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Introduction: The quality of life (QoL) in persons with chronic nonspecific low back pain (CNSLBP) is poorer than in healthy persons. Exercise therapy is a valuable therapeutic modality in CNSLBP rehabilitation. Recent research has shown that high-intensity training (HIT) is more effective than moderate-intensity training (MIT) to improve physical fitness and decrease disability1. Possibly, HIT also improves QoL more than MIT. The aim of the study was to compare the effects of HIT to MIT on QoL in persons with CNSLBP. Methods: Persons with CNSLBP performed a 12-week training program (24 sessions, 1.5 h per session, twice per week) at high or moderate intensity. The primary outcome measure, QoL, was assessed with the Short Form Health Survey (SF-36) at baseline and immediately post-intervention. A linear mixed model was carried out to evaluate the therapy effects. Results: In total, thirty-five persons (11 male, age = 43.3 y ± 9.7) participated. Between group differences (p = 0.0387) in favor of HIT were found for the physical component score (PCS) of the SF-36. Within group analysis showed an improvement in the SF-36 total score (HIT:+14.48, MIT:+11.82) and the PCS (HIT:+11.06, MIT:+10.44) in both groups. However, within group improvements in the mental component score were lacking (HIT:-1.41, MIT:-2.78). Discussion: Exercise intensity, and especially HIT, appears to be important to maximize the impact of exercise therapy on QoL in persons with CNSLBP. Process evaluation: Although HIT is an effective treatment modality in CNSLBP rehabilitation, this study did not report on the long-term effects of HIT. Process evaluation: Although HIT is an effective treatment modality in CNSLBP rehabilitation, this study did not report on the long-term effects of HIT. [ABSTRACT FROM AUTHOR]

Introduction: Persons with chronic nonspecific low back pain (CNSLBP) benefit more from high-intensity training (HIT) compared to (usual care) moderate-intensity training (MIT) to improve physical1 and psychosocial2 outcomes. However, the underlying mechanisms for these effects are unknown. A possible underlying mechanism is an improvement in diaphragm functioning. The diaphragm plays an important role in postural control3, and an impaired postural control due to diaphragm dysfunction has been shown to contribute to the development of CNSLBP. Methods: Sixty-four persons with CNSLBP will be randomly assigned to a 12-week HIT-or MIT-program. Both programs will consist of cardiorespiratory, limb strength and core muscle training. The only difference between both groups, will be the intensity of the exercise therapy. Primary outcomes will include diaphragm activation during postural control (EMG), and diaphragm strength (maximal inspiratory pressure), endurance and fatigue. Secondary outcomes will include pain processing (quantitative sensory testing), exercise capacity, and lumbar proprioceptive use during postural control. Questionnaires about pain intensity, disability, anxiety, and depression will also be inventoried. Outcomes will be assessed at baseline, during and immediately post-intervention, and at 3-and 12-months follow-up. Effects and relations will be investigated using, respectively, linear mixed models and multiple linear regression. Results: We hypothesize that diaphragm functioning will improve more after HIT compared to MIT in persons with CNSLBP. Discussion: The Breathe-(H)IT Trial will be the first study investigating the effects of HIT on diaphragm functioning in persons with CNSLBP Process evaluation: Ethical approval is currently being requested from the Medical Ethical Committee of UHasselt. [ABSTRACT FROM AUTHOR]