Effect of Number of Home Exercises on Compliance and Performance in Adults Over 65

Years of Age
Kristin D Henry, Cherie Rosemond and Lynn B Eckert
Physical Therapy. 79.3 (Mar. 1999): p270.
Copyright: COPYRIGHT 1999 Oxford University Press
http://ptjournal.apta.org.proxy3.library.mcgill.ca/site/subscriptions/

Abstract:

Background and Purpose. There is limited research on the effects of the number of exercises a
person is told to perform on compliance and performance, as defined by cueing requirements,
correct alignment, and quality of movement. Some studies of medication suggest that
compliance decreases as the number of medications increases. The purpose of this study was
to determine whether older adults comply and perform better (ie, requiring less cueing,
exhibiting correct alignment, and exhibiting controlled, coordinated, and continuous movements)
when they are asked to do 2, 5, or 8 exercises. Subjects. Subjects were 11 women and 4 men,
aged 67 to 82 years ([bar] X=72.8), who were living independently in their communities.
Methods. Subjects were randomly prescribed 2, 5, or 8 general strengthening home exercises.
They were instructed on their exercises at an initial session and asked to record the number of
repetitions performed each day in a self-report exercise log. At a return session 7 to 10 days
later, subjects were scored on their performance of the prescribed exercises using a newly
designed assessment tool. Results. The group that was prescribed 2 exercises performed
better, as defined by their performance tool score, than the group that was prescribed 8
exercises. The group that was prescribed 5 exercises was not different from the groups that
performed 2 or 8 exercises. No differences were found among groups regarding the self-report
measurement of compliance. There was a moderate correlation between performance scores
and the self report percentage rates. Conclusion and Discussion. Subjects who were prescribed
2 exercises performed better than subjects who were prescribed 8 exercises. The question of an
optimal number of exercises to prescribe to elderly people warrants further study. [Henry KD,
Rosemond C, Eckert LB. Effect of number of home exercises on compliance and performance in
adults over 65 years of age. Phys Ther. 1999; 79:270-277.]

Full Text:

Key Words: Compliance, Exercises, Older adult, Optimal performance.

With emerging changes in health care delivery, physical therapists are receiving reimbursement
for fewer treatment sessions. Physical therapists, more than ever, need to educate their patients
in techniques for self-care and prevention.

The exercises prescribed for self-care often depend on the number of areas or muscles
involved, the interval between clinic visits, and the types of exercises needed. Many of the older
adults seen by physical therapists have cognitive losses and complex medical problems
preventing them from completing all of the exercises prescribed. For many individuals, a
sedentary lifestyle has been the norm. Factors such as these may influence an older person's
willingness and ability to carry out a home exercise program with a large number of exercises.
By the year 2000, 20% of the population will be over 65 years of age.[1] More physical
therapists will be working with this population and need to understand their patients' unique
attributes in order to provide meaningful treatments.

The terms "compliance" and "adherence" are often incorrectly used interchangeably in reference
to exercise and medication prescription. Many of the existing studies involving exercise use the
term "compliance" to mean performing the exercises as directed by the physical therapist in their
mode, type, duration, and frequency.[2] According to Guccione, the term "compliance" "...
implies that the patient must do as the therapist instructs in order for the patient education
session to be successful."[3(p336)] Many authors, however, prefer the term "adherence"
because of its implication of freedom of choice and action on the part of the patient.[3] The term
"adherence" often is used to describe patients adhering to their medication prescription regimen.
[4] We chose to use the term "compliance" in our study because the traditional sense of that
term more closely matched the artificial setting of the study.

Motivation is needed for adherence to a regimen and is defined as a "complex attitude of wants,
beliefs, and rewards versus cost of the behavior."[3(p336)] The participants in our study did not
have a specific deficit at the impairment level and, therefore, did not independently search out
physical therapy exercise prescriptions. They were all volunteers who were offered a chance (by
their internal medicine physician) to participate in a study that involved general strengthening
exercises. The participants may have been motivated to volunteer for a variety of reasons,
including to improve their general strength, to participate in a local university study for altruistic
reasons, or to help their physician in any manner they could. Even though volunteering implies a
willingness to participate, we decided to use the term "compliance" in this report for 2 main
reasons. First, the participants were asked to obey unquestionably the exercise instructions and
perform them in a specific manner. Second, the motivational and independent problem-solving
aspects were not assessed, and, therefore, adherence was not fully studied.

