# Exercise as it relates to Disease/Does the choice between pilates or cycling for chronic lower back pain matter?

This fact sheet is in reference to the journal article: “Pilates Exercise or Stationary cycling for chronic nonspecific low back pain: Does it matter?”.
Created by u3084253

## What is the background to this research?

Chronic non-specific lower back pain (CNSLBP), has become a significant worldwide health and economic burden to society
* Lower back pain (LBP): Pain or discomfort below the ribs and above where legs meet the buttock.
* Non-specific: No known cause
* Chronic: The pain persists for more than 12 weeks
The prevalence of LBP is 84%, with chronic LBP 23%, and ongoing disability 11-12%. In the Australian ageing population, the number of people with LBP is increasing substantially, with treatment and prevention highly sought after. In Australia, LBP was found to be one of the most expensive diseases in 2001, with an estimated cost of $9.17 billion.
A first choice treatment for LBP is often exercise, the aim being to restore deficits in strength, endurance, and recruitment patterns of the trunk muscles. No evidence has been found to suggest which exercise may be best, with exercise programs varying enormously. An increasingly popular form of exercise for LBP is Pilates.
Pilates focuses on:
* Core stability
* Strength
* Flexibility
* Control of breathing
* Movement
* Posture.
People with CNSLBP are thought to have altered stability and control of their spinal muscles, which Pilates may address. The aim of the study was to determine whether specific trunk exercises improve pain and disability, more than a single mode of exercise which does not focus specifically on the trunk, such as stationary cycling.

## Where is the research from?

This research was conducted in Sydney, Australia at the school of Science and Health, University of Western Sydney.
The authors have been involved in prior research regarding LBP or specific trunk exercise, such as Pilates. It is important to note that no funds were received in support of this work, hence there were no conflicts of interest which may bias results.
The article has been published in Spine, which is a peer-reviewed journal indicating that this study is of good quality.

## What kind of research was this?

This study was a single-centre, single blind, randomised controlled study.

#### Table 1: Type of Research

| Type of research | Advantages/disadvantages |
| Single Centre: | One centre was used for this study, not multiple, which makes data collection easier, however the results may not necessarily be applicable to a broader population, reducing the external validity of the study. |
| Single Blinded: | Only the participants were blinded to the use of modalities in the trial, however they knew which exercise they were performing. |
| Randomised: | Good because the groups are comparable at baseline, give valid information about average effects of interventions, and randomises the confounding effects. |
| Controlled: | Controlled studies are prone to selection bias. Therapists may bias by selecting certain people. In this study, participants had selection criteria to meet. The results may not be applicable to those who do not meet selection criteria. |

## What did the research involve?

64 eligible males and females aged between 18–50 years with ongoing LBP (>12 weeks) volunteered for the study and were randomly assigned to blocks of 8. Participants were required to attend supervised exercise classes 3 times per week for 8 weeks, 30-50 minute duration. There was a specific trunk exercise group (SEG), who performed Pilates, and a stationary cycling exercise group (CEG).
They used self reporting of:
* VAS scale- pain
* The Owestry Low Back pain Disability Index (ODI)- LBP questionnaire
* Pain catastrophizing scale- catastrophic thoughts or feelings in relation to painful experiences
* Fear avoidance beliefs questionnaire- beliefs about potential harm to their back.
Self report questionnaires can be inaccurate if participants do not answer truly. As the participants were volunteering to perform exercise, they most likely already had a positive attitude towards exercise for LBP, which may have biased the results.

## What were the basic results?

The 8-week group-based program of Pilates had better short, but not long term outcomes than stationary cycling for those suffering CNSLBP.

#### Table 2: Results

| Outcome Measure | 8 week results | 6 month post-exercise results |
| VAS scale (pain) | Pain reduced slightly more in Pilates than Cycling | Reductions in pain same in both groups |
| ODI | Disability significantly lower in Pilates compared to Cycling | Reductions in disability same in both groups |
| Pain catastrophizing scale | Reduced in both groups the same | Still reduced in both groups the same |
| Fear avoidance beliefs questionnaire | Reduced in Pilates for physical activity | Reduced in Cycling for physical activity |

## What conclusions can we take from this research?

As positive outcomes were similar between groups, this indicates that improvements in CNSLBP can be observed regardless of prescribing Pilates or stationary cycling. As the participants recruited had minimal-moderate levels of pain and disability due to LBP, the results may not be applicable to those suffering from higher levels. A recent well reputed review (Cochrane) comparing Pilates with other exercises found a small effect for improvement in function at follow up. They found that it was more effective than minimal treatment, but there is no evidence to suggest that it is superior than other forms of exercise. Other studies (including a recent Australian systematic review) comparing general exercise and Pilates, reflect results of the current study, finding equivalent improvements in pain and functional ability for CNSLBP.

## Practical advice

Treating CNSLBP is complex, and people may respond differently to treatments. Exercise including Pilates or cycling, 3 times a week for 50–60 minutes may be beneficial to help reduce disability and pain associated with CNSLBP. A physiotherapist can assist you to develop a training plan for your CNSLBP which is safe and monitored.

## Further information/resources

Spine Health- trusted information for back pain
Bupa: Back pain
Better Health Channel: Pilates

## References

* 1 2 3 4 5 6 7 8 9 10 Marshall, P., Kennedy, S., Brooks, C., & Lonsdale, C. (2013). Pilates exercise or stationary cycling for chronic nonspecific low back pain: Does it matter? The Spine Journal , 38 (15), 952-959.
* 1 2 Hoy, D., Bain, C., Williams, G., March, L., Brooks, P., Blyth, F., et al. (2012). A Systematic Review of the Global Prevalence of Low Back Pain. Arthritis and Rheumatism, 64 (6), 2028-2037.
* 1 2 3 4 Mostagi, F., Dias, J., Pereira, L., Obara, K., Mazuquin, B., Silva, M., et al. (2015). Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. Journal of Bodywork and Movement Therapies, 19 (4), 636–645.
* 1 2 3 4 5 Wells, C., Kolt, G., Marshall, P., Hill, B., & Bialocerkowski, A. (2014). The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review. PLoS Online, 9 (7).
* 1 2 3 4 5 6 7 Yamato, T., Maher, C., Saragiotto, B., Hancock, M., Ostelo, R., Cabral , C., et al. (2015). Pilates for low back pain. Cochrane, 2 (7), 1-74.
* ↑ Airaksinen, O., Brox, J., Cedraschi, C., Hildebrandt, J., Klaber-Moffett, J., Kovacs, F., et al. (2006). European guidelines for the management of chronic nonspecific low back pain. European Spine Journal , 292-300.
* 1 2 Balagué, F., Mannion, A., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. The Lancet, 379 (9814), 482–491.
* ↑ Walker, B., Muller, R., & Grant, W. (2003). Low back pain in Australian adults: the economic burden. Asia Pacific Journal of Public Health, 15 (2), 79-87.
* ↑ Saragiotto, B., Maher, C., Yamato, T., Costa, L., Menezes Costa , L., Ostelo, R., et al. (2016). Motor control exercise for chronic non-specific low-back pain. Cochrane, 1, 1-157.
* ↑ Bellomo, R., Warrillow, S., & Reade, M. (2009). Why we should be wary of single-center trials. Critical Care Medicine, 37 (12), 3114-3119.
* ↑ Wajswelner, H., Metcalf, B., & Bennell, K. (2012). Clinical Pilates versus general exercise for chronic low back pain: randomized trial. Medicine and Science, in Sports and Exercise, 44 (7), 1197-1205.