Advances in Exercise Prescription for Overweight and Obese Patients with Chronic Low Back Pain

Abstract

Chronic low back pain is one of the most common conditions encountered in spine surgery, orthopedics, and rehabilitation medicine. It is also a major contributor to activity limitation, impaired quality of life, and increased healthcare burden in adults. With the increasing prevalence of overweight and obesity, obesity-related low back pain has attracted growing clinical attention. Obesity may contribute to the onset and persistence of chronic low back pain through multiple mechanisms, including increased mechanical loading of the lumbar spine, impaired core muscle function, chronic low-grade inflammation, and accelerated intervertebral disc degeneration. Current clinical guidelines generally recommend exercise therapy, patient education, and non-pharmacological comprehensive management as first-line strategies for chronic low back pain. Meanwhile, exercise prescription is also a fundamental component of obesity management, with beneficial effects on body weight, body fat, cardiopulmonary function, and musculoskeletal performance. However, several challenges remain in clinical practice, including insufficient standardization of exercise prescriptions, limited individualization, poor long-term adherence, and inadequate integration between health management services and spine-specialty care. This review summarizes the current evidence regarding exercise prescription for overweight and obese patients with chronic low back pain from the perspectives of disease burden, the relationship between obesity and low back pain, exercise-based intervention, weight management, exercise adherence, and remote monitoring. Furthermore, this review proposes a feasible model integrating the Health Management Center and the Department of Spine Surgery for individualized exercise prescription, aiming to provide a theoretical basis for clinical intervention and future research on obesity-related chronic low back pain.