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Introduction: The quality of life (QoL) in persons with chronic nonspecific low back pain (CNSLBP) is poorer than in healthy persons. Exercise therapy is a valuable therapeutic modality in CNSLBP rehabilitation. Recent research has shown that high-intensity training (HIT) is more effective than moderate-intensity training (MIT) to improve physical fitness and decrease disability1. Possibly, HIT also improves QoL more than MIT. The aim of the study was to compare the effects of HIT to MIT on QoL in persons with CNSLBP. Methods: Persons with CNSLBP performed a 12-week training program (24 sessions, 1.5 h per session, twice per week) at high or moderate intensity. The primary outcome measure, QoL, was assessed with the Short Form Health Survey (SF-36) at baseline and immediately post-intervention. A linear mixed model was carried out to evaluate the therapy effects. Results: In total, thirty-five persons (11 male, age = 43.3 y ± 9.7) participated. Between group differences (p = 0.0387) in favor of HIT were found for the physical component score (PCS) of the SF-36. Within group analysis showed an improvement in the SF-36 total score (HIT:+14.48, MIT:+11.82) and the PCS (HIT:+11.06, MIT:+10.44) in both groups. However, within group improvements in the mental component score were lacking (HIT:-1.41, MIT:-2.78). Discussion: Exercise intensity, and especially HIT, appears to be important to maximize the impact of exercise therapy on QoL in persons with CNSLBP. Process evaluation: Although HIT is an effective treatment modality in CNSLBP rehabilitation, this study did not report on the long-term effects of HIT. Process evaluation: Although HIT is an effective treatment modality in CNSLBP rehabilitation, this study did not report on the long-term effects of HIT. [ABSTRACT FROM AUTHOR]

Context: Psychosocial parameters play an important role in the onset and persistence of chronic musculoskeletal disorders (CMSDs). Exercise therapy is a valuable therapeutic modality as part of CMSD rehabilitation. Hereby, exercise intensity is an important factor regarding changes in pain and disability in multiple CMSDs. However, the impact of exercise intensity on psychosocial outcomes remains poorly explored., Objective: To identify the effects of different modes of exercise intensity on psychosocial outcomes in persons with CMSDs., Data Sources: A systematic search was conducted up to November 2020 using the following databases: PubMed/MEDline, PEDro, Cochrane Library, and Web of Science., Study Selection: Studies reporting exercise therapy in CMSDs with a predefined display of exercise intensity and an evaluation of at least 1 psychosocial outcome were included., Study Design: Systematic review., Level of Evidence: Level 2a., Data Extraction: Data regarding demographics, exercise intensity, and psychosocial outcomes were included in a descriptive analysis. Methodological quality was assessed using the PEDro scale and Critical Appraisal Skills Programme (CASP) checklist., Results: A total of 22 studies, involving 985 participants (with fibromyalgia, chronic low back pain, knee osteoarthritis, psoriatic arthritis, and axial spondyloarthritis) were included (mean PEDro score = 5.77/10). The most common psychosocial outcomes were quality of life (QoL) (n = 15), depression (n = 10), and anxiety (n = 9). QoL improved at any exercise intensity in persons with fibromyalgia. However, persons with fibromyalgia benefit more from exercising at low to moderate intensity regarding anxiety and depression. In contrast, persons with chronic low back pain benefit more from exercising at a higher intensity regarding QoL, anxiety, and depression. Other CMSDs only showed limited or conflicting results regarding the value of certain exercise intensities., Conclusion: Psychosocial outcomes are influenced by the intensity of exercise therapy in fibromyalgia and chronic low back pain, but effects differ across other CMSDs. Future research is necessary to determine the exercise intensity that yields optimal exercise therapy outcomes in specific CMSDs.