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Institut des sciences du sport et de leducation physique, Universite de Lausanne, Centre administratif de Vidy, 1015 Lausanne, Switzerland
b
Service de Rhumatologie, Departement de medecine, CHUV et Universite de Lausanne, Lausanne, Switzerland
Accepted 11 March 2008
Available online 17 September 2008
Abstract
We reviewed the literature to clarify the effects of exercise in preventing and treating nonspecific low back pain. We evaluated several
characteristics of exercise programs including specificity, individual tailoring, supervision, motivation enhancement, volume, and intensity. The
results show that exercise is effective in the primary and secondary prevention of low back pain. When used for curative treatment, exercise
diminishes disability and pain severity while improving fitness and occupational status in patients who have subacute, recurrent, or chronic low
back pain. Patients with acute low back pain are usually advised to continue their everyday activities to the greatest extent possible rather than to
start an exercise program. Supervision is crucial to the efficacy of exercise programs. Whether general or specific exercises are preferable is
unclear, and neither is there clear evidence that one-on-one sessions are superior to group sessions. Further studies are needed to determine
which patient subsets respond to specific characteristics of exercise programs and which exercise volumes and intensities are optimal.
2008 Elsevier Masson SAS. All rights reserved.
Keywords: Physical activity; Physical training; Exercise; Low back pain; Rehabilitation; Therapy; Review
1. Introduction
2. Methods
Low back pain has been a major public health burden for
many years, generating substantial work disability and
healthcare costs. Among adults in the general population, 70e
85% are believed to experience at least one episode of low
back pain at some time during their lives [1]. Nonspecific low
back pain, defined as pain with no identifiable cause, accounts
for about 85% of cases. Studies of the many treatment
modalities available for low back pain have failed to determine
which strategy is optimal. However, there is convincing
evidence of the harmful effect of bed rest, which was long
recommended for acute low back pain. Patients should
continue their everyday activities to the greatest extent
possible. Exercise is being increasingly used to treat low back
pain, and data on the effect of exercise is accumulating. We
reviewed these data to clarify the role for exercise in the
treatment and prevention of low back pain.
* Corresponding author. Tel.: 41 216 923 296; fax: 41 216 923 293.
E-mail address: yves.henchoz@unil.ch (Y. Henchoz).
1297-319X/$ - see front matter 2008 Elsevier Masson SAS. All rights reserved.
doi:10.1016/j.jbspin.2008.03.003
534
3. Results
3.1. Exercise for the prevention and treatment of low
back pain
We identified 20 reviews and meta-analyses of the efficacy
of exercise in preventing and treating low back pain published
between 1997 and 2007 (Table 1). They are discussed below.
3.1.1. Primary prevention of low back pain
Among reviews of data obtained in asymptomatic individuals, four [3e6] produced strong evidence, three [7e9]
moderate evidence, and two [10,11] conflicting evidence that
exercise was effective in preventing low back pain.
3.1.2. Secondary prevention of low back pain
One review each produced strong [3], moderate [12], and
conflicting evidence [7] that exercise prevented recurrences of
low back pain or repeated absence from work.
3.1.3. Treatment of low back pain
3.1.3.1. Acute low back pain. Eight reviews [3,5,6,13e17]
produced strong evidence that exercise was not more effective
in diminishing pain or disability than other conservative
treatments or than placebo treatments. Evidence from another
review [10] was conflicting. A meta-analysis [18] showed that
exercise was as effective as other conservative treatments or no
Table 1
Reviews and meta-analyses on the efficacy of exercise in preventing or treating
low back pain
Authors
Prevention
Treatment
?
535
Table 2
Studies comparing general exercise to specific exercise
Authors
Patients
Interventions
Effects
536
Table 3
Studies of individualized versus group exercise
Authors
Patients
Interventions
Effects
LBP, low back pain; >, significantly better than; VAS, visual analog scale; FFbH-R, Funktionsfragebogens Hannover in seiner Ruckenschmerzversion.
537
Table 4
Studies of supervised exercise versus unsupervised home exercise
Authors
Patients
Interventions
Effects
LBP, low back pain; >, significantly better than; VAS, visual analog scale.
Table 5
Studies evaluating the influence of patient motivation and preferences on the response of patients with low back pain to exercise
Authors
Patients
Interventions
Effects
LBP, low back pain; >, significantly better than; VAS, visual analog scale
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