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Improving exercise adherence in older people

What do physiotherapists think of their support to improve exercise adherence?

Exercise is a key part of the concept of global health, and insufficient physical activity has been identified as one of the factors leading to sedentarity and potentially pathology or diseases.

Exercise and physical activity are all the more significant for older people who face physiological changes and altered physical function, which may increase the risk of hospitalisation and morbidity when associated with physical inactivity.

When talking about exercise, a frequent issue for physiotherapists is the question of adherence – which is often reported as irregular. Several studies investigated ways to increase exercise adherence such computer feedback and exergaming, but also behavioural change. The latter is part of the physiotherapists' role when prescribing exercises to patients.

The purpose of this qualitative study was to get an in-depth understanding of physiotherapists' experience and perception of the support they provide to incite older patients to continue exercising. This may help implementing behavioural change techniques more effectively and therefore lead to an increased adherence. The main point highlighted by this study was overall insufficient education opportunities to learn how to motivate and to support older patients and help them continue exercising.

Three main themes resulted from this qualitative investigation:

  • Physiotherapists have an important role in stimulating older patients to continue exercising: participants talked about it as a real professional goal (i.e., providing effective support), sometines requiring assistance of other health professionals (such as doctors) to be even more efficient.
  • Physiotherapists have low confidence when it comes to supporting older patients to continue exercising. The main reason mentioned by the participants was the low rate of adherence achieved compared to their professional expectations. Such confidence however may increase with clinical experience and continuing professional development.
  • The opportunities for education are limited: participants highlighted the fact that they did not have much opportunity to learn how to support patients and stimulate adherence during their professional education. Moreover, physiotherapists treating older people had only low interest in this subject, so they did not search for specific courses in this area as a priority.

> From: Ariie et al., Prog Rehabil Med 6 (2021) 20210005 . All rights reserved to The Japanese Association of Rehabilitation Medicine. Click here for the online summary.

Expert opinion

This study shows that physiotherapists not only care about promoting exercise to older people, but that they also consider it as a real professional goal. They have expectations of results as healthcare professionals.

Earlier studies showed that the content of promotion of exercise is directly linked to the provider's confidence which – as highlighted in this study – remains low in the physiotherapist population. Gaining confidence through clinical experience and continuing professional development, also through education, training and learning opportunities (including via available evidence in literature) is therefore essential.

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