I dont know about you but I love walking around the woodland especially when it’s with the other elves and the Exercise Works folk when we find ourselves chatting about the latest evidence.
It just so happens that there is a recent systematic review that examines the effects of walking interventions on pain and self-reported function in individuals with chronic musculoskeletal pain.
Here’s what they did
They searched six electronic databases (Medline, CINAHL, PsychINFO, PEDro, Sport Discus and the Cochrane Central Register of Controlled Trials) January 1980 up to March 2014 for randomized and quasi-randomized controlled trials in adults with chronic low back pain, osteoarthritis or fibromyalgia comparing walking interventions to a non-exercise or non-walking exercise control group. Methodological quality of studies was assessed using the United States Preventative Services Task Force (USPSTF) system.
Here’s what they found
Twenty-six studies (2384 participants) were included and suitable data from 17 were pooled for meta-analysis. with a random effects model used to calculate between group mean differences and 95% confidence intervals. Data were analyzed according to length of follow-up (short-term: ≤8 weeks post randomization; medium-term: >2 months – 12 months; long-term: > 12 months).
- Twenty four of the studies were randomized controlled trials and 12 provided data for OA, eight for Fybromyalgia Syndrome, five for Chronic Low Back Pain and one included participants with chronic hip, lower back or knee pain.
- For the majority of studies (19/26, 73%) walking was supervised in a hospital clinic, gymnasium or other setting.
- Some studies combined supervised walking with instructions to walk at home; and six were home-based.
- Three studies used pedometers to assist with step-based walking
- Walking exercise was associated with small to moderate improvements in pain at short (mean difference (MD) -5.31, 95% confidence interval (95% CI) -8.06 to -2.56) and medium-term follow-up (MD -7.92, 95% CI -12.37 to -3.48).
- Improvements in function were observed at short (MD -6.47, 95% CI -12.00 to -0.95), medium (MD -9.31, 95% CI -14.00 to -4.61) and long-term follow-up (MD -5.22, 95% CI 7.21 to -3.23).
The authors concluded
Evidence of fair methodological quality suggests that walking is associated with significant improvements in outcome compared to control interventions but longer-term effectiveness is uncertain.
Using the USPSTF 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.
The Musculoskeletal Elf’s view
So it appears that exercise is beneficial in improving pain symptoms and function in people with chronic musculoskeletal pain. But are there any potential harms from exercise? Eleven studies included a statement of associated adverse events. These included two falls resulting in distal radial fractures, one fall resulting in a hip fracture, one case of plantar fasciitis. Two studies including participants with fibromyalgia reported a general increase in reporting of pain and muscle stiffness.
Overall the benefits of exercise appear to outweigh the potential harms. Please watch the excellent 15 mins video about the benefits of exercise by Doc Mike Evans 23 1/2 Hrs and spread the word by sharing on facebook or twitter or with friends.
What do you think?
- Q. Do you advise people with chronic musculoskeletal pain to undertake regular exercise?
- Q. Do you share the 23 1/2 Hrs video with patients and colleagues?
- O’Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, McDonough SM, Walking Exercise for Chronic Musculoskeletal Pain: Systematic Review and Meta- Analysis, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION (2015), doi: 10.1016/ j.apmr.2014.12.003.
- United States Preventative Services Task Force (USPSTF) system.
- 23 1/2 Hrs video, Dr Mike Evans