TYPE Mini Review

PUBLISHED 16 January 2024

DOI 10.3389/fphys.2024.1309663

Clinical effects and biological

OPEN ACCESS mechanisms of exercise on
EDITED BY
Tania Gamberi,
University of Florence, Italy
lumbar disc herniation
REVIEWED BY
Chantal Verkindt, Ziwen Wang 1†, Xindai Liu 2†, Ke Gao 1, Haowen Tuo 1,
Université de la Réunion, France
Xinxin Zhang 1* and Weiguo Liu 1*
*CORRESPONDENCE
1
Xinxin Zhang, College of Physical Education and Health, Guangxi Normal University, Guilin, China, 2College of
[email protected] International Culture and Education, Guangxi Normal University, Guilin, China
Weiguo Liu,
[email protected]
†
These authors have contributed equally to this
work and share first authorship Lumbar Disc Herniation (LDH) is a syndrome in which lumbar disc degeneration,
RECEIVED 08 October 2023 rupture of the annulus fibrosus, and herniation of the nucleus pulposus irritate
ACCEPTED 04 January 2024 and compress the nerve roots and cauda equina, resulting in the main
PUBLISHED 16 January 2024
manifestations of lumbar pain and/or lower extremity pain. There is evidence
CITATION
in various clinical areas that exercise is effective in treating LDH, and exercise
Wang Z, Liu X, Gao K, Tuo H, Zhang X and Liu W
(2024), Clinical effects and biological intervention for more than 2 weeks reduces disease activity in LDH. However, the
mechanisms of exercise on lumbar mechanism of exercise’s action in reducing disease activity in LDH is unclear. In
disc herniation. this article, we first summarize and highlight the effectiveness of exercise in
Front. Physiol. 15:1309663.
doi: 10.3389/fphys.2024.1309663 treating LDH and provide guideline recommendations regarding exercise type,
intensity, frequency, and duration. Then, we integrate the existing evidence and
COPYRIGHT
© 2024 Wang, Liu, Gao, Tuo, Zhang and Liu. propose biological mechanisms for the potential effects of exercise on
This is an open-access article distributed under neuromechanical compression, inflammatory chemical stimuli, and
the terms of the Creative Commons Attribution
autoimmune responses from the perspective of LDH pathogenesis as an entry
License (CC BY). The use, distribution or
reproduction in other forums is permitted, point. However, a large body of evidence was obtained from non-LDH
provided the original author(s) and the populations. Future research needs to investigate further the proposed
copyright owner(s) are credited and that the
biological mechanisms of exercise in reducing disease activity in LDH
original publication in this journal is cited, in
accordance with accepted academic practice. populations. This knowledge will contribute to the basic science and
No use, distribution or reproduction is strengthen the scientific basis for prescribing exercise therapy for the routine
permitted which does not comply with these
clinical treatment of LDH.
terms.

KEYWORDS

exercise, lumbar disc herniation, clinical effect, biological mechanisms, review

1 Introduction
Lumbar Disc Herniation (LDH) is a syndrome in which lumbar disc degeneration,
rupture of the annulus fibrosus, and protrusion of the nucleus pulposus irritate and
compress the nerve root and cauda equina, resulting in lumbar pain and/or lower limb
pain (Zheng et al., 2021). In recent years, the incidence of LDH has been increasing year by
year, and the incidence among young people has been rising due to the long-term use of
sedentary postures for study and work and the reduction of physical activity (Frino et al.,
2006). LDH has caused severe impacts on the daily life and work of patients, and the
increasing incidence of LDH has caused an enormous burden on society (Katz, 2006).
Therefore, the search for a safe, effective, and generalizable method for preventing and
treating LDH is a social problem that needs to be solved by medical practitioners today.
The therapeutic mechanism of LDH is closely related to the recovery of low back muscle
function. As the slow muscle fibres of the paravertebral muscles are significantly reduced in
patients with low back pain, their role in maintaining trunk posture and body position is

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Wang et al.
TABLE 1 Characteristics of included studies.

