Background Physical inactivity is a substantial public health concern and a particularly challenging problem to address. Physical activity is shown to be of therapeutic benefit to those living with chronic pain, but intervention studies have often been unsuccessful in promoting sustainable engagement with physical activity in this population.

Aim To develop a more comprehensive understanding of the barriers to engaging with sustainable physical activity and the facilitators that promote this engagement in people with chronic pain.

Design & setting The study design was qualitative, informed by behaviour change theory (the COM-B model), and participants were drawn from two settings. First, 36 adults living with moderate-severe chronic pain were recruited from a specialist NHS pain service. Secondly, 15 stakeholders were recruited to represent a range of healthcare sectors involved in supporting people with chronic pain.

Method One-to-one semi-structured interviews, informed by the COM-B model, were conducted between May 2020 and October 2021. Interviews were conducted by telephone or using online conferencing software and were transcribed verbatim and anonymised. The Framework Method was used to interpret the data.

Results The barriers to sustainable physical activity engagement in people with chronic pain are expansive, and the inclusion of stakeholder perspectives is valuable in developing a more comprehensive understanding of these barriers and also of the facilitators that are successful in promoting sustainable physical activity in this population.

Conclusions The COM-B model provides a robust theoretical framework for organising and understanding these barriers and facilitators in a way could that inform effective intervention design.

The authors have declared no competing interest.

The study was funded by the Chief Scientist Office (ref: CSO HIPS/19/26).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the London - Chelsea Research Ethics Committee (reference number: 19/LO/2012).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors.