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Study Design. A report on plenary presentations and discussions of an expert panel and workshop (Exercise as a treatment for subacute low back pain) that was held at the Amsterdam Forum VIII on Low Back Pain Research in Primary Care.Objective. To highlight important issues regarding the design, conduct, and reporting of exercise trials and to provide suggestions for improvement in each domain.Summary of Background Data. Despite improvements in the methodologic quality of randomized clinical trials on low back pain (LBP), current trials on exercise therapy still show methodologic flaws in the design and reporting of studies.Methods. Important issues in the design, conduct, and reporting of exercise trials for LBP were introduced by 4 presenters, and this was followed by a group discussion among 40 attendees. Conclusions and recommendations were extracted by the workshop panelists and summarized in this paper.Results. Workshop discussion led to the following recommendations: (1) specify a theoretical framework for exercise therapy for designing the intervention and selecting appropriate treatment efficacy measures; (2) to overcome blinding problems in exercise trials, include sham interventions and assess the success of blinding; (3) evaluate the role of patient-provider interactions through the use of self-report or observational measures; (4) to assure quality of treatment, use exercise interventions that reference existing exercise guidelines; (5) use subgroup analyses to identify subgroups of patients most likely to benefit; (6) in reporting exercise trials, include an extensive description of the study population, a detailed exercise protocol, and some measure of patient compliance; (7) further categorization of exercise interventions is needed, in terms of concept, mode, intensity, duration, frequency, and length; and (8) trial registration and publication of detailed study protocols may help to strengthen the evidence-based concerning exercise therapy for LBP.Conclusion. By paying proper attention to issues concerning the design and reporting of exercise protocols when conducting future exercise trials, research may provide a stronger evidence basis for recommending or not recommending various exercise therapies for LBP. [ABSTRACT FROM AUTHOR]

Question: Is eight weeks of high-intensity strengthening of the isolated lumbar extensors more effective than low-intensity strengthening or no strengthening? Are any gains maintained 16 weeks later? Design: Randomised, three-arm trial with concealed allocation, assessor blinding, and intention-to-treat-analysis. Participants in the waiting list control group were randomised again, after the first 8 weeks, to either the high-intensity or the low-intensity strengthening program. Participants: Sixty-five army personnel with non-specific chronic low back pain. Intervention: The high-intensity training group received 10 sessions of 15 to 20 repetitions for the isolated lumbar extensor muscles. The low-intensity training group received a nonprogressive, low-intensity resistance protocol. Outcome measures:Primary outcomes were global perceived effect and disability. Secondary outcomes were health-related quality of life, fear of movement/(re-)injury, and isometric lumbar extensor muscle strength. Measures were taken before and after the training and 16 weeks later. Results: At eight weeks, SF-36 overall score was on average 7% (95% CI 1 to 13) greater in the high-intensity training group compared with the low-intensity training group and the waiting list control group, and self-assessed decrease of back symptoms was on average 39% (95% CI 14 to 64) greater in the high-intensity training group compared with the waiting list control group. There was no difference in improvement between the groups for any other outcome at 8 weeks or 24 weeks. Conclusions: Although some beneficial effects were found, the results of this high-intensity strengthening program of the isolated lumbar extensor muscles do not clearly support the generally-claimed beneficial influence of exercise for chronic non-specific low back pain. [ABSTRACT FROM AUTHOR]