Study LDH Exercise Clinical effects

patient

Author, Design N, age Intervention group (IG) Control group (CG) JOA ODI VAS ROM NHP Effectiveness of
year or the intervention
Type Frequency Time Type Frequency Time QOL
and and
Duration Duration
Taşpınar G, RCT 54, Pilates exercise therapy 6 weeks × 45–60 min Routines without 6 weeks × 45–60 min ↑ ↑ ↑ After 6 weeks of exercise
et al. (Taşpınar 50.3 ± 6.7 3 sessions doing any exercises 3 sessions × Joint pain (VAS),
et al., 2023) 30 min functional disability
(ODI), and degree of
improvement in mood
depression (QOL) were
significantly improved.
(IG vs CG)

Selim M N, RCT 15, A.Mulligan spinal 4 weeks × NR Transcutaneous 4 weeks × 30 min ↑ ↑ After 4 weeks of exercise
et al. (Selim 48.5 ± 5.8 mobilization with leg 3 sessions electrical nerve 3 sessions × Pain conditions (VAS)
et al., 2022) movement and stimulation and functional status
transcutaneous (ODI) were significantly
electrical nerve improved. (IG vs CG)
stimulation B.
McKenzie and
02

transcutaneous
electrical nerve
stimulation

Deniz RCT 31, Water specific therapy 8 weeks × 60 min Bridging, trunk- 8 weeks × 60 min — — — After 4 weeks of exercise
Bayraktar et al. 41.5 ± 23.5 3 sessions curl, quadrupedal, 3 sessions Pain conditions (VAS),
(Bayraktar side lying, sitting functional status (ODI)
et al., 2016) on a ball and and degree of
standing improvement in mood
depression (NHP) had no
significant effect

Shen zhixiang, RCT 30, Swiss ball exercises and 4 weeks × 30 min Lumbar traction NR NR ↑ After 4 weeks of exercise
et al. (Shen 47.2 ± 11.7 lumbar traction 6 sessions Joint pain (VAS) were
et al., 2009) significantly improved.
(IG vs CG)

Yildirim P, RCT 48, Yoga exercise and 12 weeks × 60 min Patient education 12 weeks × 60 min ↑ ↑ After 12 weeks of

10.3389/fphys.2024.1309663
et al. (Yildirim 37.9 ± 7.5 patient education 2 sessions and routines 2 sessions exercise Pain conditions
and Gultekin., without doing any (VAS), and functional
2022) exercises status (ODI) were
significantly improved.
(IG vs CG)
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(Continued on following page)

Frontiers in Physiology

Wang et al.
TABLE 1 (Continued) Characteristics of included studies.

Study LDH Exercise Clinical effects

patient

Author, Design N, age Intervention group (IG) Control group (CG) JOA ODI VAS ROM NHP Effectiveness of
year or the intervention
Type Frequency Time Type Frequency Time QOL
and and
Duration Duration
Iosub, Monica RCT 77, Vojta therapy and 2 weeks × 80 min Mobility and 2 weeks × 50 min ↑ ↑ ↑ After 2 weeks of exercise
Elena, et al. 50. ± 13.1 procedures, mobility, 5 sessions strength exercises 5 sessions Pain conditions (VAS),
(Iosub et al., strength exercises and and motor control disability level, mobility
2023) motor control exercise exercises (ODI), strength, and
health-related quality of
life (NHP) were
significantly
improved. (IG)

Gulsen, RCT 64, A.Lumbar stabilization 4 weeks × 45 min Without any NR NR ↑ ↑ After 2 weeks of exercise
Mustafa, al. 53.0 ± 14.6 training 5 sessions application Muscle strength and
(Gulsen et al., B.proprioceptive endurance in the lumbar,
2019) neuromuscular pain conditions (VAS),
facilitation C.physical and functional status
03

therapy (ODI) improved

significantly. (IG vs. CG)

Xu, J. et al. (Xu RCT 72, NR Shi-style spine balance 4 weeks × 20 min Lumbar 4 weeks × 20 min ↑ ↑ After 4 weeks of exercise
et al., 2020) manipulation 3 sessions mechanical 3 sessions Pain conditions (VAS)
combined with Daoyin traction and comfort level (ODI)
therapy were significantly
improved. (IG vs. CG)

