Chapter 4 72 Health-system factors In terms of health-system prognostic factors, no prognostic factors were reported by more than one study. Discussion Main Þndings In this systematic review of prognostic factors of home-based exercise adherence in patients with chronic diseases, high-quality evidence supported that higher exercise adherence was predicted by the patient-related prognostic factor PBC. Moderate-quality evidence supported that higher exercise adherence was predicted by higher self-efficacy, having an exercise history and being motivated. Further, higher exercise adherence was predicted by the social-economic prognostic factors higher education (moderate-quality evidence) and better physical health (lowquality evidence). Also, higher exercise adherence was predicted by the conditionrelated prognostic factors, less comorbidities (moderate-quality evidence), less depressive symptoms (low-quality evidence) and being less fatigued (low-quality evidence). IdentiÞed prognostic factors of adherence to home-based exercise Patient-related Self-efficacy emerged from the review as a prognostic factor of adherence to homebased exercise. Self-efficacy has previously been reported as a prognostic factor of adherence in a systematic review of home-based physiotherapy [12] and is consistent with our findings. Also, the systematic review of Jack et al. [90] has reported that individuals with greater self-efficacy tended to be more adherent to outpatient physiotherapy. Greater self-efficacy, confidence in the ability to complete a given task, allows patients to overcome challenges with greater ease which seems especially important in home-based situations where there is no professional supervision [12]. Further, a history of exercise participation is a prognostic factor of home-based exercise adherence. This is in accordance with previous findings [12]. If a patient has successfully completed similar behaviors before, this is likely to increase their perceptions of competence and therefore the likelihood of conducting the behavior again [91]. Also, higher exercise adherence was predicted by more motivation and more PBC, where PBC is seen as a similar construct as self-efficacy [92]. Social-economic Higher education also emerged as a prognostic factor of adherence to home-based exercise. This was supported with moderate-quality evidence based on phase one and two studies. Literature shows that higher rates of exercise and more frequent
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