By BCA Member, Chris Jolliffe
Exercise is one of the most effective treatments we can recommend for many musculoskeletal conditions. Yet one of the greatest challenges in clinical practice isn't deciding what exercises to prescribe, it's helping patients do them.
Although exercise is recommended in clinical guidelines for many musculoskeletal conditions, adherence to home exercise programmes remains low. It can be tempting to assume patients simply lack motivation or are not committed to their recovery. In reality, for many patients, the challenge is not a lack of knowledge, but behaviour change.
Understanding why patients struggle to move allows us to shift our focus from prescribing exercises to supporting behaviour change.
Start with readiness
When patients attend our clinics, they are often seeking pain relief rather than an exercise programme. While some are ready to embrace change immediately, others may still be trying to understand their condition or deciding whether movement is safe.
If we prescribe rehabilitation before a patient is ready to engage, even the most evidence-based programme is unlikely to succeed. Taking time to understand a patient's readiness, concerns and priorities helps us meet them where they are rather than where we would like them to be.
Explore what stops people moving
Practical barriers
Before considering psychological barriers, it is important to recognise that many patients face genuine practical challenges to being physically active. Limited time, financial constraints, caring responsibilities, access to facilities, transport, work commitments, social support and existing health conditions can all influence participation. Exploring these barriers collaboratively allows us to develop realistic plans that fit within a patient's life rather than asking them to fit their life around an exercise programme.
While practical barriers are important, they are often only part of the picture. Even when opportunities to be active exist, patients may still struggle because of their beliefs, emotions and previous experiences.
Psychological barriers
I often think of beliefs as a sandcastle. Every experience, conversation, social media post and piece of advice from friends or healthcare professionals adds another grain of sand. Over time, those grains form a strong belief that feels like fact.
Rather than trying to knock the sandcastle down in one go by telling patients they are wrong, it is often more effective to encourage curiosity, ask questions and gradually add new evidence and experiences that allow a more helpful belief to be built. Lasting behaviour change rarely happens because we "win" an argument. Instead, it begins by helping patients become curious about their beliefs and open to new experiences.
Beliefs often influence how patients respond to movement. For many, those beliefs contribute to fear. Some patients worry that pain during activity means they are causing further damage, while others fear making their condition worse or being judged for exercising.
Shame can become another barrier to movement. Some patients feel embarrassed about exercising in public, while others experience guilt when they cannot complete every exercise, leaving them feeling they have failed. Our language matters. Framing exercise as an opportunity rather than a test, and recognising small successes rather than focusing on missed sessions, helps build confidence and maintain the therapeutic relationship.
Rather than asking, "Why isn't this patient doing their exercises?" it may be more helpful to ask, "What is making movement difficult for this person today?" That shift from judgement to curiosity can transform both the therapeutic relationship and long-term adherence.
Putting behaviour change into practice
One patient in her 50s living with fibromyalgia experienced frequent symptom flare-ups. On better days she was motivated to be more active, but during flare-ups she often felt she had failed if she could not complete her usual activities. Together, we reframed success. Instead of aiming for the "perfect" exercise session, we focused on finding movement that felt achievable each day, even if that simply meant a short walk or a few gentle stretches.
Over time, this reduced the pressure she placed on herself, improved her confidence and helped her become more consistently active. Behaviour change is not about creating the perfect exercise programme. It is about helping patients find a realistic, enjoyable and sustainable way to move that fits their life. The most effective programme is rarely the most complicated, it is the one the patient will still be doing months later.
Five things you can do tomorrow
- Meet patients where they are, not where you would like them to be.
- Explore barriers with curiosity before offering solutions.
- Tailor movement to the individual rather than expecting every patient to follow the same programme.
- Celebrate consistency and small successes rather than perfection.
- Remember that the best exercise programme is often the one the patient will still be doing six months later.
Recognising readiness allows us to meet patients where they are, rather than where we would like them to be. Exercise and physical activity remain central to evidence-based musculoskeletal care, but prescribing exercises is only one part of the process. By understanding readiness for change, exploring barriers with curiosity and tailoring movement to the individual, chiropractors can help patients develop sustainable movement habits. Success should not be measured by completing the perfect exercise programme, but by helping patients build confidence and maintain movement over the long term.
For some patients, the goal isn't to make them exercise more, it's simply to help them move more.
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