Annika Wun1, Paul Kollias1, Harry Jeong1, Rodrigo Rn Rizzo2, Aidan G Cashin3, Matthew K Bagg4, James H McAuley2, Matthew D Jones5. 1. School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia. 2. School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia. 3. Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia. 4. Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia; New College Village, University of New South Wales, Sydney, Australia. 5. School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia. Electronic address: matthew.jones@unsw.edu.au.
Abstract
BACKGROUND: Exercise is recommended for the management of chronic low back pain (CLBP). Trialists have proposed numerous mechanisms to explain why exercise improves pain and function in people with CLBP, but these are yet to be synthesised. OBJECTIVE: To synthesise the proposed mechanisms of benefit for exercise in people with CLBP. DESIGN: Review. METHODS: The Physiotherapy Evidence Database (PEDro) was searched from inception to July 2019. Randomised controlled trials of adults with CLBP, indexed in PEDro as 'fitness training', were included. Two reviewers independently screened and extracted data from each study. Data were analysed quantitatively and qualitatively using thematic analysis. RESULTS: 186 studies were identified and 110 were included in the analysis. Thirty-six studies (33%) did not provide a mechanism of benefit for exercise in people with CLBP. Of the remaining studies, most provided more than one mechanism, from which 33 unique mechanisms were identified. These were grouped into five themes which, from most to least common, were: neuromuscular (n = 105 (44%)); psychosocial (n = 87 (36%)); neurophysiological (n = 22 (9%)); cardiometabolic (n = 15 (6%)); and tissue healing (n = 12 (5%)). The effects of these proposed mechanisms on outcomes for people with CLBP were seldom examined. CONCLUSIONS: This review identified a variety of mechanisms proposed in clinical trials to explain why 'fitness training' works for people with CLBP, but these mechanisms were seldom tested. Randomised controlled trials investigating the mediating effects of these mechanisms may be warranted to better understand why exercise works for CLBP.
BACKGROUND: Exercise is recommended for the management of chronic low back pain (CLBP). Trialists have proposed numerous mechanisms to explain why exercise improves pain and function in people with CLBP, but these are yet to be synthesised. OBJECTIVE: To synthesise the proposed mechanisms of benefit for exercise in people with CLBP. DESIGN: Review. METHODS: The Physiotherapy Evidence Database (PEDro) was searched from inception to July 2019. Randomised controlled trials of adults with CLBP, indexed in PEDro as 'fitness training', were included. Two reviewers independently screened and extracted data from each study. Data were analysed quantitatively and qualitatively using thematic analysis. RESULTS: 186 studies were identified and 110 were included in the analysis. Thirty-six studies (33%) did not provide a mechanism of benefit for exercise in people with CLBP. Of the remaining studies, most provided more than one mechanism, from which 33 unique mechanisms were identified. These were grouped into five themes which, from most to least common, were: neuromuscular (n = 105 (44%)); psychosocial (n = 87 (36%)); neurophysiological (n = 22 (9%)); cardiometabolic (n = 15 (6%)); and tissue healing (n = 12 (5%)). The effects of these proposed mechanisms on outcomes for people with CLBP were seldom examined. CONCLUSIONS: This review identified a variety of mechanisms proposed in clinical trials to explain why 'fitness training' works for people with CLBP, but these mechanisms were seldom tested. Randomised controlled trials investigating the mediating effects of these mechanisms may be warranted to better understand why exercise works for CLBP.
Authors: Wilhelmus Johannes Andreas Grooten; Carina Boström; Åsa Dedering; Marie Halvorsen; Roman P Kuster; Lena Nilsson-Wikmar; Christina B Olsson; Graciela Rovner; Elena Tseli; Eva Rasmussen-Barr Journal: BMC Musculoskelet Disord Date: 2022-08-22 Impact factor: 2.562
Authors: Carlos Gevers-Montoro; Mar Romero-Santiago; Lisa Losapio; Francisco Miguel Conesa-Buendía; Dave Newell; Luis Álvarez-Galovich; Mathieu Piché; Arantxa Ortega-De Mues Journal: Front Integr Neurosci Date: 2022-04-12