Exercise Therapy for Chronic Low Back Pain: A Systematic Review of Evidence Relevant to General Practice

Abstract

Introduction. Chronic low back pain (CLBP) is one of the leading 
causes of disability worldwide and is among the most frequent 
reasons for consultation in general practice. Contemporary clinical 
guidelines consistently recommend exercise therapy as a first
line non-pharmacological intervention; however, uncertainty 
remains regarding the most effective exercise modalities and 
their long-term benefits. To systematically review the evidence 
regarding the effectiveness of exercise therapy for adults with 
chronic non-specific low back pain, with particular emphasis on 
outcomes relevant to primary care.
Methods. A systematic literature search was conducted in 
PubMed/MEDLINE, Scopus, Web of Science, Embase, and the 
Cochrane Library for studies published between January 2015 
and June 2026. Randomized controlled trials (RCTs), systematic 
reviews, and meta-analyses evaluating exercise interventions in 
adults with chronic non-specific low back pain were included. 
Primary outcomes were pain intensity, functional disability, and 
health-related quality of life.
Results. Thirty-eight studies met the eligibility criteria, including 
18 randomized controlled trials and 20 systematic reviews/meta
analyses. Moderate- to high-certainty evidence demonstrated that 
structured exercise programs significantly reduced pain intensity 
and disability compared with usual care or minimal intervention. 
Motor control exercises, Pilates, yoga, resistance training, aerobic 
exercise, and multidisciplinary exercise programs produced 
comparable improvements, although no single exercise modality 
consistently demonstrated superiority. Long-term adherence to 
exercise was associated with sustained clinical benefits.
Conclusions. Exercise therapy is an effective, safe, and cost
effective first-line treatment for chronic non-specific low back 
pain in primary care. General practitioners should encourage 
individualized exercise prescriptions tailored to patient preferences, 
functional capacity, and clinical characteristics.