José Manuel García-Moreno, Stephan U. Dombrowski, Dresden Forshner, Alex Lui, Erin Bigney, Jillian Kearney, Neil Manson, Christopher Small, Niels Wedderkopp, Jeffrey J. Hébert
Abstract
Degenerative spine conditions and physical inactivity are major public health concerns. Engaging in physical activity before spine surgery may improve postoperative outcomes experienced by patients with lumbar stenosis or lumbar disc herniation. This study aims to identify barriers and facilitators to physical activity among patients with degenerative lumbar spine conditions awaiting surgery.
Introduction
Degenerative spine conditions [1] and physical inactivity [2] are major public health concerns. Low back pain and related disorders remain one of the leading causes of disability worldwide [3]. Lumbar spinal stenosis and lumbar disc herniation are among the most common degenerative spinal conditions contributing to this burden, and both are associated with substantial pain, disability, and reduced quality of life. Lumbar spinal stenosis affects one in five older adults [4,5], and is characterized by functional limitations (e.g., reduced walking capacity due to neurogenic claudication), leg pain, back pain, and numbness or weakness in the lower extremities [6].
Methods
A qualitative study design was chosen as the most appropriate approach to address the research question. While survey-based approaches can quantify the prevalence of barriers and facilitators, they are constrained by predefined response options and may fail to capture the full range and depth of patients’ experiences and perspectives [25]. A qualitative approach, by contrast, allows patients to describe their physical activity behaviour in their own words, revealing nuanced cognitive, emotional, and contextual factors that structured instruments are unlikely to detect [26].
Results
A total of 18 patients (8 female, 10 male) consented to participate. Among these, 11 had lumbar stenosis and 7 had lumbar disc herniation. Demographic and clinical characteristics are presented in Table 1.The 18 interviews were performed in person and online (11 in person and 7 online), and the duration ranged from 18 to 48 minutes, with a mean of 35.5 minutes (SD = 8.2).
Discussion
Principal findings
This study aimed to identify the barriers and facilitators influencing engagement in physical activity among patients with degenerative lumbar conditions awaiting surgery. These patients typically experienced moderate to severe pain and substantial disability, shaping their daily functioning and perceptions of physical activity. Overall, patients described their experiences as a continuous negotiation between limitations and facilitators, reflecting the complex and dynamic interplay of personal, emotional, and contextual factors that characterise physical activity behaviour in this population.
Conclusion
Engagement in physical activity among patients with degenerative spinal conditions awaiting spine surgery is shaped by an interplay of physical, emotional, and contextual factors. By applying the TDF, this study provides a theoretically grounded understanding of these barriers and facilitators. This pattern reveals a self-reinforcing experience where multiple TDF domains coexist: pain and functional limitation co-occurr with diminished beliefs about capabilities, negative beliefs about consequences, an erosion of the physical skills needed to remain physically active, and persistent emotional distress.
Citation: García-Moreno JM, Dombrowski SU, Forshner D, Lui A, Bigney E, Kearney J, et al. (2026) Physical activity barriers and facilitators in patients awaiting spine surgery: A qualitative study. PLoS One 21(8): e0355173. https://doi.org/10.1371/journal.pone.0355173
Editor: Wanli Zang, Soochow University, CHINA
Received: February 3, 2026; Accepted: July 19, 2026; Published: August 4, 2026
Copyright: © 2026 García-Moreno et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Due to the sensitive nature of this qualitative study, full interview transcripts cannot be made publicly available as they contain detailed personal accounts that could potentially identify participants, breaching the conditions of our ethics approval (Horizon Health Network REB #2024-3370 and University of New Brunswick REB #2024-109). However, all relevant data supporting the findings are available within the manuscript and its supporting information files: • De-identified representative quotes are included throughout the Results section. • A summary of the coding framework and the quantitative distribution of quotes per domain is provided in S1 Table. Researchers who meet the criteria for access to confidential data may send requests to the Horizon Health Network Research Ethics Board (Contact: EthicsServices@HorizonNB.ca) or the University of New Brunswick Research Ethics Board (Contact: ethics@unb.ca).
Funding: This work was supported by ResearchNB (https://www.researchnb.ca) and Mitacs (https://www.mitacs.ca) through grant IT40020 awarded to JMG. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: BMI, Body Mass Index; CSORN, Canadian Spine Outcomes and Research Network; COREQ, Consolidated Criteria for Reporting Qualitative Research; EQ-VAS, EuroQol Visual Analogue Scale; GSLTPAQ, Godin-Shephard Leisure-Time Physical Activity Questionnaire; mODI, modified Oswestry Disability Index; SD, standard deviation; TDF, Theoretical Domains Framework.
