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Pilates Exercise or Stationary Cycling for Chronic Nonspecific Low Back Pain: Does it Matter? A Randomized Controlled Trial With 6-Month Follow-up

Marshall, Paul W. M., PhD; Kennedy, Suzanne, BHSc; Brooks, Cristy, BHSc; Lonsdale, Chris, PhD

doi: 10.1097/BRS.0b013e318297c1e5
Exercise Physiology/Functional Restoration

Study Design. Randomized controlled trial.

Objective. This is the companion study to a previous publication that presented 8-week pain, disability, and trunk muscle motor control results. The objective of this study was to compare the effect of 8 weeks of specific trunk exercises and stationary cycling on outcomes measures of catastrophizing and fear-avoidance beliefs (FAB) in patients with chronic nonspecific low back pain, and provide 6-month outcome data for all self-report measures.

Summary of Background Data. It is thought that any form of moderate-to-vigorous physical activity is sufficient to address catastrophizing and FAB, and concomitant levels of pain and disability.

Methods. Sixty-four patients with low back pain were randomly assigned to 8 weeks of specific trunk exercise group (SEG), or stationary cycling group (CEG). Self-rated pain, disability, catastrophizing and FAB scores were collected before, immediately after (8 wk), and 6 months after the training program. Clinically meaningful improvements were defined as greater than a 30% reduction from baseline in pain and disability scores. “Intention-to-treat” principles were used for missing data. Per-protocol analysis was performed on participants who attended at least two-thirds of the exercise sessions.

Results. At 8 weeks, disability was significantly lower in the SEG compared with the CEG (d = 0.62, P = 0.018). Pain was reduced from baseline in both the groups after training (P < 0.05), but was lower for the SEG (P < 0.05). FAB scores were reduced in the SEG at 8 weeks, and in the CEG at 6 months. No between-group differences in FAB scores were observed. Similar reductions in catastrophizing in each group were observed at each time point. At 6 months, the overall data pattern suggested no long-term difference between groups. Per-protocol analysis of clinically meaningful improvements suggests no between-group differences for how many patients are likely to report improvement.

Conclusion. Inferential statistics suggest greater improvements at 8 weeks, but not 6 months, for the SEG. Inspection of clinically meaningful changes based on a minimum level of adherence suggests no between-group differences. If a patient with low back pain adheres to either specific trunk exercises or stationary cycling, it is reasonable to think that similar improvements will be achieved.

Level of Evidence: 2

This article is the companion to previously published research, and reports behavioral outcome measures and 6-month follow-up results. Interventions were Pilates exercise or stationary cycling. Although, inferential statistics suggest greater improvements at 8 weeks after Pilates, inspection of clinically meaningful changes suggests no between-group differences if a minimum level of adherence is met.

From the School of Science and Health, University of Western Sydney, Australia.

Address correspondence and reprint requests to Paul W. M. Marshall, PhD, School of Science and Health, Building 20.G.33, Campbelltown Campus, University of Western Sydney, Locked Bag 1797 Penrith South, NSW 2751, Australia; E-mail:

Acknowledgment date: September 17, 2012. First revision date: December 14, 2012. Second revision date: January 30, 2013. Third revision date: March 17, 2013. Fourth revision date: March 27, 2013. Acceptance date: April 10, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins