Effects of eight-week water versus mat pilates on female patients with chronic nonspecific low back pain: Double-blind randomized clinical trial

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

Remote Pilates Training Is Effective in Improving Physical Fitness in Healthy Women: A Randomized Controlled Study

Despite its positive impact on physical and mental well-being, adults may refrain from performing regular physical activity, due to inadequate time, accessibility, or funds. Yet remote platforms could overcome such obstacles and increase participation. This study evaluated the effectiveness of remote-synchronous group-Pilates classes compared to in-studio classes in healthy sedentary women. In a randomized controlled design, 40 women, aged 20-45, were assigned to a Zoom or studio group-Pilates training. The intervention included twice-weekly 45 min sessions over an eight-week period. Attendance (adherence) was recorded, and the participants completed physical motor tests (plank, curl-up, stork, push-up, and V-sit and reach), Profile of Mood State Surveys, and Nordic Musculoskeletal Pain Questionnaires. Evaluations were performed at baseline, mid-intervention (4 weeks), and post intervention (8 weeks). Adherence to training was high in the Zoom and studio groups (80% and 74%, respectively). Improvements in physical motor tests were seen in both groups following the Pilates interventions, thereby indicating the effectiveness of group-Pilates Zoom training. In conclusion, remote online physical activity such as Pilates offers a good alternative to in-studio trainings, as a means for improving physical fitness and promoting a healthy lifestyle in adults, by offering a more accessible and less timely alternative to in-studio physical activity programs.

Water-Based Exercise in Patients With Nonspecific Chronic Low-Back Pain: A Systematic Review With Meta-Analysis

ABSTRACT

Babiloni-Lopez, C, Fritz, N, Ramirez-Campillo, R, and Colado, JC. Water-based exercise in patients with nonspecific chronic low-back pain: a systematic review with meta-analysis. J Strength Cond Res 38(1): 206-219, 2024-This study aimed to systematically review and synthesize evidence (i.e., active [land-based training] and nonactive controls [e.g., receiving usual care]) regarding the effects of water-based training on patients with nonspecific chronic low-back pain (NSCLBP). Web of Science (WOS), PubMed (MEDLINE), EMBASE, EBSCO (SPORTDiscus; CINAHL), and PEDro were searched, with no date restrictions, until October 2021. The included studies satisfied the following criteria: (a) NSCLBP (≥12 weeks) patients, (b) water-based intervention, (c) control group (land-based trained; nonactive group), and (d) outcomes related to pain, disability, quality of life, or flexibility. The main outcome analyzed in the meta-analysis was pain intensity. Secondary outcomes included disability, body mass index, and flexibility. The random-effects model was used, and effect size (ES) values are presented with 95% confidence intervals (CIs). The impact of heterogeneity was assessed (I2 statistic), with values of <25%, 25-75%, and >75% representing low, moderate, and high levels, respectively. Alpha was set at p < 0.05. In conclusion, 15 studies (n = 524) were meta-analyzed. After intervention, pain intensity was reduced compared with nonactive controls (ES = -3.61; p < 0.001) and a similar reduction was noted when compared with land-based trained group (ES = -0.14; p = 0.359). Greater decrease in disability (ES = 2.15; p < 0.001) and greater increase in sit-and-reach (i.e., flexibility; ES = -2.44; p < 0.001) were noted after intervention compared with the nonactive group. In conclusion, water-based exercise therapy reduces pain intensity, disability, and increases flexibility in NSCLBP compared with nonactive subjects and was equally effective compared with land-based exercise to reduce pain. Favorable effects may be expected at ≤8 weeks. However, due to several methodological issues (e.g., high heterogeneity), for the improvement of most outcomes, we are unable to provide other than a weak recommendation in favor of intervention compared with control treatment.

The effect of a six-week Aqua Pilates and Aqua Stretch intervention on pain, function, and quality of life in patients affected by ankylosing spondylitis: A rater-blind randomized controlled trial

BACKGROUND

There has been a dearth of research into the benefits of water-based workouts for ankylosing spondylitis (AS) patients.

OBJECTIVE

This study aimed to compare the effect of Aqua Stretch and Aqua Pilates in improving quality of life (QOL), function, and pain in AS patients.

