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Have you ever had a well-meaning friend or relative warn you about your workout routine? It usually goes something like this: “All that lifting is going to ruin your back,” or “Running is going to destroy your knees by the time you’re fifty.”
This is an incredibly common narrative. It is based on the idea that the human body is like a car—the more miles you put on it, the faster the parts wear down. According to this logic, exercising is “using up” your joints, and the safest way to avoid pain as you age is to do as little as possible to preserve yourself.
But what if the exact opposite is true?
A recent breakdown in the MASS Research Review [1] highlighted a fascinating study that looked at the relationship between lifestyle factors, metabolic health, and pain [2]. The findings challenge the “wear and tear” theory and suggest that we need to rethink how we view the risks of exercise.
Inactivity Is Not A Neutral Choice
When we worry about the risks of exercise, we often treat physical inactivity as the safe, pain-free “control” group. We assume that if we don’t lift weights or go for runs, we won’t get hurt.
However, the study reviewed in MASS used data from the National Health and Nutrition Examination Survey (NHANES) and examined the relationship between metabolic health, lifestyle habits, low back pain, neck pain, and functional limitation in large nationally representative cohorts [1] [2]. The results showed that both poor metabolic health and poor lifestyle status were associated with worse pain outcomes, and the pattern was consistent enough that it is hard to ignore [2].
More specifically, poor metabolic status was associated with significantly higher odds of low back pain and functional limitation, while poor lifestyle status was associated with higher odds of all three outcomes: low back pain, neck pain, and functional limitation [2]. In the study, low back pain prevalence rose from 26.4% in people with good metabolic status to 35.9% in those with poor metabolic status, while functional limitation increased from 3.8% to 16.8% across those same categories [1] [2]. On the lifestyle side, low back pain prevalence ranged from 20.9% in people with good lifestyle status to 38.2% in those with poor lifestyle status, and neck pain prevalence ranged from 10.8% to 21.1% across lifestyle groups [1] [2].
When researchers dug into the data to see which lifestyle factors were the biggest culprits, the results were striking. Physical inactivity was the single greatest predictor of both low back pain and neck pain among all the variables assessed [1] [2]. In the population-attributable fraction analysis, physical inactivity accounted for 20.8% of low back pain and 20.5% of neck pain, making it the largest contributor to both conditions at the population level [1] [2].
The study also found that specific lifestyle and metabolic risk factors mattered. For low back pain, physical inactivity, smoking, abdominal obesity, and hypertension were all associated with significantly greater odds [2]. For neck pain, physical inactivity, smoking, and poor diet stood out [2]. In other words, pain was not just randomly distributed. It clustered with the exact kinds of habits that usually go hand in hand with poor overall health.
Let that sink in. Avoiding exercise didn’t protect people from pain; it was one of the strongest predictors of experiencing it.
The Sweet Spot Of Physical Activity
This doesn’t mean that exercise is entirely without risk. As I have discussed in my previous post on Preventing Setbacks: Top 3 Causes of Exercise-Related Injuries, ignoring your body’s signals and pushing through extreme fatigue can certainly lead to injury.
In the world of highly competitive sports, where athletes are constantly pushing the absolute limits of human performance, injury rates do increase. But for the vast majority of us—the everyday individuals looking to improve our health, body composition, and longevity—the injury rates for generalized resistance training are incredibly low.
The reality is that our bodies are not like cars. When you stress a car part, it wears down. When you apply an appropriate amount of stress to human tissue through exercise, it adapts and gets stronger.
If you are completely inactive, you set a very low ceiling for what your tissues can handle. This means that everyday activities—like picking up a heavy box, doing yard work, or even just sleeping in a weird position—can expose your body to more load than it is prepared for, resulting in pain and injury.
That idea is supported by one of the more telling findings in the paper: people with poor combined metabolic and lifestyle status had the highest prevalence of all three major outcomes measured. In that group, 42.6% reported low back pain, 21.4% reported neck pain, and 17.6% reported functional limitation [1] [2]. That is a strong reminder that pain often shows up as part of a larger lifestyle and health picture rather than as proof that movement itself is harmful.
As I wrote in Why Muscle And Strength Are Key To Health And Longevity, resistance training provides unique adaptations that protect us. It builds muscle and strengthens bones, acting as an insurance policy against the physical demands of daily life.
Changing The Narrative
It is time to stop viewing exercise as a necessary evil that slowly damages our bodies. Instead, we need to view it as the training stimulus that makes us robust and resilient.
Yes, there is a risk of overuse injuries if you abruptly spike your training volume or refuse to recover properly. But there is a massive “sweet spot” between being dangerously undertrained and recklessly overtrained.
To minimize your lifetime exposure to pain and injury, the best path forward is to gradually work up to a sustainable level of physical activity. Lift weights, go for walks, and challenge your cardiovascular system. Make your body resilient enough to handle whatever life throws at it.
This is also where context matters. The MASS review makes an important distinction between ordinary exercise and the kind of excessive training loads seen in highly competitive athletes [1]. Yes, overdoing it can create problems. But for the average person, the bigger issue is usually being undertrained for the physical demands of real life. The sweet spot between doing too little and doing too much is enormous [1].
What You Can Do About It
The good news is that the risk factors identified in this study are largely modifiable. Pain is not simply your destiny. Here are the most impactful areas to focus on, with resources from the RJB Health Coaching blog to help you get started.
Move More Every Day. Since physical inactivity was the single biggest contributor to both low back and neck pain in this study, the most powerful thing you can do is simply move more. You do not need to run marathons or train like an athlete. Research supports that hitting around 7,000 steps per day provides significant health benefits. For a deep dive into why daily movement matters and how to build it into your routine, check out The Case For 7,000 Steps: Move More, Live Better.
Build Strength Through Resistance Training. Your muscles and connective tissues adapt and get stronger when you challenge them appropriately. Resistance training is one of the most effective ways to build the physical resilience that protects you from pain in daily life. If you are not sure where to start or need a reminder of why this matters so much, revisit Why Muscle And Strength Are Key To Health And Longevity.
Make Exercise A Habit You Can Stick To. The best exercise program is one you actually do consistently. If you have struggled to stay consistent in the past, 5 Science-Backed Strategies to Finally Stick With Your Exercise Routine walks through practical approaches to building lasting habits around movement.
Prioritize Sleep. Poor sleep was associated with worse lifestyle status in this study, and it also directly affects your body’s ability to recover from physical stress and manage inflammation. If your sleep is suffering, it can quietly undermine everything else you are doing. For a comprehensive look at why sleep is the cornerstone of your entire health foundation — and how poor sleep can derail your fitness, nutrition, and recovery all at once — read Sleep: The Cornerstone Of Your Health Foundation.
Manage Your Stress. Chronic stress is a significant driver of poor metabolic health, and it can increase both inflammation and pain sensitivity. If stress is a persistent challenge for you, How Stress Impacts Your Health And Sabotages Your Goals is a great place to start.
Improve Your Diet Quality. Poor diet quality was associated with higher neck pain odds in this study. Eating in a way that supports metabolic health does not need to be complicated. For a practical, no-nonsense approach to improving your diet quality by focusing on whole foods and protein rather than overhauling everything at once, check out Achieving Optimal Body Composition Via Diet Quality Improvements.
The next time someone warns you that your workouts are going to wreck your joints, you can confidently tell them that you are actually building the armor you need to stay pain-free.
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