Why is exercise prescribed for people with chronic low back pain? A review of the mechanisms of benefit proposed by clinical trialists

Wun, Annika; Kollias, Paul; Jeong, Harry; Rizzo, Rodrigo R N; Cashin, Aidan G; Bagg, Matthew K; McAuley, James H; Jones, Matthew D

doi:10.1016/j.msksp.2020.102307

Cited by 36 publications

(37 citation statements)

References 28 publications

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“…Exercise influences pain and function in CLBP by potentially 33 unique mechanisms, but a clear understanding of why it works has not yet been established [ 15 ]. These mechanisms were grouped into five themes by Wun et al [ 15 ] of which four, namely neuromuscular, neurophysiological, cardiometabolic, and tissue healing, were likely influenced by BET as well as SET. However, there is only preliminary evidence how exercise-related biopsychosocial mechanisms might mediate changes in function and pain in individuals with CLBP [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

“…SET usually accounts for about 68% of all interventions in traditional multidisciplinary rehabilitation in Germany [ 14 ]. The potential underlying mechanisms of action for SET [ 15 – 17 ] to reduce disabling CLBP are improvements in several domains: strength and endurance of back muscles, trunk flexibility, bone strength, blood supply to spinal muscles, joints, and intervertebral discs, body composition, and cardiorespiratory fitness. Those improvements could supposedly contribute to a healing process in body functions and structures, which in turn could lead to reduced pain and improved function [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial

Semrau

Hentschke

Peters

et al. 2021

BMC Musculoskelet Disord

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Background The long-term effects of behavioural medical rehabilitation (BMR), as a type of multidisciplinary rehabilitation, in the treatment of chronic non-specific low back pain (CLBP) have been shown. However, the specific effects of behavioural exercise therapy (BET) compared to standard exercise therapy (SET) within BMR are not well understood. The aim of the study was to assess the effectiveness of BMR + BET compared to BMR + SET in individuals with CLBP in a two-armed, pre-registered, multicentre, parallel, randomised controlled trial (RCT). Methods A total of 351 adults with CLBP in two rehabilitation centres were online randomised based on an ‘urn randomisation’ algorithm to either BMR + SET (n = 175) or BMR + BET (n = 176). Participants in both study groups were non-blinded and received BMR, consisting of an multidisciplinary admission, a psychosocial assessment, multidisciplinary case management, psychological treatment, health education and social counselling. The intervention group (BMR + BET) received a manualised, biopsychosocial BET within BMR. The aim of BET was to develop self-management strategies in coping with CLBP. The control group (BMR + SET) received biomedical SET within BMR with the aim to improve mainly physical fitness. Therapists in both study groups were not blinded. The BMR lasted on average 27 days, and both exercise programmes had a mean duration of 26 h. The primary outcome was functional ability at 12 months. Secondary outcomes were e.g. pain, avoidance-endurance, pain management and physical activity. The analysis was by intention-to-treat, blinded to the study group, and used a linear mixed model. Results There were no between-group differences observed in function at the end of the BMR (mean difference, 0.08; 95% CI − 2.82 to 2.99; p = 0.955), at 6 months (mean difference, − 1.80; 95% CI; − 5.57 to 1.97; p = 0.349) and at 12 months (mean difference, − 1.33; 95% CI − 5.57 to 2.92; p = 0.540). Both study groups improved in the primary outcome and most secondary outcomes at 12 months with small to medium effect sizes. Conclusion BMR + BET was not more effective in improving function and other secondary outcomes in individuals with CLBP compared to BMR + SET. Trial registration Current controlled trials NCT01666639, 16/08/2012.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial

Semrau

Hentschke

Peters

et al. 2021

BMC Musculoskelet Disord

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“…29 , 30 , 31 , 32 , 33 Although exercises are often prescribed to improve muscle function and mobility there is little evidence that those are the mechanisms behind positive clinical effects. 34 , 35 , 36 …”

Section: Why Should Clinicians Care About Self-management In Lbp?mentioning

confidence: 99%

Self-management at the core of back pain care: 10 key points for clinicians

Kongsted

Hansen

Kjær

et al. 2021

Brazilian Journal of Physical Therapy

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Highlights Self-management support is person-centred care reinforcing patient autonomy. Avoid strong clinician control and help patients developing self-efficacy. Let patients’ value-based goals and shared decisions guide management. Help patients make sense of symptoms and reframe unhelpful perspectives. Use supervised exercises as a tool to practice problem-solving skills

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“…Instead, it is recommended that exercise be prescribed based on patient preference and clinician experience (6). This broad recommendation probably re ects uncertainty about the mechanism(s) through which exercise yields positive effects on pain and function (21). It could also be that physiotherapists prescribing exercise programs have different preferences for speci c exercise types based on education and interest, or nonawareness of clinical guidelines (81).…”

Section: Discussionmentioning

confidence: 99%

“…Other exercise types, such as motor control exercises (MCE) (18) and Pilates (19), aim to increase the stability and robustness of the lumbar spine, to improve the posture, or to affect the motor control of the spinal stabilizing muscles, while Yoga (20) aims to increase physical and mental relaxation, including improved exibility and muscular strength. A recent review summarized which rationales the various exercise interventions in LBP are based on; neuromuscular and psychosocial mechanisms were proposed most often, whereas neurophysiological, cardiometabolic, and tissue healing mechanisms were proposed less often (21).…”

Section: Introductionmentioning

confidence: 99%

Summarizing the Effects of Different Exercise Types in Chronic Low Back Pain – A Systematic Review of Systematic Reviews

Grooten¹,

Boström²,

Dedering³

et al. 2021

Preprint

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Background Recently, a review of reviews concluded that exercise therapy of any type makes no difference to the effect on pain or disability in adult patients with acute low back pain (LBP). Whether this is also the case for exercise therapy in chronic LBP is still unknown. Objectives To summarize and synthesize systematic reviews (SR) and meta-analyses (MA) investigating the effects on pain and disability of common exercise types used in chronic LBP. Methods We included systematic reviews from several databases in which ≥ 75% of the studies were RCTs on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks. These were grouped into nine exercise types: Aerobic training, Aquatic exercises, Motor control exercises (MCE), Resistance training, Pilates, Sling exercises, Traditional Chinese Exercises (TCE), Walking, and Yoga. The study quality was assessed with AMSTAR-2. For each type of exercise, a narrative analysis was performed, and the levels of evidence for the effects of exercise were assessed through GRADE. Results The wide search resulted in 2,345 studies, and out of the 246 full texts that were screened, 41 SR/MA were included. Of these, 10 SR/MA were of high quality, 15 of moderate, 14 of low, and two of critically low quality. We found low to moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Resistance training, Pilates, TCE, and Yoga compared to no intervention. Few reviews were found for Aerobic, Aquatic, Sling, and Walking exercises, but with promising results. Aquatic exercises seem to be more beneficial compared to land exercises (low level of evidence). Conclusions In line with previous studies but in a broader perspective, this systematic review of reviews showed that there is low to moderate evidence that exercises are effective for reducing pain and disability compared to no or minimal interventions, but that no exercise type is more effective than other conservative interventions (very low to moderate evidence). Systematic review registration number PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=190409

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Why is exercise prescribed for people with chronic low back pain? A review of the mechanisms of benefit proposed by clinical trialists

Cited by 36 publications

References 28 publications

Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial

Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial

Self-management at the core of back pain care: 10 key points for clinicians

Summarizing the Effects of Different Exercise Types in Chronic Low Back Pain – A Systematic Review of Systematic Reviews

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