Relationship between risk of locomotive syndrome and low back pain in Japanese postpartum women: a cross-sectional study

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Locomotive syndrome is reportedly associated with low back pain and physical activity levels. However, the prevalence of locomotive syndrome and related factors in postpartum women have not been thoroughly investigated. Therefore, this study aimed to investigate the relationship between locomotive syndrome risk and low back pain and physical activity in postpartum women. Methods In this cross-sectional study, we included 86 women (30.0 ± 4.2 years) within 1 year postpartum. We assessed the locomotive syndrome risk using the stand-up test and 2-step test, physical activity using the International Physical Activity Questionnaire Short Form, and low back pain using the Oswestry Disability Index. The Oswestry Disability Index score and physical activity levels were compared between groups with and without the risk of locomotive syndrome. Results Overall, 45 women (52.3%) had a high risk of locomotive syndrome. The high-risk locomotive syndrome group had significantly higher Oswestry Disability Index [10 (0–26)] than the non-locomotive syndrome group [4 (0–24)] (p < 0.001). However, no significant difference was observed between the two groups in terms of age, number of births, or proportion of women with low physical activity levels. Conclusions The findings suggest that more than half of the women within 1 year after childbirth were at risk of locomotive syndrome, suggesting a relationship between locomotive syndrome and low back pain. Prevention of postnatal low back pain may necessitate addressing decline in prenatal motor function. The findings underscore the importance of early identification and intervention for locomotive syndrome risk in postpartum women to prevent future low back pain and improve mobility. postpartum locomotive syndrome low back pain physical activity Figures Figure 1 Figure 2 Figure 3 Background Pregnancy and childbirth can result in various physiological and anatomical changes, which may persist even after childbirth, thereby causing many physical symptoms such as low back pain (LBP) and muscle weakness [ 1 – 4 ]. LBP is a common symptom in prenatal and postpartum women, affecting approximately 50–80% of women during pregnancy [ 2 – 4 ]. While the symptoms may improve after childbirth in many women with LBP, a notable proportion (23%) of women with LBP during pregnancy remain symptomatic after childbirth, and 10% can develop LBP a decade later [ 5 , 6 ]. LBP persists after childbirth and impairs activities of daily living (ADL) and quality of life [ 7 ]. Therefore, postpartum women should understand and address the condition of locomotive organs. Exercise and physical activity (PA) are recommended for pregnant and postpartum women to reduce the risk of many pregnancy complications and promote overall health [ 8 ]. For example, the American College of Obstetrics and Gynecology (ACOG) recommends that women experiencing a healthy pregnancy should regularly engage in PA of moderate intensity for at least 20 to 30 min per day on most or all days of the week during pregnancy and the postpartum period [ 8 ]. Despite these recommendations, PA levels decrease in pregnant women [ 9 , 10 ], with only 3% of women reaching the level of PA recommended by ACOG [ 11 ]. After childbirth, PA returns to the level undertaken in the second trimester; however, although light PA may increase, moderate- and high-intensity PA decrease. Postpartum women undertake less PA and are more sedentary compared to non-postpartum counterparts [ 1 , 9 , 10 , 12 ]. Locomotive syndrome (LS) is a condition of reduced mobility due to impairment of locomotive organs, a concept proposed by the Japanese Orthopaedic Association (JOA) [ 13 , 14 ]. LS is diagnosed using the following three modalities: the stand-up test, 2-step test, and 25-question geriatric locomotive function scale (GLFS-25). LS is reportedly associated with LBP and PA [ 15 , 16 ]. A previous study reported that the prevalence of LS in young women was approximately 25% and that this prevalence increases concurrently with age [ 16 ]. In another study on nulliparous women in their 20s, only 43.6% of the participants met the reference values of the LS test score for Japanese women in their 20s [ 17 , 18 ]. Therefore, LS poses a risk not only in older adults but also in young women. Postpartum women need to maintain adequate mobility for childcare and rehabilitation and for preventing future falls and fractures. However, despite the fact that LBP and decreased prenatal PA could increase the risk of LS, the prevalence of LS and related factors in postpartum women within 1 year after delivery have not been investigated. Therefore, this study aimed to investigate LS prevalence in postpartum women and clarify factors associated with LS risk including LBP. To our best knowledge, this is the first study to investigate LS in postpartum women. Methods Participants In this cross-sectional study, the study participants were postpartum women who underwent childbirth within 1 year before enrollment. We recruited postpartum women at a local health event for pregnant and postpartum women in Aichi Prefecture, Japan, in February 2019. The inclusion criterion was an age > 20 years. We excluded pregnant women, women unable to understand the study explanation, and women with missing data. We explained our research aim and measurement items to the participants orally and in writing and obtained their written consent. Thereafter, the participants were asked to complete questionnaires and perform the LS risk tests (stand-up test and 2-step test), and their body composition was measured. Our questionnaire consisted of items on demographic data (age, height, weight, the period from the last birth, and number of births), the International Physical Activity Questionnaire Short Form (IPAQ-SF), and the Oswestry Disability Index (ODI) for assessing LBP assessment. All assessments were performed at the event venue where recruitment was conducted. LS risk test The main outcomes were the 2-step and stand-up test scores, which reflected the participants’ physical function. These tests were used to assess LS risk. The 2-step test involves measuring stride length in two steps. The participants were instructed to take two steps, each step as long as possible, and the measurement was recorded (Fig. 1 ). The 2-step test score was used to classify the LS risk level and was calculated using the following formula: length of the two steps (cm)/height (cm). In the stand-up test, the height of the lowest stool from which the participant could stand up from a sitting position using two legs or one leg was recorded. Stools of 40 cm and 20 cm heights were used. The participant was considered to have completed the trial if they succeeded in holding the final standing position for longer than 3 s without requiring any additional steps (Fig. 2 ). The criteria for LS Stage 2 were a 2-step test score < 1.1 or difficulty rising on both legs from a 20 cm-high stool in the stand-up test. The criteria for LS Stage 1 were a 2-step test score < 1.3 or difficulty rising on one leg from a 40 cm-high stool in the stand-up test (either leg) but the ability to rise on both legs from a 20 cm-high stool. Customarily, the LS test also includes the GLFS-25, a questionnaire focused on body pain and ADL in the most recent month. However, we did not administer this questionnaire in the present study, as it was originally developed for older people. A previous study revealed that the interquartile range of the GLFS-25 score was lower in women in their 20s and 30s than the cut-off points of LS Stage 1 [ 18 ]. Body composition Appendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis with a body composition analyzer (MC-780A, TANITA, Tokyo, Japan), and the skeletal muscle mass index (SMI; ASM [kg]/height 2 [m]) was calculated as an index of body composition. Body fat percentage and body mass index (BMI) were used as additional indices. PA The IPAQ-SF Japanese version is a valid and reliable assessment tool for PA [ 19 ]. The IPAQ-SF includes the frequency and duration (at least 10 min) of