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Lifestyle Foundations for Back Pain (Part 2): Activity, Weight, and Smoking

By Dr. Mitch Whittal

Apr 24, 2026

Last week: sleep and stress. This week wraps the two-part lifestyle series with the three physical habits that shape how your back feels: activity, bodyweight, and smoking. The first two are levers most people know. The third is the one most people underestimate.

Activity Level

I’m biased towards recommending resistance training as a primary form of exercise for the strength, stability, and metabolic benefits. However, it is most important to find a form of exercise that you enjoy, because that means you’ll actually do it.

Like I said about stress last week, being active and performing regular exercise bolsters our ability to tolerate stress. The benefits don’t end there, and I won’t belabour the point as I’m sure you’re aware of how exercise supports health. I’ll deliver just a few quick points of persuasion:

  1. “Use it or lose it”. Periods of extended inactivity lead to decreased capability. Get moving however you can and stay moving.
  2. Something is better than nothing. A short walk or taking the stairs nudges you in the right direction and helps build momentum towards more movement.

Healthy Bodyweight

There’s no judgment here, just some uncomfortable truths. If you’re struggling to maintain a healthy bodyweight, your joints, including those in your spine, experience greater forces with every movement. The additional forces can cause additional wear and tear on our joints. Your muscles have to produce more force to lift and control your body during movement. There is evidence showing that people living with obesity have greater systemic inflammation and higher circulating inflammatory cytokines [1]. This inflammatory environment accelerates the breakdown of our spinal tissues and sensitizes us to pain.

I won’t leave you with only doom and gloom, though. Time to get practical. Bodyweight is a function of energy balance:

  • Weight maintenance: energy intake = energy expenditure
  • Weight Gain: energy intake > energy expenditure
  • Weight Loss: energy intake < energy expenditure

We now just need to know how to manipulate each side of the equation. To expend, or burn, more than you consume, or intake, we need to do 2 simple things:

  1. Consume fewer calories, and
  2. Burn more of them.

There are countless fad diets and strategies, but I would first recommend getting a sense of how many calories you’re actually consuming. There are plenty of free tools to track and measure your food intake, like ‘MyFitnessPal’ and ‘MyNetDiary’. I realize that permanent tracking is not sustainable for most people, but tracking honestly for a week or two can significantly help people identify their largest calorie sources. From there, I would focus on these concepts:

  • Eat a balanced diet of high satiety foods
    • Satiety is a measure of how ‘full’ one feels. So the satiety index of foods is an index of how full foods make people feel. Research has differentiated between high and low satiety foods [2].
    • The big picture is to focus on foods that are high in protein, fibre, and water. Here are some of the results:

High Satiety (eat more)

  • Protein-rich foods — fish, beef, beans/lentils, eggs
  • Fruits — apples, oranges, grapes, bananas
  • High-fibre carbohydrates (less processed) — potatoes, brown pasta, whole meal / wheat bread, grain bread
  • Oats
  • Popcorn (without the butter)

Low Satiety (eat less)

  • Bakery products — croissants, cake, doughnuts
  • Fatty snacks — candy bars, peanuts/nuts, chips and crisps, ice cream
  • Harder and bulkier foods scored better, while softer, refined/processed foods scored worse
  • Side note, the index is not perfect and does not quantify nutritional content, but rather fullness. Regardless, you see that most of the foods ranking high in satiety are quite strong nutritionally, which is great news!
  • Fun asides:
    • The index was constructed relative to the fullness of white bread
    • Boiled potatoes were by far the most satiating food
  • Drink a full glass of water directly before eating each meal. This can subjectively increase fullness.
  • Identify your triggers for overeating and alter your environment to avoid them
    • Don’t stock your pantry with tasty snacks and ultra-processed foods
  • Consider restricting your feeding window
    • The “3 meals per day” human tendency is not a requirement for health
    • Restricting your eating to take place between noon and 8 pm is effective for some people
      • There’s nothing magic about this other than people tend to eat less in a condensed window. It is perfectly safe, assuming no comorbidities that require tight regulation of blood sugar levels.

I’ll end off this section with a little bit of science because I want to get something off my chest. CARBS ARE NOT THE ENEMY. You heard me. In fact, of the 3 macro nutrients, carbohydrates are tied for the lowest energy density:

  • Carbs contain 4 calories per gram
  • Proteins contain 4 calories per gram
  • Fats contain 9 calories per gram

Foods like potatoes have been given a bad wrap for unknown reasons. Not only were potatoes the most filling food measured in the satiety index study, but they’re also a low-calorie food! Where people make the mistake is pairing their filling carbohydrates with high-fat and high-sugar sauces, cheeses, and dips. One of the wonders of modern times is the abundance of low-fat and low-sugar options available to pair with your grains. Stop blaming the carbs.

Smoking

Smoking is very bad for your health, even your back. Smokers had a higher prevalence of back pain, chronic back pain, and disabling back pain [3]. Smoking also leads to more aggressive intervertebral disc degeneration and is a strong predictor of failed spinal surgery recovery. Some spine surgeons require individuals to quit smoking to prepare for surgery. This is because nicotine inhibits bone growth and raises the risk for infection. You get the point, don’t smoke.

That wraps the two-part lifestyle series: sleep, stress, activity, bodyweight, and smoking. These are the foundations underneath every rehab program. On top of them, what specifically helps YOUR back depends on which pattern you’re actually in.

If you haven’t taken the triage quiz yet, it maps your pain to one of six patterns in about five minutes. That’s the starting point for the program itself.

As always, have a great weekend.

Best,

Mitch

References

[1] Khanna et al., (2022) — https://pmc.ncbi.nlm.nih.gov/articles/PMC8967417/

[2] Holt et al., (1995) — https://pubmed.ncbi.nlm.nih.gov/7498104/

[3] Shiri et al., (2010) — https://pubmed.ncbi.nlm.nih.gov/20102998/