The challenge of exercise (non) adherence: a scoping review of methods and techniques applied to improve adherence to physical activity and exercise in people with inflammatory arthritis

Objectives: To explore the nature of methods/techniques applied to improve adherence to physical activity (PA) and exercise in people with inflammatory arthritis (IA) and identify whether studies were theory-based and/or used behaviour change techniques (BCTs).
Methods: Searches were undertaken of English language articles within 4 databases: Embase, Medline, PsycINFO and Cochrane. Articles were included if they assessed adherence to a PA and/or exercise intervention. A narrative synthesis of the findings is reported.
Results: Of 1,909 studies screened, 18 studies met inclusion criteria. Adherence was most frequently included as a secondary outcome. Reporting of adherence measures was quite poor, as 13 studies did not use a validated measure of adherence, with only three validated measures identified. The majority of studies were not theory-driven (n=13), although the Health Belief Model was the most used theoretical framework (n=5). Only two studies mentioned both theory and BCTs. Four studies reported components that were mapped onto BCTs, with goal setting being the most prevalent.
Conclusion: This scoping review found that adherence to PA and/or exercise interventions was rarely the focus of research, despite its importance in maintaining health in people with IA. Where research has been conducted in this area, serious shortcomings were revealed, as psychological theory, evidence based BCTs derived from theory and valid adherence measures were not employed to inform intervention design and target adherence, meaning interventions were sub-optimal. These results suggest there is considerable room for improvement and more high-quality research is required to investigate determinants of adherence and develop impactful interventions.