title: Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review the evidence examining effects of walking interventions on pain and self-reported function in individuals with chronic musculoskeletal pain.
  
  
  METHODS
  Six electronic databases (MEDLINE, CINAHL, PsychINFO, PEDro, Sport Discus, and the Cochrane Central Register of Controlled Trials) were searched from January 1980 to March 2014.
  
  
  METHODS
  Randomized and quasi-randomized controlled trials in adults with chronic low back pain, osteoarthritis, or fibromyalgia comparing walking interventions to a nonexercise or nonwalking exercise control group.
  
  
  METHODS
  Data were independently extracted using a standardized form. Methodological quality was assessed using the U.S. Preventive Services Task Force system.
  
  
  RESULTS
  Twenty-six studies (2384 participants) were included, and suitable data from 17 studies were pooled for meta-analysis, with a random effects model used to calculate between-group mean differences and 95% confidence intervals (CIs). Data were analyzed according to the duration of follow-up (short-term, ≤8wk postrandomization; medium-term, >2mo to 12mo; long-term, >12mo). Interventions were associated with small to moderate improvements in pain at short-term (mean difference , -5.31; 95% CI, -8.06 to -2.56) and medium-term (mean difference, -7.92; 95% CI, -12.37 to -3.48) follow-up. Improvements in function were observed at short-term (mean difference, -6.47; 95% CI, -12.00 to -0.95), medium-term (mean difference, -9.31; 95% CI, -14.00 to -4.61), and long-term (mean difference, -5.22; 95% CI, -7.21 to -3.23) follow-up.
  
  
  CONCLUSIONS
  Evidence of fair methodological quality suggests that walking is associated with significant improvements in outcome compared with control interventions but longer-term effectiveness is uncertain. With the use of the U.S. Preventive Services Task Force system, walking can be recommended as an effective form of exercise or activity for individuals with chronic musculoskeletal pain but should be supplemented with strategies aimed at maintaining participation. Further work is required for examining effects on important health-related outcomes in this population in robustly designed studies.
authors.affiliation: Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, United Kingdom; Institute of Nursing and Health Research, University of Ulster, United Kingdom.
authors.forename: Seán R
authors.initials: SR
authors.lastname: O'Connor
authors.affiliation: Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, United Kingdom.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Tully
authors.affiliation: Centre for Physiotherapy Research, University of Otago, Otago, New Zealand.
authors.forename: Brigid
authors.initials: B
authors.lastname: Ryan
authors.affiliation: Sport and Exercise Sciences Research Institute, University of Ulster, Newtownabbey, United Kingdom.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Bleakley
authors.affiliation: Centre for Physiotherapy Research, University of Otago, Otago, New Zealand.
authors.forename: George D
authors.initials: GD
authors.lastname: Baxter
authors.affiliation: Institute of Nursing and Health Research, University of Ulster, United Kingdom.
authors.forename: Judy M
authors.initials: JM
authors.lastname: Bradley
authors.affiliation: UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, United Kingdom; Institute of Nursing and Health Research, University of Ulster, United Kingdom. Electronic address: s.mcdonough@ulster.ac.uk.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: McDonough
mesh_terms: D002908:Chronic Disease; D002986:Clinical Trials as Topic; D005081:Exercise Therapy / Q000379:methods*; D005356:Fibromyalgia / Q000534:rehabilitation; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation; D059352:Musculoskeletal Pain / Q000534:rehabilitation*; D010003:Osteoarthritis / Q000534:rehabilitation; D016138:Walking
keywords: Exercise; Meta-analysis; Musculoskeletal pain; Rehabilitation; Walking