Effect of lumbar strengthening exercises on kinesiophobia in people with chronic low back pain: a systematic review

Kinesiophobia is a key psychological factor in CLBP and represents a significant barrier to functional recovery. Strength exercises are commonly recommended for CLBP, yet their specific impact on kinesiophobia remains unknown. A systematic review was conducted to evaluate the effectiveness of lumbar strengthening exercises in reducing kinesiophobia in individuals with CLBP. Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, EMBASE) were searched from inception to 18 August 2026. Randomized controlled trials (RCTs) involving adults with CLBP undergoing lumbar strengthening interventions were included. Psychological outcomes were assessed using the Tampa Scale of Kinesiophobia (TSK) and/or the Fear Avoidance Beliefs Questionnaire (FABQ). The Risk of Bias 2.0 tool was used to assess the methodological quality of the included studies, and the GRADE approach was employed to report the overall certainty of the evidence. Three RCTs were included. One trial was judged to be at high risk of bias, while two raised some methodological concerns. Interventions included high- and low-intensity lumbar-extensor strengthening, isolated lumbar-extensor or total-body resistance exercise, and isokinetic trunk strengthening, with comparison groups including waiting-list, non-exercise, core stabilization, and conventional exercise interventions. Intervention duration ranged from 4 weeks to 4 months. Findings on kinesiophobia were inconsistent: two trials found no statistically significant between-group differences, whereas one trial reported significantly greater reductions with isokinetic trunk strengthening compared with both core stabilization and conventional exercise. Overall certainty of evidence was graded as very low. The very-low-certainty of the evidence is insufficient to determine the effectiveness of lumbar strengthening exercises alone for reducing kinesiophobia in individuals with chronic non-specific low back pain. Adequately powered, high-quality randomised controlled trials are needed to determine whether lumbar strengthening exercises produce clinically meaningful reductions in kinesiophobia in this population. PROSPERO: CRD420251121653