Here's the Solution to Improve Getting Patients to Do their Exercises

Yesterday, I shared the two mistakes we can make around prescribing exercises to our patients. 

Here's how you can help your patients be consistent with their exercises so they get better results. 👇

The Power of One

I've found that giving fewer exercises to my patients has helped them achieve greater results with their treatment program. 

Sounds simple enough, right? But it can be challenging.

I want to show you how I simplify my decision-making approach to giving patients exercises. 

When we give fewer exercises, we reduce the amount of motivation our patients need. When the "motivation ask" decreases, the likelihood increases of them doing their exercises regularly. 

This is why I'm such an advocate for the Power Of One.

The idea of the Power of One is to focus on giving a single exercise to your patient during your assessment session.  

It's something I strive to do with every assessment.

By giving only one exercise during that first session, I force myself to give the exercise that will make the greatest impact. 

From my assessment, I form my diagnostic hypothesis regarding the patient's condition and the primary drivers of my patient's symptoms and dysfunction. Assuming that it is a biomechanical issue at hand, I implement an intervention within the session and then perform a retest to evaluate its effect.

Assuming my retesting confirms my hypothesis, I will provide one exercise related to my intervention for the patient to complete at home. The following session starts with a retesting of key objective data that will help give me confirmation of my working hypothesis. 

Avoid the Shotgun Approach to Exercise Prescription

I also want to avoid the shotgun approach to exercise prescription where I give a bunch of exercises, hoping that one does the trick. If a patient can do the one key exercise consistently and do it correctly, then the amount of benefit they get from that one exercise is greater than if they were given 10 inconsistently performed exercises. 

Beyond this, giving only one exercise has other important benefits.

By giving only one exercise, I help make it easy for my patient to succeed. Giving one exercise helps the patient build confidence with doing a home exercise program.

And when patients see initial success - in terms of symptom improvement and consistency with doing an exercise - they'll have more motivation and skill to add more exercises in future sessions. Success breeds success. 

It is also easier to troubleshoot habit formation with the patient early in the treatment program when you're only dealing with one exercise. Starting with one exercise makes it easier for the patient to be consistent, and it helps build confidence to tackle more exercises or more challenging exercises. 

We don't just stay with one exercise for our patients, but it can be hard to know how many exercises to give patients. 

Not too much, Not too little. Just right. 

Too many exercises can lead to overwhelm.

Too few exercises and we run the risk of not moving the patient forward as quickly as possible. 

We need to look at a few key factors when it comes to giving our patients the right number of exercises. 

Capacity: The patient's capacity - both mental and physical - needs to be considered when prescribing exercises. When one's capacity is decreased because of pain, limited social supports or work stress, their capacity to take on exercise will be impacted. 

Motivation:  We need to look at how much patient motivation the patient has coming into treatment. A high motivation level will help kick start doing home exercises and make it easier to build an exercise habit. 

Habit Formation: We need to consider the patient's habit-building skill. Patients may require help in forming a habit and sticking with an exercise. For someone who has a consistent workout or training routine, they will likely have little issue adding more exercises. But those who have limited skill or confidence in building new habits may struggle with adding exercises to their daily routine. 

Body Awareness:  Having good body awareness can help with increasing one's ability to perform an exercise well. When someone is unsure if they're doing something correctly, they will experience less confidence and less perceived success when doing the exercise. A patient with low body awareness may require more time and practice with fewer exercises before adding more exercises. 

Considering all four of these factors can help you to identify the number of exercises a patient can successfully handle. If a patient scores low on all factors, you would be more gradual in adding exercises and listen more closely for signs that the patient is struggling with their exercises. 

If a patient has the mental and physical capacity, is motivated, has skill in building habits and has a high level of body awareness, they will likely be successful in having a larger set of exercises (or more complex exercises) to complete on a regular basis. 

Up for a Challenge? 

So here's a challenge for your upcoming clinical week...

Resist giving your patients more exercises before you have the confidence that the ones you've given them are being done consistently.

When you complete a new assessment this week, see if you can focus on giving just one exercise to the patient.

Remember, the value you give and your identity as a therapist aren't tied to the number of exercises you give your patients. 

To greater flow, 

Andrew