Providing exercise instructions using multimedia may improve adherence but not patient outcomes: a systematic review and meta-analysis

Abstract

Objective: To determine whether patients have better outcomes when exercise instructions are provided using multimedia approaches compared with verbal or written instructions. Data sources: Electronic databases (MEDLINE, EMBASE, CINAHL, and PsychInfo) searched up to October 2018. Study selection: Randomized controlled trials exploring exercise-based interventions for health conditions, and comparing instructions provided using multimedia approaches with conventional verbal or written instructions. Results: Fourteen trials from seven countries were included, with a total of 2156 participants. Diagnoses included orthopaedic, neurological, pulmonary, cardiac, and women’s health conditions. A meta-analysis of three trials (140 participants) provided very low-quality evidence that multimedia exercise instructions may be more effective than written instructions in improving exercise adherence (standardized mean difference (SMD) 0.60, 95% confidence interval (CI) –0.06 to 1.25). Two of nine trials that could not be included in the meta-analysis for adherence due to heterogeneity reported that multimedia exercise instructions were more effective than written instructions in improving exercise adherence. Four other meta-analyses (three trials each) found low- to high-quality evidence that provision of exercise instructions using multimedia is no more beneficial than paper-based instructions for patient-related outcomes of pain intensity (SMD 0.09, 95% CI –0.47 to 0.28); uptake of physical activity (SMD 0.07, 95% CI −0.08 to 0.23); or physical (SMD 0.21, –0.21 to 0.64) or emotional (SMD 0.16, 95% CI −0.04 to 0.36) domains of health-related quality of life. Conclusion: Multimedia approaches to exercise instruction may result in increased adherence compared with instructions provided in written or verbal format, but there is insufficient evidence to determine whether this results in improved patient outcomes.

Evaluation of a Cervical Stabilization Exercise Program for Pain, Disability, and Physical Impairments in University Violinists with Nonspecific Neck Pain

“…Compared with previous studies, our participants received only one face-to-face instruction and then followed the instructional videos to practice cervical stabilization exercises thrice weekly. Previous studies have shown that multimedia-based exercise instructions can improve understanding and adherence to exercises [ 30 , 31 ]. Considering our positive results, instructional videos may be an effective and cost-efficient method for delivering cervical stabilization exercises.…”

Adherence and drop-out in randomized controlled trials of exercise interventions in people with multiple sclerosis: A systematic review and meta-analyses

“…5 The international community of researchers 6 and clinicians continue to develop our understanding of exercise in pwMS and work towards identifying the most effective exercise interventions for people with a range of disability 7,8,1,9,10 and in a range of settings. [11][12][13] For example, over the past twenty years interventions to enhance long-term engagement with activity [14][15][16] have been developed and evaluated and the value of incorporating behavioural interventions to support behaviour change has been investigated. [17][18][19] These developments are vital since sustained engagement in exercise is required to retain any benefits gained.…”

Feasibility of a Self-Managed, Video-Guided Exercise Program for Community-Dwelling People with Stroke

“…Offering exercise programs facilitated by technology and videos has been previously investigated for people with stroke [14,15] and in wider populations [16][17][18]. Videoguided exercise has been demonstrated to impact adherence but not outcomes over more traditional paper or booklet programs [18]. Furthermore, it has been found feasible for people with health conditions to access videos on an iPad, though not all liked using them [17].…”