low back pain ( lbp ) is a major public health problem all over the industrial countries and is one of the leading causes for sick leave and disability .
in addition , it was recommended that fitness programs and advice to stay active can reduce pain , improve function , and can prevent lbp becoming chronic .
the call center industry is one of the most expansive labor market sectors these days . in thailand
, there are an increasing number of telephone operators at the call centers day - by - day due to the economic growth of the country .
there was a high proportion of call - center operators reported musculoskeletal symptoms , and the call - center operators were exposed to working conditions that indicated an increased risk of developing musculoskeletal disorders .
nevertheless , there is few literature regarding health and working conditions among call - center operators .
hence , this study was designed with the aim of investigating the physical activity levels and incidence of lbp among call - center operators working as telephone operators .
participants in this study were call - center operators who were working as telephone operators at the company for at least 6 month .
operators were excluded if they had fracture , scoliosis , musculoskeletal disease , or injuries within 6 months prior to this study .
the questionnaire consisted of three parts ; 
 part i : demographic characteristics and job characteristics of the call - center operatorspart ii : level of physical activity and exercise intensity .
the levels of physical activity were assessed in at five levels ; never , 12 times / week , 34 times / week , and 56 times / week every day .
the operational term physical activity was as a personal training exercise or physically exercises beside from work .
in addition , based on the time spent on each exercise , the exercise intensity was assessed at 3 levels ; light , moderate , and highpart iii : a standardized nordic questionnaire for analyzing musculoskeletal discomfort in different body regions .
the pain intensity was classified into three levels as mild ( pain scale 3 ) , moderate ( pain scale ranged from 46 ) , and severe level ( pain scale 7 ) . 
 
part i : demographic characteristics and job characteristics of the call - center operators part ii : level of physical activity and exercise intensity .
the levels of physical activity were assessed in at five levels ; never , 12 times / week , 34 times / week , and 56 times / week every day .
the operational term physical activity was as a personal training exercise or physically exercises beside from work .
in addition , based on the time spent on each exercise , the exercise intensity was assessed at 3 levels ; light , moderate , and high part iii : a standardized nordic questionnaire for analyzing musculoskeletal discomfort in different body regions .
the pain intensity was classified into three levels as mild ( pain scale 3 ) , moderate ( pain scale ranged from 46 ) , and severe level ( pain scale 7 ) . frequency distribution with percentages was done on all variables .
the relationships between lbp and possible confounding factors ( nominal level categorical variables ) were computed with spearman 's correlation .
participants in this study were call - center operators who were working as telephone operators at the company for at least 6 month .
operators were excluded if they had fracture , scoliosis , musculoskeletal disease , or injuries within 6 months prior to this study .
the questionnaire consisted of three parts ; 
 part i : demographic characteristics and job characteristics of the call - center operatorspart ii : level of physical activity and exercise intensity .
the levels of physical activity were assessed in at five levels ; never , 12 times / week , 34 times / week , and 56 times / week every day .
the operational term physical activity was as a personal training exercise or physically exercises beside from work .
in addition , based on the time spent on each exercise , the exercise intensity was assessed at 3 levels ; light , moderate , and highpart iii : a standardized nordic questionnaire for analyzing musculoskeletal discomfort in different body regions .
the pain intensity was classified into three levels as mild ( pain scale 3 ) , moderate ( pain scale ranged from 46 ) , and severe level ( pain scale 7 ) . 
 
part i : demographic characteristics and job characteristics of the call - center operators part ii : level of physical activity and exercise intensity .
the levels of physical activity were assessed in at five levels ; never , 12 times / week , 34 times / week , and 56 times / week every day .
the operational term physical activity was as a personal training exercise or physically exercises beside from work .
in addition , based on the time spent on each exercise , the exercise intensity was assessed at 3 levels ; light , moderate , and high part iii : a standardized nordic questionnaire for analyzing musculoskeletal discomfort in different body regions .
the pain intensity was classified into three levels as mild ( pain scale 3 ) , moderate ( pain scale ranged from 46 ) , and severe level ( pain scale 7 ) .
