Low-Impact Aerobic Exercise

By: Peter F. Ullrich, Jr., MD

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Along with specific back exercises, aerobic exercise that increases the heart rate for a sustained period is very beneficial for helping back problems. Aerobic exercise increases the flow of blood and nutrients to back structures which supports healing, and can decrease the stiffness in the back and joints that lead to back pain. While many patients with back pain are able to participate in vigorous exercise like running or step aerobics, others find it easier to engage in low-impact exercise, which does not jar the spine.

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Benefits of aerobic exercise

Reconditioning through aerobic exercise is very useful for both rehabilitation and maintenance of the lower back. Patients who regularly undertake aerobic exercise to condition the back will benefit in several ways:

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They have fewer episodes of low back pain, and will experience less pain when an episode occurs.
They are also more likely to stay functional (e.g. continue working and carry on with recreational activities), whereas those patients with chronic low back pain who do not engage in aerobic exercise are more likely to experience the gradual loss of functional capabilities.
It is easier to control weight or lose weight, decreasing the stress placed on the spine structures and joints.
An increased production of endorphins after 30 or 40 minutes of exercise can combat pain. These bio-chemicals are the body’s natural painkiller, and frequent release of them can help patients reduce their reliance on pain medication.
Endorphins can elevate mood and relieve symptoms of depression, a condition common in those with back pain or a back injury.

Types of low impact exercise

There are several types of aerobic exercise that are gentle on the back and, when done on a regular basis, highly effective in providing conditioning.

Walking. In general, walking for exercise is very gentle on the back, and walking two to three miles three times per week is very helpful for patients. Walking also has the advantage of not requiring special equipment (except a good pair of shoes suitable for walking) and it can be done inside or outside, in almost any location, including at home on a treadmill.
Stationary bicycling. For those patients who are more comfortable seated rather than standing, biking or stationary biking may be preferable. Bicycling or ‘spinning’ classes have grown in popularity over the last decade as more people realize the benefits of this lower impact form of exercise. There are several upright and recumbent (reclining) bikes that can be purchased for home use, and many come with programs preloaded so that patients have a good variety of sessions from which to choose.
Elliptical trainer or step machine. These machines provide a low-impact workout because the participant is using pedals suspended above the ground to move in a continuous oval motion, as opposed to continuously stepping on a hard surface. The motor on the machine facilitates a smoother step or forward glide motion, which is less jarring than walking. The benefit of these machines is that they provide an aerobic workout as well as strengthening or resistance training because the arms of most cross-training machines can be pushed and pulled, thus working the upper body, and the resistance of the pedaling motion increased to require greater muscle exertion to maintain the movement.
Water therapy. Doing exercise in the water provides for effective conditioning while minimizing stress on the back because the buoyancy of water counteracts the gravitational pull that can compress the spine. When ‘unweighted’ in water, a patient becomes more mobile, and stretching and strengthening exercises are less painful. Exercises such as hip abduction lifts, bicep curls, arm circles to exercise deltoids and shoulders, and tricep kickbacks are all easier done water for most people. All these muscles build strength in the low back or neck, and reduce back pain. Water therapy exercise is especially useful for patients in too much pain to tolerate land exercises on a mat or hard floor, or for elderly patients.

Whatever low-impact exercise is used, the exercise should be vigorous enough to increase the heart rate to the target zone (which is scaled to the age of the patient) and keep it elevated. Elevating the heart rate for at least 20 minutes is required to improve cardiovascular strength, burn excess calories, and make noticeable strides in fitness.