Comparative effects of exercise modalities and dose parameters on chronic low back pain in adults: a systematic...

Although exercise therapy is widely recommended for chronic low back pain (CLBP), the comparative effectiveness of specific exercise modalities and optimal dose parameters remains unclear. This study aimed to evaluate and rank different exercise types and key dose-related factors using a network meta-analysis.

A systematic search of PubMed, Web of Science, Embase, Cochrane Library, and CNKI was conducted from database inception to December 2025. Randomised controlled trials involving adults with non-specific CLBP were included. Network meta-analysis was performed using Review Manager 5.4 and Stata 18.0. The relative efficacy of interventions was ranked using surface under the cumulative ranking curve (SUCRA).

A total of 24 randomised controlled trials were included, involving 28 intervention arms. All exercise modalities (stabilisation, resistance, traditional, combined, and motor control-based approaches) demonstrated significant improvements in pain compared with control conditions (p < 0.05). Exercise sessions lasting 15-20 min, 30-40 min, and 45-50 min were all effective, with no significant differences between durations. Frequencies of 1-2, 3, and 6-7 sessions per week significantly reduced pain, with 6-7 sessions per week ranking highest. Intervention periods of ≥16 weeks showed the greatest efficacy. SUCRA rankings indicated that traditional exercise (SUCRA = 87.9), 15-20 min per session (SUCRA = 91.6), 6-7 sessions per week (SUCRA = 91.5), and ≥16 weeks duration (SUCRA = 97.9) were most likely to be optimal.

Exercise therapy is effective for managing CLBP in adults. The most favourable combination may represent traditional exercise modalities performed for 15-20 minutes per session, 6-7 times per week, over at least 16 weeks. These findings provide evidence to inform more precise exercise prescription for CLBP rehabilitation.

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