The Effectiveness of Home-Based Exercises Versus Supervised Core Stability Exercises on Pain and Functional Disability in Controlled Hypertensive Patients with Chronic Mechanical Non-specific Low Back Pain: A Randomized Controlled Trial

Hanaa Ali Hafez, Mohamed Ahmed Mohamed, Abdelrazak A. Ahmed, Rania Hakim Hamed, Kamal Eldin Ahmed, Efrem Kentiba, Dina Sayed Abd Allah

Abstract


Purpose: This study aimed to compare the effectiveness of a home-based exercise program versus a supervised core stability exercise program in treating chronic mechanical non-specific low back pain (CMNSLBP) in patients with controlled hypertension. Methods: In this randomized controlled trial, (n=30) hypertensive patients with CMNSLBP were randomly assigned into two Group A (n=15) who received supervised core stability exercises, and Group B (n=15) followed a home-based exercise regimen. Both groups underwent a six-week intervention. Pain intensity was measured using the Visual Analog Scale (VAS; 0–10 cm), lumbar flexion range of motion (ROM) via the Modified-modified Schober test (measured in centimeters from baseline to maximal flexion), and functional disability with the Oswestry Disability Index (ODI; scored 0–100%). Assessments were conducted at baseline and after the 6-week intervention. Results: Both groups significantly improved pain intensity, lumbar flexion ROM, and functional disability. Group A’s mean VAS score decreased from 7.13 ± 1.07 to 5.13 ± 0.07 (p<0.001), while Group B’s mean VAS score decreased from 7.13 ± 1.07 to 5.36 ± 0.02 (p<0.001). Group A’s mean flexion ROM increased from 3.48 ± 0.49 cm to 3.95 ± 0.39 cm (p<0.001), and Group B’s from 3.45 ± 0.50 cm to 3.92 ± 0.46 cm (p<0.001). Group A’s mean ODI score decreased from 45.55 ± 1.3 to 32.8 ± 0.83 (p<0.001), and Group B’s from 44.95 ± 2.00 to 33.1 ± 0.13 (p<0.001). Between-group comparisons revealed significantly greater pain reduction in Group A (supervised) vs. Group B (home-based) (P=0.001), lumbar flexion ROM improvement (P=0.02), and functional disability reduction (P=0.01). Conclusion: Both supervised core stability and home-based exercise programs effectively reduce pain intensity, improve lumbar flexibility, and decrease functional disability in hypertensive patients with CMNSLBP. Supervised programs offer slightly better outcomes, but home-based programs are a viable, cost-effective alternative. Trial registration: NCT06387927, April 25th, 2024. “Retrospectively registered”

Keywords


Low Back Pain; Hypertension; Exercise Therapy; Core Strengthening; Home Care

Full Text:

PDF

References


Alqhtani, R. S., Ahmed, H., Ghulam, H. S. H., Alyami, A. M., Al Sharyah, Y. H. H., Ahmed, R., Khan, A., & Khan, A. R. (2024). Efficacy of core-strengthening and intensive dynamic back exercises on pain, core muscle endurance, and functional disability in patients with chronic non-specific low back pain: A randomized comparative study. Journal of Clinical Medicine, 13(2), 475. https://doi.org/10.3390/jcm13020475

Amjad, F., Mohseni-Bandpei, M. A., Gilani, S. A., & Shah, S. H. (2022). Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability, and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy: A randomized controlled trial. BMC Musculoskeletal Disorders, 23(255). https://doi.org/10.1186/s12891-022-05196-x

Anar, S. Ö. (2016). The effectiveness of home-based exercise programs for low back pain patients. Journal of Physical Therapy Science, 28(10), 2727–2730. https://doi.org/10.1589/jpts.28.2727

Benditz, A., Madl, M., Loher, M., & et al. (2016). Prospective medium-term results of multimodal pain management in patients with lumbar radiculopathy. Scientific Reports, 6(28187). https://doi.org/10.1038/srep28187

Burnham, R., Amatto, L., Smith, A., Burnham, T., & Amatto, A. (2022). An assessment of the validity and responsiveness of the Numerical Rating Scale version of the Pain Disability Quality-of-Life Questionnaire-Spine. Interventional Pain Medicine, 1(2), 100087. https://doi.org/10.1016/j.inpm.2022.100087

Cho, H. Y., Kim, E. H., & Kim, J. (2014). Effects of the CORE exercise program on pain and active range of motion in patients with chronic low back pain. Journal of Physical Therapy Science, 26(8), 1237–1240. https://doi.org/10.1589/jpts.26.1237

Chitale, N. Jr, Patil, D. S., Phansopkar, P., & Joshi, A. (2022). A review on treatment approaches for chronic low back pain via Mulligan's movement with mobilization and physical therapy. Cureus, 14(8), e28127. https://doi.org/10.7759/cureus.28127

