High Intensity Training to Treat Chronic Nonspecific Low Back Pain: Effectiveness of Various Exercise Modes

Abstract

High-intensity training (HIT) improves rehabilitation outcomes such as functional disability and physical performance in several chronic disorders. Promising results were also found in chronic nonspecific low back pain (CNSLBP). However, the impact of different exercise modes on HIT effectiveness in CNSLBP remains unclear. Therefore, this study evaluated the effectiveness of various HIT exercise modes and compared differences between these modes, on pain intensity, disability, and physical performance, as a therapeutic intervention for persons with CNSLBP. In a randomized comparative trial, consisting of a 12-week program, persons with CNSLBP were divided into four HIT groups, i.e., cardiorespiratory interval training coupled with either general resistance training, core strength training, combined general resistance and core strength training, or mobility exercises. Before and after the program, the Numeric Pain Rating Scale (NPRS), Modified Oswestry Disability Index (MODI), and Patient Specific Functioning Scale (PSFS) were recorded, and a cardiopulmonary exercise test (VO₂max, cycling time) and isometric trunk strength test (maximum muscle torque) were performed. Eighty participants (mean age: 44.0 y, 34 males) were included. Improvements were found within all groups after the HIT programs and ranged from -39 to -57% on the NPRS, +27 to +64% on the MODI, +38 to +89% on the PSFS, +7 to +14% on VO₂max, and +11 to +18% on cycling time. No differences between groups were found. High-intensity cardiorespiratory interval training improves CNSLBP rehabilitation outcomes when performed with other HIT exercise modes or mobility exercises. Hence, when setting up an exercise therapy program in CNSLBP rehabilitation, various HIT modes can be considered as therapy modalities.

Keywords: chronic low back pain; clinical trial; exercise therapy; high-intensity training.

Figure 1

CONSORT flowchart of the research design. Abbreviations: CNSLBP = chronic nonspecific low back pain; HITCOM = high-intensity cardiorespiratory training combined with high-intensity general resistance and high-intensity core strength training; HITSTRE = high-intensity cardiorespiratory training combined with high-intensity general resistance training; HITSTAB = high-intensity cardiorespiratory training combined with high-intensity core strength training; HITMOB = high-intensity cardiorespiratory training combined with trunk mobility exercises.

Figure 2

Strength exercises in the limb strength protocol: (1) vertical traction, (2) leg curl, (3) chest press, (4) leg press, (5) arm curl, and (6) leg extension.

Figure 3

Baseline strength exercises in the core strength protocol: (1) glute bridge, (2) glute clam, (3) lying diagonal back extension, (4) adapted knee plank, (5) adapted knee side plank, and (6) shoulder retraction with hip hinge.