METHODS

This study was conducted on 40 patients, who were randomly assigned to the Aqua Pilates, Aqua Stretch, and control groups. The experimental groups attended interventions for six-week. QOL, pain intensity, function, and fatigue were measured before and after treatments.

RESULTS

Except for the chest expanding, all variables in the Aqua Stretch group changed significantly after six weeks (p< 0.05). QOL (p= 0.002), 6MWT (p= 0.016), and Schober flexion (p= 0.011) showed changes, while BASDAI (p= 0.0001), VAS (p= 0.0001), fatigue (p= 0.0001), and Schober extension (p= 0.028) showed significant decreases. Except for chest expansion and Schober extension, which did not alter significantly after six-week of Aqua Pilates (p> 0.05), all other variables did. There was an increasing trend in 6MWT and Schober flexion (p= 0.021) and a decreasing trend in BASDAI (p= 0.002), VAS (p= 0.0001) and fatigue (p= 0.002). Except for QOL (p= 0.016), no statistically significant differences were found between the groups.

CONCLUSION

All variables had a significant change after six-week Aqua Stretch, except for the chest expanding. Chest expanding and Schober extension were the variables which had no significant change after six-week Aqua Pilates. With the exception of QOL, no statistically significant differences were found between the groups. Aqua Stretch had the greatest effect on the VAS, as measured by the minimum clinically relevant differences (MCID). Moreover, in Aqua Stretch alone, there was a notable impact on fatigue, QOL, and the BASDAI.

The effects of virtual reality training on postural sway and physical function performance on older women with chronic low back pain: A double-blind randomized clinical trial

BACKGROUND

Chronic low back pain (CLBP) is known as an important debilitating health condition among older women.

OBJECTIVE

This study aimed to evaluate the effects of eight-week virtual reality training (VRT) exercises on postural sway and physical function performance (PFP) among older women suffering from CLBP.

METHODS

Twenty-seven older women presenting with CLBP were randomized into experimental and control groups. The experimental group was instructed to perform 30-minute VRT exercises three times a week for eight weeks. Plantar pressure variables [sway velocity (SV) and anterior-posterior (AP) and medial-lateral (ML) fluctuations of the center of pressure (CoP)], 30-second chair stand test (30CST), and timed up and go (TUG) test were recorded.

RESULTS

The VRT group exhibited significant decreases in SV (p= 0.002), AP (p= 0.008), and ML (p= 0.02) fluctuations. Also, the performance of the VRT group in the 30CST and TUG tests significantly improved after the exercises (P< 0.001).

CONCLUSION

According to the results, VRT and the program used in this study should be used to enhance balance and PFP in older women with CLBP who mostly prefer activities that are accessible and feasible in low-risk environments.

Effectiveness of Pilates exercise on low back pain: a systematic review with meta-analysis

PURPOSE

Low back pain is the most frequently reported musculoskeletal disorder and represents one of the highest patient burdens in healthcare. This systematic review and meta-analysis aimed to investigate the effectiveness of Pilates exercise on pain intensity and functional disability caused by low back pain (LBP).

MATERIALS AND METHODS

A Systematic review with meta-analysis was conducted. Data sources: MEDLINE-NLM and MEDLINE-EBSCO. We also searched on Scopus Elsevier, Cochrane, DOAJ, SciELO, PEDro, and PLOS ONE databases. Eligibility criteria: randomized controlled trials (RCTs) evaluating LBP in which the primary treatment was based on Pilates exercise compared with no exercise, or non-specific exercise.

RESULTS

The search returned 1566 records of which 36 articles were included in the systematic review and 19 in the meta-analysis. Twenty-two studies compared the effects of Pilates exercise vs no exercise and 13 studies examined the effects of Pilates exercise vs non-specific exercise. Analysis showed that Pilates had a positive effect on the perception of LBP vs no exercise. A similar trend occurred with non-specific exercise.

CONCLUSIONS

Pilates exercise can decrease LBP compared to no exercise and non-specific exercise. General practitioners should consider Pilates exercise as an effective strategy to manage LBP and counteract the growing health.

TRIAL REGISTRATION

PROSPERO registration number: CRD42022308387.IMPLICATIONS FOR REHABILITATIONPilates is a good strategy for improving low back pain and is more effective than other exercise programs or no exercise.Pilates is a safe tool to apply to most of the population with low back pain.Pilates is a non-pharmacological strategy useful for counteracting low back pain.

