Chronic low back pain (cLBP) is a pervasive condition that affects millions of people globally, posing a significant challenge for those seeking effective treatment and management strategies. As fitness professionals, understanding the intricacies of cLBP, including the interplay between physical and psychological factors, is crucial for designing effective exercise programmes. A recent study titled “Relationship between Fear-Avoidance Beliefs and Reaction Time Changes Prior to and following Exercise-Induced Muscle Fatigue in Chronic Low Back Pain” provides valuable insights into how exercise-induced muscle fatigue impacts reaction times and the role of fear-avoidance beliefs in this process. This article will delve into the study’s findings and discuss practical applications for fitness professionals aiming to optimise strength training and low back pain management for clients of various ages.

Study Overview

The study aimed to explore the relationship between fear-avoidance beliefs and changes in reaction time before and after exercise-induced muscle fatigue in individuals with cLBP. It was conducted by a team of researchers from several medical and rehabilitation departments, including the First Affiliated Hospital of Sun Yat-Sen University and Guangzhou First People’s Hospital.

Chronic low back pain is often associated with prolonged neuromuscular reaction times, which can exacerbate the condition and hinder rehabilitation efforts. Reaction time, a measure of neuromuscular control efficiency, includes total reaction time (TRT), premotor time (PMT), and electromechanical delay (EMD). Previous studies have shown that psychological factors, such as fear-avoidance beliefs, can influence these reaction times. However, the specific effects of exercise-induced muscle fatigue on reaction times in cLBP patients and its correlation with fear-avoidance beliefs had not been thoroughly investigated.

The study involved 25 patients with chronic low back pain. The participants were subjected to the Biering-Sorensen test (BST) to induce muscle fatigue. Reaction times were measured using surface electromyography (s-EMG) during an arm-raising task with visual cues, both before and after muscle fatigue. The Fear-Avoidance Beliefs Questionnaire (FABQ) was used to assess the participants’ psychological attitudes toward physical activity and work-related activities.

The Results

  1. Prolonged Reaction Times: The study found that both total reaction time (TRT) and premotor time (PMT) were significantly prolonged after the participants experienced exercise-induced muscle fatigue. However, the electromechanical delay (EMD) did not show a statistically significant change.

  2. Correlation with Fear-Avoidance Beliefs: The changes in TRT and PMT were positively correlated with the FABQ scores. This means that participants with higher fear-avoidance beliefs experienced greater delays in their reaction times after muscle fatigue.

These findings suggest that both the physical effects of muscle fatigue and the psychological impact of fear-avoidance beliefs play significant roles in the neuromuscular control processes of individuals with cLBP.

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Practical Applications

For fitness professionals, these insights can be pivotal in designing and implementing effective training programmes for clients with chronic low back pain. Here’s how this information can be applied:

  1. Understanding Muscle Fatigue Impact: Recognise that muscle fatigue can significantly impair reaction times in clients with cLBP. This understanding should inform the pacing and intensity of exercises. For instance, incorporating adequate rest periods and avoiding excessive fatigue during workouts can help maintain optimal reaction times and reduce the risk of injury.

  2. Integrating Psychological Assessments: The positive correlation between fear-avoidance beliefs and reaction time delays underscores the importance of addressing psychological factors. Fitness professionals should consider using tools like the FABQ to assess clients’ psychological attitudes toward physical activity. This can help in identifying individuals who may benefit from additional psychological support or interventions.

  3. Tailoring Exercise Programmes: Develop exercise programmes that gradually build muscle endurance and strength, while minimising the risk of inducing muscle fatigue. Start with low-intensity exercises and progressively increase the difficulty as the client’s endurance improves. This approach helps in enhancing neuromuscular control without overloading the muscles.

  4. Holistic Approach: Adopt a holistic approach that includes physical training, psychological support, and lifestyle modifications. Collaborate with healthcare providers, such as physical therapists and psychologists, to create comprehensive management plans that address both the physical and psychological aspects of chronic low back pain.

  5. Educating Clients: Educate clients about the importance of balancing physical activity with adequate rest and psychological wellbeing. Encourage open communication about their pain levels and psychological concerns and adjust their exercise programmes accordingly.

  6. Adapting for Different Age Groups: Consider the age-related differences in muscle strength, endurance, and psychological resilience. Younger clients might adapt more quickly to strength training and psychological interventions, while older clients may require more gradual progression and consistent monitoring.

This study highlights the complex interplay between physical fatigue and psychological factors in managing chronic low back pain. For fitness professionals, integrating these insights into practice can lead to more effective and comprehensive treatment strategies. By understanding the impact of muscle fatigue on reaction times and addressing fear-avoidance beliefs, fitness professionals can better assist their clients in managing chronic low back pain, ultimately improving their quality of life.


Xiao, W., Yang, H., Hao, Z., Li, M., Zhao, M., Zhang, S., Zhang, G., Mao, H., & Wang, C. (2024). Relationship between Fear-Avoidance Beliefs and Reaction Time Changes Prior to and following Exercise-Induced Muscle Fatigue in Chronic Low Back Pain. Pain Research and Management, 2024, Article ID 9982411. Click here to review the full research article.

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