Individuals with low back pain: how do they view physical activity?

Background. Recent guidelines for those with acute low back pain have advoc ated early resumption of normal activity and increased physical activity. L ittle is known about the relationship between low back pain and physical ac tivity, and on the impact of that relationship on the promotion of increase d levels of physical activity within a general practice population. Objectives. We aimed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave w ith their low back pain, and the impact of those perceptions and behaviour on physical activity. Methods. Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who, because of their low back trouble, had b een referred by their GPs to a community-based, single-blind, randomized co ntrolled trial (RCT) at the University of York, which is evaluating the eff ectiveness and cost-effectiveness of a progressive exercise programme. Fift y-four interviews were conducted with this subgroup of the RCT; four inform ants were interviewed once, 19 twice and four of them three times. Intervie ws were transcribed and analysed using manual and computer-aided approaches . Results. Physical activity was perceived as (i) activities of daily living, (ii) activities causing breathlessness that they went out of the way to do and (iii) more competitive-type activity. The avoidance of physical activi ty and fear of pain returning were the two main factors directly associated with informants' backs and changes in physical activity. These two factors hindered increases in physical activity, even though the majority of infor mants believed strongly that being physically active helped ease their low back pain. Conclusions. When advocating that individuals with acute low back pain retu rn to or increase physical activity, it is important that clinicians identi fy avoidance of physical activity and/or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately. If avoidance of a ctivity and fear of pain is identified and clinicians want to encourage pat ients to take up and sustain increased physical activity, they should explo re issues of fear of pain, and avoidance of and confidence to do physical a ctivities, in addition to other factors influencing physical activity.