The effect of exercise on adrenocortical responsiveness of patients with chronic low back pain, controlled for psychological strain.

OBJECTIVE: To investigate the effects of high-intensity aerobic exercise on adrenocortical responsiveness and on standard outcome measures in patients with chronic low back pain. DESIGN: Controlled clinical trial. SETTING: Physical therapy department of a university general hospital. SUBJECTS: Sixty-four patients with chronic low back pain were randomly allocated into positive and negative suppression test groups and assigned to exercise protocol. INTERVENTIONS: Subjects in the positive and negative dexamethasone suppression test groups received a 12-week high-intensity aerobic exercise programme. MAIN OUTCOME MEASURES: Dexamethasone suppression test as an index of adrenocortical responsiveness, pain measured with the McGill Pain Questionnaire, functional status measured with the Roland Morris Disability Questionnaire, and psychological strain measured with the Hospital Anxiety and Depression Scale. RESULTS: Data analysis in the positive group identified a significant reduction of pain by 30% (t(30) = 11.2, P<0.001), a recovery of the lost functioning by 34% (t(30) = 19.7, P<0.001), a reduction of anxiety/depression by 25% (t(30) = 10.2, P<0.001), and a change in adrenocortical responsiveness by 40% (t(30) = 14.1, P<0.001). In the dexamethasone suppression test negative group, data analysis identified a significant reduction of pain by 8% (t(31) = 4.2, P<0.001), a recovery of lost functioning by 10% (t(31) = 4.8, P<0.001), a reduction of anxiety/depression by 11% (t(31) = 5.0, P<0.001), and no change in adrenocortical responsiveness (t(31) = 1.2, P=0.22). In univariate analysis between-subject differences were significant for dexamethasone suppression test (F(61) = 163, P<0.001), and for anxiety/depression (F(61) = 21.3, P<0.001). CONCLUSION: Exercise alleviated pain, functional disability and anxiety/depression, also improved adrenocortical responsiveness in patients with chronic low back pain with dexamethasone suppression test positive values.

Assessing disability in patients with rheumatic diseases: translation, reliability and validity testing of a Greek version of the Stanford Health Assessment Questionnaire (HAQ).

The purpose of this study was to translate into the Greek language the HAQ, validate its psychometric, and also, to assess the degree to which questions in the scale did address common themes, using exploratory factor analysis. HAQ has been translated into Greek (HAQ-GrV), applied to 53 patients with rheumatic pathology and validated as follows: Cronbach's alpha for the estimation of the internal consistency, and the assessment of test-retest reliability, Spearman's rho for the assessment of concurrent validity, and confirmatory factor analysis. The results showed the following: (a) The HAQ-GrV demonstrated very good internal consistency (alpha: 0.90), (b) test-retest scores produced no significant difference (P = 0.07). Spearman's rho ranged from 0.64 to 0.90 for each item. (c) Spearman's rho between HAQ-GrV and HADS was 0.31 (P < 0.05). (d) Factor analysis identified five factors with Eigen values ranging from 1.26 to 6.98, explaining totally 69.4% of the variance.

A pilot study of the effects of high-intensity aerobic exercise versus passive interventions on pain, disability, psychological strain, and serum cortisol concentrations in people with chronic low back pain.

BACKGROUND AND PURPOSE: Given the complex nature of chronic pain, the effects of high-intensity aerobic exercise on pain, disability, psychological strain, and serum cortisol concentrations in people with chronic low back pain were investigated. SUBJECTS: Twenty subjects receiving primary health care were randomly allocated into exercise and control groups. METHODS: Subjects in the exercise group received a 12-week, high-intensity aerobic exercise program. Subjects in the control group received 12 weeks of passive modalities without any form of physical activity. RESULTS: Data analysis identified reductions in pain (41%, t(10)=8.51, P<.001), disability (31%, t(10)=7.32, P<.001), and psychological strain (35%, t(10)=7.09, P<.001) in subjects in the exercise group and no changes in subjects in the control group. High-intensity exercise failed to influence serum cortisol concentrations. DISCUSSION AND CONCLUSION: Regular high-intensity aerobic exercise alleviated pain, disability, and psychological strain in subjects with chronic low back pain but did not improve serum cortisol concentrations.