“Chronic low back pain is one of the most common musculoskeletal disorders affecting men and women of all age groups. It causes the highest amount of years lived with disability of all diseases, leads to high levels of work absenteeism, and substantially burdens healthcare systems through a variety of direct and indirect financial costs.”
“Exercise therapy (ET) is advocated as a treatment for chronic nonspecific low back pain (CNSLBP). However, therapy effect sizes remain low. In other chronic disorders, training at higher intensity has resulted in greater improvements on both general health related and disease specific outcomes compared to lower-intensity ET. Possibly, high-intensity training also improves effect sizes in CNSLBP.”
| 2 sessions a week | High intensity group (HIT) | Moderate intensity group (MIT) |
| Cardio respiratory(cycle ergometer) | 5-min warm-up interval training 5x 1-min bouts (110 repetitions per minute at 100% VO2max workload), Active rest between bouts: 1 min of active rest (75 repetitions per minute at 50% VO2max workload). | 5-min warm-up, 14 min of cycling (90 repetitions per minute at 60%VO2max workload). |
| Cardio progression | Bouts increased every two sessions+10 s, up to 1 min 50 s after 12 sessions. Recovery time (1 min) between bouts remained stable. | Duration increased every two sessions with 1 min 40 s up to 22 min 40 s. |
| General resistance | 3 upper body (vertical traction, chest press, arm curl) 3 lower body exercises (leg curl, leg press, leg extension) 1x 12 repetitions 80% of 1RM | 1×15 60% of 1RM. |
| Resistance progression | Increased the workload by 5% when able to perform 10 reps on 2 consecutive sessions | |
| Core training | 6 static core exercises [glute bridge, resistance band glute clam, lying diagonal back extension, adapted knee plank, adapted knee side plank, elastic band shoulder retraction with hip hinge1 x 10 repetitions of a 10-s static hold | Identical to the protocol described in “HIT” 1×10 repetitions of a 10-s static hold. |
| Core progression | Increase hold up to 12 s and progressing to more demanding postures through the use of increased body weight bearing using elastic resistance bands,or adding additional weights. | Made more difficult by increasing the time of the static hold each 6 sessions. |
Results
| Test | HIT (n=19) | MIT (n=19) | Difference |
| Modified oswestry | 14.6% reduction (64% relative difference) | 6.2% reduction (33% relative difference) | 8.6% difference between groups (P > 0.01) in favor of HIT, with sufficient power (1 − ß = 0.83) was found. |
| Numeric pain scale | 3.2-point reduction (56% difference) | 2.2-point reduction (39% difference) | The 1.0-point difference between groups was non-significant (P = 0.08). |
| Patient-Specific Functioning Scale | 26% increase (37% relative difference) | 26% increase (39% relative difference | No difference between groups (P = 0.97) |
| V˙O2max | Increased with 4.9 mL·kg−1·min−1 (14% relative difference)Cycling time increased with 2.7 min (18% relative difference) | 1.8 mL·kg−1·min−1 (4% relative difference)1.7 min (13% relative difference) in the MIT group. | A difference of 3.1 mL·kg−1·min−1 between groups (P > 0.01) in favor of HIT, with sufficient power (1 − ß = 0.82) A 1.0-point difference between groups (P > 0.01) in favor of HIT, with borderline insufficient power (1 − ß = 0.79) was found. |
| Muscle strength | Abdominal strength – no improvementBack strength improved 0.39 N·m·kg−1 (10% relative difference) | Abdominal strength – no improvementBack strength improved 0.33 N·m·kg−1 (13% relative difference) | Abdominal strength – no differenceBack strength : No difference between groups (P = 0.88) was found. |
Discussion
“A HIT exercise program consisting of cardiorespiratory interval, general resistance, and core muscle training is a safe, feasible, and effective ET modality to improve disability, pain intensity, function, exercise capacity, and back strength in persons with CNSLBP. When this program was compared to a similar MIT exercise program, greater improvements were found on reducing disability and increasing exercise capacity. These results show the potential of HIT for increasing therapy effectiveness in persons with CNSLBP. Future research needs to shed more light on the retention of the treatment effects.”
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Originally posted on May 17, 2022 @ 4:38 pm