A large percentage of patients don’t perform the home-based rehabilitative exercises that are recommended to them.1 Even though you spend precious time deciding which exercises will be helpful and explaining them to the patient, your experience has probably been the same as most chiropractors: Too many patients just can’t seem to do their exercises. And yet, you know that if they would just do the exercises, they would get better faster. Patient cooperation and satisfaction with at-home exercise programs are important for successful outcomes.2
In my opinion, each patient has several barriers or “hurdles” to get over in order to reach the goal of exercising. The more hurdles we can lower or even eliminate, the more likely it is that the exercises will get done. Here are some ways to lower the hurdles and help your patients get to the “‘finish line.”
Lower the first big hurdle by recommending only one (or, at most, two) exercise(s) initially. This minimizes the start-up effort and decreases the amount of time required. Once a patient has been doing one or two exercises regularly for a couple of weeks, additional or more complex exercises can be more easily implemented.
Consistency for Success
Consistency helps to ensure success in many areas. When a new habit needs to be learned, frequent and regular repetition helps.3 Trying to schedule exercises into a busy schedule is difficult, especially when your patient has to decide which days to exercise and which days to rest. Since rehabilitative exercises do not tear down muscles, daily exercising is safe, and the scheduling hurdle can be eliminated. Instruct your patients to “do the exercises every day.”
Why, What, and How
Make sure your patient knows why the exercise needs to be done, and what benefits to expect. Motivation improves compliance with exercise.4 Motivation is much better when a purpose is understood and a mutual goal has been established. Explain that doing the exercise will help your patient better perform the activities he or she enjoys.
Simple Is Best
Keep instructions to patients clear and simple. This is particularly important when discussing the numbers of repetitions and “sets” (groups of repetitions). Many doctors recommend six repetitions of the exercise, followed by a brief (up to one minute) rest, done three times. This “three sets of six” concept is quick to perform and easy to understand. Recent research has shown that only one set of ten-to-twelve repetitions can be just as effective. This is particularly true when patients are just starting to exercise, and especially when they are exercising daily. Use either approach, but keep the instructions clear.
Using the “Whenever” Approach
Any time of day is the right time to exercise—what’s most important is getting the exercises done. Even though some professionals feel that athletic activities are somewhat safer in the afternoon (when muscles and joints are warmer), encourage your patients to exercise whenever it works for their schedule (and once a day is plenty).
A spouse or family member should accompany the patient when exercises are taught, so they can help ensure correct and regular performance of the exercise. A second person who wants your patient to get better can be a tremendous ally,1 one who will provide encouragement and reminders.
Focus on Function
Focus your patients on function by keeping them off the floor. Exercising in a weight-bearing position is actually easier for patients. In addition to being more focused and practical, upright exercising trains and strengthens the spine to perform better in everyday activities. Patients like the idea of doing an exercise that clearly prepares them for better function during normal activities of daily life.
Demonstrate, then watch and correct your patients’ performance of the exercise. When patients need an exercise, they usually can’t do the exercise correctly. Diagrams, pictures, even videos can’t ensure that patients will be able to figure out the suggested exercise. When you spend the time to show them the exercise, and then you guide them through it, they realize that you believe this is an important part of their treatment. Patients are then much more likely to do the exercise.1
Keep it Easy
Well-designed, easy-to-use home rehab equipment helps to ensure compliance.5 Home equipment should be easy to figure out and set up, and should help guide your patients through the necessary exercises.
Monitor and Praise
As an integral part of their rehab while under your care, all patients must record their exercising in some form of exercise log. This allows them to “give themselves a pat on the back” each time they do the exercise. And remind them to bring the exercise log with them to every adjustment, so you can see how the exercises are going. Make sure to give them praise and recognition for the exercises they perform.
At least once a week, have the patient perform their exercise in front of you. This allows you to confirm that it’s being done properly, and you can correct any faults that creep in. A regular review also reinforces, in the patient’s mind, the importance of the exercising and encourages them to continue.
Aim for a Rapid Response
There is nothing more motivating than the feeling that the most important exercises are being done. Make sure that the exercise(s) you are recommending will produce a rapid response, so the patient starts to feel the benefits of the exercising immediately. Don’t give all patients the same six exercises; instead, try to start the patient on the most important exercise for his or her condition.1
If you implement these rehab tips, your patients will be more likely to do their exercises faithfully. Once they have established the habit of doing one or two exercises, you can use the rehab review to add other exercises. With this method, a patient can gradually develop a good general fitness and spinal health exercise program while under your care.
Word will soon get around your community that you care enough about your patients to help them establish a regular spinal health and exercise program. This will build your practice, and also improve the reputation of chiropractic for years to come.
Kim D. Christensen, DC, CCSP, CSCS, DACRB, founded the SportsMedicine & Rehab Clinics of Washington. He is a popular speaker, and participates as a team physician and consultant to high school and university athletic programs. Dr. Christensen is currently a postgraduate faculty member of numerous chiropractic colleges and is the president of the American Chiropractic Association (ACA) Rehab Council. He is a “Certified Strength and Conditioning Specialist,” certified by the National Strength and Conditioning Association. Dr. Christensen is the author of numerous publications and texts on musculoskeletal rehabilitation and nutrition. He can be reached at Chiropractic Rehabilitation Consulting, 18604 NW 64th Avenue, Ridgefield, WA 98642 or by email at [email protected].
- Kamiya A, Ohsawa I, et al. A clinical survey on the compliance of exercise therapy for diabetic outpatients. Diabetes Res Clin Pract 1995; 27(2):141-145.
- Chen CY, Neufeld PS, et al. Factors influencing compliance with home exercise programs among patients with upper-extremity impairment. Am J Occup Ther 1999; 53(2):171-180.
- Rejeski WJ, Brawley LR, et al. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc 1997; 29(8):977-985.
- Friedrich M, Gittler G, et al. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 1998; 79(5):475-487.
- Stenstrom CH, Arge B, Sundbom A. Home exercise and compliance in inflammatory rheumatic diseases: a prospective clinical trial. J Rheumatol 1997; 24(3):4700-476.