Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis

Chloé Quentin, Reza Bagheri, Ukadike C Ugbolue, Emmanuel Coudeyre, Carole Pélissier, Alexis Descatha, Thibault Menini, Jean-Baptiste Bouillon-Minois, Frédéric Dutheil, Chloé Quentin, Reza Bagheri, Ukadike C Ugbolue, Emmanuel Coudeyre, Carole Pélissier, Alexis Descatha, Thibault Menini, Jean-Baptiste Bouillon-Minois, Frédéric Dutheil

Abstract

Background: Exercise therapy is recommended to treat non-specific low back pain (LBP). Home-based exercises are promising way to mitigate the lack of availability of exercise centers. In this paper, we conducted a systemic review and meta-analysis on the effects of home-based exercise on pain and functional limitation in LBP.

Method: PubMed, Cochrane, Embase and ScienceDirect were searched until April 20th, 2021. In order to be selected, studies needed to report the pain and functional limitation of patients before and after home-based exercise or after exercise both in a center and at-home. Random-effect meta-analyses and meta-regressions were conducted.

Results: We included 33 studies and 9588 patients. We found that pain intensity decreased in the exclusive home exercise group (Effect size = -0.89. 95% CI -0.99 to -0.80) and in the group which conducted exercise both at-home and at another setting (-0.73. -0.86 to -0.59). Similarly, functional limitation also decreased in both groups (-0.75. -0.91 to -0.60, and -0.70, -0.92 to -0.48, respectively). Relaxation and postural exercise seemed to be ineffective in decreasing pain intensity, whereas trunk, pelvic or leg stretching decreased pain intensity. Yoga improved functional limitation. Supervised training was the most effective method to improve pain intensity. Insufficient data precluded robust conclusions around the duration and frequency of the sessions and program.

Conclusion: Home-based exercise training improved pain intensity and functional limitation parameters in LBP.

Keywords: lumbalgia; musculoskeletal disorders; physical activity; prevention; public health.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Meta-analysis on the effect of home-based exercise on functional limitation, stratified by setting (exclusive home-based training versus home-based and other setting).
Figure A2
Figure A2
Summary of meta-analysis on the effect of home-based exercise on pain intensity and functional limitation, stratified by setting (exclusive home-based training versus home-based and other settings), supervision, and standardization of training), using only the median time of follow-up.
Figure A3
Figure A3
Metaregressions (i.e., putative influencing variables on pain intensity and functional limitation following home-based exercise in LBP), using only the median time of follow-up.
Figure A4
Figure A4
Summary of meta-analysis on the effect of home-based exercise on pain intensity and functional limitation, stratified by setting (exclusive home-based training versus home-based and other settings, supervision, and standardization of training), using only the last time of follow-up.
Figure A5
Figure A5
Metaregressions (i.e., putative influencing variables on pain intensity and functional limitation following home-based exercise in LBP), using only the last time of follow-up.
Figure A6
Figure A6
Funnel plot (meta-funnel) for effect size of home-based exercise on pain intensity and functional limitation, in low back pain. Each dot represents a single study, with its corresponding effect size (x-axis) and its associated standard error of the effect estimate (y-axis). Large high-powered studies are placed towards the top, and smaller low-powered studies towards the bottom. The plot should ideally resemble a pyramid or inverted funnel, with scatter due to sampling variation. Studies outside the funnel plot are likely to present bias.
Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Summary of methodological qualities of included studies using the SIGN checklist.
Figure 3
Figure 3
Summary of meta-analysis on the effect of home-based exercise on pain intensity and functional limitation, stratified by setting (exclusive home-based training versus home-based and other setting), supervision, and standardization of training.
Figure 4
Figure 4
Meta-analysis on the effect of home-based exercise on pain intensity, stratified by setting (exclusive home-based training versus home-based and other setting).
Figure 5
Figure 5
Metaregressions i.e., putative influencing variables on pain intensity and functional limitation following home-based exercise in LBP.

References

    1. Hoy D., Brooks P., Blyth F., Buchbinder R. The Epidemiology of low back pain. Best Pract. Res. Clin. Rheumatol. 2010;24:769–781. doi: 10.1016/j.berh.2010.10.002.
