Objective: To examine the effect of adding aerobic exercise (AE) to neck-specific exercise treatment for patients with neck pain (NP) to reduce pain and disability. Design: A prospective multicentre randomized controlled trial. Setting: Physiotherapy outpatient clinics. Subjects: Patients with nonspecific NP. Intervention: Patients with NP were randomly assigned to six weeks of neck-specific exercise with and without the addition of AE. Measures: Patients were classified as having a successful or non-successful outcome according to the Global Rating of Change (GROC). Outcome measures included Visual Analogue Scale (VAS), Neck Disability Index (NDI), Fear Avoidance Beliefs Questionnaire (FABQ) and cervicogenic headache. Assessments were performed at six-week, and three- and six-month follow-ups. Results: A total of 139 participants (mean age: 54.6 ± 10.5 years) were recruited ( n = 69 AE, n = 70 control). According to GROC, 77.4% of the AE group reported a successful outcome at six months vs. 40% in the control group ( P < 0.001). There was a significant reduction in VAS from baseline to six months in the AE vs. control group 6.73 (±1.69) to 1.89 (±1.37) vs. 6.65 (±1.67) to 3.32 (±1.82), respectively ( P  < 0.001). Significant improvements were also obtained for NDI and FABQ from baseline to six weeks in the AE group: NDI from 16.10 (±4.53) to 7.78 (±4.78) vs. 17.01 (±4.84) to 11.09 (±5.64) in the control group ( P = 0.003); FABQ from 33.53 (±9.31) to 20.94 (±841) in the AE vs. 33.45 (±10.20) to 26.83 (±10.79) in the control group ( P < 0.001). The AE group also demonstrated significant reduction in cervicogenic headache from baseline to six months ( P = 0.003). Conclusion: Adding AE to long-term neck-specific exercises is an effective treatment for reducing NP and headache in patients with NP.

The coronavirus disease of 2019 (COVID-19) greatly affected people’s lifestyles. We used an online, cross-sectional survey during a COVID-19-related lockdown in Israel, with the aim of investigating the effects of such lockdowns on students’ self-perceived stress and neck pain (NP). College students (N = 295) completed questions on sociodemographic characteristics, the Neck Disability Index (NDI), the Perceived Stress Scale, the Visual Analogue Scale (VAS), and NP frequency (four-point scale). Logistic regression models were calculated with the NDI as the dependent variable. In total, 35.6% of students experienced at least moderate NP-related disability (NDI ≥ 15), more during than before the lockdown. NP increased gradually, from a lifetime mean of 1.80 to a lockdown mean of 3.07 (χ2 = 316.72; p < 0.001). Students’ self-perceived stress was moderate, and 59.3% reported experiencing study-related stress. Higher levels of self-perceived stress, study-related stress, sitting >3 h/day, and a higher VAS score were associated with a higher risk of an NDI ≥ 15 (Nagelkerke’s R2 = 0.513, p < 0.001). The transition from on-campus to online learning seems to have exacerbated students’ NP, which was correlated to their study stress and lifestyles. These findings advocate for the need to promote the physical and mental health of students via e.g., mental health services and occupational and ergonomic consulting services.

Objective A previous randomized controlled trial revealed that combined aerobic and neck-specific exercises yielded greater improvement than neck-specific exercises alone after a 6-month intervention in outpatients with nonspecific neck pain. The aim of this secondary analysis was to identify subgroups of patients in the combined-exercises group most likely to benefit from the intervention. Methods Sixty-nine patients were included. The original trial was conducted in multiple physical therapy outpatient clinics, twice a week for 6 weeks; follow-up was 6 months after assignment. The primary outcome was the therapeutic success rate (Global Rating of Change Score ≥ +5, “quite a bit better”) after 6 weeks’ training and at the 6-month follow-up. Candidate predictors from patients’ medical history and physical examination were selected for univariable regression analysis to determine their association with treatment response status. Multivariable logistic regression analysis was used to derive preliminary clinical prediction rules. Results The clinical prediction rule contained 3 predictor variables: (1) symptom duration ≤6 months, (2) neck flexor endurance ≥18 s, and (3) absence of referred pain (Nagelkerke R2 = .40 and − 2 log likelihood = 60.30). The pre test probability of success was 61.0% in the short term and 77.0% in the long term. The post test probability of success for patients with at least 2 of the 3 predictor variables was 84.0% in the short term and 87.0% in the long term; such patients will likely benefit from this program. Conclusion A simple 3-item assessment, derived from easily obtainable baseline data, can identify patients with neck pain who may respond best to combined aerobic and neck-specific exercises. Validation is required before clinical recommendation. Impact Patients experiencing neck pain symptoms ≤6 months who have no referred pain and exhibit neck flexor endurance ≥18 s may benefit from a simple self-training program of combined aerobic and neck-specific exercises.