Evidence-Based Physical Activity Prescription and Low Back Pain

Part of a series of Spine Tuesday Webinars.

The recent EUROSPINE webinar, part of the Spine Tuesday series, provided a comprehensive overview of "Evidence based physical activity prescription and low back pain" with insights from two speakers: Dr Pocovi presenting her research on the Walk Back trial recently published in The Lancet.
We also had Dr Nicole Linder who presented her qualitative study (a study based on in-depth interviews) on patients and primary care physicians’ experience of prescribing physical activity for chronic back pain.

Dr Pocovi – The Walk Back Trial and Preventing Recurrence

The concept of a high rate of recurrence of back pain in those who had recovered from back pain was noted, and a lack of evidence in the field of prevention. Systematic reviews (careful reviews of many past studies) have found evidence to support exercise or exercise and education to prevent recurrence of pain. A lot of these were gym/group based.
The Walk Back trial was set up to see if a progressive walking programme would be effective. They recruited over 700 patients in Australia with a previous episode of back pain who had recovered – half were control, the other half had the walking intervention, which was individualised to the patient.
They found the intervention group (the group that followed the walking plan) had fewer recurrences (28% reduction), and it took longer for them to occur – by a factor of almost double. Interestingly, the programme had other effects on sleep, weight, and stress levels.

Dr Linder – Perspectives from Primary Care

And on to Dr Linder, who looked at activity for back pain from a primary care perspective in Germany.
The study was done with detailed interviews between GP and patient.
The study noted nearly all participants had a positive view on physical activity for chronic back pain. The study looked at barriers and how to overcome these to increase physical activity.
Barriers to undertaking activity might be physical, psychological, or due to pain elsewhere.
Patients mentioned being too busy and a lack of family support.
Ideas to increase physical activity included fitness trackers, commitment, and group sessions.
They found a lot of patients were worried about exercise causing low back pain, and a lot of education was around easing concerns that exercise will not cause damage to their back.

Shared Conclusions and Implications for Practice

The overall conclusions from both studies were that education is key – exercise is important and it will not do more damage. Walking was chosen because it is accessible and is a good starting point for getting more active. Education allows the patients to continue to keep the physical activity going and work around the barriers described.
The importance of keeping active even if there is a flare-up was emphasised.

Key Learnings:

• Recurrence of low back pain is common; prevention through physical activity is essential.

• The Walk Back trial showed that a personalised walking programme can reduce recurrence by 28% and delay onset of new episodes.

• Additional benefits of walking interventions include improved sleep, stress reduction, and weight control.

• Most patients and GPs support physical activity as part of chronic low back pain management.

• Key barriers to activity include physical limitations, psychological concerns, competing priorities, and lack of support.

• Tools such as fitness trackers, group activities, and patient commitment help increase adherence to physical activity.

• Fear of exercise causing harm is common; patient education is vital to dispel these misconceptions.

• Walking is accessible and can serve as a gateway to broader physical activity.

• Maintaining physical activity during flare-ups is crucial and should be encouraged.

Written by Patient Line Committee Member Simon Clark.