The participants were evaluated on whether they completed the exercises in the requested
manner and at the requested frequency and, therefore, on whether they complied with the
exercise prescription. In order to perform the exercises accurately for the evaluation, the
patients needed to learn the exercises. Guccione defined learning as an "acquisition of
knowledge or skills achieved by study, instruction, practice, and experience."[3(p340)] As
described in this report, the participants used all of these methods to learn the exercises and
perform them accurately. Learning is a required part of compliance.

Numerous attempts have been made to isolate factors that influence compliance. A literature
review by Sluijs et al[2] revealed over 200 factors that may be related to patient compliance.
These factors include sociodemographic variables (eg, age, sex, education), accessibility of
setting, patient attitude, and type of regimen.[5-12] Lorenc and Branthwaite[13] used a person's
living condition (ie, whether living alone or with someone) as the main demographic variable
related to compliance. People over 65 years of age who live alone are less compliant.[13]
According to Mayo[10] and Shephard et al,[12] problems with compliance increase in individuals
over 65 years of age. Mayo's explanation is that exercise regimens are more difficult for medical
professionals to prescribe to people in this age group because of their impaired physical status.
[10] Sluijs et al[2] also reported that older patients exhibit decreased compliance with exercise
regimens because of multiple pathologies.

Accessibility to a treatment setting and patient attitudes can become critical barriers to exercise
compliance. According to Martin,[14] compliance decreases when individuals exercise at
inconvenient locations (eg, fitness gym located across town). In contrast, Thompson et al[15]
reported that compliance is enhanced with home-based exercise programs. Some authors[2,10]
reported that noncompliance increases when clinic hours require the patient's lifestyle to be
disrupted. The time and psychological investment and internalization of the exercises can affect
the patient's willingness to comply. Decreased compliance is associated with preventative
exercises, as compared with therapeutic exercises.[2] This relationship may be attributable to
direct results not being seen by the patient with preventative exercises.

Some aspects of prescribed regimens, such as the complexity, intensity, and meaning of the
exercise program, have an effect on patient compliance. Haynes et al[6] reported that
treatments requiring more than one step or item task produced a higher rate of noncompliance.
Drug studies dominate as a major type of research on complexity of prescriptions. Haynes et
al[6] described a study in which compliance decreased when more than 3 prescribed
medications were taken daily. Sackett and Haynes[16] stated that compliance with behavioral
treatments (eg, an exercise program) is similar to drug compliance; as complexity increases,
compliance decreases. Additionally, patients are less compliant if the exercise programs are not
seen by the patients as meaningful or if the programs not individually tailored to their situation or
routine.[2,17]

A major problem for health care professionals is measuring compliance with the medical
regimen. Sluijs et al[2] stated that physical therapists lack a measurement tool for reliably
assessing patient compliance with exercises. Some methods of measuring compliance for drug
studies are pill counts and blood traces.[10] Exercise studies, by convention, rely on patient self-
report. Self-report may include the use of a questionnaire, a patient diary (eg, log sheet), or an
interview. Massie and Shephard[9] and Gerber and Nehemkis[18] showed that the degree of
compliance estimated by self-report exceeded the degree of compliance estimated by other
methods (ie, learning contracts and checklists). Although self-report methods may tend to
overestimate compliance, they are still the most cost-effective, feasible, and frequently used
methods available in assessing compliance with an exercise regimen.[6,8,11,19]

Observation of exercise performance in the clinic is another way of measuring compliance.

Observation in the clinical setting is meaningful only if it is assumed that the structured situation
of the clinic is similar to the home environment of the older person.[6] Few studies on exercise
regimens have used direct observation as a method of measuring compliance.[10] Friedrich et
al[20] used a 3-grade scale when observing patients performing their exercises after instruction
from a brochure or a therapist. Their grading scale and definition of compliance were related to
whether the goals were met and whether there were detrimental effects from the exercises
being performed incorrectly.[20] There are no scales for measuring compliance based on motor
control, alignment, and amount of cueing during demonstration of the exercises. Scales of this
type would provide more kinesiological information and potentially more reliable measurements.
Mayo[10] stated that evaluating the degree of compliance with direct observation would be
difficult, but some measure of quality could be made. By using composite indices of self report
and direct observation, more accurate portrayals of patient compliance with exercise
prescription may be possible.[10] In our study, we attempted to use self-report and
demonstration to measure compliance.

