Tataryn Nicholas, Simas Vini, Catterall Tailah, Furness James, Keogh Justin W L
Department of Physiotherapy, Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia.
Water Based Research Unit, Department of Physiotherapy, Bond University, Gold Coast, Australia.
Sports Med Open. 2021 Mar 8;7(1):17. doi: 10.1186/s40798-021-00306-w.
While chronic exercise training has been demonstrated to be an effective non-pharmacological treatment for chronic low back pain (CLBP), there has been a relative lack of evidence or clinical guidelines for whether a posterior chain resistance training programme provides any benefits over general exercise (GE).
To determine if chronic posterior chain resistance training (PCRT), defined as exercise programmes of ≥6 weeks duration focused on the thoracic, lumbar and hip extensor musculature, is more effective than GE in improving pain, level of disability, muscular strength and the number of adverse events in recreationally active and sedentary individuals with CLBP.
Four electronic databases were systematically searched from 25 September 2019 until 30 August 2020. Using the Joanna Briggs Institute (JBI) Critical Appraisal Tools checklist for randomized controlled trials (RCTs), articles were critically appraised and compared against the inclusion/exclusion criteria. Standardized mean difference (SMD), risk difference (RD) and confidence interval (CI) were calculated using Review Manager 5.3.
Eight articles were included, with a total of 408 participants (203 PCRT, 205 GE). Both PCRT and GE were effective in improving a number of CLBP-related outcomes, but these effects were often significantly greater in PCRT than GE, especially with greater training durations (i.e. 12-16 weeks compared to 6-8 weeks). Specifically, when compared to GE, PCRT demonstrated a greater reduction in pain (SMD = - 0.61 (95% CI - 1.21 to 0.00), p = 0.05; I = 74%) and level of disability (SMD = - 0.53 (95% CI - 0.97 to - 0.09), p = 0.02; I = 52%), as well as a greater increase in muscle strength (SMD = 0.67 (95% CI 0.21 to 1.13), p = 0.004; I = 0%). No differences in the number of adverse events were reported between PCRT and GE (RD = - 0.02 (95% CI - 0.10 to 0.05), p = 0.57; I = 72%).
Results of the meta-analysis indicated that 12-16 weeks of PCRT had a statistically significantly greater effect than GE on pain, level of disability and muscular strength, with no significant difference in the number of adverse events for recreationally active and sedentary patients with CLBP. Clinicians should strongly consider utilizing PCRT interventions for 12-16 weeks with patients with CLBP to maximize their improvements in pain, disability and muscle strength. Future research should focus on comparing the efficacy and adverse events associated with specific PCRT exercise training and movement patterns (i.e. deadlift, hip lift) in treating this population.
PROSPERO CRD42020155700 .
虽然长期运动训练已被证明是治疗慢性下腰痛（CLBP）的一种有效的非药物疗法，但对于后链抗阻训练计划是否比一般运动（GE）更有益，相对缺乏证据或临床指南。
确定长期后链抗阻训练（PCRT），即持续时间≥6周、专注于胸、腰和髋伸肌肌肉组织的运动计划，在改善有CLBP的休闲活动者和久坐者的疼痛、残疾程度、肌肉力量及不良事件数量方面是否比GE更有效。
从2019年9月25日至2020年8月30日对四个电子数据库进行系统检索。使用乔安娜·布里格斯研究所（JBI）随机对照试验（RCT）的批判性评价工具清单，对文章进行批判性评价，并对照纳入/排除标准进行比较。使用Review Manager 5.3计算标准化均数差（SMD）、风险差（RD）和置信区间（CI）。
纳入8篇文章，共408名参与者（203名PCRT组，205名GE组）。PCRT和GE在改善一些与CLBP相关的结局方面均有效，但这些效果在PCRT组通常比GE组显著更大，尤其是训练持续时间更长时（即12 - 16周相比于6 - 8周）。具体而言，与GE相比，PCRT在疼痛减轻方面更显著（SMD = -0.61（95%CI -1.21至0.00），p = 0.05；I² = 74%）和残疾程度降低方面更显著（SMD = -0.53（95%CI -0.97至 -0.09），p = 0.02；I² = 52%），以及肌肉力量增加方面更显著（SMD = 0.67（95%CI 0.21至1.13），p = 0.004；I² = 0%）。PCRT和GE在不良事件数量上未报告有差异（RD = -0.02（95%CI -0.10至0.05），p = 0.57；I² = 72%）。
荟萃分析结果表明，12 - 16周的PCRT在疼痛、残疾程度和肌肉力量方面比GE有统计学上显著更大的效果，对于有CLBP的休闲活动者和久坐患者，不良事件数量无显著差异。临床医生应强烈考虑对CLBP患者采用12 - 16周的PCRT干预措施，以最大程度改善他们的疼痛、残疾和肌肉力量。未来研究应专注于比较特定PCRT运动训练和动作模式（即硬拉、臀桥）在治疗该人群时的疗效和不良事件。
PROSPERO CRD42020155700