Zhou Xin et al. RCT 270, Traditional Chinese 6 weeks × 30 min Traditional 6 weeks × 30 min ↑ ↑ ↑ After 6 weeks of exercise
(Zhou et al., 40.0 ± 20.0 exercise combined 3 sessions Chinese massage 3 sessions Pain conditions (VAS),
2022) with massage functional status (ODI),
and lumbar spine
activities (ROM) were
significantly improved.
(IG vs CG)

Khanzadeh, R. RCT 30, Suspension core 8 weeks × 60 min Conventional core 8 weeks × 30 min ↑ After 8 weeks of exercise
et al. 40.3 ± 7.7 stability exercises 3 sessions stability exercises 3 sessions Joint pain (VAS) was

10.3389/fphys.2024.1309663
(Khanzadeh significantly improved.
et al., 2020) (IG vs CG)

França F R et al. RCT 23, Exercises of lumbar 8 weeks × 60 min Electrotherapy 8 weeks × 60 min ↑ ↑ After 8 weeks of exercise
(França et al., 45.1 ± 6.3 segmental stabilization 2 sessions 2 sessions × Joint pain (VAS) and
frontiersin.org

2013) functional status (ODI)

were significantly
improved. (IG vs CG)

(Continued on following page)

Frontiers in Physiology

Wang et al.
TABLE 1 (Continued) Characteristics of included studies.

Study LDH Exercise Clinical effects

patient

Author, Design N, age Intervention group (IG) Control group (CG) JOA ODI VAS ROM NHP Effectiveness of
year or the intervention
Type Frequency Time Type Frequency Time QOL
and and
Duration Duration
Javaheri A H RCT 30, Exercise Therapy and 8 weeks × 60 min No special activity 8 weeks × 60 min ↑ After 8 weeks of exercise
(Javaheri et al., 41.6 ± 5.0 Massage 3 sessions 3 sessions Quality of life (QOL)
2011) improved significantly.
(IG vs CG)

Lu Weiwei et al. RCT 50, Physiotherapy core 8 weeks × 35 min Physiotherapy and 8 weeks × 15 min ↑ ↑ After 6 weeks of exercise
(LU et al., 2014) 43.8 ± 5.6 stability exercise and 6 sessions core stability 6 sessions Pain conditions (VAS),
Proprioceptive exercise muscle strength, and
training comfort level (ODI) were
significantly improved.
04

(IG vs CG)

Dae-Keun RCT 30, Balance center 4 weeks × 30 min three-dimensional 4 weeks × 30 min ↑ After 4 weeks of exercise
Jeong et al. 33.3 ± 9.4 stabilization resistance 3 sessions stabilization 3 sessions Pain conditions and
(Jeong et al., exercise exercise group muscle strength (ODI)
2017) were significantly
improved. (IG)

Liu Ming et al. RCT 120, Conventional traction 2 weeks × 60 min Conventional 2 weeks × 30 min ↑ ↑ After 2 weeks of exercise
(Liu and Gao., 38.72 ± therapy and Mulligan 7 sessions traction therapy 7 sessions Pain conditions (VAS),
2020) 2.37 technique and Swiss Restoration of
ball exercises functionality (JOA), and
living conditions were
significantly improved.
(IG vs CG)

Notes: RCT, randomized controlled trial; JOA, japanese orthopedic association; ODI, oswestry disability index; VAS, visual analog scales; NHP, nottingham health profile; QOL, quality of life; ROM, range of motion; ↑ Indicate clinical effects improved; — Indicate no
significant effect; NR, not reported. Bold values represents the duration of the intervention.