The purpose of our study was to determine whether adults over 65 years of age perform and
comply better with 2, 5, or 8 home exercises. Three hypotheses were formulated prior to this
study: (1) Subjects who are prescribed 2 exercises will perform better than subjects who are
prescribed 8 exercises, (2) subjects who are prescribed 2 exercises will comply on their self-
report exercise log more than subjects who are prescribed 8 exercises, and (3) self-report
percentage rates will highly correlate with performance assessment tool scores.

Method

Subjects

Participants were asked to volunteer by one internal medicine physician and one of the authors
(CR) working with elderly people in 2 separate locations. The physician offered all of her
patients the opportunity to be in a study "with the University of North Carolina at Chapel Hill
looking at general strengthening exercises during the summer." The stipulations were that the
participants fit the inclusion criteria and that they would be available for both sessions. These
stipulations, unfortunately, limited the number of participants to 15. Twelve residents of
Fearrington Village and 3 residents of Carol Woods Retirement Community (both in Chapel Hill,
NC) volunteered for the study. All participants lived independently in their communities. The
subjects (11 women and 4 men) ranged in age from 67 to 82 years ([bar] X = 72.8). People were
excluded from the study if they were under 65 years of age; had difficulty following directions;
were currently receiving physical therapy; or had heart, lung, neurological, or orthopedic
problems that prevented safe performance of general exercises. The Fearrington Village
residents were the subjects who were participating in an exercise program 3 times per week.
Their generalized exercise program consisted of a 1.6-km (1-mile) walk around the pool and
light calisthenics. Each subject provided informed consent to be a volunteer.

Materials

Exercise packets were prepared for each subject. Each packet contained a list of' 2, 5, or 8
exercises (Tab. 1), a written and pictorial description of each exercise, and a self-report exercise
log. The exercises were selected by an experienced practicing physical therapist (CR, with 10
years of experience practicing physical therapy) for their functional relevance, simplicity, and
commonality as general strengthening exercises. An alternate exercise (ie, shoulder flexion,
corner push-ups, straight leg raises, shoulder shrugs, or hip extension) was used if the any of
the original exercises were not safe for particular volunteers to perform. A chair with arm rails
and a supportive back, an exercise mat, and a towel roll were made available to each subject.

Table 1.
Exercises Prescribed for Each Group

2 Exercises 5 Exercises

1 Knee extension in sitting Knee extension in sitting

2 Scapular pinch in sitting Scapular pinch in sitting
3 Hip flexion in sitting
4 Bridging in supine
5 Hamstring muscle curl in sitting
6
7
8

8 Exercises

1 Knee extension in sitting

2 Scapular pinch in sitting
3 Hip flexion in sitting
4 Bridging in supine
5 Hamstring muscle curl in sitting
6 Toe raise in standing
7 Mini squats in standing
8 Hip abduction in standing

Prior to data collection, we designed a tool to assess each individual's performance of the
exercises based on 3 components: required cueing, maintained alignment, and movement
quality. A maximum score of 12 was possible for every exercise, with 4 points allotted to each of
the 3 categories (Appendix).

Reliability

Interrater reliability for measurements obtained with the assessment tool was established using
the following approach. Five physical therapist students ranging in age from 21 to 26 years from
the University of North Carolina at Chapel Hill were instructed on knee extension and scapular
pinch in a sitting position. The range in age was acceptable, in our opinion, because there is no
defined and expected performance level for people over 65 years of age. The students were
scored on their performance by 3 raters using the assessment tool. Between the raters' scores
of the participants, there was one 1-point difference and one 2-point difference. The
performance scores of the participants ranged from 3 to 12, indicating that the raters reliably
scored all levels of the participants' performance. Two of the raters in the interrater reliability
study were the same raters as those in the actual study. The one additional rater in the reliability
study was not part of the actual study. One exercise instructor (nonrater) described file study to
each participant in both the reliability study and the actual study. The instructor read from a
script for consistency. Once interrater reliability was established as high, as defined by Munro et
al,[21] data collection began.

An intraclass correlation coefficient (1CC[2,1]) model was used to analyze the interrater
reliability data. The ICC analyzed 3 raters' results on the performance scores of 5 students,
each demonstrating 2 exercises. The ICCs for the interrater reliability test represent a
comparison of the 3 raters using the performance assessment tool. The ICGs (2,1) for exercise
1 (knee extension in a sitting position) and exercise 2 (scapular pinch in a sitting position) were
.87 and .93, respectively. Thus, the data obtained for these 2 exercises were used for
subsequent data analysis.

Procedure

Subjects participated in 2 sessions that took place at exercise facilities that were equally
accessible and convenient to the subjects. The first session was for exercise instruction. The
return session was for subject demonstration of the assigned exercises, with a rater scoring
each exercise using the performance assessment tool.