    1. Airaksinen O., Brox J.I., Cedraschi C., Hildebrandt J., Klaber-Moffett J., Kovacs F., Mannion A.F., Reis S., Staal B., Ursin H., et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur. Spine J. 2006;15:s192–s300. doi: 10.1007/s00586-006-1072-1.
    1. Searle A., Spink M., Ho A., Chuter V. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clin. Rehabil. 2015;29:1155–1167. doi: 10.1177/0269215515570379.
    1. Hayden J.A., Wilson M.N., Riley R.D., Iles R., Pincus T., Ogilvie R. Individual recovery expectations and prognosis of outcomes in non-specific low back pain: Prognostic factor review. Cochrane Database Syst. Rev. 2019 doi: 10.1002/14651858.CD011284.pub2.
    1. Kanas M., Faria R.S., Salles L.G., Sorpreso I.C.E., Martins D., Da Cunha R.A., Wajchenberg M. Home-based exercise therapy for treating non-specific chronic low back pain. Rev. Assoc. Médica Bras. 2018;64:824–831. doi: 10.1590/1806-9282.64.09.824.
    1. Balagué F., Mannion A.F., Pellise F., Cedraschi C. Non-specific low back pain. Lancet. 2012;379:482–491. doi: 10.1016/S0140-6736(11)60610-7.
    1. Opdenacker J., Delecluse C., Boen F. A 2-Year Follow-Up of a Lifestyle Physical Activity Versus a Structured Exercise Intervention in Older Adults. J. Am. Geriatr. Soc. 2011;59:1602–1611. doi: 10.1111/j.1532-5415.2011.03551.x.
    1. Chiarotto A., Boers M., Deyo R.A., Buchbinder R., Corbin T.P., Costa L.O., Foster N.E., Grotle M., Koes B.W., Kovacs F.M., et al. Core outcome measurement instruments for clinical trials in nonspecific low back pain. Pain. 2017;159:481–495. doi: 10.1097/j.pain.0000000000001117.
    1. Bombardier C. Outcome Assessments in the Evaluation of Treatment of Spinal Disorders. Spine. 2000;25:3100–3103. doi: 10.1097/00007632-200012150-00003.
    1. Ostelo R.W.J.G., Deyo R.A., Stratford P., Waddell G., Croft P., Von Korff M., Bouter L.M., Henrica C. Interpreting change scores for pain and functional status in low back pain: Towards international consensus regarding minimal important change. Spine. 2008;33:90–94. doi: 10.1097/BRS.0b013e31815e3a10.
    1. Owen P.J., Miller C.T., Mundell N.L., Verswijveren S.J.J.M., Tagliaferri S.D., Brisby H., Bowe S.J., Belavy D.L. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br. J. Sports Med. 2019;54:1279–1287. doi: 10.1136/bjsports-2019-100886.
    1. Harbour R., Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323:334–336. doi: 10.1136/bmj.323.7308.334.
    1. D’Azy C.B., Pereira B., Chiambaretta F., Dutheil F. Oxidative and Anti-Oxidative Stress Markers in Chronic Glaucoma: A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0166915. doi: 10.1371/journal.pone.0166915.
    1. Lanhers C., Pereira B., Naughton G., Trousselard M., Lesage F.-X., Dutheil F. Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis. Sports Med. 2016;47:163–173. doi: 10.1007/s40279-016-0571-4.
    1. Courtin R., Pereira B., Naughton G., Chamoux A., Chiambaretta F., Lanhers C., Dutheil F. Prevalence of dry eye disease in visual display terminal workers: A systematic review and meta-analysis. BMJ Open. 2016;6:e009675. doi: 10.1136/bmjopen-2015-009675.
    1. D’Azy C.B., Pereira B., Naughton G., Chiambaretta F., Dutheil F. Antibioprophylaxis in Prevention of Endophthalmitis in Intravitreal Injection: A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0156431. doi: 10.1371/journal.pone.0156431.
    1. Lanhers C., Pereira B., Naughton G., Trousselard M., Lesage F.-X., Dutheil F. Creatine Supplementation and Lower Limb Strength Performance: A Systematic Review and Meta-Analyses. Sports Med. 2015;45:1285–1294. doi: 10.1007/s40279-015-0337-4.
