People interested in our study will first be screened by telephone. Potentially eligible persons will be scheduled for a baseline assessment visit for confirmation of eligibility. After obtaining informed consent and confirmation of meeting the inclusion criteria, 180 participants will then be randomized with equal probability to one of three intervention arms: 1) usual medical care; 2) clinic-based individualized exercise and manual therapy; or 3) community-based group exercise. The intervention period will last a total of six weeks in each arm. Outcomes will be measured at two follow-up assessment visits; two weeks after intervention (2 month follow-up) and four months after intervention (6 month follow-up).