Sydney Trial Of Prevention: Group based Exercise and Education for Prevention of Low Back Pain: A Feasibility Study

Group exercise and education program Participants in the group ‘exercise and education program’ are to receive a single 1 hour assessment session followed by an 8 week group exercise program that is both graded and progressed, supervised by an exercise provider (registered physiotherapist). The sessions will be conducted once per week and will run for one hour. The program will run at a ratio of between 4 - 10 participants per physiotherapist. The program will also include one-on-one time with the physiotherapist to facilitate the commencement of a home exercise program (HEP) which will build upon the exercise conducted within the sessions and enable continuance of exercises once the supervised group exercise program has been completed. The participants will be provided with a single 30 minute HEP session specifically for addressing any barriers to exercise associated with the home exercise program. This HEP session will occur between group sessions three and five. The exercises / activities implemented as a part of this intervention will focus on four key areas of exercise training identified by the American College of Sports Medicine (cardiorespiratory, resistance, flexibility and neuromotor). All participants will be directed to meet the American College of Sports Medicine’s guidelines for cardiorespiratory exercise with specific resistance, flexibility and neuromotor components implemented according to areas of deficit identified in the initial assessment. The progression of the program will conform to the American College of Sports Medicine’s position statement. Assessment Session The purpose of the assessment session is to enable the exercise provider to determine the appropriate level (quantity, intensity and type) of exercises and general activity most suitable for the participant. Time will also be set aside for the implementation of the HEP. Group Sessions Exercises conducted in the group sessions will be focused on increasing strength, endurance and coordination of the trunk musculature. Specific exercises in the program may focus on a single area or include aspects from two or more areas above and will emphasise performance of functional everyday activities. Exercise providers will work with participants to provide an individualised and graded exercise program that reflects the participant’s physical capacity and the nature of the work, household, social and sporting activities the participant is involved in. All exercises will be conducted using the participant’s current level of fitness and ability as a starting point, and progress using the position statement on Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise as a guide. Exercise providers will use their clinical judgement to determine what aspects of exercise (cardiorespiratory, resistance, flexibility and neuromotor) to concentrate on in the group sessions. Attendance at group sessions will be recorded. Educational component The educational component includes education on basic anatomy and kinesiology, posture and movement, causes and management of low back pain and the benefits of exercise. The delivery of these educational components will be integrated with the provision of exercises such that as the participant is learning to perform the exercise they are also learning the theory behind what they are doing and why it is important to them. This will help in retaining the key principles of both the exercise and the education and assist in self-identification of any possible deconditioning that may occur after the exercise program has been completed. Home exercise program Participants will be given two opportunities to discuss their home exercise program one-on-one with their exercise provider: The first will be during the initial assessment; the second will be at the separate HEP session. The aim of the HEP is to have a program in place that will enable participants to continue exercising beyond the duration of the group exercise program. Compliance with the HEP will be measured using a participant exercise diary.