Precision Exercise Prescription for Lumbar Spinal Stenosis: A Randomized Feasibility and Implementation Study with a Replicable Multimodal Protocol

Background: Lumbar spinal stenosis (LSS) with neurogenic claudication is associated with reduced walking tolerance, functional limitations, and impaired daily functioning. Although exercise-based rehabilitation is recommended as a first-line conservative treatment, many published interventions remain insufficiently described, limiting reproducibility and clinical application. Objective: To provide a detailed and replicable description of an individualized multimodal exercise and walking-extension protocol for patients with LSS, and to report key implementation outcomes. Methods: This single-centre randomized controlled study included patients with LSS allocated to an experimental or usual-care control group. The intervention consisted of a 12-week supervised multimodal exercise program delivered twice weekly in small groups, combined with a home-based component and a walking extension plan. Outcomes focused on feasibility, adherence, fidelity, safety, and acceptability. The primary clinical outcome of the overarching trial was the Oswestry Disability Index (ODI). Results: A total of 60 participants completed the study. The intervention was feasible and generally well accepted. Attendance to supervised sessions was moderate, while compliance with walking diaries was limited. The protocol was delivered largely as planned, with individualized adaptations based on symptom response and movement quality. No serious adverse events were reported. Conclusions: This study provides a structured and clinically applicable framework for individualized exercise prescription in LSS. The protocol demonstrates good feasibility and acceptability, although interpretation of outcomes is limited by high attrition and variability in adherence. The findings should be interpreted with caution given the feasibility design, attrition, and variability in adherence.