Do training diaries affect and reflect adherence to home programs?

Adherence is the degree to which patients and research participants act in accordance with the advice of their clinician or researcher (1). Adherence is an important issue in the practice of health care. Incomplete adherence is widely regarded as a substantial barrier to successful outcomes (i.e., exercises don’t work if you don’t do them). It has been proposed that 5.5% of hospital admissions ( 2 million per year in the US) (2), and 1.7% of the national health care bill (3) can be attributed to poor adherence. It is not surprising then, that numerous studies have investigated ways to increase adherence (4). Many studies examine adherence to medication regimen (5,6) but adherence to exercise and home training programs, which form an important part of the management of many chronic conditions including cardiovascular disease (7) and rheumatic disease (8), is equally important. Adherence is also important in research practice. In addition to interfering with the completion of research studies, reducing statistical power, and inflating the cost of research studies, poor adherence undermines the very treatment under investigation, which increases the risk of erroneous conclusions and false rejection of effective treatments. Therefore for the researcher, equal attention must be given to maximizing and measuring adherence. One common method to evaluate and promote adherence with home programs is a training diary (4). Despite their widespread clinical and research use, it is not known how the use of a training diary affects or reflects adherence. These issues form the basis of the current study, which hypothesized that patients overestimate adherence to a home program in their training diary; using a training diary increases adherence; and overt monitoring increases adherence. Patients and Methods