Research Impact Report - Project 547

Understanding how exercise changes outcomes of importance in patients with low back pain: a realist review of prioritised treatment targets of exercise

Principle Investigator Dr Lianne Wood

Stream Early-Career Research Fellowship

Duration 24 Months

Cost £109,408

Dr Lianne Wood PhD

Lay summary

Impact statement

I am passionate about making a difference to people with LBP. This fellowship will allow me to lead a research team independently and to extend my research training and skillset. I believe exercise is the best treatment we have for patients with LBP, but because we do not understand how exercise creates change on patient outcomes of importance, it is difficult for exercise prescribers to optimise its benefits. This study will provide a programme theory for how exercise works to create effects on LBP. The resulting programme theory and training package can be tested in a future randomised controlled trial with planned mediation analysis to test if implementing this is effective in achieving better outcomes. The programme theory of how exercise works may have potential for application in other MSK persistent pain conditions, and will inform future research and exercise testing for LBP and other pain conditions.

Fundamental problem trying to address


Low back pain (LBP) is a symptom, and is most commonly due to non-specific causes. LBP is a complex condition, and affects a range of factors including physical, psychological and social, that can impact physical function, quality of life and mental well-being37. The best non-drug treatment we have for LBP is exercise, and it has been shown to have broad benefits. However, exercise is frequently prescribed to improve physical problems (like weakness) instead of these broader benefits (like self-confidence) that may actually be more important. Although clinicians prescribing exercise are good at giving out exercises, they do not often prescribe exercise with some of these broader benefits in mind. My previous research highlighted the need to design exercise programs to address these broader targets. This research would help those working with LBP and living with LBP to better understand how to prescribe and use exercise to have optimum impact. 

LBP is leading cause of disability worldwide38, and is experienced by people of all ages37. With increasing and ageing populations, more people are experiencing LBP, and it is the most common musculoskeletal reason for consulting a GP in the UK39. The associated costs of LBP are significant, with impacts on personal financial wellbeing, as well as increasing costs in healthcare and social support systems37. There are no recent incidence estimates for the UK, but previous estimates proposed that 40% of adults had experienced LBP lasting more than one day in the previous year40. In 2008 the estimated cost of treating all types of back pain in the UK exceeded £1000 million pounds a year, suggesting that, in 2021, the cost to the UK society is even greater. This cost has far reaching impacts on individuals, families, workplaces and the economy as a whole.  Exercise in a core recommended treatment but we know very little about how it works or how to maximise patients’ outcomes from exercise.

Aims & Objectives

Intellectual property

Team members & other funders

Prof Nadine Foster (University of Queensland, Australia); Prof Sarah Dean (University of Exeter, UK); Dr Jill Hayden (University of Dalhousie, Canada) and Dr Vicky Booth (University of Nottingham, UK), Dr Andrew Booth, University of Sheffield.



This research project aims to build on previous research published in Treatment targets of exercise for persistent non-specific low back pain: a consensus study – Physiotherapy ( the treatment targets of exercise interventions: do we? | British Journal of Sports Medicine (; and here Exercise Interventions for Persistent Non-Specific Low Back Pain – Does Matching Outcomes to Treatment Targets Make a Difference? A Systematic Review and Meta-Analysis – ScienceDirect



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