During the initial session, each subject was randomly assigned to 1 of 3 groups: subjects who
were prescribed 2 exercises, subjects who were prescribed 5 exercises, and subjects who were
prescribed 8 exercises. Exercise packets were prepared prior to the instructional session. The
instructor randomly selected an exercise packet tot each subject and in this way determined the
subject's group assignment. Subjects within a group were instructed on their exercises in a fixed
order (Tab. 1). Range of motion was assessed using Kendall and colleagues' description of
"within normal limits."[22] If a subject, in the view of the instructor, was limited by pain or an
orthopedic condition, the instructor selected an alternate exercise that avoided the area of
concern. Two individuals received instruction in an alternate exercise. Each subject was allotted
20 minutes maximum to learn the exercises and understand how to use the self-report exercise
log. The subjects were asked to perform 10 repetitions of each exercise, once each day, until
the return session 7 to 10 days later. The subjects were instructed to record information about
their exercise sessions using the self-report exercise log, especially noting any pain with the
exercises or any reason for noncompliance. Following the exercise instruction, a rater, who was
not the same person as the instructor and was one of the reliability study raters, used the
performance assessment tool to score each exercise. The subjects were scored on correctness
of alignment and exercise quality of movement (Appendix). The cueing component was
eliminated from the scoring because instruction for correct technique was considered as
"cueing" and, therefore, required by all participants. The rater ensured that the subjects learned
the exercises by demonstrating the correct alignment and quality of movement with a score of 8
out of 8 on the performance assessment tool (Appendix).

During the return session, we collected and reviewed the self-report exercise logs for
completeness and reasons for omissions. The original instructor asked all subjects to "perform
the exercises as you have been doing them at home." All subjects sat in the same chair in which
they were instructed, and the same towel roll was in sight and available for the subjects to use.
If subjects needed help remembering the next exercise or how to perform the exercises
accurately, then appropriate cueing was provided by the instructor. A rater, who was not the
instructor or the rater from the first session, used the performance assessment tool to score
performance as the subject demonstrated each exercise. That rater was blind to the group
assignment (2, 5, or 8 exercises) of the subjects. The rater, however, knew how to perform all of
the exercises accurately. The rater continued to score the exercises until the participant stopped
exercising. The participants' stopping point defined the completion of the prescribed exercises.
None of the participants stopped their demonstration before completing all of their exercises. A
total performance score for each exercise was tallied. After completing the exercises, all
subjects were instructed about the purpose and rationale of the study and were permitted to ask
any questions. The purpose of measuring compliance was not explained to the subjects before
the study so as to not bias the participants' typical compliance with the exercise programs.

Data Analysis

The performance assessment scores were computed for the first 2 exercises for each subject
across the exercise groups, and these 2 exercises were used for subsequent analysis. The first
2 exercises were analyzed because they were common to all groups. In addition, by analyzing
the same 2 exercises, we attempted to ensure that the exercises were of the same level of
difficulty and meaning to the participants. The self-report exercise logs were analyzed by a
statistician (Dr William Ware) for completion and omissions from the first 7 days, as all
participants performed exercises at least 7 days. A check mark on the exercise log for
completion of 10 repetitions of one exercise on one day, for example, indicated compliance with
that exercise for that particular day. Review of the 15 participants' exercise logs revealed that, if
there was an omission of a check mark on one particular day for an exercise, then all exercises
for that day also were omitted. The self-report percentage rates for all subjects were computed.
The medians of the performance scores and self-report percentage rates were computed for
each group (2, 5, or 8 exercises) and are listed in Table 2. The performance scores and self-
report percentage rates across all exercises for each subject were not computed. The
performance scores for exercises 1 and 2 and the self-report percentage rates were analyzed
for exercise groups using the Kruskal-Wallis one-way analysis of variance (ANOVA).[23]
Differences were determined using Dunn's post hoc multiple comparison test.[24] Finally, a
correlation analysis was used to determine whether a correlation existed between the
performance scores and self-report percentage rates.