10.3389/fphys.2024.1309663
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Wang et al. 10.3389/fphys.2024.1309663

weakened, and it is easy to have lumbar back muscle fatigue (Mayer extension. Secondly, exercise could be effective in improving quality
et al., 1985). Prolonged lumbar back muscle fatigue will lead to of life, mental health, or sleep status (Javaheri et al., 2011; Taşpınar
dysfunction of the tissue structure that maintains the endogenous et al., 2023) so that patients could maintain a positive and sunny
and exogenous stability of the lumbar spine, thus gradually losing attitude towards the disease without exacerbating the severity of the
the function of maintaining the spine’s stability, leading to or disease activity or particular symptoms. In addition, some specific
aggravating LDH (Stevens et al., 2007). Despite the availability of exercises could enhance muscle coordination, flexibility, and
several surgical and non-surgical measures for treating LDH balance, thus improving the stability of the lumbar spine (França
(Loupasis et al., 1999), previous studies have shown that 85% of et al., 2013; LU et al., 2014; Gulsen et al., 2019). In sum, exercise
patients prefer to be treated in non-surgical treatment (Kreiner et al., interventions positively affect rehabilitation and overall health in
2014). This may be because the two treatments have no significant patients with LDH.
difference in therapeutic efficacy (Yorimitsu et al., 2001). More As shown in Table 1, the effectiveness of exercise interventions
importantly, non-surgical conservative treatment measures may be related to types, duration, intensity, and frequency.
dominated by exercise therapy are highly beneficial in enhancing Regarding exercise types, this study found that the included
the function of lower back muscles (McGill, 1998) The 2007 clinical studies were all based on non-acute self-weighted exercises for
practice guideline “Diagnosis and treatment of lower back pain,” the lumbar and back core muscles and that different types of
jointly published by the American College of Physicians and the exercises had different effects on clinical effectiveness.
Pain Society, states that there is moderately strong evidence that Specifically, Mulligan spinal mobilization with leg movement was
exercise therapy is effective in the treatment of chronic low back pain more effective than the McKenzie method (Selim et al., 2022),
(Chou et al., 2007); The United Kingdom National Institute for lumbar stabilization training was more effective than
Health and Care Excellence guideline issued in 2010 added a proprioceptive neuromuscular facilitation (LU et al., 2014), and
recommendation for conservative treatment as a first-line suspension core stability training was more effective than traditional
treatment and stated that there is strong evidence that exercise core training (Khanzadeh et al., 2020). However, current research
therapy is effective in the treatment of chronic low back pain lacks comparative studies of the effects of multiple exercise-type
(Bernstein et al., 2017); and continued reports have shown that interventions, so the optimal type of exercise is unclear. Regarding
targeted selection of exercise exercises can enhance low back muscle exercise duration, previous studies have shown that exercise training
function and reduce their fatigue (Merritt and Merritt, 2007; Kim for 2–12 weeks or longer significantly improves physical
et al., 2013; Lee et al., 2013; Gürşen et al., 2016; Sipaviciene and performance and reduces the clinical severity of disease in
Kliziene, 2020; Li, 2021). patients with LDH (Yildirim and Gultekin, 2022). However, a 1-
The clinical effects of exercise on LDH have been extensively week exercise intervention was ineffective in patients’ disease
studied. However, to the best of our knowledge, the biological recovery (Li et al., 2022). Therefore, concerning the results of the
mechanisms of how exercise promotes recovery from LDH have current studies, exercise interventions in patients with LDH should
not yet been fully explored. Exploring the underlying biological be at least 2 weeks to enhance physical performance and reduce
mechanisms is essential for understanding the pathogenesis of LDH disease severity significantly. Regarding exercise intensity, the
and proposing new exercise therapies. included studies did not finely classify exercise intensity.
However, previous studies have shown that high-intensity
strength training (1RM ≥ 70%) and aerobic training (maximal
2 Clinical effects of exercise on patients heart rate or maximal oxygen consumption ≥70%) have a
with LDH negative effect on some elderly patients with LDH, producing
symptoms such as joint damage (Saal, 1996). Therefore, the
To summarize the evidence for the clinical effects of exercise in intensity of training should be rationally arranged according to
LDH, we conducted a literature search on PubMed and Google the patient’s condition when providing exercise interventions for
Scholar using keywords (exercise, physical activity, clinical effects, patients, and large-intensity exercise interventions should be
and lumbar disc herniation) to identify relevant trials and review avoided as much as possible. In terms of exercise frequency, Kim
articles. Because there were overlapping trial and review articles, and et al. (Kim et al., 2010) found that the follow-up exercise
some review articles had a specific focus (e.g., a particular type of intervention in 40 patients with LDH found that the patients two
exercise or clinical area). This article only reviews the 15 randomized times/a week had significantly increased their lumbar strength,
controlled trial (RCT) studies published between 2009 and decreased their Oswestry dysfunction index and significantly
2023 from the search results. The characteristics of the included decreased their back pain and leg pain scores. The patients who
articles and the effects of the exercise intervention are shown had one time/2 weeks and those who did not train had significantly
in Table 1. decreased their lumbar strength, suggesting that the frequency of
Exercise has a multifaceted positive impact on the clinical exercise should be kept at least two times/a week in order to have a
outcome of LDH. Firstly, exercise could effectively reduce pain significant effect.
(Shen et al., 2009; França et al., 2013; Gulsen et al., 2019; In conclusion, exercise could improve physical performance,
Khanzadeh et al., 2020; Xu et al., 2020; Selim et al., 2022; reduce pain, improve quality of life, improve mental health and
Yildirim and Gultekin, 2022; Zhou et al., 2022; Iosub et al., 2023; sleep, and relieve lumbar fatigue in patients with LDH. However, it is
Taşpınar et al., 2023), improve lumbar spine motion limitation necessary to investigate further what types of exercise, as well as the
(Zhou et al., 2022; Iosub et al., 2023), and significantly increase duration, frequency, and intensity of exercise, are most effective in
lumbar spine range of motion during forward flexion and backward treating LDH in the future.

