Why Kids Struggle With Home Exercise Programs (and What the Research Says Helps)
@Lynn Tanner, PT, PhD
Most of a child's therapy happens at home. A child might see their therapist for an hour a week, but the practice that builds new skills happens in the other 167 hours, usually with a parent leading it.
That's why home exercise programs are a core part of pediatric PT, OT, and speech therapy. It's also why so many therapists feel the same frustration: you build a thoughtful program, send it home, and the next visit you hear, "We didn't get to it much this week."
The good news is that researchers have studied this problem for years, although as stated below, much more research is needed. Here's what the evidence says.
Why home practice is worth getting right
Home programs aren't busywork. They are one of the best supported tools we have.
A large systematic review of pediatric occupational therapy looked at 129 studies covering 52 interventions. Home programs, parent education, coaching, family- centered care, and goal-directed training all earned the review's strongest "do it" rating (Novak and Honan, 2019).
The same review points to evidence that parent-delivered intervention, guided by a therapist, can be just as effective as therapist-delivered intervention. The authors conclude that home programs and self-management programs are an effective way to increase the intensity of therapy (Novak and Honan, 2019).
Intensity matters. The 2026 APTA Academy of Pediatric Physical Therapy guideline for developmental coordination disorder recommends high practice frequencies that combine direct sessions with home, school, and community practice. As a guide, it suggests building toward about 100 minutes of practice a week over roughly 9 weeks for a goal related task (Sargent et al., 2026). For most families, a weekly visit alone can't get there. Home practice is how kids reach the dose.
Speech research points the same way. In a 2024 study of 134 children ages 2 to 5 with language delay, children whose parents took an active role in a therapist-led, family- centered program made greater language gains than children who received therapist led sessions alone. They also made bigger gains in personal and social skills (Fan et al., 2024).
So the question isn't whether home practice matters. It's how to help families actually do it.
How often do families keep up with home programs?
Across studies, somewhere between a third and three quarters of families don't follow their child's home program as prescribed. That isn't a failure of parents. It's a sign the system around them needs more support.
A 2024 systematic review studying parents of children with cerebral palsy found non-adherence rates of 34% to 79.2%. Individual studies tell a similar story:
Table 1.
| Study | Who was studied | What they found |
|---|---|---|
| Niyonsenga et al., 2024 | Systematic review, parents of children with CP | Non-adherence ranged from 34% to 79.2% |
| Tanner and Schorr, 2024 | Systematic review, 13 studies of rehab for 318 children with cancer | Supervised session attendance ranged from 61% to 91%; unsupervised home adherence was rarely measured and ranged from under 1% to 72% |
| Williams et al., 2024 | 199 parents of children under 5 in speech and language therapy, London | 26% did not follow home recommendations |
| Alwhaibi et al., 2022 | Mothers of children with CP, birth to 12 years, Saudi Arabia | 66.1% did not follow the home program |
| Holt et al., 2020 | Scoping review, 41 studies of 2,020 children and teens ages 2 to 19 with musculoskeletal conditions | Only 54% of studies reported adherence; where reported, it ranged from 12% to 99% of prescribed exercises |
| Medina-Mirapeix et al., 2017 | 219 parents of children with developmental disabilities, 18 early intervention centers, Spain | 61.4% met prescribed frequency; 57.2% met prescribed session length |
One pattern stands out. The systematic review on pediatric cancer rehabilitation by YourSteps founder and CEO Lynn Tanner, PT, PhD, and Erica Schorr, PhD, RN, found that studies usually measure whether kids show up to supervised sessions. Far fewer measure what happens at home, and when they do, the numbers vary widely. A scoping review of children and teens with musculoskeletal conditions found the same gap: only about half of its 41 studies reported adherence at all (Holt et al., 2020). The part of therapy that happens without a therapist in the room is the part we know least about.
Most of this research comes from cerebral palsy and early intervention, and nearly all of it is from outside the US. We need more data on US families and on OT and speech home programs. Still, the pattern is consistent: keeping up at home is hard for a lot of families.
