A new qualitative evidence synthesis published in the Journal of Orthopaedic & Sports Physical Therapy explores the real-world barriers and facilitators to physical activity and exercise among people with chronic low back pain (CLBP). Drawing from 57 qualitative studies across 15 countries and over 2,700 participants, this review provides actionable insights for clinicians and program designers working to improve adherence and outcomes in this population.

Key Findings

Barriers to Physical Activity

• Pain and Fear of Movement: Many patients avoid activity due to pain intensity and fear of reinjury, limiting both the types and amount of movement they are willing to attempt. This fear often leads to avoidance behaviors and withdrawal from treatment programs.
• Lack of Perceived Safety or Interest: Monotonous or unsupervised interventions, lack of perceived improvement, and concerns about the safety or appropriateness of certain exercises reduce engagement.
• Insufficient Information and Support: Patients frequently report not receiving enough clear, empathetic information about their condition, prognosis, or the rationale for exercise. Lack of guidance from both professionals and family members is a significant barrier.
• Occupational and Socioenvironmental Factors: Time constraints, demanding workloads, financial barriers, weather, and lack of access to suitable locations often prevent regular participation in physical activity.

Facilitators for Engagement

• Professional and Social Support: Clear information, encouragement, and supervision from healthcare professionals, as well as support from family and friends, enhance confidence and motivation.
• Understanding Benefits: Knowledge of the physical and mental benefits of activity, and experiencing functional improvements, motivate patients to continue.
• Practical Adaptations: Flexible routines that fit individual schedules, preferences for home-based or locally accessible activities, and adapting to weather or time-of-day preferences help sustain engagement.

Practical Applications

• Patient Education: Clinicians should prioritize providing clear, individualized information about the safety, purpose, and expected benefits of physical activity, addressing common fears about pain and reinjury.
• Therapeutic Alliance: Building a supportive relationship, with regular feedback and encouragement, can boost adherence. Involving family and social networks may further reinforce positive behaviors.
• Tailored Interventions: Programs should be adaptable to patient routines, preferences, and environmental constraints. Varied, enjoyable activities and self-management strategies may improve long-term adherence.
• Addressing External Barriers: Recognizing and problem-solving around time, cost, and environmental challenges—such as recommending home-based exercises or flexible scheduling—can help patients overcome practical obstacles.

Limitations

• Generalizability: Most included studies were conducted in high-income countries and some focused on specific populations (e.g., athletes, veterans, women), which may limit applicability to other groups or settings.
• Study Quality: While most studies had minor methodological concerns, some lacked detailed reporting on researcher-participant relationships or potential biases, which could affect the interpretation of qualitative data.
• Population Diversity: There is a need for more research in low- and middle-income countries and among more diverse patient populations to fully understand global barriers and facilitators.

Takeaway for Practice

To improve physical activity participation among people with CLBP, clinicians should address pain-related fears, provide clear and empathetic information, foster supportive environments, and tailor interventions to individual needs and circumstances. Considering both psychological and practical barriers—and actively involving patients in shared decision-making—can help translate guideline recommendations into real-world adherence and better outcomes.

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Link to original article: https://www.jospt.org/doi/epdf/10.2519/jospt.2025.12905