Facilitators
First, patients reported their own intention to engage in exercise as the most important facilitator to adhere to the exercise program. Most patients were highly motivated to contribute to their own recovery and were convinced that the exercise program would help them to improve their health. Their own personal goals of improving condition, strength, and health increased their commitment. Also, previous positive training experiences, e.g., pre-operatively, had a positive influence on fulfillment of the exercise program. In addition, some indicated exercising to be a pleasant activity, which made it easier to adhere.Second, supervision by the physiotherapist was considered to be a strong facilitator. Within this theme, several aspects had beneficial influence on exercise adherence. With the physiotherapist encouraging the patients while performing the exercises, patients felt motivated to challenge themselves, even when they had a hard time with the exercises. In addition, some reported to experience mental support by the physiotherapists and many especially valued the medical expertise and knowledge on correct performance of all exercises, which made them feel comfortable to perform the prescribed program. Last, patients felt obligated to go to the two weekly appointments with the physiotherapist, which was for many of them a great help to bring up the necessary discipline to exercise (quote 1).“Yes, because it is in any case very important to exercise and if that is compulsory, because you have to do it, you also put aside hesitations to actually doing it. I mean, if something is obligatory, you commit to it, and that in itself is a very good thing.”With regard to the content of the exercise program, patients indicated that RDI was promoted if the components were individualized to patients’ preferences and if exercises were adjusted in case of pre-existing injuries. Also, variation in exercises, such as alternating leg and arm strength exercises, made the exercise program more attractive to comply to. Patients further reported to feel encouraged when they experienced progress in their physical condition and daily activities (quote 2).“I loved it. It made it most clear to me that I was on the mend, it was measurable, I immediately noticed that my energy was improving. Even when I was really tired at some day, I knew: When I have been to physiotherapy, I will feel better.”In line with experiencing progress themselves, patients indicated that adherence was promoted by receiving information on their training progress, i.e., quantification of training results, as well as information on the training schedule. Regarding the physical activity advice, collecting information through apps with pedometers (on their own initiative) helped three patients to achieve the prescribed guideline of activity per day. In addition, the psychosocial context influenced adherence to the home-based exercise guideline. Performing activities together with a partner and embedding the activities in daily life, e.g., walking with the dog, supported performing physical activity on a regular base.Last, logistic factors such as short distance to the training facility, having enough time for exercising (e.g., being retired), and flexibility of the appointments (e.g., in case of conflicting activities) were all mentioned as facilitators. Furthermore, the availability of equipment and good weather circumstances made it easier to fulfill the physical activity advice.