4 reasons why your patients WILL do their exercises

Several months back we published a blog about why patients don’t do their exercises. With adherence to exercise being so important to achieving optimal outcomes we wanted to revisit this all-important topic. This time let’s look at the reasons why your patients WILL do their exercises.

1. They are convinced it will make a difference

Motivation to do something comes from an expectation that the effort will be worth it. That is, the 20-30 minutes they put aside several times a week will result in less pain, better function and overall improved quality of life. If they don’t believe it, they won’t do it. Therefore your communication is so important – do your patients feel you understand their problem sufficiently? Have you provided them an understanding of why specific exercises will work for them? Patients who understand the rationale for doing exercise are more likely to be adherent (Slujis et al 1993). Delivering research evidence may be one way to do this, but often this is too technical and can be lost in translation. Referring to other patient stories is possibly more effective. Stories are remembered and if they hear how it worked for someone else then they may be more motivated to do them.

2. They are able to manage the time to do them

The patient who does their exercises, is not only convinced they will work, but the time required to complete them is manageable. Patients who do their exercises prioritise this over and above most things. A lack of time is a major reason for non-compliance (Slujis et al 1993) so if they have a realistic number of exercises to do that fits into their lifestyle then you can be more confident they will get them done.

3. They know exactly how to do their exercises

Patients who do their exercises are well educated and informed. Rather than tagging exercises to the end of their initial consultation, you’ve started their ‘treatment’ with their exercises, they’ve practiced it, you’ve given feedback and corrected them. And you’ve sent them their exercises in video format with full descriptions and all the information they need. If you’ve got a bit more time near the end of a consultation, and it’s warranted as an adjunct, then this is the time to do some manual therapy. But if a well structured exercise program is the long term solution (as it so often is), then START their treatment with it. Rushing through their exercises at the end of the session, with only 5 minutes to spare, then scribbling on a piece of paper won’t work. Unclear instructions leads to poor compliance, so send the exercises in video format so they can be reminded of how to do their exercises correctly (Miller et al 2009; Sluijs et al 1993).

4. They get the feedback which motivates

Feedback. It’s hugely important when it comes to continual learning and self improvement and it’s no different in healthcare. Feedback helps us to evaluate how we are tracking, where we can improve, and ultimately motivate us. Monitoring your patient’s adherence to their programme and providing them with regular feedback does improve adherence (Sluijs et al 1993, Escolar-Reina et al 2010).

Conclusion

Adherence to rehabilitation is an alliance between both practitioners and patients. Both have to contribute. As practitioners let’s make sure we do our part and facilitate this as much as possible.

REFERENCES

Escolar-Reina, P., Medina-Mirapeix, F., Gascón-Cánovas, J. J., Montilla-Herrador, J., Jimeno-Serrano, F. J., de Oliveira Sousa, S. L., … & Lomas-Vega, R. (2010). How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study, BMC Health Services Research, 10(1), 60.

Miller, J. S., Litva, A., & Gabbay, M. (2009). Motivating patients with shoulder and back pain to self-care: can a videotape of exercise support physiotherapy? Physiotherapy, 95(1), 29-35.

Sluijs, E. M., Kok, G. J., & van der Zee, J. (1993). Correlates of exercise compliance in physical therapy. Physical Therapy, 73(11), 771-782.