Deckers, K., De Smedt, K., Mitchell, B., Vivian, D., Russo, M., Georgius, P., Green, M., Vieceli, J., Eldabe, S., Gulve, A., van Buyten, J. P., Smet, I., Mehta, V., Ramaswamy, S., Baranidharan, G., Sullivan, R., Gassin, R., Rathmell, J., & Cilligan, C. (2018). New therapy for refractory chronic mechanical low back pain—Restorative neurostimulation to activate the lumbar multifidus: One year results of a prospective multicenter clinical trial. Neuromodulation, 21(1), 48–55. https://doi.org/10.1111/ner.12741

Doualla, M., Aminde, J., Aminde, L. N., Lekpa, F. K., Kwedi, F. M., Yenshu, E. V., & Chichom, A. M. (2019). Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa. BMC Musculoskeletal Disorders, 20(25). https://doi.org/10.1186/s12891-019-2403-9

Ebadi, S., Ansari, N. N., Naghdi, S., Jalaie, S., & Bagheri, H. (2012). The effect of continuous ultrasound on chronic non-specific low back pain: A single-blind placebo-controlled randomized trial. BMC Musculoskeletal Disorders, 13(192). https://doi.org/10.1186/1471-2474-13-192

Ebadi, S., Henschke, N., Forogh, B., Nakhostin Ansari, N., van Tulder, M. W., Babaei-Ghazani, A., & Fallah, E. (2020). Therapeutic ultrasound for chronic low back pain. Cochrane Database of Systematic Reviews, 7(7), CD009169. https://doi.org/10.1002/14651858.CD009169.pub3

Fairbank, J. C., & Pynsent, P. B. (2000). The Oswestry Disability Index. Spine, 25(22), 2940–2952. https://doi.org/10.1097/00007632-200011150-00017

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/BF03193146

França, F. R., Burke, T. N., Hanada, E. S., & Marques, A. P. (2010). Segmental stabilization and muscular strengthening in chronic low back pain: A comparative study. Clinics, 65(10), 1013–1017. https://doi.org/10.1590/S1807-59322010001000015

Frizziero, A., Pellizzon, G., Vittadini, F., Bigliardi, D., & Costantino, C. (2021). Efficacy of core stability in non-specific chronic low back pain. Journal of Functional Morphology and Kinesiology, 6(2), 37. https://doi.org/10.3390/jfmk6020037

Fu, Y., Chiarotto, A., Enthoven, W., Skou, S. T., & Koes, B. (2023). The influence of comorbidities on outcomes for older people with back pain: BACE-D cohort study. Annals of Physical and Rehabilitation Medicine, 66(7), 101754. https://doi.org/10.1016/j.rehab.2023.101754

Fritz, J. M., & Piva, S. R. (2003). Physical impairment index: Reliability, validity, and responsiveness in patients with acute low back pain. Spine, 28(11), 1189–1194. https://doi.org/10.1097/01.BRS.0000067270.50897

Gaowgzeh, R. A. M., Chevidikunnan, M. F., BinMulayh, E. A., & Khan, F. (2020). Effect of spinal decompression therapy and core stabilization exercises in management of lumbar disc prolapse: A single blind randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation, 33(2), 225–231. https://doi.org/10.3233/BMR-171099

Gilligan, C., Volschenk, W., Russo, M., Green, M., Gilmore, C., Mehta, V., Deckers, K., De Smedt, K., Latif, U., Georgius, P., Gentile, J., Mitchell, B., Langhorst, M., Huygen, F., Baranidharan, G., Patel, V., Mironer, E., Ross, E., Carayannopoulos, A., … Eldabe, S. (2021). An implantable restorative-neurostimulator for refractory mechanical chronic low back pain: A randomized sham-controlled clinical trial. Pain, 162(10), 2486–2498. https://doi.org/10.1097/j.pain.0000000000002258

Gordon, R., & Bloxham, S. (2016). A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare, 4(2), 22. https://doi.org/10.3390/healthcare4020022

Hidalgo, B., Pitance, L., Hall, T., Detrembleur, C., & Nielens, H. (2015). Short-term effects of Mulligan mobilization with movement on pain, disability, and kinematic spinal movements in patients with non-specific low back pain: A randomized placebo-controlled trial. Journal of Manipulative and Physiological Therapeutics, 38(6), 365–374. https://doi.org/10.1016/j.jmpt.2015.06.013

Hlaing, S. S., Puntumetakul, R., Khine, E. E., & Boucaut, R. (2021). Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute non-specific low back pain: A randomized controlled trial. BMC Musculoskeletal Disorders, 22(998). https://doi.org/10.1186/s12891-021-04858-6

Huang, Y., & Ye, J. (2024). Association between hypertension and osteoporosis: A population-based cross-sectional study. BMC Musculoskeletal Disorders, 25(434). https://doi.org/10.1186/s12891-024-07553-4

Hussien, H. M., Abdel-Raoof, N. A., Kattabei, O. M., & Ahmed, H. H. (2017). Effect of Mulligan Concept lumbar SNAG on chronic non-specific low back pain. Journal of Chiropractic Medicine, 16(2), 94–102. https://doi.org/10.1016/j.jcm.2017.01.003

