Therapeutic adherence: definition
Therapeutic adherence is the extent to which a patient's behavior matches the recommendations agreed with the health professional: taking medication, completing exercise sessions, attending follow-up appointments, following lifestyle advice. This is the meaning used by the World Health Organization in its 2003 report on adherence to long-term therapies. Adherence is not a personality trait: it depends on many factors, many of which professionals can modify. It can be measured, supported and improved.
Adherence, concordance, compliance: what are the differences?
Three related terms coexist in the literature and are worth distinguishing.
| Term | What it covers | Nuance |
|---|---|---|
| Adherence | The observable behavior: does the patient actually follow the prescription? | Reference term, measurable (French: observance) |
| Concordance (French: adhésion) | The patient's ownership of the treatment, including agreement and motivation | Emphasizes the patient's active role in the decision |
| Compliance | Historical term focused on conformity with the prescription | Considered paternalistic, gradually replaced by adherence |
In French clinical practice, observance and adhésion are often used interchangeably. The useful distinction lies elsewhere: adherence is observed, concordance is built.
Why adherence matters so much in movement-based therapies
For a drug, nonadherence deprives the patient of the expected effect. For physical activity, the link is even more direct: regularity is part of the prescription. French texts and guidelines state this explicitly.
- The French National Authority for Health (HAS) recommends at least 2.5 hours of moderate-intensity physical activity per week, spread over 3 to 5 sessions.
- The French Public Health Code gives adapted physical activity a specific goal: enabling the person to adopt a physically active lifestyle on a regular basis (article D. 1172-1).
- In type 2 diabetes, the HAS states that regular physical activity is what reduces the risk of micro- and macrovascular complications and improves glycemic control.
- After breast, colorectal or prostate cancer, the HAS recommends lifelong physical or sporting activity once the adapted physical activity program ends.
Yet poor adherence to exercise programs is frequently reported among people with chronic diseases and older adults. This is the starting point of a 2021 evidence synthesis on the factors behind exercise adherence.
Factors behind nonadherence
This umbrella review analyzed 55 literature reviews on exercise adherence in patients with chronic diseases and older adults. It identified fourteen key factors, each cited by at least ten reviews. Read in reverse, they describe the main reasons why a program is not followed.
- The program itself: poorly suited characteristics, lack of supervision, unpleasant experiences, difficulty fitting it into daily life.
- The patient's knowledge and expectations: insufficient information on benefits and risks, unsuitable expectations, low self-efficacy.
- The patient's role: passive role, goals set without them, barriers and preferences not explored at the outset.
- Follow-up: little communication, little feedback, progress not tracked or not visible.
- The environment: lack of social support, limited involvement of professionals from different disciplines.
Levers to improve adherence
Turned the right way, the same factors point to the levers. The review concludes that exercise adherence depends on many variables that professionals can control and modify.
- Explore before prescribing: the person's characteristics, the barriers they face and what can help them.
- Tailor the program to their abilities and preferences, with activities they enjoy and that fit into daily life. This is a core principle of functional rehabilitation.
- Set goals with the patient and give them an active role: shared decision-making turns an instruction into a personal project.
- Inform about benefits and risks, to set realistic expectations and strengthen self-efficacy.
- Organize follow-up: supervision, communication, feedback and visible tracking of progress.
- Rely on a local relay: the exercise on prescription framework and the network of Sport-Health Centers offer supervised support toward lasting practice.
Measuring adherence: available methods
No method is perfect; combining them is useful.
- Self-report methods: questionnaires and logs, easy to use but dependent on the patient's memory and perception.
- Indirect objective methods: count of completed sessions, attendance at appointments.
- Direct objective methods: measurement of physical fitness and functional capacity over time.
In an adapted physical activity program, the initial and final assessments required by the regulations make it possible to compare how the program went with changes in physical fitness and functional capacity.
Frequently asked questions
What is therapeutic adherence?
It is the extent to which a patient's behavior matches the recommendations agreed with the health professional. It covers medication intake, exercise sessions, follow-up appointments and lifestyle advice.
What is the difference between adherence and concordance?
Adherence describes observable behavior: does the patient follow the prescription? Concordance adds the dimension of ownership: does the patient agree with the treatment and feel motivated to follow it? In French the two terms are often used interchangeably, but concordance is built whereas adherence is observed.
Why do patients stop their exercise programs?
There is rarely a single cause. A 2021 evidence synthesis highlights poorly suited or unpleasant programs, lack of supervision and follow-up, unsuitable expectations, low self-efficacy, a passive patient role and lack of social support.
How can adherence to a physical activity program be improved?
The levers most often cited by literature reviews work in combination: exploring the patient's barriers and preferences, tailoring the program, setting goals with the patient, informing them about benefits and risks, and organizing follow-up with feedback on progress. A local relay, such as a Sport-Health Center, can take over supervision.
How is adherence measured?
Through self-report methods (questionnaires, logs), indirect objective methods (completed sessions, attendance) and direct objective methods (changes in physical fitness and functional capacity). Since none is perfect, combining them is useful.
Does adherence only concern medication?
No. The concept applies to any care recommendation: drug treatments, adapted physical activity programs, rehabilitation, lifestyle advice and follow-up appointments. For physical activity, regularity is part of the prescription itself.
Editorial review in progress by MYA's editorial committee.
Editorial content intended to inform health professionals. It does not constitute individual medical advice and does not replace assessment by a professional.