Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain

Frost, Helen; Moffett, Jonathan; Moser, Jane; Fairbank, Jeremy

doi:10.1136/bmj.310.6973.151

Cited by 267 publications

(121 citation statements)

References 24 publications

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“…This finding complements accounts of the positive effect of walking on low back pain seen in anecdotal accounts [4], case reports [26], or indirectly, where walking played some part in a general activity and fitness programme [2,3,10,11,34]. Also, it suggests that the response to walking might be useful in the classification of low back pain patients.…”

Section: Discussionsupporting

confidence: 81%

The effect of walking faster on people with acute low back pain

2003

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IntroductionWalking is a functional activity that is commonly affected in people with low back pain [24, 38]. Although there is accumulating evidence that movements of the pelvis and lumbar spine play an important role in unimpaired gait [7,14,18,19, 28, 30, 32, 36, 40], little is known about how back pain affects these movements.A recent study found that the differences in pelvic and lumbar movements during self-selected speed walking between those with and without back pain were relatively small [31]. The movement deficits of people with back pain might become more apparent during the change from self-selected speed to fast walking, when extra demands are placed on the locomotor system. In people without impairment, fast walking has been associated with increased stride length and cadence [43] and increased transverseplane movements of the lumbar spine (relative to the pelvis) [8]. There is evidence that people with chronic low back pain find it difficult to increase the transverse plane rotations of the thorax when increasing walking speed Abstract Little is known about selfselected speed and fast walking in people with acute low back pain. This study aimed to investigate (1) the strategies that people with acute low back pain use to change from self-selected speed to fast walking and (2) the effect of a period of treadmill walking on level of back pain. Eight participants with acute low back pain and eight matched control participants were evaluated during self-selected speed and fast walking on a treadmill. The eight participants with back pain were retested 6 weeks later when pain had resolved. Measurements were taken of (1) three-dimensional angular movements of the pelvis and lumbar spine using a videoanalysis system, (2) the timing and distance parameters of walking, and (3) pain levels as measured by a visual analogue scale. We found that to walk faster, those with acute low back pain increased stride length and the frontal plane movements of pelvic list and lumbar lateral flexion (pelvis) to a greater extent than when symptoms had resolved. We also found that 10 min of treadmill walking at selfselected speed led to a reduction in the level of back pain and that there was a high degree of negative correlation between level of back pain and stride length. An additional 5 min of fast walking did not lead to any further changes in level of back pain. These findings support clinical recommendations that the moderate physical activity of walking may be beneficial in the management of people with acute low back pain. To walk faster, people with acute low back pain may utilise strategies that had been limited at self-selected speed, without any increase in pain.

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Section: Discussionsupporting

confidence: 81%

The effect of walking faster on people with acute low back pain

2003

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“…The cost-effectiveness of home exercises as well as group exercises is confirmed in the literature (Frost et al 1995, Moffett et al 1999. It appears that while most physiotherapists in this study prescribe home exercises, few make use of group exercise classes, which could also save time for the physiotherapist (Moffett et al 1999).…”

Section: Discussionsupporting

confidence: 63%

“…It is also necessary that the costeffectiveness of group exercises, as confirmed in the literature (Frost et al 1995, Moffett et al 1999, should be brought to the attention of different role players so that medical aid societies can re-imburse physiotherapists appropriately. In this way it might be possible for more physiotherapists to absorb the initial costs of setting up facilities needed for group exercises.…”

Section: Discussionmentioning

confidence: 99%

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Private practitioners`use of exercise therapy in lower back pain

Strydom

Faure

Bester

2005

South African Journal of Physiotherapy

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“…Frost et al 30 reported that patients with chronic LBP who attended the fitness class increased their walking capacity by 25% compared with no change in the control group (Po0.005). In a prospective study of exercise tolerance on the treadmill before and after decompressive laminectomy in 50 patients with severe lumbar spinal stenosis, the mean total ambulation time increased significantly (Po0.001) from 6.91 min in the preoperative trial to 13.26 min in the postoperative trial.…”

Section: Discussionmentioning

confidence: 99%

Relationship between ambulation and obesity in older persons with and without low back pain

et al. 2003

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CONTEXT: For obese older persons, ambulation is both functionally important and a means of weight control. The relationship between weight and ambulation is not known in this population. Also, the extent to which pain interferes with ambulation is not studied. OBJECTIVE: To examine the relationship between obesity and ambulation, and to determine the effect of pain and body mass index (BMI) on ambulation in older persons. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of 82 older persons, ages 55-79 y, some with no back pain recruited from the community, others with back pain or spinal stenosis recruited from a magnetic resonance imaging (MRI) scanner as part of a larger university study of spinal stenosis. OUTCOME MEASURES: Age, Visual Analog Scales for pain, BMI, patient diagnosis (no pain, mechanical back pain, and spinal stenosis), walking velocity and stride length on a 15-min laboratory ambulation test, and 1-week community ambulation measured with a pedometer (steps, distance, and energy expenditure). RESULTS: BMI had a significant inverse relationship with ambulatory measurements in terms of the distance walked, steps taken, and walking velocity. Pain severity and pain category also had a significant inverse relationship with these measures. A negative correlation was observed between pain and obesity, although the relationship was statistically nonsignificant. DISCUSSION: Obese older people walked less than the nonobese older people. Pain was associated with decreased ambulation. Clinicians who intend to encourage increased ambulation in older obese persons should consider possible barriers posed by musculoskeletal pain.

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Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain

Cited by 267 publications

References 24 publications

The effect of walking faster on people with acute low back pain

The effect of walking faster on people with acute low back pain

Private practitioners`use of exercise therapy in lower back pain

Relationship between ambulation and obesity in older persons with and without low back pain

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