Physical activity and exercise for the management of chronic low back pain as a component of multimorbidity: from problem to practice

BACKGROUND: Multimorbidity, characterized by the presence of two or more long-term health conditions, has emerged as a significant health challenge. People with chronic low back pain (CLBP) often live with one or more other long-term health conditions, and this is associated with higher medical costs and worse outcomes. There is a growing need for effective management of multimorbidity in the context of CLBP, but clinicians currently receive limited guidance on how best to do so. Exercise is an evidence-based strategy for the management of both CLBP and associated long-term health conditions, though the way it is prescribed for CLBP differs from that for other chronic diseases. This may limit its effectiveness for managing co-morbidities alongside CLBP. OBJECTIVE: The aims of this masterclass are to: 1) describe the prevalence and impact of multimorbidity in the context of CLBP; 2) discuss the role of physical activity and exercise in the management of CLBP as a component of multimorbidity; 3) provide practical recommendations for clinical practice to improve assessment and management of CLBP as a component of multimorbidity; and 4) discuss future research directions to improve management of people with CLBP as a component of multimorbidity. DISCUSSION: We discuss how clinicians can modify their management of people with CLBP to also address other co-occurring, long-term health conditions through physical activity and exercise. We provide considerations for assessment, as well as examples of how to adjust exercise approaches for people with CLBP who also have additional long-term health conditions.