Motivators, barriers, and facilitators for starting and continuing a swimming program for chronic back pain: a qualitative study.

Participants held positive expectations of swimming for low back pain management prior to starting the program, which were largely fulfilled during their swimming experience.

• Theme one focused on 'participants' positive expectations of swimming for low back pain, enjoyment, and general health, and how this was largely fulfilled in their swimming experience'
• Swimming is anecdotally recommended by health professionals for management of low back pain
• 19 individuals with chronic low back pain who had completed a structured physiotherapist-facilitated swimming program participated
• Data were collected via semi-structured online focus groups and analyzed using framework analysis

Clinician involvement facilitated participants in building confidence with swimming by providing guidance and keeping participants accountable.

• Theme two highlighted 'how the clinician facilitated participants in building confidence with swimming by providing guidance and keeping participants accountable'
• The swimming program was facilitated by a physiotherapist
• Interview questions specifically addressed facilitators and barriers to early engagement with swimming
• Clinician support appeared particularly important during the initial period of swimming participation

Continuing to swim after an initial supported period was difficult despite perceived benefits, due to cumulative practical barriers.

• Theme three focused on 'the difficulty of continuing to swim, despite perceived benefits, due to cumulative practical barriers such as the time, cost, and access'
• Interview questions specifically addressed facilitators and barriers to continuing swimming after an initial period of support
• The barriers were described as 'cumulative,' suggesting multiple factors compounded the difficulty of adherence
• Clinicians are advised to 'discuss these practical barriers to assist patients with making informed decisions before starting a swimming program'

Swimming may be a suitable introductory exercise for people with chronic low back pain before transitioning to other more sustainable exercise modes.

• Authors concluded that 'swimming may be a highly suitable introduction to regular exercise, before transitioning to other, more sustainable, exercise modes in the longer-term'
• Little is known about the unique considerations for people with chronic low back pain when participating in swimming
• 19 participants were included, all of whom had completed a structured swimming program
• The study used qualitative methods, specifically semi-structured focus groups conducted online with framework analysis