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.