Abstract
Background: A home exercise program is an important part of recovery from musculoskeletal injuries and can improve pain, quality of life, and self-efficacy. However, there are often challenges with patient adherence and measuring compliance. Mood and pain can have a positive and negative affect on a patient’s adherence and performance. Digital health, such as Recupe, provides an opportunity to examine the relationship between pain, mood, and exercise adherence outside the clinic.
 Methods: A total of 864 subjects were retrospectively analyzed to assess mood and reps completed per session, mood and time spent exercising per session, and mood and pain level. Mood was measured using three categories: “Happy,” “Neutral,” and “Sad.” Pain was measured using the Numerical Pain Rating Scale (NPRS) of 0-10.
 Results: The subject population included 331 males, 359 females, and 174 not stated. The average reps completed per session was 218.2 (130.0) for the “Happy” group, 163.3 (101.4) for the “Neutral” group, and 140.0 (95.7) for the “Sad” group with p-values <0.0001 between all groups. The average time spent exercising per session were 29.54 minutes (24.63) for the “Happy” group, 21.80 minutes (18.30) for the “Neutral” group, and 22.31 minutes (21.23) for the “Sad” group with p-values <0.0001 between all groups. Lastly, the average pain level for each mood was 1.93 (1.69) for the “Happy” group, 4.4 (1.82) for the “Neutral” group, and 6.1 (2.00) for the “Sad” group with p-values <0.0001 between all groups.
 Conclusion: There is a significant correlation between mood, reported pain levels, and adherence to the patients’ exercise programs. Patients who report higher pain levels, simultaneously report more depressed moods and demonstrate decreased exercise times and repetition counts. Yet, while this correlation is clear, the causation factor is not known and requires more research. Clinicians should look to observe this pattern in patients to possibly improve recovery.
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