How much walking is enough for chronic low back pain? A systematic review and dose-response meta-analysis

To determine the dose-response relationship of a walking program and compare different delivery methods of walking exercise for patients with chronic low back pain (CLBP).

A systematic search of PubMed/MEDLINE, Web of Science, Scopus, Embase, and the Cochrane Library was conducted from inception to October 21, 2024. We included randomized controlled trials (RCTs) of walking programs without other exercise cointerventions in people with CLBP. Outcome measures were pain intensity and disability. The dose-response relationship was assessed using a restricted cubic spline model.

Thirteen RCTs were included. The meta-analysis showed a statistically significant reduction in pain intensity (standardized mean difference [SMD]: -0.59, 95% confidence interval [CI]: -0.95 to -0.24) and disability (SMD: -0.69, 95% CI: -1.14 to -0.23) with low and moderate certainty of evidence, respectively. The spline model showed a U-shaped association between total minutes of walking programs and reduction in pain intensity and disability. The largest effect for pain reduction was obtained at a total duration of 1000 minutes (SMD: -0.67, 95% CI: -0.76 to -0.59) distributed over a mean of 8 weeks, whereas for disability, the largest effect was found with a total of 900 minutes (SMD: -0.61, 95% CI: -0.69 to -0.53). Subgroup analysis showed larger effect sizes when walking exercise was performed outdoors and when motivational support was considered; however, no significant differences between subgroups were found.

Accruing 1000 minutes of walking over 8 weeks is associated with the largest reduction in back pain, while 900 minutes is associated with the largest reduction in disability. These findings may be valuable in optimizing walking programs for people with CLBP.