Understanding how exercise changes outcomes of importance in patients with low back pain: a realist review of prioritised treatment targets of exercise

Low back pain (LBP) is a symptom, and is most commonly due to non-specific causes. LBP is a complex condition, and affects a range of factors including physical, psychological and social, that can impact physical function, quality of life and mental well-being37. The best non-drug treatment we have for LBP is exercise, and it has been shown to have broad benefits. However, exercise is frequently prescribed to improve physical problems (like weakness) instead of these broader benefits (like self-confidence) that may actually be more important. Although clinicians prescribing exercise are good at giving out exercises, they do not often prescribe exercise with some of these broader benefits in mind. My previous research highlighted the need to design exercise programs to address these broader targets. This research would help those working with LBP and living with LBP to better understand how to prescribe and use exercise to have optimum impact. 

LBP is leading cause of disability worldwide38, and is experienced by people of all ages37. With increasing and ageing populations, more people are experiencing LBP, and it is the most common musculoskeletal reason for consulting a GP in the UK39. The associated costs of LBP are significant, with impacts on personal financial wellbeing, as well as increasing costs in healthcare and social support systems37. There are no recent incidence estimates for the UK, but previous estimates proposed that 40% of adults had experienced LBP lasting more than one day in the previous year40. In 2008 the estimated cost of treating all types of back pain in the UK exceeded £1000 million pounds a year, suggesting that, in 2021, the cost to the UK society is even greater. This cost has far reaching impacts on individuals, families, workplaces and the economy as a whole.  Exercise in a core recommended treatment but we know very little about how it works or how to maximise patients’ outcomes from exercise.