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      The effects of strength exercise and walking on lumbar function, pain level, and body composition in chronic back pain patients

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          Abstract

          The beneficial effects of a strength exercise program and a combined exercise program of strength training plus walking were examined in overweight with chronic back pain patients. The participants were randomly placed in the strength exercise group (SEG, n=15), combined exercise group (CEG, n=15), and control group (CG, n=6). All subjects performed exercise twice per week, 50 min per session with a professional instructors for 12 weeks. In order to evaluate exercise intervention effects, lumbar function was measured by back strength and flexibility. Roland-Morris disability questionnaire (RMDQ) and visual analogue scale (VAS) were used to evaluate pain level. Fat and muscle mass were measured to compare body composition changes. All measurements were performed before and after 12 weeks of exercise program. Lumbar function: Back strength was significantly different over time, and significant time×group differences were found between SEG and CG and, CEG and CG. Pain disorder degree: VAS showed a significant group difference, and significant time×group differences were shown between SEG and CG, and CEG and CG. Also, RMDG showed a significant difference between CEG and CG. Body composition: Fat mass was significantly different over time×group between SEG and CG. In conclusion, participating in strength and walking exercises were beneficial to improve lumbar function. Also, the combined exercise program was more effective for reducing pain levels than the strength exercise. Finally, fat mass was reduced in this study and this may play a possible role in the improvement of lumbar function and reduction in low back pain.

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          Most cited references36

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          The association between obesity and low back pain: a meta-analysis.

          This meta-analysis assessed the association between overweight/obesity and low back pain. The authors systematically searched the Medline (National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier, Amsterdam, the Netherlands) databases until May 2009. Ninety-five studies were reviewed and 33 included in the meta-analyses. In cross-sectional studies, obesity was associated with increased prevalence of low back pain in the past 12 months (pooled odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14, 1.54), seeking care for low back pain (OR = 1.56, 95% CI: 1.46, 1.67), and chronic low back pain (OR = 1.43, 95% CI: 1.28, 1.60). Compared with non-overweight people, overweight people had a higher prevalence of low back pain but a lower prevalence of low back pain compared with obese people. In cohort studies, only obesity was associated with increased incidence of low back pain for > or =1 day in the past 12 months (OR = 1.53, 95% CI: 1.22, 1.92). Results remained consistent after adjusting for publication bias and limiting the analyses to studies that controlled for potential confounders. Findings indicate that overweight and obesity increase the risk of low back pain. Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.
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            Core stability and its relationship to lower extremity function and injury.

            Core stability may provide several benefits to the musculoskeletal system, from maintaining low back health to preventing knee ligament injury. As a result, the acquisition and maintenance of core stability is of great interest to physical therapists, athletic trainers, and musculoskeletal researchers. Core stability is the ability of the lumbopelvic hip complex to prevent buckling and to return to equilibrium after perturbation. Although static elements (bone and soft tissue) contribute to some degree, core stability is predominantly maintained by the dynamic function of muscular elements. There is a clear relationship between trunk muscle activity and lower extremity movement. Current evidence suggests that decreased core stability may predispose to injury and that appropriate training may reduce injury. Core stability can be tested using isometric, isokinetic, and isoinertial methods. Appropriate intervention may result in decreased rates of back and lower extremity injury.
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              Disc degeneration of the lumbar spine in relation to overweight.

              To study the association between overweight and lumbar disc degeneration. Population-based 4-y follow-up magnetic resonance imaging (MRI) study. The subjects were 129 working middle-aged men selected to the baseline magnetic resonance imaging (MRI) study from a cohort of 1832 men representing three occupations: machine drivers, construction carpenters, and office workers. The selection was based on the paticipants' age (40-45 y) and place of residence. MR images of the lumbar spines were obtained at baseline and at 4-y follow-up. Signal intensity of the nucleus pulposus of the discs L2/L3-L4/L5 was visually assessed by two readers using the adjacent cerebrospinal fluid as an intensity reference. The weight (at age 25 and 40-45 y) and height of the subjects, history of car driving, smoking, and back injuries were assessed by questionnaire. Multiple regression analyses allowing for occupation, history of car driving, smoking, and back injuries showed that persistent overweight (body mass index (BMI) > or =25 kg/m(2) at both ages) associated strongly with an increased risk of the number of lumbar discs with decreased signal intensity of nucleus pulposus at follow-up, adjusted odds ratio (OR) being 4.3 (95% confidence intervals (95% CIs) 1.3-14.3). Overweight at young age (risk ratio (RR) 3.8; 95% CI 1.4-10.4) was a stronger predictor of an increase in the number of degenerated discs during follow-up than overweight in middle age (RR 1.3; 95% CI 0.7-2.7). The study provides evidence that the BMI above 25 kg/m(2) increases the risk of lumbar disc degeneration. Overweight at young age seems to be particularly detrimental.
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                Author and article information

                Journal
                J Exerc Rehabil
                J Exerc Rehabil
                Journal of Exercise Rehabilitation
                Korean Society of Exercise Rehabilitation
                2288-176X
                2288-1778
                October 2016
                31 October 2016
                : 12
                : 5
                : 463-470
                Affiliations
                [1 ]Department of Physical Education, Graduate School, Sangmyung University, Seoul, Korea
                [2 ]Department of Sport & Health Science, College of Natural Science, Sangmyung University, Seoul, Korea
                Author notes
                [* ]Corresponding author: Suh-Jung Kang, http://orcid.org/0000-0002-8284-9299, Department of Exercise and Health Science, College of Natural Science, Sangmyung University, 7, Hongjimun 2ga-gil, Jongno-gu, Seoul 03015, Korea, Tel.: +82-2-2287-5136 Fax: +82-2-2287-0075, E-mail: suhjkang@ 123456smu.ac.kr
                Article
                jer-12-5-463
                10.12965/jer.1632650.325
                5091063
                27807526
                d045f685-dae7-4c04-a6d5-b9622ca9d9a0
                Copyright © 2016 Korean Society of Exercise Rehabilitation

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 June 2016
                : 24 September 2016
                Categories
                Original Article

                back pain,walking exercise,strength exercise
                back pain, walking exercise, strength exercise

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