From theory into practice: insights from a real-world implementation model for tailored exercise prescription in chronic diseases

Background: Although physical exercise is an evidence-based treatment for patients with chronic diseases, providing benefits in terms of morbidity, mortality and quality of life, its implementation in real-world healthcare systems is still limited. Even when physicians recommend physical activity, compliance and adherence to exercise programs remain very low. This study aims to implement a real-world model for tailored exercise prescription (TEP) in an outpatient clinic to evaluate feasibility, effectiveness, compliance and adherence. Methods: A TEP was set for each participant, based on a complete clinical and functional evaluation including cardiopulmonary exercise testing and fitness test battery. Subsequent supervised training sessions (STS) were performed for at least 6 weeks. After 6 months functional evaluations were repeated, also assessing compliance with general recommendations and adherence to the prescribed exercise program. Results: A total of 312 patients (44% male) with a mean age of 52.1 ± 13.6 years were enrolled. The most frequent main chronic conditions were obesity (47%), solid organ transplantation (32%), primary cardiovascular diseases (8%) and cancer (4%). The initial STS program was completed by 85.9% of patients, all without adverse events. Patient compliance, measured as attendance at the follow-up meeting, was 53.2%, while adherence to the TEP during the 6-month program was 44.9%. Conclusion: A real-word model for TEP followed by a period of STS is feasible in patients with chronic diseases in a real outpatient clinical setting. However, intervention strategies based on behavioral change and motivation are needed to foster greater compliance and adherence in the mid-to-long term.