What gets in the way
The biggest barriers aren't about motivation. They're about confidence, stress, and how well the program fits into real family life.
That same systematic review grouped what drives adherence into three buckets:
The child. Younger children and children with stronger gross motor function tended to have better adherence.
The caregiver. Parents who felt confident and knowledgeable, had strong social support, and had lower stress, anxiety, and depression kept up better. So did parents who saw fewer barriers to fitting exercises into the day.
The therapist relationship. A parent's sense of a supportive, collaborative relationship with the therapist was one of the strongest positive factors.
Other studies echo this. In the Spanish study of 219 parents, those who saw few barriers to building exercises into their daily routine were 2.6 to 4.8 times more likely to adhere. In speech therapy, how important a parent felt a recommendation was, and how confident they felt doing it, predicted whether it happened at home.
The same patterns show up beyond cerebral palsy. In the scoping review of 41 studies of kids with musculoskeletal conditions, the most common barriers were time, where the exercise had to happen, and negative experiences like pain or boredom. The most common helpers were social: family involvement, group exercise, peer support, and a strong relationship with the clinician. Exercise that felt fun helped too (Holt et al., 2020).
Children going through cancer treatment face extra hurdles. In the pediatric cancer review, the most common barriers were fatigue, illness, time, and motivation. What helped was support from peers or caregivers, and supervision (Tanner and Schorr, 2024). A small UK study of parents of children with CP heard similar themes. Parents described the time and effort home programs take, frustration when therapists changed often, and goals or routines that felt unrealistic. What helped was involving siblings and friends, making exercises fun and part of everyday activities, and setting realistic goals with manageable routines (Peplow and Carpenter, 2013).
The takeaway for us as clinicians: many of these factors are hard to change, like a child's diagnosis or a family's circumstances. But a parent's confidence, their understanding of why each activity matters, and their relationship with the therapist are things we can strengthen.
What the research says helps
Of everything researchers have looked at, the support a therapist gives around the program is the factor clinics can influence most.
An early intervention study is one of the most practical papers on this. It looked at specific things therapists did and how much each one raised the odds that parents followed the prescribed frequency:
Table 2.
| What the therapist did | How much more likely parents were to adhere |
|---|---|
| Shared information about the child's progress with the exercises | 3.75 times |
| Gave advice on fitting exercises into the daily routine | 2.54 times |
| Checked the parent's skills during follow up | 2.21 times |
| Asked about home adherence | 2.20 times |
| Explained why the exercises are useful | 2.17 times |
Source: Medina-Mirapeix et al., 2017. Odds ratios from a survey of 219 parents.
The rest of the research points the same way:
Build the relationship. In a systematic review studying parents of children with cerebral palsy, a parent's sense of a supportive, collaborative relationship with the therapist was one of the factors most strongly linked to keeping up at home (Niyonsenga et al., 2024). Unlike a child's diagnosis or a family's circumstances, it's something therapists can build.
Show, don't just tell. In a US survey of 446 parents of young children with motor delays, parents said a therapist modeling the activity was the most helpful technique for keeping up at home. And 63% said they wanted more time spent on coaching (Gmmash et al., 2021).
Explain the why. In speech therapy, parents who rated a recommendation as important were far more likely to do it (Williams et al., 2024).
Build parent confidence. Self efficacy shows up again and again as a predictor. Showing, practicing together, and checking skills all help.
Fit the program to the family, and make it fun. In the same US survey, home activities that fit daily routines and the home environment, and that the child enjoyed, were linked to better adherence (Gmmash et al., 2021). A 2026 focus group study of speech and language therapists also found that individualizing the program was central to making home practice work (Pritchard et al., 2026). Practical ideas from the musculoskeletal scoping review include keeping the number of exercises small to limit time demands, using games and crafts with younger children, letting teens pick their own music or turn exercises into a competition, and inviting siblings or friends to join in (Holt et al., 2020).
