On Exercise and Chronic Back Pain

Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain.JA Hayden, MW van Tulder, G TomlinsonAnn Intern Med 2005 5;142(9):776-85


In this paper, the authors review in a systematic manner the literature on exercise intervention characteristics to identify those exercises (and associated features) that are more likely to improve function, decrease pain and diminish work absenteeism in adults with chronic low back pain. Forty three trials (72 exercise treatments and 31 comparison groups, 3226 participants) were included. Significant improvements on pain and function scores were observed for individually designed programs, supervised home exercise programs and group and individually supervised programs as compared to home exercises only. Stretching and strengthening exercises were the best. In addition, more intensive programs (more than 20 hours total time) and those that included additional conservative measures were also more beneficial. These results were derived using a meta-analyses and meta-regression. The figures presented help significantly in the interpretation of the data given that most readers will not understand the statistical methods used. As with the other article (Ann Intern Med 2005; 142: 765-775), the limitations of this study relate primarily to the quality of the primary data which, for the most part, is not very good. Nevertheless, the message to the clinician is clear; well designed and professionally supervised programs are more likely to be effective than programs than do not meet these qualifications. Again, this is far from the recommendation clinicians oftentimes make to their patients of remaining physically active despite chronic low back pain.

– Graciela S. Alarcon, MD