Faculty Collaboration Database

Back strength predicts walking improvement in obese, older adults with chronic low back pain. PM R 2014 May;6(5):418-26

Date

11/12/2013

Pubmed ID

24211698

Pubmed Central ID

PMC4013252

DOI

10.1016/j.pmrj.2013.11.002

Scopus ID

2-s2.0-84901291736 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

OBJECTIVE: To compare the effects of 4 months of isolated lumbar resistance exercise and total body resistance exercise on walking performance in obese, older adults with chronic low back pain. A secondary analysis examined whether responsiveness to training modulated walking improvement.

DESIGN: Randomized, controlled trial.

SETTING: Research laboratory affiliated with tertiary care facility.

METHODS AND INTERVENTION: Participants (N = 49; 60-85 years) were randomized into a 4-month resistance exercise intervention (TOTRX), lumbar extensor exercise intervention (LEXT), or a control group (CON).

MAIN OUTCOME MEASUREMENTS: Walking performance, maximal low back strength and leg strength, and average resting and low back pain severity score (from an 11-point numerical pain rating scale; NRSpain) were collected at baseline and month 4.

RESULTS: The TOTRX and LEXT improved lumbar extensor strength relative to CON, and the TOTRX (P < .05). NRSpain scores at month 4 were lowest in the TOTRX group compared with the LEXT and CON groups, respectively (2.0 ± 1.7 points vs 3.7 ± 2.6 points and 4.6 ± 2.4 points; P < .006). A total of 53% and 67% of participants in the TOTRX and LEXT groups were responders who made lumbar extensor strength gains that achieved ≥20% greater than baseline values. Although the TOTRX demonstrated the greatest improvement in walking endurance among the intervention groups, this did not reach significance (10.1 ± 12.2% improvement in TOTRX vs 7.4 ± 30.0% LEXT and -1.7 ± 17.4% CON; P = .11). Gait speed increased most in the TOTRX (9.0 ± 13.5%) compared with the LEXT and CON groups (P < .05). The change in lumbar extensor strength explained 10.6% of the variance of the regression model for the change in walking endurance (P = .024).

CONCLUSIONS: The use of LEXT and TOTRX produced similar modest improvements in patients' walking endurance. Lumbar extensor strength gain compared with leg strength gain is a moderate but important contributor to walking endurance in obese older adults with chronic low back pain. Responders to resistance exercise programs (event those with only lumbar extension exercise) who make at least a 20% improvement in strength can expect better improvement in walking endurance than those who do not achieve this strength improvement.

Author List

Vincent HK, Vincent KR, Seay AN, Conrad BP, Hurley RW, George SZ

Author

Robert W. Hurley MD, PhD Adjunct Professor of Anesthesiology and CTSI in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Back Muscles
Female
Gait
Humans
Low Back Pain
Male
Middle Aged
Muscle Strength
Obesity
Physical Endurance
Regression Analysis
Resistance Training
Walking