Table 1 Inclusion and exclusion criteria

Inclusion criteria

1. Age greater than or equal to 50 years

2. Clinical symptoms of back and/or radiating lower limb or buttock pain; fatigue or loss of sensation in the lower limbs aggravated by walking and/or standing and relieved by sitting.

3. Intermittent or persistent pain without progressive neurological dysfunction

4. Symptoms and signs for more than 3 months

5. Imaging-confirmed spinal canal narrowing using MRI, CT scan

6. Clinical signs and symptoms corresponding to segmental level of narrowing identified by imaging

7. Patients with degenerative spondylolisthesis are included

8. Not considered to be a surgical candidate (in the next 12 months) or patient unwilling to have surgery

9. Able to perform mild-moderate exercise

10. Able to walk without assistive devices for at least 20 m, but less than 30 min continuously

11. Able to give written informed consent and complete interviews and questionnaires in English.

Exclusion criteria

1. Severe degenerative stenosis with intractable pain and progressive neurological dysfunction

2. Lumbar spinal stenosis not caused by degeneration

3. Lumbar herniated disc diagnosed during the last 12 months

4. Previous back surgery for lumbar spinal stenosis or instability

5. Underlying spinal disorder such as ankylosing spondylitis, neoplasm, infection or metabolic disease

6. Intermittent claudication due to vascular disease

7. Severe osteoarthrosis or arthritis of lower extremities causing limited walking ability

8. Neurologic disease causing impaired function of the lower limbs, including diabetes

9. Psychiatric disorders and /or cognitively impaired