PA of high, moderate, and low intensity in a usual week and sedentary time during a typical day. PA level below 600 metabolic equivalent (MET) min/week was categorized as low PA, and that of more than 600 MET min/week was categorized as moderate and high PA. In addition, sedentary time in the IPAQ-SF was used as an index of inactivity. LBP The ODI is a disease-specific self-report outcome tool used to measure functional disability related to LBP [ 20 ], and the reliability and validity of the Japanese version have been reported [ 21 ]. The ODI consists of the following 10 items: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social functioning, and traveling. For each item, the participant rates the level of disability on a scale from 0 to 5. The final score is calculated as follows: (total score) ×100 / (5 × number of items answered). Scores range from 0 (no disability) to 100 (most severe disability). The cut-off value for functional disability due to LBP was set to 12 points based on a previous study [ 22 ]. Statistical analyses Participants who met the criteria for LS Stage 1 or 2 in either the 2-step or stand-up test were classified as the high-risk LS group, whereas those who did not were classified as the non-LS group. The Mann–Whitney U test was used to compare continuous data between the high-risk LS and non-LS groups. Categorical data are presented as number (percentage) and were assessed using the chi-square test. A P-value < .05 was considered significant. All analyses in this study were performed using IBM SPSS Statistics ver. 28 (IBM Corp, Armonk, NY, USA). Results In this study, we initially recruited 102 postpartum women, of whom 16 were excluded because of missing data (unanswered questionnaire items). The remaining 86 women were divided into the high-risk LS and non-LS groups (Fig. 3 . The mean age of all the participants was 30.0 ± 4.2 years, and 52.3% of the women had a high risk of LS. In the stand-up test, all 13 women who met the criteria for LS could stand up on both legs from a 20 cm-high stool and were classified as having LS Stage 1, and none of them were classified as having LS Stage 2. In the 2-step test, 30 women had a 2-step score < 1.3 (LS Stage 1), and three women had a 2-step score < 1.1 (LS Stage 2). Only one woman was at risk in both the stand-up and 2-step tests. The high-risk LS group had a significantly higher ODI than did the non-LS group. However, no significant difference was observed between the two groups in terms of age, BMI, the period from the last birth, number of births, low PA, sedentary time, SMI, and body fat percentage (Table 1 ). Comparing the subscale of the ODI between the two groups, the high-risk LS group had a significantly higher score for pain intensity and sitting (Table 2 ). Table 1 Characteristics of postnatal women with and without a high risk of locomotive syndrome Overall (n = 86) High-risk LS group (n = 45) Non-LS group (n = 41) p-value Age (years) 30 (21–40) 31 (21–40) 28 (25–39) 0.11 Body mass index (kg/m²) 20.1 (15.8–34.6) 20.3 (17.2–34.6) 19.9 (15.8–25) 0.22 Period since the last birth (months) 7 (1–11) 7 (1–10) 7 (2–11) 0.22 Number of births (number) 0.66 1 58 (67.4) 32 (71.1) 26 (63.4) 2 23 (26.7) 10 (22.2) 13 (31.7) 3 5 (5.8) 3 (6.7) 2 (4.9) ODI score (%) 7.5 (0–26) 10 (0–26) 4 (0–24) < 0.001 Low physical activity (number) 53 (61.6) 26 (57.8) 27 (65.8) 0.44 Sedentary time (min/day) 240 (30–1140) 225 (30–1140) 240 (60–900) 0.71 Skeletal muscle mass index (kg/m²) 6.7 (5.6–8.7) 6.7 (5.9–8.7) 6.7 (5.6–7.5) 0.81 Body fat percentage (%) 25.9 (12.9–48.6) 26.2 (17–48.6) 25.2 (12.9–35.8) 0.27 Stand-up test (number) 14 (16.2) 14 (31.1) 0 (0.0) < 0.001 2-step test (number) 33 (38.4) 33 (73.3) 0 (0.0) < 0.001 2-step test score 1.3 (1.0–1.5) 1.2 (1.0–1.5) 1.4 (1.3–1.5) < 0.001 LS: Locomotive syndrome, ODI: Oswestry Disability Index; Mann–Whitney U test, median (range): age, BMI, period from the last birth, ODI score, sedentary time, skeletal muscle mass index, body fat percentage, 2-step test score; Chi-square test, n (%): the number of births, low physical activity, and stand-up test Table 2 Subscale ODI score in postnatal women with and without a high risk of locomotive syndrome Overall (n = 86) High-risk LS group (n = 45) Non-LS group (n = 41) p-value Pain intensity 1 (0–4) 1 (0–4) 1 (0–3) 0.03 Personal care 0 (0–1) 0 (0–1) 0 (0–1) 0.74 Lifting 0 (0–2) 1 (0–2) 0 (0–2) 0.06 Walking 0 (0–1) 0 (0–1) 0 (0–1) 0.20 Sitting 1 (0–2) 1 (0–2) 0 (0–2) 0.02 Standing 1 (0–2) 1 (0–2) 0 (0–2) 0.09 Sleeping 0 (0–2) 0 (0–2) 0 (0–2) 0.33 Sex life 0 (0–5) (n = 71) 0 (0–5) (n = 33) 0 (0–1) (n = 38) 0.27 Social life 0 (0–2) (n = 82) 0 (0–2) (n = 40) 0 (0–1) (n = 42) 0.41 Traveling 0 (0–4) 0 (0–4) 0 (0–1) 0.09 ODI: Oswestry Disability Index, LS: Locomotive syndrome Mann–Whitney U test, median (range) Discussion In this study, we investigated prevalence of LS and explored factors associated with LS risk in postpartum women. We found that 52.3% of postpartum women within 1 year after childbirth had a high risk of LS, which is approximately twice the proportion of non-pregnant women in their 20s (24.5%) and 30s (26.5%) and close to the proportion of those in their 60s (53.5%) [ 23 ]. This underscores the increased likelihood of impaired mobility in postpartum women compared with that in other counterpart women of the same age. Many intervention studies aimed at improving LS have been conducted. Notably, studies on electrical muscle stimulation of the quadriceps in older women [ 24 ] and hip flexor muscle strengthening [ 25 ] have shown improvements in the 2-step test scores. Similarly, a study on middle-aged individuals who performed squats and open-eyed single-legged standing revealed improvements in the stand-up test score [ 26 ]. Furthermore, a study conducted among older women who exercised their trunk muscles using training equipment showed improvements in both the 2-step and stand-up test scores [ 27 ]. In the present study, 38.4% and 16.2% of the participants were classified as LS based on the 2-step and stand-up test, respectively, and only one participant met the criteria based on both tests. Although no significant difference was noted in the SMI, it may be possible to improve LS by changing the approach depending on which LS test’s criteria are met. In the present study, only LBP was associated with LS risk. Previous studies targeting young and middle adulthood have revealed that LBP is related to LS [ 15 , 16 ], suggesting LBP as a potential risk factor for LS, even in postpartum women. In terms of ADL, we suggested that the high-risk LS group was more significantly affected by pain than was the non-LS group, especially in the sitting position. In the stand-up test, starting from a sitting position might be influenced by LBP, potentially impacting the test results. A previous study has shown that the strength of the hip muscles, including the abductors and extensors, is decreased in individuals with non-specific chronic LBP [ 28 ]. These muscles are important for standing up or taking longer strides. In the present study, we did not examine the hip muscle strength; nonetheless, some participants with LBP might have had weakened hip muscles, which may have contributed to the LS risk. However, some participants with LS did not have LBP at the time of measurement. van Benten et al. reported that single-leg standing balance was reduced despite self-reported resolution of pregnancy-related pelvic girdle pain [ 29 ]. This suggests that even after having recovered from pelvic pain in the postpartum period, women may have difficulty in rising on one leg from a 40 cm-high stool or their maximum stride length may be reduced due to decline in their balance function, which may lead to LS. Although moderate-to-high PA levels were associated with a lower LS risk, we found no significant difference in PA levels between the high-risk LS and non-LS groups. Regarding PA, 61.6% of the women in this study had low PA levels, despite the ACOG recommendation for postpartum women [ 8 ]. In the non-LS group, 57% of the participants had a low PA level. Therefore, no significant difference was noted between the two groups in terms of PA levels. Most pregnant women decrease their PA levels throughout pregnancy [ 9 , 10 ], and PA levels remain low after giving birth [ 1 , 9 , 10 , 12 ]. Based on a previous study that identified determinants of changes in PA across the transition period to parenthood [ 30 ], possible barriers to postpartum PA include limited time owing to childcare or other tasks and physical difficulties such as pelvic floor disorder. Pelvic floor disorder is a common postpartum symptom, and many postpartum women experience urinary incontinence. Pelvic floor symptoms are considered a barrier to exercise participation [ 31 ]. However, provision of accurate information from a medical professional can facilitate PA during pregnancy and after childbirth. Therefore, medical professionals, including obstetricians, midwives, and physiotherapists, should develop approaches to increase PA of pregnant and postpartum women. In particular, it may be difficult for postpartum women to balance childcare responsibilities and find time for exercise. In this study, no significant relationship was observed between LS risk and PA levels; however, the PA of mothers with children should be increased, as most women have low PA levels after childbirth. This study has several limitations. First, the study design was cross-sectional, and the causal relationship between LS risk and LBP is unknown. Second, we did not obtain GLFS-25 data; therefore, the results of only few previous studies can be compared to those of our study. Third, the participants were recruited at a local health event, potentially excluding women with severe LBP. Finally, the JOA revised the clinical decision limits and introduced a new LS stage, Stage 3, in 2020 [ 32 ]; there were only two stages when we conducted this survey in 2018. Hence, the highest stage in this report was Stage 2. However, the present study indicates that decreased locomotive function before or during pregnancy may be a contributing factor to LBP. Medical professionals, including obstetricians, midwives, and physiotherapists, should be vigilant in assessing LS risk among postpartum women and provide appropriate interventions to promote mobility and overall health. Further validation, including intervention studies to prevent the decline in locomotive function before pregnancy as this may prevent LBP after childbirth, is needed. Conclusion This study demonstrated that 52.3% of postpartum women within 1 year after childbirth were at risk of LS, suggesting a relationship between LS risk and LBP. The high prevalence of LS among postpartum women underscores the importance of early detection and intervention strategies to prevent or mitigate LS-related impairments in mobility. Future research should focus on longitudinal studies to establish causality between LBP and LS risk in postpartum women. Abbreviations LBP low back pain ADL activities of daily living PA physical activity ACOG the American College of Obstetrics and Gynecology LS locomotive syndrome JOA the Japanese Orthopaedic Association GLFS-25 the 25-question geriatric locomotive function scale IPAQ-SF International Physical Activity Questionnaire Short Form ODI Oswestry Disability Index ASM appendicular skeletal muscle mass SMI skeletal muscle mass index BMI body mass index IPAQ-SF, International Physical Activity Questionnaire Short Form MET, metabolic equivalent Declarations Ethics approval and consent to participate Written informed consent was obtained from each participant per the guidelines approved by the Research Ethics Committee and the Declaration of Human Rights (Helsinki, 1975). The study protocol was approved by the Research Ethics Committees of Kyoto University (approval number R1840) and Kio University (approval number R1-01). Consent for publication Written informed consent for use was obtained from the model in the pictures. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors’ contributions YK, DM, and TI proposed the research ideas, and YK, DM, TI, MT, and TA designed the study. YK, DM, TI, and RK carried out the studies and drafted the manuscript. MT and TA revised the manuscript. All authors have read and approved the final manuscript. Acknowledgements The authors are especially grateful to all the participants for their willingness to participate in the study. We thank the staff of “HAPPY MAMA FESTA” for assisting with this study. We are also grateful to the members of Kio University, Kyoto University, and Nagoya University for their helpful suggestions and their help carrying out the measurements. References Deering RE, Cruz M, Senefeld JW, Pashibin T, Eickmeyer S, Hunter SK. Impaired trunk flexor strength, fatigability, and steadiness in postpartum women. Med Sci Sports Exerc. 2018;50:1558–69. Fast A, Shapiro D, Ducommun EJ, Friedmann LW, Bouklas T, Floman Y. Low-back pain in pregnancy. Spine (Phila Pa 1976). 1987;12:368–71. Orvieto R, Achiron A, Ben-Rafael Z, Gelernter I, Achiron R. Low-back pain of pregnancy. Acta Obstet Gynecol Scand. 1994;73:209–14. Morino S, Ishihara M, Umezaki F, Hatanaka H, Iijima H, Yamashita M, et al. Low back pain and causative movements in pregnancy: a prospective cohort study. BMC Musculoskelet Disord. 2017;18:416. Norén L, Ostgaard S, Johansson G, Ostgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J. 2002;11:267–71. Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard HC. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord. 2016;17:276. Gutke A, Lundberg M, Östgaard HC, Öberg B. Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. Eur Spine J. 2011;20:440–8. Physical activity and. exercise during pregnancy and the postpartum period: ACOG Committee Opinion. Obstet Gynecol. 2020;135:e178–88. Hesketh KR, Evenson KR, Stroo M, Clancy SM, Østbye T, Benjamin-Neelon SE. Physical activity and sedentary behavior during pregnancy and postpartum, measured using hip and wrist-worn accelerometers. Prev Med Rep. 2018;10:337–45. Borodulin K, Evenson KR, Herring AH. Physical activity patterns during pregnancy through postpartum. BMC Womens Health. 2009;9:32. Borodulin KM, Evenson KR, Wen F, Herring AH, Benson AM. Physical activity patterns during pregnancy. Med Sci Sports Exerc. 2008;40:1901–8. Evenson KR, Herring AH, Wen F. Self-Reported and objectively measured physical activity among a cohort of postpartum women: the PIN Postpartum Study. J Phys Act Health. 2012;9:5–20. Nakamura K. A super-aged society and the locomotive syndrome. J Orthop Sci. 2008;13:1–2. Nakamura K, Ogata T. Locomotive syndrome: definition and management. Clin Rev Bone Min Metab. 2016;14:56–67. Hirano K, Imagama S, Hasegawa Y, Ito Z, Muramoto A, Ishiguro N. The influence of locomotive syndrome on health-related quality of life in a community-living population. Mod Rheumatol. 2013;23:939–44. Nishimura A, Ohtsuki M, Kato T, Nagao R, Ito N, Kato K, et al. Locomotive syndrome testing in young and middle adulthood. Mod Rheumatol. 2020;30:178–83. Uesugi Y, Kanaya S, Nakanishi H, Naito Y. The relationship between locomotive syndrome risk, gait pattern, and standing posture in young Japanese women: a cross-sectional study. Healthc (Basel). 2020;8:565. Yamada K, Ito YM, Akagi M, Chosa E, Fuji T, Hirano K, et al. Reference values for the locomotive syndrome risk test quantifying mobility of 8681 adults aged 20–89 years: a cross-sectional nationwide study in Japan. J Orthop Sci. 2020;25:1084–92. Murase N, Katsumura T, Ueda C, Inoue S, Shimomitsu T. Validity and reliability of the Japanese version of the International Physical Activity Questionnaire. J Health Welf Stat. 2002;49:1–9. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25:2940-52. Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K. Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Short-Form 36. Spine (Phila Pa 1976). 2003;28:1601–7. Tonosu J, Takeshita K, Hara N, Matsudaira K, Kato S, Masuda K, et al. The normative score and the cut-off value of the Oswestry Disability Index (ODI). Eur Spine J. 2012;21:1596–602. Yoshinaga S, Shiomitsu T, Kamohara M, Fujii Y, Chosa E, Tsuruta K. Lifestyle-related signs of locomotive syndrome in the general Japanese population: a cross-sectional study. J Orthop Sci. 2019;24:1105–9. Nishikawa Y, Watanabe K, Kawade S, Takahashi T, Kimura H, Maruyama H, et al. The effect of a portable electrical muscle stimulation device at home on muscle strength and activation patterns in locomotive syndrome patients: a randomized control trial. J Electromyogr Kinesiol. 