TY - JOUR
T1 - Effects of Exercise Training on Fear-Avoidance in Pain and Pain-Free Populations
T2 - Systematic Review and Meta-analysis
AU - Hanel, Joshua
AU - Owen, Patrick J
AU - Held, Steffen
AU - Tagliaferri, Scott D
AU - Miller, Clint T
AU - Donath, Lars
AU - Belavy, Daniel L
PY - 2020/9/18
Y1 - 2020/9/18
N2 - 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 < 0.001, GRADE: very low). For individuals with neck pain, exercise training was not more effective than non-exercise comparator groups for reducing fear-avoidance (0.061 [- 0.360, 0.482], P = 0.777, GRADE: very low).CONCLUSION: There is very low to low-quality evidence that exercise training is effective for reducing fear-avoidance, including in people with low back pain. Exercise training may be more effective than no intervention for reducing fear avoidance, but there is very low-quality evidence that non-exercise interventions are as effective as exercise for fear avoidance. Few studies with low risk of bias is a limitation.TRAIL REGISTRATION: PROSPERO Registration Number: CRD42019139678.
AB - 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 < 0.001, GRADE: very low). For individuals with neck pain, exercise training was not more effective than non-exercise comparator groups for reducing fear-avoidance (0.061 [- 0.360, 0.482], P = 0.777, GRADE: very low).CONCLUSION: There is very low to low-quality evidence that exercise training is effective for reducing fear-avoidance, including in people with low back pain. Exercise training may be more effective than no intervention for reducing fear avoidance, but there is very low-quality evidence that non-exercise interventions are as effective as exercise for fear avoidance. Few studies with low risk of bias is a limitation.TRAIL REGISTRATION: PROSPERO Registration Number: CRD42019139678.
KW - Adult
KW - Anxiety
KW - Exercise Therapy
KW - Fear
KW - Humans
KW - Low Back Pain/therapy
KW - Randomized Controlled Trials as Topic
U2 - 10.1007/s40279-020-01345-1
DO - 10.1007/s40279-020-01345-1
M3 - Journal articles
C2 - 32946074
SN - 1179-2035
VL - 50
SP - 2193
EP - 2207
JO - Sports medicine (Auckland, N.Z.)
JF - Sports medicine (Auckland, N.Z.)
IS - 12
ER -