Can breathing exercises effectively treat people with chronic non-specific low back pain? A systemic review with meta-analysis

Abstract

Objective

To evaluate the effects of breathing exercises on pain, function, pulmonary and muscle parameters, and psychological factors in chronic non-specific low back pain (CNLBP).

Data Sources

PubMed, MEDLINE, CINAHL, EMBASE, Web of Science, PEDro, and Airiti Library were searched up to September 17, 2024.

Methods

A systematic review (CRD42024567159) of randomised controlled trials (RCT) comparing breathing exercises to interventions without breathing exercises for CNLBP was conducted. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using Cochrane's RoB 2 tool. Standardised mean differences (SMDs) with 95% confidence intervals (CI) were calculated using a random-effects model. Interventions included diaphragmatic, slow or deep breathing, and forced exhalation techniques, with durations ranging from 2 to 12 weeks. Evidence certainty was assessed using the GRADE framework, and subgroup analyses explored potential heterogeneity.

Results

Seventeen studies (633 participants) met inclusion criteria. Breathing exercises reduced pain intensity (SMD −1.11; 95% CI −1.71 to −0.51) and improved functional capacity (e.g., Oswestry Disability Index, SMD −0.56; 95% CI −0.88 to −0.25). Positive effects were observed in respiratory function (e.g., forced vital capacity, SMD 0.46; 95% CI 0.18 to 0.74), core muscle activity (e.g., transverse abdominis activation assessed via surface electromyography, SMD 0.82; 95% CI 0.47 to 1.17), and fear-avoidance beliefs (e.g., FABQ-subscales, SMD −0.56; 95% CI −0.97 to −0.15). However, heterogeneity was high, five studies had a high risk of bias, and GRADE assessment indicated low to very low evidence certainty.

Conclusion

Breathing exercises may benefit pain, function, and respiratory and psychological outcomes in CNLBP. Effects appear more pronounced in athletes regarding the reduction of pain. Further high-quality research is needed to support the findings and establish their clinical applicability.