Effects of breathing exercises on chronic low back pain: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND: A range of studies concerning the effects of breathing exercises on chronic low back pain (CLBP) have been proven inconclusive. OBJECTIVE: The study aimed to evaluate the effectiveness of breathing exercises for the treatment of CLBP. METHODS: We considered randomized controlled trials in English or Chinese that used breathing exercises for the treatment of CLBP. An electronic search was performed in the MEDLINE, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang, and CBM databases for articles published up to November 2022. Two reviewers independently screened the articles, assessed the risk of bias using the Cochrane risk of bias tool, and extracted the data. The outcomes included pain, lumbar function and pulmonary function post-intervention. RESULTS: A total of thirteen studies ( n = 677) satisfied the inclusion criteria. The meta-analysis results demonstrated a significant effect of breathing exercises on the Visual Analog Scale (VAS) score (SMD = 0.84, 95% CI: 1.24 to 0.45, P < 0.0001), the Oswestry Disability Index (ODI) score (SMD = 0.74, 95% CI: 0.95 to 0.54, P < 0.00001), Forced Vital Capacity (FVC) score (MD = 0.24, 95% CI: 0.10 to 0.37, P = 0.0006), Forced Expiratory Volume in 1 second /Forced Vital Capacity (FEV1/FVC) (MD = 1.90, 95% CI: 0.73 to 3.07, P = 0.001), although there was no significant difference between the breathing exercises and control interventions for Forced Expiratory Volume in the first second (FEV1) score (MD = 0.22, 95% CI = [0.00, 0.43], P = 0.05), and Maximal Voluntary Ventilation (MVV) score (MD = 8.22, 95% CI = [ 4.02, 20.45], P = 0.19). CONCLUSION: Breathing exercises can reduce pain, assist people with lumbar disabilities, and improve pulmonary function, and could be considered as a potential alternative treatment for CLBP.