Why patients don't do their home exercises, and what actually helps

Patients who skip their home exercises are rarely just lazy. The research points mostly to things you can influence. Does the patient believe they can do the program and mean to do it, and does anyone at home back them up? Much of that can be shaped before the patient leaves your room.

How big the problem is

A systematic review by Essery and colleagues looked at home-based physical therapy and noted that non-adherence can reach 70%. That is the upper end of what has been reported. Still, most physios will recognize the patient who comes back two weeks later having done very little.

What predicts who does their exercises

The same review found relatively strong evidence for a short list of predictors:

1. The patient intends to do the program.
2. They feel able to do it. This is self-efficacy.
3. They are self-motivated.
4. They have stuck with exercise before.
5. They have support from people around them.

Most of these are about belief and confidence. You cannot change a patient's history, but you can build their confidence and help them plan in a single session.

Five changes that help

Give fewer exercises

A second systematic review, by Bachmann and colleagues, recommends giving 2 to 4 exercises at most. If you have more to give, stage them: start with the ones that matter most and add more at the next visit.

Make them practice it in front of you

Watching you demonstrate is not the same as doing it. Have the patient do a few reps while you watch and correct. Getting it right once in the room is a quick way to build self-efficacy, which is on the predictor list above.

Tie it to something they already do

"Do these twice a day" is vague. "Do the calf raises while the kettle boils, and the bridges before you get out of bed" gives the exercise a place in the day. Ask the patient where it fits. Their answer will usually suit their day better than yours.

Explain why, in one sentence

Self-motivation is on the predictor list above, and a clear reason gives the patient something to hold on to. Something like "this strengthens the thigh muscle that takes the strain when you walk down stairs" is enough. Keep it accurate and hopeful, and avoid phrases that make the body sound broken.

Send it somewhere they will actually look

A printed sheet is easy to lose. A video on the phone is there when the patient is at home and unsure how an exercise goes, and it lets them check their own form. In a randomized trial of 80 people with musculoskeletal conditions by Lambert and colleagues, patients who got their program on an app, with follow-up phone calls and text messages, reported slightly better adherence after 4 weeks than patients given a paper handout. The authors note that the clinical importance of that difference is unclear.

Check in early

Bachmann and colleagues list support and guidance from the physio among the factors linked to better adherence. A short message in the first few days ("How are the exercises going?") gives the patient a chance to tell you about pain that is putting them off, an exercise they misunderstood or a schedule that is not working. It also tells the patient you are paying attention.

What to do at the follow-up

Ask how often they managed the exercises, and ask it neutrally. "Most people find it hard to do them every day. How has it been for you?" is more likely to get an honest answer. "Have you been doing your exercises?" usually gets a yes.

Then adjust. If they did one exercise faithfully and ignored two, keep the one and ask what got in the way of the others. Low mood, anxiety or a sense of helplessness can also get in the way, and Bachmann and colleagues list these among the barriers. If they seem to be part of the picture, talk about it and involve the patient's doctor where needed.

The short version

Give fewer exercises and have the patient practice them in the room. Tie them to a daily habit, explain them in plain words and send them to the phone. None of it is complicated. Doing it with every patient on a busy day is the hard part, and that is where a good system helps.

References

1. Essery R, Geraghty AW, Kirby S, Yardley L. Predictors of adherence to home-based physical therapies: a systematic review. Disability and Rehabilitation. 2017;39(6):519-534. doi:10.3109/09638288.2016.1153160
2. Bachmann C, Oesch P, Bachmann S. Recommendations for improving adherence to home-based exercise: a systematic review. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2018;28(1):20-31. doi:10.1055/s-0043-120527
3. Lambert TE, Harvey LA, Avdalis C, et al. An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy. 2017;63(3):161-167. doi:10.1016/j.jphys.2017.05.015

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-25.