SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Exercise Physiology
This article is part of the Research TopicExercise as a Central Pillar for Targeted Health and PerformanceView all 13 articles
Effects of exercise dose based on the ACSM recommendations on Pain and disability in non-specific low back pain patients: a systematic review and meta-analysis of randomized controlled trials
Provisionally accepted
- Rongchang People's Hospital, Chongqing, China
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Background: Low back pain (LBP) is characterized by pain or discomfort between the costal margins and the inferior gluteal folds, with or without radiation to the lower limbs. It significantly affects patients' overall health and quality of life. Purpose: This study aims to investigate the effects of exercise therapy and adherence to the American College of Sports Medicine (ACSM) guidelines on treatment outcomes in patients with LBP. Methods: The literature search, concluded on June 26, 2025, included studies that investigated the effects of exercise interventions in patients diagnosed with LBP and that provided sufficient data for calculating the Standardized Mean Difference (SMD). The primary outcome measure was the Visual Analogue Scale (VAS), and secondary outcomes included the Oswestry Disability Index (ODI) and the Roland-Morris Disability Questionnaire (RDQ/RMDQ). Results: Among 22,723 records, 36 studies (n = 2,284) were eligible for qualitative synthesis. The meta-analysis showed an overall SMD for pain of -1.28 (95% CI -1.63, -0.94). In the subgroup with high adherence to the ACSM guidelines, the pooled SMD was -1.98 (95% CI -2.58, -1.38), whereas in the low-or uncertain-adherence subgroup it was -0.72 (95% CI -1.01, -0.43). For disability, the overall SMD was -1.10 (95% CI -1.58, -0.62) on the ODI. High adherence yielded a mean difference of -1.31 (95% CI -1.81, -0.80) and low adherence yielded -0.99 (95% CI -1.71, -0.28). The overall SMD was -0.77 (95% CI -1.07, -0.47) on the RDQ; the corresponding values were -1.39 (95% CI - 2.51, -0.26) for high adherence and -0.54 (95% CI -0.76, -0.31) for low adherence. Conclusion: The results suggest that exercise interventions with high adherence to the ACSM recommendations are more effective in improving pain and disability in individuals with LBP than interventions with low or uncertain adherence to these guidelines.
Keywords: ACSM, Exercise, Meta-analysis, Non-specific low back pain, Systematic review
Received: 14 Oct 2025; Accepted: 30 Jan 2026.
Copyright: © 2026 Tan, Tan, Xie, Zeng, Xie, Wang and Wen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Huan Wang
Fei Wen
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