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Home Physical Exercise Interventions in Chronic Non-Specific Low Back Pain: Systematic Review and Multivariate

Diego Lapuente-Hernández1,2, Marina Gil-Calvo2,3, Juan Nicolás Cuenca-Zaldívar4,5,6

  • 1Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain.

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|September 13, 2025
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Summary

Supervised in-person exercise is more effective than unsupervised home exercise for reducing pain and disability in non-specific chronic low back pain (NSCLBP). Body mass index (BMI) negatively moderated this effect, indicating personalized approaches are crucial.

Keywords:
exercise therapyfunctional disabilitylow back painmultivariate meta-analysispain intensity

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Area of Science:

  • Rehabilitation Medicine
  • Physical Therapy
  • Pain Management

Background:

  • Low back pain is a leading cause of disability, with non-specific chronic low back pain (NSCLBP) affecting a significant portion of the population.
  • Physical exercise is a primary treatment for NSCLBP, and remote interventions are gaining interest.
  • Understanding the efficacy of home-based exercise programs compared to supervised interventions is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To systematically review and meta-analyze the effect of home exercise interventions on pain intensity and functional disability in individuals with NSCLBP.
  • To compare the effectiveness of unsupervised home exercise versus supervised in-person exercise for NSCLBP management.
  • To investigate potential moderating factors, such as age and body mass index (BMI), on treatment outcomes.

Main Methods:

  • A systematic review and meta-analysis of six studies published up to April 2024.
  • Both univariate and multivariate meta-analyses were performed, adjusting for age and BMI using meta-regression.
  • Heterogeneity was assessed using Cochran's Q test and I² estimator, with effect sizes calculated using Hedges' G.

Main Results:

  • A statistically significant pre-/post-treatment effect favoring supervised in-person exercise was observed for both functional disability (moderate effect) and pain intensity (large effect).
  • Meta-regression revealed that BMI significantly and negatively moderated the treatment effect for both outcomes.
  • The included studies exhibited moderate-to-high methodological quality but a heterogeneous risk of bias.

Conclusions:

  • Unsupervised home exercise is less effective than supervised in-person exercise for reducing pain and functional disability in the short term for individuals with NSCLBP.
  • BMI is a significant moderator, suggesting that interventions should be tailored based on patient characteristics.
  • Further research may be needed to optimize home-based exercise protocols for NSCLBP management, potentially incorporating personalized strategies.