title: What are patient beliefs and perceptions about exercise for nonspecific chronic low back pain? A systematic review of qualitative studies.
abstract: OBJECTIVE
  The global burden of low back pain is the highest ranked condition contributing to years of living with disability. Exercise is moderately effective, and adherence to exercise may improve if participants are engaged. Identification of elements that enhance engagement would enable clinicians to prescribe appropriate interventions. The review objective was to identify and synthesize qualitative empirical studies that have explored beliefs about exercise therapy of people with nonspecific chronic low back pain.
  
  
  METHODS
  Two independent reviewers conducted a structured review and metasynthesis informed by Cochrane and Campbell Collaboration guidelines and the PRISMA statement. Fifteen papers were included for data extraction, method quality assessment, and thematic analysis.
  
  
  RESULTS
  Four key themes emerged: (1) perceptions and classification of exercise; (2) role and impact of the health professional; (3) exercise and activity enablers/facilitators; (4) exercise and activity barriers. Participants believed that there were distinctions between general activity, real/fitness exercise, and medical exercise. Levels of acquired skills and capability and participant experience with exercise culture require consideration in program design. People participating in exercise classes and group work may be more comfortable when matched for abilities and experience. When an intervention interferes with everyday life and appears to be ineffective or too difficult to implement, people make a reasoned decision to discontinue.
  
  
  CONCLUSIONS
  People are likely to prefer and participate in exercise or training programs and activities that are designed with consideration of their preferences, circumstances, fitness levels, and exercise experiences.
authors.affiliation: *Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia †Warwick Medical School, Clinical Trials Unit, Coventry, UK.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Slade
authors.forename: Shilpa
authors.initials: S
authors.lastname: Patel
authors.forename: Martin
authors.initials: M
authors.lastname: Underwood
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Keating
mesh_terms: D000328:Adult; D015444:Exercise / Q000523:psychology*; D005081:Exercise Therapy / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged