Exercise-Based Interventions for the Management of Low Back Pain in Adolescents in School Settings: A Systematic Review

Background/Objectives: To synthesize the effects of school-based exercise interventions in adolescents with nonspecific low back pain. Methods: PubMed/MEDLINE, Scopus, Web of Science, CENTRAL, PEDro, ScienceDirect, and supplementary sources were searched through 21 May 2026. Randomized and quasi-randomized controlled trials involving adolescents aged 10–19 years and delivering exercise wholly or substantially within schools were eligible. Risk of bias was assessed using Cochrane RoB 1, and findings were synthesized narratively. Results: Of 1935 records, two randomized trials and one quasi-experimental controlled trial (194 allocated participants) were included. Fanucchi et al. reported between-group reductions in past-month pain of 2.2 cm on a 10-cm visual analogue scale (95% CI 1.0–3.5) at 3 months and 2.0 cm (95% CI 0.5–3.5) at 6 months; absolute reductions in 3-month low back pain prevalence were 24% (95% CI 4–41) and 40% (95% CI 18–57), respectively. Jones et al. reported a large effect size for pain severity after 8 weeks (ES = 1.47). Javadipour et al. reported favorable pain and motor-function outcomes, but incomplete and internally inconsistent reporting limited interpretation. No study assessed low-back-pain-related disability using a validated instrument. All studies had high risk of bias in at least one domain, most commonly blinding. Heterogeneity precluded meta-analysis. Conclusions: Limited evidence suggests that school-based exercise may reduce pain intensity and pain prevalence over six months and improve selected physical outcomes in adolescents aged 12–15 years. The small, heterogeneous evidence base and risk of bias preclude conclusions or recommendations regarding modality or dosage.