Comparative biopsychosocial effects of yoga, spinal stabilization, and aerobic exercises in chronic non-specific low back pain: A randomized controlled trial
Physiotherapy Theory and Practice, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Publication Date: 2026
- Doi Number: 10.1080/09593985.2026.2676083
- Journal Name: Physiotherapy Theory and Practice
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, MEDLINE
- Keywords: aerobic, biopsychosocial, exercise, low back pain, Physiotherapy, yoga
- Hacettepe University Affiliated: Yes
Abstract
Background: Although exercise is a commonly recommended intervention for individuals with chronic nonspecific low back pain (cNSLBP), the comparative efficacy of different modalities across comprehensive biopsychosocial variables remains unclear. Objective: This study aimed to compare the effects of yoga, spinal stabilization exercises (SSE), and aerobic exercise on pain, disability, pain cognitions, gait, and metabolic capacity in individuals with cNSLBP. Methods: This prospective, three-arm randomized controlled trial included 74 individuals who were allocated to yoga, SSE, or aerobic exercise. Interventions were administered for 8 weeks (2 sessions/week, 60 min). Primary outcomes were pain intensity and disability. Secondary outcomes included pain catastrophizing, fear avoidance, alexithymia, cognitive function, back awareness, quality of life, gait characteristics, and 6-Minute Walk Test (6MWT) distance. Results: All groups showed comparable and significant improvements over time in primary outcomes, including resting pain intensity (p <.001; RTE: 0.624, 0.371), activity pain intensity (p <.001; RTE: 0.707, 0.291), night pain intensity (p <.001, RTE: 0.640, 0.358), and disability (p <.001, ηp2 = 0.523). Regarding secondary outcomes, similar patterns of recovery were observed across psychosocial, cognitive, gait, and 6MWT measures (FDR-adjusted main time effects p <.05; ηp2 range: 0.076–0.518; RTE range: 0.367–0.631). Conclusion: Yoga, SSE, and aerobic exercises are similarly effective in improving biopsychosocial outcomes, particularly pain and disability, in cNSLBP. These findings suggest that incorporating any of these structured exercises can yield comparable clinical benefits, allowing treatments to be tailored to patient preferences. Registration number: NCT04000685.