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. 2024 Oct 1;165(10):2200-2214.
doi: 10.1097/j.pain.0000000000003234. Epub 2024 Apr 16.

Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence

Yannick L Gilanyi  1   2 , Brishna Shah  1   2 , Aidan G Cashin  1   2 , Mitchell T Gibbs  1   2 , Jessica Bellamy  1 , Richard Day  3 , James H McAuley  1   2 , Matthew D Jones  1   2
Affiliations

Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence

Yannick L Gilanyi et al. Pain. .

Abstract

Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Prisma 2020 flow diagram outlining the study identification, screening, and inclusion processes. CLBP, chronic low back pain.
Figure 2.
Figure 2.
Barries and enablers to exercise adherence at different time points. The horizontal bars represent the exercise time points (pre, during, and/or post-exercise) that barriers and enablers span across.
Figure 3.
Figure 3.
Barriers and enablers mapped to the relevant domains of the Theoretical Domains Framework (TDF).
See this image and copyright information in PMC

References

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