Three in four physical therapy patients skip their home exercises - and it is costing them their recovery

The math of recovery: 3 hours of clinic against 168 hours of life

Physical therapy works when patients do the work. A session with a therapist - typically one to three hours per week - provides guidance, correction, and supervised practice. The rest of the week's recovery happens elsewhere. Or it doesn't.

A national survey of 1,006 Americans, commissioned by The Ohio State University Wexner Medical Center, has put numbers to a problem physical therapists observe daily: three out of four patients (76%) do not complete their assigned home exercise programs. Only one in four (24%) finishes all of the homework their therapist assigns. The consequences range from slowed recovery to additional medical procedures that might have been avoided with more consistent follow-through.

"The one to three hours per week a patient spends in physical therapy pales in comparison to the 168 hours we have in a given week," explained Kyle Smith, PT, a physical therapist at Ohio State Medical Center. "And that one to three hours patients are physically in the clinic is not enough to make big changes in the grand scheme of things."

Who follows through and who does not

The survey asked participants what share of their assigned at-home PT sessions they completed. The results mapped out a distribution heavily weighted toward partial completion. About 28% completed 75 to 99% of their sessions. Another 27% completed 50 to 74%. Only 11% finished 25 to 49% of their exercises, and 8% completed between 1 and 25%. Just 2% reported completing none of their homework at all.

Age turned out to be a strong predictor of completion. Adults 65 and older were significantly more likely to finish all their assigned exercises than those under 30 - 30% versus 12%. The older group was also much less likely to finish only a small fraction: just 5% of those 65 and older completed only 1 to 25% of their at-home PT, compared to 15% of those under 30. This gap likely reflects differences in available time, motivation structures, and how individuals in different life stages experience the consequences of incomplete recovery.

Among the reasons patients gave for not completing their homework, forgetting or lacking reminders topped the list at 40%. Schedule conflicts and insufficient time were cited by one-third (33%) of respondents. These are the most tractable barriers - both are amenable to technological solutions like reminder applications and behavioral approaches like habit stacking.

Making home exercises stick

Smith and his team approach the compliance problem practically, working with each patient to design routines that fit into existing daily patterns rather than requiring dedicated separate time slots. The specific examples Smith offers are deliberately low-barrier: parking farther away at work or the grocery store to build in more walking; balancing on one leg while brushing teeth; doing stretches or bodyweight squats during commercial breaks.

"As physical therapists, we need to educate patients that it is going to take some work on their end to reach the goals they have to ultimately build strength and mobility and decrease the body's pain sensitivity," said Smith.

The principle underlying these adaptations is habit stacking - attaching new behaviors to existing routine behaviors so that the new action is triggered by something already happening reliably each day. Research on habit formation supports this approach as more effective for sustaining behavior change than scheduling dedicated exercise time that competes with other priorities.

The stakes of non-compliance

The consequences of incomplete home exercise programs extend beyond slower recovery. In some cases, failure to complete assigned homework leads to outcomes that require additional medical intervention - repeat procedures, surgeries that might have been avoided, or complications that extend the rehabilitation timeline considerably. For patients recovering from joint replacement surgery, ligament repair, or neurological conditions, the home exercise program is not supplementary to recovery; it is the primary driver of functional restoration between sessions.

The survey represents a self-reported sample and carries limitations of that methodology - social desirability effects may cause some respondents to overreport completion, meaning the true non-compliance rate could be even higher than 76%.

Physical therapists increasingly use digital tools - apps, video libraries, and automated reminders - to address the forgetting problem. The survey data suggest that attention to the specific barriers patients report, rather than generic encouragement to "do your exercises," is the more productive intervention point. Forty percent of non-compliant patients say they forget. That is a problem with a technological solution that does not require redesigning the therapy itself.