Original research| Volume 99, ISSUE 11, P2251-2256, November 2018

Energy Impairments in Older Adults With Low Back Pain and Radiculopathy: A Matched Case-Control Study

Published:April 23, 2018DOI:


      • Older adults with CLBPR have poor energy efficiency and capacity
      • Prior work has shown that poor efficiency and capacity contribute to worse mobility
      • Future research should identify the underlying mechanisms to these energy deficits



      To investigate the impact that the presence of chronic low back pain with radiculopathy (CLBPR) may have on (1) energy efficiency and (2) energy capacity among community-dwelling older adults.


      Matched case-control study.


      Clinical research laboratory.


      Included in the analysis were community-dwelling older adults (N=38, 60-85 years) with and without CLBPR. Participants were matched between-groups on age (±5 years), sex, and diabetic status.


      Not applicable.

      Main Outcome Measures

      Energy cost of walking at self-selected speed (ie, energy efficiency) and peak volume of oxygen consumed (ie, energy capacity).


      Older adults with CLBPR had a higher energy cost of walking at self-selected speed (P=.009) and lower peak volume of oxygen consumed while walking (P=.050), compared to those without pain.


      Older adults with CLBPR may benefit from specific rehabilitative interventions that target these potentially modifiable energetic outcomes, thereby reducing the risk of mobility decline. Future studies should identify which mechanisms specifically contribute to diminished energy efficiency and capacity among older adults with CLBPR.


      List of abbreviations:

