Open Access Highly Accessed Study protocol

Efficacy of graded activity versus supervised exercises in patients with chronic non-specific low back pain: protocol of a randomised controlled trial

Mauricio Oliveira Magalhaes*, Fábio Jorge Renovato França, Thomaz Nogueira Burke, Luiz Armando Vidal Ramos, Ana Paula de Moura Campos Carvalho e Silva, Gabriel Peixoto Leao Almeida, Susan Lee King Yuan and Amélia Pasqual Marques

Author Affiliations

Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil

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BMC Musculoskeletal Disorders 2013, 14:36  doi:10.1186/1471-2474-14-36

Published: 21 January 2013



Low back pain is a relevant public health problem, being an important cause of work absenteeism worldwide, as well as affecting the quality of life of sufferers and their individual functional performances. Supervised active physical routines and of cognitive-behavioral therapies are recommended for the treatment of chronic Low back pain, although evidence to support the effectiveness of different techniques is missing. Accordingly, the aim of this study is to contrast the effectiveness of two types of exercises, graded activity or supervised, in decreasing symptoms of chronic low back pain.


Sample will consist of 66 patients, blindly allocated into one of two groups: 1) Graded activity which, based on an operant approach, will use time-contingent methods aiming to increase participants’ activity levels; 2) Supervised exercise, where participants will be trained for strengthening, stretching, and motor control targeting different muscle groups. Interventions will last one hour, and will happen twice a week for 6 weeks. Outcomes (pain, disability, quality of life, global perceived effect, return to work, physical activity, physical capacity, and kinesiophobia) will be assessed at baseline, at treatment end, and three and six months after treatment end. Data collection will be conducted by an investigator blinded to treatment allocation.


This project describes the randomisation method that will be used to compare the effectiveness of two different treatments for chronic low back pain: graded activity and supervised exercises. Since optimal approach for patients with chronic back pain have yet not been defined based on evidence, good quality studies on the subject are necessary.

Trial registration