2019;45:46–52. Sato H, Kondo S, Saito M, Saura R. Effects of strengthening the hip flexor muscles on walking ability and the locomotive syndrome rank test: an intervention study. J Orthop Sci. 2020;25:892–6. Nishimura A, Ohtsuki M, Kato T, Nagao-Nishiwaki R, Senga Y, Kato K, et al. Is locomotion training effective for middle-aged workers? J Occup Health. 2021;63:e12303. Kato S, Demura S, Kurokawa Y, Takahashi N, Shinmura K, Yokogawa N, et al. Efficacy and safety of abdominal trunk muscle strengthening using an innovative device in elderly patients with chronic low back pain: a pilot study. Ann Rehabil Med. 2020;44:246–55. Pizol GZ, Ferro Moura Franco K, Cristiane Miyamoto G, Nunes Cabral CM. Is there hip muscle weakness in adults with chronic non-specific low back pain? A cross-sectional study. BMC Musculoskelet Disord. 2023;24:798. van Benten E, Coppieters MW, Pool JJM, Pool-Goudzwaard AL. Differences in balance control despite self-reported resolution of pregnancy-related pelvic girdle pain. a cross-sectional study. Musculoskelet Sci Pract. 2022;62:102620. Versele V, Stok FM, Dieberger A, Deliens T, Aerenhouts D, Deforche B, et al. Determinants of changes in women’s and men’s physical activity and sedentary behavior across the transition to parenthood: a focus group study. Int J Environ Res Public Health. 2022;19:2421. Dakic JG, Cook J, Hay-Smith J, Lin KY, Ekegren C, Frawley HC. Pelvic floor symptoms are an overlooked barrier to exercise participation: a cross-sectional online survey of 4556 women who are symptomatic. Phys Ther. 2022;102:pzab284. Locomotive Challenge Council. Locomotive syndrome. In: Locomotive Challenge Council, Locomotive syndrome pamphlet 2020. Japanese Orthopaedic Association. 2020. https://locomo-joa.jp . Accessed 30 Apr 2023. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4147568","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285697254,"identity":"f3bb4dd6-9265-4d1a-b6a6-8d2f9cfbd1f5","order_by":0,"name":"Yuu Kajiwara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYFACNgYGCQMQg/kwQwJEKIFYLWzJJGiBAB5j4pxlcIAt8YNFwWF58/Yznw0eVDDI8zcwPHtAQMthCQmDw4ZzzuRuTkg4w2A44wBDugF+LewNQC23GWcw5G4+kNjGwLiBgSFNgoCW5h9ALfYz+N88BmmxJ0IL2zGQLYkzJHKYE4BaEglqkTzMlmYhYfA/eYbEM2ODhDMSyTMOE/AL3/E249sSf9JsZ/AnP5b8UWFj29/ek/YAnxaFw8BoR3IHkMnMk4ZPB4N8AwMD4wdUMfZjeLWMglEwCkbBiAMA5JZGo6TMigYAAAAASUVORK5CYII=","orcid":"","institution":"Kio University","correspondingAuthor":true,"prefix":"","firstName":"Yuu","middleName":"","lastName":"Kajiwara","suffix":""},{"id":285697255,"identity":"6941fd00-bf9f-41f8-8efe-aaf4c639cc97","order_by":1,"name":"Daisuke Matsumoto","email":"","orcid":"","institution":"Kio University","correspondingAuthor":false,"prefix":"","firstName":"Daisuke","middleName":"","lastName":"Matsumoto","suffix":""},{"id":285697256,"identity":"edcf02ae-05fc-40f6-9833-655bf3334199","order_by":2,"name":"Tomoe Inoue-Hirakawa","email":"","orcid":"","institution":"Nagoya University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tomoe","middleName":"","lastName":"Inoue-Hirakawa","suffix":""},{"id":285697257,"identity":"6c6addf5-9002-4091-9b59-143b577b02f3","order_by":3,"name":"Rika Kawabe","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Rika","middleName":"","lastName":"Kawabe","suffix":""},{"id":285697258,"identity":"8f6b85a1-1e5a-4c48-a175-3ceff1588a48","order_by":4,"name":"Momoko Nagai-Tanima","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Momoko","middleName":"","lastName":"Nagai-Tanima","suffix":""},{"id":285697259,"identity":"e4d027c2-967a-45bc-9759-bf0ee9ce5d9a","order_by":5,"name":"Tomoki Aoyama","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Tomoki","middleName":"","lastName":"Aoyama","suffix":""}],"badges":[],"createdAt":"2024-03-22 06:44:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4147568/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4147568/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53842606,"identity":"67ae1f5d-e653-414a-a52f-13187b1eba11","added_by":"auto","created_at":"2024-04-01 07:47:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":733763,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTwo-step test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants are instructed to take two steps, each step as long as possible, and the length of two steps from toes to toes is recorded. The 2-step score is used to classify the LS risk level and is calculated using the following formula: length of the two steps (cm)/height (cm). A 2-step score of ≥1.3 indicates “no risk of LS”. LS Stage 1 is defined as 2-step score \u0026lt;1.3, while LS Stage 2 is defined as 2-step score \u0026lt;1.1.\u003c/p\u003e\n\u003cp\u003eLS: locomotive syndrome\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4147568/v1/3baddc37ad0ca5d0e777185b.png"},{"id":53842605,"identity":"9cbb1b6f-ce2f-4f7e-8a5f-d8cfec4f174e","added_by":"auto","created_at":"2024-04-01 07:47:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":870048,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStand-up test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(a) For test A, participants show no risk in completing the task. The criterion for LS Stage 1 is difficulty in completing the test A (either leg) but being able to complete (b) test B. The criterion for LS Stage 2 is difficulty in completing test B.\u003c/p\u003e\n\u003cp\u003eLS: locomotive syndrome\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4147568/v1/1af5bc7f70b3eebac103b76e.png"},{"id":53842607,"identity":"c07cc60f-3596-40d0-897d-709fb16efa6e","added_by":"auto","created_at":"2024-04-01 07:47:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":27696,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of participant inclusion, exclusion, and grouping\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStand-up test: The number of persons who cannot stand up on a single leg from a stool with a 40-cm height\u003c/p\u003e\n\u003cp\u003eTwo-step test: The number of persons with a 2-step test score \u0026lt; 1\u003c/p\u003e\n\u003cp\u003eLS: locomotive syndrome\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4147568/v1/1b16202ef33f72ce2c46dfaf.png"},{"id":57888198,"identity":"ce767ab2-02f8-4747-b205-24e9d9f22ade","added_by":"auto","created_at":"2024-06-07 05:38:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2224034,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4147568/v1/833db95d-72ea-44b7-abce-3ecb03d53450.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between risk of locomotive syndrome and low back pain in Japanese postpartum women: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003ePregnancy and childbirth can result in various physiological and anatomical changes, which may persist even after childbirth, thereby causing many physical symptoms such as low back pain (LBP) and muscle weakness [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. LBP is a common symptom in prenatal and postpartum women, affecting approximately 50\u0026ndash;80% of women during pregnancy [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While the symptoms may improve after childbirth in many women with LBP, a notable proportion (23%) of women with LBP during pregnancy remain symptomatic after childbirth, and 10% can develop LBP a decade later [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. LBP persists after childbirth and impairs activities of daily living (ADL) and quality of life [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, postpartum women should understand and address the condition of locomotive organs.