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The effectiveness of walking as an intervention for low back pain: a systematic review

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Abstract

As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low–moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP.

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References

  1. ACC. http://www.acc.co.nz/search.results/index.htm?ssUserText=low+back+pain+guidelines. Accessed 14 Sep 2009

  2. Al-Obaidi SM, Al-Zoabi B, Al-Shuwaie N, Al-Zaabie N, Nelson RM (2003) The influence of pain and pain-related fear and disability beliefs on walking velocity in chronic low back pain. Int J Rehabil Res 26(2):101–108

    Article  PubMed  Google Scholar 

  3. Al-Obaidi SM, Beattie P, Al-Zoabi B, Al-Wekeel S (2005) The relationship of anticipated pain and fear avoidance beliefs to outcome in patients with chronic low back pain who are not receiving workers’ compensation. Spine 30(9):1051–1057

    Article  PubMed  Google Scholar 

  4. Alton F, Baldey L, Caplan S, Morrissey MC (1998) A kinematic comparison of overground and treadmill walking. Clin Biomech 13(6):434–440

    Article  Google Scholar 

  5. American College of Sports Medicine (1998) Position stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 30(6):975–991

    Article  Google Scholar 

  6. Basler HD, Bertalanffy H, Quint S, Wilke A, Wolf U (2007) TTM-based counselling in physiotherapy does not contribute to an increase of adherence to activity recommendations in older adults with chronic low back pain–a randomised controlled trial. Eur J Pain 11(1):31–37

    Article  PubMed  Google Scholar 

  7. Bombardier C (2000) Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine 25(24):3100–3103

    Article  CAS  PubMed  Google Scholar 

  8. Borman P, Keskin D, Bodur H (2003) The efficacy of lumbar traction in the management of patients with low back pain. Rheumatol Int 23(2):82–86

    PubMed  Google Scholar 

  9. Bussmann JBJ, Ebner-Priemer UW, Fahrenberg J (2009) Ambulatory activity monitoring: progress in measurement of activity, posture, and specific motion patterns in daily life. Eur Psychol 14(2):142–152

    Article  Google Scholar 

  10. Dishman RK, O’Connor PJ (2009) Lessons in exercise neurobiology: the case of endorphins. Ment Health Phys Act 2(1):4–9

    Article  Google Scholar 

  11. Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384

    Article  CAS  PubMed  Google Scholar 

  12. Durwood BR, Baer GD, Rowe PJ (1999) Walking. In: Functional human movement: measurement and analysis, chap 6. Butterworth Heinmann, Oxford, pp 93–105

  13. Evans D (2003) Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. J Clin Nurs 12(1):77–84

    Article  PubMed  Google Scholar 

  14. Ferrell BA, Josephson KR, Pollan AM, Loy S, Ferrell BR (1997) A randomized trial of walking versus physical methods for chronic pain management. Aging 9(1–2):99–105

    CAS  PubMed  Google Scholar 

  15. Fletcher J (2007) What is heterogeneity and is it important? BMJ 334(7584):94–96

    Article  PubMed  Google Scholar 

  16. Garfin JM, Garfin SR (2002) Low back pain: exercises to prevent recurrence. Consultant 42(3):357–361

    Google Scholar 

  17. Gose EE, Naguszewski WK, Naguszewski RK (1998) Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study. Neurol Res 20(3):186–190

    CAS  PubMed  Google Scholar 

  18. Hagen EL, Grasdal A, Eriksen HR (2003) Does early intervention with a light mobilisation program reduce long-term sick leave for low back pain: a 3-year follow-up study. Spine 28(20):2309–2316

    Article  Google Scholar 

  19. Hayden JA, van Tulder MW, Tomlinson G (2005) Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 142(9):776–785

    PubMed  Google Scholar 

  20. Himmelreich H, Vogt L, Banzer W (2008) Gluteal muscle recruitment during level, incline and stair ambulation in healthy subjects and chronic low back pain patients. J Back Musculoskelet Rehabil 21(3):193–199

    Google Scholar 

  21. Hoppe DJ, Schemitsch EH, Morshed S, Tornetta P 3rd, Bhandari M (2009) Hierarchy of evidence: where observational studies fit in and why we need them. J Bone Joint Surg Am 91(Suppl 3):2–9

    Article  PubMed  Google Scholar 

  22. Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, Speizer FE, Manson JE (1999) Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA 282(15):1433–1439

    Article  CAS  PubMed  Google Scholar 

  23. Hurley DA, O’Donoghue G, Tully MA, Klaber Moffett J, van Mechelen W, Daly L, Boreham C, McDonough S (2009) A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial [The supervised walking in comparison to fitness training for back pain (SWIFT) trial]. BMC Musculoskelet Disord 10(1):79–90

