OBJECTIVES: The objectives of this review were to: (i) determine the effectiveness of exercise following lumbar decompression surgery; (ii) identify what the essential components of such exercise programmes should be; and (iii) evaluate the quality of research in this area based on current research initiatives. PATIENTS AND METHODS: A literature search and methodological assessment identified nine high quality RCTs evaluating 1,250 patients. RESULTS: The key finding from this review was that there is strong evidence to support the long-term effectiveness of structured intensive exercise programmes, initiated 4 to 6 weeks post-operatively. Rehabilitation should not be precautionary; however, further research is needed to validate the earlier use of exercise. Back, abdominal and lower limb strengthening were found to offer the most positive results, but the exact parameters of an ideal exercise programme remain unknown. Encouraging activity through behavioural programmes or advice is also important. CONCLUSIONS: While the methodological quality and use of recommended outcome measures in this area has improved, future studies should be explicit about the exact details of exercises and advice programmes offered to these patients.

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