Effects of different breathing patterns combined with core stability exercises in a hybrid telerehabilitation program for chronic nonspecific low back pain: a randomized controlled trial

PURPOSE: To compare the effects of two different breathing-training modalities combined with core stability exercise (CSE) versus CSE alone on pain, function, and related multidimensional outcomes in individuals with chronic nonspecific low back pain within a hybrid telerehabilitation model. DESIGN: Assessor-blinded randomized controlled trial. METHODS: Fifty-four participants were randomly assigned to diaphragmatic breathing plus CSE, abdominal drawing-in maneuver plus CSE, or CSE alone. All received a 4-week hybrid telerehabilitation programme with 3-month follow-up. Primary outcomes were pain intensity and disability. Secondary outcomes included kinesiophobia, health-related quality of life, perceived recovery, proprioception, and postural balance. RESULTS: Compared with CSE alone, both breathing-combined interventions resulted in greater reductions in pain intensity (abdominal drawing-in maneuver [ADIM]+CSE: -0.67; diaphragmatic breathing exercise [DBE]+CSE: -0.98) and greater improvements in functional disability (ADIM+CSE: -1.71; DBE+CSE: -2.25), with partial effects maintained at 3 months. Both intervention groups also showed superior improvements in kinesiophobia, perceived recovery, proprioception, and postural control under eyes-closed conditions. No significant differences were observed between breathing modalities. CONCLUSION: In this small randomized trial, combining breathing training with core stability exercise was associated with greater short-term improvements in pain, functional disability, and selected sensorimotor outcomes than CSE alone. These preliminary findings require confirmation in larger trials.