Background: Low back pain (LBP) occurs in all countries and in all age groups, especially in working population, low- and middle-income countries. Current guidelines recommend graded exercise or physical activity and biopsychosocial framework. Yoga and walking are effective physical activities for chronic low back pain (CLBP). Yoga offers a combination of physical, psychological and spiritual well-being; and walking is low cost, easily performed during daily activities, and requires no special training or supervision. Performed in group, yoga and walking are getting closer to the biopsychosocial framework and require minimal accessories and could be therefore, more economically convenient.

Objective: This study aims to highlight the effectiveness of collective and combined physical activity (yoga plus walking) for non-specific CLBP on impairments, activity limitations and participation restriction in Burundi.

Hypothesis: Collective and combined physical activity could improve functional independence and socio-professional participation better than individual physical therapy sessions in individuals with CLBP.

Methods: In this randomized controlled trial of over 24 weeks (12 weeks of intervention, 12 weeks of follow-up), data of individuals with non-specific CLBP pain will be analyzed. Experimental intervention will be implemented as group-based and combined (yoga plus pedometer-based walking) physical activity sessions (60 min) three times a week for each physical activity. Individual physical therapy sessions (120 min, three times a week) will stand for control intervention. Participants will be assessed before and at the end of the 12-week intervention period, and at the end of the 12-week follow-up period. Assessment will be based on the International Classification of Functioning, Disability and Health (ICF). Pain, abdominal muscles endurance, trunk extensor muscles endurance, depression, fear avoidance and exertion perception will be assessed respectively with 0-10 numerical rating scale, Shirado test, Sorensen test, Beck Depression Inventory, Fear-Avoidance Beliefs Questionnaire, and Borg Rating of Perceived Exertion scale. Activity limitations (primary outcome) will be assessed with Roland and Morris back pain questionnaire, day average number of steps, 6MWT. Participation restrictions will be assessed with 5-Item Pain Disability Index.

Discussion: This trial will investigate the effectiveness of combined walking and yoga for chronic low back pain management. If proven to be effective, this approach will constitute an advance in the management of low back pain with combined and collective physical activity. This program aims to address biopsychosocial aspects of CLBP by using a physical activity program that has physical, psychological and social effects. The outcomes will be incorporated in the presentation in July 2020.

Implications: This study could set up an effective, structured group-based physical activity program that may be a low cost and accessible alternative to physical therapy for people with chronic low back pain; especially from low-incomes countries.

Key words: Chronic low back pain, Yoga, Walking, Randomized Controlled Trial

Funding acknowledgements: This work is supported by ‘Wallonie-Bruxelles International (WBI)’ and ‘Association pour la Promotion de l'Education et de la Formation à l’Etranger (APEFE)’