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Chronic low back pain significantly affects quality of sleep. Sleep problems should be addressed as an integral part of the pain management plan.

Abstract-This study evaluated which of two different stairstepping techniques produced a higher level of perceived physical exertion and whether magnetic resonance imaging (MRI) can identify gluteus maximus activation during stepper exercise and/ or differences in gluteus maximus activation between exercise techniques. The study was a prospective, single-blind, randomized, two-period, crossover trial. The stair-stepping techniques were 15-minute sessions of (1) short steps with arms unsupported (Short) or (2) full steps with arms supported (Full). The main outcomes measured were time to reach a rating of perceived exertion (RPE) of 13, StairMaster console intensity level, volunteers' judgment as the most strenuous technique, and gluteus maximus MRI signal intensity. We found that participants performing the Short exercise technique reached an RPE of 13 sooner (mean difference 105 +/-54 seconds, p = 0.04) and were unable to reach higher StairMaster intensity levels (mean difference 2.7 +/-0.2, p < 0.001). Eighty-three percent of subjects declared the Short technique more demanding (p = 0.002). For both group sessions, the MRI signal after exercise was higher than at rest (p < 0.001). We found no MRI differences between stepping techniques. Rehabilitation and conditioning programs may benefit from the Short technique because it is perceived as a more challenging physical training activity; MRI can be used to identify metabolic muscle activation during aerobic exercise.

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