  24. Hurwitz EL, Morgenstern H, Chiao C (2005) Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study. Am J Public Health 95(10):1817–1824

    Article  PubMed  Google Scholar 

  25. Joffe D, Watkins M, Steiner L, Pfeifer BA (2002) Treadmill ambulation with partial body weight support for the treatment of low back and leg pain. JOSPT 32(5):202–213

    Google Scholar 

  26. Joo Lee S, Hilder J (2008) Biomechanics of overground vs. treadmill walking in healthy individuals. J Appl Physiol 104(3):747–775

    Article  Google Scholar 

  27. Karmisholt K, Gotzsche PC (2005) Physical activity for secondary prevention of disease. Systematic reviews of randomised clinical trials. Dan Med Bull 52(2):90–94

    PubMed  Google Scholar 

  28. Koes B, van Tulder M, Ostelo R, Burton K, Waddell G (2001) Clinical guidelines for the management of low back pain in primary care. Spine 26(22):2504–2514

    Article  CAS  PubMed  Google Scholar 

  29. Korecki CL, Kuo CK, Tuan RS, Iatridis JC (2009) Intervertebral disc cell response to dynamic compression is age and frequency dependent. J Orthop Res 27(6):800–806

    Article  PubMed  Google Scholar 

  30. Kovar PA, Allegrante JP, Mackenzie CR, Peterson MGE, Gutrn B, Charlson ME (1992) Supervised fitness walking in patients with osteoarthritis of the knee: a randomised controlled trial. Ann Intern Med 116(7):529–534

    CAS  PubMed  Google Scholar 

  31. Lehmann TR, Spratt KF, Lehmann KK (1993) Predicting long-term disability in low back injured workers presenting to a spine consultant. Spine 18(8):1103–1112

    Article  CAS  PubMed  Google Scholar 

  32. Liddle SD, Baxter GD, Gracey JH (2004) Exercise and chronic low back pain: what works? Pain 107(1–2):176–190

    Article  PubMed  Google Scholar 

  33. Liddle SD, Gracey JH, Baxter GD (2007) Advice for the management of low back pain: a systematic review of randomised controlled trials. Man Ther 12(4):310–327

    Article  PubMed  Google Scholar 

  34. Malmivaara A, Hakkinen U, Aro T et al (1995) Treatment of acute low back pain- bed rest, exercise, or ordinary activity? N Engl J Med 332(6):351–355

    Article  CAS  PubMed  Google Scholar 

  35. McBride D, Begg D, Herbison P, Buckingham K (2004) Low back pain in young New Zealanders. N Z Med J 117(1203):8

    Google Scholar 

  36. Mirovsky Y, Grober A, Blankstein A, Stabholz L (2006) The effect of ambulatory lumbar traction combined with treadmill on patients with chronic low back pain. J Back Musculoskelet Rehabil 19(2–3):73–78

    Google Scholar 

  37. Morris JN, Hardman AE (1997) Walking to health. Sports Med 23(5):306–332

    Article  CAS  PubMed  Google Scholar 

  38. Morso L, Hartvigsen J, Puggaard L, Manniche C (2006) Nordic walking and chronic low back pain: design of a randomised clinical trial. BMC Musculoskelet Disord 2(7):77–81

    Article  Google Scholar 

  39. Murray MP, Spurr GB, Sepic SB, Gardner GM, Mollinger LA (1985) Treadmill vs. floor walking: kinematics, electromyogram, and heart rate. J Appl Physiol 59(1):87–91

    Google Scholar 

  40. O’Rielly SC, Muir KR, Doherty M (1999) Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Ann Rheum Dis 58(1):15–19

    Article  Google Scholar 

  41. Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M (2008) A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act 6(5):56

    Article  Google Scholar 

  42. Regnaux JP, Robertson J, Smail DB, Daniel O, Bussel B (2006) Human treadmill walking needs attention. J Neuroeng Rehabil 21(3):19

    Article  Google Scholar 

  43. Ryan CG, Grant PM, Dall PM, Gray H, Newton M, Granat MH (2009) Individuals with chronic low back pain have a lower level, and an altered pattern, of physical activity compared with matched controls: an observational study. Aust J Physiother 55(1):53–58

    PubMed  Google Scholar 

  44. Sculco AD, Paup DC, Bo Fernhall, Sculco MJ (2001) Effects of aerobic exercise on low back pain patients in treatment. Spine J 1(2):95–101

    Article  CAS  PubMed  Google Scholar 

  45. Siegal PZ, Brackbill RM, Heath GW (1995) The epidemiology of walking for exercise: implications for promoting activity among sedentary groups. Public Health Briefs 85(5):706–710

    Google Scholar 

  46. Smeets RJ, van Geel KD, Verbunt JA (2009) Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain? Arch Phys Med Rehabil 90(1):109–117