\u003c/p\u003e \u003cp\u003eExercise and physical activity (PA) are recommended for pregnant and postpartum women to reduce the risk of many pregnancy complications and promote overall health [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. For example, the American College of Obstetrics and Gynecology (ACOG) recommends that women experiencing a healthy pregnancy should regularly engage in PA of moderate intensity for at least 20 to 30 min per day on most or all days of the week during pregnancy and the postpartum period [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite these recommendations, PA levels decrease in pregnant women [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], with only 3% of women reaching the level of PA recommended by ACOG [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. After childbirth, PA returns to the level undertaken in the second trimester; however, although light PA may increase, moderate- and high-intensity PA decrease. Postpartum women undertake less PA and are more sedentary compared to non-postpartum counterparts [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLocomotive syndrome (LS) is a condition of reduced mobility due to impairment of locomotive organs, a concept proposed by the Japanese Orthopaedic Association (JOA) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. LS is diagnosed using the following three modalities: the stand-up test, 2-step test, and 25-question geriatric locomotive function scale (GLFS-25). LS is reportedly associated with LBP and PA [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A previous study reported that the prevalence of LS in young women was approximately 25% and that this prevalence increases concurrently with age [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In another study on nulliparous women in their 20s, only 43.6% of the participants met the reference values of the LS test score for Japanese women in their 20s [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, LS poses a risk not only in older adults but also in young women. Postpartum women need to maintain adequate mobility for childcare and rehabilitation and for preventing future falls and fractures. However, despite the fact that LBP and decreased prenatal PA could increase the risk of LS, the prevalence of LS and related factors in postpartum women within 1 year after delivery have not been investigated. Therefore, this study aimed to investigate LS prevalence in postpartum women and clarify factors associated with LS risk including LBP. To our best knowledge, this is the first study to investigate LS in postpartum women.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, the study participants were postpartum women who underwent childbirth within 1 year before enrollment. We recruited postpartum women at a local health event for pregnant and postpartum women in Aichi Prefecture, Japan, in February 2019. The inclusion criterion was an age\u0026thinsp;\u0026gt;\u0026thinsp;20 years. We excluded pregnant women, women unable to understand the study explanation, and women with missing data. We explained our research aim and measurement items to the participants orally and in writing and obtained their written consent. Thereafter, the participants were asked to complete questionnaires and perform the LS risk tests (stand-up test and 2-step test), and their body composition was measured. Our questionnaire consisted of items on demographic data (age, height, weight, the period from the last birth, and number of births), the International Physical Activity Questionnaire Short Form (IPAQ-SF), and the Oswestry Disability Index (ODI) for assessing LBP assessment. All assessments were performed at the event venue where recruitment was conducted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eLS risk test\u003c/h2\u003e \u003cp\u003eThe main outcomes were the 2-step and stand-up test scores, which reflected the participants\u0026rsquo; physical function. These tests were used to assess LS risk. The 2-step test involves measuring stride length in two steps. The participants were instructed to take two steps, each step as long as possible, and the measurement was recorded (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The 2-step test score was used to classify the LS risk level and was calculated using the following formula: length of the two steps (cm)/height (cm). In the stand-up test, the height of the lowest stool from which the participant could stand up from a sitting position using two legs or one leg was recorded. Stools of 40 cm and 20 cm heights were used. The participant was considered to have completed the trial if they succeeded in holding the final standing position for longer than 3 s without requiring any additional steps (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The criteria for LS Stage 2 were a 2-step test score\u0026thinsp;\u0026lt;\u0026thinsp;1.1 or difficulty rising on both legs from a 20 cm-high stool in the stand-up test. The criteria for LS Stage 1 were a 2-step test score\u0026thinsp;\u0026lt;\u0026thinsp;1.3 or difficulty rising on one leg from a 40 cm-high stool in the stand-up test (either leg) but the ability to rise on both legs from a 20 cm-high stool.\u003c/p\u003e \u003cp\u003eCustomarily, the LS test also includes the GLFS-25, a questionnaire focused on body pain and ADL in the most recent month. However, we did not administer this questionnaire in the present study, as it was originally developed for older people. A previous study revealed that the interquartile range of the GLFS-25 score was lower in women in their 20s and 30s than the cut-off points of LS Stage 1 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eBody composition\u003c/h2\u003e \u003cp\u003eAppendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis with a body composition analyzer (MC-780A, TANITA, Tokyo, Japan), and the skeletal muscle mass index (SMI; ASM [kg]/height\u003csup\u003e2\u003c/sup\u003e [m]) was calculated as an index of body composition. Body fat percentage and body mass index (BMI) were used as additional indices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePA\u003c/h2\u003e \u003cp\u003eThe IPAQ-SF Japanese version is a valid and reliable assessment tool for PA [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The IPAQ-SF includes the frequency and duration (at least 10 min) of PA of high, moderate, and low intensity in a usual week and sedentary time during a typical day. PA level below 600 metabolic equivalent (MET) min/week was categorized as low PA, and that of more than 600 MET min/week was categorized as moderate and high PA. In addition, sedentary time in the IPAQ-SF was used as an index of inactivity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eLBP\u003c/h2\u003e \u003cp\u003eThe ODI is a disease-specific self-report outcome tool used to measure functional disability related to LBP [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and the reliability and validity of the Japanese version have been reported [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The ODI consists of the following 10 items: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social functioning, and traveling. For each item, the participant rates the level of disability on a scale from 0 to 5. The final score is calculated as follows: (total score) \u0026times;100 / (5 \u0026times; number of items answered). Scores range from 0 (no disability) to 100 (most severe disability). The cut-off value for functional disability due to LBP was set to 12 points based on a previous study [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eParticipants who met the criteria for LS Stage 1 or 2 in either the 2-step or stand-up test were classified as the high-risk LS group, whereas those who did not were classified as the non-LS group. The Mann\u0026ndash;Whitney U test was used to compare continuous data between the high-risk LS and non-LS groups. Categorical data are presented as number (percentage) and were assessed using the chi-square test. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;.05 was considered significant. All analyses in this study were performed using IBM SPSS Statistics ver. 28 (IBM Corp, Armonk, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, we initially recruited 102 postpartum women, of whom 16 were excluded because of missing data (unanswered questionnaire items). The remaining 86 women were divided into the high-risk LS and non-LS groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The mean age of all the participants was 30.