Barriers and Facilitators to Long-Term Adherence in an Ongoing, Supervised, Gym-Based Exercise Program Among Adults With Chronic Conditions in Regional Australia.

Background/objective: Adherence rates to supervised gym-based exercise programs traditionally decline over time, highlighting the need to understand participants' perceptions regarding barriers and facilitators to long-term participation. To explore the experiences of people with one or more chronic conditions participating in an ongoing, supervised, gym-based exercise program in regional Australia.

Method: Semistructured interviews were completed with 40 participants and were analyzed thematically using a descriptive qualitative approach.

Results: Forty participants were stratified by age (over and under 65 years) and exercise frequency (regular vs. irregular) with 10 in each classification group. Five themes were identified that appeared to explain adherence: (1) A safe space for oneself, (2) Role modeling and social networking, (3) Seeing the value in exercise, (4) Accredited exercise physiologist support, and (5) Prioritizing exercise ahead of family responsibilities. Many participants over 65 years described the ways that the exercise program had positive benefits for arresting age-related decline in their day-to-day function, whereas participants under 65 years reported positive mental and physical benefits such as feeling happier, getting stronger, and having a more positive outlook on life.

Conclusion: Successful long-term adherence was facilitated by accredited exercise physiologists who invested time in establishing shared goals with participants and maintained regular, quality interactions. This professional support created accountability and enabled progressive program modification based on individual needs and progress. Professionals should focus on these to build effective therapeutic relationships in gyms-based exercise programs. Having a space for oneself and peer motivation enable participation, while role and family commitments can hinder it. Significance/Implications: Findings highlight specific strategies for exercise professionals to enhance long-term program adherence: building strong therapeutic relationships through regular support and individualized attention, creating safe and supportive exercise environments, and implementing flexible scheduling to accommodate family commitments. The identified role of peer support and professional supervision provides a framework for designing sustainable exercise programs in regional community settings. Exercise physiologists should focus on fostering these elements while addressing practical barriers to participation. This study received ethical clearance from The Monash Health Medical Research Ethics Committee; Number: 58571.