Exercise therapy for treatment of non-specific low back pain
Open accessAbstract
BACKGROUND: Exercise therapy is widely used as an intervention in low-back pain. OBJECTIVES: To evaluate the effectiveness of exercise therapy in adult non-specific acute, subacute and chronic low-back pain versus no treatment and other conservative treatments. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (Issue 3, 2004), MEDLINE, EMBASE, PsychInfo, CINAHL databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. SELECTION CRITERIA: Randomized controlled trials evaluating exercise therapy for adult non-specific low-back pain and measuring pain, function, return-to-work/absenteeism, and/or global improvement outcomes. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short, intermediate, and long-term follow-up. MAIN RESULTS: Sixty-one randomized controlled trials (6390 participants) met inclusion criteria: acute (11), subacute (6) and chronic (43) low-back pain (1 unclear). Evidence was found of effectiveness in chronic populations relative to comparisons at all follow-up periods; pooled mean improvement was 7.3 points (95% CI, 3.7 to 10.9) for pain (out of 100), 2.5 points (1.0 to 3.9) for function (out of 100) at earliest follow-up. In studies investigating patients (i.e. presenting to healthcare providers) mean improvement was 13.3 points (5.5 to 21.1) for pain, 6.9 (2.2 to 11.7) for function, representing significantly greater improvement over studies where participants included those recruited from a general population (e.g. with advertisements). There is some evidence of effectiveness of graded-activity exercise program in subacute low-back pain in occupational settings, though the evidence for other types of exercise therapy in other populations is inconsistent. There was evidence of equal effectiveness relative to comparisons in acute populations [pain: 0.03 points (95% CI, -1.3 to 1.4)]. LIMITATIONS: This review largely reflects limitations of the literature, including low quality studies with heterogeneous outcome measures, inconsistent and poor reporting, and possibility of publication bias. AUTHORS' CONCLUSIONS: Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in healthcare populations. In subacute low-back pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. In acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.
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Physical exercise has been shown to reduce depression, seems to reduce pain, and is recommended as an adjunctive treatment for anxiety disorders.
“Physical exercise has been shown to reduce depression [14], seems to reduce pain [15] and is recommended as an adjunctive treatment for anxiety disorders [16].”
From Effects of Inpatient Multicomponent Occupational Rehabilitation versus Less Comprehensive Outpatient Rehabilitation on Somatic and Mental Health: Secondary Outcomes of a Randomized Clinical Trial. (2017) · cites this paper as [15]
Citation [15] supports only the pain clause. The Authors’ Conclusions report that exercise therapy reduces pain in chronic low-back pain, but the citing sentence leaves the pain condition unspecified and thus states the finding more broadly than this review supports. Depression and anxiety are attached to other citations and are not assessed here. (LLM, conf=0.85)
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- Authors
- Hayden, J., van Tulder, M. W., Malmivaara, A., & Koes, B. W.
- Affiliations
- Dalhousie University (CA)
- VU University; Department of Health Sciences, Faculty of Earth and Life Sciences; PO Box 7057 Room U454 Amsterdam Netherlands 1007 MB
- Finnish Institute for Health and Welfare (FI)
- Erasmus MC (NL)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2005-07-20
- Volume
- 2011
- Issue
- 2
- Pages
- CD000335-CD000335
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC10068907
- OpenAlex
- W1779075490
- Cited by
- 879
- References
- 136
- Citations by year
- 2026: 13 · 2025: 28 · 2024: 35 · 2023: 39 · 2022: 36 · 2021: 58 · 2020: 48 · 2019: 45 · 2018: 41 · 2017: 61 · 2016: 54 · 2015: 72 · 2014: 39 · 2013: 43 · 2012: 49
- FWCI
- 3.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- VU Research Portal (submittedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Keywords
- exercise therapy, non-specific low back pain, chronic low back pain, acute low back pain, subacute low back pain, analgesia, functional improvement, return to work, absenteeism, conservative treatment, exercise adherence, publication bias
- MeSH terms
- Acute Disease, Exercise Therapy, Humans, Randomized Controlled Trials as Topic, Low Back Pain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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