A mixed methods feasibility study of a COMorbidity-adapted Exercise program for older adults with low BACK pain (COME-BACK)

There will be three phases for the single group, comorbidity-adapted exercise program (intervention): diagnostic, development and intervention phases. Diagnostic phase: At Macquarie University, a primary health care practitioner (PHCP) will obtain a thorough medical history, and then perform a physical and functional examination to determine contraindications and restrictions to an exercise program. This is expected to take 45 minutes. Development phase: In the first exercise program session, anticipated to be 60 minutes duration and will be held at Macquarie University, the PHCP will design and tailor the session to adapt the exercise program to the older individual, and provide patient education. The exercise program will be consist of lower extremity and back extensor muscle-strength training, aerobic training, core stability exercises, balance training and lower limb and back stretching based on an inventory. Adapting the exercise program for individual patients will include tailoring the exercise frequency, intensity, timing, and exercise type based on the presenting comorbid condition(s). At this session the PHCPs will provide patient education, explore the participant’s goals, motivations and barriers to an exercise program and provide the participant with paper-based GLA:D Back pain education material. Intervention phase: The exercise program will consist of 16 sessions throughout the eight-week exercise program. There will be two PCHP supervised sessions per week with each session being approximately 60 minutes in duration. Exercise program sessions will be provided in a group exercise session, at Macquarie University. The Borg Rate of Perceived Exertion scale will be used to monitor training intensity during each supervised exercise program session, and it is expected that exercise programs sessions will be of low to moderate intensity. Educational and coaching strategies will supplement the comorbidity-adapted exercise program throughout each supervised session, with adaptation to the exercise program patient directed. Attendance will be recorded at each exercise session throughout the study and adherence to the exercise program will be assessed using an exercise diary to document the proportion of available sessions attended, the completion of each session, whether participants could complete each component of the exercise program (i.e duration and/or repetitions) and whether participants could complete the full duration of the exercise program. After their last session, participants will be interviewed by the research assistant to explore the feasibility of the exercise program and barriers and facilitators to their participation.