Patient Population:

No information was provided on the patient population.

Intervention:

Interventions designed to improve adherence to exercise recommendations. Delivered in: primary care, outpatient or community-based settings.

Comparison:

Comparison groups included “usual care”, wait listed control groups, education or advice, other exercise programs or therapeutic interventions (e.g. therapeutic ultrasound). There were 42 trials (described in a total of 59 papers) included in the present review. All but one of the included studies were RCTs. Delphi scores ranged from 2-8 overall (average score = 5). The majority of trials were considered to be of moderate methodological quality; 6 poor quality trials were identified. 23 trials studied individuals with OA (n=4894); these focused on the knee most often. The authors grouped trials into 5 broad categories – those examining 1) type of exercise therapy, 2) delivery of exercise, 3) exercise + specific adherence component 4) self-management programs and 5) interventions based on cognitive/behavioural principles.

Outcome:

1. Exercise type is not an important factor in adherence. Level = Silver, GRADE = Moderate.
2. There is conflicting evidence regarding water-based exercise. Level=Sliver, GRADE = Low.
3. Supervised exercise is more effective for improving weekly training frequency than unsupervised exercise (Level = silver; GRADE=moderate).
4. Attendance at exercise sessions may be better for individual vs. group exercise (Level=silver; GRADE=Moderate).
5. Supplementing home exercise with group exercise may improve activity levels (Level=silver, GRADE=moderate).
6. Accuracy of exercise performance may be improved by offering either refresher sessions or audio/videotapes of exercise sessions (Level=Silver, GRADE=Low).
7. Interventions intended to address adherence specifically may be effective in improving frequency/duration of exercise as well as attendance at exercise sessions (Level=Silver, GRADE; Moderate).
8. The addition of counselling based on the trans-theoretical model of change to physiotherapy does not appear to be associated with benefit when compared to physiotherapy alone (Level=Silver; GRADE = Moderate).
9. Self-management programs improve exercise frequency compared to wait listed or no intervention control groups (Level=Silver, GRADE = Moderate).
10. Behavioural graded activity is effective in improving adherence to a home exercise program (Level=silver; GRADE = Moderate).
11. Interventions based on cognitive behavioural therapy may be effective for improving adherence in individuals with whiplash-based disorder (Level=silver; GRADE=moderate).
12. CBT-based approaches may not be as effective in other chronic MSK patient groups (Level=silver, GRADE=Moderate).