In the context of the physical exercise, we can include the people who oversee the program, which could be limited to the technician, or also include other professionals such as the physician. In addition to adherence, previous research has shown that poorly perceived social support has been related to lower mental health, higher risk of developing certain diseases, lower life expectancy, lower physical activity levels, more stress and poorer resilience [107]. On the other hand, satisfactory social support can encourage optimism and self-esteem, reducing stress and depressive symptoms [108], which could affect adherence to exercise. For decades, the World Health Organization (WHO) has advocated for several different stages in the improvement of approaches to adherence among patients with chronic diseases.2) In the past, patients themselves were considered to be the source of non-adherence.
Thomas 2002 published and unpublished data
For example, block out the time in your planner for exercise and do not schedule anything else during that time. Reduce costs and improve your reimbursement rate with a modern, all-in-one clinic management software. Understanding these patterns allows you to tailor solution-focused interventions for maximum impact.
Building Motivation and Self-Efficacy
We consulted experts in order to find additional papers and unpublished studies and used the OMNI Gateway to find relevant grey literature from health organisations and patient groups. We contacted authors when we needed to clarify data to be able to include trials in the review. The critical appraisal with the AMSTAR-2 tool (see Table 4) showed that four reviews were rated with moderate to high quality [7, 16, 27, 35], whereas all others resulted in a critically low to low overall confidence in the review. Frequent shortcomings were not explaining the reasons for the inclusion of primary study designs, and an insufficient discussion of the heterogeneity observed. Adopting a growth mindset can help individuals cultivate a lifelong commitment to physical activity and maintain a positive and resilient attitude towards exercise.
- Work out with friends.Exercising with a buddy or in groups offers social support, encouragement, and accountability (Anshel, Petruzello, & Labbe, 2019).
- The average length of the follow up across all the studies was less than nine months, with a range from three weeks (Luszczynska 2006) to 30 months (Harkapaa 1990; Mikesky 2006).
- In many cases, only single dimension approaches limited to patient factors have been taken.
- Thus, that criterion is based on the number of dropouts, but it does not establish the need of completing a minimum percentage of sessions (attendance) nor the involvement of the participants during the sessions.
- It is a critical component of exercise effectiveness, as regular participation is necessary to reap the benefits of physical activity, such as improved cardiovascular health, weight management, and enhanced mental well-being 1.The importance of exercise adherence cannot be overstated.
- While the majority of people who take an aerobics class, do so for external reasons – to lose weight or improve their health.
1The stages of change/trans-theoretical models of behaviour change
Furthermore, it must be noted that when the exercise program is based on technology, the interpretation of adherence may be different, since sometimes researchers are assessing adherence to a device instead of adherence to physical exercise [28]. Furthermore, supervision also makes the evaluation of adherence easier and more accurate, avoiding the use of self-reported exercise registries and problems related to the use of monitoring technology. In this regard, Hughes, Salmon, Galvin, Casey, and Clifford [44] showed that adherence (assessed through self-reported registries) to exercise was higher in unsupervised home exercise programs while the benefits were lower than those observed in class-based supervised exercise.
Social and cultural support
On the other hand, each of the positive aspects of the chosen alternative and the negative aspects of the rejected alternative are consistent with the decision. Difficult decisions should arouse more dissonance than easy decisions because there will be a greater proportion of dissonant cognitions after a difficult decision than after an easy one. Therefore, one important aspect is that the more committed to an act a person is, the more the individual will change his or her attitudes in the direction of the behavior he or she has performed.
Theoretical models to explain (non-)adherence and (a) motivation as well as techniques to promote behaviour change have been extensively studied in health and exercise psychology [9–11]. The current umbrella review has identified several key factors to improve adherence to exercise in patients with chronic diseases, as well as some practical recommendations for professionals and researchers. Given the relevance of adherence to exercise to achieve the expected results and avoid sedentary behavior, all those aspects should be considered when exercise programs are designed.
Blixen 2004 published data only
Patient education with a more constructive educational approach builds upon the knowledge of the patient, supporting him/her in exploring and co-constructing knowledge which is very relevant in physiotherapy as research has shown [55, 56]. More than 70% of the included reviews identified the need for carrying out a pre-participation comprehensive analysis of the participants’ characteristics and the potential barriers and facilitators. Thirty-six of the 55 included reviews found that some aspects like the health status (including physical and mental health) or previous habits (such as physical activity level, smoking, or alcohol intake) are relevant factors to predict exercise adherence.
