Those who think they have not time for exercise will be required to find time for illness.”– Anon.
Other studies (citations available) came up with similar observations and conclusions:
- Personal factors – overall health, education, childhood engagement in sports, and other demographics – are indicators of whether individuals were likely to stick with exercise programs, but they are not the most important influencers.
- Self efficacy – a patient’s confidence in their ability to complete an exercise program – is a strong factor in determining whether the patient will continue on a program.
- Tailored exercise – the adjustment of exercise to suit the needs and abilities of the individual – enhances self-efficacy and increases the likelihood of exercise adherence.
- Intervention – being accountable to another person who provides advice and encouragement – is another strong motivator to continue exercise. Even positive intervention by a spouse who is not able to provide advice has an effect on adherence
- Ongoing adaptive support – the combination of monitoring, intervention, and tailored exercise – is the best combination of motivators with the highest likelihood of success.
Like many good intentions, a commitment to exercise tends to fall short of being put into action, particularly over the long term. As the proprietor of any fitness club will tell you, it is far easier to sign up a new member than to convince an existing member who has fallen away to return to their training schedule, even when the money has already been spent. A lack of exercise adherence – a patient’s commitment to performing prescribed exercise on a regular and ongoing basis – is the single greatest obstacle to a patient’s quest for physical fitness, more daunting even than convincing the patient to exchange their sedentary lifestyle for an active one.
Many studies have probed the nature of exercise adherence and why it is so difficult to attain. The findings and recommendations of some of the major ones are summarized here. Cumulatively, they present a strong argument in favor of adaptive support (see below) as the best way to provide the support a patient at this crossroads in their life. Simply stated, the patient cannot achieve exercise adherence on their own.
This holds true regardless of the patient’s demographic. In Portugal, a randomized controlled trial among sedentary women around 70 years of age showed that although they were capable of incorporating meaningful exercise into their lives, most of them failed to do so by the end of the two-year follow-up. Those who did attributed intervention – the involvement of another person in monitoring their program – and tailored exercise – the fine-tuning of exercise programs to the unique needs of the individual – to their success.
A similar outcome was observed in an Australian study of sedentary 14-year-old students. Over the six-month study, some students were provided with pedometers to record their activity, and email supervision to provide advice and monitoring. The students who received the intervention and feedback made substantial progress in adopting a healthier lifestyle and left their couch-bound peers in the dust.
New Zealand’s Green Prescription program – their version of prescribed exercise – produced significant improvements in levels of physical activity and overall quality of life among sedentary adults of all ages. In fact, other studies have shown adaptive support to be more important than available time, convenience, and other personal factors in an individual’s exercise adherence.