Exercise Adherence Scale

Instructions
The Exercise Adherence Scale (EXAS) aims to measure the patient’s adherence to recommended home-based exercises
by a physiotherapist or other healthcare professional.
First, the physiotherapist or other healthcare professional recommends and records frequency and intensity for the
home-based exercises and practices performance of the exercises together with the patient. During the patient’s next
visit, adherence to the home-based exercise recommendations is recorded and quality of performance is rated by the
physiotherapist.

Table 1 is an example of home-based exercise recommendations.

In column A the exercise(s) are specified. It is important that the recommended exercises are defined clearly, so that
during the follow-up visit quality of performance of the recommended exercises can be scored. Describe in column B
what the purpose of the exercise(s) is/are. In the remaining columns (C, D and E), the recommended frequency and
intensity of the exercise(s) is recorded.

Table 1 Completed example of home-based exercise recommendations

A. Name and/or B. Describe the C. Number of D. Number of E. Number of sets and

description of purpose of the exercise: days per week. times per day. number of repetitions
recommended For example: per body side OR Time
exercises: (starting mobilizing, muscle in seconds or minutes
position and strengthening, per body side.
performance). stabilizing or a
combination.
Exercise 1.

2 set(s)
Single knee to chest
Mobilizing 7 days 3x per day 10 repetitions
while lying down
second(s)

Exercise 2.

2 set(s)

Superman exercise Muscle strengthening 4 days 2x per day 10 repetitions

second(s)

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 Home-based Exercise Recommendations

Instructions
Use column A and B to clearly describe and clarify the exercise(s) you recommend to the patient to perform at home.
Record the purpose of the exercise(s), specify how many days per week and per day, the number of series and
repetitions per exercise or the time per exercise you recommend.

Table 2 Home-based Exercise recommendations

A. Name and/or description of
recommended exercises:
(starting position and
performance).
Exercise 1.
B. Describe the purpose of C. Number of D. Number of E. Number of sets and
the exercise: For example: days per week. times per day. number of repetitions per
mobilizing, muscle body side OR Time in
strengthening, stabilizing or seconds or minutes per body
a combination. side.

set(s)

days x per day repetitions

second(s)

Exercise 2.

set(s)

days x per day repetitions

second(s)

Exercise 3.

set(s)

days x per day repetitions

second(s)

Exercise 4.

set(s)

days x per day repetitions

second(s)

Exercise 5.

set(s)

days x per day repetitions

second(s)

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 Home-based Exercise Performance (to be completed with the patient during follow-up assessment)

Interview instructions:
‘Home exercise performance’ should be completed together with the patient. Read the questions one by one to the
patient and record the answers of the patient in table 4 (see next page).

Read the next part to the patient:

“You have been advised to perform exercises at home. Everyone performs exercises differently. You may have had
difficulty performing the exercises. Or perhaps forget to perform the exercises. Because it is important that the exercises
are performed correctly, I will ask you a few questions and ask you to perform the prescribed exercises as you did them
at home.”

1. Were you able to perform the exercises as recommended since your last visit?
 Yes
 Partial
 No

Instructions:
Ask the patient in what frequency and intensity the exercises were performed at home and record the patient’s
responses in table 4. Score the quality of exercise performance using the score matrix in table 3. Repeat this for each
exercise separately.

Thinking back to the period since your last visit:

1. On how many days did you perform the recommended exercise?
2. How many times per day did you perform the recommended exercise in the last week?
3. How many sets and repetitions or duration in minutes/seconds did you perform the recommended exercise
last week (if applicable, per body side)?
4. “Could you please show me how you performed the recommended exercise at home?

Table 3 Score matrix for quality of exercise performance

Excellent Good Reasonable Moderate Poor

All parts of the home-based Most parts of the exercise are The majority or all of the
exercise are performed performed well according to parts of the exercise are not
perfectly according to the the recommendations by the performed according to the
recommendations by the therapist. Important parts of recommendations by the
therapist. There is no room for the exercise can be improved. therapist. It is very unlikely
improvement. It is certain the The desired effect of the that the desired effect of the
desired effect of the exercise exercise is likely to have been exercise has been achieved.
has been achieved. achieved.

