Enhancing adherence to prescribed exercise: structured behavioral interventions in clinical exercise programs.

Abstract

Exercise training is an integral component in the management of many chronic, lifestyle-related diseases. Therapeutic exercise training is an accepted adjunct to medical therapy for two of the four leading causes of death—cardiovascular disease and chronic obstructive pulmonary disease (COPD)—and is considered one of the three cornerstones of treatment for diabetes mellitus. For each of these chronic conditions, the scientific literature clearly demonstrates that exercise is both beneficial and safe when applicable guidelines are followed. For example, an expert panel convened by the Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute conducted an extensive review of the scientific literature and concluded that patients with cardiovascular disease who participate in cardiac rehabilitation programs (CRP) realize substantial improvements in a variety of domains.1 Moreover, the panel asserted that scientific evidence consistently demonstrates that exercise training improves exercise tolerance, morbidity, and the ability to return to work after a cardiovascular event.2 The panel also found strong, albeit less consistent, evidence that exercise leads to improvements in cardiac symptoms, blood lipids, blood pressure, psychosocial well-being, and mortality.2 Exercise training also is an important component of contemporary pulmonary rehabilitation programs. A number of recent reviews have summarized the findings of research conducted over the past three decades.3–5 A consistent finding among most of the studies reviewed is that exercise leads to improvements in physical functioning as measured by timed walks for distance (6or 12-minute walks) and walking duration on the treadmill. Further, in one of the most comprehensive studies on pulmonary rehabilitation to date, Ries et al.6 randomized 119 patients with COPD to either an 8-week comprehensive pulmonary rehabilitation program or an 8-week education program. After the 8-week intervention, patients in the comprehensive pulmonary rehabilitation groups realized significant improvements in exercise tolerance, symptoms of breathlessness, and walking self-efficacy compared with the education group. Lastly, exercise plays an important role in the treatment plan of most patients with diabetes. Common benefits of exercise for these patients include reduced risk of cardiovascular disease, improvements in body weight and composition, decreased blood pressure, and, for those with type 2 diabetes, improvement in glycemic control (i.e., glycosylated hemoglobin [HbA1c] levels).7,8 In addition, exercise training may reduce anxiety and enhance mood, self-esteem, and quality of life in these patients.9