Quick Overview
A team at the University of Bologna, with colleagues in Trento and the United States, pooled five fair tests of walking versus other exercise for chronic low back pain. The trials included 329 adults, average age about 43. Pain, disability, quality of life, and fear of movement improved in a similar way in both groups. The differences were small and not statistically significant at short, mid, and long follow-up. Adding walking to exercise did not clearly add a short-term gain. The paper is a peer-reviewed meta-analysis in Disability and Rehabilitation. The full post explains the doses, the scores, and what the numbers do not prove.
We always provide direct links to the original research at the end of every article so you can review the evidence yourself.
Walking worked about as well as gym-style exercise for long-term back pain, review of five trials finds
Most people with a sore back are told to keep moving. Many are also sent to an exercise class. A team of rehabilitation scientists asked a simple question. Does plain walking help as much as other exercise?
The paper is a systematic review and meta-analysis of randomized trials. That means the authors hunted for fair tests, then pooled the numbers. Carla Vanti and colleagues led the work. They are based at the University of Bologna in Italy, with co-authors from a neuro-rehabilitation hospital in Trento and George Mason University in the United States. The paper appeared in Disability and Rehabilitation, published by Taylor & Francis.
They searched six research databases up to 31 December 2016. The search found 1,887 records, plus one extra paper from other sources. After screening, only five randomized trials made the cut. Those trials enrolled 329 adults with chronic nonspecific low back pain. The average age was about 43. The trials came from Denmark, Ireland, the United Kingdom, Israel, and Korea, and were published from 2010 to 2015.
Chronic here meant pain lasting more than three months. Trials of pain from tumours, scoliosis, or known disease were left out. So were studies that were not true randomized tests.
Walking was not one single recipe. Some people walked outdoors for 30 minutes, five days a week, using a booklet. Some did supervised Nordic walking in small groups, twice a week for eight weeks. Some walked on a treadmill for 40 minutes. Two trials added walking to an exercise program and compared that with exercise alone. The other side of the comparison was structured exercise. That included circuit training, trunk and limb strengthening, and usual physiotherapy.
The researchers scored study quality with the PEDro scale. Scores ran from 4 out of 10 to 8 out of 10. The average was 6.6. Four of the five trials met the usual “good quality” mark of 6. Patients and therapists could not be blinded, because you know if you are walking. Four trials hid the group assignment until it was made. Three blinded the people who measured results.
They looked at pain, disability, quality of life, and fear of movement. Follow-up was short-term (under three months), mid-term (three to six months), and long-term (six months or more).
Walking was not better than exercise. It was also not worse. For pain, the pooled effect was small and not statistically significant. Short-term effect size was −0.17. Mid-term was −0.18. Long-term was −0.22. The confidence ranges all crossed zero. That means the trials could not show a real difference.
Disability told the same story. Short-term effect size was −0.11 across three trials and 258 people. Mid-term was −0.08. Long-term was −0.17. Again, no clear winner. Quality of life edged slightly toward walking, with effect sizes of 0.08, 0.07, and 0.05. Those differences were tiny and not significant. Fear of movement at short term was −0.33, also not significant, and the trials did not agree closely with each other.
Adding walking on top of exercise did not clearly beat exercise alone. Short-term pain effect size was −0.09. Short-term disability was −0.28. Both came from two small trials and 76 people. Neither result was significant.
Inside each group, people often felt a bit better. Pain and disability fell after walking and after exercise. But few changes reached the authors’ bar for a meaningful clinical difference. For example, a 30 percent drop in pain, or a 10-point drop on a 100-point disability score. In the Nordic walking trial, function scores did reach that bar more often in the walking group. In the treadmill trial, disability improved enough to count in the walking group, but not in the strengthening group. Across the set, the authors still called clinical relevance poor.
Side effects were uncommon and mostly unrelated to the programs. The trials reported 31 events. Fourteen were flu or other illness. Two were allergic reactions. One was a road crash. One was an ankle sprain. Six were extra pain in a leg. Seven were a rise in low back pain.
The authors’ own conclusion is careful. Pain, disability, quality of life, and fear-avoidance improved in a similar way with walking or with exercise. Walking may be a simpler and less expensive option. Adding walking to exercise did not bring a clear extra gain in the short term. They also said the evidence was not strong enough for firm treatment rules. Samples were small. Walking dose and walking type differed. Only one trial had more than 50 people in a group.
This is a summary of published research, not personal medical advice. Back pain has many causes. A person with new, severe, or worsening symptoms should speak with a qualified clinician before starting a new program.
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Research Summary
| Detail | What the paper reports |
|---|---|
| Title | The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials |
| Link | https://doi.org/10.1080/09638288.2017.1410730 |
| Authors | Carla Vanti, Simone Andreatta, Silvia Borghi, Andrew Anthony Guccione, Paolo Pillastrini, Lucia Bertozzi |
| Centres | University of Bologna, Italy; Neuro-Rehabilitation Hospital of Trento, Italy; George Mason University, USA |
| Journal | Disability and Rehabilitation, Taylor & Francis, 2019, volume 41, issue 6, pages 622–632. Online 5 December 2017 |
| Question | Does walking alone, or walking added to exercise, change pain, disability, quality of life, and fear-avoidance compared with other exercise in chronic low back pain? |
| Search | MEDLINE, CINAHL, PEDro, CENTRAL, PsychINFO, and SPORTDiscus, from inception to 31 December 2016. 1,887 records plus 1 from other sources |
| Included trials | Five randomized trials, published 2010–2015, from Denmark, Ireland, the United Kingdom, Israel, and Korea |
| People | 329 adults with chronic nonspecific low back pain, mean age about 43 (range 28.4–49.5). Pain for more than three months. Specific causes such as tumour or scoliosis were excluded |
| Walking programs | Outdoor walking, treadmill walking, and Nordic walking, usually 30–50 minutes a session, for 6–8 weeks, from 2 to 7 sessions a week |
| Comparison | Structured exercise, circuit training, strengthening, usual physiotherapy, or exercise alone versus exercise plus walking |
| Quality | PEDro scores from 4/10 to 8/10, mean 6.6. Four trials scored at least 6/10. Patients and therapists could not be blinded |
| Pain | Walking versus exercise: short-term effect size −0.17, mid-term −0.18, long-term −0.22. All small and not significant. Adding walking: −0.09, not significant |
| Disability | Walking versus exercise: short-term −0.11, mid-term −0.08, long-term −0.17. Adding walking: −0.28. None were significant |
| Quality of life and fear | Quality of life effect sizes 0.08, 0.07, and 0.05 across follow-ups. Short-term fear-avoidance −0.33. All not significant |
| Clinical meaning | Few results reached the authors’ minimal important change. They judged clinical relevance poor in both walking and exercise groups |
| Harm | 31 adverse events: 14 flu or other illness, 2 allergic reactions, 1 road crash, 1 ankle sprain, 6 increased leg pain, 7 increased low back pain. Most were not tied to the program |
| Conclusion | Walking and exercise gave similar changes in pain, disability, quality of life, and fear-avoidance. Adding walking did not clearly improve short-term results. Evidence was not strong enough for firm treatment advice |
| Limits | Small samples, different walking doses and types, exercise programs poorly described, and no test of walking speed, strength, or aerobic fitness |
| What it did not study | Electrical muscle stimulation, a full body EMS system, or any device. Those outcomes are not in this paper |
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