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Process of change refer to the covert and overt activities that people use to progress through the aforementioned stages. The process of change construct provides strategies for patients and guidelines for interventionists to help patients transition from one stage to the next. As people move toward Action and Maintenance, they rely more on commitments, conditioning, contingencies, environmental controls, and support [39]. In particular there was often insufficient data on exercise adherence to be able to consistently extract this information.

Exercise combined with a specific ‚adherence’ component

Statistical pooling was not possible due to differences in the populations, interventions and outcomes in the included trials. It was also not possible to complete Clinical Relevance tables and Summary of Findings tables. As well as the items in the Delphi list, we also looked at the proportion of withdrawals from each of the trials.

• For instance, self-monitoring or self-regulation could be not adequate among people who are in the pre-contemplation or contemplation stages of change according to the transtheoretical model [62,81].
• Patients should be involved in a program of self-monitoring, self-management, and active counseling.
• We reduced this to 279 after matching titles and abstracts against the inclusion criteria.
• First, the results of the global analysis revealed that initial exploration of participant’s characteristics, barriers, and facilitators seemed to be crucial to enhance exercise adherence in general chronic patients and older adults.
• Where this is the case the full text of the papers have to be searched, which can substantially increase the number of papers that have to be obtained and filtered before they can be excluded from the review.
• In this line, eight reviews support the relevance of autonomy, which is one of the basic psychological needs to improve intrinsic motivation [103], and empowerment, which would also suggest that giving the participants an active role in the exercise programs may increase the adherence to exercise.

2The role of intrinsic and extrinsic motivation in exercise adherence

Nour et al compared a SMP that included a cognitive behavioural approach and home visits to a waiting list control group in 113 people with arthritis (Nour 2006). The trial showed a significant difference in favour of the combined treatment package in change in overall exercise frequency and in the change in frequency of stretching exercises, but not for change in strengthening exercises or walking frequency over three months. In the trial by Yip et al, 182 people were randomised to either a SMP that included activity goals and a pedometer or a control group that received routine treatment from orthopaedic doctors or outpatient clinics (Yip 2007).

Their primary concern is whether they will be able to exercise consistently or will fail. In these cases, one helpful approach can be to first prompt individuals to reassess their confidence about changing on a 1–10 scale, then ask what would help them step up to the next number on the scale. Daily record keeping, goal setting, prompts such as leaving running shoes and exercise clothes out in the morning, and planning when to exercise are very useful strategies. To systematically search, critically appraise and summarise all RCTs or quasi‐RCTs pertaining to the efficacy and effectiveness of interventions targeting adherence to exercise therapy and physical activity recommendations, in adults, 18 years or over, with chronic musculoskeletal pain. For low back pain, guidelines recommend advice to continue normal activity and supervised, graded reactivation, since this leads to less chronic disability and work loss (COST B ; NICE 2009; Waddell 1999). The most recent and comprehensive systematic review concludes that exercise therapy in general is effective for chronic back pain in terms of both pain and function (Hayden 2005a).

To develop the programme, the authors conducted a literature review, interviewed experts in the field, and carried out a pilot study. We set up electronic forms in Microsoft Access to record the quality assessment and extracted data from each trial. We recorded details of the study, such as setting, patients, interventions, methods and outcomes as well as results for the outcomes of relevance to the review. This summary of a Cochrane review presents what we know about the effect of different ways of helping people with chronic musculoskeletal pain to stick to exercise and physical activity. Though this detail is just a small piece of what can impact someone’s overall exercise adherence, the goal is to shed some awareness on how our thinking can derail our best intentions.

Give Up on “No Pain, No Gain”: Finding Enjoyment in Physical Activity

A pedometer was also given to participants for three days to act as positive reinforcement for walking. Talbot et al supplemented an arthritis self‐management programme with a walking programme, in which participants used a pedometer to monitor their daily step count (Talbot 2003). The population of interest for this review was adults (18 years old and over) with persistent or episodic pain lasting more than three months in the axial skeleton (neck and low back) or large peripheral joints (hip, knee, shoulder). You can enhance your exercise adherence by setting SMART goals, building motivation and self-efficacy, and creating a supportive environment for exercise. Exercise adherence is influenced by personal, social, and environmental factors, including demographic characteristics, motivation, self-efficacy, social support, and access to exercise facilities.

