Dr. Eugene Wai, MD, FRCSC, is an orthopedic surgeon who specializes in the care of adult spinal disorders. He is also an Associate Professor in the Department of Surgery at the University of Ottawa. In addition he is the Research Chair for the Canadian Spine Society.
Denise C. Lawrence Wai BScPT is a Physical Therapist in Ottawa and a Research Assistant at The Ottawa Hospital.
Susan Yungblut, PT, MBA Physiotherapist, Liquidgym, Ottawa; Nordic Walking Instructor and Urban Poling Master Trainer, OttawaNordicWalks; Past Director, Exercise is Medicine Canada.
R. Michael Galbraith, DO, CCFP (SEM), Dip Sport Med Private practice Elite Sports Medicine in Lethbridge, AB.. Head Team Physician, Lethbridge Hurricanes (WHL). Clinical Lecturer, Dept of Family Medicine, University of Calgary School of Medicine.
Ted Findlay, DO, CCFP, FCFP is a Clinical Assistant Professor in the Department of Medicine at the University of Calgary. He is also in a Private Family Medicine practice. In addition he is on Medical Staff at Alberta Health Services, Calgary Zone in Calgary, Alberta.

Abstract
Exercise is one of the most effective and simplest evidence-based recommendations to manage acute and chronic back pain. This paper discusses the physiology and evidence to support exercise as effective treatment. We will provide guidance on how to assess and prescribe exercise and offer methods to educate and encourage physical activity for patients with back pain.
Key Words: Back Pain, Physical Activity, Exercise Prescription, Motivational Interviewing.

Clinical Case
Kevin is a 43 year-old software engineer who presents to your office with a new complaint of low back pain that he first noticed 5 days ago when reaching for his slippers. His pain rapidly increased and began to spread to his left leg. He is severely limited with his ability to sit comfortably. Currently, his back pain radiates down the left leg to the lateral aspect of the foot. The leg pain is worse than the pain in the back. He denies bowel or bladder difficulties. He is otherwise healthy.

Kevin has had occasional episodes of low back pain since he was in his 20s, when he was a college football player. Since starting his career in software engineering, he has not maintained his previous fitness levels and his job requires prolonged sitting without breaks. His Exercise Vital Sign (See below in How to Assess) is currently 0.¹

On examination, he has bilateral iliolumbar muscle spasms. His lumbar active range of movement is markedly limited. Flexion reproduces his leg pain. He has a positive left straight leg test with reproduction of his typical leg dominant pain. There is mild weakness with left ankle plantar flexion and decreased left ankle reflex. The rest of his physical exam is non-contributory.

Clinically, you suspect an S1 radiculopathy. You are aware of the TOP guidelines that recommend no MRI imaging be performed in the acute phase even in the presence of radiculopathy unless there are clinical red flags.² You are also aware of the TOP recommendations for patient education and promotion of exercise.
What exercise recommendations would you give to Kevin?