• M W van Tulder, A Malmivaara, R Esmail, and B W Koes.
• Institute for Research in Extramural Medicine, Vrije Universiteit, van der Boechorststraat 7, Amsterdam, NETHERLANDS, 1081 BT. mw.van_tulder.emgo@med.vu.nl
• Cochrane Db Syst Rev. 2000 Jan 1 (2): CD000335.

BackgroundExercise therapy is a widely used treatment for low back pain.ObjectivesThe objective of this review was to assess the effectiveness of exercise therapy for low back pain with regard to pain intensity, functional status, overall improvement and return to work.Search StrategyWe searched the Cochrane Controlled Trials Register (1999, issue 1), MEDLINE (1966 - April 1999), EMBASE (1988 - September 1998), PsycLIT (from 1984 to April 1999) and reference lists of articles.Selection CriteriaRandomised trials of all types of exercise therapy for subjects with non-specific low back pain with or without radiation into the legs.Data Collection And AnalysisTwo reviewers independently extracted data and assessed trial quality. Because trials were considered heterogeneous with regard to study populations, interventions and outcomes, we decided not to perform a meta-analysis but to summarise the results using a rating system of four levels of evidence (strong, moderate, limited or no evidence).Main Results39 RCTs were identified. There is strong evidence that exercise therapy is not more effective than inactive or other active treatments it has been compared with for acute low back pain. There is conflicting evidence on the effectiveness of exercise therapy compared with inactive treatments for chronic low back pain. Exercise therapy was more effective than usual care by the general practitioner and equally effective as conventional physiotherapy for chronic low back pain.Reviewer's ConclusionsThe evidence summarised in this systematic review does not indicate that specific exercises are effective for the treatment of acute low back pain. Exercises may be helpful for chronic low back pain patients to increase return to normal daily activities and work.

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