By, Luke Pitts – O2X On-Site Specialist
General Training in Rehabilitation
Exercise is a key component of rehabilitation, particularly for chronic low back pain (NSCLBP). Research consistently shows that while no single exercise method is superior, engaging in regular physical activity—whether strength training, flexibility exercises, aerobic fitness, or even walking—can significantly reduce pain and improve function. The focus should be on adherence rather than the specific type of exercise, as all active approaches provide comparable benefits. Additionally, exercise alone or combined with education helps prevent low back pain, reinforcing its essential role in rehabilitation and long-term health.
Figure 3. Cholewicki et al. Journal of Orthopaedic & Sports Physical Therapy. (2019)
As we can see in figure 3, we can see that pain is an incredibly complex problem that many human performance professionals aim to address daily. When we review current evidence we can see that no specific exercise works for every individual when addressing chronic back pain, but rather the general benefits of exercise may and does influence specific factors like pain self-efficacy, pain catastrophizing, cytokine response and inflammation, and many other biopsychosocial factors influencing pain.
Back Pain:
“Exercise intervention programmes involving either muscular strength, flexibility or aerobic fitness are beneficial for non-specific, chronic low back pain (NSCLBP), but not acute low back pain (ALBP), [Most] patients recover [from ALBP] in 4–6 weeks with or without a treatment…NSCLBP pain should not been considered as a homogenous condition meaning all cases are identical. This suggests that a specific intervention programme focusing on one area of fitness for a group of NSCLBP patients may not be appropriate…a general exercise programme which combines muscular strength, flexibility and aerobic fitness would be beneficial for rehabilitation of NSCLBP.” (Gordon and Bloxham 2016) “The current evidence suggests that exercise alone or in combination with education is effective for preventing LBP.” (Steffens et Al 2016)“There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term [for low back pain].” (Smith et Al 2014) “A six-week walk training programme was as effective as six weeks of specific strengthening exercises programme for [reducing chronic pain in] the low back.” (Shnayderman and Katz-Leurer 2012) “Inferential statistics suggest greater improvements at 8 weeks, but not 6 months, for the SEG. Inspection of clinically meaningful changes based on a minimum level of adherence suggests no between-group differences. If a patient with low back pain adheres to either specific trunk exercises or stationary cycling, it is reasonable to think that similar improvements will be achieved.” (Marshall et Al 2013) “Consistencies in responses were seen with acute and chronic exercise and both pro- and anti-inflammatory cytokines. Chronic exercise is associated with a consistent shift towards a more anti-inflammatory cytokine profile (Transforming Growth Factor-beta, and Interleukin-2 and 13, whereas acute bouts of intense exercise can transiently increase pro-inflammatory cytokine levels.” (Cook et Al 2024) “results indicated that sedentary time and light physical activity (LPA) significantly predicted pain inhibitory function on the conditioned pain modulation (CPM) test, with less sedentary time and greater LPA per day associated with greater pain inhibitory capacity…moderate to vigorous physical activity (MVPA) predicted pain facilitation on the temporal summation test, with greater MVPA associated with less TS of pain.” (Naugle et Al 2017)
Injury Rates:
“Aerobic fitness alone predicted future injury after controlling for all risk factors [in service members participating in Initial Entry Training (IET)]” (Kreisel et Al 2025)
General Training for Metabolic Health
Diabetes/Insulin Resistance:
“Insulin action in muscle and liver can be modified by acute bouts of exercise and by regular physical activity…Regular training increases muscle capillary density, oxidative capacity, lipid metabolism, and insulin signaling proteins” (Colberg et Al 2016) “Physical activity (PA) associated with blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.” (Colberg et Al 2010) “Regular exercise is a formidable regulator of insulin sensitivity and overall systemic metabolism through both acute events driven by each exercise bout and through chronic adaptations…exerts many of its metabolic benefit through the liver, adipose tissue, vasculature and pancreas…reduces metabolic disease risk by activating metabolic changes in non-skeletal-muscle tissue.” (Thyfault and Bergouignan 2021) “acute metabolic effects of exercise are mostly due to insulin-independent effects, exercise training may improve muscle insulin sensitivity and is considered a key tool in the prevention and treatment of metabolic disorders.” (Moghetti et Al 2016) “resting muscle metabolism account for part of the variance in metabolic rate among individuals and may play a role in the pathogenesis of obesity.” (Zurlo et Al 1990)
General Training for Physical Performance
How Biking for 4 Minutes Can Improve Your Ruck Time:
Tabata intervals, most commonly performed on a stationary bicycle, consist of 7-8 rounds of 20s effort and 10s rest, completing 8 rounds would equate to 4 minutes of total work.“6- to 12-week Tabata training increases the body’s VO2max by 9.2–15.0%…useful to enhance sports performances that depend on both the aerobic and anaerobic energy-releasing systems for resynthesizing the ATP used during the specific sports.” (Tabata 2019) “Soldiers with a high VO₂ peak showed a lower mean HR and peak BCT throughout the long-distance march [~21 mile], as well as higher performance motivation, no dropouts, and lower energy deficit [compared to low VO₂ peak canidates].” (Oeschger et Al 2022) Ruck performance is highly stressed for SFAS selection: “Road march 2 and road march 1 times accounted for the largest proportion of variance in selection outcome.” (Farina et Al 2019) “ACFT total score and both raw and scaled scores for leg tuck, 2-mile run, and sprint-drag-carry showed significant moderate-to-large associations with Tactical Foot March.” (Withrow et Al 2023)
Exercise For Soreness/Pain Tolerance:
“In pain-free populations, a single bout of aerobic or resistance exercise typically leads to EIH [exercise-induced hypoalgesia], a generalized decrease in pain sensitivity that occurs during exercise and for a short time afterward. EIH is more variable in chronic pain populations and may be impaired in some people, with pain sensitivity remaining unchanged or even increasing in response to exercise.” (Rice et Al 2019) “Pain tolerance increased with higher total activity levels, and more for those who increased their activity level during follow-up. This indicates that not only total PA amount matters but also the direction of change.” (Årnes et Al 2023)
Exercise for Spinal Disc Health:
“Physical activity impacts health and disease in multiple body tissues including the intervertebral discs…Increased dynamic loading through physical activity and decreased static loading from sedentary time benefit intervertebral disc health. Physical activity, particularly vigorous activity, is beneficial in helping maintain intervertebral disc health.” (Bowden et Al 2017)
Exercise for Chronic Disease/Longevity:
“Physical inactivity is a primary cause of most chronic diseases…the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life…conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.” (Booth et Al 2012) “Recreational physical activity independently predicted reduced cardiovascular mortality over fifteen years.” (Dhaliwal et Al 2013)
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About O2X On-Site Specialist Luke Pitts:
Luke Pitts is a highly experienced O2X On-Site Human Performance Specialist, certified in Strength and Conditioning, with over a decade of expertise. His career has involved working with diverse populations including elite military units, Division 1 athletes, professional baseball players, world-champion powerlifters, youth athletes, and the general public. Pitts’ skills encompass comprehensive training and education programs, data science and process optimization, and project management and curriculum development, all aimed at delivering immediate and sustainable improvements in human performance.
About O2X Human Performance:
O2X Human Performance provides comprehensive, science-backed programs to hundreds of public safety departments, federal agencies, and the military. O2X works with clients to elevate culture, improve mental and physical wellbeing, support healthy lifestyles, and reduce healthcare costs associated with injuries and illnesses. Driven by results and cutting edge research, O2X programs are designed and delivered by a team of Special Operations veterans, high level athletes, and hundreds of leading experts in their respective fields of human performance.