Ravaud 2004 published data only

One study found that for a person to continue in an exercise program they would need to find enjoyment and/or growth of competencies in the physical activities. If this doesn’t happen within a reasonable amount of time for that person, they are very likely to drop out. Achieving exercise adherence is simple if you have a realistic plan in place, strategies in place for any slip-ups along the way, and the knowledge, skills, desire, and support needed to get you there.

Case Study

Several reviews of BCTs in physical exercise interventions have highlighted the effectiveness of short-term techniques in different populations. For example, Finne et al. [25] and Carey et al. [26] demonstrated that BCTs, such as the use of cues and incentives, rewards (social and nonspecific), or graded tasks, increase motivation to exercise among cancer patients. Another review carried out by Howlett et al. [27] showed that biofeedback, demonstration of behavior, behavior practice/rehearsal, and graded tasks were effective short-term intervention techniques for healthy inactive participants. Other populations, such as people with overweight [28], substance use disorders [29], or dementia [30], also show greater involvement in physical activity when BCT-based interventions target immediate purposes. Thus, to increase motivation during exercise sessions, it is necessary to select the best technique according to the population of interest. Although healthy lifestyles (HL) offer a number of health benefits, nonadherence to recommended lifestyle changes remains a frequent and difficult obstacle to realizing these benefits.

Goal-Setting Techniques for Exercise Adherence

Cognitive dissonance occurs when there is a discrepancy between a person’s beliefs and behavior. This can occur when people act in a way that is inconsistent with the way they believe they should act. Put another way, the more difficult the task is, the greater the value given to the reinforcers that follow task completion.

There was no consistency in the measures of exercise adherence, with a wide variety of continuous and dichotomous/categorical measures used, which may not capture data on all domains of exercise activity. For example, measurement of the number of times per week an individual engages in exercise fails to assess other domains such as intensity or duration of exercise, and thus workout consistency this approach fails to provide clear insight into overall activity or exercise levels (Matthews 2002; Melanson 1996). Mostly, the measures and methods we found in the included trials were indirect and self‐reported, which could be prone to recall and social desirability biases (Matthews 2002; Sallis 2000). An objective measure was used in only one trial (Talbot 2003), which measured physical activity with accelerometers and pedometers. Use of motion sensors, such as accelerometers, reduces the likelihood of biases from recall and other sources in clinical trials (Matthews 2005), although still relies on the participant adhering to the request to wear them, and in some instances record daily step count. As no single measure of exercise adherence is superior, it is suggested that using two or more methods might allow strengths of one method to help compensate for weaknesses of the other (Treuth 2002).

Effects of adherence interventions

However, that same patient may not feel that change is important, that change could feel worse than staying the same, or that change is less important right now than other priorities. Expert tips and insights tailored to fitness enthusiasts aspiring to become professionals and coaches looking to grow their fitness business. From training advice to business strategies, our content is designed to inspire, educate, and help you succeed in the fitness industry. Finally, we must set realistic objectives for a period of time in agreement with the patient. They should be neither below nor above what is logically expected, so they should be well reasoned. As we have already mentioned, the follow-up and constant communication with the patient is vital for them to feel confident and motivated with their therapy.

Koumantakis 2005 published data only

If the level of effort is too low, the immediate purpose (the reinforcer) will not be valued, and the dissonance will be reduced in the sense of the initial low motivation. Therefore, immediate purpose is both a motivation for action and a lever for dissonance reduction. Thus, by strengthening the link between attitude and behavior (i.e., by increasing adherence), people will be able to deploy more effort and to involve more executive control. In contrast, when people are motivated to be involved in exercise sessions, the dissonance is low or nonexistent, and it could be important to use preparatory acts, such as sponsoring a peer in a free manner, to increase commitment to the behavior and strengthen the link between attitude and behavior. Experiment with different strategies, find what works best for you, and adapt them to fit your lifestyle. Incorporating goal setting, self-monitoring, and positive reinforcement into your exercise routine enhances exercise adherence and increases your chances of long-term success.

References to studies included in this review

It can be useful to help patients develop a plan for making sure that a lapse does not evolve into relapse. Supportive literature and other resources can also be helpful to avoid a relapse from happening. When individuals have relapsed, it can be useful to prompt the individual to reassess how confident they feel that they can change and how important they feel resuming exercise is. The individual can then reaffirm their motivations for change and articulate the next step in preparing for exercise again. Combining MoI and the TTM strategies to increase PA is an approach to maximize the likelihood that the patient will initiate or increase their level of PA. A list of potential questions for providers to ask themselves prior to offering behavioral counseling is provided in Table 1.