Why don't people do their physio exercises? Part 1 - Is it your Physio’s fault?

Every patient who has seen a Physio will be set homework in the form of exercise programmes. The literature comprehensively states that most injuries will have a positive benefit from exercise-based treatment at some stage in the rehabilitation process. Be it stretches, resistance training or sports specific drills, Physios will prescribe exercise to aid their patient’s recovery.

However, most patients do not do their exercises as prescribed. It seems crazy that some patients who are given high-quality, evidence-based treatment plans for their problems are failing to complete them. 

Some patients will say that “I don’t like exercise” or “exercise is hard, just give me a pill I can take instead”. Surely it is far easier to take a pill for a problem and this surely would increase compliance. After all it takes seconds to take a pill every morning right? Then you find out that 70% of all patients who are prescribed medications do not take their medications as their doctor prescribed. 

Effort is clearly not a significant factor for people doing their exercises. There are many more nuanced reasons for why this may be and sometimes it is actually the Physiotherapist who is at fault.

Is it actually the Physio’s fault?

How can it be the Physios fault? Is it not the patient that needs to adhere to the programme? I would argue not in all cases. 

All Physios train for a number of years, keep up with a programme of CPD and see tens of thousands of patients over a career. Knowledge and experience counts for a lot in the world of healthcare but it does not necessarily make you an expert at helping patients stick to their programmes. 

Too many exercises

Have you ever been to see a Physio and had excellent care? They have explained your condition, the rationale for their treatment and met your expectations fully. They have then given you a home exercise programme with ten or more exercises on it which need to be done three times per day

Obviously, the Physio is coming from a place of care and wants the best for you, but an exercise list which crosses several pages with overly complex exercises is unreasonable for any patient to complete. Evidence suggests that giving patients any more than three exercises reduces compliance by half and giving someone more than six drops that to around 20%. Giving someone two or three meaningful exercises that get done is far better than six that don’t. 

Write stuff down

Evidence also suggests that patients may only retain as little as 20% of everything that is discussed in a consultation after 24 hours. How can health care professions expect patients to be compliant when retention levels are so low? We, as practitioners, just give patients tools to aid their recall. Writing things down for them or summarizing their programme on an exercise sheet or an online app to act as an aide-memoire. We can also film patients going through their exercises on their phones so they can check how to perform the movements. Having something for patients to refer back to can really help. 

Making exercises meaningful

Physios, as with other healthcare professionals, can be guilty of over medicalising a situation. For example, “my patient has back pain and I must give them spinal strengthening exercises”. The patient then gets admittedly some good exercises for their spine but unfortunately, they are boring. The patient then loathes to do them and subsequently stops doing them. 

A better way to approach the issue may be to ask the patient what they enjoy doing or what they need to be able to do when they are recovered. We can then see if we can fit an exercise around this meaningful activity. I remember seeing a patient who needed to be able to lift objects down from shelves at work. I asked the patient to create that environment at home but with lower shelf heights. The patient then got various items of different sizes and gradually practiced this regularly and took great joy finding random things to put on the shelves. Because the exercise had meaning for the patient and they could clearly see the end goal, the patient’s compliance was excellent and they recovered well. 

If you are finding your exercises boring, speak to your Physio and work with them to create a meaningful exercise programme for you. You may have to think outside the box but this is certainly a way to make your rehab more interesting and keep you on track. 

Spouse Test

There is also another test which Physios can do which is called the Spouse Test. You ask your patient at the end of the session “So when you go home to your partner tonight, what are you going to tell them about today's session?” This is an incredibly powerful way for the patient to summarize what you have discussed with them and a useful way to check they have understood everything from your interaction. You can quickly and easily find out if they can recall their exercises so you can be more confident they will remember them when they get home. 

It can often be a struggle to keep up with your home exercise programmes but it isn’t always your fault. If you are struggling, reflect on this article and speak to your Physio today so you can work together to achieve your goals.