Suffer from inexplicable lower-back pain? Exercise may be the best way to keep it away, according to a new analysis of remedies, including workouts, shoe inserts and support belts. 

"We did an evaluation of high quality studies on the prevention of back problem episodes in adults [and] found that, surprisingly, exercise is the only intervention that works, and other popular interventions don't work," says Stanley Bigos, emeritus professor of orthopedic surgery at the University of Washington in Seattle, and lead author of the analysis published recently in The Spine Journal.

Bigos and his colleagues identified 20 trials of nearly 30,000 people between the ages of 18 and 65 on ways to reduce the frequency and severity of lower-back problems. The studies, most of which lasted one to two years, reviewed a range of techniques, including exercise regimens (designed to increase flexibility and strengthen muscles supporting the spine), shoe inserts (to cushion the joints and reduce pressure on the spine), lumbar supports (corset-like belts to support the back and limit its movement), and educational programs to teach people how to move, especially when lifting heavy objects, to limit their chances or wrenching their backs.

Exercises such as lifting free weights and doing leg and trunk lifts to fortify core muscles proved effective at staving off pain, Bigos says. The studies in the review focused mainly on exercises to build muscle strength and endurance – not intense cardio workouts, but Bigos says that speed walking, cycling, and other activities that increase heart rate and improve overall fitness also benefit back health.

This research strongly supports what doctors have long suspected: that physical activity helps prevent low back pain, agrees Daryll Dykes, a spine surgeon at the Twin Cities Spine Center in Minneapolis. Even people with pre-existing low back pain, including those with injuries such as muscle strains, certain minor fractures of the vertebrae (back bones), or small tears in the jellylike disks that cushion the back bones, are likely to benefit from low-impact workouts such as walking and swimming (Most of these injuries heal on their own within weeks, he says). But Dykes cautions that it may be too early to rule out possible benefits of the other interventions examined. 

"I don't think this study definitively concludes that the other factors are not important," he says, noting that he has found that teaching people how to move their backs in ways that minimize jarring, excessive bending and lifting helps them recover from existing back problems and seems to prevent future bouts.

"Having back pain is a part of life, like graying, balding and wrinkling," Bigos says, noting that surveys suggest some 50 percent of the working-age population in the U.S. is limited in some way by lower-back pain at least once a year. (According to the National Institute of Neurological Disorders and Stroke in Bethesda, MD, low back trouble is the most common job-related disability in the U.S.) To keep it in check, he adds: "Stay active, don't get out of shape, and gradually work your way toward [higher exercise goals]."