Kaiser, M., Brambrink, S., Benditz, A., Achenbach, L., Gehentges, M., & König, M. A. (2022). Increase in lower limb strength after multimodal pain management in patients with low back pain. Medicina, 58(7), 837. https://doi.org/10.3390/medicina58070837

Kahere, M., Hlongwa, M., & Ginindza, T. G. (2022). A scoping review on the epidemiology of chronic low back pain among adults in sub-Saharan Africa. International Journal of Environmental Research and Public Health, 19(5), 2964. https://doi.org/10.3390/ijerph19052964

Kerkhoff, A. C., Moreira, L. B., Fuchs, F. D., & Fuchs, S. C. (2012). Association between hypertension and musculoskeletal complaints: A population-based study. Journal of Hypertension, 30(11), 2112–2117. https://doi.org/10.1097/HJH.0b013e3283588268

Kuukkanen, T., Mälkiä, E., Kautiainen, H., & Pohjolainen, T. (2007). Effectiveness of a home exercise programme in low back pain: A randomized five-year follow-up study. Physiotherapy Research International, 12(4), 213–224. https://doi.org/10.1002/pri.378

Martha Cristina Melo Cruz, Maria Teresa Santeularia Verges, Carme Rius Llorens, Ignasi J. Gich Saladich, & Elena Català Puigbó. (2022). Influence of comorbidities on pain intensity in patients with chronic low back pain. Medicina Clínica (English Edition), 159(2), 73–77. https://doi.org/10.1016/j.medcle.2021.09.026

Nasir, N., Gondal, M. J., Qamar, M., & Basharat, A. (2018). Mulligan mobilization with movement can alleviate non-specific chronic low back pain; A randomized controlled trial. Saudi Journal of Sports Medicine, 18(1), 14. https://doi.org/10.4103/sjsm.sjsm_48_17

Puntumetakul, R., Areeudomwong, P., Emasithi, A., & Yamauchi, J. (2013). Effect of 10-week core stabilization exercise training and detraining on pain-related outcomes in patients with clinical lumbar instability. Patient Preference and Adherence, 7, 1189–1199. https://doi.org/10.2147/PPA.S50436

Puntumetakul, R., Saiklang, P., Tapanya, W., Chatprem, T., Kanpittaya, J., Arayawichanon, P., & Boucaut, R. (2021). The effects of core stabilization exercise with the abdominal drawing-in maneuver technique versus general strengthening exercise on lumbar segmental motion in patients with clinical lumbar instability: A randomized controlled trial with 12-month follow-up. International Journal of Environmental Research and Public Health, 18(15), 7811. https://doi.org/10.3390/ijerph18157811

Schwab, F., Mekhail, N., Patel, K. V., Deer, T., Pope, J., Falowski, S., & Kapural, L. (2025). Restorative neurostimulation therapy compared to optimal medical management: A randomized evaluation (RESTORE) for the treatment of chronic mechanical low back pain due to multifidus dysfunction. Pain Therapy, 14(401–423). https://doi.org/10.1007/s40122-024-00689-0

Sipaviciene, S., & Pilelis, V. (2024). Effects of home exercise and manual therapy or supervised exercise on non-specific chronic low back pain and disability. Applied Sciences, 14(5), 1725. https://doi.org/10.3390/app14051725

Smith, B. E., Littlewood, C., & May, S. (2014). An update of stabilisation exercises for low back pain: A systematic review with meta-analysis. BMC Musculoskeletal Disorders, 15(416). https://doi.org/10.1186/1471-2474-15-416

Smrcina, Z., Woelfel, S., & Burcal, C. (2022). A systematic review of the effectiveness of core stability exercises in patients with non-specific low back pain. International Journal of Sports Physical Therapy, 17(5), 766-774. https://doi.org/10.26603/001c.37251

Thomson, S., Chawla, R., Love-Jones, S., & Baranowski, A. (2021). Restorative neurostimulation for chronic mechanical low back pain: Results from a prospective multi-centre longitudinal cohort. Pain Therapy, 10(1451–1465). https://doi.org/10.1007/s40122-021-00307-3

Vianin, M. (2008). Psychometric properties and clinical usefulness of the Oswestry Disability Index. Journal of Chiropractic Medicine, 7(4), 161–163. https://doi.org/10.1016/j.jcm.2008.07.001




DOI: https://doi.org/10.7575/aiac.ijkss.v.13n.2p.70

Refbacks

  • There are currently no refbacks.




License URL: https://creativecommons.org/licenses/by/4.0/

2013-2025 (CC-BY) Australian International Academic Centre PTY.LTD.

International Journal of Kinesiology and Sports Science

You may require to add the 'aiac.org.au' domain to your e-mail 'safe list’ If you do not receive e-mail in your 'inbox'. Otherwise, you may check your 'Spam mail' or 'junk mail' folders.