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You have full access to this open access article. We searched for randomized controlled trials RCTs in electronic databases inception to 17 May We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types predominantly very low certainty evidence , pain reduction was associated with aerobic exercise and Pilates vs.
Improved function was associated with mixed exercise vs. Temporary increased minor pain was associated with mixed exercise vs.
Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP. Exercise therapy or structured exercise programs are widely used to manage low back pain LBP. For people with chronic primary LBP CPLBP , exercise therapy may improve musculoskeletal function, while also benefiting most other body systems and mental wellbeing [ 3 ].
In turn, this may reduce pain and functional limitations, and improve emotional and psychological wellbeing [ 2 ]. Exercise therapy is accessible globally. Hayden and colleagues published a Cochrane review literature search date ending 28 April to assess the impact of exercise therapy on pain and functional limitations for the management of chronic LBP in adults compared to placebo, no treatment, or usual care pooled together , or other conservative treatments randomized controlled trials RCTs ; 24, participants [ 2 ] and a network meta-analysis comparing different types of exercise treatments [ 4 ].
They concluded with moderate certainty that exercise reduces pain and functional limitations when compared to no treatment, usual care, or sham, but not when compared to other conservative treatments [ 2 ]. To develop clinical practice guideline recommendations for the management of CPLBP in adults, the WHO commissioned the current systematic review to update the evidence and expand the aims of Hayden et al.