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Exercise intensity matters in chronic nonspecific low back pain rehabilitation
Verbrugghe J, Agten A, Stevens S, Hansen D, Demoulin C, Eijnde BO, Vandenabeele F, Timmermans A
Medicine and Science in Sports and Exercise 2019;51(12):2434-2442
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

INTRODUCTION: Exercise therapy (ET) is advocated as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapy effect sizes remain low. In other chronic disorders, training at higher intensity has resulted in greater improvements on both general health related and disease specific outcomes compared to lower intensity ET. Possibly, high intensity training also improves effect sizes in CNSLBP. OBJECTIVE: To compare the effects of a high intensity ET program with a similar moderate intensity ET program on disability, pain, function, exercise capacity, and abdominal/back muscle strength in persons with CNSLBP. METHODS: In a randomized controlled trial, persons with CNSLBP performed a 12-week ET program (24 sessions, 1.5 hours/session, 2x/week) at high (HIT) or moderate intensity (MIT). Questionnaires to assess disability (Modified Oswestry Index (MODI)), pain intensity (Numeric Pain Rating Scale (NPRS)), and function (Patient Specific Functioning Scale (PSFS)), a cardiopulmonary exercise test to assess exercise capacity (VO2max, cycling time), and a maximum isometric muscle strength test to assess abdominal/back muscle strength (maximum muscle torque) were administered at baseline and after the training program. RESULTS: Thirty-eight participants (HIT n = 19, MIT n = 19) were included (mean age 44.1y, SD 9.8, 12 males). Groups did not differ at baseline. Between group differences (p < 0.01) in favor of HIT were found for MODI, VO2max, and cycling time. Within group improvements (p < 0.01) were found in both groups on MODI (HIT -64%, MIT -33%), NPRS (HIT -56%, MIT -39%), PSFS (HIT +37%, MIT +39%), VO2max (HIT +14, MIT +4%), cycling time (HIT +18%, MIT +13%), and back muscle strength (HIT +10%, MIT +14%). CONCLUSION: HIT proved to be a feasible, well tolerated, and effective therapy modality in CNSLBP. Moreover, it shows greater improvements on disability and exercise capacity than a similar ET performed at moderate intensity.

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