Exercise Intensity Matters in Chronic Nonspecific Low Back Pain Rehabilitation

Abstract

Introduction Exercise therapy (ET) is advocated as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapy effect sizes remain low. In other chronic disorders, training at higher intensity has resulted in greater improvements on both general health related and disease specific outcomes compared to lower-intensity ET. Possibly, high-intensity training also improves effect sizes in CNSLBP. Objective To compare the effects of a high-intensity ET program with a similar moderate-intensity ET program on disability, pain, function, exercise capacity, and abdominal/back muscle strength in persons with CNSLBP. Methods In a randomized controlled trial, persons with CNSLBP performed a 12-wk ET program (24 sessions, 1.5 h per session, twice per week) at high-intensity training (HIT) or moderate-intensity training (MIT). Questionnaires to assess disability (Modified Oswestry Index [MODI]), pain intensity (Numeric Pain Rating Scale), and function (Patient Specific Functioning Scale), a cardiopulmonary exercise test to assess exercise capacity (V˙O2max, cycling time), and a maximum isometric muscle strength test to assess abdominal/back muscle strength (maximum muscle torque) were administered at baseline and after the training program. Results Thirty-eight participants (HIT: n = 19, MIT: n = 19) were included (mean age, 44.1 yr, SD = 9.8, 12 males). Groups did not differ at baseline. Between group differences (P < 0.01) in favor of HIT were found for MODI, V˙O2max, and cycling time. Within group improvements (P < 0.01) were found in both groups on MODI (HIT:−64%, MIT:−33%), Numeric Pain Rating Scale (HIT, −56%; MIT, −39%), Patient-Specific Functioning Scale (HIT:+37%, MIT:+39%), V˙O2max (HIT:+14, MIT:+4%), cycling time (HIT:+18%, MIT:+13%), and back muscle strength (HIT:+10%, MIT:+14%). Conclusions High-intensity training proved to be a feasible, well tolerated, and effective therapy modality in CNSLBP. Moreover, it shows greater improvements on disability and exercise capacity than a similar ET performed at moderate intensity.

High Intensity Training to Treat Chronic Nonspecific Low Back Pain: Effectiveness of Various Exercise Modes

“…The present randomized comparative trial is part of a larger project entitled “ High intensity training in chronic nonspecific low back pain”, which evaluates the effects of training intensity and various training modes in CNSLBP rehabilitation through a prospectively registered, five-arm, RCT organized at REVAL (Hasselt University, Diepenbeek, Belgium). The results of the effectiveness of HIT in comparison to a moderate-intensity training group have been published previously [ 28 ]. The current manuscript describes phase two, which evaluates the difference between four exercise modes of HIT.…”

“…In this respect, Verbrugghe et al already evaluated the effectiveness of a combined high-intensity protocol of cardiorespiratory interval, general resistance, and core strength training in CNSLBP rehabilitation and found greater improvements on disability and exercise capacity, compared to a similar protocol performed at moderate intensity [ 28 ]. Hence, the increased physical stimulus of HIT clearly provided an added effectiveness in CNSLBP.…”

Acute Effects of a Combined Strength and Endurance Training Rehabilitation Protocol for Patients in Different Professions with Back Pain

“…In terms of therapy, there has been a significant change from bed rest and passive treatments to active therapy measures in recent decades [19], with the therapeutic focus on building the muscles of the back and trunk on strength training equipment to stabilize the spine [20][21][22]. Strength training is often embedded in back training programs [23,24], which take into account the different loads of different professions and offer jobspecific posture and movement training.…”

Muscular blood oxygen level-dependent MRI is beneficial to evaluate effectiveness of an exercise prescription

“…Regular and appropriate exercise improves health status (1), lowers the risk of chronic diseases (2), and strengthens muscular function (blood flow and oxygenation level) (3). Exercise training, such as back extension exercises, is often used to improve the strength and endurance of the core lumbar paraspinal muscles (namely, the multifidus, longissimus, and iliocostalis muscles), and can even prevent and treat pain in the lower back (4,5).…”

“…The same Different people are suitable for different exercise Original Article prescription may bring different effects on everyone. The effectiveness of such prescriptions varies depending on the form, intensity, and duration of the exercise (3,5,6). However, it is unclear whether an exercise prescription can be effective for a healthy individual and a patient undergoing rehabilitation (7,8).…”