Background: There is some evidence for the effectiveness of exercise therapy and clearer evidence for encouraging physical activity. The Back to Fitness programme was developed with this in mind. It is a simple and inexpensive treatment aimed at increasing normal use of the spine.

Objective: To compare the effects of a group exercise programme with individual physiotherapy for low back pain patients.

Method: Back Pain patients (n=237) referred to physiotherapy departments in a materially deprived part of the North East of England were randomised either to individual physiotherapy as usual or to the Back to Fitness programme. The primary outcome measure was the Roland Disability Questionnaire (RDQ). Secondary measures were the SF12, EQ5D and Pain Self-Efficacy questionnaire. Health care diaries were collected in order to compare the health care costs for the two treatment groups. Patients were followed up 3 months and 12 months after randomisation. Analysis was by intention to treat.

Results: In line with recent studies there were no statistically significant differences between the treatment groups on any outcome measure over time. An economic analysis highlighted the cost savings of the Back to Fitness programme. However, only small improvements in disability (RDQ) scores were observed in either treatment group. This contrasts with recent studies on the effects of individual physiotherapy and exercise therapy, and with previous reports on the effects of the Back to Fitness programme. One explanation may be socio-demographic related. An exploration of the deprivation sub-groups based on the Townsend Index of Material Deprivation suggested that poorer patients may have poorer outcomes.

Conclusions: There were no significant differences at outcome between treatment groups. The exercise programme tended to be slightly beneficial but neither therapy significantly reduced disability. Further research could explore the possible impact of material deprivation on outcome.

Background and Purpose: The purpose of this study was to find out if a sub group of patients might particularly benefit from a structured programme of exercise classes. Such a programme originally designed for chronic back patients, has been further developed for use in the community, and has been shown to have a small but significant effect in reducing disability¹. Recent evidence points to the potentially important role of fear, distress and depression in predicting outcome.

Method and results: A subgroup analysis was carried out on patient outcomes from a randomised controlled trial comparing a ‘Back to Fitness’ programme of exercise classes with usual GP care, in order to test whether patients with high scores on measures of fear-avoidance and distress/depression benefit the most. Data from 179 back pain patients were analysed after categorising baseline scores on fear-avoidance beliefs (high/low) and distress/depression (at risk/normal). The main outcome measure was the Roland Disability Questionnaire. Outcomes were compared between the intervention and control groups at 6 weeks, 6 months and 12 months.

High fear-avoiders fared significantly better in the exercise programme than in usual GP care at 6 weeks and at 1 year. Low fear-avoiders did not. Patients who were distressed or depressed were significantly better off at 6 weeks but the benefits were not maintained long-term.

Conclusion: Patients with high levels of fear-avoidance beliefs could significantly benefit from the Back to Fitness programme. In the clinical setting, it might be worth screening patients for high fear avoidance beliefs and making such a programme available to them.