    1. Tricco A.C., Lillie E., Zarin W., O’Brien K., Colquhoun H., Kastner M., Levac D., Ng C., Sharpe J.P., Wilson K., et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med. Res. Methodol. 2016;16:1–10. doi: 10.1186/s12874-016-0116-4.
    1. Alp A., Mengi G., Avsaroglu A.H., Mert M., Sigirli D. Efficacy of Core-Stabilization Exercise and Its Comparison with Home-Based Conventional Exercise in Low Back Pain Patients. Bursa Uludag Univ. Res. Inf. Syst. 2014 doi: 10.5152/tftrd.2014.26817.
    1. Frih Z.B.S., Fendri Y., Jellad A., Boudoukhane S., Rejeb N. Efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain: A randomized, controlled study. Ann. Phys. Rehabil. Med. 2009;52:485–496. doi: 10.1016/j.rehab.2009.04.002.
    1. Bertozzi L., Villafañe J.H., Capra F., Reci M., Pillastrini P. Effect of an Exercise Programme for the Prevention of Back and Neck Pain in Poultry Slaughterhouse Workers. Occup. Ther. Int. 2014;22:36–42. doi: 10.1002/oti.1382.
    1. Bronfort G., Maiers M.J., Evans R.L., Schulz C., Bracha Y., Svendsen K.H., Grimm R.H., Owens E.F., Garvey T.A., Transfeldt E.E. Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: A randomized clinical trial. Spine J. 2011;11:585–598. doi: 10.1016/j.spinee.2011.01.036.
    1. Buttagat V., Techakhot P., Wiriya W., Mueller M., Areeudomwong P. Effectiveness of traditional Thai self-massage combined with stretching exercises for the treatment of patients with chronic non-specific low back pain: A single-blinded randomized controlled trial. J. Bodyw. Mov. Ther. 2020;24:19–24. doi: 10.1016/j.jbmt.2019.03.017.
    1. Chhabra H.S., Sharma S., Verma S. Smartphone app in self-management of chronic low back pain: A randomized controlled trial. Eur. Spine J. 2018;27:2862–2874. doi: 10.1007/s00586-018-5788-5.
    1. Chaléat-Valayer E., Denis A., Abelin-Genevois K., Zelmar A., Siani-Trebern F., Touzet S., Bergeret A., Colin C., Fassier J.B. Long-term effectiveness of an educational and physical intervention for preventing low-back pain recurrence: A randomized controlled trial. Scand. J. Work Environ. Health. 2016;42:510–519. doi: 10.5271/sjweh.3597.
    1. Descarreaux M., Normand M.C., Laurencelle L., Dugas C. Evaluation of a specific home exercise program for low back pain. J. Manip. Physiol. Ther. 2002;25:497–503. doi: 10.1067/mmt.2002.127078.
    1. Ewert T., Limm H., Wessels T., Rackwitz B., Von Garnier K., Freumuth R., Stucki G. The Comparative Effectiveness of a Multimodal Program Versus Exercise Alone for the Secondary Prevention of Chronic Low Back Pain and Disability. PM&R. 2009;1:798–808. doi: 10.1016/j.pmrj.2009.07.006.
    1. Frost H., Lamb S., Moffett K.A.J., Fairbank T.J., Moser S.J. A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial. Pain. 1998;75:273–279. doi: 10.1016/S0304-3959(98)00005-0.
    1. Garcia A.N., Costa L.D.C.M., da Silva T.M., Gondo F.L.B., Cyrillo F.N., Costa R.A., Costa L. Effectiveness of Back School Versus McKenzie Exercises in Patients with Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. Phys. Ther. 2013;93:729–747. doi: 10.2522/ptj.20120414.
    1. Goode A.P., Taylor S.S., Hastings S.N., Stanwyck C., Coffman C.J., Allen K.D. Effects of a Home-Based Telephone-Supported Physical Activity Program for Older Adult Veterans with Chronic Low Back Pain. Phys. Ther. 2018;98:369–380. doi: 10.1093/ptj/pzy026.
    1. Groessl E.J., Liu L., Chang D.G., Wetherell J.L., Bormann J.E., Atkinson J.H., Baxi S., Schmalzl L. Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial. Am. J. Prev. Med. 2017;53:599–608. doi: 10.1016/j.amepre.2017.05.019.
