Supervised programs that include stretching and strengthening exercises are more likely than other types of therapy to relieve chronic low back pain and improve function, according to analyses reported Monday.

As described in the Annals of Internal Medicine, Dr. Jill A. Hayden, at the Institute for Work and Health in Toronto, and associates first analyzed 61 trials involving 6390 subjects that evaluated exercise therapy for treatment of low back pain.

For chronic (longer than 12 weeks) low back pain, their analysis provided “strong evidence” that exercise helped. On a 100-point scale, exercise reduced pain by 10 points more than did no treatment, and 6 points more than with other conservative treatments.

For low back pain that had persisted for 6 to 12 weeks, there was a small benefit for graded-activity exercise programs, but for acute back pain (less than 6 weeks duration) there appeared to be no overall benefit from exercise therapy.

In a second article, Hayden and another group of associates evaluated 43 trials of 72 exercise treatment groups and 31 comparison groups of patients with chronic low back pain.

This analysis showed that “an individually designed, high-dose exercise program delivered through supervised home exercises with regular practitioner follow-up” was most effective, with a mean of 18 points in improvement in pain scores and 5.5 points in function scores compared with no treatment.

Stretching was associated with the largest improvement in pain, while strengthening exercises appeared to be most effective in improving function, compared with aerobic, coordination and mobilizing exercises.

Although these data are “useful,” the researchers conclude that “clinicians need to use clinical judgment in applying our results to individual patients.”

SOURCE: Annals of Internal Medicine, May 3, 2005.