Exercise Therapy in the Management of Chronic Low Back Pain: Current Evidence and Practical Implications – A Narrative Review

Background: Chronic low back pain (CLBP) is a multifactorial condition influenced by physical, psychological, and social factors. Exercise therapy is a core element of conservative management, yet it encompasses highly heterogeneous interventions. Aim: This narrative review summarizes current evidence on the effectiveness and safety of exercise therapy for CLBP, focusing on exercise modalities, optimal doses, individualization, special populations, delivery methods, and practical implications. Material and Methods: A narrative literature review was conducted primarily through PubMed and completed in August 2026. The search was limited to studies published in the preceding five years involving adult participants with CLBP, including systematic reviews, meta-analyses, and randomized controlled trials. Results: Exercise therapy produces a clinically important reduction in pain intensity (approx. 15 points on a 0–100 scale) and a smaller improvement in functional disability compared to no treatment or placebo. No single exercise modality has demonstrated consistent superiority. Regular participation (15–30 minutes per session, three times per week, programs lasting at least 16 weeks) is favorable. Benefits are most evident versus inactive controls and diminish when compared with other active treatments. Adherence, individualization, and continued physical activity are key determinants of success. Exercise is generally safe, with mild, transient musculoskeletal symptoms being the most common adverse effects. Conclusions: Exercise therapy is an effective, adaptable, and safe non-pharmacological intervention for CLBP. Outcomes depend less on the specific modality than on adequate dosage, sustained adherence, and a patient-centred approach integrating individual preferences, functional goals, and psychological strategies.