Meta-analysis of core muscle training for chronic non-specific low back pain shows low-quality evidence of benefit

ObjectiveTo systematically evaluate and compare the relative effectiveness of different core muscle training modalities in alleviating pain and improving function in individuals with chronic non-specific low back pain (CNLBP).MethodsChinese and English language databases were systematically searched for randomized controlled trials involving individuals with CNLBP. Intervention groups received core training either alone or combined with other therapies, while control groups received usual rehabilitation or other exercise interventions. Primary outcomes were pain intensity and disability scores. Risk of bias was assessed using the Cochrane RoB 2.0 tool. A random-effects meta-analysis was performed using RevMan 5.4 software, with subgroup analyses conducted to examine the moderating effects of intervention type and intervention duration. Forest plots and funnel plots were generated using MATLAB-R2024.ResultsFifteen randomized controlled trialswere included. Meta-analysis revealed that core training significantly improved pain (SMD = –0.56, 95% CI: –1.08 to –0.03) and function (SMD = –0.81, 95% CI: –1.38 to –0.25). subgroup analyses indicated that combined interventions significantly improved function (SMD = –0.96, P = 0.002), although the test for subgroup differences between combined and single-modality interventions was not statistically significant (P = 0.96), and intervention durations of ≥ 8 weeks were associated with more pronounced analgesic effects. The overall quality of evidence was rated as “low,” primarily due to risk of bias and high heterogeneity.ConclusionCurrent direct comparative evidence suggests that augmenting core training with additional rehabilitative components may confer greater benefits for functional improvement, while extending the intervention duration beyond eight weeks may optimize pain relief. Clinical decisions regarding training modality selection should be individualized based on the patient’s primary treatment goal. Further high-quality research is warranted to strengthen the evidence base for comparisons between specific training modalities.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/view/CRD420251031252], identifier [CRD420251031252].