Start with the child's goals, and decide together. The 2026 APTA guideline for developmental coordination disorder strongly recommends task oriented intervention guided by the child's goals. It also recommends shared decision making with the child and family to set goals and build the home program, with activities the child enjoys and the family can realistically fit into daily life (Sargent et al., 2026). The Novak review found the same ingredients in the most effective OT approaches: start with the child's goal, practice real activities in everyday settings, repeat often at home, and keep the challenge "just right" so success feels good.
Stay connected between visits. Asking about home practice and sharing progress keep the program alive between sessions. Just asking about adherence made families 2.2 times more likely to follow the prescribed frequency (Medina-Mirapeix et al., 2017).
We still have work to do on goals. The APTA guideline notes that many parents don't feel fully included in goal setting, and research it cites found low agreement between parents and therapists on what goals a child was actually working toward.
One more lesson from the research: the strategies clinicians reach for most, like reminders, rewards, and education, don't always match the barriers a family actually faces. The musculoskeletal scoping review recommends taking time to find each family's specific barriers and choosing a strategy that targets them. It also notes a real tension between involving caregivers and giving kids ownership of their own program, which takes balance as children get older.
Where digital tools fit
Digital home programs show real promise. The pediatric studies are still small, though, so we should be honest about what we know and what we don't.
Here's what we know so far:
Digital support can boost adherence, at least in the short term. A 2022 systematic review pulled together 10 randomized trials with 1,117 participants across many rehab populations. In 7 of the 10 trials, adding a digital tool to a home exercise program led to better adherence than the program alone. The three trials that found no difference followed people longer, so long term effects are less certain (Lang et al., 2022). Most of these studies were not in children.
Too few apps are built with the people who use them. A review of 69 randomized trials of health apps for chronic conditions found that only about one third reported involving patients or health care professionals in development (Cucciniello et al., 2021).
The lesson: technology doesn't replace the therapist. The best use of digital tools is to extend what the research says works. That means keeping the therapist connected to the family between visits, making progress visible, explaining the why, and making practice something kids want to do.
How we built YourSteps® with families
We didn't want to build another app nobody used. So YourSteps® was developed and tested with children and their parents, along with pediatric physical, occupational, and speech therapists. We shared how we built and tested it at the 2025 Pediatric Healthcare Innovation Summit in Atlanta (Tanner, 2025).
When we asked families about home programs before YourSteps, we heard the same things over and over. They were confused about what to do at home. They forgot details from the visit. They didn't know which handouts were for this week and which were from weeks ago. Apps weren’t made for kids to use with their parents. Those are exactly the barriers the research describes, and our patient advisory board helped us design around them.
We built YourSteps around family-centered care, an approach with strong research behind it.
Family-centered care treats parents as partners and as the experts on their own child. It earned the strongest "do it" rating in the Novak review for children with brain injury or CP, and the 2026 APTA guideline builds shared decision making into both goal setting and home programs. That's why YourSteps keeps therapists and caregivers communicating and deciding together, and why so many activities include a family member or friend.
How YourSteps® is designed to help families keep up at home
Every feature in YourSteps® maps back to a barrier or helper the research describes.
Fun, interactive exercises and challenges. Boredom and a lack of enjoyment are among the most common reasons kids stop practicing, and exercise that feels fun helps. Activities like Side to Side Hot Lava, Hospital Animal Yoga, and Arm Strengthening at the Playground turn home practice into play.
Smartphone sensor challenges. Games and friendly competition came up again and again as ways to keep kids engaged, especially older kids. YourSteps uses the phone's built in motion sensors to turn exercises into interactive challenges kids can play.
Progress front and center. Parents whose therapists shared information about their child’s progress were 3.75 times more likely to follow the home exercise program (Medina-Mirapeix et al., 2017). In YourSteps, the child and family can track their progress in the app, and the therapist can see it remotely, so progress is easy to share and talk about between visits.
Points, rewards, and customized gamification. Rewards and feedback are among the strategies clinicians use most. In YourSteps, kids earn points and rewards for every exercise and challenge they complete, and the game elements can be customized to what motivates each child.
