The Role of Physical Exercise and Inactivity in Pain Recurrence and Absenteeism From Work After Active Outpatient Rehabilitation for Recurrent or Chronic Low Back Pain

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Abstract
Study Design. An observational follow-up. Objectives. To analyze the role of physical exercise and inactivity on the long-term outcome after active outpatient low back rehabilitation. Summary of Background Data. There is considerable evidence documenting the efficacy of exercise in the conservative treatment of chronic low back pain, but the role of exercises after the guided treatment period on the long-term success and maintenance of the results is not known. Methods. One hundred twenty-five patients with low back pain, who had participated in a 12-week active low back rehabilitation program, were asked about subjective pain and disability on the average of 14 months after the treatment. The outcomes were defined as a recurrence of persistent pain and work absenteeism, and a survival or failure analysis was performed between those who had continued exercising and who had been physically inactive. Results. Recurrences of persistent pain during the follow-up period were fewer (P = 0.03) among those who had maintained regular exercise habits after the treatment than among those who had been physically inactive. Similarly, work absenteeism was less (P < 0.01) among physically active than among physically inactive persons. However, patients with good outcome in pain reduction after low back pain rehabilitation were more likely to participate in physical exercise. Conclusions. Exercises are beneficial after guided treatment in the maintenance of the results of active treatment for recurrent chronic low back pain in the long term, but those with less favorable outcome in rehabilitation are less likely to participate in exercises afterward. In active treatment programs, it is recommended that exercises be incorporated after the guided treatment.