Optimal exercise dose in adults with chronic low back pain disorders: systematic review with dose-response network meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: OBJECTIVE: To quantify exercise dose-response relationships and estimate the optimal dose in adults with chronic low back pain disorders (CLBDs). DESIGN: Systematic review with random-effects model-based (non-linear) dose-response network meta-analysis. Risk of bias was assessed with Cochrane RoB 2 and certainty with the minimally contextualised Grading of Recommendations, Assessment, Development and Evaluation framework. A ≥5-point change (scaled 0-100) was predefined as clinically meaningful. DATA SOURCES: Six databases, two trial registries and citations were searched to 3 June 2025 ELIGIBILITY CRITERIA: Randomised controlled trials of exercise in adults (≥18 years) with CLBDs assessing disability or back pain at short (>1 day and ≤3 months), intermediate (>3 months and<12 months) and long-term (≥12 months) follow-up. RESULTS: We included 239 trials (252 reports); 99.2% included non-specific chronic low back pain; two trials included radicular presentations. The model-predicted optimal dose for short-term disability was 4 sessions/week, 25 min/session over 13 weeks. For short-term pain intensity, the optimal dose was 3 sessions/week, 30 min/session over 8 weeks. However, credible intervals of most dose-levels overlapped. Few dose combinations were clinically meaningful beyond the short term. 84% of trials were at high risk of bias and certainty was very low to low. Adverse events (reported in 28.5% of trials) were predominantly non-serious and musculoskeletal. CONCLUSIONS: Exercise training delivered at low to moderate doses was associated with short-term improvements in disability and pain intensity, which may be clinically meaningful, with limited additional benefit at higher exposure. Model-predicted doses provide guidance for exercise prescription; but the available evidence does not support a single optimal exercise dose and should be interpreted with caution given the low to very low certainty of evidence. Exercise training for radicular presentations is a key evidence gap.
Authors: Nitin Kumar Arora, Tobias Saueressig, Tim Schleimer, Hugo Pedder, Xiaolong Chen, Aminu Alhassan Ibrahim, Lars Donath, Katja Ehrenbrusthoff, Jon J Ford, Andrew J Hahne, Ludwig Hammel, Eva-Maria Huessler, Ashish Diwan, Svenja Kaczorowski, Clint T Miller, Niamh L Mundell, Heike Norda, Patrick J Owen, Shikha Sharma, Scott D Tagliaferri, Sam Vickery, Tomer Yona, Xiaohui Zhao, Daniel L Belavý
Institutions: German Sport University Cologne, Bochum University of Applied Sciences, University of Bristol, Capital Medical University, UNSW Sydney, Xuan Wu Hospital of the Capital Medical University, St George Hospital, Tishk International University, La Trobe University, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen University Hospital, Royal Adelaide Hospital, Adelaide University, Deakin University, Eastern Health, Monash University, The University of Melbourne, Orygen, Maastricht University, Xi'an University of Architecture and Technology
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7212089299
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