Effect of aquatic physical therapy on chronic low back pain: a systematic review and meta-analysis

BACKGROUND

Chronic low back pain is a common musculoskeletal disease. With the increasing number of patients, it has become a huge economic and social burden. It is urgent to relieve the burden of patients. There are many common rehabilitation methods, and aquatic physical therapy is one of them. The purpose of this systematic review and meta-analysis is to summarize the existing literature and analyze the impact of aquatic physical therapy on pain intensity, quality of life and disability of patients with chronic low back pain.

METHODS

Through 8 databases, we searched randomized controlled trials on the effect of aquatic physical therapy on patients with chronic low back pain. These trials published results on pain intensity, quality of life, and disability. This review is guided by Cochrane Handbook for systematic reviews of interventions version 5.1.0. The level of evidence was assessed through GRADE.

RESULTS

A total of 13 articles involving 597 patients were included. The results showed that compared with the control group, aquatic physical therapy alleviated the pain intensity (Visual Analogue Scale: SMD = -0.68, 95%CI:-0.91 to -0.46, Z = 5.92, P < 0.00001) and improved quality of life (physical components of 36-Item Short Form Health Survey or Short-Form 12: SMD = 0.63, 95%CI:0.36 to 0.90, Ζ = 4.57, P < 0.00001; mental components of 36-Item Short Form Health Survey or Short-Form 12: SMD = 0.59, 95%CI:0.10 to 1.08, Ζ = 2.35, P = 0.02), and reduced disability (Roland Morris Disability Questionnaire: SMD = -0.42, 95%CI:-0.66 to -0.17, Ζ = 3.34, P = 0.0008; Oswestry Disability Index or Oswestry Low Back Pain Disability Questionnaire: SMD = -0.54, 95%CI:-1.07 to -0.01, Ζ = 1.99, P = 0.05). However, aquatic physical therapy did not improve patients' pain at rest (Visual Analogue Scale at rest: SMD = -0.60, 95%CI:-1.42 to 0.23, Ζ = 1.41, P = 0.16). We found very low or low evidence of effects of aquatic physical therapy on pain intensity, quality of life, and disability in patients with chronic low back pain compared with no aquatic physical therapy.

CONCLUSIONS

Our systematic review showed that aquatic physical therapy could benefit patients with chronic low back pain. However, because the articles included in this systematic review have high bias risk or are unclear, more high-quality randomized controlled trials are needed to verify.

Benefits of aquatic exercise in adults with and without chronic disease-A systematic review with meta-analysis

Aquatic exercise is being increasingly recommended for healthy individuals as well as people with some special health conditions. A systematic review with meta-analysis was performed to synthesize and analyze data on the effects of water-based training (WT) programs on health status and physical fitness of healthy adults and adults with diseases to develop useful recommendations for health and sports professionals. We searched three databases (PubMed, Web of Science, and Scopus) up to June 2021 for randomized trials that examined WT in adults. A total of 62 studies were included, of which 26 involved only healthy individuals and 36 focused on adults with chronic diseases. In the healthy group, the effects of WT on strength, balance, and cardiorespiratory fitness were beneficial, indicating the usefulness of performing WT for at least 12 weeks (2-3x/week, 46-65 min/session). Among adults with diseases, improvements were observed in patients with fibromyalgia (in balance and cardiorespiratory fitness), bone diseases (pain, balance, flexibility, and strength), coronary artery disease (strength and anthropometry), hypertension (quality of life), stroke (quality of life), diabetes (balance and quality of life), multiple sclerosis (quality of life and balance), and Parkinson's disease (pain, gait, cardiorespiratory fitness, and quality of life). Research is required to determine the effects of WT on patients with heart disease, especially coronary artery disease. In adults with chronic disease, benefits in physical fitness and/or other health-related measures were mainly observed after 8-16 weeks of training. WT is an effective physical activity when the intention is to enhance health and physical fitness in healthy adults and adults with chronic diseases.

Exercise therapy for chronic low back pain

BACKGROUND

Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs.

OBJECTIVES

The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments.

SEARCH METHODS

We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update.

SELECTION CRITERIA

We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration.

DATA COLLECTION AND ANALYSIS

Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo.

MAIN RESULTS

We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias.  Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups.

AUTHORS' CONCLUSIONS

We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.