A diary can explain what happened between visits, but a row of ticks cannot explain why. A patient may finish every set with an easier band, stop halfway because of symptoms, or practise without recording it. A useful review preserves these distinctions instead of turning every entry into a single adherence percentage.
Know what the record can establish
In a 2018 clinical measurement study, 54 adults aged 45 or older with chronic knee pain completed a home quadriceps programme. Exercise diaries overestimated completion compared with accelerometers concealed in ankle cuff weights, with substantial variation between participants. This does not make a patient’s account unhelpful. It shows why a diary should be treated as reported experience rather than an exact instrument reading.
A camera record has limits too. It can miss an attempt when tracking fails, and it does not explain work, sleep or practical barriers. Keep the source of each observation visible: reported by the patient, captured by a device, or assessed in a consultation. A discrepancy is a question to explore, not proof that one person is being dishonest.
Choose fields that lead to a decision
- Plan: which exercise version and dose were intended?
- Practice: what was actually attempted, including changes in resistance, range or support?
- Response: what happened during the task and later?
- Function: did a relevant daily activity feel different?
- Question: what does the patient need clarified before the next attempt?
This is a suggested review structure, not a validated outcome measure. Keep it short enough to complete. If a field never changes what you discuss or decide, reconsider why you are asking the patient to fill it in. Offer another format when writing, language, vision or device access makes the diary difficult.
Review a blank entry as unknown
Start with a neutral question: “There is no entry here. What happened that day?” The answer might be no practice, forgotten recording, a technical problem, or a decision to follow an agreed rest plan. Record the answer separately. Do not silently convert a blank into zero exercise or an interrupted recording into a completed session.
If you ask for a weekly summary, make the time period explicit. A recollection entered on Friday about Monday should not look identical to an entry made immediately after Monday’s session. The distinction helps everyone understand how much precision the record can reasonably support.
Turn the review into one clear next step
Consider a fictional example: a patient reports fewer repetitions on three evenings, while morning sessions remain unchanged. The useful question is whether the evening routine, symptoms or setup differed. The answer may lead to clearer instructions, a different schedule or a clinical reassessment. It should not automatically trigger a higher exercise target to make the totals match.
At the end of the discussion, document the agreed change and the date it starts. Ask the patient to explain which version they will follow next. NICE’s shared-decision-making guidance supports recording preferences and decisions so they remain available in later conversations; a diary is one possible input to that conversation.
For identifying the reasons a programme becomes difficult to follow, read why home exercise adherence is hard
Separate review from urgent contact
Tell patients when the diary is normally reviewed and how to contact the service for concerns that should not wait. A diary can support a planned review without creating an expectation that every entry receives immediate attention. Make that distinction part of onboarding and repeat it when the care plan changes.
Do not use diary totals alone to diagnose deterioration, infer exercise quality or establish billing eligibility. New concerning symptoms need the appropriate clinical assessment and contact route, even when the diary looks complete.