Melania Cardellat-González

Purpose: Kinesiophobia is a psychosocial factor associated with pain persistence and disability in individuals with nonspecific chronic low back pain (NSCLBP). Although exercise therapy is commonly recommended, its isolated effect on kinesiophobia remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of standalone exercise in reducing kinesiophobia in adults with NSCLBP. Methods: A systematic search was conducted in MEDLINE, Cochrane Library, Web of Science, and Scopus without date or language restrictions. Randomized controlled trials including adults with NSCLBP (≥3 months) receiving standalone exercise were eligible. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses calculated mean differences (MD) and standardized mean differences (SMD). Meta-regression explored heterogeneity. Results: Eight randomized controlled trials involving 854 participants were included. Studies presented some concerns regarding risk of bias, and certainty of evidence was rated as low. Standalone exercise significantly reduced kinesiophobia compared with passive controls and usual care (MD = −5.38; 95% CI −7.63 to −3.13; SMD = −1.03), exceeding the minimal clinically important difference. However, considerable heterogeneity was observed (I² ≈ 94%), and meta-regression did not identify significant moderators. These findings were exploratory and limited by the small number of studies. Conclusion: Standalone exercise may reduce kinesiophobia in adults with NSCLBP; however, heterogeneity, methodological concerns, and low-certainty evidence limit confidence in the pooled effect estimate. Therefore, the observed effect should be interpreted as an overall trend rather than a consistent effect across populations and interventions.

Systematic review with meta-analysis to evaluate the efficacy of resistance training (RT) in improving pain intensity, quality of life, and disability in people with nonspecific chronic low back pain (NSCLBP). Searches were conducted in April 2025 using MEDLINE, Scopus, Web of Science, and the Cochrane Library. Randomized controlled trials (RCTs) that compared RT interventions with any treatment and assessed pain intensity, quality of life, or disability in adults with NSCLBP were included. A pairwise random-effects meta-analysis was performed by subgroup according to the comparison treatment. Risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool (RoB 2), and certainty of evidence was evaluated using the GRADE approach. Ten RCTs (n = 434) showed significant improvements in pain intensity (SMD = -1.15; 95% CI [-1.67, -0.62], p < 0.0001) and disability (SMD = -2.76; 95% CI [-3.90, -1.62], p < 0.00001) favoring RT. No statistical or clinical significance was observed in the quality of life. Only pain intensity reached clinical significance. The certainty of the evidence was rated as "moderate" for all variables. RT programs effectively reduce pain intensity and disability in patients with NSCLBP. Moderate certainty of evidence suggests that RT can be recommended for NSCLBP. Further research is required to confirm these findings. CRD42024505897.

Background: Therapeutic exercise (TE) is recommended as the first line of treatment for low back pain (LBP), but questions remain about the true efficacy of TE in the acute phase. This study aimed to evaluate the effectiveness of isolated TE in reducing pain intensity and disability in patients with acute or subacute LBP. Methods: A systematic review with meta-analysis was conducted following the PRISMA guidelines. Randomized controlled trials (RCTs) that analyzed therapeutic exercise alone in one of the intervention groups and assessed pain intensity and disability were included; both outcomes were considered primary in this review. The quality of evidence was assessed using the GRADE tool. Results: Five RCTs were included. Meta-analyses were performed in subgroups according to the comparators: usual care, education, manual therapy, and bed rest. Statistically significant differences in favor of TE were found only when compared to usual care (SMD = −0.23; 95% CI [−0.45, −0.01]; p = 0.04). Conclusions: TE, when prescribed as an isolated intervention, appears to be more effective than usual care in improving short-term disability outcomes in patients with acute LBP. However, the limited quality and number of available studies, together with the typically favorable natural course of acute LBP, suggest that these findings should be interpreted with caution. Current evidence supports the integration of exercise within a comprehensive, multimodal management plan that addresses the physical, psychological, and social dimensions of pain.

Background and Objective: Guidelines recommend combining physical and psychological programmes for chronic low back pain (CLBP); however, exercise therapy (ET) and manual therapy (MT) are often delivered separately. This systematic review with meta‐analysis and meta‐regression of randomised controlled trials (RCTs) aimed to compare the efficacy of ET with MT in terms of pain intensity, disability and physical function in people with CLBP. Databases and Data Treatment: MEDLINE, Web of Science, PEDro, Cochrane Library and Scopus were searched July–August 2024 for RCTs comparing ET with MT in participants aged 18–54 years. Outcomes were extracted for the short‐, medium‐ and long‐term follow‐up periods. Risk of bias (RoB 2.0 Cochrane Tool) and certainty of evidence (GRADE) were appraised. Results: Six RCTs (743 patients) were included. Meta‐analyses showed, albeit non‐clinically relevant, a significant difference for long‐term in favour of ET for disability (SMD = −0.25, 95% CI [−0.43, −0.07], p = 0.007). Meta‐regression showed that the female–male ratio, treatment duration and mean age explain variability in pain intensity and disability. Conclusions: ET had a small beneficial effect on long‐term disability in people with CLBP. Nevertheless, evidence does not provide conclusive differences between both the treatments overall, influenced by heterogeneity and the number of studies included. Biopsychosocial factors may moderate the differences in outcomes. The GRADE assessment revealed very low certainty across all outcomes, highlighting the lack of high‐quality research. Significance Statement: ET may offer small long‐term benefits over MT for disability in people with CLBP. Differences seem to be influenced by sex, age and treatment duration. The choice of ET over MT, or vice versa, as a stand‐alone treatment does not appear to be supported by current evidence. PROSPERO Registration Number: CRD42024569120

Objective: The objective was to compare the effectiveness of a combined pain neuroscience education and resistance training program (PNE + RT) with that of a combined aerobic and flexibility exercise program (AE + FE). Design: A randomized pilot study was conducted in women with fibromyalgia. Methods: Thirty‐one women with fibromyalgia were randomized into the experimental group (PNE + RT, n = 15) and the usual care group (AE + FE, n = 16). Both groups carried out the intervention 3 days a week for 12 weeks. Primary outcomes were pain intensity, disability, and symptoms related to central sensitization (CS). Among them, pain intensity was considered the main primary endpoint for statistical analysis and interpretation. Secondary outcomes were pressure pain threshold (PPT), maximum handgrip strength (MHS), and stiffness. Results: Statistically significant between‐group differences were found in favor of PNE + RT group for short‐term pain intensity ( p < 0.05) and PPT trapezius ( p < 0.05). PNE + RT also showed statistically significant within‐group improvements in pain intensity ( p < 0.01), CS‐related symptoms ( p < 0.01), PPT quadriceps ( p < 0.01), and MHS of the left hand ( p < 0.01). Disability improved significantly in both groups ( p < 0.01). There were no significant changes in stiffness. Conclusion: The PNE + RT program is more effective than the AE + FE program in improving pain intensity in the short term and PPT in the trapezius muscle in the long term. PNE + RT is also effective in improving disability, pain intensity, CS‐related symptoms (short and long term), and left MHS and PPT in the quadriceps muscle (long term), although it is not more effective than AE + FE. The AE + FE program is only effective in improving disability. These findings are preliminary, and larger studies are needed to confirm the results. Trial Registration: ClinicalTrials.gov identifier: NCT04855851