Combined and Aquatic Exercise in Chronic Low Back Pain

The goal of this randomized clinical trial is to evaluate the effects of a combined aquatic- and land-based exercise program, as well as an aquatic-exercise program, compared with a control group receiving home-based exercise, on pain, disability, and functional capacity in adults with CLBP. Secondary objectives include examining the effects on fear of movement, anxiety and depression, quadriceps and hand-grip strength, and lumbar mobility. The main question it aims to answer is: "Which type of exercise program is most effective at improving pain, disability, functional capacity, fear of movement, anxiety and depression, quadriceps and hand-grip strength, and lumbar mobility in adults with chronic low back pain?". Participants will perform an aquatic-based exercise program (aquatic group), a combined aquatic and land-based exercise program (aquatic and land group), or a land-based exercise program (home group). Researchers will compare groups to find any differences in pain, disability, functional capacity, kinesiophobia, anxiety and depression, quadriceps and hand-grip strength, and lumbar mobility.

Inclusion Criteria: * all genders; * aged over 18 years; * Chronic Low Back Pain lasting three months or longer and with an intensity of 3 or higher on the Visual Analogue Scale at rest. Exclusion Criteria: * Individuals who refuse to participate or do not provide informed consent; * Pain radiating to the lower limb; * Recent pregnancy or childbirth (less than 8 weeks ago); * Ongoing physical therapy treatments; * Severe rheumatological, neurological, neoplastic, cardiovascular diseases or other conditions that could prevent full participation in the intervention; * History of spinal surgery; * Inflammatory, infectious, or malignant spinal diseases; * Psychiatric disorders that may affect adherence and symptom assessment.