Effects of Strength Training in Chronic Low Back Pain Patients

October 24, 2017 updated by: Juliana Pennone, University of Sao Paulo

Effects of Strength Training Upon Biomechanical, Morphological and Inflammatory Parameters of Chronic Low Back Pain Patients

Although it is known that chronic low back pain (CLBP) have a multifactorial etiology, the investigations about it are mostly specific to each investigation area, making difficult to understand this complex condition. The purpose of the study was to investigate CLBP from a multidisciplinary approach, analyzing biomechanical, morphological and inflammatory parameters aiming to compare the influence of two strength training protocols, one of low intensity and low volume (LIT) and one of high intensity and high volume (HIT). In both experiments, pain intensity and level of functional disability were analyzed (by analogue scale of pain and Oswestry Index), Ground Reaction Forces (GRF - AMTI BP600900 - 2000 force plate), kinematics of lower limbs (Inertial Sensors by Noraxon) and electromyography of the rectus abdominis, external oblique, lumbar multifidus, medial gluteus, vastus lateralis and biceps femoris muscles (TelemyoDTS) during gait and sit-to-stand, inflammatory cytokines by Multiplex in blood samples and cross-sectional area (CSA) of the lumbar multifidus by ultrasound imaging.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

The subjects with CLBP were randomly assigned to two groups: the high intensity resistance training (HIRT) group and the low intensity resistance training (LIRT) groups.

All of the participants were informed of the purposes and procedures involved in the study and signed an informed consent form before participation. The experimental protocol was approved by the Institutional Review Board.

The intervention for both groups consisted of 12 weeks of two weekly training sessions, with at least 48 hours of interval between sessions. The HIRT performed the squat, deadlift and lunge exercises, as these exercises induce high core muscles activity. HIRT started with two weeks of low intensity exercises emphasizing the activation of core muscles (pelvic elevation with feet on the floor, "superman", static supine bridge on bosu), and the technique of the selected resistance exercises (e.g. squat, deadlift, and lunges). Participants performed 3 sets of 10 repetitions per exercise. In the third and forth weeks, participants performed the exercises from the previous weeks and also static unipedal forward flexion on bosu and dynamic unipedal forward flexion and the main exercises with a load corresponding to (50% of the 1 RM load (Brzycki, 1993).This formula is applied in a test that the subject is encouraged to perform the maximal number of repetitions possible with a predetermined load. The chosen load must allow the subject to achieve a maximum of ten repetitions, which guarantee a good RM prediction. The weight lifted and repetitions performed are applied in the equation to calculate the 1 RM estimation.

From the 5th to the 12th week, participants performed only the selected resistance exercises (squat, deadlift and lundge) with progressive higher intensities (from 12RM to 8RM). A 3-min rest interval was allowed between sets and exercises.

The LIRT group performed very low intensity and volume exercises (i.e. 1 set per exercise). Exercises started with participants lying on a firm surface, with the back supported, knees bent and feet flat on the floor. Then, participants performed the following exercises: 1) inhaling and exhaling and then isometrically contract in gluteal and abdominal muscles for 20 seconds and relax; 2) raising the head, lifting the chin and shoulders toward the chest for 20 seconds and relax; 3) raising one knee towards the chest and raising the head and shoulders likewise in the second exercise for 20s, relaxing, and changing the leg.; 4) raising both knees towards the chest in the same time that raise the head and shoulder off the floor during 20 seconds and relax.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
26

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Brazil
      • São Paulo, Brazil, 05508-030
        • Juliana Pennone

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Being ≥18 years old
  • Present low back or lumbo-sacral pain and function restriction (i.e. >15% in the Oswestry Questionnaire) for 12 weeks or longer
  • Do not present any functional anatomical-abnormalities, neuromuscular joint diseases and acute symptoms of pain
  • Recent participation in an exercise program (at least 12 weeks)
  • Pregnancy or diseases that can directly impact systemic inflammation (i.e: cancer, diabetes, hypertension)

Exclusion Criteria:

• Minimum adherence to the training protocol, defined as performing at least 75% of the training sessions.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: High intensity resistance training (HIRT)

12 weeks of two weekly training sessions, with at least 48 hours of interval between sessions. The HIRT performed the squat, deadlift and lunge exercises, as these exercises induce high core muscles activity. HIRT started with two weeks of low intensity exercises emphasizing the activation of core muscles (pelvic elevation with feet on the floor, "superman", static supine bridge on bosu), and the technique of the selected resistance exercises (e.g. squat, deadlift, and lunges). Participants performed 3 sets of 10 repetitions per exercise. In the third and forth weeks, participants performed the exercises from the previous weeks and also static unipedal forward flexion on bosu and dynamic unipedal forward flexion and the main exercises with a load corresponding to (50% of the 1 RM load (Brzycki, 1993).

