, 2006). Low self-efficacy was identified as a barrier to treatment adherence (Shaw et al., 1994, Taylor and May, 1996, Stenstrom et al., 1997, Chen et al., 1999, Oliver and Cronan, 2002 and Milne et al., 2005). Poor self-efficacy could explain a patient’s low confidence in their ability to overcome obstacles to initiating, maintaining

or recovering RAD001 supplier from relapses in exercise (Sniehotta et al., 2005). Low self-efficacy could be identified by clinicians using simple questions such as “How confident are you that you can…” (a) “overcome obstacles to exercising?” or (b) “return to exercise, despite having relapsed for several weeks?” Strategies to address low self-efficacy should be specific to the individual’s stage of exercise behaviour or perceived obstacles (Scholz et al., 2005). The use of strategies such as agreeing realistic expectations (Jensen and Lorish, 1994), setting treatment goals (Evans and Hardy, 2002), action planning (Sniehotta et al., 2005), coping planning

and positive reinforcement (Gohner and Schlicht, 2006) may help increase patient self-efficacy and adherence. Depression (Minor and Brown, 1993, Shaw et al., 1994, Rejeski et al., 1997 and Oliver and Cronan, 2002), anxiety (Minor and Brown, 1993 and Dobkin et al., 2006) and helplessness (Sluijs et al., 1993 and Castenada et al., 1998) were barriers to treatment adherence. Physiotherapists should be sensitive to the presence of anxiety, selleck depression and helplessness and ensure that these patients are referred to relevant healthcare services for appropriate management as required.

Simultaneously ensuring that pain is being effectively managed may be helpful in reducing anxiety or depression which is pain related. Additionally it may be helpful to reinforce the message that exercise is an effective way of countering both low mood and negative thoughts, whilst simultaneously improving pain and function (Lim et al., 2005). Greater social support and encouragement for exercise in this group of patients may provide motivation, role models and guidance that may be important (Castenada et al., 1998). Low levels of mafosfamide social activity (Funch and Gale, 1986, Minor and Brown, 1993, Sluijs et al., 1993, Rejeski et al., 1997 and Oliver and Cronan, 2002) and social or familial support (Shaw et al., 1994) were barriers to treatment adherence. Some patients believe they would more readily exercise if accompanied by someone else during their activity (Milroy and O’Neil, 2000 and Campbell et al., 2001). The support provided by the physiotherapist, the development of the patient–practitioner relationship and positive feedback from the physiotherapist may also increase adherence (Sluijs et al., 1993 and Campbell et al., 2001). Clinicians could consider organising rehabilitation programmes which incorporate social contact and support.