Factores físicos asociados a la adherencia en el ejercicio terapéutico en adultos con dolor lumbar crónico inespecífico: revisión sistemática

Abstract

Nonspecific chronic low back pain (NCLBP) is one of the leading causes of disability worldwide, with a significant impact on quality of life and high socioeconomic costs. Therapeutic exercise is considered the most recommended intervention in clinical guidelines; however, its effectiveness is strongly conditioned by patient adherence. Previous studies have identified psychological and social factors as determinants of adherence; however, there is a knowledge gap regarding physical factors. A systematic review was conducted following the PRISMA statement, with searches in PubMed and Cochrane, considering publications published bet- ween 2015 and 2025, in both English and Spanish. Randomized clinical trials, observational studies, cohort studies, and qualitative studies that analyzed physical factors related to adherence in adults with NCLBP were included. Methodological quality was assessed using the MMAT (2018) tool, and findings were synthesized using thematic analysis. Of 102 records identified, six studies met the inclusion criteria, with a total of 386 participants. The results generated through thematic analysis were three main themes: (1) characteristics of the exercise program, where supervised, individualized, progressive, and varied programs favored adherence, in contrast to technical complexity and monotony, which were related to program dropout; (2) patient physical condition, where low physical capacity, fatigue, and comorbidities limited continuity, in contrast to improved physical condition, which was associated with greater adherence; (3) physiological responses to exercise, where early pain reduction and strength gain acted as facilitators, while post-exercise pain and fatigue were frequent causes of dropout. In conclusion, adherence to therapeutic exercise in adults with CLID is influenced by multiple physical factors that may act as facilitators or barriers. These findings reinforce the need to design individualized, supervised, and progressive programs and to incorporate future research with prolonged follow-ups and standardized measures of adherence to optimize the effectiveness of interventions.