Exercise Therapy for Low Back Pain: Evidence, Benefits, and Clinical Recommendations

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Low back pain (LBP) is one of the most common and costly musculoskeletal conditions globally. This umbrella review brings together findings from 70 systematic reviews—43 of which include meta-analyses—to evaluate the benefits and risks of exercise therapy and physical activity (PA) for both managing and preventing LBP.

The findings point to consistent, small short-term improvements in pain and disability, but overall, the quality of evidence remains low to moderate, and adverse event reporting is limited.

Exercise and Physical Activity Offer Small, Short-Term Benefits

  • 35 reviews reported small but consistent improvements in pain and function—especially within the first 3 months of starting an exercise program.
  • The most effective types of exercise included:
    • Pilates
    • Motor control exercises
    • Yoga
    • Mixed programs (e.g., aerobic + strength + stretching)
  • Exercise and leisure-time PA also reduced the risk of LBP recurrence, although definitions of recurrence varied widely.
  • Network meta-analyses ranked Pilates and motor control exercises as the most effective for pain relief—but with low certainty.

Long-Term Benefits Are Unclear

  • Most benefits were observed within 3 months of intervention.
  • Evidence for long-term effects (8+ months) was limited and inconclusive.
  • Certainty of results ranged from moderate to very low, due to:
    • Inconsistent definitions of LBP
    • Small effect sizes
    • Short follow-up durations

Adverse Events: Underreported, Mostly Mild

  • Only 31% of reviews mentioned adverse events.
  • When reported, side effects were mild—typically muscle soreness or temporary pain increases, especially in yoga-based programs.
  • No serious adverse events were reported, but most studies did not systematically track safety outcomes.

Outcomes Depend on Type and Intensity of Activity

  • Moderate leisure-time PA (e.g., walking, gardening) and structured exercises like Pilates or strengthening routines were linked to lower recurrence rates.
  • High-intensity activities (e.g., vigorous housework or labor) were not more effective and sometimes associated with worsened outcomes.
  • Program characteristics:
    • Duration: 2 weeks to 12 months
    • Frequency: 1 to 5 times per week
    • Session length: at least 40 minutes

What Future Research Needs to Address

  • Clearer, more standardized definitions of LBP recurrence
  • Better long-term data and outcome tracking
  • More distinction between acute, subacute, and chronic LBP
  • Consistent adverse event tracking
  • Personalized exercise programs based on patient needs and LBP type

Takeaways for Clinicians

  • Recommend moderate exercise therapy and leisure-time PA for managing LBP and preventing recurrence.
  • Highlight that programs like Pilates, yoga, motor control exercises, and mixed routines offer consistent—though modest—benefits.
  • Emphasize patient preference when selecting an exercise type, as this may improve adherence and long-term results.
  • Reassure patients that adverse events are rare and typically mild.

Comachio, J., Beckenkamp, P. R., Ho, E. K. Y., Abdel Shaheed, C., Stamatakis, E., Ferreira, M. L., Lan, Q., Mork, P. J., Holtermann, A., Wang, D. X. M., & Ferreira, P. H. (2025). Benefits and harms of exercise therapy and physical activity for low back pain: An umbrella review. Journal of Sport and Health Science, Advance online publication. https://doi.org/10.1016/j.jshs.2025.101038