Short answer: To improve home exercise program adherence, prescribe fewer exercises (usually 3 to 5, about 10 to 15 minutes a day). Choose exercises that change symptoms or function the patient cares about. Teach each one in the clinic and back it up with written, illustrated or video instructions. Deliver the program in a format and language the patient understands. Then track completion and follow up between visits.
Home exercise programs are where most of the work of rehab happens, but much of it never gets done. Studies of musculoskeletal patients put non-adherence at roughly 30% to 50% (Argent et al., 2018). When patients skip their home program, progress slows, visits get spent re-teaching, and outcomes suffer.
We first published this guide in 2014 with five simple rules. They still hold. This update adds what research and better tools have shown since then.
Why patients don't do their home exercises
Adherence is less about willpower and more about whether the program fits the patient's life. A systematic review of 30 studies found the most consistent predictors of adherence were:
- the patient’s intention to do the exercises
- self-motivation
- self-efficacy (confidence they can do them correctly)
- a history of sticking with exercise
- social support
(Essery et al., Disability and Rehabilitation, 2017).
Patients also name practical barriers: forgetting, lack of time, pain during exercise, and not being sure they are doing an exercise right. Each strategy below targets one or more of these.
1. Keep the program short: 3 to 5 exercises, 10 to 15 minutes
Ten to fifteen minutes fits into almost anyone's day. A program of 20 exercises that takes an hour is much more likely to be abandoned. For most patients that means about 3 to 5 exercises, including rest periods.
The research points the same way. In a small randomized trial of adults over 65, those given 2 exercises performed them better than those given 8 (Henry, Rosemond & Eckert, Physical Therapy, 1999). Fewer exercises means more attention for each one.
In practice: If a patient needs more than five exercises, split them across days (for example, A and B programs) instead of assigning them all at once.
2. Prescribe exercises the patient can feel working
If you remember one thing from this article, make it this. Patients keep doing exercises that reduce their symptoms or improve something they care about, and they drop the ones that don't.
Tie each exercise to the patient's own goal, such as climbing stairs without pain, lifting a grandchild or getting back on the court. Say that link out loud when you teach it. Goal setting is one of the interventions research reviews identify as promising for adherence (Peek et al., Physiotherapy, 2016).
In practice: Recheck symptoms after each exercise in the clinic. If an exercise doesn't change anything, replace it before it goes home.
3. Teach it in person, then send it home in writing and on video
Patients forget much of what they are told in a visit, and verbal instructions alone don't hold up. In a randomized trial of 96 people with acute low back pain:
- patients given written and illustrated instructions on top of verbal teaching averaged 77.4% compliance
- patients given verbal instruction alone averaged 38.1%
(Schneiders, Zusman & Singer, Manual Therapy, 1998).
Video adds what a drawing can't show, such as tempo, range of motion and form. In a pilot randomized trial in people with stroke, a mobile video-guided program produced higher three-month adherence than a paper pamphlet: 75.6% vs. 55.2% (Chung et al., Hong Kong Physiotherapy Journal, 2020).
In practice: Have the patient perform every exercise once before leaving. Send them home with written instructions that include sets, reps, hold times, rest and frequency, plus a picture or video of each exercise.
For more of the research, see Paper vs Digital Home Exercise Programs: What the Research Shows.
4. Match the format and language to the patient
There is no single best format. Some patients do best with a printed handout and line drawings on the refrigerator. Others want video on their phone. Patients who don't read English well need instructions in their own language, or the program will not be followed no matter how well it was designed.
In practice: Ask patients how they would like to receive their program. Offer print, email or a link, and an app. For patients with limited English, send instructions in their preferred language. Use larger print and fewer exercises per page for older adults.
5. Build confidence and plan around barriers
Self-efficacy is one of the strongest predictors of adherence. Patients who are unsure whether they are doing an exercise right tend to stop.
In practice:
- Ask “When during your day will you do these?” and attach the program to an existing habit, such as after brushing teeth or during the evening news.
- Ask what might get in the way, and solve it together (time, pain, equipment, childcare).
