4 Ways Health Professionals Can Help With Patient Exercise Adherence
Author: Samantha Edwards, Physiotherapist
As a Physiotherapist I prescribe exercises to patients every day, however, that doesn’t mean the patient will do the recommended exercises. Here are 4 strategies that I have been taught and use in my practice to help patients with exercise adherence. Before we start, I want to talk about two important terms (each could be separate blog posts on it’s own, but for the sake of this blog I will keep it simple). The first term I want to mention is “motivational interviewing”, this is a technique used to help elicit behavior change in an individual. The other important term is the “biopsychosocial model” which includes the biological, social, and psychological components that make up an individual. The 4 tips I talk about today will fall under the umbrella of these two terms. As a healthcare provider it is important to look at the greater picture to better recognize why someone may not be doing their exercises or their recommended program. Here are 4 strategies that can be helpful in increasing exercise adherence.
1. Therapeutic alliance
Developing a good therapeutic alliance (TA) between practitioner and patient is important. It is important for the patient to feel supported by their health care provider. Studies have shown that a good therapeutic alliance is a strong predictor of treatment success (Ferreira PH et al, 2013).
2. Talk less, listen more
It is important to listen and to be empathetic towards your patient as this will also help to establish a good TA. Listen to your patient to find out what activities they enjoy, or on the hand, what activities do they not enjoy. Use this information to adjust the trajectory of their exercise program. For example, if they hate biking but they are told to start biking to help with knee pain, that most likely will not be a successful recommendation. You know yourself that you are far more likely to participate in an activity if you enjoy the process.
3. Address barriers to exercise
Why is the patient not exercising or following their rehab protocol? Is it due to pain? Lack of time? Are they fearful of movement? Lack of childcare? Lack of understanding? Lack of equipment or finances? Low mood/motivation? The list can go on… Once barriers have been addressed we (the healthcare provider) need to provide resources and education to limit those barriers and tailor our recommendations towards things that are attainable.
4. Multidisciplinary approach
It is important for health care providers to work within their scope and acknowledge when referral is appropriate to help the whole person, not just the complaint or injury. Use a multidisciplinary approach and refer out when and where needed; this can be a super helpful way to eliminate barriers to adherence and facilitate success for the whole person.
Here are some additional resources if you are interesting in reading more in depth to this topic:
Diener I., Kargela, M. and Louw, A. (2016). Listening is therapy: Patient interviewing from a pain science perspective. Physiotherapy Theory and Practice, 32(5), pp.356-367.
Ferreira PH et al (2013). The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain, Physical Therapy, Volume 93, Issue 4. Pages 470–478, https://doi.org/10.2522/ptj.20120137
