Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
Institute of Movement Sciences, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
Eur Spine J. 2023 Mar;32(3):787-796. doi: 10.1007/s00586-022-07471-w. Epub 2022 Dec 2.
Increased fatty infiltration in paraspinal muscles has been recognized as a feature of muscle quality loss in people with Low Back Pain (LBP) and is highly associated with the severity of LBP and dysfunction. Reducing fatty infiltration has been recognized as a rehabilitation aim. An earlier systematic review published in 2014 revealed conflicting evidence for the reversibility of paraspinal muscle quality by means of exercise and no updates have been published since. A new systematic literature search is warranted.
Pubmed, CINAHL and Embase were searched from inception to July 2022. Randomized, non-randomized controlled trials (RCT and non-RCT) and single-arm trials were included if they reported the effect of exercise on paraspinal fatty infiltration in people with LBP. Effect sizes and statistical power were calculated for (1) exercise versus control, and (2) pre-post exercise changes. Available data from the RCTs were pooled via meta-analysis when appropriate. Otherwise, data were synthesized qualitatively.
Two RCTs, one non-RCT and three single-arm trials met the selection criteria. Data were not pooled due to substantial clinical heterogeneity. Effect sizes from the RCTs revealed no significant difference for exercise versus control. One single-arm trial with high risk of bias demonstrated a significant pre-post difference with moderate effect size, but only at one (T12-L1) of the investigated levels.
Moderate quality evidence is available that paraspinal fatty infiltration is not reversible with exercise in people with LBP. More larger RCT's are needed to draw firmer conclusions.
人们已经认识到，腰部疼痛（LBP）患者的脊柱旁肌肉脂肪浸润增加是肌肉质量下降的特征，并且与 LBP 的严重程度和功能障碍高度相关。减少脂肪浸润已被认为是康复的目标。2014 年发表的一项早期系统评价显示，运动对脊柱旁肌肉质量的逆转作用存在相互矛盾的证据，此后一直没有更新。因此需要进行新的系统文献检索。
从建库到 2022 年 7 月，检索了 Pubmed、CINAHL 和 Embase。如果研究报告了运动对 LBP 患者脊柱旁脂肪浸润的影响，则纳入随机、非随机对照试验（RCT 和非 RCT）和单臂试验。计算了（1）运动与对照组之间，以及（2）运动前后变化的效应大小和统计功效。如果合适，通过荟萃分析对 RCT 中的可用数据进行汇总；否则，定性综合数据。
符合选择标准的有两项 RCT、一项非 RCT 和三项单臂试验。由于存在显著的临床异质性，数据未进行汇总。RCT 的效应大小显示，运动与对照组之间无显著差异。一项偏倚风险高的单臂试验显示出显著的前后差异，具有中等效应量，但仅在一个（T12-L1）研究水平上。
现有中等质量证据表明，运动不能逆转 LBP 患者的脊柱旁脂肪浸润。需要更多更大的 RCT 来得出更确定的结论。
