Cited by 321Musculoskeletal pain and rehabilitationPregnancy-related medical researchSpine and Intervertebral Disc Pathology

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Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis

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Hayden, Jill A, Ellis, Jenna, Ogilvie, Rachel, Stewart, Samuel A, Bagg, Matthew K, Stanojevic, Sanja, Yamato, Tiê P, Saragiotto, Bruno T·2021·Journal of Physiotherapy

DOI 10.1016/j.jphys.2021.09.004

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Abstract

QUESTION: What are the effects of specific types of exercise treatments on pain intensity and functional limitation outcomes for adults with chronic low back pain? DESIGN: Systematic review with network meta-analysis of randomised controlled trials. PARTICIPANTS: Adults with non-specific low back pain for ≥ 12 weeks. INTERVENTION: Exercise treatments prescribed or planned by a health professional that involved conducting specific activities, postures and/or movements with a goal to improve low back pain outcomes. OUTCOME MEASURES: Pain intensity (eg, visual analogue scale or numerical rating scale) and back-related functional limitations (eg, Roland Morris Disability Questionnaire or Oswestry Disability Index), each standardised to range from 0 to 100. RESULTS: This review included 217 randomised controlled trials with 20,969 participants and 507 treatment groups. Most exercise types were more effective than minimal treatment for pain and functional limitation outcomes. Network meta-analysis results were compatible with moderate to clinically important treatment effects for Pilates, McKenzie therapy, and functional restoration (pain only) and flexibility exercises (function only) compared with minimal treatment, other effective treatments and other exercise types. The estimated mean differences for these exercise types compared with minimal treatment ranged from -15 to -19 for pain and from -10 to -12 for functional limitation. CONCLUSION: This review found evidence that Pilates, McKenzie therapy and functional restoration were more effective than other types of exercise treatment for reducing pain intensity and functional limitations. Nevertheless, people with chronic low back pain should be encouraged to perform the exercise that they enjoy to promote adherence. REGISTRATION: DOI:10.1002/14651858.CD009790.

