité, AP-HP, Lariboisière–Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation 2 rue Ambroise Paré Paris 75010 France

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 05 November 2026

Highlights

•	Lower aerobic fitness is linked to worse disability and pain in chronic back pain.
•	No adjusted link was found between aerobic fitness and psychosocial disability.
•	Aerobic fitness added 1–4% to explained outcome variance in chronic back pain.

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Abstract

Background

Reduced cardiorespiratory fitness may contribute to disability in nonspecific chronic low back pain (NSCLBP), but its independent association with functional outcomes remains unclear.

Objective

To assess the association between maximal oxygen consumption (VO ₂ max) and disability-related outcomes in NSCLBP.

Methods

This retrospective observational study included participants evaluated for participation in a multidisciplinary rehabilitation program between 2001 and 2025. Individuals with a maximal exercise test ending in exhaustion, available VO ₂ max data, and at least 1 non-missing outcome were included. Disability outcomes comprised functional disability (Quebec Back Pain Disability Scale, QBPDS, primary outcome), pain intensity, including global pain, radicular pain, and low back pain (LBP), and multidimensional impact (Dallas Pain Questionnaire scores, DPQ). Associations were assessed using adjusted median quantile regression models and expressed per one interquartile range (IQR) decrease in VO ₂ max. Additional explained variance (ΔR ² ) was estimated using linear regression.

Results

A total of 336 participants were analyzed (median age 43.0 years; 54% women; 54% on sick leave, work-related injury leave, or unemployed because of LBP; median LBP duration: 67.2 months). Lower VO ₂ max was significantly associated with greater functional disability (QBPDS scores) (coefficient = 5.22), higher global pain (coefficient = 4.11), higher LBP (coefficient = 4.24), and greater impairment in daily activities (higher DPQ daily activity scores) (coefficient = 3.92). The additional explained variance of VO ₂ max ranged from approximately 1% to 4%.

Conclusions

Lower VO ₂ max is associated with higher pain and disability in NSCLBP, although its independent contribution to outcome variability remains modest. These findings suggest that, in accordance with the concept of multifactorial disability, cardiorespiratory fitness is associated with disability but does not account for all its variability.

Data registration

This retrospective observational study was not registered in an international study database because prospective registration was not required for this study design. The study was locally registered under reference no. 20191106104903.

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Keywords : cardiorespiratory fitness, disability, functional status, nonspecific chronic low back pain, pain, VO ₂ max