General strength and conditioning versus motor control with manual therapy for improving depressive symptoms in chronic low back pain: A randomised feasibility trial

Megan Teychenne, Karen E Lamb, Luana Main, Clint Miller, Andrew Hahne, Jon Ford, Simon Rosenbaum, Daniel Belavy, Megan Teychenne, Karen E Lamb, Luana Main, Clint Miller, Andrew Hahne, Jon Ford, Simon Rosenbaum, Daniel Belavy

Abstract

Objectives: Exercise can be used as a treatment for depressive symptoms in the general population. However, little is known as to whether exercise has mental health benefits for adults experiencing chronic low back pain (CLBP). The aim of this study was to examine the feasibility of two intervention protocols commonly used in clinical practice for treating chronic low back pain, but with differing exercise dose, on depressive symptoms.

Methods: Forty men and women (mean age = 35) experiencing chronic persistent (>3 months), non-specific low back pain were recruited into a randomised clinical trial during 2015-2016. Participants were randomised to receive motor control (low-dose exercise) and manual therapy (n = 20), or general strength and conditioning training (moderate-dose exercise) (n = 20). Depressive symptoms were assessed fortnightly throughout a 6-month follow-up period using the Centre for Epidemiologic Studies Depression Scale (CES-D 10). Linear mixed models were used to examine within-group and between-group changes in depressive symptoms.

Results: Mean CES-D 10 score at baseline was 9.17 (SD = 4.32). There was evidence of a small decrease in average depressive symptoms over time (β -0.19 per fortnight, 95% CI = -0.34, -0.02). However, there was no evidence that change over time was dependent on treatment group.

Conclusions: Reduction in depressive symptoms amongst adults with CLBP occurred with both treatment methods (motor control [low-dose exercise] and manual therapy; or general strength and conditioning [moderate-dose exercise]). Further interventions including a true control group are needed to draw conclusions as to the effectiveness of each of these treatment methods on depressive symptoms amongst adults with CLBP.

Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12615001270505. Registered on 20 November 2015.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Participant recruitment flowchart.
Fig 1. Participant recruitment flowchart.
Fig 2. Observed mean CES-D 10 values…
Fig 2. Observed mean CES-D 10 values at each time point for the two groups.
Error bars show +/- 1 standard error. Legend: MCMT, Motor control and manual therapy; GSC, General strength and conditioning.

