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Strategies for Home Exercise Prescription

Original Editor - Wanda van Niekerk

Top Contributors - Wanda van Niekerk and Jess Bell  

Home Exercise Prescription

Home exercise prescription includes both patient education and exercise.[1] It is a strategy that rehabilitation professionals widely use. There is evidence suggesting that patients often have low adherence to therapist-prescribed home exercises,[2] despite good adherence being instrumental to positive outcomes.[3] Contributors to adherence to a home exercise programme include[4]:

  • self-motivation to exercise
  • self-efficacy
  • previous adherence to exercise programmes
  • social support

Barriers to home exercise adherence include[4]:

  • "boring exercises"
  • restrictions in personal environment
  • lack of support

Factors to consider when prescribing home exercise can include[1]:

  • dosing - the frequency, intensity and duration of exercises
  • the environment
  • functional relevance

One approach that can be used is the "Toothbrush Method". Exercises are prescribed so that functional-focused exercises can be incorporated into a patient's daily tasks and become part of their daily routine.[1] These exercises are[1]:

  • brief
  • related to function
  • related to patient goals
  • not limited by environmental barriers, such as where the person works or lives
  • frequent, brief exercise sessions or workouts at different effort levels spread across the day

An example may be an individual with a lateral ankle sprain who has decreased balance on the injured side. The person can perform one-leg balancing exercises in the mornings while brushing their teeth, holding onto the sink if needed. Later during the day, the person can perform single leg squats while preparing lunch. Before they climb into bed, they can perform ankle alphabet exercises to improve range of motion and strength.

A realist review of the contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain reported the following[5]:

  • optimising engagement, adherence and outcomes in therapeutic exercise can be achieved by:
    • activating trust
    • motivation
    • confidence
  • a strong therapeutic alliance and rapport build trust, which enables a holistic assessment and the understanding of individual needs and beliefs
  • tailoring exercises to individual goals, along with personalised advice and education, boost confidence and motivation for adherence to prescribed therapeutic exercises
  • other factors that enhance motivation and adherence are:
    • timely follow-up
    • perceived benefits
    • peer support

Practical strategies to help rehabilitation professionals in supporting exercise adherence among stroke survivors were developed as part of a Delphi consensus.[6] Strategies were grouped into nine domains. Table 2 shows these domains and some practical examples of strategies. Although these domains and strategies are specific to patients with stroke, many of the principles and ideas can be used and applied to a range of patients with different conditions. The full article and list of strategies can be found here.

Table 2. Framework for enhancing adherence to home therapeutic exercises[6]
Domains Strategies
Patient education on stroke and recovery
  • Education about stroke, the treatment and adherence
  • Written instructions and pictures
  • Testimonials from recovered patients
Exercise prescription
  • Videos of exercises
  • Meaningful and relevant exercises
  • Individualised programme
Feedback and supervision
  • Feedback from patients and feedback on their progress from rehabilitation professionals
  • Regular contact with a rehabilitation professional
  • Activity log
Cognitive remediation
  • Motivational interviewing
  • Education on the benefits of therapeutic exercise
Involvement of family members
  • Exercise buddies
  • Emotional support
Involvement of society
  • Involvement of friends
  • Involvement in group sessions
Promoting self-efficacy
  • Goal setting
  • Provide activities that can be done independently
Motivational strategies
  • Recording videos of the patient to show improvement
  • Feedback on progress
  • mHealth - monitoring, assessment or therapy delivered using mobile devices
Reminder strategies
  • Reminder phone calls
  • Sticky notes
  • Auditory - use voice recording during therapy sessions
  • WhatsApp (or similar) for reminders

References

  1. ↑ 1.0 1.1 1.2 1.3 McElrath E, Arena S, Scully J. Exercise Prescription Considerations to Optimize Home Program Adherence. Home Healthcare Now. 2023 Mar 1;41(2):112-3.
  2. ↑ Beinart NA, Goodchild CE, Weinman JA, Ayis S, Godfrey EL. Individual and intervention-related factors associated with adherence to home exercise in chronic low back pain: a systematic review. The Spine Journal. 2013 Dec 1;13(12):1940-50.
  3. ↑ Yalew ES, Melese AZ, Guadie YG, Gashaw M. Adherence to home-based exercise program and its predictors among patients treated in physiotherapy outpatient department in Amhara Region Hospitals in Ethiopia: A prospective cross-sectional study. Patient Preference and Adherence. 2022 Feb 26:561-72.
  4. ↑ 4.0 4.1 Ormel HL, Van Der Schoot GG, Sluiter WJ, Jalving M, Gietema JA, Walenkamp AM. Predictors of adherence to exercise interventions during and after cancer treatment: a systematic review. Psycho‐oncology. 2018 Mar;27(3):713-24.
  5. ↑ Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. British Journal of Sports Medicine. 2024 Feb 1;58(4):222-30.
  6. ↑ 6.0 6.1 Mahmood A, Deshmukh A, Natarajan M, Marsden D, Vyslysel G, Padickaparambil S, Shwetha TS, Direito A, Kumaran S, Girish N, Sachdev H. Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus. BMJ open. 2022 Jan 1;12(1):e055946.
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