Swimming Linked to Reduced Disability in Low Back Pain

TOPLINEA swimming and education program was associated with reduced disability and improved patient satisfaction and pain self-efficacy at 8 weeks compared with education alone among adults with chronic low back pain, a trial showed.METHODOLOGYThis two-arm, parallel-group randomized controlled trial (EduSwim) in Australia in 2024 included 76 adults (mean age, 41 years; 85% women) with current nonspecific low back pain lasting ≥ 12 weeks who experienced some disability, had a pain score of ≥ 3/10 on the numeric pain rating scale (NPRS), and could swim 25 m in water with confidence.The participants were randomly assigned to receive 8 weeks of either an individualized swimming program (four video telehealth sessions incorporating health coaching principles coupled with free pool access) and telehealth education on key messages regarding back pain (intervention group; n = 39) or telehealth education alone (control group; n = 37).The primary outcome was disability at 8 weeks, measured using the Roland-Morris Disability Questionnaire. Secondary outcomes were pain intensity (measured using the NPRS), patient-specific functional limitation (measured using the Patient-Specific Functional Scale), pain self-efficacy (measured using the Pain Self-Efficacy Questionnaire), fear of movement (measured using the Physical Activity Subscale of the Fear-Avoidance Beliefs Questionnaire), patient-perceived global improvement, and adverse events.Patients were followed for 52 weeks, and the analyses were adjusted for the duration of low back pain.TAKEAWAYThe intervention group had reduced disability compared with the control group at 8 weeks (mean difference in score, -2.5; P = .02), although the benefit was not sustained at 52 weeks.The between-group differences in pain intensity and fear of movement were not statistically significant. The intervention group showed statistically significant improvement in patient-specific function compared with the control group only at 26 weeks (mean difference in score, 0.9; P = .04).The intervention group had improved pain self-efficacy compared with the control group at 8 weeks (mean difference in score, 4.8; P = .02), and this benefit persisted at 26 weeks (mean difference in score, 6.8; P < .0001). A greater proportion of participants in the intervention group than in the control group reported being satisfied or very satisfied (95% vs 46%).A greater proportion of participants in the intervention group than in the control group reported adverse events (56% vs 30%; Fisher exact test P = .02).IN PRACTICE“Clinicians can consider a swimming program, delivered with health-coaching principles, as an effective exercise to improve disability in patients with chronic low back pain. Future research is required to explore options to help maintain adherence to swimming programs in the longer term and produce more precise estimates of the effectiveness of swimming,” the investigators of the study wrote.SOURCEThe study was led by Deborah M. Wareham, Macquarie University, Sydney, Australia. It was published online on July 21 in the British Journal of Sports Medicine.LIMITATIONSThe trial was limited by a pragmatic design, relatively small sample size, predominant inclusion of women and physically active individuals with preexisting swimming experience and water competence, decline in self-reported adherence over time, and a lack of an estimation of the relative importance of each component of the intervention.DISCLOSURESThe study was funded by the Physiotherapy Research Foundation and the Australia & New Zealand Low Back Pain Research Network. The study also received support through an Australian Government Research Training Program Scholarship. Disclosure information for the study investigators is available in the original study publication.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.