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Additional file 6 of Effectiveness of m-health-based core strengthening exercise and health education for public safety workers with chronic non-specific low back pain: study protocol for a superiority randomized controlled trial (SAFEBACK)
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Additional file 4 of Summarizing the effects of different exercise types in chronic low back pain – a systematic review of systematic reviews
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Additional file 2 of Summarizing the effects of different exercise types in chronic low back pain – a systematic review of systematic reviews
Grooten, W. J. A., Boström, C., Dedering, Å., Halvorsen, M., Kuster, R. P., Nilsson-Wikmar, L. B., Olsson, C. B., Rovner, G., Tseli, E., & Rasmussen-Barr, E. (2022) · Figshare · doi:10.6084/m9.figshare.20545776
Additional file 3 of Effectiveness of m-health-based core strengthening exercise and health education for public safety workers with chronic non-specific low back pain: study protocol for a superiority randomized controlled trial (SAFEBACK)
Marins, E. F., Caputo, E. L., KRUGER, V., Junior, D. M., Scaglioni, F., Del Vecchio, F. B., Primo, T. T., & Alberton, C. L. (2024) · Figshare · doi:10.6084/m9.figshare.26648406
Additional file 3 of Summarizing the effects of different exercise types in chronic low back pain – a systematic review of systematic reviews
Grooten, W. J. A., Boström, C., Dedering, Å., Halvorsen, M., Kuster, R. P., Nilsson-Wikmar, L. B., Olsson, C. B., Rovner, G., Tseli, E., & Rasmussen-Barr, E. (2022) · Figshare · doi:10.6084/m9.figshare.20545782
Additional file 3 of Physical activity during pregnancy: a systematic review for the assessment of current evidence with future recommendations
Budler, L. C., & Budler, M. (2022) · Figshare · doi:10.6084/m9.figshare.20329921
Additional file 1 of Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up
Mikkonen, J., Luomajoki, H., Airaksinen, O., Goubert, L., & Leinonen, V. (2023) · Figshare · doi:10.6084/m9.figshare.22774246
Additional file 3 of Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up
Mikkonen, J., Luomajoki, H., Airaksinen, O., Goubert, L., & Leinonen, V. (2023) · Figshare · doi:10.6084/m9.figshare.22774252
Additional file 5 of Effectiveness of m-health-based core strengthening exercise and health education for public safety workers with chronic non-specific low back pain: study protocol for a superiority randomized controlled trial (SAFEBACK)
Marins, E. F., Caputo, E. L., KRUGER, V., Junior, D. M., Scaglioni, F., Del Vecchio, F. B., Primo, T. T., & Alberton, C. L. (2024) · Figshare · doi:10.6084/m9.figshare.26648412
Additional file 2 of Effectiveness of m-health-based core strengthening exercise and health education for public safety workers with chronic non-specific low back pain: study protocol for a superiority randomized controlled trial (SAFEBACK)
Marins, E. F., Caputo, E. L., KRUGER, V., Junior, D. M., Scaglioni, F., Del Vecchio, F. B., Primo, T. T., & Alberton, C. L. (2024) · Figshare · doi:10.6084/m9.figshare.26648403
Additional file 1 of Rescaling pain intensity measures for meta-analyses of analgesic medicines for low back pain appears justified: an empirical examination from randomised trials
Wewege, M. A., Jones, M. D., Williams, S. A., Kamper, S. J., & McAuley, J. H. (2022) · Figshare · doi:10.6084/m9.figshare.21506765
Additional file 2 of Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up
Mikkonen, J., Luomajoki, H., Airaksinen, O., Goubert, L., & Leinonen, V. (2023) · Figshare · doi:10.6084/m9.figshare.22774249
Additional file 1 of Physical activity during pregnancy: a systematic review for the assessment of current evidence with future recommendations
Budler, L. C., & Budler, M. (2022) · Figshare · doi:10.6084/m9.figshare.20329915
A Chinese Guideline for the Diagnosis and Treatment of Chronic LOW Back Pain (2024 Edition)
Cheng, Z.-X., Liu, X.-G., Lu, Y., Ma, K., Dong, H., Liu, Q., Yang, X., Lu, L.-J., Liu, T.-H., Wang, L., et al. (2025) · International Journal of Pain Research · doi:10.11648/j.ijpr.20250104.14
Response to letter to the editor regarding “DMA Clinical Pilates TM exercises improved clinical and biomechanical outcomes for adults with nonspecific chronic low back pain: a randomized controlled trial”
Kwok, B. C., & Kong, P. W. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2630788
Analysis of the effectiveness of therapeutic physical education in the treatment and rehabilitation of patients with degenerative spine conditions: a review
Miryutova, N. F., Gameeva, E. V., Степанова, А. М., & Владимировна, Т. А. (2026) · Bulletin of Rehabilitation Medicine · doi:10.38025/2078-1962-2026-25-1-75-83
Prevalence and Predictive Factors of Active Myofascial Trigger Points Among Office Workers Using to Visual Display Terminals: A Cross-Sectional Study
Poveda-Pagán, E. J., Lozano-Quijada, C., Hernández-Sánchez, S., Marhuenda, J. V. T., Pintado, E. L., Segura, J., & Gascón-Jaén, J. (2026) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2026.100606
Effects of line dancing and flexibility training on chronic non-specific low back pain among college students: A randomized controlled trial
Qu, Y., Liu, Z., Li, J., & Chan, D. K. C. (2026) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2026.103346
Effects of exercise dose based on the ACSM recommendations on pain and disability in non-specific low back pain patients: a systematic review and meta-analysis of randomized controlled trials
谭涛, Tan, X., Xie, J., Zeng, B., Xie, J., Wang, H., & Wen, F. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1725132
Transcranial direct current stimulation (tDCS) over the dorso-lateral-prefrontal cortex in combination with exercises for the treatment of individuals with chronic low back pain (STOP-Low Back Pain Trial): study protocol for a randomised controlled trial
Pourchet, T., Armand, S., Martins, C., Barrué-Belou, S., Genevay, S., & Nicolo, P. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-111649
The Physio2Future Model as a guide for responsible physiotherapy of the future in Germany: a Delphi study among German physiotherapists in leadership positions
Alt, A. (2026) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2025.0101
INTERVENTION EFFECT OF EXERCISE TRAINING PROGRAM USING DEEP LEARNING-BASED MOTION ANALYSIS SYSTEM ON PATIENTS WITH LOW BACK PAIN
ZHAO, J. (2026) · Journal of Mechanics in Medicine and Biology · doi:10.1142/s0219519426500211
Comparative effectiveness of non-pharmacological interventions for depression and anxiety in chronic low back pain: a Bayesian network meta-analysis of randomized controlled trials
Chen, L., Zeng, L., Lai, Y.-T., Li, W., & Li, J. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1765762
Smartphone-Based Telerehabilitation for Low Back Pain: A Randomized Controlled Trial on Pain, Disability, Fear-Avoidance, and Trunk Muscle Endurance
Liao, C.-Y., Lin, B.-S., Liang, H., Wang, P., Huang, T.-J., & Lee, S.-H. (2026) · IEEE Transactions on Human-Machine Systems · doi:10.1109/thms.2026.3682700
Components of Standardized Motor Control and Movement Quality Measures in Low Back Pain: A Framework-Based Scoping Review
Pfluegler, G., Klinger, M., Ley, C., & Luedtke, K. (2026) · JOSPT Methods · doi:10.2519/josptmethods.2026.0027
Effect of Warm Acupuncture Combined with Integrated Nursing Scheme on Pain and Self-Management Ability in Patients with Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial
Zhang, Q., Xie, J., & Song, M. (2026) · Acupuncture & Electro-Therapeutics Research · doi:10.1177/03601293261446339
Effect of exercise interventions on clinical outcomes in patients with chronic low back pain and central sensitisation: A randomized controlled trial
Ganesh, G. S., Khan, A. R., Khan, A., & Das, S. P. (2026) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2026.04.024
An International Physical Exercise Screening Questionnaire (IPESQ)
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Comparative effects of exercise modalities and dose parameters on chronic low back pain in adults: a systematic review and network meta-analysis
Wang, L., Zhou, C., & Zhai, C. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1836061
NSAID Use Attenuates the Protective Effect of Physical Activity on Chronic Low Back Pain: A Cross-Sectional Analysis of NHANES 2009–2010
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Comparative biopsychosocial effects of yoga, spinal stabilization, and aerobic exercises in chronic non-specific low back pain: A randomized controlled trial
Öz, M., Ozturk, E., Huri, G., & Ülger, Ö. (2026) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2026.2676083

