Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis

Owen PJ, Miller CT, Mundell NL, Verswijveren SJ, Tagliaferri SD, Brisby H, Bowe SJ, & Belavy DL. Br J Sports Med. 2019 Epub ahead of print: November 18, 2019. DOI:10.1135/bjsports-2019-100886

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Take-Home Message

A clinician may want to select the type of exercise for a person with non-specific chronic low back pain based on that patient’s goals (e.g., improved pain, function, or mental health).


Exercise is often recommended for people with non-specific chronic low back pain; however, it remains unclear which specific types of exercise may be most effective. These authors conducted a systematic review and network meta-analysis to determine the effectiveness of various exercise approaches on pain, physical function, mental health, and trunk muscle strength in people with chronic low back pain. The authors included randomized trials if they had one outcome measure of interest among adults with non-specific low back pain lasting greater than 12 weeks. The authors also evaluated the 89 trials for quality, risk of bias, and other qualitative outcomes. The studies varied in sample sizes, ages, sex, and duration/intensity of pain. Overall, aerobic and resistance training led to better outcomes than no treatment for pain, function, and mental health. However, the authors reported that depending on the outcome of interest, the most effective exercise training varied.  Pilates was most effective for pain reduction, resistance and aerobic training was most effective for improving mental health and resistance, and stabilization/motor control training were most effective for improving physical function.  However, the authors noted that these are not strong recommendations and should be interpreted with caution due to the low quality of evidence and inconsistent findings.


Overall, the authors found that there is low quality of evidence for exercise interventions for chronic low back pain.  Certain exercises may work best depending on the outcome of interest in people with chronic low back pain. This emphasizes a patient-centered approach, meaning we should be determining what the patient’s main complaints or goals might be and then select the appropriate exercise approach. If a patient has numerous goals then aerobic and resistance training may be sound approaches. Unfortunately, we lack high-quality research to help improve the quality of evidence and recommendations that exist.  Ultimately, clinicians should be taking a patient-centered approach.  We should be assessing a patient’s symptoms, understanding their level of disability, and what their goals might be, to best decide which exercise interventions might be most appropriate.

Questions for Discussion

What patient-reported outcomes to you utilize in patients with chronic low back pain?  What have you found the most clinical success with improving patients with low back pain?

Written by: Nicole M. Cattano
Reviewed by: Jeffrey Driban

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