Periodized Resistance Training Versus Aerobic Training in Managing Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial.

Abstract

Background and purpose Nonspecific chronic low back pain (NSCLBP) is a leading cause of disability worldwide. While exercise is a cornerstone of management, the comparative effectiveness of periodized resistance training (RT) versus aerobic training (AT) within a clinical rehabilitation context remains unclear. Moreover, an evidence gap exists regarding the application of periodized models and their impact on psychological outcomes, such as kinesiophobia. This randomized controlled trial aimed to compare the effects of periodized RT and periodized AT on pain intensity, functional disability, kinesiophobia, trunk-related muscular performance, and endurance in individuals with NSCLBP. Methods Thirty-eight participants with NSCLBP were randomly allocated to an RT group (n = 19) or an AT group (n = 19). Both groups trained three times weekly for 8 weeks. Primary outcomes were pain intensity (Visual Analogue Scale), Functional disability (Arabic-translated Oswestry Disability Index), and kinesiophobia (Arabic-translated Tampa Scale of kinesiophobia). Secondary outcomes were isometric strength (hip extensors and latissimus dorsi) measured with a handheld dynamometer, and trunk muscular endurance assessed via the Biering-Sorensen Test and a standardized static abdominal endurance protocol. Because several outcomes were imbalanced at baseline, the primary analysis used analysis of covariance (ANCOVA), with post-treatment score as the dependent variable, treatment group as the fixed factor, and the corresponding baseline value as the covariate. Adjusted mean differences (AMD), 95% confidence intervals (CI), exact p-values, and partial eta squared (η 2 p) were reported. Results All 38 randomized participants completed the intervention and post-treatment assessments. Compared with AT, RT resulted in lower adjusted post-treatment scores for pain (AMD = -2.71, 95% CI -3.17 to -2.25, p 2 p = 0.804), disability (AMD = -0.20, 95% CI -0.25 to -0.15, p 2 p = 0.641), and kinesiophobia (AMD = -5.54, 95% CI -7.89 to -3.19, p 2 p = 0.395). RT also produced higher adjusted post-treatment values for all strength and endurance measures, with large effect sizes (η 2 p = 0.480-0.693). Conclusion In this sample of adults with NSCLBP, the tested periodized RT program produced more favorable adjusted post-treatment outcomes than the tested periodized AT program across pain, disability, kinesiophobia, muscular strength, and trunk endurance. These findings support periodized resistance training as a rehabilitation option for NSCLBP, although larger trials with longer follow-up are warranted. Trial registration ClinicalTrial.gov (Identifier: NCT06922981).