title: Randomized Clinical Trial of Lumbar Instrumented Fusion and Cognitive Intervention and Exercises in Patients with Chronic Low Back Pain and Disc Degeneration Summary health statistics for U.S. adults: National Health Interview Survey, 2001. Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Functional performance and inflammatory cytokines after squat exercises and whole-body vibration in elderly individuals with knee osteoarthritis. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial.
abstract: Study Design . Single blind r and omized study . Objectives . To compare the effectiveness of  lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration . Summary of Background Data . To the authors ’ best knowledge , only one r and omized study has evaluated the effectiveness of lumbar fusion . The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician . Patients and Methods . Sixty-four patients aged 25–60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4–L5 and /or L5–S1 at radiographic examination were r and omized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy , or cognitive intervention and exercises . The cognitive intervention consisted of a lecture to give the patient an underst and ing that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it . This was reinforced by three daily physical exercise sessions for 3 weeks . The main outcome measure was the Oswestry Disability Index . Results . At the 1-year follow-up visit , 97 % of the patients , including 6 patients who had either not attended treatment or changed groups , were examined . The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery , compared with 42 to 30 after cognitive intervention and exercises . The mean difference between groups was 2.3 ( −6.7 to 11.4 ) ( P = 0.33 ) . Improvements inback pain , use of analgesics , emotional distress , life satisfaction , and return to work were not different . Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment , and lower limb pain was reduced more after surgery . The success rateaccording to an independent observer was 70 % after surgery and 76 % after cognitive intervention and exercises .  The early complication rate in the surgical group was 18 % . Conclusion . The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration r and omized to cognitive intervention and exercises , or lumbar fusion OBJECTIVES This report presents health statistics from the 2001 National Health Interview Survey for the civilian noninstitutionalized adult population classified by sex , age , race and Hispanic origin , poverty status , and region of residence for chronic condition prevalence , health status and functional limitations , health care access and utilization , health behaviors , and human immunodeficiency virus ( HIV ) testing . Also , health statistics by education , income , health insurance coverage , marital status , and place of residence are presented for health status and limitations in activity , health care access and utilization , health behaviors , and knowledge and attitudes toward HIV . SOURCE OF DATA The National Health Interview Survey is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention 's National Center for Health Statistics and is representative of the civilian noninstitutionalized U.S. population . Sociodemographic data are collected for everyone in the family during face-to-face interviews with adults present at the time of the interview . The health information for adults in this report was obtained from one r and omly selected adult per family . HIGHLIGHTS In 2001 , 64 % of adults 18 years of age and over reported excellent or very good health . Fifty-eight percent of adults never participated in any type of vigorous leisure-time physical activity , and 13 % of adults did not have a usual place of health care . Twelve percent of adults had been told by a doctor or health professional that they had heart disease , and 21 % had been told on two or more visits that they had hypertension . Nearly a quarter of all adults were current smokers , and 22 % were former smokers . Based on estimates of body mass index , 36 % of adults were overweight and 23 % were obese OBJECTIVES This report presents health statistics from the 2010 National Health Interview Survey ( NHIS ) for the civilian noninstitutionalized adult population , classified by sex , age , race and Hispanic origin , education , family income , poverty status , health insurance coverage , marital status , and place and region of residence . Estimates are presented for selected chronic conditions and mental health characteristics , functional limitations , health status , health behaviors , health care access and utilization , and human immunodeficiency virus testing . Percentages and percent distributions are presented in both age-adjusted and unadjusted versions . DATA SOURCE NHIS is a household , multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention 's National Center for Health Statistics . In 2010 , data were collected on 27,157 adults in the Sample Adult question naire . The conditional response rate was 77.3 % , and the final response rate was 60.8 % . The health information for adults in this report was obtained from one r and omly selected adult per family . In very rare instances where the sample adult was not able to respond for himself or herself , a proxy was used . HIGHLIGHTS In 2010 , 61 % of adults aged 18 years and over had excellent or very good health . Twelve percent of adults had been told by a doctor or health professional that they had heart disease , 25 % had been told on two or more visits that they had hypertension , 9 % had been told they had diabetes , and 22 % had been told they had some form of arthritis , rheumatoid arthritis , gout , lupus , or fibromyalgia . Twenty-one percent of adults were current smokers , and 21 % were former smokers . Based on estimates of body mass index , 35 % of adults were overweight and 27 % were obese OBJECTIVE To investigate the effects of squat exercises combined with whole-body vibration on the plasma concentration of inflammatory