Table 2. Median Performance Assessment Scores(a) and Self-Report Percentage Rates

Median
Performance
Median Score of Self- Assessment Scores
Group Report Percentages (%) (Out of Possible 12)

2 exercises 100 11.5

5 exercises 100 11
8 exercises 100 10.25

(a) Median of a number of scores arranged in order of values is the middle number of the
distribution if n is odd (eg, n=3).[24]

Results

The Kruskal-Wallis one-way ANOVA revealed a difference among groups (H=6.195, df=2, P [is
less than] .046).[23] The average scores for the groups that were prescribed 2, 5, and 8
exercises were 11.4, 8.2, and 4.4, respectively. Dunn's post hoc test revealed a difference
between subjects who were prescribed 2 exercises and subjects who were prescribed 8
exercises.[24]
Table 2 shows the group medians for the self-report percentage rates. The self-report
percentage rate was based on the number of exercises performed per total number prescribed.
The Kruskal-Wallis one-way ANOVA results indicated no differences among groups with 2, 5, or
8 exercises.[23] A correlation analysis of the exercise compliance, as measured by an exercise
log, and of performance, as measured by direct observation, yielded a correlation coefficient of
.54.

Discussion

The hypotheses that were formulated prior to this study were: (1) Subjects who are prescribed 2
exercises will perform better than subjects who are prescribed 8 exercises, (2) subjects who are
prescribed 2 exercises will comply on their self-report exercise log (ie, by completing their home
exercises and documenting their performance) more than subjects who are prescribed 8
exercises, and (3) self-report percentage rates will highly correlate with performance
assessment tool scores.

The reliability of the performance assessment scores obtained for exercises 1 and 2 may not
indicate that all performance scores of other exercises have similarly high reliability. Future
studies on the reliability of scores for this performance assessment tool obtained for multiple
exercises would allow therapists to more fully understand the differences in each exercise and
whether they all are evaluated equally. Another limitation to the reliability study is that students
ranging in age from 21 to 26 years were used from a convenience sample instead of people
over 65 years of age. Often, people over 65 years of age demonstrate different performance
abilities than people under 65 years of age. There is, however, no defined performance level
according to age. We believe that the use of people with varying ages is acceptable for the
reliability study, but it is a limitation.

Hypothesis 1 was supported because we found a difference in performance scores was among
groups. An apparent tendency was that the median performance score of each exercise group
decreased as the number of exercises increased (Tab. 2), and a difference occurred between
the group that was prescribed 2 exercises and the group that was prescribed 8 exercises. The
data suggest that performance may decrease when subjects are prescribed 5 exercises, but
further study is needed. A few limitations regarding the analysis that led to the support for
hypothesis 1 are discussed. First, there were 5 participants in each group, and a larger sample
size may provide more information about the effect of various numbers of prescribed exercises.
Second, 20 minutes was allotted for the instruction session for all of the exercises. In future
research, perhaps each exercise should be allotted a set amount of time instead of a time for
the whole exercise session. Third, the analysis of the exercises may be more informative if all of
the exercises are evaluated and not just the first 2 exercises. Fourth, some participants were
exercising previously and other participants were not. With these limitations, this study did not
determine an optimal number of exercises to prescribe. It supports the idea, however, that
subjects who are prescribed 2 exercises perform better (as indicated by higher scores on
exercise quality of movement, alignment throughout the exercise, and cueing requirement) than
subjects who are prescribed 8 exercises. If we can assume that higher performance scores are
secondary to increased practice and thus increased compliance with an exercise program, then
this assumption supports use of the performance assessment tool as a measure of compliance.
In future studies, the performance assessment tool may be used in the clinic.

A moderate correlation was found between the performance assessment tool scores and the
self-report percentage rates, making the correlation positive. Two possible reasons for the
correlation are (1) the participants placed check marks on their self-report exercise log even
when they did not perform the exercises and, therefore, did not practice the exercises and (2)
the assessment tool was not sensitive enough to detect changes in performance when
participants complied completely. In our view, the correlation provides evidence that the
performance assessment tool is similar to the self-report in indicating compliance. Both scores,
however, demonstrate high compliance rates.

There were, in our opinion, 4 factors present in our study that could positively influence
compliance and performance. The first factor was that the subjects' overall level of fitness and
attitude toward exercise may have been more favorable than for the average adult over 65
years of age. The majority of the subjects were recruited from an exercise class that met 3 times
a week throughout the year. The median scores for each of the 3 exercise groups (2, 5, and 8
exercises) on the measurement tool were 11.5, 11, and 10.25, respectively. These scores
suggest that the subjects' level of performance was good overall. Second, subjects volunteered
for this study, which was advertised through their physician and exercise instructor. If the
subjects had no intention of doing the exercises, they probably would not have volunteered.
Often in physical therapy clinical settings, patients are receiving treatment not because they
have volunteered, but because it was prescribed by their physician. Third, all the subjects in this
study were from above-average socioeconomic settings. Some of the literature suggest that this
factor may positively influence compliance." Fourth, the exercise regimen was short-term and
had a definite ending date. Long-term exercise programs are more difficult to maintain and
would require a longitudinal study to monitor compliance.[2]

