Decreased Mood Correlated with Decreased Exercise Adherence and Increased Pain

Timothy Hui *

Plethy Inc, United States of America.

Arielle West

Plethy Inc, United States of America.

Jamin Gorham

Plethy Inc, United States of America.

Yordanos Woldebirhan

Plethy Inc, United States of America.

Subu Subramanian

Plethy Inc, United States of America.

*Author to whom correspondence should be addressed.


Background: A home exercise program is an important part of recovery from musculoskeletal injuries and can improve pain, quality of life, and self-efficacy.  However, there are often challenges with patient adherence and measuring compliance. Mood and pain can have a positive and negative affect on a patient’s adherence and performance. Digital health, such as Recupe, provides an opportunity to examine the relationship between pain, mood, and exercise adherence outside the clinic.

Methods: A total of 864 subjects were retrospectively analyzed to assess mood and reps completed per session, mood and time spent exercising per session, and mood and pain level. Mood was measured using three categories: “Happy,” “Neutral,” and “Sad.” Pain was measured using the Numerical Pain Rating Scale (NPRS) of 0-10.

Results: The subject population included 331 males, 359 females, and 174 not stated. The average reps completed per session was 218.2 (130.0) for the “Happy” group, 163.3 (101.4) for the “Neutral” group, and 140.0 (95.7) for the “Sad” group with p-values <0.0001 between all groups.  The average time spent exercising per session were 29.54 minutes (24.63) for the “Happy” group, 21.80 minutes (18.30) for the “Neutral” group, and 22.31 minutes (21.23) for the “Sad” group with p-values <0.0001 between all groups. Lastly, the average pain level for each mood was 1.93 (1.69) for the “Happy” group, 4.4 (1.82) for the “Neutral” group, and 6.1 (2.00) for the “Sad” group with p-values <0.0001 between all groups.

Conclusion: There is a significant correlation between mood, reported pain levels, and adherence to the patients’ exercise programs. Patients who report higher pain levels, simultaneously report more depressed moods and demonstrate decreased exercise times and repetition counts. Yet, while this correlation is clear, the causation factor is not known and requires more research.  Clinicians should look to observe this pattern in patients to possibly improve recovery.

Keywords: Mood, physical therapy, exercise adherence, orthopedics, digital health

How to Cite

Hui , T., West , A., Gorham , J., Woldebirhan , Y., & Subramanian , S. (2023). Decreased Mood Correlated with Decreased Exercise Adherence and Increased Pain. Journal of Advances in Medicine and Medical Research, 35(14), 72–76.


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Hush, Julia M, Kirsten Cameron, Martin Mackey. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Physical Therapy. 2011; 91.1:25-36.

Reeve J, Stiller K, Nicol K, McPherson K. M, Birch P, Gordon IR, Denehy L. A postoperative shoulder exercise program improves function and decreases pain following open thoracotomy: a randomised trial. Journal of Physiotherapy. 2010;56(4): 245-252.

Hernández AMR, Alarcón T, Menéndez-Colino R, Maestre IM, González-Montalvo JI, Puime ÁO. Factors affecting exercise program adherence in patients with acute hip fracture and impact on one-year survival. Brazilian Journal of Physical Therapy. 2020;24(6):479-487.

Jönsson T, Ekvall Hansson E, Thorstensson CA, et al. The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy - an intervention study with a reference group. BMC Musculoskelet Disord. 2018;19:198.


Rivera-Torres, Solymar, Thomas D. Fahey, Miguel A. Rivera. Adherence to exercise programs in older adults: informative report. Gerontology and Geriatric Medicine. 2019;5:2333721418823604.

McLean SM, Burton M, Bradley L, Littlewood C. Interventions for enhancing adherence with physiotherapy: a systematic review. Manual Therapy. 2010; 15(6):514-521.

Nicolson PJ, Hinman RS, Wrigley TV, Stratford PW, Bennell KL. Self-reported home exercise adherence: a validity and reliability study using concealed accelerometers. Journal of Orthopaedic & Sports Physical Therapy. 2018;48(12): 943-950.

Essery R, Geraghty AWA, Kirby S, Yardley L. Predictors of adherence to home-based physical therapies: a systematic review. 2016;3160:39:519–534. DOI:

Picha, Kelsey J, Dana M. Howell. A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self‐efficacy. Musculoskeletal Care. 2018;16.1:233-237.

Chen, Chiung-Ying, et al. Factors influencing compliance with home exercise programs among patients with upper-extremity impairment. The American Journal of Occupational Therapy. 1999;53.2:171-180.

Schoo, Adrian Martinus M, Morris ME, Bui QM. The effects of mode of exercise instruction on compliance with a home exercise program in older adults with osteoarthritis. Physiotherapy. 2005;91.2: 79-86.

Bennell, Kim L, et al. Does a web-based exercise programming system improve home exercise adherence for people with musculoskeletal conditions?: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation. 2019;98.10:850-858.

Bergbom, Sofia, et al. Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. Physical Therapy. 2011;91.5: 754-764.

Best, John R, Jennifer C. Davis, Teresa Liu‐Ambrose. Longitudinal analysis of physical performance, functional status, physical activity, and mood in relation to executive function in older adults who fall. Journal of the American Geriatrics Society. 2015;63.6:1112-1120.

López-Sendín, Nuria, et al. Effects of physical therapy on pain and mood in patients with terminal cancer: a pilot randomized clinical trial. The Journal of Alternative and Complementary Medicine. 2012;18.5:480-486.

Boolani, Ali, et al. Six minutes of physical activity improves mood in older adults: a pilot study. Journal of Geriatric Physical Therapy. 2021;44.1:18-24.

Ershadi, Ghazal, et al. Comprehensive musculoskeletal care platform enabling at-home patient care. VISIGRAPP (2: HUCAPP); 2022.

Jack K, McLean SM, Moffett JK, Gardiner E. Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review. Man Ther. 2010 Jun;15(3):220-8. Doi: 10.1016/j.math.2009.12.004. Epub 2010 Feb 16. PMID: 20163979; PMCID: PMC2923776.

Keogh, Edmund, Lance M. McCracken, Christopher Eccleston. Gender moderates the association between depression and disability in chronic pain patients. European Journal of Pain. 2006;10.5: 413-422.