Authors: Hayden, J. A., Ellis, J., Ogilvie, R., Stewart, S. A., Bagg, M. K., Stanojevic, S., Yamato, T. P., & Saragiotto, B. T.
Affiliations: Dalhousie University (CA)
Department of Water (AU)
The University of Sydney (AU)
Corresponding author: Hayden, Jill A
ORCID: Hayden, Jill A
Ellis, Jenna
Ogilvie, Rachel
Stewart, Samuel A
Bagg, Matthew K
Stanojevic, Sanja
Yamato, Tiê P
Saragiotto, Bruno T
Venue: Journal of Physiotherapy
Publisher: Elsevier BV
Published: 2021-10
Volume: 67
Issue: 4
Pages: 252-262
ISSN: 1836-9553 (ISSN-L)
DOI: 10.1016/j.jphys.2021.09.004
OpenAlex: W3199777986
Cited by: 321
References: 39
Citations by year: 2026: 49 · 2025: 63 · 2024: 72 · 2023: 85 · 2022: 50 · 2021: 2
FWCI: 6.62
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Journal of physiotherapy (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Fundação de Amparo à Pesquisa do Estado de São Paulo (2019/10330-4, 2020/14231-8)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Keywords: chronic low back pain, exercise therapy, Pilates, McKenzie therapy, functional restoration, flexibility training, pain intensity, functional limitations, disability, exercise adherence, non-specific low back pain
MeSH terms: Network Meta-Analysis, Adult, Exercise Therapy, Humans, Pain Measurement, Low Back Pain, Chronic Pain

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Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis

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