One factor that we believe might have negatively influenced compliance was that the exercises
prescribed were general strengthening exercises, which are considered preventative exercises
rather than curative exercises. According to Sluijs et al,[2] preventative exercises usually have
less meaning to the patient than curative exercises, and people who consider their exercises as
meaningful are more compliant. Second, the performance assessment tool may not be sensitive
enough for all of the patients with various noncontributing past medical histories. A more
sensitive scale may yield lower scores. Future studies with larger samples of subjects from
differing socioeconomic groups, a variety of fitness levels, and more narrow age ranges would
be beneficial. Different types of exercises could be examined, such as a cardiovascular program
incorporating walking and bicycling. Finally, performing this type of study in a clinical
environment may produce more generalizable results, because that is where physical therapists
typically prescribe exercises.

Conclusions

Health care reform may limit the number of clinic visits, requiring physical therapists to be more
efficient and effective in planning home exercise programs and educating their patients. The
managed care environment encourages physical therapists to capture the opportunity to focus
on patient education during their treatment sessions. Patient compliance is necessary for these
home exercise programs to be successful. Although physical therapists are aware that some
patients do not comply, little research has been done to target the most appropriate number of
exercises to prescribe. In our experience, we believe that patients are often given more
instructions than they can manage, requiring more changes in lifestyle than they are willing to
make. In our view, physical therapists should consider the type and frequency of exercises they
prescribe. Our results suggest that patients will perform better with fewer home exercises. When
prescribing home exercise programs, we recommend that physical therapists keep in mind
these results while tailoring the treatment regimen to the individual needs of the patient.

Acknowledgments

We acknowledge Dr William Ware for his assistance with statistical analysis and Dr Michael
Gross, Dr Philip Witt, and Dr Vicki Mercer for reviewing the manuscript.

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Appendix. Henry-Eckert Performance Assessment Tool

Name--

The performance score will be the sum of the 3 components.

A maximum of 12 points is possible for each exercise.

I. Cueing

1 2

Relied on Exercise Sheet, or Moderate Verbal and/or

Maximum Verbal and/or Manual Manual Cueing
Cueing

II. Alignment

1 2

Alignment Never Correct Alignment

Established Maintained <50% of
Exercise

III. Exercise Quality

1 2

Lacks Control, Controlled, Coordinated,

Coordination, and/or and Continuous <50% of
Rhythm During Exercise Exercise

Exercise#--

The performance score will be the sum of the 3 components.

A maximum of 12 points is possible for each exercise.

I. Cueing
 3 4

Minimum Verbal and/or No Cueing

Manual Cueing

II. Alignment

3 4

Correct Alignment Alignment Maintained

Maintained- >50% of Throughout Exercise
Exercise

III. Exercise Quality

3 4

Controlled, Coordinated, Controlled, Coordinated,

and Continuous >50% of and Continuous
Exercise Throughout Exercise

TOTAL = --

KD Henry, PT, is Physical Therapist II, Physical Medicine and Rehabilitation Department, The
Johns Hopkins Hospital, Osier 159, 600 N Wolfe St, Baltimore, MD 21287. Address all
correspondence to Mrs Henry.

C Rosemond, PT, GCS, is Clinical Assistant Professor, Division of Physical Therapy, The
University of North Carolina at Chapel Hill, Chapel Hill, NC.

LB Eckert, PT, is a graduate of the University of North Carolina at Chapel Hill.

This study was funded in part by The Allied Health Project Grant: Geriatric Education, Research,
and Practice in Physical Therapy, US Department of Health and Human Services (CFDA
93.191).

This study was approved by the Committee on the Protection of the Rights of Human Subjects
at the University of North Carolina at Chapel Hill (approval #93-MAHD-287).

This article was submitted November 25, 1996, and was accepted October 13, 1998.

Source Citation (MLA 8th Edition)

Henry, Kristin D, et al. "Effect of Number of Home Exercises on Compliance and Performance in
Adults Over 65 Years of Age." Physical Therapy, Mar. 1999, p. 270. Expanded Academic
ASAP, http://link.galegroup.com/apps/doc/A54207932/EAIM?
u=crepuq_mcgill&sid=EAIM&xid=92dd4d83. Accessed 30 July 2018.

Gale Document Number: GALE|A54207932