    Article  PubMed  Google Scholar 

  47. SPARC http://pushplay.sparc.org.nz/. Accessed 16 Sep 2009

  48. Sterling M, Jull G, Wright A (2001) The effect of musculoskeletal pain on motor activity and control. J Pain 2(3):135–145

    Article  CAS  PubMed  Google Scholar 

  49. Strathy GM, Chao EY, Laughman RK (1983) Changes in knee function associated with treadmill ambulation. J Biomech 16(7):517–522

    Article  CAS  PubMed  Google Scholar 

  50. Sullivan MS, Kues JM, Mayhew TP (1996) Treatment categories for low back pain: a methodological approach. JOSPT 24(6):359–364

    CAS  PubMed  Google Scholar 

  51. Swezey R (1996) Spine update exercise for osteoporosis-is walking enough? Spine 21(23):2809–2813

    Article  CAS  PubMed  Google Scholar 

  52. Swinkels-Meewisse IE, Roelofs J, Verbeek AL, Oostendorp RA, Vlaeyen JW (2003) Fear of movement/(re)injury, disability and participation in acute low back pain. Pain 105(1–2):371–379

    Article  PubMed  Google Scholar 

  53. Talbot LA, Gaines JM, Huynh TN, Metter EJ (2003) A home-based pedometer driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geriatr Soc 51(3):387–392

    Article  PubMed  Google Scholar 

  54. Taylor NF, Evans OM, Goldie PA (2003) The effect of walking faster on people with acute low back pain. Eur Spine J 12(2):166–172

    PubMed  Google Scholar 

  55. Torstensen TA, Ljunggren AE, Meen HD, Odland E, Mowinckel P, Geijerstam S (1998) Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain. A pragmatic, randomized, single-blinded, controlled trial with 1-year follow-up. Spine 23(23):2616–2624

    Google Scholar 

  56. Tudor-Locke C, Burkett L, Reis JP, Ainsworth BE, Macera CA, Wilson DK (2005) How many days of pedometer monitoring predict weekly physical activity in adults? Prev Med 40(3):293–298

    Article  CAS  PubMed  Google Scholar 

  57. Turner JA, Clancy S, McQuade KJ, Cardenas DD (1990) Effectiveness of behavioral therapy for chronic low back pain: a component analysis. J Consult Clin Psychol 58(5):573–579

    Article  CAS  PubMed  Google Scholar 

  58. Urban JP, Smith S, Fairbank JC (2004) Nutrition of the intervertebral disc. Spine 29(23):2700–2709

    Article  PubMed  Google Scholar 

  59. van Tulder M, Koes B, Bouter L (1995) A cost-of-illness study of back pain in the Netherlands. Pain 62(2):233–240

    Article  PubMed  Google Scholar 

  60. van Tulder M, Koes B, Bouter L (1997) Conservative treatment of acute and chronic non-specific low back pain: a systematic review of randomised controlled trials of the most common interventions. Spine 22(18):2128–2156

    Article  PubMed  Google Scholar 

  61. van Tulder M, Malmivaara A, Esmail R, Koes B (2000) Exercise therapy for low back pain: a systematic review within the framework of the Cochrane collaboration back review group. Spine 25(21):2784–2796

    Article  PubMed  Google Scholar 

  62. van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A (2006) Chapter 3: European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15(Suppl 2):S169–S191

    Article  PubMed  Google Scholar 

  63. van Weering MG, Vollenbroek-Hutten MM, Tönis TM, Hermens HJ (2009) Daily physical activities in chronic lower back pain patients assessed with accelerometry. Eur J Pain 13(6):649–654

    Article  PubMed  Google Scholar 

  64. Verbunt JA, Westerterp KR, van deer Heijden GJ, Seelen HA, Vlaeyen JW, Knottnerus JA (2001) Physical activity in daily life in patients with chronic low back pain. Arch Phys Med Rehabil 82(6):726–730

    Article  CAS  PubMed  Google Scholar 

  65. Waddell G, Feder G, Lewis M (1997) Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract 47(423):647–652

    CAS  PubMed  Google Scholar 

  66. Waddell G (1987) A new clinical model for the treatment of low back pain. Spine 12(7):632–644

    Article  CAS  PubMed  Google Scholar 

  67. Xu Y, Bach E, Orhede E (1997) Work environment and low back pain: the influence of occupational activity. Occup Environ Med 54(10):741–745

    Article  CAS  PubMed  Google Scholar 

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Hendrick, P., Te Wake, A.M., Tikkisetty, A.S. et al. The effectiveness of walking as an intervention for low back pain: a systematic review. Eur Spine J 19, 1613–1620 (2010). https://doi.org/10.1007/s00586-010-1412-z

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  • DOI: https://doi.org/10.1007/s00586-010-1412-z

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