Daher A, Carel RS, Tzipi K, et al. The effectiveness of an aerobic exercise training on patients with neck pain during a short- and long-term follow-up: a prospective double-blind randomized controlled trial. Clin Rehabil. 2020 May;34(5):617-629. doi: 10.1177/0269215520912000. Epub 2020 Mar 17. (Original study)

OBJECTIVE: To examine the effect of adding aerobic exercise (AE) to neck-specific exercise treatment for patients with neck pain (NP) to reduce pain and disability.

DESIGN: A prospective multicentre randomized controlled trial.

SETTING: Physiotherapy outpatient clinics.

SUBJECTS: Patients with nonspecific NP.

INTERVENTION: Patients with NP were randomly assigned to six weeks of neck-specific exercise with and without the addition of AE.

MEASURES: Patients were classified as having a successful or non-successful outcome according to the Global Rating of Change (GROC). Outcome measures included Visual Analogue Scale (VAS), Neck Disability Index (NDI), Fear Avoidance Beliefs Questionnaire (FABQ) and cervicogenic headache. Assessments were performed at six-week, and three- and six-month follow-ups.

RESULTS: A total of 139 participants (mean age: 54.6 ± 10.5 years) were recruited (n = 69 AE, n = 70 control). According to GROC, 77.4% of the AE group reported a successful outcome at six months vs. 40% in the control group (P < 0.001). There was a significant reduction in VAS from baseline to six months in the AE vs. control group 6.73 (±1.69) to 1.89 (±1.37) vs. 6.65 (±1.67) to 3.32 (±1.82), respectively (P < 0.001). Significant improvements were also obtained for NDI and FABQ from baseline to six weeks in the AE group: NDI from 16.10 (±4.53) to 7.78 (±4.78) vs. 17.01 (±4.84) to 11.09 (±5.64) in the control group (P = 0.003); FABQ from 33.53 (±9.31) to 20.94 (±841) in the AE vs. 33.45 (±10.20) to 26.83 (±10.79) in the control group (P < 0.001). The AE group also demonstrated significant reduction in cervicogenic headache from baseline to six months (P = 0.003).

CONCLUSION: Adding AE to long-term neck-specific exercises is an effective treatment for reducing NP and headache in patients with NP.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 6 / 7
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Comments from MORE raters

Physician rater

Excellent research, but the title is incorrect. The intervention was specific neck exercises, aerobic exercises and massage.

Physician rater

In patients with neck pain with or without headache, the addition of a walking aerobic exercise program significantly improved neck pain, headaches, and cervical ROM.

Physician rater

These interesting study results have to be taken with a grain of salt as the intervention group of aerobic exercise has additional exercise above and beyond that of the control group. Nonetheless this study continues to validate the importance of exercise for various types of MSK pain.

Physician rater

This double blind randomised control trial of patients with neck pain looked at the benefit of addition of aerobic exercises in the form of either cycling or walking to neck specific exercises. There were 139 subjects and multiple outcomes were assessed. The addition of aerobic exercises clearly improved all outcomes over the group receiving only neck specific exercises at 6 weeks, three months and six months follow up suggesting that it is worthwhile for patients with neck pain to add an aerobic exercise program to neck specific exercises.

Rehab Clinician (OT/PT) rater

The article showed evidence that adding aerobic exercises to neck-specific exercises for neck pain patients was beneficial in long term follow up. This is something that we have long assumed and indeed hoped that happened and this article provides some of the evidence. It is great that we can add this evidence to our pile of things that "we know we know" instead of just "what we think we know."

Rehab Clinician (OT/PT) rater

We know the value of exercise in neck pain, but this article helps to start stratifying what type of exercise is beneficial and is quite specific with outlining the exercises involved, It is a step away from our deep neck flexor WAD type management. Further details in this field would be interested.
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