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 years, and 52.3% of the women had a high risk of LS. In the stand-up test, all 13 women who met the criteria for LS could stand up on both legs from a 20 cm-high stool and were classified as having LS Stage 1, and none of them were classified as having LS Stage 2. In the 2-step test, 30 women had a 2-step score\u0026thinsp;\u0026lt;\u0026thinsp;1.3 (LS Stage 1), and three women had a 2-step score\u0026thinsp;\u0026lt;\u0026thinsp;1.1 (LS Stage 2). Only one woman was at risk in both the stand-up and 2-step tests.\u003c/p\u003e \u003cp\u003eThe high-risk LS group had a significantly higher ODI than did the non-LS group. However, no significant difference was observed between the two groups in terms of age, BMI, the period from the last birth, number of births, low PA, sedentary time, SMI, and body fat percentage (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Comparing the subscale of the ODI between the two groups, the high-risk LS group had a significantly higher score for pain intensity and sitting (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of postnatal women with and without a high risk of locomotive syndrome\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-risk LS group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-LS group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (21\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (21\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (25\u0026ndash;39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.1 (15.8\u0026ndash;34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.3 (17.2\u0026ndash;34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.9 (15.8\u0026ndash;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriod since the last birth (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (1\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (1\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (2\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of births (number)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (71.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (63.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI score (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5 (0\u0026ndash;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (0\u0026ndash;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (0\u0026ndash;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow physical activity (number)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (61.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedentary time (min/day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e240 (30\u0026ndash;1140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225 (30\u0026ndash;1140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e240 (60\u0026ndash;900)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkeletal muscle mass index (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.7 (5.6\u0026ndash;8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7 (5.9\u0026ndash;8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7 (5.6\u0026ndash;7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody fat percentage (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.9 (12.9\u0026ndash;48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.2 (17\u0026ndash;48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.2 (12.9\u0026ndash;35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStand-up test (number)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-step test (number)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-step test score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3 (1.0\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2 (1.0\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 (1.3\u0026ndash;1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eLS: Locomotive syndrome, ODI: Oswestry Disability Index; Mann\u0026ndash;Whitney U test, median (range): age, BMI, period from the last birth, ODI score, sedentary time, skeletal muscle mass index, body fat percentage, 2-step test score; Chi-square test, n (%): the number of births, low physical activity, and stand-up test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSubscale ODI score in postnatal women with and without a high risk of locomotive syndrome\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-risk LS group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-LS group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLifting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSitting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStanding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleeping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;5)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;5)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraveling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eODI: Oswestry Disability Index, LS: Locomotive syndrome\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eMann\u0026ndash;Whitney U test, median (range)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eIn this study, we investigated prevalence of LS and explored factors associated with LS risk in postpartum women. We found that 52.3% of postpartum women within 1 year after childbirth had a high risk of LS, which is approximately twice the proportion of non-pregnant women in their 20s (24.5%) and 30s (26.5%) and close to the proportion of those in their 60s (53.5%) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This underscores the increased likelihood of impaired mobility in postpartum women compared with that in other counterpart women of the same age.\u003c/p\u003e \u003cp\u003eMany intervention studies aimed at improving LS have been conducted. Notably, studies on electrical muscle stimulation of the quadriceps in older women [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and hip flexor muscle strengthening [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] have shown improvements in the 2-step test scores. Similarly, a study on middle-aged individuals who performed squats and open-eyed single-legged standing revealed improvements in the stand-up test score [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Furthermore, a study conducted among older women who exercised their trunk muscles using training equipment showed improvements in both the 2-step and stand-up test scores [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In the present study, 38.4% and 16.2% of the participants were classified as LS based on the 2-step and stand-up test, respectively, and only one participant met the criteria based on both tests. Although no significant difference was noted in the SMI, it may be possible to improve LS by changing the approach depending on which LS test\u0026rsquo;s criteria are met.\u003c/p\u003e \u003cp\u003eIn the present study, only LBP was associated with LS risk. Previous studies targeting young and middle adulthood have revealed that LBP is related to LS [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], suggesting LBP as a potential risk factor for LS, even in postpartum women. In terms of ADL, we suggested that the high-risk LS group was more significantly affected by pain than was the non-LS group, especially in the sitting position. In the stand-up test, starting from a sitting position might be influenced by LBP, potentially impacting the test results. A previous study has shown that the strength of the hip muscles, including the abductors and extensors, is decreased in individuals with non-specific chronic LBP [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These muscles are important for standing up or taking longer strides. In the present study, we did not examine the hip muscle strength; nonetheless, some participants with LBP might have had weakened hip muscles, which may have contributed to the LS risk.\u003c/p\u003e \u003cp\u003eHowever, some participants with LS did not have LBP at the time of measurement. van Benten et al. reported that single-leg standing balance was reduced despite self-reported resolution of pregnancy-related pelvic girdle pain [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This suggests that even after having recovered from pelvic pain in the postpartum period, women may have difficulty in rising on one leg from a 40 cm-high stool or their maximum stride length may be reduced due to decline in their balance function, which may lead to LS.