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Are your patients actually doing their exercises? Here's what the research says

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You send a patient home with a program. Three weeks later at the follow-up it turns out half of it never got done. That isn't bad luck or poor motivation; it's the rule.

How big is the problem

Precise percentages are hard to come by here. A 2024 overview of systematic reviews states that non-adherence in physiotherapy can run as high as 70 percent, particularly in unsupervised home exercise programmes (Ley & Putz, 2024). Argent and colleagues, writing in JMIR mHealth and uHealth, put it at up to 50 percent (Argent et al., 2018).

A systematic review in BMJ Open shows why so many different figures circulate. Bollen and colleagues found 58 studies using 61 different ways of measuring adherence between them: 29 questionnaires, 29 logs, two visual analogue scales and one tally counter. Of all those instruments, two scored positively on a single psychometric property. Most had never been tested for validity or reliability at all (Bollen et al., 2014).

That is the honest position. Adherence is clearly a large problem. Any exact percentage you come across rests on a measure that probably was not validated.

Why don't patients follow the program

A systematic review in Manual Therapy went through twenty high-quality studies on barriers to adherence in musculoskeletal physiotherapy (Jack et al., 2010). There was strong evidence for: low physical activity beforehand, low adherence during treatment itself, low self-efficacy, depression, anxiety, helplessness, poor social support, a high perceived number of barriers to exercise, and more pain while exercising.

A more recent review in Musculoskeletal Science and Practice identified thirteen modifiable determinants across 28 studies (Chester et al., 2023). The three that came up most often: self-efficacy, social support, and whether the patient sees the point of the exercise.

The thread running through all of it: the problem is rarely the exercises. It is how the patient experiences them, whether they fit into the week, and whether the patient believes they can do them.

What digital support adds

It works in the short term

A systematic review of randomised trials in Archives of Physiotherapy pooled ten RCTs covering 1,117 participants (Lang et al., 2022). Seven of the ten found a significant difference in adherence favouring the digital intervention. Three found no difference.

Those three are the interesting ones. They were precisely the trials with the longest follow-up. The authors conclude that digital support likely increases adherence in the short term, and that longer-term effects are less certain.

Video helps with execution

That evidence is older and firmer than the digital evidence. In a randomised study in Physical Therapy, participants learned an exercise program through live instruction, video, or a paper handout. The handout group made more than twice as many errors as the other two, and no difference was found between live and video (Reo & Mercer, 2004). A later trial found a video that showed and corrected common mistakes just as effective as a single instruction session with a physical therapist (Berkoff et al., 2016). We went into that in more depth in video versus paper.

On adherence specifically, a meta-analysis in Telemedicine and e-Health looked at home-based video exercise programs in people over 65: 26 studies, 1,292 participants, a weighted retention rate of 91.1 percent and an attendance rate of 85.0 percent (Rihova et al., 2024). Two further findings from the same analysis are worth noting: longer sessions cut attendance sharply, and programs without live contact with a coach scored lower than sessions where that contact was present.

Dutch data

The Dutch e-Exercise program was tested in a cluster-randomised trial in people with hip or knee osteoarthritis (Kloek et al., 2018). The result is more nuanced than it is usually retold: on the primary outcomes, e-Exercise was not more effective than usual physical therapy. Both groups improved. The difference was in the input: the e-Exercise group had an average of five face-to-face sessions against twelve for the control group.

Equivalent outcomes at fewer than half the contact moments is a meaningful result. It is simply a different claim from "digital works better".

What apps still lack

A systematic review in JMIR mHealth and uHealth assessed patient-facing physiotherapy apps on the behaviour change techniques built into them (Merolli et al., 2024). Those techniques, which are central to how physiotherapy actually changes behaviour, are frequently missing. A more recent evaluation of prescription apps for professional use reaches a comparable verdict on clinical usability (Wu et al., 2026).

There is a market, then, but the quality varies.

It isn't always better

An honest note: not every trial shows a benefit. A randomised study in BMJ Open gave children with cerebral palsy and other neurodevelopmental disabilities their home exercise program for eight weeks either through an online platform or on paper (Johnson et al., 2020). The percentage of exercises completed did not differ significantly: 62.8 against 55.8 percent. Goal-based outcomes showed no difference either. Both groups improved.

Effectiveness depends on the patient group, the context, and how the tool is put to use. In children, where the parent is the engine, the platform added nothing over a printout.

Conclusion

Adherence to home exercise is a large and persistent problem. Digital support demonstrably helps in the short term; over longer periods the evidence is thin. The strongest evidence is not about the technology but about the instruction: moving images produce more accurate performance than a printout with pictures, and that has held for twenty years.

Want to read the underlying studies yourself? We summarised 23 of them on instruction, home exercise programs and digital care and grouped them by theme on our research page, including the trials that found no difference.

Sources

  • Argent, R., Daly, A. & Caulfield, B. (2018). Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? JMIR mHealth and uHealth, 6(3), e47. PMID 29496655
  • Ley, C. & Putz, P. (2024). Efficacy of interventions and techniques on adherence to physiotherapy in adults: an overview of systematic reviews and panoramic meta-analysis. Systematic Reviews, 13, 137. PMID 38773659
  • Bollen, J.C. et al. (2014). A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties. BMJ Open, 4(6), e005044. PMID 24972606
  • Jack, K., McLean, S.M., Moffett, J.K. & Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Manual Therapy, 15(3), 220-228. PMID 20163979
  • Chester, R. et al. (2023). Behaviour Change Techniques to promote self-management and home exercise adherence for people attending physiotherapy with musculoskeletal conditions. Musculoskeletal Science and Practice, 66, 102776. PMID 37301059
  • Lang, S., McLelland, C., MacDonald, D. & Hamilton, D.F. (2022). Do digital interventions increase adherence to home exercise rehabilitation? A systematic review of randomised controlled trials. Archives of Physiotherapy, 12(1), 24. PMID 36184611
  • Reo, J.A. & Mercer, V.S. (2004). Effects of live, videotaped, or written instruction on learning an upper-extremity exercise program. Physical Therapy, 84(7), 622-633. PMID 15225081
  • Berkoff, D.J. et al. (2016). Corrected error video versus a physical therapist instructed home exercise program. International Journal of Sports Physical Therapy, 11(5), 757-764. PMID 27757288
  • Rihova, M. et al. (2024). Adherence and Retention Rates to Home-Based Video Exercise Programs in Older Adults: Systematic Review and Meta-Analysis. Telemedicine and e-Health, 30(11), 2649-2661. PMID 39072676
  • Kloek, C.J.J. et al. (2018). Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial. Physical Therapy, 98(7), 560-570. PMID 29788253
  • Merolli, M. et al. (2024). Evaluation of Patient-Facing Mobile Apps to Support Physiotherapy Care: Systematic Review. JMIR mHealth and uHealth, 12, e55003. PMID 38437018
  • Wu, C.-H., Chang, C.-N. & Chang, C.-F. (2026). Clinical Usability of Exercise Prescription Apps for Professional Use: Systematic Review and Multidimensional Evaluation. JMIR mHealth and uHealth. DOI 10.2196/77616
  • Johnson, R.W. et al. (2020). Can an online exercise prescription tool improve adherence to home exercise programmes in children with cerebral palsy and other neurodevelopmental disabilities? BMJ Open, 10(12), e040108. PMID 33371023