Efficacy of exercise-based interventions for pain intensity in children and adolescents with nonspecific chronic low back pain: a systematic review with meta-analysis

Background Exercise interventions represent a widespread approach for managing nonspecific chronic low back pain (CLBP) in pediatric and adolescent populations, either as standalone treatments or in combination with supplementary therapies. However, the magnitude of their impact on pain severity has not been systematically quantified. Objective To meta-analyze the effects of (1) standalone exercise therapy versus no intervention/usual care and (2) exercise therapy plus adjunctive therapies versus exercise therapy alone on pain intensity in children and adolescents with nonspecific CLBP. Data sources Five databases (Cochrane Library, Medline, Web of Science, PubMed, Embase) were searched from inception to January 2026, restricting included studies to those published in English. Study selection nonspecific CLBP patients aged 6–19 years were selected. Inclusion criteria mandated that studies be controlled clinical trials featuring pre-intervention and post-intervention assessments, with reported measures of pain intensity. Data Extraction Two reviewers independently executed data extraction and bias risk evaluation. Result In a meta-analysis of two trials ( n = 125), exercise-based interventions compared with no intervention/usual care showed an uncertain effect on pain intensity (SMD = −0.99, 95% CI −9.00 to 7.01), with substantial heterogeneity. Interventions combining exercise with adjunctive therapies were associated with a small additional reduction in pain intensity compared with exercise alone (3 studies, n = 280; SMD = −0.38, 95% CI −0.56 to −0.20). Conclusion Evidence from randomized trials is limited, and the overall certainty is very low. Exercise-based interventions may reduce pain intensity compared with no intervention/usual care, but the estimate is highly uncertain because of very serious imprecision. Adding adjunctive therapies to exercise may provide a small incremental reduction in pain, although confidence in this effect remains low, and further well-designed, adequately powered trials are needed.