\u003c/p\u003e \u003cp\u003eAlthough moderate-to-high PA levels were associated with a lower LS risk, we found no significant difference in PA levels between the high-risk LS and non-LS groups. Regarding PA, 61.6% of the women in this study had low PA levels, despite the ACOG recommendation for postpartum women [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the non-LS group, 57% of the participants had a low PA level. Therefore, no significant difference was noted between the two groups in terms of PA levels. Most pregnant women decrease their PA levels throughout pregnancy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and PA levels remain low after giving birth [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Based on a previous study that identified determinants of changes in PA across the transition period to parenthood [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], possible barriers to postpartum PA include limited time owing to childcare or other tasks and physical difficulties such as pelvic floor disorder. Pelvic floor disorder is a common postpartum symptom, and many postpartum women experience urinary incontinence. Pelvic floor symptoms are considered a barrier to exercise participation [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, provision of accurate information from a medical professional can facilitate PA during pregnancy and after childbirth. Therefore, medical professionals, including obstetricians, midwives, and physiotherapists, should develop approaches to increase PA of pregnant and postpartum women. In particular, it may be difficult for postpartum women to balance childcare responsibilities and find time for exercise. In this study, no significant relationship was observed between LS risk and PA levels; however, the PA of mothers with children should be increased, as most women have low PA levels after childbirth.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the study design was cross-sectional, and the causal relationship between LS risk and LBP is unknown. Second, we did not obtain GLFS-25 data; therefore, the results of only few previous studies can be compared to those of our study. Third, the participants were recruited at a local health event, potentially excluding women with severe LBP. Finally, the JOA revised the clinical decision limits and introduced a new LS stage, Stage 3, in 2020 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]; there were only two stages when we conducted this survey in 2018. Hence, the highest stage in this report was Stage 2. However, the present study indicates that decreased locomotive function before or during pregnancy may be a contributing factor to LBP. Medical professionals, including obstetricians, midwives, and physiotherapists, should be vigilant in assessing LS risk among postpartum women and provide appropriate interventions to promote mobility and overall health. Further validation, including intervention studies to prevent the decline in locomotive function before pregnancy as this may prevent LBP after childbirth, is needed.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that 52.3% of postpartum women within 1 year after childbirth were at risk of LS, suggesting a relationship between LS risk and LBP. The high prevalence of LS among postpartum women underscores the importance of early detection and intervention strategies to prevent or mitigate LS-related impairments in mobility. Future research should focus on longitudinal studies to establish causality between LBP and LS risk in postpartum women.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elow back pain\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eactivities of daily living\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ephysical activity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACOG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe American College of Obstetrics and Gynecology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elocomotive syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJOA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe Japanese Orthopaedic Association\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGLFS-25\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ethe 25-question geriatric locomotive function scale\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIPAQ-SF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Physical Activity Questionnaire Short Form\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eODI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOswestry Disability Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eappendicular skeletal muscle mass\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eskeletal muscle mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIPAQ-SF, International Physical Activity Questionnaire Short Form\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMET, metabolic equivalent\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from each participant per the guidelines approved by the Research Ethics Committee and the Declaration of Human Rights (Helsinki, 1975). The study protocol was approved by the Research Ethics Committees of Kyoto University (approval number R1840) and Kio University (approval number R1-01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for use was obtained from the model in the pictures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYK, DM, and TI proposed the research ideas, and YK, DM, TI, MT, and TA designed the study. YK, DM, TI, and RK carried out the studies and drafted the manuscript. MT and TA revised the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are especially grateful to all the participants for their willingness to participate in the study. We thank the staff of \u0026ldquo;HAPPY MAMA FESTA\u0026rdquo; for assisting with this study. We are also grateful to the members of Kio University, Kyoto University, and Nagoya University for their helpful suggestions and their help carrying out the measurements.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDeering RE, Cruz M, Senefeld JW, Pashibin T, Eickmeyer S, Hunter SK. Impaired trunk flexor strength, fatigability, and steadiness in postpartum women. Med Sci Sports Exerc. 2018;50:1558\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFast A, Shapiro D, Ducommun EJ, Friedmann LW, Bouklas T, Floman Y. Low-back pain in pregnancy. Spine (Phila Pa 1976). 1987;12:368\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrvieto R, Achiron A, Ben-Rafael Z, Gelernter I, Achiron R. Low-back pain of pregnancy. Acta Obstet Gynecol Scand. 1994;73:209\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorino S, Ishihara M, Umezaki F, Hatanaka H, Iijima H, Yamashita M, et al. Low back pain and causative movements in pregnancy: a prospective cohort study. BMC Musculoskelet Disord. 2017;18:416.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNor\u0026eacute;n L, Ostgaard S, Johansson G, Ostgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J. 2002;11:267\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard HC. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord. 2016;17:276.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGutke A, Lundberg M, \u0026Ouml;stgaard HC, \u0026Ouml;berg B. Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. Eur Spine J. 2011;20:440\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhysical activity and. exercise during pregnancy and the postpartum period: ACOG Committee Opinion. Obstet Gynecol. 2020;135:e178\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHesketh KR, Evenson KR, Stroo M, Clancy SM, \u0026Oslash;stbye T, Benjamin-Neelon SE. Physical activity and sedentary behavior during pregnancy and postpartum, measured using hip and wrist-worn accelerometers. Prev Med Rep. 2018;10:337\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorodulin K, Evenson KR, Herring AH. Physical activity patterns during pregnancy through postpartum. BMC Womens Health. 2009;9:32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorodulin KM, Evenson KR, Wen F, Herring AH, Benson AM. Physical activity patterns during pregnancy. Med Sci Sports Exerc. 