Introduction: Chronic pain is a public health crisis, affecting 20% of American adults. While physical activity (PA) is proven intervention to manage chronic pain, many affected adults are inactive. To encourage PA uptake and long-term participation, individuals need appropriate PA opportunities, chronic pain and PA education, along with learning effective behavior change techniques. Traditional PA interventions, developed by researchers, may lack key end-user desired elements, reducing effectiveness. Involving end-users in co-designing interventions can better address diverse experiences and needs of adults living with chronic pain. We used a co-design framework, theory, and evidence to develop an acceptable and motivating PA intervention for adults with chronic pain.

Methods: A seven-stage co-design process, spanning 12 months, involved: (1) forming Active Living for Pain (ALP) research team, (2) preparing co-design materials, (3) recruiting co-design participants with moderate to severe chronic pain, (4) engaging in generative co-design activities, including two focus group meetings, (5) intervention framing, (6) analyzing data, and (7) intervention presentation and validation with co-design participants.

Results: The ALP: Movement That Matters intervention was designed to be realistic, acceptable, and motivating for co-design participants. This 12-week intervention includes two 1.5-hour sessions each week for 8 weeks, followed by two booster sessions in weeks 10 and 12. Sessions integrate PA opportunities and education, alongside pain education, behavior change techniques, and social support activities to promote motivation and confident PA participation.

Conclusion: Co-designing interventions prioritizes end users' perspectives and promotes ongoing collaboration between researchers and end-users, addressing the limitations of traditional researcher-driven intervention development.