Resistance training for chronic low back pain in the elderly: A systematic review




Spine, Musculoskeletal pain, Chronic low back pain, Resistance training, Older adults


Chronic low back pain is a musculoskeletal pathology with a considerably high prevalence in the elderly. This condition increases disability and negatively affects the quality of life. Muscular resistance training is being used as a cornerstone in interventions for elder people due to the numerous benefits associated with physical and functional health. For this reason, the purpose of this study was to systematically review the literature on the main characteristics of resistance training programs in the elder population with chronic low back pain. A literature search in five databases (PubMed, Scopus, Web of Science, Sports Discuss, and Cochrane Library) was carried out. Inclusion-exclusion criteria were used to select experimental studies applying resistance training programs to aging adults older than 60 ages with chronic lumbar pain. PEDro scale was used to evaluate the quality of the included studies. From the first 223 articles retrieved, 8 were selected to be further analysed. All the studies presented good methodological quality (PEDro scale from 6 to 10) and low bias risk. In summary, resistance training programs have been proven useful to significantly reduce pain and inability. Furthermore, significant improvements in quality of life and muscular strength parameters are guaranteed.


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Aagaard, P., Suetta, C., Caserotti, P., Magnusson, S. P., & Kjaer, M. (2010). Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure. Scand J Med Sci Spor, 20(1), 49-64.

Akuthota, V., & Nadler, S. F. (2004). Core strengthening. Arch Phys Med Rehabil 85, 86-92.

Apel, J. M., Lacey, R. M., & Kell, R. T. (2011). A Comparison of Traditional and Weekly Undulating Periodized Strength Training Programs with Total Volume and Intensity Equated. J Strength Cond Res, 25(3), 694-703.

Bo Andersen, L., Wedderkopp, N., & Leboeuf-Yde, C. (2006). Association Between Back Pain and Physical Fitness in Adolescents. Spine, 31(15), 1740-1744.

Calatayud, J., Borreani, S., Martin, J., Martin, F., Flandez, J., & Colado, J. C. (2015). Core muscle activity in a series of balance exercises with different stability conditions. Gait Posture, 42(2), 186-192.

Calatayud, J., Casaña, J., Martín, F., Jakobsen, M. D., Colado, J. C., & Andersen, L. L. (2017). Progression of Core Stability Exercises Based on the Extent of Muscle Activity. Am J Phys Med Rehabil, 96 (10), 694-699.

Charette, S. L., McEvoy, L., Pyka, G., Snow-Harter, C., Guido, D., Wiswell, R. A., & Marcus, R. (1991). Muscle hypertrophy response to resistance training in older women. J Appl Physiol, 70(5), 1912-1916.

Colado, J. C., & García-Massó, X. (2009). Technique and Safety Aspects of Resistance Exercises: A Systematic Review of the Literature. Phys Sportsmed, 37(2), 104-111.

Cress, M. E., Buchner, D. M., Prohaska, T., Rimmer, J., Brown, M., Macera, C., DiPietro, L., & Chodzko-Zajko, W. (2005). Best Practices for Physical Activity Programs and Behavior Counseling in Older Adult Populations. J Aging Phys Act, 13(1), 61-74.

Domenichiello, A. F., & Ramsden, C. E. (2019). The silent epidemic of chronic pain in older adults. Prog Neuropsychopharmacol Biol Psychiatry, 93, 284-290.

Dundar, U., Solak, O., Yigit, I., Evcik, D., & Kavuncu, V. (2009). Clinical Effectiveness of Aquatic Exercise to Treat Chronic Low Back Pain. Spine, 34(14), 1436-1440.

Flicker, P. L., Fleckenstein, J. L., Ferry, K., Payne, J., Ward, C., Mayer, T., Parkey, R. W., & Peshock, R. M. (1993). Lumbar Muscle Usage in Chronic Low Back Pain. Spine, 18(5), 582-586.

Gatti, R., Faccendini, S., Tettamanti, A., Barbero, M., Balestri, A., & Calori, G. (2011). Efficacy of Trunk Balance Exercises for Individuals With Chronic Low Back Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther, 41(8), 542-552.

Goldberg, A. L., Etlinger, J. D., Goldspink, D. F., & Jablecki, C. (1975). Mechanism of work-induced hypertrophy of skeletal muscle. Med Sci Sports, 7(3), 185-198.

Graves, J. E., Webb, D. C., Pollock, M. L., Matkozich, J., Leggett, S. H., Carpenter, D. M., Foster, D. N., & Cirulli, J. (1994). Pelvic stabilization during resistance training: Its effect on the development of lumbar extension strength. Arch Phys Med Rehabil, 75(2), 210-215.

Hadjistavropoulos, T., Fitzgerald, T. D., & Marchildon, G. P. (2010). Practice Guidelines for Assessing Pain in Older Persons with Dementia Residing in Long-Term Care Facilities. Physiother Can, 62(2), 104-113.

