Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis

• Published in: The journal of orthopaedic and sports physical therapy Vol. 52; no. 8; pp. 505 - 521
• Main Authors: Fernández-Rodríguez, Rubén, Álvarez-Bueno, Celia, Cavero-Redondo, Iván, Torres-Costoso, Ana, Pozuelo-Carrascosa, Diana P., Reina-Gutiérrez, Sara, Pascual-Morena, Carlos, Martínez-Vizcaíno, Vicente
• Format: Journal Article
• Language: English
• Published: 01-08-2022
• ISSN: 0190-6011; 1938-1344
• DOI: 10.2519/jospt.2022.10671

OBJECTIVETo determine which type of exercise is best for reducing pain and disability in adults with chronic low back pain (LBP). DESIGNSystematic review with a network meta-analysis (NMA) of randomized controlled trials (RCTs). LITERATURE SEARCHSix electronic databases were systematically searched from inception to July 2021. STUDY SELECTION CRITERIARCTs testing the effects of exercise on reducing self-perceived pain or disability in adults (aged 18-65 years) with chronic LBP. DATA SYNTHESISWe followed the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, incorporating NMAs of health care interventions) statement when reporting our NMA. A frequentist NMA was conducted. The probability of each intervention being the most effective was conducted according to surface under the cumulative ranking curve (SUCRA) values. RESULTSWe included 118 trials (9710 participants). There were 28 head-to-head comparisons, 7 indirect comparisons for pain, and 8 indirect comparisons for disability. Compared with control, all types of physical exercises were effective for improving pain and disability, except for stretching exercises (for reducing pain) and the McKenzie method (for reducing disability). The most effective interventions for reducing pain were Pilates, mind-body, and core-based exercises. The most effective interventions for reducing disability were Pilates, strength, and core-based exercises. On SUCRA analysis, Pilates had the highest likelihood for reducing pain (93%) and disability (98%). CONCLUSIONAlthough most exercise interventions had benefits for managing pain and disability in chronic LBP, the most beneficial programs were those that included (1) at least 1 to 2 sessions per week of Pilates or strength exercises; (2) sessions of less than 60 minutes of core-based, strength, or mind-body exercises; and (3) training programs from 3 to 9 weeks of Pilates and core-based exercises. J Orthop Sports Phys Ther 2022;52(8):505-521. Epub: 19 June 2022. doi:10.2519/jospt.2022.10671.