    1. Haufe S., Wiechmann K., Stein L., Kück M., Smith A., Meineke S., Zirkelbach Y., Duarte S.R., Drupp M., Tegtbur U. Low-dose, non-supervised, health insurance initiated exercise for the treatment and prevention of chronic low back pain in employees. Results from a randomized controlled trial. PLoS ONE. 2017;12:e0178585. doi: 10.1371/journal.pone.0178585.
    1. Ibrahim A.A., Akindele M.O., Ganiyu S.O. Motor control exercise and patient education program for low resource rural community dwelling adults with chronic low back pain: A pilot randomized clinical trial. J. Exerc. Rehabil. 2018;14:851–863. doi: 10.12965/jer.1836348.174.
    1. Iversen V.M., Vasseljen O., Mork P.J., Berthelsen I.R., Børke J.-B.B., Berheussen G.F., Tveter A.T., Salvesen Ø., Fimland M.S. Resistance training in addition to multidisciplinary rehabilitation for patients with chronic pain in the low back: Study protocol. Contemp. Clin. Trials Commun. 2017;6:115–121. doi: 10.1016/j.conctc.2017.04.001.
    1. Kendall K.D., Emery C.A., Wiley J.P., Ferber R. The effect of the addition of hip strengthening exercises to a lumbopelvic exercise programme for the treatment of non-specific low back pain: A randomized controlled trial. J. Sci. Med. Sport. 2015;18:626–631. doi: 10.1016/j.jsams.2014.11.006.
    1. Doğan K., Tur B.S., Kurtaiş Y., Atay M.B. Comparison of three different approaches in the treatment of chronic low back pain. Clin. Rheumatol. 2008;27:873–881. doi: 10.1007/s10067-007-0815-7.
    1. Kuukkanen T., Mälkiä E., Kautiainen H., Pohjolainen T. Effectiveness of a home exercise programme in low back pain: A randomized five-year follow-up study. Physiother. Res. Int. J. Res. Clin. Phys. Ther. 2007;12:213–224. doi: 10.1002/pri.378.
    1. Kuukkanen T.M., Mälkiä E.A. An experimental controlled study on postural sway and therapeutic exercise in subjects with low back pain. Clin. Rehabil. 2000;14:192–202. doi: 10.1191/026921500667300454.
    1. Miller J., Stanley I., Moore K. Videotaped exercise instruction: A randomised controlled trial in musculoskeletal physiotherapy. Physiother. Theory Pract. 2004;20:145–154. doi: 10.1080/09593980490487375.
    1. Neyaz O., Sumila L., Nanda S., Wadhwa S. Effectiveness of Hatha Yoga Versus Conventional Therapeutic Exercises for Chronic Nonspecific Low-Back Pain. J. Altern. Complement. Med. 2019;25:938–945. doi: 10.1089/acm.2019.0140.
    1. Shirado O., Doi T., Akai M., Hoshino Y., Fujino K., Hayashi K., Marui E., Iwaya T. Multicenter Randomized Controlled Trial to Evaluate the Effect of Home-Based Exercise on Patients with Chronic Low Back Pain. Spine. 2010;35:E811–E819. doi: 10.1097/BRS.0b013e3181d7a4d2.
    1. Schulz C., Evans R., Maiers M., Schulz K., Leininger B., Bronfort G. Spinal manipulative therapy and exercise for older adults with chronic low back pain: A randomized clinical trial. Chiropr. Man Ther. 2019;27:1–14. doi: 10.1186/s12998-019-0243-1.
    1. Sakuma Y., Sasaki-Otomaru A., Ishida S., Kanoya Y., Arakawa C., Mochizuki Y., Seiishi Y., Sato C. Effect of a Home-Based Simple Yoga Program in Child-Care Workers: A Randomized Controlled Trial. J. Altern. Complement. Med. 2012;18:769–776. doi: 10.1089/acm.2011.0080.
    1. Tottoli C.R., van Tulder M., da Silva E.N., Marques Y.A., Martins W.R., Carregaro R.L. Effectiveness and cost-effectiveness of Pilates versus home-based exercises in individuals with chronic non-specific low back pain: Randomised controlled trial protocol. Eur. J. Physiother. 2019;23:95–101. doi: 10.1080/21679169.2019.1645883.