- Tell patients what normal soreness feels like and what should make them stop and call you.
- Involve a family member or caregiver when it helps. Social support predicts adherence.
6. Track completion and follow up between visits
What gets checked gets done. Feedback and self-monitoring are among the most promising adherence interventions (Peek et al., 2016). In a randomized trial of 80 people with musculoskeletal conditions, an app with remote support produced better adherence than paper handouts (Lambert et al., Journal of Physiotherapy, 2017).
In practice: Use a system that shows you which patients are completing their program, and lets patients report pain and difficulty. Reach out early to patients who fall behind, rather than finding out at the next visit. If your practice bills Remote Therapeutic Monitoring (RTM), this between-visit monitoring can also be reimbursed, subject to payer rules.
7. Update the program regularly
Doing the same exercises week after week gets boring, and a program that never changes tells the patient they have stopped progressing. Swap in new exercises that work toward the same goals, and progress load, range or difficulty as the patient improves. Each update is also a natural moment to ask for feedback.
In practice: Review and update the home program at most visits, even if only one exercise changes. Small rewards and milestones can add motivation for patients who respond to them.
Home exercise adherence checklist
| Before the patient leaves | Between visits |
|---|---|
| 3 to 5 exercises, 10 to 15 minutes | Patient can see their program on their phone, by email or on paper |
| Each exercise linked to the patient’s goal | Completion is tracked |
| Patient has performed every exercise once | Pain and difficulty are reported |
| Written instructions with sets, reps, frequency and pictures or video | Early outreach to patients who fall behind |
| Format and language the patient chose | Program updated as the patient progresses |
| A plan for when and where they’ll do it |
How Exercise Pro Live helps
Exercise Pro Live was built by physical therapists to make these strategies easy to follow in a busy clinic:
- Build short programs in minutes from the 7,000+ professionally filmed HD exercise videos, each with a line drawing. Search by body part, condition, equipment, body position or movement.
- Deliver programs in the patient’s preferred format. Patients can use the free Exercise Now app, a web link or email, or a printed handout, in 130+ languages.
- Build and send programs from a phone or tablet with the Exercise Pro Live Engage app, including in the patient’s home.
- See who is doing their program. Patients log completion and report pain and difficulty, and RTM tools are included in every plan.
- Add motivation with built-in rewards and gamification.
Frequently Asked Questions
What percentage of patients do their home exercise program?
Estimates vary because adherence is hard to measure. In musculoskeletal patients, studies commonly report that roughly 30% to 50% don't adhere to their home exercises (Argent et al., 2018). Adherence tends to be higher when programs are short, clearly taught and followed up.
How many exercises should a home exercise program include?
For most patients, 3 to 5 exercises taking about 10 to 15 minutes a day is a good target. In a randomized trial of adults over 65, people given 2 exercises performed them better than people given 8. If a patient needs more exercises, split them across days rather than assigning them all at once.
How long should a home exercise program take each day?
Aim for about 10 to 15 minutes, including rest periods. Short programs are easier to fit into a daily routine, which makes them more likely to get done.
Are video home exercise programs better than paper handouts?
Video and app-based programs have produced better adherence than paper handouts in several randomized trials, including one in people with stroke (75.6% vs. 55.2% at three months). Paper still works well for some patients. The best format is the one the patient will use, and many clinics offer both.
Is there a free trial of Exercise Pro Live?
Yes, Exercise Pro Live offers a free, full-featured two-week trial with no credit card required.
How can I tell whether patients are doing their home exercises?
Use a home exercise system that records when patients complete their program and lets them report pain and difficulty. Then follow up with patients who fall behind. If your practice bills Remote Therapeutic Monitoring (RTM), this monitoring may also be reimbursable, subject to payer rules.
What predicts whether a patient will stick with a home exercise program?
A systematic review of 30 studies found the most consistent predictors were the patient's intention to exercise, self-motivation, self-efficacy, past exercise habits and social support. Building confidence and involving family or caregivers can help.
Make your next home program one patients actually do
Build a short, video-based home program in minutes and see who is completing it between visits.