Effectiveness, mediators and moderators of remote live vs. prerecorded physical exercise training for chronic low back pain

Remote physical exercise training offers a more accessible alternative for the management of chronic low back pain (CLBP). However, the effectiveness of various remote delivery methods for this population are unclear. This randomized controlled trial compared live interactive training via videoconference to individual prerecorded video training sessions in patients with CLBP. Ninety-four individuals with CLBP were randomly assigned to a waitlist or to a 12-week general exercise program delivered by a certified kinesiologist, either through live interactive or prerecorded video sessions. The training intensity for the 3 weekly one-hour sessions was adapted to each participant’s fitness level. A total of 57 patients (average age 48.4 ±12.5 years, 36 women) completed the study, with comparable rates of attrition in the three groups. Those performing exercise, irrespective of modality, experienced significant and clinically meaningful (>20%) reduction in pain intensity ratings compared to waitlist. Similarly, exercise training (vs. waitlist) decreased movement-evoked pain. No differences were observed between both forms of training for pain intensity, perceived difficulty, effort, fatigue, satisfaction or pain evoked during the training sessions. The therapeutic effects of physical exercise training were moderated by sex, with women reporting less pain relief, and mediated by pain catastrophizing and functional performance (as measured by a repeated chair stand task). Altogether, these results support remote exercise training, independent of the mode of delivery, as an accessible alternative for the administration of physical exercise training for individuals with CLBP.