markers and the functional performance of elderly individuals with knee osteoarthritis ( OA ) . DESIGN Clinical , prospect i ve , r and omized , single-blinded study . SETTING Exercise physiology laboratory . PARTICIPANTS Elderly subjects with knee OA ( N=32 ) were divided into 3 groups : ( 1 ) squat exercises on a vibratory platform ( platform group , n=11 ) ; ( 2 ) squat exercises without vibration ( squat group , n=10 ) ; and ( 3 ) the control group ( n=11 ) . INTERVENTIONS The structured program of squat exercises in the platform and squat groups was conducted 3 times per week , on alternate days , for 12 weeks . MAIN OUTCOME MEASURES Plasma soluble tumor necrosis factor-α receptors 1 ( sTNFR1 ) and 2 ( sTNFR2 ) were measured using immunoassays ( the enzyme-linked immunosorbent assay method ) . The Western Ontario and McMaster Universities Osteoarthritis Index question naire was used to evaluate self-reported physical function , pain , and stiffness . The 6-minute walk test , the Berg Balance Scale , and gait speed were used to evaluate physical function . RESULTS In the platform group , there were significant reductions in the plasma concentrations of the inflammatory markers sTNFR1 and sTNFR2 ( P<.001 and P<.05 , respectively ) and self-reported pain ( P<.05 ) compared with the control group , and there was an increase in balance ( P<.05 ) and speed and distance walked ( P<.05 and P<.001 , respectively ) . In addition , the platform group walked faster than the squat group ( P<.01 ) . CONCLUSIONS The results suggest that whole-body vibration training improves self-perception of pain , balance , gait quality , and inflammatory markers in elderly subjects with knee OA IMPORTANCE Knee osteoarthritis ( OA ) , a common cause of chronic pain and disability , has biomechanical and inflammatory origins and is exacerbated by obesity . OBJECTIVE To determine whether a ≥10 % reduction in body weight induced by diet , with or without exercise , would improve mechanistic and clinical outcomes more than exercise alone . DESIGN , SETTING , AND PARTICIPANTS Single-blind , 18-month , r and omized clinical trial at Wake Forest University between July 2006 and April 2011 . The diet and exercise interventions were center-based with options for the exercise groups to transition to a home-based program . Participants were 454 overweight and obese older community-dwelling adults ( age ≥55 years with body mass index of 27 - 41 ) with pain and radiographic knee OA . INTERVENTIONS Intensive diet-induced weight loss plus exercise , intensive diet-induced weight loss , or exercise . MAIN OUTCOMES AND MEASURES Mechanistic primary outcomes : knee joint compressive force and plasma IL-6 levels ; secondary clinical outcomes : self-reported pain ( range , 0 - 20 ) , function ( range , 0 - 68 ) , mobility , and health-related quality of life ( range , 0 - 100 ) . RESULTS Three hundred ninety-nine participants ( 88 % ) completed the study . Mean weight loss for diet + exercise participants was 10.6 kg ( 11.4 % ) ; for the diet group , 8.9 kg ( 9.5 % ) ; and for the exercise group , 1.8 kg ( 2.0 % ) . After 18 months , knee compressive forces were lower in diet participants ( mean , 2487 N ; 95 % CI , 2393 to 2581 ) compared with exercise participants ( 2687 N ; 95 % CI , 2590 to 2784 , pairwise difference [Δ](exercise vs diet ) = 200 N ; 95 % CI , 55 to 345 ; P = .007 ) . Concentrations of IL-6 were lower in diet + exercise ( 2.7 pg/mL ; 95 % CI , 2.5 to 3.0 ) and diet participants ( 2.7 pg/mL ; 95 % CI , 2.4 to 3.0 ) compared with exercise participants ( 3.1 pg/mL ; 95 % CI , 2.9 to 3.4 ; Δ(exercise vs diet + exercise ) = 0.39 pg/mL ; 95 % CI , -0.03 to 0.81 ; P = .007 ; Δ(exercise vs diet ) = 0.43 pg/mL ; 95 % CI , 0.01 to 0.85 , P = .006 ) . The diet + exercise group had less pain ( 3.6 ; 95 % CI , 3.2 to 4.1 ) and better function ( 14.1 ; 95 % CI , 12.6 to 15.6 ) than both the diet group ( 4.8 ; 95 % CI , 4.3 to 5.2 ) and exercise group ( 4.7 ; 95 % CI , 4.2 to 5.1 , Δ(exercise vs diet + exercise ) = 1.02 ; 95 % CI , 0.33 to 1.71 ; P(pain ) = .004 ; 18.4 ; 95 % CI , 16.9 to 19.9 ; Δ(exercise vs diet + exercise ) , 4.29 ; 95 % CI , 2.07 to 6.50 ; P(function ) < .001 ) . The diet + exercise group ( 44.7 ; 95 % CI , 43.4 to 46.0 ) also had better physical health-related quality of life scores than the exercise group ( 41.9 ; 95 % CI , 40.5 to 43.2 ; Δ(exercise vs diet + exercise ) = -2.81 ; 95 % CI , -4.76 to -0.86 ; P = .005 ) . CONCLUSIONS AND RELEVANCE Among overweight and obese adults with knee OA , after 18 months , participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels than those in the exercise group ; those in the diet group had greater reductions in knee compressive force than those in the exercise group . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00381290
target: Inflammatory markers were most commonly measured followed by neurotransmitter-related genes and metabolite-detecting genes .
  After exercise interventions , changes in biomarkers involved in neurotransmission and inflammation suggest a hypoalgesic exercise effect .
  Significant biomarker associations were found with pain intensity , fatigue , depression , anxiety , and quality of life .
  Discussion : It remains a question whether biomarkers can be used as objective measures for risk assessment , diagnosis , or evaluation or as surrogate endpoints in chronic pain .
  Regardless , the potential translational value of biomarkers in chronic pain is evident .
background: Background : Chronic pain is highly prevalent .
  Current management is challenged by lack of vali date d objective measures like biological markers .
  Clinical pain studies employing exercise interventions have evaluated biomarkers ; however , it is unclear how exercise impacts biomarkers involved in pain pathways and whether these markers are associated with relevant pain-related outcomes .
  This systematic review evaluates data from clinical studies employing exercise interventions in chronic musculoskeletal nonmalignant pain conditions in which biomarkers in pain pathways were measured .