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Wang et al. 10.3389/fphys.2024.1309663

FIGURE 1
Biological mechanisms of exercise for lumbar spondylosis.

3 Biological mechanisms of exercise in while decreasing the sympathetic mediator norepinephrine in the
the treatment of LDH vegetative nerves (Jia et al., 2020). This means that the central and
vegetative functions are adjusted. Interestingly, the results of
In recent years, the pathogenesis, diagnosis and treatment of previous studies also found that herniated discs often do not
LDH have been gradually improved through many experimental directly compress the nerve roots but rather cause compression
and clinical studies. Previous studies have concluded that the and congestion of the vertebral veins below the intervertebral
biological mechanisms of LDH pathogenesis are the mechanical foramina, limiting reflux, followed by impaired capillary blood
compression doctrine, inflammatory chemical stimulation doctrine, flow and finally affecting arterial blood supply (Rydevik et al.,
and autoimmune doctrine (Meng et al., 2022). Exercise could 1984; Hoyland et al., 1989). Therefore, vertebral venous stasis is
produce a series of biological responses to the three doctrines important in radicular pain (Parke and Watanabe, 1985). In this
and promote the recovery of LDH (Figure 1). regard, long-term systematic exercise can produce well-adapted
changes in human blood viscosity by appropriately decreasing it
within a certain range (Pichon et al., 2016).
3.1 Biological mechanisms of exercise to Based on the above studies, exercise could improve the function of
reduce mechanical compression of nerves the peripheral tissues of the spine, increase the lumbar spinal space,
reduce and release the extrusion of the protruding material on the
The previous study found that taijiquan exercise positively intervertebral foraminal nerve roots and vertebral organs, prompt the
affected LDH (Deng and Xia, 2018), and both peroneal motor intervertebral disc space to generate negative pressure and reduce the
and sensory nerves were significantly improved (Zou et al., pressure within the lumbar spinal interspace, and effectively improve
2019). This suggests that tai chi exercise improves the stability of the microcirculation of the lesion blocking localization (Lam et al.,
the lumbosacral spine, relieves the compressed lumbosacral nerves 2018). This may be an important biological mechanism for exercise to
to varying degrees, and then improves the conduction function of reduce the mechanical compression of nerves. However, there are no
the peripheral nerves. In addition, previous studies have also shown studies to investigate the effect of exercise on vertebral vein blood
that exercise significantly increased the metabolic level of the central viscosity and other blood characteristics in LDH currently, and further
nervous system mediator 5-hydroxytryptamine (Wipfli et al., 2011) research is needed.

