Exercise is medicine, but perhaps not for preventing low back pain: a randomized trial of exercise and education to prevent low back pain recurrence

OBJECTIVE: To assess whether an exercise and education program was more effective than an education booklet for preventing recurrence of low back pain (LBP). DESIGN: Randomized controlled trial. METHODS: Participants aged 18 years or older who had recovered from an episode of LBP within the previous week were recruited from primary care practices and the community. Participants were randomized to receive either 12 weeks of exercise and education (8 supervised exercise sessions and 3 one-on-one sessions) or a control (education booklet). The primary outcome was time to recurrence of LBP during the 1-year follow-up. Times to recurrence of LBP leading to activity limitation, care seeking, and work absence were secondary outcomes. Data were analyzed with Cox regression using intention-to-treat principles. RESULTS: We planned to include 160 participants but included 111 (exercise and education, n = 57; educational booklet, n = 54). At the end of the study period, data completeness was 84.2%. Thirty-six (63%) participants in the exercise and education group and 31 (57%) participants in the control group had a recurrence of LBP. There was no statistically significant difference in time to recurrence of pain between groups (hazard ratio = 1.09; 95% confidence interval: 0.7, 1.8). There was no statistically significant effect for any of the secondary outcomes. CONCLUSION: Among people recently recovered from LBP, exercise and education may not meaningfully reduce risk of recurrence compared to providing an educational booklet