Adherence to Home Exercise Program in Older Adults

Physical therapy and a home exercise program are two parts of a whole. Generally, home exercise programs (HEP) are given to patients after the physical therapy initial evaluation and updated as the patient progresses. The patient’s recovery is greatly dependent on how compliant he or she is to the home program that was given.


Exercising at home conditions the body between PT visits. Performing the HEP subsequent days will keep the body limber and will also speed up strength gains. Those who don’t perform their HEP and rely on just PT for improvement will not retain muscle memory between visits and will not build improved function.

There are a few reasons why adults are non-compliant to their HEP:

  • Increased pain and discomfort. Increased or unexpected pain levels might deter the patient from participating in their HEP. Many patients will think their program should be decreasing their pain and, therefore, will avoid them completely if they increase symptoms.
  • Lack of motivation. Some conditions may be emotionally draining causing the patient to feel depressed and alone. The feeling of isolation, sadness, and frustration can make it difficult to find the motivation to perform exercises.
  • Time constraints. Some patients think there just isn’t enough time to do their home exercise program. Anyone that has a full time job and/or looks after a family can find it difficult to squeeze in an exercise regimen.
  • Patient-therapist relationship. The communication between the PT and the patient can have a strong effect on the patient’s performance of home exercises. Factors affecting compliance may include: patient’s understanding of the exercise, the therapist’s verbal or visual explanation, and the quality of the explanation.

Attaining patient compliance is a problem that persists in all aspects of health care. Past studies have shown that approximately one-third to two-thirds of patients are noncompliant with exercise. For those with arthritis, only 45% to 60% of patients have been compliant with exercise. Compliance to a HEP also declines substantially after short-term supervision by a physical therapist has been terminated.

Patients themselves have the ability to control how well they can adhere to a HEP. Here are some tips:

  • Track workouts. Use a journal to log what exercises you did, when you did them, and which ones you have questions or concerns about.
  • Break up the routine throughout the day. The HEP does not need to be completed in one sitting. The exercises can work around your schedule; however, take advantage of any spare time you might have.
  • Stay goal-oriented. Ask your physical therapist to help you set short-term, measureable, and attainable goals to improve your overall motivation.
  • Communicate with your Physical Therapist. Be sure to bring up any concerns or questions you have about the exercises. If you are still confused, it may be helpful to have the exercise demonstrated or explained in a different way.
  • Schedule for consistency. Frequent and regular repetition helps to ensure success.
  • Recruit allies. Ask a spouse or a close friend to exercise with you, or to simply provide encouragement and reminders

The first step is always figuring out what obstacles are preventing the patient from doing their HEP. Implementing these tips will increase the likelihood of patients doing their exercises faithfully, leading to greater success!

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