Prognostic factors of adherence 73 exercise participation have been correlated with increased education [93]. Among adults over 65 years of age, education has not been found to be a significant prognostic factor of adherence in prospective exercise trials, yet larger longitudinal survey samples have indicated significant associations [93]. Social support was found as not predictive of home-based exercise adherence. This was a surprising finding because a common assumption is that patients who have more social support will be more adherent to exercise programs. Social support was reported as a strong prognostic factor of adherence to home-based physiotherapy [12]. However, our finding was supported with low-quality evidence because of contradictory results and serious limitations. Therefore, this finding needs further investigation; who benefits from more social support where and when. Condition-related The presence of less depressive symptoms predicted better adherence. This also has been found in previous research [12]. Patients reporting feelings of depression were less likely to complete their exercises than those who did not have feelings of depression [94]. Two other condition-related prognostic factors of exercise adherence in this study were having less comorbidities and being less fatigued. Patients with less than two comorbidities and being less fatigued were more confident in the ability to complete their exercises. When predicting exercise adherence, the most prognostic factors were found in the patient-related, social/economic and condition-related domains. Relatively little research has been conducted on the health-system factors and therapy-related factors of adherence. The common belief that patients are solely responsible for taking their treatment is misleading and most often reflects a misunderstanding of how other factors affect people’s behavior and capacity to adhere to their treatment [5]. Evidence available, might be biased by the traditional misconception that adherence is a patient-driven problem. This along with the fact that few predictors have been found, with low-quality evidence, suggests that follow-up research is needed to better understand and predict adherence in people with chronic diseases. This should also take into account the study design. Between-study heterogeneity is the rule rather than the exception in prognostic factor research [14]. Longitudinal research designs are the only acceptable ones that provide prognostic evidence [26]. Of the 57 studies included in this systematic review, 22 studies had a cross-sectional design. These designs can show correlations but are not the best design for examining predictive factors. Often a lot of factors are studied in relative small sample sizes, giving potentially high risk of bias [26].
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