Exercise prescription for improving chronic low back pain in adults: a network meta-analysis

Abstract

Objective: This study aims to investigate the impact of various combinations of exercise prescription variables-namely type, duration, frequency, and period-on improving chronic low back pain (CLBP) in adults. The goal is to provide evidence to inform the development of exercise prescriptions for CLBP interventions.

Methods: Data sources were obtained from EBSCO, PubMed, Web of Science, Embase, and Cochrane, with the search conducted up to June 30, 2024. Two independent reviewers screened the literature, extracted data, and assessed the risk of bias in the included studies. A network meta-analysis (NMA) was performed using Stata 17.0 software, and the surface under the cumulative ranking (SUCRA) was utilized to rank the effectiveness of the exercise prescription variables.

Results: Significant effects were observed for durations of 15-30 min [SMD = -1.62, 95% CI (-2.32, -0.92)] and ≥60 min [SMD = -0.81, 95% CI (-1.58, -0.03)] when compared to the control group. Intervention periods of 4 weeks [SMD = -1.82, 95% CI (-3.37, -0.28)], 12 weeks [SMD = -1.18, 95% CI (-1.85, -0.51)], and ≥16 weeks [SMD = -2.75, 95% CI (-4.26, -1.24)] also resulted in significantly better outcomes compared to the control group. The intervention effect for durations of ≥16 weeks was significantly greater than that for 12 weeks [SMD = -2.17, 95% CI (-3.58, -0.47)] and 6 weeks [SMD = -2.18, 95% CI (-3.85, -0.45)]. A frequency of three sessions per week [SMD = -1.44, 95% CI (-2.09, -0.78)] demonstrated significantly superior outcomes compared to the control group. An intervention duration of 15 to 30 min (SUCRA = 94.6), three sessions per week (SUCRA = 87), an intervention period of ≥16 weeks (SUCRA = 95.4), and Tai Chi exercise (SUCRA = 77.4) may be the most effective approaches for improving chronic low back pain in adults.

Conclusion: Tai Chi exercise, lasting 15 to 30 min per session, performed three times a week over an intervention period of at least 16 weeks, may represent the most effective intervention for alleviating chronic low back pain in adults. However, due to the limited number of studies included, further research is necessary to provide stronger evidence.

Keywords: Tai Chi; chronic low back pain; exercise prescription; intervention effectiveness; network meta-analysis.

Figure 1

PRISMA flow diagram of the study process.

Figure 2

Bias risk diagram for each item.

Figure 3

Overall bias risk diagram.

Figure 4

Network plot of the impact of exercise prescription elements on chronic low back pain control in adults. 1, con; 2, Core stabilization exercise; 3, Combination exercise; 4, Pilates; 5, Yoga; 6, Qigong; 7, Sling exercise; 8, Swiss ball; 9, Strength exercise; 10, Disturbance exercise; 11, Abdominal crunch exercise A; 12, Taichi; A, con; B, 1–2 times; C, 3 times; D, 5 times; E, 7 times; H, con; I, 15–30 min; J, 40 min; K, 45 min; L,50 min; M, ≥60 min; a, con; b, 4 weeks; c, 6 weeks; d, 8 weeks; e, 12 weeks; f, 13 weeks; j, ≥16weeks.

Figure 5

League table of pairwise comparisons of intervention effects for different elements of exercise types.

Figure 6

League table of pairwise comparisons of intervention effects for different elements of exercise duration.

Figure 7

League table of pairwise comparisons of intervention effects for different elements of exercise frequency.

Figure 8

League table of pairwise comparisons of intervention effects for different elements of exercise period. The red numbers are statistically significant.

Figure 9

Probability ranking chart of intervention effects for different elements of exercise prescription dose. Type, con; trt2, Core stabilization exercise; trt3, Combination exercise; trt4, Pilates; trt5, Yoga; trt6, Qigong; trt7, Sling exercise; trt8, Swiss ball; trt9, Strength exercise; trt10, Disturbance exercise; trt11, Abdominal crunch exercise; trt12, Taichi; Duration, con; trtH, 15–30 min; trtI, 40 min; trtJ, 45 min; trtK, 45 min; trtL, ≥60 min; Frequency, con; trtB, 1–2 times; trtC, 3 times; trtD, 5 times; trtE, 7 times; Period, con; trtb, 4 weeks; trtc, 6 weeks; trtd, 8 weeks; trte, 12 weeks; trtf, 13 weeks; trtj, ≥16 weeks.

Figure 10

Funnel plot of intervention effects for different elements of exercise prescription dose. Type: A, con; B, Core stabilization exercise; C, Combination exercise; D, Pilates; E, Yoga; F, Qigong; G, Sling exercise; H, Swiss ball; I, Strength exercise; J, Disturbance exercise; K, Abdominal crunch exercise; L, Taichi; Duration: A, con; B, 15–30 min; C, 40 min; D, 45 min; E, 50 min, E, ≥60 min; Frequency: A, con; B, 1–2 times; C, 3 times; D, 5 times; E, 7 times; Period: A, con; B, 4 weeks; C, 6 weeks; D, 8 weeks; E, 12 weeks; F, 13 weeks; G ≥16 weeks.