Two facts are well-known about chronic low back pain (LBP). 1) Exercise helps. 2) People quit exercising after a while. In this study researchers from the University of Vienna in Austria look at the long-term effect of combining exercise with a motivational program for patients with LBP.

Two groups of patients were included in this study. One group (control) did the standard exercise program. The second group was given the same exercises plus counseling. They also were given information, positive feedback, and a treatment contract. And they kept an exercise diary.

Everyone was seen one-on-one by a physiotherapist for 10 sessions. Everyone was rechecked at three and a half weeks, four months, 12 months, and five years. Measures of success included pain, disability, and working ability.

The authors reported a big difference between the two groups. Both groups had better function and less disability. But the motivational group had more than twice the improvement. Patients in the motivational group were the only ones to show improved work ability after five years.

It appears that unsupervised exercise at home just doesn't work for people with low back pain. Motivation and support does increase compliance with an exercise program.

The authors suggest two reasons for this finding. First, patients had a set of tools that could be used easily in the future. Second the extra motivational program may have helped patients do the exercises correctly instead of just doing them regularly.

Martin Friedrich, MD, et al. Long-Term Effect of a Combined Exercise and Motivational Program on the Level of Disability of Patients with Chronic Low Back Pain. In Spine. May 1, 2005. Vol. 30. No. 9. Pp. 995-1000.