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Effects of home strength training and stretching versus stretching alone after lumbar disk surgery : a randomized study with a 1-year follow-up . OBJECTIVE To assess the adherence to and effects of a 12-month combined strength and stretching home exercise regimen versus stretching alone , on patient outcome after lumbar disk surgery . DESIGN Randomized controlled trial . SETTING Departments of physical medicine and rehabilitation and orthopedics at a Finnish hospital . PARTICIPANTS Patients ( N=126 ) were randomized into either a combined strength training and stretching group ( STG , n=65 ) or a control group ( CG , n=61 ) . INTERVENTION The STG was instructed to perform strength training and both the STG and CG were instructed in the same stretching and stabilization exercises for 12 months . MAIN OUTCOME MEASURES Pain on the visual analog scale ( VAS ) , the Oswestry and the Million disability indexes , isometric and dynamic trunk muscle strength , mobility in the lumbar spine , and straight-leg raising were measured . RESULTS The trial was completed by 71 % and 77 % of the patients from the STG and the CG , respectively . The mean strength training frequency decreased from 1.5 to 0.6 times a week in the STG during the intervention . The mean stretching frequency decreased from 3.7 to 1.6 times a week in both groups . Median back and leg pain varied between 17 and 23 mm ( VAS ) , and the Million and Oswestry indices varied between 14 and 23 points 2 months postoperatively . No statistically significant changes took place in these outcome measures during the 12-month follow-up in both groups . The changes in isometric trunk extension favored the STG ( P =.016 ) during the first 2 months . However , during the whole 12-month training period , both dynamic and isometric back extension and flexion strength , as well as mobility of the spine and repetitive squat-test results , improved significantly in both groups , and no differences were found in any of the physical function parameters between the STG and CG . CONCLUSIONS At the 12-month follow-up , no statistically significant changes were found in the physical function , pain , or disability measures between the groups . In the STG , training adherence with regard to training frequency and intensity remained too low to lead to specific training-induced adaptations in the neuromuscular system . Progressive loading , supervision of training , and psychosocial support is needed in long-term rehabilitation programs to maintain patient motivation .
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Intervention_Physical
home strength training and stretching
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Intervention_Physical
stretching alone
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Intervention_Physical
combined strength and stretching home exercise regimen
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Intervention_Physical
stretching alone
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Intervention_Physical
combined strength training and stretching group
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Intervention_Control
control group
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Intervention_Physical
strength training
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Intervention_Physical
stretching and stabilization exercises
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Intervention_Physical
stretching
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Outcome_Physical
visual analog scale ( VAS ) , the Oswestry and the Million disability indexes , isometric and dynamic trunk muscle strength , mobility in the lumbar spine , and straight-leg raising
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Outcome_Physical
mean strength training frequency
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Outcome_Physical
mean stretching frequency
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Outcome_Pain
Median back and leg pain
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Outcome_Physical
Million and Oswestry indices
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Outcome_Physical
isometric trunk extension
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Outcome_Physical
dynamic and isometric back extension and flexion strength
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Outcome_Physical
mobility of the spine and repetitive squat-test results
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Outcome_Physical
physical function parameters
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Outcome_Physical
physical function
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Outcome_Pain
, pain
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Outcome_Physical
, or disability measures
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Participant_Condition
lumbar disk surgery
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Participant_Condition
after lumbar disk surgery
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Participant_Sample-size
N=126