Overcoming Barriers to Exercise Compliance

Patrick Milroy, MA, DC
January 02, 2008
Written by Patrick Milroy, MA, DC
Empower patients to eliminate obstacles that restrict their well-being
Non-compliance with home exercise prescription seems endemic to chiropractic practice. Ideally, we want patients to follow our recommendations so that they become fully involved in their recovery and well-being. The identification of any prohibitory factors is a vital step toward an effective exercise pattern in which the patient assumes an active role in their own health and wellness management. 

Does your patient believe that they have the skill and coordination to properly perform a prescribed exercise? If not, this would be an example of an “attitudinal barrier.” An assigned exercise that is beyond a patient’s ability may result in anxiety and subsequent poor compliance. Inversely, compliance will also decrease if the patient is not sufficiently challenged.

Poor communication can create non-compliance. Did you educate the patient on why the exercise is important? Did you provide clear and concise instruction?

Were you confident when you prescribed the exercise? Did you provide words of encouragement?
Economic barriers are real for many. Fortunately, most of the basic home-based exercise does not require equipment, a gym membership or a personal trainer. Third-party payers often eagerly will cover their client’s gym membership. But not all patients have the means to maintain membership after injury settlement. Did you establish a home-based exercise program that the patient can employ once visits to the gym have ended? 
Did you explore the patient’s life experience with regard to exercise? Were their past attempts at exercise and/or sport successful and enjoyable … or not? Pleasant associations with exercise can be an excellent motivator.

Negative memories about exercise must be uncovered. The doctor and patient can then brainstorm on ways to make exercise a pleasant prospect. Further follow-up and ongoing dialog will help the patient to stay on course.

Remedial exercise has to match your patient’s health status. Prescribing exercise too early in a treatment pro-
gram might cause further pain, aggravate injury and undo previous corrective work. Exercises that are overly challenging relative to weakness, obesity, lack of range of motion, or poor cardiovascular status will result in non-compliance.

Obviously, in order to make accurate exercise prescriptions, you must assess your patient’s state of health through conducting a thorough history and examination. Indeed, underlying health issues can become a motivation for exercise.

As an example, daily walking can be suggested as the first and primary spinal stability exercise for the patient with cardiovascular issues. Help the patient understand that walking will strengthen their spinal stability muscles as well as improve their cardiovascular fitness.

The success of fitness clubs is largely due to their inherently social nature. Does your patient have the support of family when performing home-based exercises? You could invite the patient to bring a partner or friend along to an office visit so they too might become educated on the role of exercise, spinal health, and chiropractic.

Those patients who are simply not interested in exercising at home should be encouraged to join a gym or health club. Have a list of community resources with contact information on hand. Caution about over-exercising outside the home as well-intentioned fitness club trainers do not necessarily accommodate your patient’s health status and treatment goals.

“I just don’t have time to exercise.” Whether real or perceived, this is one of the most common patient responses. Never ignore this statement. These individuals need encouragement and suggestions on how to incorporate the exercise that you prescribe. Keep the number of exercises to a minimum. Ask the patient if they can find “x” number of minutes in their day for the exercise. Use your personal exercise regimen to illustrate how a schedule can be prioritized. Make it seem easy. Spinal stability exercise can be done during commercials while watching television; each commercial break allows for one to three sets of one or more exercises. 

Patients are more likely to embrace exercise when they are a part of the prescription process. Provide three or four basic spinal stability exercises but allow the patient to freely choose any two on a given day. Self-determination and discipline enhanced through exercise can assist the patient to take control of their condition.

Set goals for the prescribed exercises, and once they have been met, come up with a choice of more challenging advanced exercise.

Our patients often carry many constraints – real or perceived – with them, which are obscured beyond the presenting health concerns. Through attentive care, you can join with them to knock over those obstacles.•

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