Abstract Objective: To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain. Design: A double-blind prospective randomized controlled trial. Setting: Physical therapy outpatient department, tertiary care. Patients: Ninety-three low back pain patients were randomly assigned to either a standard exercise program ( n = 49) or a combined exercise and motivation program ( n = 44). Interventions: Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1 2 weeks, 4 months, and 12 months. Main Outcome Measures: Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance. Results: The patients in the motivation group were significantly more likely to attend their exercise therapy appointments ( p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score ( p = .004) and pain intensity ( p ≤ .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance ( p = .01) and in abdominal muscle strength ( p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program. Conclusion: The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.