approximately 20% of people older than 65  years suffer from low back problems1 . in particular , lumbar spinal stenosis ( lss ) the main symptoms are 
 described as back and buttock pain and/or weakness , numbness , and neurologic claudication 
 that is exacerbated by standing , backward bending , and walking2 . to manage patients with lss , decompressive laminectomy and fusion procedures are commonly 
 recommended3 . katz et al.4 reported that surgical operations improve 
 patients functional ability and that 60% to 80% of patients are satisfied . however , 4  years 
 after spinal stenosis surgery , referred pain may develop , and severe impairment decreases 
 the physical aspects of patients quality of life5 . the most negative element of repeat surgery is its high cost6 ; the reoperation rate for patients with lss 
 is 5% to 23%7 . notably , 21 studies of 
 predictors of postoperative clinical outcomes in lss identified depression , cardiovascular 
 comorbidities , walking inability , and poor subjective outcomes8 . conservative treatment such as therapeutic exercises may achieve clinical recovery , 
 improvements in disability , reductions in pain , increased satisfaction , and better function 
 among patients with chronic low back pain and lss9 , and many studies10 have investigated the effectiveness of conservative interventions 
 ( lumbar flexion exercises , stretching , and mobility exercises ) . however , the pain often 
 recurs when the exercise program is discontinued . the recent increase in the aging 
 population and rising incidence of chronic disease have led to higher medical expenses11 , and policy makers are moving in the 
 direction of self - management of chronic conditions12 . therefore , to effectively manage patients with lss , a home 
 exercise program may be needed . it has been reported that patients with lss have an altered gait pattern due to symptom 
 such as neurologic claudication13 . wide - based gait , slow walking , and short stride are often shown to alleviate neurologic 
 claudication in patients with lss13 , 14 . although self - stretching of the hip 
 flexors as a home exercise is recommended for pain - free gait in patients with lss15 , there is limited experimental 
 evidence . backstrom et al.15 argued that exercise 
 is essential in the treatment of patients with lss and suggested a specific self - exercise 
 program . however , few studies have compared the effects of home exercise among 
 community - dwelling patients with lss . the purpose of this study was to identify the effect 
 of a 4-week home exercise program in terms of how it affects self - reported questionnaire 
 scores and gait parameters in community - dwelling patients with lss . all participants ( nine females and six females , 68.2  5.8  years of age , 61.93  9.5  kg , 
 161.2  8.3  cm ) were diagnosed with degenerated lss by physicians using magnetic resonance 
 imaging or computed tomography . all participated in a health - promotion program in a 
 community health center in pusan , south korea . the inclusion criteria were 1 ) age of 
 55  years or more ; 2 ) pain in the low back , buttocks , gluteal region , or / and lower extremity ; 
 and 3 ) alleviation of symptoms of neurogenic claudication when sitting or lying and 
 aggravation of symptoms when standing and walking . subjects were excluded if they had severe 
 neurologic signs and symptoms , coronary artery disease , severe vascular or pulmonary 
 disease , recent lumbar  thoracic fractures , spinal tumor or infection , or lower extremity 
 fracture . all 
 subjects were evaluated using three self - reported low back disability scales ( oswestry 
 disability index [ odi ] , roland - morris disability questionnaire [ rdq ] , and spinal stenosis 
 scale [ sss ] ) to assess their level of pain and functional status before and after the home 
 exercise program . to assess the walking velocity and stride and step lengths , we used a 
 gaitrite system ( cir systems , inc . , sparta , nj , usa ) , which detects the activation of 
 sensors and automatically calculates the spatiotemporal gait parameters . during the 4-week 
 exercise program , all participants were asked to perform exercises 5 days / week ( total of 20 
 repetitions ) , and each session was 40  min in duration . the home exercise program comprised 
 knee - to - chest exercises , thoracic extension self - mobilization , double knee - to - chest 
 exercises , lower abdominal strengthening exercises , lumbar rotation stretching , hip 
 abduction strengthening exercises , rectus femoris self - stretching , and iliopsoas 
 self - stretching , as reported by backstrom et al.15 . the results were analyzed statistically using the paired t - test , 
 and statistical significance was set at a value of p  0.05 . the odi ( r = 0.702 , p < 0.004 ) , rdq ( r = 0.939 , p < 0.000 ) , sss - ss ( r = 0.885 , p < 
 0.000 ) , and sss - fs ( r = 0.765 , p < 0.001 ) scores were improved significantly after home 
