07/08/2017
**The 5 Big Barriers to Exercise Adherence**
1. Low levels of physical activity at baseline or in previous weeks
• Recognise and be ready to mitigate the barriers to initiating/ adhering to exercise programmes; (poor programme organisation, poor education, poor history of exercise, perceived physical frailty, perceived poor health and readiness to change)
• Discuss the benefits of exercise, how all these barriers can be modified and discuss the positive outcomes if they are changed
• Motivational interviewing, develop collaborative goals and coping plans
2. Low in-treatment adherence with exercise
• Patients who are more compliant at the start of the program are more likely to be complaint at the end = Keep it interesting, progressive and always check in with them
• Improved exercise tolerance in rehab = less progression of problems
• What to do in the session - 1) provide explicit verbal instruction, check the patient's recall and support this with additional written instructions 2) employing motivational techniques such as counselling sessions, positive feedback, reward, written treatment contracts and exercise diaries
• Setting goals, drawing up action plans and coping plans which have been agreed collaboratively between the clinician and patient may also be effective
3. Low self-efficacy, depression, anxiety, helplessness, poor social support or activity
[Low self-efficacy]
• Self-efficacy can be assessed by asking the following: “How confident are you that you can overcome obstacles to exercising?” or “How confident are you that you can return to exercise, despite having relapsed for several weeks?
• Assess the patients’ stage of behavioural change = this will reflect the type of treatment given
• Develop a solid patient-practitioner relationship and therapeutic alliance
[Depression, anxiety, helplessness or poor social support or activity]
• Yellow flags to treatment; referral may be necessary if these are prominent barriers
• Consider discussing how beneficial exercise is to mental health
• Discuss how social interaction is important and can provide positive role models
• Does the individual know of someone they can exercise with (family, friends etc.)?
• Would they be suitable for group exercise?
4. Greater perceived number of barriers to exercise
• Barriers included transportation problems, child care needs, work schedules, lack of time, family dependents, financial constraints, convenience and forgetting.
• We need to be aware of difficulties that patients foresee in relation to adhering with a proposed treatment plan and act collaboratively with them to design treatment plans which are customised to the patient’s life circumstances
• Develop a coping plan and include strategies for barriers
5. Increased pain levels during exercise
• This is an extremely crucial aspect as we don’t want to let patients perceive that exercise/ movement causes pain. Pain education is a must (pain doesn’t = harm)
• Use: analgesics, heat, ice, passive physiotherapy treatments etc. for pain relief prior to exercise >> Graded exposure to exercise and physical activity
Poor adherence to treatment can have negative effects on outcomes and healthcare cost. However, little is known about the barriers to treatment adherence within physiotherapy. The aim of this systematic review was to identify barriers to treatment adherence in patients typically managed in musculosk...
