Clinical guidelines recommend exercise for the management of chronic low back pain (CLBP). Numerous mechanisms have been proposed for how exercise might work to improve pain and disability in people with CLBP, but these were yet to be synthesised. The aim of our systematic review was to determine the proposed mechanisms of benefit for exercise by examining the rationale(s) proposed by clinical trialists for the exercise interventions they provided in their studies of people with CLBP.

We performed a review of ‘fitness training’ trials indexed in the Physiotherapy Evidence Database (PEDro) in adults with CLBP. For each included study, the proposed mechanism(s) were extracted by two researchers. We then counted the number of times each of these mechanisms was proposed and grouped them into themes.

We included 110 studies, where a comparable number of unimodal and multimodal exercise interventions were delivered. Neuromuscular mechanisms, such as improvements in muscle strength and motor control were the most commonly proposed. Psychosocial mechanisms such as reducing fear avoidance and improving self-efficacy were also common. Other themes related to neurophysiological, cardiometabolic, and tissue healing were less common. Biomedical mechanisms were proposed about 20% more than psychosocial mechanisms.

Our findings indicate that the mechanism(s) proposed by trialists for exercise in CLBP are varied. Regardless, our review provides a list of mechanisms that may be investigated as mediators (a variable that is affected by the intervention and in turn affects the outcomes) to guide future exercise studies in CLBP.

In terms of the slightly unusual presentation of the results, I was inspired by my colleague Edel O’Hagan who recently summarised her research to the tune of a nursery rhyme and challenged me to do the same. So here we are. A nursery rhyme summary of our systematic review.

Thank you @Mattjones0203!

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