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

Background: Swimming is anecdotally recommended by health professionals for management of low back pain; but little is known about the unique considerations for people with chronic low back pain when participating in swimming. Objective: To explore the motivations, facilitators, and barriers to participating in swimming for individuals with chronic low back pain. Methods: Semi-structured focus groups were completed online, including 19 individuals who had completed a structured swimming program facilitated by a physiotherapist. Interview questions focused on motivations for starting a swimming program, facilitators and barriers to early engagement with swimming, and facilitators and barriers to continuing swimming after an initial period of support. Focus group recordings were transcribed, and framework analysis was used. Results: Three major themes were generated. 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. Theme two highlighted how the clinician facilitated participants in building confidence with swimming by providing guidance and keeping participants accountable. 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. Conclusion: Although participants experienced benefits from swimming, continuing to swim was difficult due to multiple practical barriers. Clinicians should discuss these practical barriers to assist patients with making informed decisions before starting a swimming program. Swimming may be a highly suitable introduction to regular exercise, before transitioning to other, more sustainable, exercise modes in the longer-term.