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Wang et al. 10.3389/fphys.2024.1309663

3.2 Biological mechanisms by which (Faelli et al., 2020) found that IL-1β levels were significantly
exercise ameliorates inflammatory reduced after 24 sessions of HIFT training. Hoffman-Goetz et al.
chemical stimuli (Hoffman-Goetz et al., 2010) found that prolonged moderate to
moderate-intensity exercise increased IL-10 secretion. In a study
The innate immune system triggers inflammation once immune by Rahimi et al. (Rahimi and Hormones, 2019), 8 weeks of
cells detect infection or tissue damage (Weyand and Goronzy, 2021). resistance training reduces IL-17 levels. Regular exercise
Previous studies have pointed out that inflammatory mediators and (Alizadeh et al., 2015; Conroy et al., 2016; Karstoft and
related cytokines are essential in LDH (Djuric et al., 2019), with Pedersen, 2016) reduces IL-1β, IL-17 and increases IL-10
tumour necrosis factor-alpha (TNF-α) being a key mediator of the levels. Interestingly, some studies pointed out that the effect of
inflammatory response (Driscoll et al., 1997). In addition, Pelosi exercise on cytokine may be related to the intensity and type of
et al. (Pelosi et al., 2007) found that localized expression of IGF-1 exercise, as Peake et al. (Peake et al., 2005) found that, after
in skeletal muscle by transgenic techniques significantly athletes ran at different exercise intensities, IL-10 was
downregulated the expression of the inflammatory factor TNF-α. significantly increased in the high-intensity group, while there
The study of Wang et al. further demonstrated that the serum levels was no change in the other groups. IL-17 levels increased after
of inflammatory factors (such as IL-6 and TNF-α) were negatively high-intensity running but decreased after free exercise (Duzova
correlated with the levels of IGF-1 (Wang et al., 2019). Therefore, et al., 2009; Cook et al., 2013). Based on the above findings, the
IGF-1 has an inhibitory effect on inflammatory factors such as TNF- present study concluded that exercise may improve LDH disease
α and IL-6. by decreasing the concentrations of IL-1β and IL-6 and
On the other hand, previous studies on exercise interventions increasing the concentration of IL-10. However, the
have shown that exercise could affect IGF-1 levels in skeletal improvement effect may be limited by the intensity or type of
muscle and the circulatory system (Kim et al., 2019; Norling et al., exercise, which could be further explored in future studies.
2020). IGFBP and IGF-1 levels in skeletal muscle were Regarding immunoglobulins, previous studies (Naylor et al.,
significantly upregulated in humans after high-intensity 1975; Kang et al., 1996; Duzova et al., 2009) demonstrated that
aerobic exercise (Kraemer et al., 2017). Resistance training the levels of IgG and IgM were significantly elevated in patients
also raises circulation IGF-1 levels (Rojas Vega et al., 2010), with LDH, and the concentrations of IgG and IgM were positively
with intermittent aerobic exercise being more effective than correlated with the severity of LDH. As with cytokine, few
continuous aerobic exercise (Żebrowska et al., 2018). The previous studies have investigated the effects of exercise on
above studies have amply demonstrated the facilitating effect modulating immunoglobulins in patients with LDH, mainly
of exercise on IGF-1 synthesis, which may be an important focusing on studies in normal populations. Previous studies
biological mechanism by which exercise ameliorates have shown that prolonged high-intensity exercise training
inflammatory chemical stimuli. However, the dependence of reduces IgG, IgM, and IgA concentrations and increases the
IGF-1 on the type, duration, intensity, and frequency of degree of reduction with increasing exercise load (Coppola
exercise is not clear, so it is of great research value to explore et al., 2005). Interestingly, however, a study by Mitchell et al.
the correlation in the future. (Mitchell et al., 1996) showed no significant change in IgG and
IgM concentrations after 12 weeks of moderate-intensity
exercise. In contrast, Nieman et al. (Nieman and Pedersen,
3.3 Biological mechanisms by which 1999) found a significant increase in IgM and IgG
exercise modulates the concentrations after prolonged moderate-intensity exercise.
autoimmune response This could be a difference caused by the different types of
exercise in the two studies. To address the controversial
Few studies have investigated how exercise improves LDH by phenomena in the existing studies, future studies should use
modulating the immune system. However, the mechanisms of the randomized controlled trials to investigate the effects of different
immune system’s action on LDH have been discussed in various types or intensities of exercise on the immunoglobulins of
studies, mainly focusing on cytokine and immunoglobulins patients with LDH and also to investigate further how other
(Naylor et al., 1975; Miyamoto et al., 2000; Shamji et al., immunologically active substances act on patients with LDH, in
2010). Regarding immune factors, previous studies (Miyamoto order to find the optimal exercise therapy.
et al., 2000; Shamji et al., 2010; Al-Obaidi and Mahmoud, 2014;
Djuric et al., 2020) detected the presence of large amounts of IL-
1β, IL-17, and IL-10 in the intervertebral discs of patients with 4 Conclusion
LDH and investigated the mechanism of their action on LDH.
The results showed a significant negative correlation between the Extensive research has focused on the clinical efficacy of exercise
concentrations of IL-1β and IL-17 and the condition of LDH (Al- in treating LDH. Substantial evidence indicates that exercise
Obaidi and Mahmoud, 2014; Tan et al., 2022). At the same time, therapy’s varying types, durations, and intensities are clinically
IL-10, a critical immunosuppressive factor, had a significant effective for LDH, and in particular, that the use of non-acute
positive correlation with the condition of LDH (Uçeyler et al., self-weighted exercise types, exercise durations exceeding 2 weeks,
2007). Although fewer studies investigate the effects of exercise and non-high-intensity exercise therapies could alleviate disease
on modulating cytokine in patients with LDH, many previous activity. Nevertheless, most current literature primarily emphasizes
studies have been conducted in normal populations. Faelli et al. clinical observation. It relies on subjective scoring criteria like VAS

