Effects of Exercise Training on Fear-Avoidance in Pain and Pain-Free Populations: Systematic Review and Meta-analysis
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SYSTEMATIC REVIEW
Effects of Exercise Training on Fear‑Avoidance in Pain and Pain‑Free Populations: Systematic Review and Meta‑analysis Joshua Hanel1 · Patrick J. Owen1 · Steffen Held2 · Scott D. Tagliaferri1 · Clint T. Miller1 · Lars Donath2 · Daniel L. Belavy1
© Springer Nature Switzerland AG 2020
Abstract Background Fear of pain and movement is an important factor in the development of hypervigilance and avoidance behaviours. Objective We examined the effectiveness of exercise training on improving fear-avoidance beliefs. Methods A systematic review (data sources: MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL) and metaanalysis of randomised controlled/clinical trials of exercise training in adults versus relevant nonexercise comparators that quantified fear-avoidance was conducted. Results After screening 4603 identified records, 17 (2014 participants) and 13 (1152 participants) studies were eligible for qualitative and quantitative synthesis, respectively. Pairwise meta-analysis showed exercise training was more effective than all non-exercise comparators (standardised mean difference (SMD) [95% CI] − 0.378 [− 0.623, − 0.133], P = 0.002, Grading of Recommendations Assessment, Development and Evaluation [GRADE]: very low) for reducing fear-avoidance. Exercise training was more effective than true control for reducing fear avoidance (− 0.407 [− 0.750, − 0.065], P = 0.020, GRADE: very low), however it was not more effective than other interventions (− 0.243 [− 0.614, 0.128], P = 0.199, GRADE: very low). In people with low back pain, exercise training was more effective than non-exercise comparator groups for reducing fear-avoidance (− 0.530 [− 0.755, − 0.304], P 12 weeks)
Chronic low back pain (> 12 weeks)
Study
Bernard et al. (2015) [24]
Cruz Diaz et al. (2017) [33]
Cruz Diaz et al. (2018) [34]
Harts et al. (2008) [35]
65 (0)
62 (66)
98 (64)
121 (100)
N (% females)
Table 1 Characteristics of included studies (n = 17)
42
37
36
65
Mean age (years)
8 weeks
12 weeks
12 weeks
24
High-intensity training: lumbar extensor resistance training at approximately 50% of the maximal isometric Lumbar extension strength (10 sessions over 8 weeks) Low-intensity training: lumbar extensor resistance training at a maximum of 20% of the maximal isometric lumbar extension strength (10 sessions over 8 weeks)
Mat Pilates (session frequency and duration not reported) (n = 34) Equipment based Pilates with apparatus (session frequency and duration not reported) (n = 34) Mat Pilates: 2 × 50-min sessions per week) (n = 32)
Walking (3 × 40-min sessions per week)
Interven- Exercise training intervention length tions (weeks)
Yes
Yes TSK-17 (17–68 High intensity training: points) 33.0 (8.0) Low intensity training: 33.0 (8.0) Control: 37.0 (10.0)
No treatment (n = 30)
TSK-17 (17–68 Mat Pilates: 27.5 (6.8) points) Control: 32.5 (6.1)
Inclusion in metaanalysis
No treatment, received a booklet about non-specific low back pain (n = 30) Waitlist control
End intervention mean (standard deviation)
– No (post-int
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