    1. Wajswelner H., Metcalf B., Bennell K. Clinical Pilates versus General Exercise for Chronic Low Back Pain. Med. Sci. Sports Exerc. 2012;44:1197–1205. doi: 10.1249/MSS.0b013e318248f665.
    1. Winter S. Effectiveness of targeted home-based hip exercises in individuals with non-specific chronic or recurrent low back pain with reduced hip mobility: A randomised trial. J. Back Musculoskelet. Rehabil. 2015;28:811–825. doi: 10.3233/BMR-150589.
    1. Bronfort G., Hondras M.A., Schulz C., Evans R.L., Long C.R., Grimm R. Spinal Manipulation and Home Exercise with Advice for Subacute and Chronic Back-Related Leg Pain. Ann. Intern. Med. 2014;161:381–391. doi: 10.7326/M14-0006.
    1. Michalsen A., Kunz N., Jeitler M., Brunnhuber S., Meier L., Lüdtke R., Büssing A., Kessler C. Effectiveness of focused meditation for patients with chronic low back pain—A randomized controlled clinical trial. Complement. Ther. Med. 2016;26:79–84. doi: 10.1016/j.ctim.2016.03.010.
    1. Zadro J., Shirley D., Simic M., Mousavi S.J., Ceprnja D., Maka K., Sung J., Ferreira P. Video-Game–Based Exercises for Older People with Chronic Low Back Pain: A Randomized Controlledtable Trial (GAMEBACK) Phys. Ther. 2018;99:14–27. doi: 10.1093/ptj/pzy112.
    1. Saper R.B., LeMaster C., Delitto A., Sherman K.J., Herman P.M., Sadikova E., Stevans J., Keosaian J.E., Cerrada C.J., Femia A.L., et al. Yoga, Physical Therapy, or Education for Chronic Low Back Pain. Ann. Intern. Med. 2017;167:85–94. doi: 10.7326/M16-2579.
    1. Bernardelli G., Vigna L., Nava C., Colonna V.D.G., Andersen L.L., Consonni D., Riboldi L. Physical Activity in Healthcare Workers with Low Back Pain. J. Occup. Environ. Med. 2020;62:e245–e249. doi: 10.1097/JOM.0000000000001844.
    1. Anwer S., Alghadir A., Brismée J.-M. Effect of Home Exercise Program in Patients with Knee Osteoarthritis. J. Geriatr. Phys. Ther. 2016;39:38–48. doi: 10.1519/JPT.0000000000000045.
    1. Hayden J.A., van Tulder M., Tomlinson G. Systematic Review: Strategies for Using Exercise Therapy to Improve Outcomes in Chronic Low Back Pain. Ann. Intern. Med. 2005;142:776–785. doi: 10.7326/0003-4819-142-9-200505030-00014.
    1. DeBusk R.F., Stenestrand U., Sheehan M., Haskell W.L. Training Effects of Long Versus Short Bouts of Exercise in Healthy Subjects. Am. J. Cardiol. 1990;65:1010–1013. doi: 10.1016/0002-9149(90)91005-Q.
    1. Kim H., Reece J., Kang M. Effects of Accumulated Short Bouts of Exercise on Weight and Obesity Indices in Adults: A Meta-Analysis. Am. J. Health Promot. 2020;34:96–104. doi: 10.1177/0890117119872863.
    1. Sukhato K., Lotrakul M., Dellow A., Ittasakul P., Thakkinstian A., Anothaisintawee T. Efficacy of home-based non-pharmacological interventions for treating depression: A systematic review and network meta-analysis of randomised controlled trials. BMJ Open. 2017;7:e014499. doi: 10.1136/bmjopen-2016-014499.
    1. Flynn A. Home-based prescribed exercise improves balance-related activities in people with Parkinson’s disease and has ben-efits similar to centre-based exercise: A systematic review. J. Physiother. 2019;65:189–199. doi: 10.1016/j.jphys.2019.08.003.
