The Path to Exercise Adherence

I had the wonderful opportunity to attend Dr. Mike Israetel’s presentation “From Inspiration to Passion” at the National Strength and Conditioning Association’s 2018 Personal Trainer conference. I believe that the points he made are also valid from the perspective of getting physical therapy patients to adhere to their home exercise program.

Dr. Israeltel’s presentation addressed adherence in diet and fitness clients. He highlights that the client’s desire to adhere to the plan will fluctuate over time and psychological states. He identifies six constructs that clients/patients go through that coaches/therapists can utilize to maintain exercise compliance.

1. Inspiration
2. Motivation
3. Intention
4. Discipline
5. Habit
6. Passion

Inspiration: Inspiration represents the patient’s first step towards recovery. For PT patients, an illness, injury, significant pain, or functional mobility issues are the typical sources of inspiration to visit you, the physical therapist. Unfortunately, inspiration doesn’t last long and can quickly disappear when the patient realizes that you actually want them to exercise to get better and can’t wave your magic wand or give them special pills to suddenly make them better.

To help inspire your patients, you can educate them about the benefits of home exercise and provide them with relatable success stories.

Motivation: Motivation is the desire to do something about a goal and begins after inspiration. It is a less intense emotion compared to inspiration but longer lasting. Motivation will rise and fall but is not dependable in the long term.

From a physical therapist’s perspective, recognizing that your patient’s inspiration may end before the completion of their initial evaluation, you need to start helping them activate their motivational emotions by helping them set specific and realistic goals in their first visit.

As motivation will fluctuate, it is important to add another layer of structure to overcome the periods when motivation is low.

Intention: Intention is a commitment to actually do something and can give your patient the impetus to fill in the adherence gap when motivation is low. Intention develops within days of beginning the program and is especially important in the first month of the program.

To help develop intention in your patients, you can help them create a plan to execute their exercises to achieve their goals. Plan details don’t matter nearly as much as having a plan.

Discipline: When your patient’s motivations are low, they need discipline to fulfil their intentions. Your patients can use willpower to execute the plan.

You can help your patient by cultivating their discipline. You can remind your patients that motivation will wane and sometimes it will be tough to get through their home exercises. Remind them that it will get better but they have to continue with their plan.

Unfortunately, willpower is exhaustible and can be consumed by other aspects in your patient’s life. If your patient is experiencing high level of stress or other demands on their life, they may not have any willpower left to apply to do their home exercises.

Habit: After more than a month, activities soon start to become habits. The longer your patients regularly do their home exercises, the stronger the habit becomes. Maintaining a habit requires less discipline resulting in better compliance.

An exercise plan that suits your patient’s preferences are more likely to become habits. Understanding your patients and creating a home exercise plan that is sustainable and convenient for them is more likely to become a habit. Asking non-active patients to suddenly allocate an hour a day towards home exercise is likely not going to become a habit.

Passion: Passion is a deep love for the process of exercising.

Most physical therapy patients will not be under treatment long enough to develop a passion for exercising. However, physical therapy can lead a patient towards a passion for wellness and fitness that they pursue with a health and fitness coach.

Recognizing what your patients are passionate about may help you motivate them to exercise to get back to doing what they love to do.