Objectives: To investigate participant experience of exercise programs for non-specific chronic low back pain (NSCLBP) and factors perceived to be important for engagement and participation.

Methods: Qualitative methods with three focus groups facilitated by an independent, experienced facilitator.

Participants: Eighteen people (> 18 years) who could speak, read and understand English and who had participated in an exercise program for NSCLBP.

Design: Participants were guided with a set of pre-determined questions and encouraged to give personal opinions freely. Data were transcribed verbatim, read independently by 2 researchers and analysed thematically using grounded theory.

Results: All focus group results concurred. Enablers for exercise participation included shared decision-making and effective communication; a history of exercise or fitness experience; individualised and supervised programs in a preferred environment; family support; variety and fun; motivation strategies; education and explanation. Barriers included lack of time, cost, boredom, symptom aggravation, consequences of stigma and dissatisfaction with formal exercise and gym ‘culture’. Perceived benefits of exercise were improved general fitness, a sense of achievement and increased activity, participation and social engagement. These results have informed the development of a clinician checklist for exercise program design that includes shared decision-making. A draft questionnaire for participant exercise preferences is also proposed.

Conclusion: People are likely to prefer and participate in exercise programs that are designed with consideration of their preferences, circumstances and past experiences. A mechanism for systematically recruiting information about patient preferences has not previously been proposed. Items suitable for inclusion in such an instrument are presented.