Is exercise for low back pain worth the gain? Yes, studies show — but only for long-term low back pain.

Different doctors recommend different exercises for different patients. What works? Jill A. Hayden, DC, of Canada's Institute for Work & Health, led a team that analyzed studies evaluating exercise therapy in people with low back pain that lasted at least three months. They looked at 43 studies of 72 exercise treatments. They found that stretching and strengthening exercises worked best in patients with chronic low back pain to improve pain and function.

They found:

— For low back pain lasting six to 12 weeks, a program of gradually increasing exercise helps people get back to work sooner.

— For acute low back pain — lasting less than six weeks — there's no proof that exercise helps.

But these are only overall results, combining many different kinds of exercise therapies. Hayden and colleagues suggest that individualized treatment — with plenty of professional supervision — is most helpful.

And a lot is up to patients themselves. Those who stick with recommended exercises tend to end up with the least pain and the best function.

"Clinically meaningful improvements in pain are possible," Hayden and colleagues write. "The most effective strategy seems to be individually designed exercise programs delivered in a supervised format (for example, home exercises with regular therapist follow-up) and encouraging adherence to achieve [lots of exercise]."

Stretching exercises were most helpful for relieving pain. Strengthening exercises were most helpful for regaining function. And keeping up with exercise was more helpful than exercise of less than 20 hours duration.

Also found to be helpful for low back pain:

— Staying active

— Using the over-the-counter pain relievers such as aspirin, ibuprofen, and naproxen

— Manual therapy

The findings appear in the May 3 issue of Annals of Internal Medicine.

By Daniel J. DeNoon reviewed by Brunilda Nazario, MD

SOURCE: Hayden, J.A. Annals of Internal Medicine, May 3, 2005; vol 142: pp 765-775 and 776-785.