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The impact of aerobic fitness on functioning in chronic back pain

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Abstract

Despite lack of convincing evidence that reduced aerobic fitness is associated with chronic back pain (CBP), exercise programs are regarded as being effective for persons with non-specific CBP. It is unsure whether gain in aerobic fitness following intervention is associated with functioning improvement in persons with CBP. The objective of this prospective cohort study was to study the impact of aerobic fitness on functioning in persons with CBP, at baseline and following 3-week intensive interdisciplinary intervention. This study included persons who had passed 8 weeks of sick-listing because of back pain (n = 94) and were referred to a 3-week intensive biopsychosocial rehabilitation program. Aerobic fitness was assessed with a sub-maximal bicycle test at baseline, at admission to and discharge from the rehabilitation program, and at 6 months follow-up. Contextual factors, body function, activity and participation were evaluated before and after intervention. In addition, working ability was recorded at 3-years follow-up. At baseline aerobic fitness was reduced in most subjects, but improved significantly following intervention. Baseline measurements and intervention effects did not differ among the diagnostic sub-groups. Neither contextual factors nor functioning at baseline were associated with aerobic fitness. Increase in aerobic fitness was not associated with improvements in functioning and contextual factors and work-return following intervention either. From this study we conclude that improvement of aerobic fitness seems of limited value as goal of treatment outcome for patients with CBP.

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Notes

  1. All residents in Norway are required to be members of the National Social Insurance Scheme. Individuals with a sickness leave exceeding 3 days need a sickness certificate from their primary physician. Individuals with more than 8 weeks of sickness leave must be issued the Sickness Certificate II to be eligible for more sickness benefits.

  2. Now: Hospital for Rehabilitation—Stavern, Rikshospitalet Medical Centre

  3. For civil servants there are no detailed data registered at the local National Social Insurance offices.

References

  1. Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, Charlot J, Dreiser RL, Legrand E, Rozenberg S, Vautravers P (2000) The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine 25:1S–33S

    Article  PubMed  CAS  Google Scholar 

  2. Åstrand P-O, Rodahl K (1987) Textbook of work physiology. Physiological bases of exercise. McGraw-Hill Book Company, Singapore

    Google Scholar 

  3. Blair SN, Cheng Y, Holder JS (2001) Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc 33:S379–S399

    Article  PubMed  CAS  Google Scholar 

  4. Brennan GP, Ruhling RO, Hood RS, Shultz BB, Johnson SC, Andrews BC (1987) Physical characteristics of patients with herniated intervertebral lumbar discs. Spine 12:699–702

    Article  PubMed  CAS  Google Scholar 

  5. Brox JI, Storheim K, Holm I, Friis A, Reikeras O (2005) Disability, pain, psychological factors and physical performance in healthy controls, patients with sub-acute and chronic low back pain: a case-control study. J Rehabil Med 37:95–99

    Article  PubMed  Google Scholar 

  6. COST B13 Working Group on Guidelines for Chronic Low Back Pain. European guidelines for the management of chronic non-specific low back pain (2004) European Commission Research Directorate General

  7. Cunha IT, Simmonds MJ, Protas EJ, Jones S (2002) Back pain, physical function, and estimates of aerobic capacity: what are the relationships among methods and measures? Am J Phys Med Rehabil 81:913–920

    Article  Google Scholar 

  8. Danielsen Ø (1989) Den nye bredde idretten. Ønsker og behov for fysisk aktivitet. 3. Delrapport for prosjektet ‘Idrett, fritid og levekår’. 088. Oslo, Fafo

  9. Fairbank JC, Davies JB, Couper J, O’Brian JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–272

    PubMed  CAS  Google Scholar 

  10. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Pina IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104:1694–1740

    Article  PubMed  CAS  Google Scholar 

  11. Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C (2002) Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev. CD000963

  12. Haldorsen EMH, Wormgoor MEA, Bjørholt PG, Ursin H (1998) Predictors for outcome of a functional restoration program for low back patients—a 12 month follow-up study. Eur J Phys Med Rehabil 8:103–109

