This study aimed to compare the long-term effects of flexion- and extension-based lumbar exercises on chronic axial low back pain (LBP). This was a 1-year follow-up of a prospective, assessor-blind, randomized controlled trial. Patients with axial LBP (intensity ≥ 5/10) for > 6 months allocated to the flexion or extension exercise group. Patients underwent four sessions of a supervised treatment program and were required to perform their assigned exercises daily at home. Clinical outcomes were obtained at baseline, 1, 3, 6 months, and 1-year. A total of 56 patients (age, 54.3 years) were included, with 27 and 29 in the flexion and extension groups, respectively. Baseline pain and functional scales were similar between both groups. The mean (± standard deviation) baseline average back pain was 6.00 ± 1.00 and 5.83 ± 1.20 in the flexion and extension groups, respectively. At 1-year, the average pain was 3.78 ± 1.40 and 2.26 ± 2.62 (mean between-group difference, 1.52; 95% confidence interval 0.56–2.47; p = 0.002), favoring extension exercise. The extension group tended to have more improvements in current pain, least pain, and pain interference than the flexion group at 1-year. However, there was no group difference in worst pain and functional scales. In this controlled trial involving patients with chronic axial LBP, extension-based lumbar exercise was more effective in reducing pain than flexion-based exercises at 1-year, advocating lumbar extension movement pattern as a component for therapeutic exercise for chronic LBP.

Clinical Trial Registration No.: NCT02938689 (Registered on www.clinicaltrial.gov; first registration date was 19/10/2016).

本研究旨在比较基于屈曲和伸展的腰椎锻炼对慢性轴性腰痛 (LBP) 的长期影响。这是一项前瞻性、评估者盲法、随机对照试验的一年随访。轴性 LBP（强度 ≥ 5/10）> 6 个月的患者被分配到屈曲或伸展运动组。患者接受了四次监督治疗计划，并被要求每天在家进行指定的锻炼。临床结果是在基线、1、3、6 个月和 1 年时获得的。共有 56 名患者（年龄 54.3 岁）纳入研究，其中屈曲组 27 例，伸展组 29 例。两组之间的基线疼痛和功能量表相似。屈曲组和伸展组的平均（±标准差）基线平均背痛分别为 6.00 ± 1.00 和 5.83 ± 1.20。 1 年时，平均疼痛为 3.78 ± 1.40 和 2.26 ± 2.62（组间平均差异为 1.52；95% 置信区间 0.56–2.47； p = 0.002 ），有利于伸展运动。一年后，伸展组在当前疼痛、疼痛最少和疼痛干扰方面往往比屈曲组有更多改善。然而，最严重的疼痛和功能量表没有组间差异。在这项涉及慢性中轴腰痛患者的对照试验中，一年后基于伸展的腰椎运动比基于屈曲的运动更能有效地减轻疼痛，提倡将腰椎伸展运动模式作为慢性腰痛治疗运动的组成部分。

临床试验注册号：NCT02938689（在www.clinicaltrial.gov上注册；首次注册日期为2016年10月19日）。