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

Abstract

Introduction: Patients 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 and grade the quality of variables associated with (non-)adherence to home-based exercise therapy in patients with chronic diseases. Methods: Cohort 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 1th 2022. We included studies with participants ³ 18 years with a chronic disease as an indication for home-based exercise therapy and providing data (quantitative and qualitative) on prognostic factors of (non)adherence to home-based exercise. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool for observational studies, the Quality Assessment Tool for Observational Cohort and Cross- sectional studies of the National Institutes of Health (NIH) for cross-sectional studies and the Critical Appraisal Skills Program (CASP) qualitative checklist for the qualitative studies. Prognostic factors of adherence were identified and graded for quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies. We performed a meta-analysis and best evidence synthesis of the obtained information. Results: A total of 68 studies (11 qualitative and 57 quantitative) 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. Conclusion: These 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. Registration: The protocol of this systematic review is registered in PROSPERO with registration number 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.…”

Development and Validation of a Multivariable Exercise Adherence Prediction Model for Patients with COPD: A Prospective Cohort Study

“…A previous performed systematic review and meta-analysis of prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases 19 formed the basis. According to this systematic review and meta-analysis higher exercise adherence was predicted by self-efficacy, exercise history, motivation, education, physical health, comorbidities, depression, fatigue, and support from a healthcare provider.…”

“…According to this systematic review and meta-analysis higher exercise adherence was predicted by self-efficacy, exercise history, motivation, education, physical health, comorbidities, depression, fatigue, and support from a healthcare provider. 19 …”

“…According to this systematic review and meta-analysis higher exercise adherence was predicted by self-efficacy, exercise history, motivation, education, physical health, comorbidities, depression, fatigue, and support from a healthcare provider. 19 Further, in paramedical professions, it is widely accepted that the treatment regimen alone cannot fully account for patient outcome. 20 The relationship between patient and therapist (therapeutic alliance) has been viewed as an important determinant of treatment outcome and is considered central to the therapeutic process.…”

“…A recent performed systematic review indicated variables associated with adherence. 19 Further, TPB as the state-of-the-art model to predict adherence behaviors in patients with a chronic disease, was used. 36 This study also has some limitations.…”