    Google Scholar 

  13. Havik OE, Mæland JG (1983) ADI-skjemaet. Reliabilitet og validitet for et kort spørreskjema rettet mot angst, depresjon og irritabilitet. Tidsskrift for Norsk Psykologforening 20:70–78

    Google Scholar 

  14. Hayden J, Tulder M, Malmivaara A, Koes B (2005) Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. CD000335

  15. Hurri H, Mellin G, Korhonen O, Harjula R, Harkapaa K, Luoma J (1991) Aerobic capacity among chronic low-back-pain patients. J Spinal Disord 4:34–38

    PubMed  CAS  Google Scholar 

  16. Hutten MM, Hermens HJ, Ijzerman MJ, Lousberg R, Zilvold G (1999) Distribution of psychological aspects in subgroups of chronic low back pain patients divided on the score of physical performance. Int J Rehabil Res 22:261–268

    Article  PubMed  CAS  Google Scholar 

  17. Keeley J, Mayer TG, Cox R, Gatchel RJ, Smith J, Mooney V (1986) Quantification of lumbar function. Part 5: Reliability of range-of-motion measures in the sagittal plane and an in vivo torso rotation measurement technique. Spine 11:31–35

    Article  PubMed  CAS  Google Scholar 

  18. Keller A, Hellesnes J, Brox JI (2001) Reliabilty of the isokinetic trunk extensor test, Biering-Sørensen test, and Åstrand bicycle test. Assessment of intraclass correlation coefficient and critical difference in patients with chronic low back pain and healthy individuals. Spine 26:771–777

    Article  PubMed  CAS  Google Scholar 

  19. Kool J, de Bie R, Oesch P, Knusel O, van den Brandt P, Bachmann S (2004) Exercise reduces sick leave in patients with non-acute non-specific low back pain: a meta-analysis. J Rehabil Med 36:49–62

    Article  PubMed  Google Scholar 

  20. Koopman FS, Edelaar M, Slikker R, Reynders K, van der Woude LH, Hoozemans MJ (2004) Effectiveness of a multidisciplinary occupational training program for chronic low back pain: a prospective cohort study. Am J Phys Med Rehabil 83:94–103

    Article  PubMed  Google Scholar 

  21. Lakka TA, Kauhanen J, Salonen JT (1996) Conditioning leisure time physical activity and cardiorespiratory fitness in sociodemographic groups of middle-ages men in eastern Finland. Int J Epidemiol 25:86–93

    Article  PubMed  CAS  Google Scholar 

  22. LeFort SM, Hannah TE (1994) Return to work following an aquafitness and muscle strengthening program for the low back injured. Arch Phys Med Rehabil 75:1247–1255

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Ljungkvist I (2000) Short- and long-term effects of a 12-week intensive functional restoration programme in individuals work-disabled by chronic spinal pain. Scand J Rehab Med 40:1–14

    CAS  Google Scholar 

  25. Mayer TG, Gatchel RJ (1988) Functional restoration for spinal disorders: the sports medicine approach. Lea Febiger, Philadelphia

    Google Scholar 

  26. McQuade KJ, Turner JA, Buchner DM (1988) Physical fitness and chronic low back pain. An analysis of the relationships among fitness, functional limitations, and depression. Clin Orthop Relat Res 233:198–204

    Google Scholar 

  27. Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M (2004) Exercise as a treatment for chronic low back pain. Spine J 4:106–115

    Article  PubMed  Google Scholar 

  28. Robert JJ, Blide RW, McWhorter K, Coursey C (1995) The effects of a work hardening program on cardiovascular fitness and muscular strength. Spine 20:1187–1193

    Article  PubMed  CAS  Google Scholar 

  29. Schmidt AJ (1985) Cognitive factors in the performance level of chronic low back pain patients. J Psychosom Res 29:183–189

    Article  PubMed  CAS  Google Scholar 

  30. Schonstein E, Kenny D, Keating J, Koes B, Herbert RD (2003) Physical conditioning programs for workers with back and neck pain: a cochrane systematic review. Spine 28:E391–E395

