Effectiveness of walking versus mind-body therapies in Chronic Low Back Pain: A Systematic Review and Meta-analysis of recent Randomized Controlled Trials

Purpose: Walking and MBT are commonly recommended to relieve pain and improve function in chronic low back pain (CLBP). The purpose of this study was to conduct a systematic review and meta-analysis comparing the effectiveness of walking and MBT in CLBP management. Methods: We included randomized controlled trials comparing walking or mind body therapy (yoga, meditation, tai chi, and qigong) to any other intervention or control in adults with CLBP. Studies were identified through MEDLINE/PubMed, Cochrane library, PsycInfo, Scopus, ScienceDirect databases. The research was limited to studies published, in English and French, between January 2008 and December 2018. Two reviewers independently selected the studies, extracted the results, and assessed the Studies quality using PEDRO scale and the risk of bias of the studies with the Cochrane risk of bias tool. Thirty-one RCTs concerning the effects of walking or MBT were included in this study. Statistical analyses were performed using Review Manager Version 5.3 software under a random effects model. We used 95% CIs of the SMD to facilitate comparison of the effects of different treatments. Pain and disability outcomes were analyzed in this study. Results: Our findings showed that walking was as effective as control interventions at short-term and slightly superior at intermediate term for pain and activity limitations. In contrast, MBT, especially Yoga, were more effective than control interventions at short term for the pain and the activity limitations. The magnitude of yoga effect decreased with time; yoga was no longer superior to the control interventions for pain at 6 months follow up. We were inconclusive when comparing others MBT (tai chi, meditation, qigong) to walking due to the limited number of available trials of these MBT. Conclusion: We found that MBT, especially yoga, seem to be more effective at short term while walking seems to be more effective at intermediate term follow up. Combination of walking and MBT responds to biopsychosocial model of CLBP and might be a valuable therapy for CLBP at all terms follow up due to the combined effect of these two interventions. We recommend trials combining, and comparing walking to MBT for CLBP management.