Cited by 152Behavioral Health and InterventionsMusculoskeletal pain and rehabilitationHealth Policy Implementation Science

Behaviour change techniques associated with adherence to prescribed exercise in patients with persistent musculoskeletal pain: Systematic review

Open access
Meade, Laura B., Bearne, Lindsay M., Sweeney, Louise H., Alageel, Samah H., Godfrey, Emma L.·2019·British Journal of Health Psychology

Abstract

PURPOSE: Exercise (planned, structured, repetitive movement) improves pain and function in people with persistent musculoskeletal pain (PMSK), but adherence is often poor. This systematic review evaluates the evidence from randomized controlled trials (RCTs) on the effectiveness of interventions to improve exercise adherence in people with PMSK and describes the content, context, and theoretical underpinning of behaviour change interventions designed to increase adherence. METHODS: Nine electronic databases were searched from inception dates to August 2017. Studies were included if they were RCTs that included adults with PMSK ≥3 months; ≥one measure of exercise adherence, exercise prescribed to both groups, and employed ≥one behaviour change technique (BCT) in the treatment group. Independent data extraction, theory coding, BCT taxonomy coding, and quality assessment using Cochrane Risk of Bias (RoB) tool was conducted by two reviewers. RESULTS: Eight RCTs (five low, three high RoB) met inclusion criteria. Five trials reported between-group differences in exercise adherence, favouring the treatment group. Three trials reported theoretical underpinning. There was moderate evidence that five BCTs, social support, goal setting, instruction of behaviour, demonstration of behaviour, and practice/rehearsal, improved exercise adherence. Interventions employing ≤seven BCTs, unique to those included in the control group, were most effective at enhancing exercise adherence. CONCLUSIONS: Limited moderate-quality evidence supports using a small number of BCTs to enhance exercise adherence in people with PMSK. Further research should explore the associations and synergies between BCTs and explicitly report how theory was utilized. This may inform recommendations for health care professionals working with this population. Statement of contribution What is already known on this subject? Exercise (i.e., planned, structured, repetitive movements) improves pain and function in people with persistent musculoskeletal pain (PMSK). Many people with PMSK do not adhere to exercises prescribed by a health care professional. Little research has explored how to enhance adherence to prescribed exercise in people with PMSK. What does this study add? Moderate-quality evidence from eight trials suggests behaviour change interventions enhance exercise adherence. Social support, goal setting, demonstration, instruction, and rehearsal were employed in effective interventions. Interventions with ≤7 behaviour change techniques were more effective at improving adherence than those employing >7.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/bjhp.12324

Cites

66 of 67 references verified1 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The labor of psychologists may enhance adherence to exercise by conducting different behavioral change techniques or cognitive-behavioral programs.

    “Furthermore, the labor of psychologists may enhance adherence to exercise by conducting different behavioral change techniques or cognitive-behavioral programs [49,50,55,56,60,65].”

    From Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review (2021) · cites this paper as [56]

    The Discussion (page unavailable) reports moderate-quality evidence that interventions incorporating behaviour change techniques can improve adherence to prescribed exercise in people with persistent musculoskeletal pain. The Results, ‘Context of the interventions’ (page unavailable), include one psychologist-delivered trial with greater adherence, but the Discussion says there is minimal evidence favoring one provider over another. The review therefore supports the possible benefit of these techniques, not a distinct benefit from psychologists’ involvement or from cognitive-behavioral programs specifically. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Dieppe, P. (2012). Chronic musculoskeletal pain In Colvin L. A. & Fallon M. (Eds.), ABF of pain (1st ed., pp. 16– 19). Hoboken, NJ: John Wiley.
  2. Lefcourt, H. M. (1981). Research with the locus of control construct vol. 1, assessment methods. New York, NY; London, UK: Academic Press.
  3. National Institute of Health and Care Excellence (2016). Low back pain and sciatica in over 16s: Assessment and management. NICE Guideline. 27929617
  4. World Health Organization (2011). Global recommendations on physical activity for health. Retrieved from http://www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf 26180873

Cited by

Sorted by citations

Authors
Meade, L. B., Bearne, L. M., Sweeney, L. H., Alageel, S. H., & Godfrey, E. L.
Affiliations
King's College London (GB)
Corresponding author
  • Meade, Laura B.
  • Godfrey, Emma L.
Venue
British Journal of Health Psychology
Publisher
Wiley
Published
2018-06-17
Volume
24
Issue
1
Pages
10-30
ISSN
  • 1359-107X (ISSN-L)
  • 2044-8287
OpenAlex
W2803407939
Cited by
152
References
67
Citations by year
2026: 20 · 2025: 23 · 2024: 22 · 2023: 16 · 2022: 29 · 2021: 22 · 2020: 16 · 2019: 3
FWCI
1.39
Type
journal article
Language
en
Open access
Locations
  • British Journal of Health Psychology (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research Repository (Kingston University London) (acceptedVersion)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by-nc)
Topics
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
behaviour change techniques, exercise adherence, chronic musculoskeletal pain, behaviour change interventions, social support, goal setting, BCT taxonomy
MeSH terms
Adolescent, Adult, Aged, Behavior Therapy, Exercise Therapy, Female, Humans, Male, Middle Aged, Patient Compliance, Randomized Controlled Trials as Topic, Young Adult, Musculoskeletal Pain

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review