Abstract
BACKGROUND: Pain is a significant risk factor for cognitive decline in older adults. Chronic low back pain (CLBP) is particularly associated with memory impairment and decreased quality of life. This study aimed to examine the relationship between CLBP and memory impairment and to evaluate the effectiveness of aquarobic exercise as a non-pharmacological intervention. METHODS: A total of 80 older women aged 65 years and above, with CLBP lasting >1 year, were recruited and randomly assigned to an experimental group (n = 68) or a control group (n = 84), using a 40:60 allocation to account for potential dropouts. The experimental group participated in 60-minute aquarobic sessions twice a week for 12 weeks, while the control group maintained a sedentary lifestyle. Participants' characteristics included a mean age of 70.14 ± 1.48 years in the experimental group and 71.07 ± 1.04 years in the control group, with a mean CLBP duration of 8.68 ± 0.31 years and 8.71 ± 0.48 years, respectively. Data were analyzed using independent t-tests, repeated-measures analysis of variance, and structural equation modeling (SEM) to assess changes in mobility limitations, sleep disturbance, and subjective memory impairment. RESULTS: After the intervention, the experimental group showed significant improvements across all measured variables. The Back Pain Disability Index significantly decreased (mean difference = -7.6, 95% CI: -10.5 to -4.9, P < .001), as did sleep disturbance (mean difference = -4.2, 95% CI: -6.8 to-1.5, P < .001) and subjective memory impairment (mean difference = -3.9, 95% CI: -6.1 to -1.7, P < .001). Structural equation modeling further revealed that the improvement in Back Pain Disability Index positively affected sleep and memory outcomes (P < .01), suggesting that physical pain relief mediates cognitive and psychological enhancement. CONCLUSION: Aquarobic exercise significantly improved functional mobility, sleep quality, and memory in older women with CLBP. These findings support aquarobics as an effective, holistic, and non-pharmacological intervention that enhances both physical and cognitive health in the elderly population.