Häkkinen, K., Kallinen, M., Izquierdo, M., Jokelainen, K., Lassila, H., Mälkiä, E., Kraemer, W. J., Newton, R. U., & Alen, M. (1998). Changes in agonist-antagonist EMG, muscle CSA, and force during strength training in middle-aged and older people. J Appl Physiol, 84(4), 1341-1349.

Hartigan, C., Rainville, J., Sobel, J. B., & Hipona, M. (2000). Long-term exercise adherence after intensive rehabilitation for chronic low back pain. Med Sci Sports Exerc, 32(3), 551-557.

Hayden, J. A., van Tulder, M. W., & Tomlinson, G. (2005). Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain. Ann Intern Med, 142(9), 776.

Hibbs, A. E., Thompson, K. G., French, D., Wrigley, A., & Spears, I. (2008). Optimizing Performance by Improving Core Stability and Core Strength. Sports Med, 38(12), 995-1008.

Hodges, P. W. (2011). Pain and motor control: From the laboratory to rehabilitation. Journal of Electromyography and Kinesiology, 21(2), 220-228.

Holmes, B., Leggett, S., Mooney, V., Nichols, J., Negri, S., & Hoeyberghs, A. (1996a). Comparison of Female Geriatric Lumbar-Extension Strength. J Electromyogr Kinesiol, 9(1), 17???22.

Irandoust, K., & Taheri, M. (2015). The effects of aquatic exercise on body composition and nonspecific low back pain in elderly males. J Phys Ther Sci, 27(2), 433-435.

Iversen, M. D., Fossel, A. H., & Katz, J. N. (2003). Enhancing function in older adults with chronic low back pain: a pilot study of endurance training. Arch Phys Med Rehabil, 84(9), 1324-1331.

Jackson, J. K., Shepherd, T. R., & Kell, R. T. (2011a). The Influence of Periodized Resistance Training on Recreationally Active Males with Chronic Nonspecific Low Back Pain. J Strength Cond Res, 25(1), 242-251.

Kargarfard, M., Dehghadani, M, M., & Ghias, R. (2013). The Effect of Aquatic Exercise Therapy on Muscle Strength and Joint's Range of Motion in Hemophilia Patients. Int J Prev Med, 4(1), 50-56.

Katz, R. T. (2001). Impairment and Disability Rating in Low Back Pain. Phys Med Rehabil Clin N Am, 12(3), 681-694.

Kell, R. T., & Asmundson, G. J. G. (2009). A Comparison of Two Forms of Periodized Exercise Rehabilitation Programs in the Management of Chronic Nonspecific Low-Back Pain. J Strength Cond Res, 23(2), 513-523.

Knutzen, K. M., Pendergrast, B. A., Lindsey, B., B., & Brilla, L. R. (2007). The effect of high resistance weight training on reported pain in older adults. J Sci Med Sport, 6(4), 455-460.

Koltyn, K. F. (2002). Exercise-Induced Hypoalgesia and Intensity of Exercise. Sports Med, 32(8), 477-487.

Koltyn, K. F., & Arbogast, R. W. (1998). Perception of pain after resistance exercise. Br J Sports Med, 32(1), 20-24.

Kraemer, W. J., Häkkinen, K., Newton, R. U., Nindl, B. C., Volek, J. S., McCormick, M., Gotshalk, L. A., Gordon, S. E., Fleck, S. J., Campbell, W. W., Putukian, M., & Evans, W. J. (1999). Effects of heavy-resistance training on hormonal response patterns in younger vs. older men. J Appl Physiol, 87(3), 982-992.

Lemmer, J. T., Martel, G. F., Hurlbut, D. E., & Hurley, B. F. (2007). Age and Sex Differentially Affect Regional Changes in One Repetition Maximum Strength. J Strength Cond Res, 21(3), 731.

Liu-Ambrose, T. Y. L., Khan, K. M., Eng, J. J., Lord, S. R., Lentle, B., & McKay, H. A. (2005). Both resistance and agility training reduce back pain and improve health-related quality of life in older women with low bone mass. Osteoporos Int, 16(11), 1321-1329.

Maher, C. (2004). Effective physical treatment for chronic low back pain. Orthop Clin North Am, 35(1), 57-64.

Malmivaara, A., Häkkinen, U., Aro, T., Heinrichs, M. L., Koskenniemi, L., Kuosma, E., Lappi, S., Paloheimo, R., Servo, C., Vaaranen, V., & Hernberg, S. (1995). The Treatment of Acute Low Back Pain - Bed Rest, Exercises, or Ordinary Activity? N Engl J Med, 332(6), 351-355.

Marcell, T. J. (2003). Review Article: Sarcopenia: Causes, Consequences, and Preventions. J Gerontol A Biol Sci Med Sci, 58(10), M911-M916.

Maul, I., Läubli, T., Oliveri, M., & Krueger, H. (2005). Long-term effects of supervised physical training in secondary prevention of low back pain. Eur Spine J, 14(6), 599-611.