From the 5th to the 12th week, participants performed only the selected resistance exercises with progressive higher intensities (from 12RM to 8RM).
Other: Resistance training
Comparison between high and low intensities trainings described in arms
Active Comparator: Low intensity resistance training (LIRT)
12 weeks of two weekly training sessions, with at least 48 hours of interval between sessions.The LIRT group performed very low intensity and volume exercises (i.e. 1 set per exercise). Exercises started with participants lying on a firm surface, with the back supported, knees bent and feet flat on the floor. Then, participants performed the following exercises: 1) inhaling and exhaling and then isometrically contract in gluteal and abdominal muscles for 20 seconds and relax; 2) raising the head, lifting the chin and shoulders toward the chest for 20 seconds and relax; 3) raising one knee towards the chest and raising the head and shoulders likewise in the second exercise for 20s, relaxing, and changing the leg.; 4) raising both knees towards the chest in the same time that raise the head and shoulder off the floor during 20 seconds and relax.
Other: Resistance training
Comparison between high and low intensities trainings described in arms

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Electromyographic activity of lower limb muscles during walking and sit-to-stand.
Time Frame: 12 weeks
Electromyographic signal (1500 Hz) will be obtained from rectus abdominis, left and right external oblique, left and right lumbar multifidus, gluteus medius of the dominant limb, biceps femoris of the dominant limb, and vastus lateralis of the dominant limb using a wireless device (TeleMyoDTS,,Noraxon,CITY, USA). The location of the electrodes followed the SENIAM project database. Before electrode placement, skin sites will be shaved and abraded to remove hair and dead skin. Bipolar active surface electrodes (Meditrace 200, Kendal, silver; recording diameter = 1 mm; inter-electrode distance = 1 cm) were used. Electromyographic signal will be filtered using a band pass fourth order Butterworth filter with cut off frequency of 20 Hz and 450Hz.EMG data will be normalized by 200ms RMS peak .
12 weeks
Kinematic data for the lower limbs during walking and sit-to-stand
Time Frame: 12 weeks
Seven inertial sensors (9DOF - Myomotion Inertial designed by Noraxon) will be placed on the pelvis and bilaterally in thigh, shank and foot. Sensors will be used to obtain three-dimensional orientation of the lower limbs in relation to pelvis and relative lower limb joints angles. Ankle dorsiflexion, knee extension and hip flexion were presented as a positive angles. Kinematic data will be sampled at 100 Hz and low-pass filtered at 6 Hz (fourth-order, zero-lag, Butterworth).
12 weeks
Kinetic data for the lower limbs during walking and sit-to-stand
Time Frame: 12 weeks
Vertical ground reaction force (GFR) data will be obtained using either one (i.e. sit-to-stand) or two (i.e walking) strain gauge force plates(AMTI BP600900 - 2000;Watertown, EUA).GFR data will be sampled at 200 Hz and low-pass filtered at 50 Hz (fourth-order, zero-lag, Butterworth), and normalized by bodyweight. Sit-to-stand GFR parameters will be: peak vertical force, time to peak vertical force, and load rate both for stand up phase and sit down phases. Selected walking kinematics parameters will be first and second vertical peak force, time to first and second vertical peaks, load rate, total impulse, maximal deflection (i.e. minimum force value between the peaks) and time to maximal deflection.
12 weeks
Inflammatory Parameters
Time Frame: 12 weeks

Blood samples (10 ml) will be obtained from the antecubital vein. After collection, the blood will be centrifuged at 3000 rpm for 15 min at 4° degrees. Plasma and serum will be storage in plastic microtubes at -80° degrees for posterior analysis of cytokines production of each participant by a qualified professional.

The Multiplex Analysis of Sample Protein Content will be performed: each 10 ml of collected blood sample will be incubated with the mixture of Megaplex microspheres and covered with the specific antibodies for 2 h. The detection of target antigens bounded to the microspheres will be performed with a mixture of biotinylated capture antibodies after incubation for 1 h followed by incubation with streptavidin labeled with phycoerithrin for 30 min. The microspheres will be then analyzed with the phycoerithrinMagpix® instrument (Life Technologies, Grand Island, NY, USA). Citokines concentration will be normalized to total protein concentration.
12 weeks
Cross sectional area of lumbar multifidus
Time Frame: 12 weeks
Lumbar multifidus ultrasound images will be obtained (transverse orientation at L4 in both sides of the spine with the subjects in prone lying position) using a B-mode ultrasound with a 7.5-MHz linear-array probe (SonoAce R3, Samsung-Medison, Gangwon-do, South Korea).The multifidus location will be determined by palpation of the spinous process of L5 and L4. L5 is deep, small and blunted bony point lying at the center of the lumbo-sacraldepression, on progression in a cranial direction is the comparatively large spinous process of L4. Ultrasound images will be obtained with SonoaceR3 equipment and their measurements in Image Jsoftware. For each subjects will be calculated the mean of CSA of the right and left sides of the lumbar multifidus.
12 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Sao Paulo

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

  • Blackburn SE, Portney LG. Electromyographic activity of back musculature during Williams' flexion exercises. Phys Ther. 1981 Jun;61(6):878-85. Bressel E1, Willardson JM, Thompson B, Fontana FE. Effect of instruction, surface stability, and load intensity on trunk muscle activity. J Electromyogr Kinesiol. 2009 Dec;19(6):e500-4. doi: 10.1016/j.jelekin.2008.10.006. Epub 2008 Dec 2. Carpes, FP, Reinehr, FB, and Mota, CB. Effects of a program for trunk strength and stability on pain, low back and pelvis kinematics, and body balance: A pilot study. J Bodyw Mov Ther 12: 22-30, 2008. Clark, D, Lambert, M, and Hunter, A. Muscle activation in the loaded free barbell squat: a brief review. J Strength Cond Res 26: 1169-1178, 2012 Escamilla, RF, Francisco, AC, Kayes, A V, Speer, KP, and Moorman III, CT. An electromyographic analysis of sumo and conventional style deadlifts. Med Sci Sport Exerc 34: 682-688, 2002. Kristensen, J and Franklyn-Miller A. Resistance training in musculoskeletal rehabilitation: a systematic review. Br J Sports Med 46: 719-726, 2012.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 6, 2017

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
May 5, 2017

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 29, 2017

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
October 1, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 24, 2017

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 31, 2017

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 31, 2017

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 24, 2017

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • Juliana Pennone

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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