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Participants underwent magnetic resonance imaging at baseline and post-intervention to assess paraspinal muscle volume (cm3) and fatty infiltration (% FI) at L3-L4, L4-L5, and L5-S1. Pain, disability, quality of life, pain-related fear (catastrophizing and Kinesiophobia), and anxiety were assessed via validated self-reported questionnaires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mixed-design ANOVA revealed no significant time \u00d7 group interactions for paraspinal muscle volume and %FI. An exploratory analysis revealed a significant increase in multifidus %FI in the control group at L3-L4, L4-L5, and L5-S1, with a concomitant increase in multifidus volume at L3-L4 and L5-S1. The exercise group had a significant increase in multifidus %FI and volume at L5-S1. Significant time \u00d7 group interactions for pain, disability, catastrophizing and kinesiophobia, and a main effect of group in physical and mental health were found. Significant correlations were found between changes in patient-reported and functional outcomes with paraspinal muscle morphology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Multimodal exercise programs may help prevent LBP-related paraspinal muscle atrophy and %FI, and lead to concomitant improvements in pain, disability and pain-related fear in individuals with CLBP.\n                      \n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09593020261419928","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:29:23Z","timestamp":1773926963000},"page":"127-144","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of a multimodal exercise program on paraspinal muscle morphology and clinical outcomes in chronic low back pain"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6126-7310","authenticated-orcid":false,"given":"Brent","family":"Rosenstein","sequence":"first","affiliation":[{"name":"Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0343-8900","authenticated-orcid":false,"given":"Maxime","family":"Bergevin","sequence":"additional","affiliation":[{"name":"\u00c9cole de kin\u00e9siologie et des sciences de l'activit\u00e9 physique (EKSAP), Facult\u00e9 de m\u00e9decine, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"},{"name":"Centre de recherche de l'Institut universitaire de g\u00e9riatrie de Montr\u00e9al (CRIUGM), Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Bobeuf","sequence":"additional","affiliation":[{"name":"Centre de recherche de l'Institut universitaire de g\u00e9riatrie de Montr\u00e9al (CRIUGM), Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2258-8194","authenticated-orcid":false,"given":"Louis","family":"Bherer","sequence":"additional","affiliation":[{"name":"Centre de recherche de l'Institut universitaire de g\u00e9riatrie de Montr\u00e9al (CRIUGM), Montreal, Quebec, Canada"},{"name":"D\u00e9partement de m\u00e9decine, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"},{"name":"Centre de Recherche, Institut de Cardiologie de Montr\u00e9al, Montreal, Quebec, CanadaCentre de Recherche, Institut de Cardiologie de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9302-5183","authenticated-orcid":false,"given":"Benjamin","family":"Pageaux","sequence":"additional","affiliation":[{"name":"\u00c9cole de kin\u00e9siologie et des sciences de l'activit\u00e9 physique (EKSAP), Facult\u00e9 de m\u00e9decine, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"},{"name":"Centre de recherche de l'Institut universitaire de g\u00e9riatrie de Montr\u00e9al (CRIUGM), Montreal, Quebec, Canada"},{"name":"Centre interdisciplinaire de recherche sur le cerveau et l\u2019apprentissage (CIRCA), Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3335-445X","authenticated-orcid":false,"given":"Mathieu","family":"Roy","sequence":"additional","affiliation":[{"name":"School of Health, Concordia University, Montreal, Quebec, Canada"},{"name":"Alan Edwards Centre for Research on Pain (AECRP), McGill University, Montreal, Quebec, Canada"},{"name":"Department of Anesthesiology, McGill University, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1189-3591","authenticated-orcid":false,"given":"Maryse","family":"Fortin","sequence":"additional","affiliation":[{"name":"Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada"},{"name":"School of Health, Concordia University, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_3_3_2_2","article-title":"The global epidemic of low back pain","volume":"5","author":"The Lancet R","year":"2023","unstructured":"The Lancet R. 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