ABSTRACT Effects of Recreational Physical Activity and Back Exercises on Low Back Pain and Psychological Distress: Findings From the UCLA Low Back Pain Study Eric L. Hurwitz, DC, PhD, Hal Morgenstern, PhD and Chi Chiao, MS, PhD Objectives. We sought to estimate the effects of recreational physical activity and back exercises on low back pain, related disability, and psychological distress among patients randomized to chiropractic or medical care in a managed care setting. Methods. Low back pain patients (n=681) were randomized and followed for 18 months. Participation in recreational physical activities, use of back exercises, and low back pain, related disability, and psychological distress were measured at baseline, at 6 weeks, and at 6, 12, and 18 months. Multivariate logistic regression modeling was used to estimate adjusted associations of physical activity and back exercises with concurrent and subsequent pain, disability, and psychological distress. Results. Participation in recreational physical activities was inversely associated—both cross-sectionally and longitudinally—with low back pain, related disability, and psychological distress. By contrast, back exercise was positively associated—both cross-sectionally and longitudinally—with low back pain and related disability. Conclusions. These results suggest that individuals with low back pain should refrain from specific back exercises and instead focus on nonspecific physical activities to reduce pain and improve psychological health. October 2005, Vol 95, No. 10 | American Journal of Public Health 1817-1824 Eric L. Hurwitz is with the Department of Epidemiology, School of Public Health, University of California, Los Angeles, and the Southern California University of Health Sciences, Whittier. Hal Morgenstern is with the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor. Chi Chiao is with the Department of Community Health Sciences, School of Public Health, University of California, Los Angeles.