The analysis performed revealed 14 key factors of exercise programs that may positively influence their adherence rates. As Table 2 shows, these topics reported different sub-key aspects that represent in more detail the characteristics of the most adhered programs. Altering the paradigm of behavioral change models seems to be a novel approach for promoting exercise adherence. The target behavior (exercise) also facilitates change not only by developing motivation and volition but also by changing attitudes. In other words, involving and committing people in their exercise behaviors is an effective lever for initiating and developing adherence, and behavioral change theories could benefit from this behavioral perspective.
This could be explained by an over-estimation of adherence rates due to social desirability and obsequious responses from the participants [12]. However, the advantages of supervision are documented, allowing participants to access the professional’s knowledge, feedback, and support, which may increase self-efficacy and reduce the discouraging feeling and potential risks [16]. Although some authors have pointed that the characteristics of the exercise program may be related to exercise adherence, some aspects, like the type of exercise or exercise intensity, are not often reported as key factors to promote adherence. In this regard, we found a similar number of reviews showing that variables like intensity, frequency, or volume are relevant and reviews reporting that they are not. Furthermore, if participants only do exercise within the exercise program, they would not be following the recommendations of the WHO [5]. Therefore, the current study aimed to systematically review published reviews on the study of adherence to physical exercise in chronic patients and older adults and to identify those adherence-related key factors more frequently suggested by reviews for chronic disease patients and older adults.
Identifying Common Barriers to Exercise Adherence
Motivational interviewing, which is a collaborative, patient-centred communication style to promote behaviour change [49], was used in three studies, indicating positive effects on exercise compliance, physical activity and exercise at home in two trials, whereas no effect in a pilot study [28]. There is low evidence from three RCTs for positive effects of the therapist-patient alliance on global assessments; however, the efficacy on adherence-related outcomes is unclear [36]. Patient-led goal setting was more often a component within efficacious interventions than therapist-led goal setting [17].
However, in current research, the role of medical service providers has been regarded as much more important. This will be done by enumerating the variety of elements that must be included within the framework of a systematic approach to improve adherence. Seventeen out of 42 trials evaluated different types of exercise therapy or physical activity. Only two of these (Fransen 2007; Ylinen 2003) found a difference between types for any of the adherence outcomes measured.
Importance of systematic interventions in the 5 areas
Without any doubt, these factors are the most widely cited in workout personalization technology the scientific literature about adherence to exercise in chronic patients and older adults. Several models from social psychology, such as cognitive dissonance theory [52] and commitment theory [53,54,55], could be useful for developing new ways of studying adherence to exercise. Indeed, numerous studies based on these models have shown that individuals who are committed to a behavior modify their attitudes a posteriori to make them more in line with their past behaviors. Thus, behavioral changes can promote attitude changes through cognitive dissonance [52]. Cognitive dissonance has been studied using several paradigms, including the effort justification paradigm, the difficult decision paradigm, and the induced compliance paradigm, all of which are designed to commit people to their behavior [56]. Since exercising is an effort-based decision, particular attention can be given to the place of effort in these models and how deploying effort in certain circumstances can further commit individuals in their behavior and lead to attitude change.
Leveraging Social Support for Exercise Motivation
Alternatively, combine this course with our level 3 Bulletproof Business Course and build your fitness business with a successful exercise referral scheme. By incorporating these strategies, you can significantly improve your clients’ adherence to their exercise routines, leading to better health outcomes and a more rewarding training experience for both you and your clients. Something as simple as adapting their exercises to everyday household activities such as brushing their teeth, preparing their meals, etc. are examples that we can use with our patients. “So that you don’t forget doing your exercises, you can include your program every day after breakfast, or before taking your dog out“.
The social ecological model raises the need for systematic changes that are broader and more diverse than just families and schools in order to maintain healthy behavior for a long period of time. Factors influencing patients’ behavior in the ecological aspect include personal, interpersonal, organizational, community, and public policy factors. A recent emphasis on social context proposes an approach of intervening behavioral changes through the organized fusion of community situations, the government, and policies in addition to the healthcare system. The task force concluded that, in relation to the adherence intervention for primary prevention of cardiovascular diseases, currently there is no randomized controlled trial evidences for clinical hard outcomes essential for generating the formal grade of recommendation with level of evidence.
Messier 2004 published data only
Thus, there may be new or alternative intervention approaches that resulted efficacious but were not covered by this overview. Furthermore, reviews that focused only on the use of digital apps or tools, e.g. virtual reality, gamification, exergames or tele-rehabilitation, were excluded from this overview. Several reviews in this field include adherence-related outcomes, showing potential efficacy as well as limitations of the use of digital tools [72,73,74,75,76,77,78,79,80,81,82,83]. While we did not exclude reviews from another language, the search was conducted only in English, which may omit important reviews in other languages. All included reviews (and as far as reported, also the original RCTs) were conducted in economically developed countries; however, social-cultural and context-specific factors influence participation and adherence [67,68,69,70,71].