Proper execution of home exercises is crucial for effective physical therapy and exercise training.
Yes, it can be frustrating for therapists when patients are unable to comply with home exercises, as it can lead to slower progress and less effective treatment outcomes.
However, it’s important for therapists to understand that there can be various reasons why patients may not be able to comply with home exercises, such as lack of time, motivation, or access to equipment. Therapists should collaborate with patients to identify and address barriers to compliance, adjust exercise programs, provide education and resources, and offer encouragement and feedback. Clear communication about the benefits of home exercises can also motivate patients to take an active role in their recovery.
Approximately 95% of my patients dutifully perform their prescribed home exercises, with an accuracy rate of approximately 80%. Moreover, they are enthusiastic about communicating with me regarding their progress and challenges.
In my almost ten years of practice, only a handful of patients, about ten in total, have failed to comply with their prescribed exercises. About one-fifth of these non-compliant patients were my family members (you know how family can be 😅).
One patient once said to me, “The home exercises you assigned are easy to follow. The instructions are clear and precise, making them easy to execute at home. I am committed to dutifully performing them!”
Recently, I came across an informative article on the Physio Network website about making home exercise programs more time-efficient (How to Make Your Home Exercise Programs More Time Friendly). It has valuable information to share. I also gathered nine strategies from experts worldwide and my own experience to improve compliance and accuracy with home exercises. These tips can be helpful for anyone, not just therapists.
9 Effective Strategies to Improve Compliance and Accuracy with Home Exercise Practice
[Considerations for planning home program exercises]
1. Time
Consider the patient’s available time for exercising each day and design the exercise plan and dosage (duration, frequency, and number of repetitions) accordingly. Ensure that the exercise dosage is sufficient to achieve the intended goals.
■ Example:
Each exercise should be performed for 1-2 minutes per side, 2-3 times per day.
Based on my experience, prescribing three exercises to be performed twice a day has been more effective in achieving the desired outcomes compared to six exercises done once a day.
2. Environment
When designing a home exercise program, it is important to consider the environment in which the patient will perform the exercises, such as at home or in the office. It’s also important to consider the equipment available to them. Simpler and more convenient exercises are easier for patients to perform regularly.
■ Example:
A patient says, “I can use my break time in the office to do seated exercises, but I’m busy taking care of my child when I get home.” In this situation, it is recommended to provide seated exercises that can be done in the office.
Reminder
Do not make assumptions about the client’s situation. Always confirm the details with them. Here are two interesting stories to share:
Story 1:
The client said, “I have enough space at home to lie down,” so I gave her an exercise to do in a lying position. A week later, the client said, ” I forgot to mention that my nine cats would crawl all over me when I lie down, making it impossible to do the exercise.” This experience taught me the importance of confirming all details with patients/clients before prescribing exercises, such as asking directly, “Can you do the exercise while lying down?”
Story 2:
Once, I assumed that everyone has walls in their home and gave an exercise that required the wall for support. However, a week later, the client informed me that she didn’t have a wall to lean on at home because she was afraid of getting it dirty, and she couldn’t do the home exercise. From then on, I learned to ask patients/clients to think about whether they have walls or other supports at home during their treatment sessions.
[Details Of Instruction]
3. Understanding the Purposes and Effects of the Home Exercises
Clearly communicate to the client the purpose of each exercise and the benefits that can be achieved.
■Example:
- By practising exercises that increase lumbar spine control and coordination, you can prevent continuous pulling or overloading of the lumbar tissue.
- By increasing hip joint mobility, you can avoid excessive movements of the lumbar spine.
- Mobility exercise can also help maintain joint mobility and enhance the effectiveness of manual therapy.
- Improving the recruitment efficiency of specific muscles can give overworked muscles a chance to rest and recover.
4. Give patients/clients clear instructions
Provide the client with clear and concise instructions, including hand cues and demonstrations, to guide them through the steps of the exercise:
■Example:
Step 1: Lie on your side with your thigh forward at a 45-degree angle, and your knee bent at a 90-degree angle.
Step 2: Keep your pelvis stable and use 30% of your strength to raise your knee toward the ceiling while keeping your feet together.
Step 3: Slowly lower your knee back down, closing it as you return to the starting position.
Be sure to repeat these instructions to the client, offering guidance and feedback to ensure the proper execution of the exercise.
5. Key details of the movements
Identifying and addressing the details of movements that patients/clients might struggle with, ensuring they understand the movements correctly, and can differentiate between the right and wrong movements when perform them.
6. Record Home exercises on patients’/clients’ phones
At the end of the session, it is recommended that the therapist use the client’s own phone to record them performing the home exercises. As the client performs the exercises, the therapist should provide verbal instructions and emphasize key details of the movements to ensure proper form and movement. Recording the client rather than the therapist can facilitate effective practice for the following reasons:
Each person has unique ranges of motion.
Recording the exercises allows the client to review while also confirming that they can execute the exercises correctly without the therapist’s manual guidance.
Recording provides visual feedback that can aid in identifying any areas of improvement or adjustment needed for the client’s movement.
By using the client’s own phone to record the exercises, the client can easily access the videos at home to continue practicing and improving their technique. This also ensures that the client has full control over the videos and can easily refer to them as needed for ongoing practice.
Reminder:
It is important to encourage patients/clients to record their home exercises, even if they insist that they will remember without recording. Based on my ten years of experience, out of ten patients/clients who didn’t record, eleven of them forgot! It is not that patients/clients intend to deceive us, but rather they may not fully realize how challenging it can be to remember various steps and details. By encouraging patients/clients to record their exercises, we can help ensure that they have an accurate and reliable resource to refer to for ongoing practice and progress monitoring.
[Always Monitoring Progress for Effective Home Exercise]
7. Ask the patient to demonstrate the home exercises
To ensure that patients are practicing effective home exercises, it is crucial to confirm their progress and execution status. I always prioritize this by inquiring about their home exercise practice at the beginning of each session. This not only highlights the significance of home practice but also enables me to assess whether any adjustments need to be made to the treatment plan. If patients are performing the exercises accurately but not experiencing the desired therapeutic or training effects, it may be necessary to change the direction of treatment. Conversely, if patients are having difficulty executing the exercises correctly, it is important to identify the underlying reason and address it accordingly.
8. Positive reinforcement for exercise motivation
Providing positive feedback and encouragement is essential, whether the exercise has produced the desired effect or is proving challenging for the individual. As long as they are making an effort to practice, positive reinforcement is crucial to keep them motivated and committed to their exercise routine.
9. Addressing patient’s reasons for not doing home exercise
In the event that a patient is not doing home exercise, it is important to ask for the reason and address the problem accordingly.
■Example:
If the patient is hesitant to exercise due to the fear of doing it incorrectly, I will assure them that as long as the exercise is not causing discomfort, it is acceptable even if it is not executed perfectly. In such cases, I will offer guidance and encourage them to practice repeatedly during the session until they feel confident in distinguishing the correct form from incorrect form.
On the other hand, if the reason for not exercising is that there are too many movements involved, I will streamline the variety of exercises and confirm the most suitable time and posture for the patient to perform them.
The above is a summary of the 9 tips for increasing the execution rate and correctness of home exercise based on the steps for giving exercise.
Do you have any additional methods to share for increasing the execution rate and correctness of home exercise? Or as a patient, what do you find difficult about performing home exercise and what kind of help do you hope your therapist can provide to make it easier to carry out? Feel free to leave a comment and let’s get healthy together!
■ Appointment / Collaboration ►►https://suzannetang.com/contact/
Join me on Facebook, Instagram, and YouTube to stay connected.
Your encouragement means a lot to me!