Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain

A Randomized, Controlled Trial

20 December 2005 | Volume 143 Issue 12 | Pages 849-856

Background: Chronic low back pain is a common problem that has only modestly effective treatment options.

Objective: To determine whether yoga is more effective than conventional therapeutic exercise or a self-care book for patients with chronic low back pain.

Design: Randomized, controlled trial.

Setting: A nonprofit, integrated health care system.

Patients: 101 adults with chronic low back pain.

Intervention: 12-week sessions of yoga or conventional therapeutic exercise classes or a self-care book.

Measurements: Primary outcomes were back-related functional status (modified 24-point Roland Disability Scale) and "bothersomeness" of pain (11-point numerical scale). The primary time point was 12 weeks. Clinically significant change was considered to be 2.5 points on the functional status scale and 1.5 points on the bothersomeness scale. Secondary outcomes were days of restricted activity, general health status, and medication use.

Results: After adjustment for baseline values, back-related function in the yoga group was superior to the book and exercise groups at 12 weeks (yoga vs. book: mean difference, –3.4 [95% CI, –5.1 to – 1.6] [P < 0.001]; yoga vs. exercise: mean difference, –1.8 [CI, –3.5 to – 0.1] [P = 0.034]). No significant differences in symptom bothersomeness were found between any 2 groups at 12 weeks; at 26 weeks, the yoga group was superior to the book group with respect to this measure (mean difference, –2.2 [CI, –3.2 to – 1.2]; P < 0.001). At 26 weeks, back-related function in the yoga group was superior to the book group (mean difference, –3.6 [CI, –5.4 to – 1.8]; P < 0.001).

Limitations: Participants in this study were followed for only 26 weeks after randomization. Only 1 instructor delivered each intervention.

Conclusions: Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months.

Editors' Notes Context Yoga combines exercise with achieving a state of mental focus through breathing. In the United States, 1 million people practice yoga for low back pain. Contribution The authors recruited patients who had a recent primary care visit for low back pain and randomly assigned 101 to yoga or conventional exercise or a self-care book. Patients in the yoga and exercise groups reported good adherence at 26 weeks. Compared with self-care, symptoms were milder and function was better with yoga. The exercise group had intermediate outcomes. Symptoms improved between 12 and 26 weeks only with yoga. Implications Yoga was a more effective treatment for low back pain than a self-care book. —The Editors

 

Author and Article Information

From Group Health Cooperative and University of Washington, Seattle, Washington.

ClinicalTrials.gov identifier: NCT00056212.

Acknowledgments: The authors thank Gary Kraftsow and Robin Rothenberg for developing the yoga intervention and Robin Rothenberg for teaching the yoga classes; John Maisano, PT, for developing the exercise intervention and for teaching those classes; and John Ewing, Christel Kratohvil, Rene Talenti, and Linda Wehnes for assistance in the conduct of the study and Kristin Delaney for analytical help.

Grant Support: By the National Center for Complementary and Alternative Medicine (grant R21AT 001215) and the National Institute for Arthritis and Musculoskeletal and Skin Diseases (grant P60AR48093).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Karen J. Sherman, PhD, MPH, Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101; e-mail, Sherman.k{at}ghc.org

Current Author Addresses: Drs. Sherman, Cherkin, and Miglioretti and Ms. Erro: Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.

Dr. Deyo: University of Washington Harborview Medical Center, Box 359780, 325 Ninth Avenue, Seattle, WA 98104.

Author Contributions: Conception and design: K.J. Sherman, D.C. Cherkin, D.L. Miglioretti, R.A. Deyo.

Analysis and interpretation of the data: K.J. Sherman, D.C. Cherkin, J. Erro, D.L. Miglioretti, R.A. Deyo.

Drafting of the article: K.J. Sherman, D.C. Cherkin, D.L. Miglioretti.

Critical revision of the article for important intellectual content: K.J. Sherman, D.C. Cherkin, J. Erro, D.L. Miglioretti, R.A. Deyo.

Final approval of the article: K.J. Sherman, D.C. Cherkin, D.L. Miglioretti, R.A. Deyo.

Statistical expertise: D.L. Miglioretti.

Obtaining of funding: K.J. Sherman.

Administrative, technical, or logistic support: K.J. Sherman, J. Erro.

Collection and assembly of data: J. Erro.