• Seán R O'Connor, Mark A Tully, Brigid Ryan, Chris M Bleakley, George D Baxter, Judy M Bradley, and Suzanne M McDonough.
• Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, United Kingdom; Institute of Nursing and Health Research, University of Ulster, United Kingdom.
• Arch Phys Med Rehabil. 2015 Apr 1;96(4):724-734.e3.

ObjectiveTo systematically review the evidence examining effects of walking interventions on pain and self-reported function in individuals with chronic musculoskeletal pain.Data SourcesSix electronic databases (MEDLINE, CINAHL, PsychINFO, PEDro, Sport Discus, and the Cochrane Central Register of Controlled Trials) were searched from January 1980 to March 2014.Study SelectionRandomized and quasi-randomized controlled trials in adults with chronic low back pain, osteoarthritis, or fibromyalgia comparing walking interventions to a nonexercise or nonwalking exercise control group.Data ExtractionData were independently extracted using a standardized form. Methodological quality was assessed using the U.S. Preventive Services Task Force system.Data SynthesisTwenty-six studies (2384 participants) were included, and suitable data from 17 studies were pooled for meta-analysis, with a random effects model used to calculate between-group mean differences and 95% confidence intervals (CIs). Data were analyzed according to the duration of follow-up (short-term, ≤8wk postrandomization; medium-term, >2mo to 12mo; long-term, >12mo). Interventions were associated with small to moderate improvements in pain at short-term (mean difference , -5.31; 95% CI, -8.06 to -2.56) and medium-term (mean difference, -7.92; 95% CI, -12.37 to -3.48) follow-up. Improvements in function were observed at short-term (mean difference, -6.47; 95% CI, -12.00 to -0.95), medium-term (mean difference, -9.31; 95% CI, -14.00 to -4.61), and long-term (mean difference, -5.22; 95% CI, -7.21 to -3.23) follow-up.ConclusionsEvidence of fair methodological quality suggests that walking is associated with significant improvements in outcome compared with control interventions but longer-term effectiveness is uncertain. With the use of the U.S. Preventive Services Task Force system, walking can be recommended as an effective form of exercise or activity for individuals with chronic musculoskeletal pain but should be supplemented with strategies aimed at maintaining participation. Further work is required for examining effects on important health-related outcomes in this population in robustly designed studies.Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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