January 2021: January is normally a time to start afresh, set resolutions, goals and aspirations for the year ahead. As physios we motivate and encourage people who come to see us to exercise regularly. EULAR guidelines state: ‘Patients should be educated about axSpA and encouraged to exercise on a regular basis and stop smoking; physical therapy should be considered’. (van der Heijde et al., 2017). Physiotherapists provide people with axSpA with structured exercise programmes with the aim of improving spinal mobility, pain, cardiovascular function and quality of life. The difficulty is that for the exercise programmes to be successful people need to participate in these.
Adherence is defined as the extent to which a person’s behaviour corresponds with the recommendations from a health care professional (WHO., 2003). This term adherence takes into account that people have a choice about whether they act on any recommendations. The term compliance has been used to describe the extent a person’s behaviour corresponds to HCP recommendations, however, compliance implies that an individual does not have a choice (Taube, 2016).
Just like new year’s resolutions for everyone, sticking to an exercise programme can be difficult. Whether a person adheres or not to the recommendations from their HCP can depend on a number of factors. One approach when studying adherence, is to consider that adherence is determined by the interplay of factors relating to five constructs; socioeconomic, healthcare, condition, treatment and patient related (WHO., 2003). This approach can be used to study factors within these dimensions to any regime for example taking medicine appropriately, unhealthy diet and insufficient levels of physical activity/exercise.
January is here once again bringing with her snow, gale force winds, but this year there is also a new strain of covid, anxiety for the future, a new lock down, home-schooling for some, carers responsibilities for others. It’s possibly even harder for everyone to be motivated to move and follow exercise programmes. Even the new year’s resolutions by Judy Murray fell by the wayside as she signed up for dry Jan and announced on twitter:
‘My dry January lasted 8 days. An outstanding effort in the circumstance’
So what can physiotherapists do to help? As there are numerous factors within each dimension of adherence, physiotherapists should first concentrate on those factors which we can change, interventions are one such area. Providing group exercise and support in groups is one approach suggested to aid adherence. Face to face group exercise in covid circumstances is difficult as the risks of covid mean minimising non-essential contact such as exercise groups. The Gartnavel National Axial Spondylarthritis Society (NASS) group moved their weekly exercise class onto ZOOM. For some members they did not have the internet or the equipment or the computer skills to adopt this new method. We miss those members and it highlights that this one method of delivery is not suitable for all, but we also gained other members who could not afford as much time away from families but half an hour in the other room was achievable. As the instructor I have learned the new skill of how to take these classes. I was grateful for hints from other groups such as log on a little later so the members have time to chat recognising the importance of social support in aiding adherence and mental health. Another good tip was to make sure to have lots of room to exercise – the first class I took I was stuck in a corner and the stretches were not successful. Also try to give a list of equipment such as chair to hold onto ahead of the session, and of course the mistake we have all made at one point – remember to unmute your mic! On the whole these classes have worked well and it’s been great that we have been able to adapt these and continue, with good attendance each week. The very nature of Zoom means that travel is not an issue so for people where there are no local NASS classes this is no longer a barrier.
In between NASS classes getting in a routine and trying exercise most days is important, and recognising that this can be difficult especially at the present, is necessary. Support can help people continue their exercises, so checking in with a neighbour, family member or friend or collectively setting step goals. And if anyone falls away from an exercise programme just like Judy Murray and her dry January then it’s simply time to try again.
References:
Taube, K.M., 2016. Patient–doctor relationship in dermatology: from compliance to concordance. Acta Dermato-Venereologica , 96 (217), pp.25-29.
van der Heijde, D., Ramiro, S., Landewé, R., Baraliakos, X., Van den Bosch, F., Sepriano, A., Regel, A., Ciurea, A., Dagfinrud, H., Dougados, M. and van Gaalen, F., 2017. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Annals of the rheumatic diseases , 76 (6), pp.978-991.
World Health Organization, 2003. Adherence to long-term therapies: evidence for action . World Health Organization.
Marie Therese