Exercise reduces sick leave in patients with non-acute non-specific low back pain: a meta-analysis

Kool, Jan; Bie, Rob A. de; Oesch, Peter; Knüsel, O; Brandt, Piet A. van den; Bachmann, Stefan

doi:10.1080/16501970310020104

Cited by 93 publications

(48 citation statements)

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“…It is also doubtful whether persons with back pain develop aerobic deconditioning or whether reduced aerobic fitness is associated with other aspects related to CBP such as pain intensity, activity limitation, depression, fear of injury and kinesiophobia [7,15,26,37,38,42,43]. Furthermore, there is inconclusive evidence for the predictive value of aerobic fitness for work-return in CBP [20,22,24,33] Although in general aerobic fitness shows a doseresponse relation to health outcomes [3], at present, there is modest evidence to suggest that exercise therapy and behavioural and multidisciplinary treatment programs that include exercise therapy are effective in reducing pain, improving physical functioning and activity and reducing the number of sick days in CBP [6,19,23,27,34]. Depending on intensity and duration, many of these programs for persons with CBP that include aerobic training do indeed affect aerobic fitness [28,33,36].…”

Section: Introductionmentioning

confidence: 99%

The impact of aerobic fitness on functioning in chronic back pain

Wormgoor¹,

Indahl²,

Tulder

et al. 2007

Eur Spine J

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Despite lack of convincing evidence that reduced aerobic fitness is associated with chronic back pain (CBP), exercise programs are regarded as being effective for persons with non-specific CBP. It is unsure whether gain in aerobic fitness following intervention is associated with functioning improvement in persons with CBP. The objective of this prospective cohort study was to study the impact of aerobic fitness on functioning in persons with CBP, at baseline and following 3-week intensive interdisciplinary intervention. This study included persons who had passed 8 weeks of sick-listing because of back pain (n = 94) and were referred to a 3-week intensive biopsychosocial rehabilitation program. Aerobic fitness was assessed with a sub-maximal bicycle test at baseline, at admission to and discharge from the rehabilitation program, and at 6 months follow-up. Contextual factors, body function, activity and participation were evaluated before and after intervention. In addition, working ability was recorded at 3-years followup. At baseline aerobic fitness was reduced in most subjects, but improved significantly following intervention. Baseline measurements and intervention effects did not differ among the diagnostic sub-groups. Neither contextual factors nor functioning at baseline were associated with aerobic fitness. Increase in aerobic fitness was not associated with improvements in functioning and contextual factors and work-return following intervention either. From this study we conclude that improvement of aerobic fitness seems of limited value as goal of treatment outcome for patients with CBP.

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Section: Introductionmentioning

confidence: 99%

The impact of aerobic fitness on functioning in chronic back pain

Wormgoor¹,

Indahl²,

Tulder

et al. 2007

Eur Spine J

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“…Knowing that the outcome return to work is an important measure for the effectiveness of an exercise treatment there is need for further research. 42 Research is also needed to enhance the knowledge about functional mechanisms of segmental stabilizing exercises. This knowledge combined with clinical findings might improve the ability to identify subgroups of patients with low back pain and which subgroups benefit from segmental stabilizing exercises and which do not.…”

Section: Implications For Researchmentioning

confidence: 99%

Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials

Rackwitz

Bie

Limm³

et al. 2006

Clin Rehabil

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128

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Study design: A systematic review of randomized controlled trials. Objectives: To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment. Results: Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain. Conclusion: For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions.

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“…Since the completion of van Tulder and colleagues' systematic review, several new trials have been published. Recent reviews on related topics have been restricted by population (2)(3)(4) or type of exercise therapy (5) and have used only qualitative methods of synthesis (2,3,5,6). Recent clinical guidelines that included exercise therapy for low back pain used quantitative methods to synthesize results of randomized, controlled trials; controlled trials; and observational studies (7); however, only 12 studies overlap with the 61 trials included in our review.…”

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confidence: 99%

Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain

Hayden

Tulder

Malmivaara³

et al. 2005

Ann Intern Med

506

298

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Background: Exercise therapy is widely used as an intervention in low back pain.Objective: To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments.Data Sources: MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews.Study Selection: Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes.Data Extraction: Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up.Data Synthesis: 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, ؊1.3 to 1.4 points]).Limitations: Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent and poor reporting, and possibility of publication bias.Conclusions: Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations. In subacute low back pain populations, some evidence suggests that a gradedactivity program improves absenteeism outcomes, although evidence for other types of exercise is unclear. In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments. Ann Intern Med. 2005;142:765-775. www.annals.org For author affiliations, see end of text.L ow back pain is one of the leading causes of disability.Exercise therapy is a management strategy that is widely used in low back pain. It encompasses a heterogeneous group of interventions ranging from general physical fitness or aerobic exercise to muscle-strengthening and various types of flexibility and stretching exercises.In 20...

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Exercise reduces sick leave in patients with non-acute non-specific low back pain: a meta-analysis

Abstract: The reviewed trials provide strong evidence that exercise significantly reduces sick days during the first follow-up year.

Cited by 93 publications

References 80 publications

The impact of aerobic fitness on functioning in chronic back pain

The impact of aerobic fitness on functioning in chronic back pain

Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials

Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain

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