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Cardiovascular Responses to Repetitive McKenzie Lumbar Spine Exercises

S Al-Obaidi, PT, PhD, is Assistant Professor, Department of Physical Therapy, Faculty of Allied Health Sciences, Kuwait University, Kuwait, 90805 (alobaidi{at}hsc.kuniv.edu.kw).
J Anthony, PT, is Instructor, School of Rehabilitation Sciences, University of British Columbia, and Physical Therapist, St. Paul's Hospital, Vancouver, Canada. He was Physical Therapist, Cardiovascular/Cardiorespiratory Team, Kuwait Dalhousie Project, Kuwait, at the time of this study
E Dean, PT, PhD, is Professor, School of Rehabilitation Sciences, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5. Dr Dean was Senior, Cardiovascular/Cardiorespiratory Team, Kuwait Dalhousie Project, at the time of this study
N Al-Shuwai, PT, is Clinical Instructor, Department of Physical Therapy, Kuwait University

Address all correspondence to Dr Al-Obaidi

Background and Purpose. Repetitive exercises of the type recommended by McKenzie for the lumbar spine, such as flexion and extension exercises in standing (FIS and EIS) and lying positions (FIL and EIL), have been used in the management of low back pain for over 20 years. The cardiovascular effects of exercises that involve postural stabilization and the arms and of exercises performed in a lying position are well known. Therefore, the purpose of this study was to examine the cardiovascular effects of 4 exercises used in the McKenzie system. Subjects and Methods. One hundred subjects without cardiovascular or cardiopulmonary disease (mean age=31 years, SD=6.1, range=22–44) and who were representative of people susceptible to low back pain were studied. Subjects were randomly assigned to 1 of 4 exercise groups (ie, FIS, EIS, FIL, and EIL). Subjects performed sets of 10, 15, and 20 repetitions of the assigned exercise, with a 15-minute rest between sets. Heart rate, blood pressure, and rate-pressure product (an index of myocardial work) were recorded before and after each set of repetitions. Results. After 10 repetitions, flexion and extension in lying were more hemodynamically demanding than in standing. This trend persisted for 15 and 20 repetitions; however, at 20 repetitions, the hemodynamic demands were different across exercise groups (ie, FIL>EIL>FIS>EIS). Discussion and Conclusion. Repetitive exercises of the type suggested by McKenzie for the lumbar spine can have cardiovascular effects in people with no cardiovascular or cardiopulmonary conditions. These effects may be important with respect to cardiac work, and patients for whom these exercises are indicated should have a cardiac and pulmonary risk factor assessment to determine whether heart rate and blood pressure should be monitored.

Key Words: Blood pressure • Cardiovascular responses • Extension in lying • Extension in standing • Flexion in lying • Flexion in standing • Heart rate • Low back pain • McKenzie lumbar spine exercises • Rate-pressure product • Repetitions

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