Clinical Pilates versus General Exercise for Chronic Low Back Pain : Medicine & Science in Sports & Exercise

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Clinical Pilates versus General Exercise for Chronic Low Back Pain

Xue-Qiang, Wang; Jie-Jiao, Zheng; Pei-Jie, Chen Ph.D.

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Medicine & Science in Sports & Exercise 45(3):p 603, March 2013. | DOI: 10.1249/MSS.0b013e3182811213
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Dear Editor-in-Chief:

Exercise plays a role in the management of patients with chronic low back pain (CLBP) (1–3), but we do not know what forms of exercise are best for improving pain and function. Therefore, we read with much interest the article by Wajswelner et al. (8), who compare two types of exercise for patients with CLBP. The article was indeed an excellent randomized trial. However, in our minds, some potential limitations merit consideration.

First, the participants in the study of Wajswelner et al. (8) performed only two exercise sessions per week, which was probably too few sessions per week for differences in effectiveness of the two intervention programs to have been observed. The participants attended group exercise sessions at one of the trial clinics twice a week for the 6-wk duration of the program. However, the results of the study of Kell et al. (4) showed that 4-d·wk−1 training volume is most effective at treating CLBP. In addition, Nguyen and Randolph (6) suggested that exercise conducted under the supervision of a therapist three to five times per week is highly recommended as a first-line therapy in the treatment of low back pain.

Second, what statistical analysis should be used to compare responses between groups in the study? The authors used separate one-way ANCOVA and χ2 analysis to assess the effects of exercise. However, we do not think this statistical analysis is suitable for the study. In our minds, intervention effects on primary and secondary outcome measures should be assessed using mixed repeated-measures ANOVA, with and without adjustment for baseline and time-varying covariates (e.g., age, sex, height, weight, body mass index, duration of disease, symptoms, and medication use). Then, the independent-sample t-test (with 95% confidence intervals) should be used to compare the mean values between the Pilates group and the general group on the same dependent variable. Paired t-tests were used to examine within group changes from baseline to 24 wk.

Lastly, the authors reported that participants were randomly allocated in permuted blocks of six and eight, stratified by age (18–35, 35–55, and 55–70 yr) and gender, to either the clinical Pilates group or the general exercise group. However, the authors did not include a population of schoolchildren afflicted with CLBP in their study population. Masiero et al. (5) showed that nonspecific LBP is a frequent event in schoolchildren, and estimates of lifetime prevalence for LBP in children vary from 20% to 43% (5,7). Although LBP occurs most frequently in middle-age and older people, the findings reported in this article would be strengthened by follow-up studies that include schoolchildren.

We agree on the following conclusions of the authors: the 6-wk intervention period was relatively short, and the dropout rate for the 6-month follow-up period was relatively high. These factors may affect the results of the study. And further rigorous, multicenter randomized controlled trials with large sample size need to be carried out.

Wang Xue-Qiang

Department of Sport Rehabilitation

Shanghai University of Sport

Shanghai, China

Zheng Jie-Jiao

Department of Rehabilitation Medicine

Huadong Hospital Affiliated to Fudan University

Shanghai, China

Chen Pei-Jie, Ph.D.

Department of Sport Rehabilitation

Shanghai University of Sport

Shanghai, China


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