References

    1. World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization, 2017.
    1. Wang PS, Beck AL, Berglund P, McKenas DK, Pronk NP, Simon GE, et al. Effects of Major Depression on Moment-in-Time Work Performance. Am J Psychiatry. 2004;161: 1885–91. 10.1176/ajp.161.10.1885
    1. Sivertsen H, Bjorklof GH, Engedal K, Selbaek G, Helvik AS. Depression and Quality of Life in Older Persons: A Review. Dement Geriatr Cogn Disord. 2015;40: 311–39. 10.1159/000437299
    1. Dhar AK, Barton DA. Depression and the link with cardiovascular disease. Front Psychiatry. 2016;7: 33 10.3389/fpsyt.2016.00033
    1. Gorman JM. Comorbid depression and anxiety spectrum disorders. Depress Anxiety. 1996;4: 160–8. 10.1002/(SICI)1520-6394(1996)4:4<160::AID-DA2>;2-J
    1. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: A literature review. Arch Intern Med. 2003;163: 2433–45. 10.1001/archinte.163.20.2433
    1. Sullivan MJ, Reesor K, Mikail S, Fisher R. The treatment of depression in chronic low back pain: review and recommendations. Pain. 1992;50: 5–13.
    1. Pinheiro MB, Ferreira ML, Refshauge K, Ordoñana JR, Machado GC, Prado LR, et al. Symptoms of depression and risk of new episodes of low back pain: a systematic review and meta‐analysis. Arthritis Care Res. 2015;67: 1591–603.
    1. Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77: 42–51. 10.1016/j.jpsychires.2016.02.023
    1. Gordon BR, McDowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. Association of efficacy of resistance exercise training with depressive symptoms: meta-analysis and meta-regression analysis of randomized clinical trials. JAMA Psychiatry. 2018;75: 566–76. 10.1001/jamapsychiatry.2018.0572
    1. Hoffman MD, Hoffman DR. Does aerobic exercise improve pain perception and mood? A review of the evidence related to healthy and chronic pain subjects. Curr Pain Headache Rep. 2007;11: 93–7.
    1. Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE. Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. Arthritis Rheum. 2004;51: 890–8. 10.1002/art.20828
    1. Sculco AD, Paup DC, Fernhall B, Sculco MJ. Effects of aerobic exercise on low back pain patients in treatment. Spine J. 2001;1: 95–101.
    1. Focht BC, Gauvin L, Rejeski WJ. The contribution of daily experiences and acute exercise to fluctuations in daily feeling states among older, obese adults with knee osteoarthritis. J Behav Med. 2004;27: 101–21.
    1. World Confederation for Physical Therapy. Promoting International Excellence and Unity in Clinical and Academic standards for Manual/Musculoskeletal Physiotherapists 2015 [27th August 2018]. Available from: .
    1. Espí-López GV, López-Bueno L, Vicente-Herrero MT, Martinez-Arnau FM, Monzani L. Efficacy of manual therapy on anxiety and depression in patients with tension-type headache. A randomized controlled clinical trial. Int J Osteopath Med. 2016;22: 11–20.
    1. Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Booth MS, et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018;18: 866–79. 10.1016/j.spinee.2018.01.013
    1. Simson KJ, Miller CT, Ford J, Hahne A, Main L, Rantalainen T, et al. Optimising conservative management of chronic low back pain: study protocol for a randomised controlled trial. Trials. 2017;18: 184 10.1186/s13063-017-1913-8
    1. Ahn C, Heo M, Zhang S. Sample Size Calculations for Clustered and Longitudinal Outcomes in Clinical Research. New York: CRC Press; 2015.
    1. Teychenne M, Abbott G, Lamb KE, Rosenbaum S, Ball K. Is the link between movement and mental health a two-way street? Prospective associations between physical activity, sedentary behaviour and depressive symptoms among women living in socioeconomically disadvantaged neighbourhoods. Prev Med. 2017;102: 72–8. 10.1016/j.ypmed.2017.07.005
    1. Ford JJ, Thompson SL, Hahne AJ. A classification and treatment protocol for low back disorders: Part 1–specific manual therapy. Phys Ther Rev. 2011;16: 168–77.
    1. Richardson C, Jull G. Muscle control–pain control. What exercises would you prescribe? Man Ther. 1995;1: 2–10. 10.1054/math.1995.0243
    1. Ford JJ, Hahne AJ, Chan A, Surkitt LD. A classification and treatment protocol for low back disorders Part 3–Functional restoration for intervertebral disc related disorders. Phys Ther Rev. 2012;17: 55–75.
    1. Maitland G. The Maitland concept: assessment, examination and treatment by passive movement. Physical therapy of the low back Clin Phys Ther. 1987;13: 135–56.
    1. Radloff LS. The CES-D Scale: a self reported depression scale for research in the general population. Appl Psychol Meas. 1977;1: 385–401.
    1. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: Evaluation of a short form of the CES-D. Am J Prev Med. 1994;10: 77–84.
    1. Zhang Y, Alyass A, Vanniyasingam T, Sadeghirad B, Flórez ID, Pichika SC, et al. A systematic survey of the methods literature on the reporting quality and optimal methods of handling participants with missing outcome data for continuous outcomes in randomized controlled trials. J Clin Epidemiol. 2017;88: 67–80. 10.1016/j.jclinepi.2017.05.016
    1. Schuch FB, Vancampfort D, Firth J, Rosenbaum S, Ward PB, Silva ES, et al. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am J Psychiatry. 2018;175: 631–48. 10.1176/appi.ajp.2018.17111194
    1. Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45: 649–57. 10.1016/j.amepre.2013.08.001
    1. Dishman RK. Brain monoamines, exercise, and behavioral stress: animal models. Med Sci Sports Exerc. 1997;29: 63–74.
    1. Laske C, Banschbach S, Stransky E, Bosch S, Straten G, Machann J, et al. Exercise-induced normalization of decreased BDNF serum concentration in elderly women with remitted major depression. Int J Neuropsychopharmacol. 2010;13: 595–602. 10.1017/S1461145709991234
    1. Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry. 2009;65: 732–41. 10.1016/j.biopsych.2008.11.029
    1. Hallgren M, Herring MP, Owen N, Dunstan D, Ekblom Ö, Helgadottir B, et al. Exercise, Physical Activity, and Sedentary Behavior in the Treatment of Depression: Broadening the Scientific Perspectives and Clinical Opportunities. Front Psychiatry. 2016;7.
    1. Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC. Home versus center based physical activity programs in older adults. The Cochrane Library. 2005;1: CD004017.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe