The commonest reason exercise fails in musculoskeletal practice is that it was never actually prescribed. 'Do some quadriceps exercises' is advice, not a treatment, and it is followed about as well as advice usually is.
A prescription has four numbers: which exercise, how many repetitions, how many sets, how many days a week. Write all four. Then add the duration — how many weeks before you expect to see change — because a patient who expects relief in a fortnight will stop in a fortnight.
The intensity instruction is the one most often omitted and most often got wrong. 'Moderate' means nothing to a patient. A usable version is that the last two or three repetitions of each set should feel genuinely hard, and if the set finishes comfortably the load is too light. That single sentence converts an abstraction into something a patient can self-regulate at home.
Say what pain is acceptable. Some discomfort during and shortly after exercise is expected in osteoarthritis and is not damage. Pain that is still worse the next morning means the dose was too high. Without that rule, the first sore day ends the programme.
And book the review. An exercise programme with no follow-up appointment is a programme with no progression, and a load that was appropriate in week one is too light by week six. If a supervised or centre-based option exists, use it — it worked better than home programmes — but a written home programme reviewed at six weeks beats an unwritten one reviewed never.
- Write four numbers: exercise, repetitions, sets, days per week — plus how many weeks before improvement is expected
- Define intensity usably: the last two or three repetitions of each set should feel genuinely hard
- Set the pain rule: discomfort during and after is acceptable; still worse next morning means reduce the load
- Book a review to progress the load — a programme without progression stalls by about six weeks
- Use supervised or centre-based delivery where available; it outperformed home programmes
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