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Shnayderman, I. & Katz-Leurer, M. (2012). An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomised controlled trial. Clinical Rehabilitation, 27(3), pp. 207-214.

Chronic low back pain

Walking activity

Strength training

Randomised controlled trial

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Physiotherapy Agency Database (2019). PEDro Statistics. Retrieved from
https://www.pedro.org.au/english/downloads/pedro-statistics/.
Shnayderman, I. & Katz-Leurer, M. (2012). An aerobic walking programme versus
muscle strengthening programme for chronic low back pain: a randomised
controlled trial. Clinical Rehabilitation, 27(3), pp. 207-214.
Verhagen, A.P., de Vet, H.C., de Bie, R.A., Kessels, A.G., Boers, M., Bouter, L.M., &
Knipschild, P.G. (1998). The Deplhi list: a criteria list for quality assessment of
randomized clinical trials for conducting systematic reviews developed by
Delphi consensus. Journal of Clinical Epidemiology, 51(12), pp. 1235-1241.

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11. Point measures and measures of variability

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11. Point measures and measures of variability

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Yes, the medians were present which shows measures of variability in Table 2 (below).

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Yes, comparisons were reported post interventions between groups using baseline measurements.

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9. All subjects received the treatment or control condition or data was analysed by                              “intention to treat”  

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9. All subjects received the treatment or control condition or data was analysed by                              “intention to treat”  

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Yes, all data analysed was based on an intention to treat and all subjects received the treatment or control

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8. Outcomes from > 85% of the subjects   

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8. Outcomes from > 85% of the subjects   

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No, 9 participants withdrew. Therefore; 9/52=0.17, 1-0.17=0.83 which is < 85%.

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7. There was blinding of all assessors  

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7. There was blinding of all assessors  

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Yes, assessors were unaware of group allocation throughout the study therefore were blinded

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6. There was blinding of all therapists 

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6. There was blinding of all therapists 

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Yes, two physical therapists during pre and post treatment were blind to subject allocations.

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5. There was blinding of all subjects   

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5. There was blinding of all subjects   

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No; subjects received an explanation about the two types of intervention and had a 50% chance of being apart of the intervention group

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4. The groups were similar at baseline  

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4. The groups were similar at baseline  

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Yes, because there was no evident statistically significant baseline differences between the two groups concerning demographic or clinical parameters (p-value >0.05)

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Yes, participants' name were delivered in sealed envelopes which was revealed by an independent researcher who was not part of the assessment or intervention

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2. Subjects randomly allocated to groups 

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2. Subjects randomly allocated to groups 

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Yes, participants were randomly assigned to 2 groups - the walking or exercise group (control) by block randomisation

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Yes, criteria for this study was specified, as seen above in the inclusion and exclusion criteria.

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The study found that the number of sessions is significantly correlated with the effect of exercise on pain with additional exercise increasing the treatment effect size. Though doctors agree that lower back pain is a heterogeneous condition, thus having an exclusionary criteria may improve treatment outcomes.

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The table below demonstrates that there was an improvement from pre to post intervention in both groups in metres covered during the six minute walking test. The difference in the intervention group was greater than that of the control group, however Shnayderman and Katz-Leurer state that the difference was not significant. They failed to state p-values for the outcomes measured.

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Participants were recruited from the Department of Physiotherapy, Maccabi Healthcare Services in Lod, Israel. This study doesn't indicate if the outpatient clinic in Israel was regional, rural or in the city, the specificity of the clinic itself (specific or generic) and fails to denote the patient base information (number of patients per day, age, gender etc.)

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Single-Blinded, Longitudinal Randomised Controlled Trial

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The study investigated whether walking was a more effective exercise intervention compared to low back exercises by measuring muscle endurance and lower back pain. To establish this, the primary outcome was the six minute walking test. This was measured by subjecting participants to the walking test before commencing the intervention and six weeks after commencing the intervention. Researchers gathered this data by having participants walking as far as they could within six minutes, and calculated their mean distance covered per minute, measured in metres.

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The "exercise" (control) group were involved in full body exercises consisting of movements that helped with pain relief. It involved a 5 minute warm up, progressing into ascending weighted exercise and concluded with a 5 minute cool down period. This  routine was repeated over a six week course, twice a week, adding an extra 5 minutes every week until the fifth week. Like the intervention, the same assessment conductors were used to coordinate the programme. Specific exercise movements, weight and the number of reps and sets weren’t denoted. The study didn't specify if the 5 minute warm up and cool down was included in the exercise session for the first week.

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Participants in the “walking” group utilised a treadmill for their sessions. Walking occured twice a week, starting off with 20 minutes during the first week and gradually increasing by five minutes every week. Each walking and exercise period was supervised by two senior physical therapists (7 and 20 years of experience in musculoskeletal rehabilitation). Both indicated great expertise and training in conducting this study and weren’t informed of the allocations prior. Each training session comprised of a 5 minute self selected speed warm up, unspecified time of intense walking speed and ended with a 5 minute self selected speed cool down period. Although the study included low to moderate intensity was based on heart rate using the Karvonen formula, it didn't specify the actual speed of “intense walking”. It also didn't specify if the 5 minute warm up and cool down was included in the 20 minutes session and the length of time in between.

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Inclusion criteria:

Males and females aged between 18-65 who were suffering from chronic low back pain for at least 3 months with or without radiation to the lower limb

Exclusion criteria

Participation in physical activity which is more strenuous than slow-paced walking two times per week or more

Existing fracture or has had surgery in the spinal or lower extremity in the last 6 months

Active cardiovascular disease/unstable angina/congestive heart failure/coronary arteries bypassed in the previous 6 months

Undergoing cancer treatment

Lower back pain due to a car accident

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The study was performed in the physical therapy department of an unspecified public health organisation. Thus, future application may be difficult due to unclear specifics. Implementing an exclusionary criteria to form more homogenous groups, such as pain severity, may assist in better treatment and specific target exercises. A longer intervention than this study (6 weeks) could possibly have shown significant differences. Additionally, performing a long-term followup could result in a greater assessment of the effectiveness and benefits of different training methods.

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PEDro outlines the criteria appropriate for RCTs.  It was founded by Verhagen and colleagues at the Department of Epidemiology, University of Maastricht (Verhagen A.P et al., 1998).

For a study to be considered a "good" study, the criteria of at least 6 out of 11 is to be marked when using PEDro. In this case, the study achieved a score of 9 out of 11, presenting itself as high quality.