2008;40:1901\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvenson KR, Herring AH, Wen F. Self-Reported and objectively measured physical activity among a cohort of postpartum women: the PIN Postpartum Study. J Phys Act Health. 2012;9:5\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakamura K. A super-aged society and the locomotive syndrome. J Orthop Sci. 2008;13:1\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakamura K, Ogata T. Locomotive syndrome: definition and management. Clin Rev Bone Min Metab. 2016;14:56\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirano K, Imagama S, Hasegawa Y, Ito Z, Muramoto A, Ishiguro N. The influence of locomotive syndrome on health-related quality of life in a community-living population. Mod Rheumatol. 2013;23:939\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishimura A, Ohtsuki M, Kato T, Nagao R, Ito N, Kato K, et al. Locomotive syndrome testing in young and middle adulthood. Mod Rheumatol. 2020;30:178\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUesugi Y, Kanaya S, Nakanishi H, Naito Y. The relationship between locomotive syndrome risk, gait pattern, and standing posture in young Japanese women: a cross-sectional study. Healthc (Basel). 2020;8:565.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamada K, Ito YM, Akagi M, Chosa E, Fuji T, Hirano K, et al. Reference values for the locomotive syndrome risk test quantifying mobility of 8681 adults aged 20\u0026ndash;89 years: a cross-sectional nationwide study in Japan. J Orthop Sci. 2020;25:1084\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurase N, Katsumura T, Ueda C, Inoue S, Shimomitsu T. Validity and reliability of the Japanese version of the International Physical Activity Questionnaire. J Health Welf Stat. 2002;49:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25:2940-52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K. Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Short-Form 36. Spine (Phila Pa 1976). 2003;28:1601\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTonosu J, Takeshita K, Hara N, Matsudaira K, Kato S, Masuda K, et al. The normative score and the cut-off value of the Oswestry Disability Index (ODI). Eur Spine J. 2012;21:1596\u0026ndash;602.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoshinaga S, Shiomitsu T, Kamohara M, Fujii Y, Chosa E, Tsuruta K. Lifestyle-related signs of locomotive syndrome in the general Japanese population: a cross-sectional study. J Orthop Sci. 2019;24:1105\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishikawa Y, Watanabe K, Kawade S, Takahashi T, Kimura H, Maruyama H, et al. The effect of a portable electrical muscle stimulation device at home on muscle strength and activation patterns in locomotive syndrome patients: a randomized control trial. J Electromyogr Kinesiol. 2019;45:46\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSato H, Kondo S, Saito M, Saura R. Effects of strengthening the hip flexor muscles on walking ability and the locomotive syndrome rank test: an intervention study. J Orthop Sci. 2020;25:892\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishimura A, Ohtsuki M, Kato T, Nagao-Nishiwaki R, Senga Y, Kato K, et al. Is locomotion training effective for middle-aged workers? J Occup Health. 2021;63:e12303.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKato S, Demura S, Kurokawa Y, Takahashi N, Shinmura K, Yokogawa N, et al. Efficacy and safety of abdominal trunk muscle strengthening using an innovative device in elderly patients with chronic low back pain: a pilot study. Ann Rehabil Med. 2020;44:246\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePizol GZ, Ferro Moura Franco K, Cristiane Miyamoto G, Nunes Cabral CM. Is there hip muscle weakness in adults with chronic non-specific low back pain? A cross-sectional study. BMC Musculoskelet Disord. 2023;24:798.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Benten E, Coppieters MW, Pool JJM, Pool-Goudzwaard AL. Differences in balance control despite self-reported resolution of pregnancy-related pelvic girdle pain. a cross-sectional study. Musculoskelet Sci Pract. 2022;62:102620.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVersele V, Stok FM, Dieberger A, Deliens T, Aerenhouts D, Deforche B, et al. Determinants of changes in women\u0026rsquo;s and men\u0026rsquo;s physical activity and sedentary behavior across the transition to parenthood: a focus group study. Int J Environ Res Public Health. 2022;19:2421.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDakic JG, Cook J, Hay-Smith J, Lin KY, Ekegren C, Frawley HC. Pelvic floor symptoms are an overlooked barrier to exercise participation: a cross-sectional online survey of 4556 women who are symptomatic. Phys Ther. 2022;102:pzab284.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLocomotive Challenge Council. Locomotive syndrome. In: Locomotive Challenge Council, Locomotive syndrome pamphlet 2020. Japanese Orthopaedic Association. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://locomo-joa.jp\u003c/span\u003e\u003cspan address=\"https://locomo-joa.jp\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 30 Apr 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"postpartum, locomotive syndrome, low back pain, physical activity","lastPublishedDoi":"10.21203/rs.3.rs-4147568/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4147568/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePregnancy and childbirth lead to various physiological and anatomical changes, often resulting in low back pain and decline in physical activity in postpartum women. Locomotive syndrome is reportedly associated with low back pain and physical activity levels. However, the prevalence of locomotive syndrome and related factors in postpartum women have not been thoroughly investigated. Therefore, this study aimed to investigate the relationship between locomotive syndrome risk and low back pain and physical activity in postpartum women.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, we included 86 women (30.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 years) within 1 year postpartum. We assessed the locomotive syndrome risk using the stand-up test and 2-step test, physical activity using the International Physical Activity Questionnaire Short Form, and low back pain using the Oswestry Disability Index. The Oswestry Disability Index score and physical activity levels were compared between groups with and without the risk of locomotive syndrome.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall, 45 women (52.3%) had a high risk of locomotive syndrome. The high-risk locomotive syndrome group had significantly higher Oswestry Disability Index [10 (0\u0026ndash;26)] than the non-locomotive syndrome group [4 (0\u0026ndash;24)] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, no significant difference was observed between the two groups in terms of age, number of births, or proportion of women with low physical activity levels.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe findings suggest that more than half of the women within 1 year after childbirth were at risk of locomotive syndrome, suggesting a relationship between locomotive syndrome and low back pain. Prevention of postnatal low back pain may necessitate addressing decline in prenatal motor function. The findings underscore the importance of early identification and intervention for locomotive syndrome risk in postpartum women to prevent future low back pain and improve mobility.\u003c/p\u003e","manuscriptTitle":"Relationship between risk of locomotive syndrome and low back pain in Japanese postpartum women: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-01 07:47:05","doi":"10.21203/rs.3.rs-4147568/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ef7efedc-3052-4f28-82fe-692d6279de7f","owner":[],"postedDate":"April 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-07T05:30:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-01 07:47:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4147568","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4147568","identity":"rs-4147568","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}