QUESTION: What factors do participants in exercise programs for chronic low back pain perceive to be important for engagement and participation? DESIGN: Qualitative study of three focus groups. PARTICIPANTS: 18 adults with chronic low back pain who had participated in exercise programs for chronic low back pain. RESULTS: All focus group results concurred and two significant themes emerged from the focus group data. The first was that the experience of exercise informed participant preferences with respect to exercise environment and type of exercise. Participants described a range of positive and negative experiences, a desire to master exercise techniques, and a preference for exercise that matched their abilities and prior skills. The second significant theme was the helpful and empowering skills of the care-provider, and care-seeker ability to identify and articulate their own needs. Participants regarded carer expertise favourably when positive results were achieved early in the interaction, but were frustrated when they were not listened to and symptoms were aggravated. The relationship was enhanced by effective communication. Participants also recognised they needed to be aware of their own skills and abilities and, and that financial or family support incentives encouraged their adherence to a program. CONCLUSION: People are likely to prefer and participate in exercise programs that are designed with consideration of their preferences, circumstances, and past exercise experiences. We propose that information about patient exercise preferences should be collected systematically.