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. 2023 Mar;32(3):787-796.
doi: 10.1007/s00586-022-07471-w. Epub 2022 Dec 2.

Is fatty infiltration in paraspinal muscles reversible with exercise in people with low back pain? A systematic review

E O Wesselink  1 , J J M Pool  2 , J Mollema  2 , K A Weber 2nd  3 , J M Elliott  4   5 , M W Coppieters  6   7 , A L Pool-Goudzwaard  6   8
Affiliations

Is fatty infiltration in paraspinal muscles reversible with exercise in people with low back pain? A systematic review

E O Wesselink et al. Eur Spine J. 2023 Mar.

Abstract

Purpose: Increased fatty infiltration in paraspinal muscles has been recognized as a feature of muscle quality loss in people with Low Back Pain (LBP) and is highly associated with the severity of LBP and dysfunction. Reducing fatty infiltration has been recognized as a rehabilitation aim. An earlier systematic review published in 2014 revealed conflicting evidence for the reversibility of paraspinal muscle quality by means of exercise and no updates have been published since. A new systematic literature search is warranted.

Method: Pubmed, CINAHL and Embase were searched from inception to July 2022. Randomized, non-randomized controlled trials (RCT and non-RCT) and single-arm trials were included if they reported the effect of exercise on paraspinal fatty infiltration in people with LBP. Effect sizes and statistical power were calculated for (1) exercise versus control, and (2) pre-post exercise changes. Available data from the RCTs were pooled via meta-analysis when appropriate. Otherwise, data were synthesized qualitatively.

Results: Two RCTs, one non-RCT and three single-arm trials met the selection criteria. Data were not pooled due to substantial clinical heterogeneity. Effect sizes from the RCTs revealed no significant difference for exercise versus control. One single-arm trial with high risk of bias demonstrated a significant pre-post difference with moderate effect size, but only at one (T12-L1) of the investigated levels.

Conclusion: Moderate quality evidence is available that paraspinal fatty infiltration is not reversible with exercise in people with LBP. More larger RCT's are needed to draw firmer conclusions.

Keywords: Adipose tissue; Morphology; Physical Therapy; Rehabilitation.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Figures

FIGURE 1.
FIGURE 1.
Prisma flow diagram
FIGURE 2.
FIGURE 2.
Forest plots summarizing the effect sizes of exercise for changes in fatty infiltration in paraspinal muscles. Panel A summarises exercise versus control, and Panel B summarises pre-post exercise changes. An increase in muscle density corresponds with decrease of fatty infiltration as muscle density correlates inversely with the amount of fatty infiltration [22]. CI = Confidence Interval, FI = Fatty Infiltration; SD = Standard Deviation; Std = Standard, IV= Independent Variable, Total = number of participants.
See this image and copyright information in PMC

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