Does social support impact on exercise adherence in patients with chronic low back pain?

Introduction:
Initiating and maintaining physical activity (PA) (including participation in exercise) is particularly difficult for at risk groups such as those with chronic LBP. The impact of perceived social support on exercise adherence in people with LBP following discharge from treatment is unclear. This prognostic study therefore aimed to assess whether there is a relationship between perceived social support in individuals who have recently been discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise.
Methods:
This prognostic study employed a secondary analysis of data collected as part of a randomised control trial (RCT) The Buddy Study. Two prognostic outcomes were investigated in this study: the total number of exercise sessions, and the total amount of exercise performed (frequency and duration) in the 6-month follow-up period using count data obtained from weekly diaries. Poisson regression analyses were used to assess the relationship between participants’ perceived level of social support at baseline and the (1) the total number of exercise sessions; and (2) the total amount of exercise performed (frequency and duration) in the 6-month period. Where a relationship was observed, the stata SEM command was used for the mediation analysis.
Results:
After adjusting for covariates, a positive relationship was found between participants perceived social support at baseline and the total number of exercise sessions they performed (IRR: 1.56 p=0.002, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR: 1.57 p=0.027, 95%CI: -1.05 to 2.35) the 6-month follow up period.
For individuals with a social support score of 5 (maximum score for this cohort), the predicted total number of exercise sessions performed in the 6-month follow up period was 107 (p = 0.000, 95% CI: 66.78 to 147.70) and the predicted total amount of exercise performed in the 6-month follow up period was 4034.02 minutes (p = 0.000, 95% CI: 2577.75 to 5490.29).
No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercises sessions performed (β 3.89 p= 0.417, 95% CI: -5.51 to 13.29) or the total amount of exercise performed (β 267.84 p= 0.349, 95% CI: -292.15 to 827.82).
Discussion:
Globally, guidelines for the management of chronic non-specific LBP recommend active treatments. Long term success of LBP management therefore, relies on patient adherence to the exercise advice provided, and yet adherence to home exercise programs is undeniably poor with approximately 50% of patients with chronic LBP non-compliant with home exercise programs.
These results suggest that perceived social support may improve exercise frequency and duration, and therefore, the total number of exercise sessions performed as well as the total amount of exercise performed, in a 6-month period following discharge from treatment.
Impact/Application to the field:
Adherence to advice to increase physical activity for managing LBP is poor and harnessing social support may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP.