High Intensity Training Is an Effective Modality to Improve Long-Term Disability and Exercise Capacity in Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial

Abstract

Previous research indicates that high intensity training (HIT) is a more effective exercise modality, as opposed to moderate intensity training (MIT), to improve disability and physical performance in persons with chronic nonspecific low back pain (CNSLBP). However, it is unclear how well benefits are maintained after intervention cessation. This study aimed to evaluate the long-term effectiveness of HIT on disability, pain intensity, patient-specific functioning, exercise capacity, and trunk muscle strength, and to compare the long-term effectiveness of HIT with MIT in persons with CNSLBP. Persons with CNSLBP (n = 35) who participated in a randomized controlled trial comparing effects of an HIT versus MIT intervention (24 sessions/12 weeks) were included for evaluation at baseline (PRE), directly after (POST), and six months after program finalization (FU) on disability, pain intensity, exercise capacity, patient-specific functioning, and trunk muscle strength. A general linear model was used to evaluate PRE-FU and POST-FU deltas of these outcome measures in each group (time effects) and differences between HIT and MIT (interaction effects). Ultimately, twenty-nine participants (mean age = 44.1 year) were analysed (HIT:16; MIT:13). Six participants were lost to follow-up. At FU, pain intensity, disability, and patient-specific functioning were maintained at the level of POST (which was significant from PRE, p < 0.05) in both groups. However, HIT led to a greater conservation of lowered disability and improved exercise capacity when compared with MIT (p < 0.05). HIT leads to a greater maintenance of lowered disability and improved exercise capacity when compared to MIT six months after cessation of a 12-week supervised exercise therapy intervention, in persons with CNSLBP.

A Preliminary Study on the Equivalence between Standing Back-Extension and Superman Training in Lumbar Multifidus Exercise

“…In recent years, the research on LBP has shifted from the degeneration of bone structure to the bone-joint-soft tissue system, and it is considered that the reduction of lumbar balance and lumbar muscle strength is the main cause of nonspecific chronic LBP. Therefore, paravertebral, back, and lateral abdominal muscle strength exercises are of great significance in improving the clinical symptoms of nonspecific chronic LBP [ 5 ].…”

Higher intensity exercise reduces disability more than lower intensity exercise in adults with chronic low back pain: A systematic review and meta‐analysis

“…Following automated and manual removal of duplicates, 673 articles were screened by title and abstract, of which 472 were removed. From the remaining 201 studies, 195 were excluded after full-text review leaving four trials reported across five studies that met the inclusion criteria (Cerini et al, 2022;Harts et al, 2008;Helmhout et al, 2004;Verbrugghe et al, 2019Verbrugghe et al, , 2021.…”

“…All interventions were supervised but varied considerably in the dose of exercise prescribed. The length of exercise interventions ranged from 8 to 12 weeks, with three studies assessing outcomes at 6 months post‐randomisation (Harts et al., 2008; Helmhout et al., 2004; Verbrugghe et al., 2021). Therefore, all analyses are restricted to short‐medium‐term time points.…”

“…Verbrugghe et al found a small difference in pain at end-treatment in favour of higher intensity exercise, but the confidence interval was wide spanning a moderate and clinically meaningful reduction to no reduction at all (mean difference = −1 [95% CI: −2.2 to 0.1] out of 10) (Verbrugghe et al, 2019). At 6-month follow-up, the difference still favoured higher intensity exercise but was smaller (−0.5 out of 10, no confidence interval provided) (Verbrugghe et al, 2021). Cerini et al found a small difference in pain at end-treatment in favour of higher intensity exercise, again with a wide confidence interval spanning a small reduction to a moderate increase in pain (median difference = −0.5 [95% CI: −1 to 2] out of 10) (Cerini et al, 2022).…”

High-Intensity Interval Training for Knee Osteoarthritis: A Narrative Review

“…HIIT gained significant popularity worldwide as a fitness trend, and recent research has demonstrated its potential in reducing disability in people with different chronic musculoskeletal disorders such as fibromyalgia [36], axial spondylarthritis [61] and chronic non-specific low back pain [62][63][64][65]. In our review, we examined the effects of HIIT on knee OA as a standalone exercise modality or in comparison to training modalities with other exercise intensities such as MICT and LIT, or to CT. To the best of our knowledge, this is the first review that assessed the potential role of HIIT in mitigating symptoms associated with knee OA.…”