Moher, D. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med, 151(4), 264.

Moritani, T., & deVries, H. A., H. A. (1979). Neural factors versus hypertrophy in the time course of muscle strength gain. Am J Phys Med Rehabil, 58(3), 115- 130.

Moseley, G. L., & Hodges, P. W. (2005). Are the Changes in Postural Control Associated With Low Back Pain Caused by Pain Interference? Clin J Pain, 21(4), 323-329.

Mutubuki, E. N., Beljon, Y., Maas, E. T., Huygen, F. J. P. M., Ostelo, R. W. J. G., van Tulder, M. W., & van Dongen, J. M. (2019). The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients. Qual Life Res, 29(1), 275-287.

Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., & King, A. C. (2007). Physical Activity and Public Health in Older Adults. Circulation, 116(9), 1094-1105.

Reid, M. C., Williams, C. S., & Gill, T. M. (2005). Back Pain and Decline in Lower Extremity Physical Function Among Community-Dwelling Older Persons. J Gerontol A Biol Sci Med Sci, 60(6), 793-797.

Schild von Spannenberg, S., Jones, G. T., & Macfarlane, G. J. (2012). The evidence base for managing older persons with low back pain. Br J Pain, 6(4), 166-169.

Shiri, R., Karppinen, J., Leino-Arjas, P., Solovieva, S., & Viikari-Juntura, E. (2009). The Association Between Obesity and Low Back Pain: A Meta-Analysis. Am J Epidemiol, 171(2), 135-154.

Simmons, V., & Hansen, P. D. (1996). Effectiveness of Water Exercise on Postural Mobility in the Well Elderly: An Experimental Study on Balance Enhancement. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 51A(5), M233-M238.

Singh, M. A. F. (2002). Exercise Comes of Age: Rationale and Recommendations for a Geriatric Exercise Prescription. J Gerontol A Biol Sci Med Sci, 57(5), M262-M282.

Smith, D., Bissell, G., Bruce-Low, S., & Wakefield, C. (2011). The effect of lumbar extension training with and without pelvic stabilization on lumbar strength and low back pain1. J Back Musculoskelet Rehabil, 24(4), 241-249.

Spennewyn, K. C. (2008). Strength Outcomes in Fixed Versus Free-Form Resistance Equipment. J Strength Cond Res 22(1), 75-81.

Standaert, C. J. (2008). Low Back Pain in the Adolescent Athlete. Phys Med Rehabil Clin N Am, 19(2), 287-304.

Taylor, J. B., Goode, A. P., George, S. Z., & Cook, C. E. (2014). Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. Spine J, 14(10), 2299-2319.

Tsui, S. L., Chen, P. P., & Ng, K. F. J. (2010). Pain Medicine: A Multidisciplinary Approach (1.a ed.). Hong Kong University Press.

Ugur, M., Derouiche, L., & Massotte, D. (2018). Heteromerization Modulates mu Opioid Receptor Functional Properties in vivo. Front Pharmacol, 9, 1240.

Urquhart, D. M., Berry, P., Wluka, A. E., Strauss, B. J., Wang, Y., Proietto, J., Jones, G., Dixon, J. B., & Cicuttini, F. M. (2011). 2011 Young Investigator Award Winner. Spine, 36(16), 1320-1325.

Vadalà, G., Russo, F., De Salvatore, S., Cortina, G., Albo, E., Papalia, R., & Denaro, V. (2020). Physical Activity for the Treatment of Chronic Low Back Pain in Elderly Patients: A Systematic Review. Clin Med, 9(4), 1023.

Verna, J. L., Mayer, J. M., Mooney, V., Pierra, E. A., Robertson, V. L., & Graves, J. E. (2002). Back Extension Endurance and Strength. Spine, 27(16), 1772-1777.

Vincent, H. K., George, S. Z., Seay, A. N., Vincent, K. R., & Hurley, R. W. (2014a). Resistance Exercise, Disability, and Pain Catastrophizing in Obese Adults with Back Pain. Med Sci Sports Exerc, 46(9), 1693-1701.

Vincent, H. K., Vincent, K. R., Seay, A. N., Conrad, B. P., Hurley, R. W., & George, S. Z. (2014b). Back Strength Predicts Walking Improvement in Obese, Older Adults with Chronic Low Back Pain. PM R, 6(5), 418-426.

World Health Organization (2016). Acción multisectorial para un envejecimiento sano basado en el ciclo de vida: proyecto de estrategia y plan de acción mundiales sobre el envejecimiento y la salud. 69.ª ASAMBLEA MUNDIAL DE LA SALUD. Punto 13.4 del orden del día provisional (p. A69/17). Ginebra: OMS. Retrieved from


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How to Cite

Fritz, N. B., Gene-Morales, J., Saez-Berlanga, A., Juesas, A., Flandez, J., & Colado, J. C. (2021). Resistance training for chronic low back pain in the elderly: A systematic review. Journal of Human Sport and Exercise, 16(3proc), S1506-S1520.

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