the relationships between lbp and possible confounding factors ( nominal level categorical variables ) were computed with spearman 's correlation .
anthropometrical data for participants in this study were age 27.8  3.1 years , height 159.97  6.26 cm , weight 52.89  12.89 kg , females 86.7% ( n = 91 ) , and males 13.3% ( n = 14 ) .
most of them ( 95% ) never had experience as telephone operator prior to this job .
the call - center operators had sedentary workstyle ; most of the time they were sitting in front of the computers at their desk in a confined space and wearing headsets , answering the phone calls , and searching the telephone number for the clients .
they worked at least 6 days / week , with an average of 8 hours / day .
sixty - one percent worked over time with an average of 2 h / day .
most of them had to receive calls ranged from 500600 calls / person / day , and spent time on each calls approximately 45 seconds .
majority of participants had low level of personal training physical activity ; 40% of the participants had never exercised , 34.3% exercised 12 times / week , only 10.4% of the participants exercised everyday [ figure 1 ] . however , most who did physical exercise spent less than 30 min / time [ figure 2 ] .
based on the time spent on each exercise , their exercise intensity was classified to low ( 49.2% ) , moderate ( 46% ) level , and high ( 4.8% ) level [ figure 3 ] .
level of physical activity in times per week time spent per exercise of participants who exercised level of exercise intensity of participants who exercised the overall self - reported prevalence of lbp was 65.7% ( n = 69 ) .
figure 4 shows that majority of lbp operators reported high level of lbp pain severity ( score 7 on a 10-pont pain numerical rating scale [ figure 4 ] .
level of low back pain severity of participants there was significant correlation between low level of physical activity and low back pain , we observed that spearman 's correlation coefficient , rs , was 0.9 , which is statistically significant ( p = 0.001 ) .
in addition , 58.1% of participants stated that their low back pain caused by their job characteristic .
remarkably , there was 62.9% of them reported that lbp was aggravated by sitting during a 6-hour working shift .
furthermore , there were correlation between working period , and working space with the occurrence of low back pain ( p < 0.05 ) .
anthropometrical data for participants in this study were age 27.8  3.1 years , height 159.97  6.26 cm , weight 52.89  12.89 kg , females 86.7% ( n = 91 ) , and males 13.3% ( n = 14 ) .
most of them ( 95% ) never had experience as telephone operator prior to this job .
the call - center operators had sedentary workstyle ; most of the time they were sitting in front of the computers at their desk in a confined space and wearing headsets , answering the phone calls , and searching the telephone number for the clients .
they worked at least 6 days / week , with an average of 8 hours / day .
sixty - one percent worked over time with an average of 2 h / day .
most of them had to receive calls ranged from 500600 calls / person / day , and spent time on each calls approximately 45 seconds .
majority of participants had low level of personal training physical activity ; 40% of the participants had never exercised , 34.3% exercised 12 times / week , only 10.4% of the participants exercised everyday [ figure 1 ] .
however , most who did physical exercise spent less than 30 min / time [ figure 2 ] .
based on the time spent on each exercise , their exercise intensity was classified to low ( 49.2% ) , moderate ( 46% ) level , and high ( 4.8% ) level [ figure 3 ] .
level of physical activity in times per week time spent per exercise of participants who exercised level of exercise intensity of participants who exercised
the overall self - reported prevalence of lbp was 65.7% ( n = 69 ) .
figure 4 shows that majority of lbp operators reported high level of lbp pain severity ( score 7 on a 10-pont pain numerical rating scale [ figure 4 ] .
there was significant correlation between low level of physical activity and low back pain , we observed that spearman 's correlation coefficient , rs , was 0.9 , which is statistically significant ( p = 0.001 ) .
in addition , 58.1% of participants stated that their low back pain caused by their job characteristic .
remarkably , there was 62.9% of them reported that lbp was aggravated by sitting during a 6-hour working shift .
furthermore , there were correlation between working period , and working space with the occurrence of low back pain ( p < 0.05 ) .