    1. Wuytack F., Devane D., Stovold E., McDonnell M., Casey M., McDonnell T.J., Gillespie P., Raymakers A., Lacasse Y., McCarthy B. Comparison of outpatient and home-based exercise training programmes for COPD: A systematic review and meta-analysis. Respirology. 2017;23:272–283. doi: 10.1111/resp.13224.
    1. Anderson L., Thompson D., Oldridge N., Zwisler A.-D., Rees K., Martin N., Taylor R.S. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst. Rev. 2016;1:CD001800. doi: 10.1002/14651858.cd001800.pub3.
    1. Van Middelkoop M., Rubinstein S.M., Verhagen A.P., Ostelo R., Koes B., van Tulder M.W. Exercise therapy for chronic nonspecific low-back pain. Best Pract. Res. Clin. Rheumatol. 2010;24:193–204. doi: 10.1016/j.berh.2010.01.002.
    1. Karlsson M., Bergenheim A., Larsson M.E.H., Nordeman L., Van Tulder M., Bernhardsson S. Effects of exercise therapy in patients with acute low back pain: A systematic review of systematic reviews. Syst. Rev. 2020;9:1–25. doi: 10.1186/s13643-020-01412-8.
    1. Saner J., Bergman E.M., de Bie R.A., Sieben J.M. Low back pain patients’ perspectives on long-term adherence to home-based exercise programmes in physiotherapy. Musculoskelet. Sci. Pract. 2018;38:77–82. doi: 10.1016/j.msksp.2018.09.002.
    1. Lacroix A., Hortobágyi T., Beurskens R., Granacher U. Effects of Supervised vs. Unsupervised Training Programs on Balance and Muscle Strength in Older Adults: A Systematic Review and Meta-Analysis. Sports Med. 2017;47:2341–2361. doi: 10.1007/s40279-017-0747-6.
    1. Ferreira M.L., Smeets R.J., Kamper S.J., Ferreira P.H., Machado L.A. Can we explain heterogeneity among randomized clinical trials of exercise for chronic back pain? A meta-regression analysis of randomized controlled trials. Phys. Ther. 2010;90:1383–1403. doi: 10.2522/ptj.20090332.
    1. Alschuler K.N., Hoodin F., Murphy S.L., Rice J., Geisser M.E. Factors contributing to physical activity in a chronic low back pain clinical sample: A comprehensive analysis using continuous ambulatory monitoring. Pain. 2011;152:2521–2527. doi: 10.1016/j.pain.2011.07.017.
    1. Mura G. Active exergames to improve cognitive functioning in neurological disabilities: A systematic review and meta-analysis. Eur. J. Phys. Rehabil. Med. 2018;54:13. doi: 10.23736/S1973-9087.17.04680-9.
    1. Brownson R.C., Baker E.A., Housemann R.A., Brennan L.K., Bacak S.J. Environmental and Policy Determinants of Physical Activity in the United States. Am. J. Public Health. 2001;91:1995–2003. doi: 10.2105/AJPH.91.12.1995.
    1. Medina-Mirapeix F., Escolar-Reina P., Gascón-Cánovas J.J., Montilla-Herrador J., Jimeno-Serrano F.J., Collins S.M. Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: An observational study. BMC Musculoskelet. Disord. 2009;10:155. doi: 10.1186/1471-2474-10-155.
    1. Murphy M.H., Lahart I., Carlin A., Murtagh E. The Effects of Continuous Compared to Accumulated Exercise on Health: A Meta-Analytic Review. Sports Med. 2019;49:1585–1607. doi: 10.1007/s40279-019-01145-2.
    1. Bener A., El-Rufaie O.F., Siyam A., Abuzeid M.S.O., Toth F., Lovasz G. Epidemiology of low back pain in the United Arab Emirates. APLAR J. Rheumatol. 2004;7:189–195. doi: 10.1111/j.1479-8077.2004.00093.x.
    1. Byberg L. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. BMJ. 2009 doi: 10.1136/bmj.b688.
    1. Dutheil F., Comptour A., Morlon R., Mermillod M., Pereira B., Baker J.S., Charkhabi M., Clinchamps M., Bourdel N. Autism spectrum disorder and air pollution: A systematic review and meta-analysis. Environ. Pollut. 2021;278:116856. doi: 10.1016/j.envpol.2021.116856.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi