Prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases: A systematic review and meta-analysis

Abstract

BackgroundPatients with a chronic disease may have an increased risk of non-adherence to prescribed home-based exercise therapy. We performed a systematic review with the aim to identify variables associated with adherence to home-based exercise therapy in patients with chronic diseases and to grade the quality of evidence for the association between these prognostic factors and adherence.MethodsCohort studies, cross-sectional studies and the experimental arm of randomized trials were identified using a search strategy applied to PubMed, Embase, PsychINFO and CINAHL from inception until August 1, 2022. We included studies with participants ≥18 years with a chronic disease as an indication for home-based exercise therapy and providing data on prognostic factors of adherence to home-based exercise. To structure the data, we categorized the identified prognostic factors into the five WHO-domains; (1) Patient-related, (2) Social/economic, (3) Therapy-related, (4) Condition-related, and (5) Health system factors. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Prognostic factors of adherence were identified and the quality of the evidence between the prognostic factors and adherence were graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies. We performed a meta-analysis of the obtained information.ResultsA total of 57 studies were included. Within patient-related factors moderate- and high-quality evidence suggested that more self-efficacy, exercise history, motivation and perceived behavioral control predicted higher adherence. Within social-economic factors moderate-quality evidence suggested more education and physical health to be predictive of higher adherence and within condition-related factors moderate- and low-quality evidence suggested that less comorbidities, depression and fatigue predicted higher adherence. For the domains therapy-related and health-system factors there was not enough information to determine the quality evidence of the prognostic factors.ConclusionThese findings might aid the development of future home-based exercise programs as well as the identification of individuals who may require extra support to benefit from prescribed home-based exercise therapy.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277003, identifier PROSPERO CRD42021277003.

Regarding Evidence on Exercise/Physical Fitness: The Miracle Drug

“…In a recent systematic review of clinical trials that included unsupervised exercise interventions for subject populations with knee osteoarthropathy (OA), Smith et al7 identified substantial variation in methodologies for the collection and reporting of exercise adherence data, as well as multiple common methodological flaws that can be observed among studies that met the review's inclusion criteria. Similar observations can be made for literature that includes unsupervised exercise among a wide variety of populations and, unfortunately, flawed methodologies for adherence monitoring and reporting likely extend to exercise research conducted on several clinical populations 7,9,10. Not only is there a common concern with the validity of commonly used measurements that investigate adherence to exercise interventions, there are a surprisingly high number of studies that do not describe how adherence was measured or do not indicate whether adherence even was measured at all 7,9,10.…”

“…8 Further, different tissues have physiologic responses to specific mechanical stimuli (loading properties) imposed on body structures, which can be harnessed to achieve tissue healing with appropriate exercise selections. [10][11][12] One well-known example is the implementation of weight-bearing exercise (ie, cyclical axial compression loading) to stimulate osteoblastic activity and improve bone mineral density. 13 Another well-known example is the body of evidence advocating for eccentric exercise to address various tendinopathies throughout the body (eg, Achilles tendinosis and patellar tendinosis).…”

“…Examples from the Guide to Physical Therapist Practice include increasing tolerance to activities, improving sensory awareness, diminish swelling, improving safety, and enhancing or maintaining physical performance to name a few 8. Further, different tissues have physiologic responses to specific mechanical stimuli (loading properties) imposed on body structures, which can be harnessed to achieve tissue healing with appropriate exercise selections 10–12. One well-known example is the implementation of weight-bearing exercise (ie, cyclical axial compression loading) to stimulate osteoblastic activity and improve bone mineral density 13.…”

“…Similar observations can be made for literature that includes unsupervised exercise among a wide variety of populations and, unfortunately, flawed methodologies for adherence monitoring and reporting likely extend to exercise research conducted on several clinical populations. 7,9,10 Not only is there a common concern with the validity of commonly used measurements that investigate adherence to exercise interventions, there are a surprisingly high number of studies that do not describe how adherence was measured or do not indicate whether adherence even was measured at all. 7,9,10 Smith et al proposed an important clinical implication that may result from the reportedly observed methodological flaws and variation of adherence data collection among knee OA trials; the commonality of these overarching research limitations could adversely affect "what is known about the efficacy of exercise interventions for people with knee OA."…”

“…7,9,10 Not only is there a common concern with the validity of commonly used measurements that investigate adherence to exercise interventions, there are a surprisingly high number of studies that do not describe how adherence was measured or do not indicate whether adherence even was measured at all. 7,9,10 Smith et al proposed an important clinical implication that may result from the reportedly observed methodological flaws and variation of adherence data collection among knee OA trials; the commonality of these overarching research limitations could adversely affect "what is known about the efficacy of exercise interventions for people with knee OA." 7 Given the widespread nature of exercise adherence measurement and reporting among various other populations, we may need to reflect on our conclusions about dose-response relationships and efficacy of exercise interventions.…”