OBJECTIVES: To determine whether exercise is more effective than usual care to reduce work disability in patients with non-acute non-specific low back pain, and if so. to explore which type of exercise is most effective. METHODS: Systematic review and meta-analysis of randomized controlled trials investigating the effectiveness of exercise in non-acute non-specific low back pain, and reporting on work disability. DATA SOURCES: Medline, Embase, PEDro, Cochrane Library databases, NIOSHTIC-2, and PsycINFO until August 2008. Work disability data were converted to odds ratios. Random effects meta-analyses were conducted. RESULTS: A total of 23 trials met the inclusion criteria, 20 of which were suitable for inclusion in meta-analysis allowing 17 comparisons of exercise interventions with usual care and 11 comparisons of 2 different exercise interventions. A statistically significant effect in favour of exercise on work disability was found in the long term (odds ratio (OR) 0.66, 95 percent confidence interval (CI) 0.48 to 0.92) but not in the short (OR 0.80, 95 percent CI 0.51 to 1.25) and intermediate term (OR 0.78, 95 percent CI 0.45 to 1.34). Meta-regression indicated no significant effect of specific exercise characteristics. CONCLUSION: Exercise interventions have a significant effect on work disability in patients with non-acute non-specific low back pain in the long term. No conclusions can be made regarding exercise types.

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