    Article  PubMed  Google Scholar 

  31. Smeets RJ, Wade D, Hidding A, Van Leeuwen PJ, Vlaeyen JW, Knottnerus JA (2006) The association of physical deconditioning and chronic low back pain: a hypothesis-oriented systematic review. Disabil Rehabil 28:673–693

    Article  PubMed  Google Scholar 

  32. Smilkstein G, Ashworth C, Montano D (1982) Validity and reliability of the family APGAR as a test of family function. J Fam Pract 10:311

    Google Scholar 

  33. Storheim K, Brox JI, Holm I, Bo K (2005) Predictors of return to work in patients sick listed for sub-acute low back pain: a 12-month follow-up study. J Rehabil Med 37:365–371

    Article  PubMed  Google Scholar 

  34. Hayden JA, van Tulder MW, Malmivaara A, Koes BW (2005) Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD000335. doi:10.1002/14651858. Pub 2.

  35. Valim V, Oliveira LM, Suda AL, Silva LE, Faro M, Neto TL, Feldman D, Natour J (2002) Peak oxygen uptake and ventilatory anaerobic threshold in fibromyalgia. J Rheumatol 29:353–357

    PubMed  Google Scholar 

  36. Velde van der G, Mierau D (2000) The effects of exercise on percentile rank aerobic capacity, pain, and sef-rated disability in patients with chronic low-back pain: A retrospective chart review. Arch Phys Med Rehabil 81:1457–1463

    Article  PubMed  Google Scholar 

  37. Verbunt JA, Seelen HA, Vlaeyen JW, van de Heijden GJ, Heuts PH, Pons K, Knottnerus JA (2003) Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. Eur J Pain 7:9–21

    Article  PubMed  Google Scholar 

  38. Verbunt JA, Seelen HA, Vlaeyen JW, van der Heijden GJ, Knottnerus JA (2003) Fear of injury and physical deconditioning in patients with chronic low back pain. Arch Phys Med Rehabil 84:1227–1232

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  40. Wallbom AS, Geisser ME, Haig AJ, Yamakawa K, Montgomery D (2002) Concordance between rating of perceived exertion and function in persons with chronic, disabling back pain. J Occup Rehabil 12:93–98

    Article  PubMed  Google Scholar 

  41. Wie SL (1996) An evaluation of lifting function in persons with low-back pain. An assessment and evaluation of the reliability and validity of the dynamic lift test “Kystatesten Lifting-low.” Master’s thesis. Bergen: University of Bergen. (GENERIC)Ref Type: Thesis/Dissertation

  42. Wittink H, Hoskins MT, Wagner A, Sukiennik A, Rogers W (2000) Deconditioning in patients with chronic low back pain: fact or fiction? Spine 25:2221–2228

    Article  PubMed  CAS  Google Scholar 

  43. Wittink H, Michel TH, Sukiennik A, Gascon C, Rogers W (2002) The association of pain with aerobic fitness in patients with chronic low back pain. Arch Phys Med Rehabil 83:1467–1471

    Article  PubMed  Google Scholar 

  44. Wolfe F, Multicenter Criteria Committee (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum 33:160–172

    Article  PubMed  CAS  Google Scholar 

  45. Wormgoor ME, Indahl A, van Tulder MW, Kemper HC (2006) Functioning description according to the icf model in chronic back pain: disablement appears even more complex with decreasing symptom-specificity. J Rehabil Med 38:93–99

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hospital for Rehabilitation—Stavern, Rikshospitalet Medical Center, P.O. 160, 3291, Stavern, Norway

    Marjon E. A. Wormgoor & Aage Indahl

  2. Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands

    Maurits W. van Tulder & Han C. G. Kemper

  3. Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands

    Maurits W. van Tulder

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  1. Marjon E. A. Wormgoor
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  2. Aage Indahl
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  3. Maurits W. van Tulder
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  4. Han C. G. Kemper
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Correspondence to Marjon E. A. Wormgoor.

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Wormgoor, M.E.A., Indahl, A., van Tulder, M.W. et al. The impact of aerobic fitness on functioning in chronic back pain. Eur Spine J 17, 475–483 (2008). https://doi.org/10.1007/s00586-007-0547-z

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