Exercise programs starting 4 to 6 weeks postsurgery in adults after first-time lumbar disc surgery seem to lead to a faster decrease in pain and disability than no treatment, and high-intensity exercise programs seem to lead to a faster decrease in pain and disability than low-intensity programs, say authors of a systematic review published in the August 1 issue of Spine (Vol 34, Issue 17).

Search strategies were performed on CENTRAL (The Cochrane Library 2007, Issue 2) and MEDLINE, EMBASE, CINAHL, and PsycINFO up to May 2007. All randomized controlled trials without language limitations were included. Pairs of review authors independently assessed studies for eligibility and risk of bias. 

Fourteen studies were included, 7 of which had a low risk of bias. Most programs were only assessed in one study. Statistical pooling only was completed for three comparisons in which exercises started 4 to 6 weeks postsurgery: exercise programs versus no treatment, high versus low- intensity exercise programs, and supervised versus home exercises. The authors found low-quality evidence that exercises are more effective than no treatment for pain at short-term follow-up and moderate evidence that exercises are more effective for functional status on short-term follow-up. They found low-quality evidence that high-intensity exercises are slightly more effective than low-intensity exercise programs for pain in the short-term and moderate evidence that they are more effective for functional status in the short-term. Additionally, the authors found low-quality evidence that there were no significant differences between supervised and home exercises for short-term pain relief. None of the studies reported that exercises increased the reoperation rate.