Effects of exercise therapy on disability, mobility, and quality of life in the elderly with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials.

Shi-Kun Zhang, Mei-Ling Gu, Ting Zhang, Hong Xu, Su-Jie Mao, Wen-Sheng Zhou

Journal: Journal of orthopaedic surgery and research 2023;18(1):513

PMID: 37468931

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Plain Language Summary

Chronic low back pain (CLBP) is the most common health problem among the elderly and one of the leading causes of dysfunction and disability. In addition to clinical therapy and physiotherapy, exercise therapy is one of the most common therapies for CLBP. The aim of this study was to compare the effects of exercise therapy on disability, mobility, and quality of life in the elderly with CLBP. This study was a systematic review and meta-analysis of sixteen studies. Results showed that exercise therapy effectively improved pain, dysfunction and quality of life in people over 60 years of age. However, there were not any significant changes in the walking test (timed up and go test index) for CLBP in the elderly. Authors concluded that exercise therapy to improve CLBP symptoms in the elderly can focus on aerobic, strength, comprehensive, and mind–body exercises based on the exercise cycle (≥12 weeks), exercise frequency (≥3 times/week), and single exercise time (≥60 min) - whilst ensuring that the regime is safe and effective for the rehabilitation of CLBP patients.

Abstract

BACKGROUND

Exercise is an effective treatment in chronic low back pain (CLBP), but there are few studies on CLBP in the elderly, and the intervention effect is controversial. We aimed to compare the efficacy of different exercises therapy on CLBP, dysfunction, quality of life, and mobility in the elderly.

METHODS

We searched Web of Science, MEDLINE, Cochrane Library, Chinese National Knowledge Infrastructure, EMBASE, and PubMed from the database inception till December 31, 2022. The publication languages were Chinese and English. Randomized controlled trials (RCTs) of exercise intervention in the elderly (≥ 60 years) with CLBP were included. Two reviewers independently extracted the data and evaluated them using the Revised Cochrane Risk of Bias Tool for Randomized Trials 2 (RoB2). The pooled effect sizes on different aspects of outcome measures were calculated.

RESULTS

Sixteen articles (18 RCTs) were included, comprising a total of 989 participants. The quality of included studies was relatively high. Meta-analysis results indicated that exercise therapy could improve visual analog scale (VAS) (WMD = - 1.75, 95% CI - 2.59, - 0.92, p < 0.05), Oswestry disability index (ODI) (WMD = - 9.42, 95% CI - 15.04, - 3.79, p < 0,005), short-form 36-item health survey physical composite summary (SF-36PCS) (WMD = 7.07, 95% CI 1.01, 13.14, p < 0.05), short-form 36-item health survey mental composite summary (SF-36MCS) (WMD = 7.88, 95% CI 0.09, 15.67, p < 0.05), and timed up and go test (TUG) (WMD = - 0.92, 95% CI - 2.22, 0.38, p < 0.005).

CONCLUSION

Exercise therapy effectively improved VAS, ODI, and SF-36 indexes in the elderly. Based on the subgroup, when designing the exercise therapy regimen, aerobics, strength, and mind-body exercise (≥ 12 weeks, ≥ 3 times/week, ≥ 60 min) should be considered carefully, to ensure the safety and effectiveness for the rehabilitation of CLBP patients. More high-quality trials are needed in future to confirm the effect of exercise on SF-36 and TUG indexes.

Address: Department of Police Physical Education, Jiangsu Police Institute, Nanjing, Jiangsu Province, China.; Nanjing Tian-zheng Primary School, Nanjing, China.; Department of Sport & Health Science, College of Natural Science, Sangmyung University, Seoul, Korea.; Graduate School of Nanjing University of Physical Education, Nanjing Sport Institute, Nanjing, China.; Department of Physical Education, Nanjing Xiao-Zhuang University, Nanjing, China. [email protected].

DOI: 10.1186/s13018-023-03988-y