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FRI0561-HPR Effect of Cognitive Behavioral Therapy and Exercise versus Supervised Exercise Program in Patients with Chronic Nonspecific Low Back Pain: A Randomized Controlled
  1. A.P. Marques,
  2. M.O. Magalhães,
  3. J. Comachio,
  4. L.H.A. Muto,
  5. A.P.M.C. Carvalho e Silva,
  6. G.P.L. Almeida,
  7. F.J.R. França,
  8. L.A.V. Ramos,
  9. T.N. Burke
  1. Fisioterapia, Fonoaudiologia, Terapia Ocupacional, Univ. de São Paulo, São Paulo, Brazil


Background Low back pain (LBP) is a major health problem that is associated with reduced functional performance and biopsychosocial factors. The practice of supervised exercise has shown positive results in reducing pain and disability, but we still have inconclusive results regarding the graded activity in patients with LBP.

Objectives Evaluate the effect of gradual activity and exercise versus supervised exercises in patients with chronic nonspecific low back pain in the outcomes pain, functional disability, Global Perceived effect and kinesiophobia.

Methods This study examined 66 patients with low back pain: Graded Activity Group (GA) n=33 mean age 47 (10.7) BMI 28.4 (3.9) kg/m2 and Supervised Exercise Group (SE) n=33 mean age 47 (8.6), BMI 26.7 (4.2) kg/m2. The interventions were individualized, one hour per session, for six weeks and often twice a week. Patients in the GA was based in the protocol described by Macedo (1), which are based on individualized, progressive and sub-maximal exercises aiming to improve physical fitness and stimulate changes in behavioral and attitudes due to pain. The Supervised Exercised group was based in the protocol described by França (3) using stretching, strengthening and motor control exercises. Intergroup statistical analysis was performed using the t test and Mann- Whitney for data with normal and without normal distribution respectively. α=0.05.

Results Patients improved outcome for pain intensity (mean difference -0.3 points and 95% CI -1.62 to 1.02) and for functional disability (mean difference -1.5 and both IC 95% -4.32 to 1.32). No statistically significant difference for all outcome variables was observed.

Table 1.

Difference between groups after six weeks of intervention

Conclusions No statistically significant difference between groups, so both treatments have benefits for patients with LBP.


  1. Macedo LG, Latimer J, Maher CG, Hodges PW, Nicholas M, Tonkin L, et al. Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial. BMC Musculoskelet Disord 2008;9:65.

  2. França FR, Burke TN, Caffaro RR, Ramos LA, Marques AP. Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial. J Manipulative Physiol Ther 2012 May;35(4):279-85.

Acknowledgements FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.3670

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