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Wang et al. 10.3389/fphys.2024.1309663

and JOA in its assessment, lacking quantitative and precise Author contributions
observation indexes to improve its credibility. Consequently, this
review begins by examining the pathogenesis of LDH. It proceeds ZW: Writing–original draft. XL: Visualization, Writing–original
to delve into three facets of the biological mechanisms influenced draft. KG: Visualization, Writing–original draft. HT: Visualization,
by exercise: mechanical compression, inflammatory chemical Writing–original draft. XZ: Writing–review and editing. WL:
stimulation, and autoimmunity. Subsequently, this review takes Writing–review and editing.
the pathogenesis of LDH as an entry point to discuss the
biological mechanisms of exercise in three aspects: mechanical
compression, inflammatory chemical stimulation, and Funding
autoimmunity. However, the relevant evidence is mainly based
on non-LDH patients, and the effect of exercise type on the The author(s) declare financial support was received for the
biological response of LDH patients is not yet clear and needs to research, authorship, and/or publication of this article. This study
be further explored. was supported by Guangxi Normal University Cross-disciplinary
projects (2021JC011).

5 Future directions
Conflict of interest
In response to the existing studies, we suggest that the
biological response to exercise should be explored in patients The authors declare that the research was conducted in the
with LDH, and we recommend a long intervention follow-up absence of any commercial or financial relationships that could be
study. Future research directions can be explored in the following construed as a potential conflict of interest.
three areas: 1) The effect of exercise on vertebral venous blood
viscosity and exploring adaptive changes; 2) Exercise plays a
positive role in IGF-1 production, exploring the dependence of Publisher’s note
IGF-1 on exercise mode and intensity and the inhibitory effect of
IGF-1 on the inflammatory factor THF-α; 3) Depending on the All claims expressed in this article are solely those of the authors
intensity and type of exercise, the effects of exercise on other and do not necessarily represent those of their affiliated
immunoreactive substances were further investigated to reveal organizations, or those of the publisher, the editors and the
the potential modulatory effects of exercise on the immune reviewers. Any product that may be evaluated in this article, or
system of patients with LDH and to determine the optimal claim that may be made by its manufacturer, is not guaranteed or
exercise treatment measures. endorsed by the publisher.

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