the main findings in this study were that a majority of the call - center operators reported low level of physical activity , there was a prevalence of lbp at 65.7% , and there was significant association between lbp and low level of physical activity , job characteristics , and work space .
the prevalence of lbp in call - center operators in this study was 65.7% , which is found to be high as in those who work as office workers .
it was suggested that work - related factors were associated with the occurrence of musculoskeletal symptoms . as seen in this present study
, there were association between lbp and work factor , i.e. , sitting continuous for long periods of working hours and working in a confined space . in the present study , the participants working as telephone operators and spent long continuous time sitting in front of the computer than other sedentary job .
this result agreed with the study on call - center operators working condition in sweden .
a hypothesis has been proposed that low level of physical activity may be a risk factor in experiencing lbp .
the fact that in the present study we found the same results as the recommended one .
the report of us department of health and human services ( 1996 ) suggested that significant health benefits can be obtained by including a moderate amount of physical activity ( e.g. , 30 minutes of brisk walking or raking leaves , 15 minutes of running , or 45 minutes of playing volleyball ) on most , if not all , days of the week .
recently , it was suggested that strenuous physical activity at least once a week is protective for incidence of lbp .
therefore , through a modest increase in daily physical activity , the call - center operators can improve their health and quality of life .
the validity of the concept of lbp is difficult to establish because of the subjectivity of pain .
however , goodman and mcgrath claimed that any measure of pain which is not based on self - report will likely yield inaccurate results .
thus , the questions on lbp were fairly good , in that we investigated the severity and frequency of pain .
further , the current physical activity itself is important in the evaluation of the impact of activity level on lbp . therefore , the present study asked the operators him / herself about their lbp , and physical activity level .
strengths of this study are the use of a randomized sample , validated questionnaire , and high response rate ( 70% ) .
it is , however , a first study in thailand , these results may be not representative for all call - center operators .
further research in this area should focus upon a broader approach when investigating adolescent lbp associated with physical activity , including type of activities performed , technical skill , and body awareness through long - term , clinical , cross - sectional studies .
the majority of operators in this study had low level of physical activity and suffered from lbp .
the incidence of low back pain was associated to their level of physical activity and work factors .
 background : call - center operators are exposed to working conditions that indicate an increased risk of developing musculoskeletal disorders . nevertheless , there are few studies regarding health and working condition in call - center operators . 
 thus , this study was designed to investigate the physical activity levels and prevalence of low back pain ( lbp ) in thai call - center operators.materials and methods : a self - reported questionnaire was distributed to 150 operators at a call center to identify the physical activity levels , prevalence of lbp , personal characteristics , and associated work factors.results:the questionnaire response rate was 70% ( n = 105 ) . 
 the participants ' age was 27.8  3.1 years , height was 159.97  6.26 cm , weight was 52.89  12.89 kg , and females 86.7% ( n = 91 ) , and males 13.3% ( n = 14 ) . 
 participants worked at least 6 days every week , with an average of 8 hours each day . 
 sixty - one percent of them worked over time with an average 2 h / day . 
 forty percent of the participants had no exercise ; 34.3% exercised 12 times / week . 
 those who did physical exercise spent less than 30 min / time . 
 the overall self - reported prevalence of lbp was 65.7% , and they reported high severity of lbp for 42.9% . 
 all participants reported that their lbp as recurring , and 62.9% reported that lbp was aggravating by sitting during working hours.conclusion:the call - center operators had a sedentary work style . 
 the majority of operators in this study had low level of physical activity and suffered from low back pain . 
 the prevalence of low back pain was associated to their level of physical activity and work factors . 
INTRODUCTION
MATERIALS AND METHODS
Participants
The questionnaire
Statistical analysis
RESULTS
Questionnaires response rate
Characteristics of participants
Job characteristics as a call-center operator
Levels of physical activity
Incidence of low back pain
Correlation between low back pain and work factors
DISCUSSION
CONCLUSION
Financial support and sponsorship
Conflicts of interest