Oral Presentation Sydney Spinal Symposium 2026

Barriers and enablers to running in adults with chronic low back pain: a mixed methods study from the ASTEROID randomised controlled trial (141387)

Christopher Neason 1 2 3 , Claire L Samanna 1 2 , Daniel L Belavy 4 , Matthew J Clarkson 5 , Clint T Miller 1 , Ulrike H Mitchell 6 , Niamh L Mundell 1 , David Scott 1 7 , Scott D Tagliaferri 8 9 , Patrick J Owen 2 10
  1. Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
  2. Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
  3. Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
  4. Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
  5. Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
  6. Department of Exercise Sciences, Brigham Young University, Provo, Utah, United States of America
  7. School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  8. Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
  9. Orygen, Parkville, Victoria, Australia
  10. Eastern Health Emergency Medicine Program, Melbourne, VIC, Australia

Aims: To explore predictors of adherence and perceived barriers and enablers to participation following a run-walk interval training intervention in adults with chronic low back pain.

Methods: Twenty adults (10 female, 10 male; mean [SD] age: 33.6 [5.3] years) with non-specific chronic low back pain were randomised to a 12-week digitally delivered run-walk interval training intervention (ACTRN12622001276741). Sociodemographic, clinical, and physical performance measures were assessed at baseline. A stepwise multiple Poisson regression model estimated mutually adjusted incident rate ratios (IRR) for the total number of training sessions completed (adherence) using all statistically significant univariable covariates and employed an adjusted α of 0.10 to enter and 0.20 to remove. Semi-structured qualitative interviews were completed at the 12-week follow-up with a purposive sample of 19 participants.

Results: Mean (SD) adherence was 70.4% (20.4%), equivalent to 2.1 of three sessions per week. Highest level of education (IRR [95%CI]: 0.91 [0.83, 0.98], P=0.021), 30-second single-leg sit-to-stand performance (1.03 [1.01, 1.04], P=0.002), and max single-leg calf raise performance (0.99 [0.98, 1.00], P=0.018) were independently associated with adherence (pseudo R2: 0.14, P<0.001). Reflexive thematic analysis identified three barriers and three enablers. Barriers were: (1) pain and soreness; (2) environmental factors (e.g. weather, daylight); and (3) work, family and lifestyle commitments. Enablers were: (1) self-reported improvements in pain and fitness; (2) achievable and flexible programming; and (3) accountability, structure, and support.

Conclusions: In adults with non-specific chronic low back pain, baseline physical capacity and educational attainment were associated with adherence to a 12-week run-walk intervention. Qualitative findings identified modifiable factors influenced adherence, including symptom responses, environmental and lifestyle constraints, and key intervention features such as program flexibility, structure, and support. Findings may inform strategies to optimise adherence to running-based interventions.