Ask a room of physiotherapists what proportion of their patients do the home programme as prescribed, and the estimates land somewhere around half. The research on exercise adherence in musculoskeletal care is consistently less flattering than that, and the gap between the estimate and the reality is itself the interesting part: we are poor judges of it because we almost never find out.
The adherence number nobody likes
Three things follow from a low adherence rate, and only the first is obvious.
- The treatment underperforms, and it looks like the treatment was wrong rather than undone.
- Your clinical reasoning gets corrupted. If you do not know whether the programme was done, a poor outcome tells you nothing. You cannot distinguish “this approach is not working for this person” from “this person has not started”, and those need opposite responses.
- The patient stops coming, usually without saying so, because from where they sit nothing is improving.
Everything below is aimed at those three, and most of it costs nothing.
The programme is too long
The most common prescription error is volume. Eight exercises, three times a day, is roughly forty-five minutes of a person’s evening, every evening, for something that is not yet their identity. It gets done for four days.
The version that survives contact with a real week:
- Two or three exercises at the start. You can add later; you cannot un-overwhelm someone.
- Once a day, unless there is a reason it must be more.
- Attached to something that already happens. After brushing teeth, while the kettle boils, before the shower. An exercise with a time of day attached is done far more than one with a frequency attached.
- Under ten minutes, and say so out loud: “this is about eight minutes”. People decline unknown amounts of time.
A shorter programme that is done beats a complete one that is not, and it is not close.
Paper, PDF, video, 3D: what gets used
Every format works for somebody, and the failure modes are predictable:
- Handwritten on paper. Personal and immediate; lost within a fortnight, and unreadable the following month.
- A printed sheet of line drawings. Survives longer, ends up on the fridge, and is the format older patients most often prefer. The drawings are frequently ambiguous about what is actually moving.
- A PDF by email. Arrives, is opened once, and is then buried under thirty emails. Almost never reopened in week three.
- Video or 3D on the phone. Unambiguous about the movement, always to hand, and reopened far more than anything else — provided getting to it takes one tap and no password.
That last clause is doing most of the work. A brilliant exercise video behind a login the patient has to recover is worse than a photocopy on the fridge. The decisive property of the format is not richness, it is how many steps stand between the patient and the exercise at nine in the evening.
Send one to yourself
Prescribe a real programme, send the link to your own phone and open it as the patient would. That is the test that matters.
Create a free account → No credit card. The first 7 days have no limits at all.The instruction that decides whether it happens
Most prescriptions specify sets, repetitions and frequency, and omit the two things patients actually need in order to continue:
- What it should feel like, and what is too much. “A stretch, not a sharp pain. Soreness the next morning that settles by lunchtime is fine. Soreness that is still there the following evening means do half as many.” Without this, the first twinge ends the programme, because the patient reasonably assumes they are doing damage.
- Why this exercise. One sentence connecting it to the thing they want back. “This is the one that gets you back on the stairs without the handrail.” People do not persist with abstract exercises; they persist with a route to something they miss.
Both belong in writing, on the programme itself, not only in the room. What is said in the room is gone by Thursday.
Knowing whether they did it
“How did you get on with the exercises?” asked at the start of a session is a question that reliably produces a polite answer rather than a true one. The patient does not want to disappoint you, which is entirely human and makes the question nearly useless.
Two better approaches:
- Ask about the obstacle rather than the compliance. “Which one got skipped most?” assumes some were skipped, gives permission, and produces usable information — usually that one exercise hurt, or took too long, or was not understood.
- Let the record come from the patient. If they can mark that they did it and add what it felt like, you arrive at the next session with data rather than recollection. It also changes the patient’s own relationship with the programme: something that is logged is done more than something that is merely assigned.
Progressing without another appointment
An exercise that stays the same for six weeks stops working, biologically and psychologically. But progression normally waits for the next appointment, which might be a fortnight away, so patients spend half of each interval on a load that is no longer doing anything.
Two things that help, neither of which requires seeing them:
- Build the progression into the prescription. “When ten is easy, go to fifteen. When fifteen is easy, message me.” The patient can advance safely without waiting for you.
- Update the programme remotely when their log tells you it is time, rather than at the next visit. This is where digital prescription genuinely beats paper — not the pretty pictures, the fact that you can change it on a Tuesday afternoon without anyone travelling.
When the patient does not read well
A meaningful proportion of patients will not tell you that they struggle with written instructions, and no format fixes that on its own. What helps: a demonstration they can watch as many times as they like, an instruction read aloud in the room while they follow it on their own phone, and a family member on the same link. Whatever you use, being able to hand the same thing to a daughter or a carer matters more than the file format.
How Physioly does exercises, honestly
The patient gets a personal link — sent through whatever messaging app they already use — which opens on their exercises with a 3D demonstration of each movement, alongside their next appointments and a confirmation button. They create no account, install nothing, and there is no password. That last part is not a small thing: it is the difference between a programme that is opened in week three and one that is not.
From the same link they can record that they did the session, and add pain, effort and symptoms. That log lands on their record, so the next session starts from what actually happened rather than from what either of you remembers.
What is not there:
- No automatic reminders. The system composes the message; sending it is you. For a programme that depends on nudges, that is a real limitation and worth knowing before you choose.
- No video of you demonstrating. The demonstrations are 3D animations, not recordings of your own patients or of you.
- No automatic progression. You decide when to advance the programme; the software does not do it from the log.
- No exercise-only product. This is part of the clinical record rather than a standalone prescription tool, which is an advantage if you want one place and a disadvantage if you already have software you like.
If the deciding feature is automated reminder sequences, a dedicated exercise platform will do that better. If what you want is the programme attached to the record, reaching the patient without an install, and coming back with what they actually did, that is what this is — and the free plan costs nothing forever with an unlimited first week.
Related: what patients will and will not install, and the people who stop coming without telling you.
Questions we get asked
How many exercises should a home programme have?
Two or three at the start, once a day, under ten minutes, attached to something that already happens in the patient’s day. Eight exercises three times a day is around forty-five minutes of someone’s evening and typically gets done for about four days. A shorter programme that is done beats a complete one that is not.
What is the best format for home exercise instructions?
Whichever one reaches the exercise in the fewest steps at nine in the evening. Video or 3D on the phone is reopened far more than a PDF by email or a printed sheet, but only if there is no login to recover. A brilliant video behind a password the patient has forgotten is worse than a photocopy on the fridge.
How do you know if a patient is doing their exercises?
Not by asking how they got on, which reliably produces a polite answer. Ask which one got skipped most — it assumes some were, gives permission and usually reveals that one hurt, took too long or was not understood. Better still, let the patient log each session themselves so you arrive at the next appointment with a record rather than a recollection.
Should home exercises be progressed between appointments?
Yes, and two things make it possible without another visit. Build the progression into the prescription — when ten is easy go to fifteen — so the patient can advance safely on their own, and update the programme remotely when their log says it is time. Staying on the same load for six weeks stops working both biologically and psychologically.
Do patients need an app to receive their exercises from Physioly?
No. They get a personal link sent through the messaging app they already use, which opens on their exercises with a 3D demonstration of each movement, their next appointments and a confirmation button. No account, no install, no password. From the same link they can log that they did the session and add pain, effort and symptoms, which lands on their record.