However, when only methodologically robust trials were included in the analysis a smaller effect in favour of exercise was observed.
However, only four trials (n = 326) with adequate allocation concealment, blinding and ITT analysis were located, resulting in a more modest effect size in favour of exercise.
Pooled data from seven trials (n = 373) with long-term follow-up data also found a small clinical effect in favour of exercise.
From these studies, 28 RCTs (n = 1101) were included in a meta-analysis revealing a moderate to large effect in favour of exercise over standard treatment or control.
We did not find consistent evidence in favour of exercise referral schemes in outcomes based on physical fitness, psychological wellbeing, overall health related quality of life, blood pressure, serum lipid levels, indices of obesity, glycaemic control, or respiratory function.
Therefore, we calculated the sample size (that is, the heterogeneity corrected optimal information size (HOIS)) required to detect or reject a minimal relevant difference of two points on the mean pain relief and function scales in favour of exercise compared with no exercise control.
Although in direction of favour of exercise intervention, there was no statistically significant differences between groups in total healthcare (−£128, 95% CI: -734 to 478), combined health and social care costs (£-35£-35% CI: -817 to 746) or QALYs (0.03, 95% CI: -0.02 to 0.03) at 20 weeks.
Our findings differ from the Byström et al [ 22] review which concluded long term benefit to disability in favour of stabilisation exercises over general exercises and with regards to pain at intermediate term.
FABQ (physical activity) (0-24) and FABQ (work) (0-42) for Marshall and Kennedy [ 77] at short term follow-up had a non significant mean difference of 2.2 (95% CI −1.3 to 5.6) and 2.3 (95% CI −1.8 to 6.5) respectively in favour of stabilisation exercises, when compared to stationary bike exercises.
The treatment effect was in favour of supervised exercises at six, 12, and 18 weeks.
