Your study showed that group-based exercise had sustained benefits for pain and disability. What do you think makes group-based exercise particularly effective for older adults with chronic non-specific low back pain? 

Group exercises address the mechanisms causing the physical and psychological changes older adults experience and have the ability to promote social interaction. 

Thus, group exercise targets all domains of the biopsychosocial model. 

This type of comprehensive care is an effective form of pain management. 

The effect on falls was unclear at eight weeks but showed a promising trend at later time points. 

Could you elaborate on why this might be and whether a longer or more intensive exercise program could enhance fall prevention? 

After eight weeks the number of falls among the participants was small, which directly affects the effect estimates. 

When a greater number of falls are observed, the effect estimate tends to appear more promising. 

Longer protocols may show a greater effect on reducing the number of falls due to the extended training time and higher number of fall events recorded. 

Brazilian physiotherapist and researcher Dr Hytalo Silva is investigating group-based exercise for low back pain in older adults

Your trial adapted exercises based on feasibility testing and participant feedback. What were the most important adaptations you made and how did they influence adherence and outcomes? 

The main adaptations involved reducing fall risk factors and modifying the ground exercises to be performed when sitting or standing. 

We also incorporated regular opportunities for free conversation and social gatherings to increase the bond between participants. 

Fear of falling did not improve with the intervention, despite improvements in pain and physical activity. 

What might explain this and how could future interventions better target fear of falling? 

Issues that go beyond physical activity (ie, psychological or cognitive barriers) can influence fear of falling. 

Implementing psychotherapies could be essential to address key issues to improve this outcome. 

Given that exercise adherence was relatively high in your study, what specific strategies did you find most effective in keeping older participants engaged and motivated? 

Participants contributed to the protocol by feeling part of the treatment process. 

There was a strong connection between the group and a sense of collaboration among participants. In addition, adapting the exercises to individual physical abilities prevented participants from feeling embarrassed for not being able to perform certain activities. 

How do you see these findings being translated into clinical practice? What are the key barriers to implementing group-based exercise programs for older adults in primary healthcare settings? 

This protocol has proven to be viable in the primary healthcare environment and is easy to apply and low cost. 

The main barriers are physical and mobility limitations; for this reason, the activity should be carried out as close as possible to the participants, not only in a community centre but also in several locations considering the limited mobility of this population. 

>> Hytalo Silva is a physiotherapist with a Master of Rehabilitation and Functional Performance and a PhD in Health Sciences from the Universidade Federal dos Vales do Jequitinhonha e Mucuri. 

Click here to read the study.

Course of interest: 

Stepping up clinical care of back pain through deliberate practice: key tools for clinical diagnosis and management