A Cochrane review [Abstract] 1 included 42 studies with a total of 8 243 subjects, mainly with osteoarthritis and spinal pain. Methods used for improving and measuring adherence in the included trials were inconsistent. Two of the 17 trials that compared different types of exercise showed positive effects, suggesting that the type of exercise is not an important factor in improving exercise adherence. Six trials studied different methods of delivering exercise, such as supervising exercise sessions, refresher sessions and audio or videotapes of the exercises to take home. Of these, 5 trials found interventions improved exercise adherence. Four trials evaluated specific interventions targeting exercise adherence; 3 of these showed a positive effect on exercise adherence. In 8 trials studying self-management programmes, 6 improved adherence measures. One trial found graded activity was more effective than usual care for improving exercise adherence. Cognitive behavioural therapy was effective in a trial in people with whiplash-associated disorder, but not in trials of people with other chronic musculoskeletal pain. In the trials that showed a positive effect on adherence, association between clinical outcomes and exercise adherence was conflicting.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by inconsistency (heterogeneity in interventions and outcomes).
Primary/Secondary Keywords