Effectiveness, Mediators and Moderators of Remote Live vs. Pre‐Recorded Physical Exercise Training for Chronic Low Back Pain

ABSTRACT Background Remote physical exercise training offers a more accessible alternative for the management of chronic low back pain (CLBP). However, the effectiveness of various remote delivery methods for this population is unclear. Methods This study was a randomized controlled trial comparing live interactive training via videoconference to individual pre‐recorded video training sessions in patients with CLBP. Ninety‐four individuals with CLBP were randomly assigned to a waitlist or to a 12‐week general exercise program delivered by a certified kinesiologist, either through live interactive or pre‐recorded video sessions. The training intensity for the 3 weekly one‐hour sessions was adapted to each participant's fitness level. Results A total of 57 patients (average age 48.4 ± 12.5 years, 36 women) completed the study, with comparable rates of attrition in the three groups. Those performing exercise, irrespective of modality, experienced significant and clinically worthwhile (> 20%) reductions in pain intensity ratings compared to waitlist. Similarly, exercise training (vs. waitlist) decreased movement‐evoked pain. No differences were observed between both forms of training for pain intensity, perceived difficulty, effort, fatigue, satisfaction or pain evoked during the training sessions. The therapeutic effects of physical exercise training were moderated by sex, with women reporting less pain relief, and mediated by improvements in self‐perceived general health, increased levels of physical activity and greater gait speed (4‐m gait task). Conclusions Altogether, these results support that, independently of the mode of delivery (live vs. pre‐recorded), remote exercise training is an accessible alternative to effectively alleviate CLBP. Significance Statement Live and pre‐recorded remote physical exercise training were equally effective in reducing pain intensity and movement‐evoked pain. Across modalities, the clinical effects of remote exercise appeared to be mediated by increased engagement in physical activity, faster gait speed, and improvements in self‐rated general health. Together, these findings suggest that exercise training may reduce pain by improving general health–related behaviours and beliefs.