      BMI (body mass index), CLBPR (chronic low back pain with radiculopathy), Vo2 (volume of oxygen consumed), Vo2peak (peak volume of oxygen consumed)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hicks G.E.
        • Gaines J.M.
        • Shardell M.
        • Simonsick E.M.
        Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study.
        Arthritis Rheum. 2008; 59: 1306-1313
        • Lurie J.
        • Tomkins-Lane C.
        Management of lumbar spinal stenosis.
        BMJ. 2016; 352: h6234
        • Guralnik J.M.
        • Ferrucci L.
        • Simonsick E.M.
        • Salive M.E.
        • Wallace R.B.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Perera S.
        • Patel K.V.
        • Rosano C.
        • et al.
        Gait speed predicts incident disability: a pooled analysis.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 63-71
        • Schrack J.A.
        • Simonsick E.M.
        • Chaves P.H.
        • Ferrucci L.
        The role of energetic cost in the age-related slowing of gait speed.
        J Am Geriatr Soc. 2012; 60: 1811-1816
        • Schrack J.A.
        • Simonsick E.M.
        • Ferrucci L.
        The relationship of the energetic cost of slow walking and peak energy expenditure to gait speed in mid-to-late life.
        Am J Phys Med Rehabil. 2013; 92: 28-35
        • Schrack J.A.
        • Zipunnikov V.
        • Simonsick E.M.
        • Studenski S.
        • Ferrucci L.
        Rising energetic cost of walking predicts gait speed decline with aging.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 947-953
        • Gussoni M.
        • Margonato V.
        • Ventura R.
        • Veicsteinas A.
        Energy cost of walking with hip joint impairment.
        Phys Ther. 1990; 70: 295-301
        • Ko S.U.
        • Simonsick E.M.
        • Ferrucci L.
        Gait energetic efficiency in older adults with and without knee pain: results from the Baltimore Longitudinal Study of Aging.
        Age (Dordr). 2015; 37: 9754
        • Smeets R.J.
        • Wittink H.
        • Hidding A.
        • Knottnerus J.A.
        Do patients with chronic low back pain have a lower level of aerobic fitness than healthy controls?: are pain, disability, fear of injury, working status, or level of leisure time activity associated with the difference in aerobic fitness level?.
        Spine (Phila Pa 1976). 2006; 31 ([discussion 98]): 90-97
        • Coyle P.C.
        • Schrack J.A.
        • Hicks G.E.
        Pain energy model of mobility limitation in the older adult.
        Pain Med. 2017;
        • Battié M.C.
        • Jones C.A.
        • Schopflocher D.P.
        • Hu R.W.
        Health-related quality of life and comorbidities associated with lumbar spinal stenosis.
        Spine J. 2012; 12: 189-195
        • Schrack J.A.
        • Knuth N.D.
        • Simonsick E.M.
        • Ferrucci L.
        “IDEAL” aging is associated with lower resting metabolic rate: the Baltimore Longitudinal Study of Aging.
        J Am Geriatr Soc. 2014; 62: 667-672
        • Morey M.C.
        • Pieper C.F.
        • Cornoni-Huntley J.
        Is there a threshold between peak oxygen uptake and self-reported physical functioning in older adults?.
        Med Sci Sports Exerc. 1998; 30: 1223-1229
        • Hicks G.E.
        • Manal T.J.
        Psychometric properties of commonly used low back disability questionnaires: are they useful for older adults with low back pain?.
        Pain Med. 2009; 10: 85-94
        • Taylor L.J.
        • Harris J.
        • Epps C.D.
        • Herr K.
        Psychometric evaluation of selected pain intensity scales for use with cognitively impaired and cognitively intact older adults.
        Rehabil Nurs. 2005; 30: 55-61
        • Ramos-Jiménez A.
        • Hernández-Torres R.P.
        • Torres-Durán P.V.
        • et al.
        The respiratory exchange ratio is associated with fitness indicators both in trained and untrained men: a possible application for people with reduced exercise tolerance.
        Clin Med Circ Respirat Pulm Med. 2008; 2: 1-9
        • Simonsick E.M.
        • Fan E.
        • Fleg J.L.
        Estimating cardiorespiratory fitness in well-functioning older adults: treadmill validation of the long distance corridor walk.
        J Am Geriatr Soc. 2006; 54: 127-132
        • Schrack J.A.
        • Simonsick E.M.
        • Ferrucci L.
        The energetic pathway to mobility loss: an emerging new framework for longitudinal studies on aging.
        J Am Geriatr Soc. 2010; 58: S329-S336
        • Papadakis N.C.
        • Christakis D.G.
        • Tzagarakis G.N.
        • et al.
        Gait variability measurements in lumbar spinal stenosis patients: part B. Preoperative versus postoperative gait variability.
        Physiol Meas. 2009; 30: 1187-1195
        • Suda Y.
        • Saitou M.
        • Shibasaki K.
        • Yamazaki N.
        • Chiba K.
        • Toyama Y.
        Gait analysis of patients with neurogenic intermittent claudication.
        Spine (Phila Pa 1976). 2002; 27: 2509-2513
        • Larish D.D.
        • Martin P.E.
        • Mungiole M.
        Characteristic patterns of gait in the healthy old.
        Ann N Y Acad Sci. 1988; 515: 18-32
        • Perera S.
        • Mody S.H.
        • Woodman R.C.
        • Studenski S.A.
        Meaningful change and responsiveness in common physical performance measures in older adults.
        J Am Geriatr Soc. 2006; 54: 743-749
        • Brach J.S.
        • Lowry K.
        • Perera S.
        • et al.
        Improving motor control in walking: a randomized clinical trial in older adults with subclinical walking difficulty.
        Arch Phys Med Rehabil. 2015; 96: 388-394
        • Huang G.
        • Gibson C.A.
        • Tran Z.V.
        • Osness W.H.
        Controlled endurance exercise training and Vo2max changes in older adults: a meta-analysis.
        Prev Cardiol. 2005; 8: 217-225
        • Berryman N.
        • Gayda M.
        • Nigam A.
        • Juneau M.
        • Bherer L.
        • Bosquet L.
        Comparison of the metabolic energy cost of overground and treadmill walking in older adults.
        Eur J Appl Physiol. 2012; 112: 1613-1620
        • Parvataneni K.
        • Ploeg L.
        • Olney S.J.
        • Brouwer B.
        Kinematic, kinetic and metabolic parameters of treadmill versus overground walking in healthy older adults.
        Clin Biomech (Bristol, Avon). 2009; 24: 95-100