Public health

Concrete evidence on the value of exercise for back pain

Exercise combined with education reduces the risk of low back pain, a systematic review by Australian authors confirms.

The review was conducted by researcher Daniel Steffens and colleagues from The George Institute for Global Health in Sydney and involved 23 studies and 30,850 participants.

The research team found evidence for both exercise alone (35 percent risk reduction for a low back pain (LBP) episode and 78 percent risk reduction for sick leave) and for exercise and education (45 percent risk reduction for an LBP episode) for the prevention of LBP up to one year.

However they also found the effect size reduced (exercise and education) or disappeared (exercise alone) in the longer term (> 1 year).

This finding raises the important issue that, for exercise to remain protective against future LBP, it is likely that ongoing exercise is required,” concluded the authors in the study published online in JAMA Internal Medicine.

Other interventions such as back belts and shoe inserts do not appear to be associated with the prevention of low back pain, they added.

In an accompanying editorial Timothy S. Carey and Janet Freburger from The University of North Carolina at Chapel Hill said the review provided “concrete evidence on the value of exercise” for lower back pain.

The benefits were fairly consistent across studies, and the effect size (approximately 25%-40%) was large enough to have clinical and policy importance, they wrote.

“If a medication or injection were available that reduced LBP recurrence by such an amount, we would be reading the marketing materials in our journals and viewing them on television,” they said (*editors note: our best quote of the year so far).

But physicians did not often prescribe exercise following an episode of LBP, they noted.

Payers, professional societies, consumers, and members of health care delivery systems will need to work together to address the barriers to exercise after low back pain, they said.

“The potential benefits to the health system, patients, and employers are substantial,” they concluded.

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