Effects of multi-modal exercise on pain and brain activation in individuals with chronic low back pain:a randomized control trial

Jihua Zou
Purpose:

To assess the pain level of patients with chronic back pain by the Numeric Rating Scale (NRS) at 6 week follow up.To assess the post-treatment cognitive improvement using MoCA and Trail Making Tests.To evaluate the regulation of brain activation through fNIRS measurements during dual-task and resting paradigm.To explore the changes in health-related quality of life and LBP-related disabilty.

Methods:

This study is a prospective, two-arm, randomized controlled trial involving patients with CLBP. Seventy-four participants with CLBP will be assigned to either the intervention group or the control group. Participants in the intervention group will receive a 60-minute multi-modal exercise intervention（MEI） twice a week over six weeks. The outcomes will be assessed by pain intensity using the Numeric Rating Scale (NRS), and cognitive improvement will be assessed by Montreal Cognitive Assessment（MoCA）and the completion times of Trail Making Tests at baseline, 3-week after the start of the treatment, and immediately post-treatment (6 weeks from the beginning of the treatment). Other outcomes will be the regulation of brain activation through fNIRS measurements during the cognitive dual-task and resting paradigm, and the SF-12 questionnaire for measuring health-related quality of life, and the Oswestry Disability Index (ODI) for measuring LBP-related disability at baseline, 3-week after the start of the treatment, and immediately post-treatment .

Results:

A total of 60 patients (30 patients per group) were recruited. There was a significant difference in NRS at week 4 between the MEI group and control group (most severe NRS: −3.00 vs −1.50; adjusted mean difference −1.08, 95% CI −1.68 to −0.49; P .001). The signal in the mPFC region decreases, while the signal in the DLPFC region increases during the resting state.

Conclusion(s):

The multi-model exercise intervention will lead to a significant reduction in pain intensity and an improvement in cognitive function among those with CLBP and cognitive decline. The multi-modal training can help CLBP patients alleviate pain, thereby rationalizing brain resource allocation during additional tasks and improving brain activation.

Implications:

We strive to demonstrate that by improving physical training, we can reduce pain processing load in brain regions and improve brain activation, thus expecting to achieve an effect on cognitive function in patients with CLBP.

Funding acknowledgements:
National Health Commission multi-center collaborative horizontal research project (Grant No. DCMST-NHC-2019-AHT-01).
Keywords:
Chronic low back pain
Brain Activation
Multimodal Exercise Telerehabilitation
Primary topic:
Musculoskeletal: spine
Second topic:
Pain and pain management
Third topic:
Neurology
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Ethics approved by ZhuJiang Hospital Ethics Committee. Clinical Trial Registry of China ChiCTR2300073185;https://www.chictr.org.cn/showproj.html?proj=198413.
Provide the ethics approval number:
2023-KY-017
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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