The association of pain with aerobic fitness in patients with chronic low back pain


      Wittink H, Hoskins Michel T, Sukiennik A, Gascon C, Rogers W. The association of pain with aerobic fitness in patients with chronic low back pain. Arch Phys Med Rehabil 2002;83:1467-71. Objective: To investigate the association of aerobic fitness (V̇O2max) with pain intensity as reported by a sample of patients with chronic low back pain (LBP). Design: Cross-sectional with partial longitudinal follow-up. Setting: Outpatient interdisciplinary pain management program in a teaching hospital. Patients: A convenience sample of 75 patients with chronic LBP. Intervention: Patients reported pain intensity before and after undergoing a modified treadmill test. Peak VO2 was measured by using indirect calorimetry. Predicted V̇O2max was determined by extrapolating peak VO2 and heart rate values during testing to predicted maximal heart rate. Main Outcome Measures: Aerobic fitness and pain intensity before and after testing. Results: No significant relation was found between pain intensity and predicted V̇O2max or aerobic fitness. Conclusion: There is no association between pain intensity and aerobic fitness. Deconditioning, defined as a lack of cardiovascular fitness levels normal for age and gender, therefore does not contribute to pain intensity in patients with chronic LBP. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • van Tulder MW
        • Koes BW
        • Bouter LM.
        Conservative treatment of chronic low back pain. A systematic mega-review of 80 randomized clinical trials of 14 interventions.
        Spine. 1996; 1: 245-286
        • Faas A.
        Exercises: which ones are worth trying, for which patients, and when?.
        Spine. 1996; 21: 2874-2878
        • Abenhaim L
        • Rossignol M
        • Valat JP
        • et al.
        The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain.
        Spine. 2000; 25: 1S-33S
        • Cady L
        • Thomas P
        • Karwasky R.
        Program for increasing health and physical fitness of fire firefighters.
        J Occup Med. 1985; 27: 110-114
        • Battie MC
        • Bigos SJ
        • Fisher LD
        • et al.
        A prospective study of the role of cardiovascular risk factors and fitness in industrial back pain complaints.
        Spine. 1989; 14: 141-147
        • Crombez G
        • Vervaet L
        • Lysens R
        • Baeyens F
        • Eelen P.
        Avoidance and confrontation of painful, back-straining movements in chronic back pain patients.
        Behav Modification. 1998; 22: 62-77
        • Vlaeyen JW
        • Linton SJ.
        Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.
        Pain. 2000; 85: 317-332
        • Hultman G
        • Nordin M
        • Saraste H
        • Ohlsen H.
        Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain.
        J Spinal Disord. 1993; 6: 114-123
        • Mayer TG
        • Gatchel RJ.
        Functional restoration for spinal disorders. The sports medicine approach.
        Lea & Febiger, Philadelphia1988
        • Zusman M.
        Instigators of activity intolerance.
        Manual Ther. 1997; 2: 75-86
        • McQuade K
        • Turner J
        • Buchner DM.
        Physical fitness and chronic low back pain. An analysis of the relationship among fitness, functional limitations and depression.
        Clin Orthop. 1988;Aug; 233: 198-204
        • Hazard RG
        • Fenwick JW
        • Kalisch SM
        • et al.
        Functional restoration with behavioral support. A one-year prospective study of patients with chronic low-back pain.
        Spine. 1989; 14: 157-161
        • Brennan GP
        • Shultz BB
        • Hood RS
        • Zahniser JC
        • Johnson SC
        • Gerber AH.
        The effects of aerobic exercise after lumbar microdiscectomy.
        Spine. 1994; 19: 735-739
        • Hurri H
        • Mellin G
        • Korhonen O
        • Harjula R
        • Harkapaa K
        • Luoma J.
        Aerobic capacity among chronic low-back-pain patients.
        J Spinal Disord. 1991; 4: 34-38
        • Wittink H
        • Michel TH
        • Kulich R
        • et al.
        Aerobic fitness testing in patients with chronic low back pain: which test is best?.
        Spine. 2000; 25: 1704-1710
        • Bruce R
        • Kusumi F
        • Hosmer D.
        Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease.
        Am Heart J. 1973; 85: 546-562
        • McInnis K
        • Balady G
        • Weiner D
        • Ryan T.
        Comparison of ischaemic and physiologic responses during exercise tests in men using the standard and modified Bruce protocols.
        Am J Cardiol. 1992; 69: 84-89
        • Tarlov AR
        • Ware Jr, JE
        • Greenfield S
        • Nelson EC
        • Perrin E
        • Zubkoff M.
        • The Medical Outcomes Study
        An application of methods for monitoring the results of medical care.
        JAMA. 1989; 262: 925-930
      1. Accident Rehabilitation and Compensation Insurance Corp and the National Health Committee. New Zealand acute low back pain guide. ACC and National Health Committee, Wellington (NZ)1997
        • Bigos S
        • Bowyer O
        • Braen G
        • et al.
        Acute low back problems in adults. Clinical Practice Guideline No. 14.
        US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Rockville (MD)Dec 1994 (AHCPR Publ. No. 95-0643)
        • American College of Sports Medicine
        ACSM's guidelines for exercise testing and prescription.
        4th ed. Williams & Wilkins, Baltimore1991
        • Blevins J
        • Broeder CE.
        The Vista Metabolic System.
        East Tennessee State Univ, Johnson City (TN)1995
        • Jensen MP
        • Karoly P.
        Self-report scales and procedures for assessing pain in adults.
        in: Handbook of pain assessment. Guilford Pr, New York1992: 135-151
        • Jensen MP
        • Karoly P
        • Braver S.
        The measurement of clinical pain intensity: a comparison of six methods.
        Pain. 1986; 27: 117-126
        • Kremer E
        • Atkinson JH
        • Ignelzi RJ.
        Measurement of pain: patient preference does not confound pain measurement.
        Pain. 1981; 10: 241-248
        • Ohnhaus EE
        • Adler R.
        Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale.
        Pain. 1975; : 1379-1384
        • Jensen MP
        • Turner JA
        • Romano JM.
        What is the maximum number of levels needed in pain intensity measurement?.
        Pain. 1994; 58: 387-392
        • Åstrand I
        • Åstrand PO
        • Rodahl K.
        Maximal heart rate during work in older men.
        J Appl Physiol. 1959; 14: 562-566
        • Åstrand PO.
        Experimental studies of physical work capacity in relation to sex and age.
        ([dissertation]) Munkgaard, Copenhagen1952
        • Taylor HL
        • Buskirk E
        • Henschel A.
        Maximal oxygen intake as an objective measure of cardiorespiratory performance.
        J Appl Physiol. 1955; 8: 73-80
        • Åstrand P
        • Rodahl K.
        Textbook of work physiology, physiological bases of exercise.
        3rd ed. McGraw-Hill, New York1986
        • Rowell LB
        • Taylor HL
        • Wang Y.
        Limitations to prediction of maximal oxygen uptake.
        J Appl Physiol. 1964; 19: 919-927
        • Davies CT.
        Limitations to the prediction of maximum oxygen intake from cardiac frequency measurements.
        J Appl Physiol. 1968; 24: 700-706
        • Waddell G
        • Newton M
        • Henderson I
        • Somerville D
        • Main CJ.
        A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.
        Pain. 1993; 52: 157-168
        • Styf JR
        • Ballard RE
        • Fechner K
        • Watenpaugh DE
        • Kahan NJ
        • Hargens AR.
        Height increase, neuromuscular function, and back pain during 6 degrees head-down tilt with traction.
        Aviat Space Environ Med. 1997; 68: 24-29
        • Dirks JF
        • Wunder J
        • Kinsman R
        • et al.
        A pain rating scale and a pain behavior checklist for clinical use: development, norms, and the consistency score.
        Psychother Psychosom. 1993; 59: 41-49
        • Hazard RG
        • Bendix A
        • Fenwick JW.
        Disability exaggeration as a predictor of functional restoration outcomes for patients with chronic low-back pain.
        Spine. 1991; 16: 1062-1067