Run-Walk Exercise May Help Lower Back Pain Save

Adults younger than age 45 with chronic, nonspecific lower back pain saw significant pain relief with a structured run-walk program in a randomized trial.

At the end of 12 weeks, participants in the program scored their pain level an average 15.3 points lower (95% CI 5.3-25.3), on a 100-point scale, than a "waitlist" group who received usual care, according to Patrick J. Owen, PhD, of Monash University in Melbourne, Australia, and colleagues.

Participants' assessment of their disability also improved significantly with the program relative to usual care, as assessed with the Oswestry Disability Index (difference 5.2 points out of 100, 95% CI 0.2-10.1), they reported in the British Journal of Sports Medicine.

It's one of the first prospective studies to examine whether running -- previously shown to help prevent lower back pain-- might help relieve the condition when already established, the researchers said.

The benefit seen in the trial wasn't unalloyed, however. Of the 20 patients assigned to the program, nine experienced adverse effects considered "likely study-related." These included seven cases of knee and/or ankle pain and one of cardiac syncope. The ninth individual experienced worsened back pain, Owen and colleagues noted. None of these, though, were considered serious.

Owen's group observed that running has often been discouraged for people suffering chronic back pain, with clinicians often preferring to recommend lower-impact activities such as swimming or cycling. Actual evidence for this, however, has been scant, and given that running is arguably more popular -- and less needful of expensive equipment or facilities such as pools -- a scientific test of its therapeutic potential was warranted, the researchers suggested.

The ASTEROID (Assessing Safety and Treatment Efficacy of Running On Intervertebral Discs) trial got underway in 2022. Forty adults younger than age 45 with chronic, nonspecific lower back pain were recruited and randomized 1:1 to the program or the waitlist. People already running regularly were excluded, as were those with acute or intermittent back pain.

Mean age for those enrolled was about 33 and half were women. Self-rated current pain scores averaged 31 in the intervention group and 40 among controls. This latter difference was also reflected in related baseline measures: disability scores were higher and regular physical activity levels considerably lower in the control group.

As Owen and colleagues explained, the program involved "short running intervals interspersed with rest periods of walking," at three 30-minute sessions per week. Interactive video consultations were provided regularly, and participants received written information about running, but they were on their own to perform the prescribed activities. During each session, participants performed six to 10 repeats of run-walk cycles lasting 2-4 minutes.

Running intensity was scaled up over 13 stages; participants began at stages 1-3, depending on how they performed during a 2-minute running test at baseline. Each successive stage involved more running and less walking. Thus, participants at stage 1 ran for about 2 minutes per session, increasing over the 12 weeks to as much as 24 minutes (In practice, few participants followed this steady progression; individuals' actual running distances rose and fell almost randomly from week to week, although the general trend was upward in most cases).

Usual care consisted of standard primary-care level advice and over-the-counter medications. Following the main study period, control participants could then receive the intervention.

Owen's group stopped short of wholeheartedly backing the intervention as a therapy for lower back pain, in part because of the small number of participants and their careful selection. It also wasn't certain which aspects of the intervention -- the actual exercise versus the education and contact with professionals -- were most responsible for the reduced pain. It might have mattered, too, that the control group was in worse pain and was less active at baseline than those assigned to the program.

But the investigators did offer a hedged recommendation: "While it is unclear if running should be used to treat nonspecific chronic LBP [lower back pain], given the potential health benefits, a conservative run-walk programme likely represents a suitable form of exercise training for individuals with nonspecific chronic LBP who enjoy running or have avoided running in the past due to safety concerns."