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Table 4 Home-based Exercise intensity, frequency reported by the patient and quality of performance

A. The B. Quality of the C. Number of D. Number of E. Number of sets and number of

exercise(s). performance of days per week. times per day. repetitions per body side OR Time in
the exercises.** seconds or minutes per body side.
Very good
Good set(s)
Exercise 1.
Reasonable days x per day repetitions
Moderate
second(s)
Poor

Very good
Good set(s)
Exercise 2.
Reasonable days x per day repetitions

Moderate second(s)
Poor
Very good
Good set(s)
Exercise 3.
Reasonable days x per day repetitions
Moderate second(s)
Poor
Very good
Good set(s)
Exercise 4.
Reasonable days x per day repetitions

Moderate second(s)
Poor
Very good
Good set(s)
Exercise 5.
Reasonable days x per day repetitions
Moderate second(s)
Poor
**Draw a circle around what applies.

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Scoring form
The Exercise Adherence Score for the recommended home-based exercises is calculated in three steps.

Step 1:
The ratio between performed exercises on frequency and intensity reported by the patient and recommendations from the
physiotherapist is calculated for each exercise. The ratio is then multiplied by 100 to get the percentage adherence. This is
done separately for each individual exercise.

𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑎𝑦𝑠 ∗ 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑡𝑖𝑚𝑒𝑠 𝑝𝑒𝑟 𝑑𝑎𝑦 ∗ 𝑠𝑒𝑡𝑠 ∗ 𝑟𝑒𝑝𝑒𝑡𝑖𝑡𝑖𝑜𝑛𝑠 𝑟𝑒𝑝𝑜𝑟𝑡𝑒𝑑 𝑏𝑦 𝑡ℎ𝑒 𝑝𝑎𝑡𝑖𝑒𝑛𝑡
Adherence percentage = ∗ 100
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑎𝑦𝑠 ∗ 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑡𝑖𝑚𝑒𝑠 𝑝𝑒𝑟 𝑑𝑎𝑦 ∗ 𝑠𝑒𝑡𝑠 ∗ 𝑟𝑒𝑝𝑒𝑡𝑖𝑡𝑖𝑜𝑛𝑠 𝑟𝑒𝑐𝑜𝑚𝑚𝑒𝑛𝑑𝑒𝑑 𝑏𝑦 𝑡ℎ𝑒 𝑡ℎ𝑒𝑟𝑎𝑝𝑖𝑠𝑡

Please note that patient reported adherence to frequency and intensity cannot exceed therapist recommendations.

Step 2:
The quality of performance score is used to calculate the exercise adherence score of the individual exercise. To do this
multiply the adherence percentage with the quality of performance score for the individual exercise.

Exercise Adherence score individual exercise = Adherence percentage ∗ 𝑞𝑢𝑎𝑙𝑖𝑡𝑦 𝑜𝑓 𝑝𝑒𝑟𝑓𝑜𝑟𝑚𝑎𝑛𝑐𝑒 𝑠𝑐𝑜𝑟𝑒

The quality of performance score depends on the rating for the quality of exercise performance by the patient for each
individual exercise as rated by the therapist (table 5).

Table 5 Quality of performance score

Quality of Quality
performance score score

Very good 1

Good 0.8

Reasonable 0.6

Moderate 0.4

Poor 0.2

Step 3:
Calculating the exercise adherence score is done by averaging the exercise adherence scores for all individual exercises.

Exercise adherence exercise 1+Exercise adherence exercise 2+ …+Exercise adherence exercise 𝑛

Exercise Adherence Score =
𝑛

Please cite as:

R.M. Arensman, R.H.J.G. Geelen, T. Koppenaal, C. Veenhof, M. F. Pisters. Measuring Exercise Adherence in patients
with Low Back Pain: The development, validity and reliability of the Exercise Adherence Scale (EXAS). In press. 2019

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