Some chronic back
pain patients are so unfit they cannot participate in the activities of daily
living, let alone complete a rehabilitation program, according to a new study by
Frank Boumphrey, MD, and colleagues at the Cleveland Clinic.
One patient with
back pain of 10 years duration hit her anaerobic threshold when doctors tried to
walk her across the room. Other
patients lacked the aerobic fitness to garden, take a slow walk. Or ride a bike.
Obviously none of these patients are going to return to blue-collar jobs
“All the subjects
in this study were exceptionally unfit,” reported Boumphrey at the annual
meeting of the North American Spine Society in Minneapolis.
“None of them could walk and play golf at the same time.”
Boumphrey et al.
studied a group of 13 males and eight females who had long-term disabling back
pain. “We chose patients who had
been out of work because of their back pain for six months or more,” said
Boumphrey. The mean age of the
women was 44 and the men 41. The
subjects had been off work for anywhere from six months to 11 years.
To gauge the
patients’ aerobic capacity, Boumphrey et al. measured the accumulation of
lactic acid in the patients’ blood while they exercised.
The patients worked out on a stationary bicycle at a present workload
until they reached their anaerobic thresholds, i.e., when lactic acid began to
accumulate in the blood. The
researchers compared the patients’ results to norms taken from a Canadian
fitness survey in 1981.
displayed dismal aerobic capacity. Boumphrey
expressed the patients’ performance in terms of METS, or metabolic equivalent
would be the energy consumed by a person lying flat on his back and not
thinking," he explained. Sitting
in a chair would account between two and three metabolic equivalents, slow
walking about four, and slow bike riding or slow running between eight and 10.
“All our patients
were four or less,” stressed Boumphrey. “In
other words, they were just about able to sit in a chair and be active.
Most of the activities of daily living, when done continuously, would go
above their anaerobic threshold. All
of these subjects would have had difficulty with the average rehab program.”
Boumphrey et al. do
not claim that the subjects are typical of chronic back pain patients.
However, they observe that aerobic fitness is often an issue in patients
with longstanding back problems.
“We conclude that
in very chronic patients, aerobic fitness should probably be one of the primary
goals of rehabilitation. Many of
these patients are so unfit that their exercise program should be based on
measured anaerobic threshold rather than on any preconceived plan,” says
Boumphrey. Patients who attempt to
carry out rehabilitation exercise programs without developing sufficient aerobic
fitness may develop an overtraining syndrome that could aggravate their back