 exercise . among the spatiotemporal gait parameters , walking velocity ( p = 0.09 ) , step and 
 stride lengths on the left ( p = 0.51 and p = 0.99 , respectively ) , and step and stride 
 lengths on the right ( p = 0.86 and p = 0.61 , respectively ) were not changed significantly . before and after the exercise program , the walking pain intensity was improved significantly 
 ( p = 0.05 and p = 0.026 , respectively ) ( table 
 1table 1 . self - reported questionnaires and comparison of spatiotemporal gait parameters 
 and pain intensity before home exercise and after home exercisevariablemean  sdbefore home exerciseafter home exerciseodi ( % ) 37.488.1323.9911.33*rdq10.874.357.204.63*sss - ss2.501.011.910.81*sss - fs1.730.701.270.42*before vas ( 100  mm)32.6630.5823.6624.81*after vas ( 100  mm)52.0026.7743.0025.26*lt step length ( cm)51.165.8350.726.75lt stride length ( cm)101.7812.51101.8015.21rt step length ( cm)50.116.9449.977.92rt stride length ( cm)101.3612.69102.0914.94velocity ( cm / s)85.8216.9789.1816.99odi , oswestry disability index ; rdq , roland - morris disability questionnaire ; sss - ss , 
 spinal stenosis scale - symptom subscale ; sss - fs , spinal stenosis scale - function 
 subscale ; vas , visual analogue scale . odi , oswestry disability index ; rdq , roland - morris disability questionnaire ; sss - ss , 
 spinal stenosis scale - symptom subscale ; sss - fs , spinal stenosis scale - function 
 subscale ; vas , visual analogue scale . we assessed the effect of home exercise on self - reported questionnaire scores and gait 
 parameters in patients with lss . lumbar flexion exercises are effective for increasing the sagittal plane dimensions of the 
 central spinal canal , strengthening the abdominal muscles , and improving spinal 
 mobility15 , 16 . furthermore , improved hip flexibility is frequently necessary for 
 a pain - free gait in patients with lss15 . 
 a previous case study17 and one 
 randomized controlled trial9 reported that 
 lumbar flexion exercises reduced pain and significantly improved the average odi score among 
 patients with lss . in addition , combined flexion exercise ( treadmill walking with body 
 weight support vs. cycling ) was beneficial , as evidenced by both the modified odi and rdq 
 scores18 . gait training was not performed in our study . in some 
 studies , unlike ours , lumbar flexion exercises and gait training were performed together . whitman et al.9 suggested two 6-week 
 conservative treatment programs for patients with lss ; one program included manual therapy , 
 body weight - supported treadmill walking , and exercise , and the other program included lumbar 
 flexion exercises , a treadmill walking program , and ultrasound therapy . gait training in 
 patients with lss is beneficial to the cardiovascular system , enhances mobility and 
 strength , and decreases fear avoidance issues related to walking15 . these results suggest that home - based exercise with gait 
 training is necessary to change gait parameters . we consider that specific gait training 
 such as body weight - supported treadmill walking was not included in our home - exercise 
 program , which resulted in no significant changes in gait parameters after the 4-week 
 exercise program . this study had several limitations : 1 ) the small number of subjects , 2 ) lack of a control 
 group , and 3 ) complete exclusion of medications . however , our results regarding home 
 exercise are encouraging and suggest that elderly patients with lss can experience clinical 
 improvement characterized by a marked reduction in symptoms and an increase in function . in conclusion , home exercise improved the scores of three self - reported questionnaires 
 ( odi , ssq , and rdq ) , but it did not change gait parameters in patients with lss in the 
 current study . in future studies , the effects of home exercise that includes other lumbar 
 spine exercises and gait training should be evaluated .
[ purpose ] the present study was performed to identify the effect of a home exercise 
 program on the self - reported disability index and gait parameters in patients with lumbar 
 spinal stenosis ( lss ) . 
 [ methods ] fifteen patients with lss were enrolled in this study and 
 were trained in a 4-week home exercise program ( 40  min / day ) . 
 all patients were evaluated 
 with three self - reported disability indices ( oswestry disability index , roland - morris 
 disability questionnaire , and spinal stenosis scale ) , and gait parameters were assessed 
 using a gaitrite system before and after the home exercise program . 
 [ results ] patients 
 with lss showed significant decreases in the self - reported questionnaire scores and pain 
 intensity after the home exercise program . however , the gait parameters did not 
 significantly change . 
 [ conclusion ] these findings suggest that home exercise programs can 
 improve self - reported questionnaire scores and decrease pain in patients with lss .