Exercise therapy for chronic low back pain.

This Cochrane systematic review asked whether exercise therapy helps adults with chronic non-specific low back pain (pain lasting more than 12 weeks) more than no treatment, usual care, placebo, or other conservative treatments. The researchers pooled data from 249 randomised controlled trials, mostly from Europe, Asia, North America, and the Middle East, with participants averaging 43.7 years old. Compared to no treatment, usual care, or placebo, exercise showed a statistically significant and clinically important reduction in pain (moderate-certainty evidence), but the improvement in functional limitations, while statistically significant, was smaller and did not meet the review's threshold for a clinically important difference. Compared to other conservative treatments, exercise showed small improvements in both pain and function that did not meet the clinically important threshold overall.

Certainty was downgraded mainly due to inconsistency across trials and some evidence of publication bias, and most trials carried risk of bias, particularly because participants and providers could not be blinded to exercise treatment.

This large review combined results from 249 studies of exercise for chronic low back pain (pain lasting more than 12 weeks) to see whether it helps compared to no treatment, usual care, placebo, or other treatments like manual therapy or education. When compared to no treatment, usual care, or placebo, exercise led to a meaningful reduction in pain, based on moderate-certainty evidence. However, the improvement in day-to-day functioning, while statistically real, was smaller than what the researchers considered a clinically important change.

When compared to other conservative treatments overall, exercise showed small improvements in pain and function, but these were not considered clinically important. Exercise appeared more effective than education alone or general physical therapy for pain, but not clearly different from manual therapy. The evidence has limitations: most studies could not blind participants to which treatment they received, which can influence how people report their pain, and there was inconsistency across studies.

Adverse effects, when tracked, were mostly minor, such as muscle soreness, occurring at similar rates in exercise and comparison groups.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This Cochrane review pooled 249 RCTs of exercise therapy for chronic non-specific low back pain against no treatment, usual care, placebo, and other conservative interventions. Most trials (61%) compared multiple exercise types, and 57% compared exercise to non-exercise treatments.

Risk of bias was substantial, with 79% of trials at risk of performance bias due to inevitable difficulty blinding exercise interventions. Against no treatment, usual care, or placebo, moderate-certainty evidence showed a clinically important reduction in pain (MD -15.2, 95% CI -18.3 to -12.2), while the functional limitations effect (MD -6.8, 95% CI -8.3 to -5.3), though moderate-certainty, fell short of the prespecified 10-point threshold. Against other conservative treatments pooled together, effects on pain (low-certainty) and function (moderate-certainty) were smaller and not clinically important.

Subgroup analyses suggested exercise outperformed education alone and non-exercise physical therapy for pain, with no difference versus manual therapy. Certainty was downgraded primarily for heterogeneity and possible publication bias.

Adverse effects, reported in 86 studies, were mostly minor and occurred at broadly similar rates between exercise and comparison groups, though systematic harms tracking was limited to 12 studies.