A personalized experience for parent and child. Programs work best when they fit a family's real routines, and kids need more ownership as they grow. YourSteps lets parents and children use the app in ways that fit their family, so a younger child can practice alongside a parent while an older child takes the lead.
Goals at the center. Clinical guidelines call for home programs built around the child's own goals, set together with the family. In YourSteps, each home program connects to the child's goals, and families can see what they've completed today and what they're working toward next.
Messaging with therapists. Checking in, sharing progress, and a strong relationship with the therapist are some of the best supported ways to help families keep going. Messaging lets families ask questions between visits and lets therapists check in, encourage, and adjust the program.
None of this replaces the therapist. It's there to support the therapist and family relationship that the research keeps pointing back to.
What this means for your clinic or health system
If you lead a pediatric therapy team, the research gives you a clear place to start:
Treat adherence as a team problem, not a family problem. Many families struggle. Plan for it.
Learn about remote therapeutic monitoring (RTM) to support sustainability and outcomes for more children. Checking in and sharing progress are linked to better adherence. Where payers cover it, RTM lets clinics bill for monitoring and supporting home programs between visits, which can help make that support sustainable.
Make the why easy to share. Parents follow through more when they understand what each activity is for.
Keep programs realistic for busy families. Help parents fit practice into routines they already have.
Support the parent, not just the child. Confidence and stress shape what happens at home.
Every child deserves the chance to make the most of their therapy, and so much of that happens at home. If you'd like to see how YourSteps® helps therapists support families between visits, request a demo.
References
Niyonsenga J, et al. The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: a systematic review. PLOS ONE. 2024;19(6):e0305432. doi:10.1371/journal.pone.0305432
Tanner L, Schorr E. Factors related to rehabilitation adherence in pediatric cancer: a systematic review. Rehabil Oncol. 2024;42(4):149-163. doi:10.1097/01.REO.0000000000000372
Williams P, Slonims V, Weinman J. Turning up and tuning in: factors associated with parental non-attendance and non-adherence in intervention for young children with speech, language communication needs. Int J Lang Commun Disord. 2024;59(2):762-778. doi:10.1111/1460-6984.12961
Alwhaibi RM, Omer AB, Khan R. Factors affecting mothers' adherence to home exercise programs designed for their children with cerebral palsy. Int J Environ Res Public Health. 2022;19(17):10792. doi:10.3390/ijerph191710792
Holt CJ, McKay CD, Truong LK, Le CY, Gross DP, Whittaker JL. Sticking to it: a scoping review of adherence to exercise therapy interventions in children and adolescents with musculoskeletal conditions. J Orthop Sports Phys Ther. 2020;50(9):503-515. doi:10.2519/jospt.2020.9715
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Novak I, Honan I. Effectiveness of paediatric occupational therapy for children with disabilities: a systematic review. Aust Occup Ther J. 2019;66(3):258-273. doi:10.1111/1440-1630.12573
Sargent B, Mueller M, Iverson E, Frazier M, Kaplan SL. Physical therapy management of children with developmental coordination disorder: a 2026 evidence-based clinical practice guideline from the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2026;38:297-333. doi:10.1097/PEP.0000000000001284
Fan Q, et al. The effectiveness of therapist-led family-centered language intervention for children with language delay. Transl Pediatr. 2024;13(10):1720-1736. doi:10.21037/tp-24-225
Peplow UC, Carpenter C. Perceptions of parents of children with cerebral palsy about the relevance of, and adherence to, exercise programs: a qualitative study. Phys Occup Ther Pediatr. 2013;33(3):285-299. doi:10.3109/01942638.2013.773954
Gmmash AS, Effgen SK, Skubik-Peplaski C, Lane JD. Parental adherence to home activities in early intervention for young children with delayed motor development. Phys Ther. 2021;101(4). doi:10.1093/ptj/pzab023
Pritchard K, et al. Team Speech Sounds: how speech and language therapists work with parents of young children with speech sound disorder. Int J Lang Commun Disord. 2026;61(2):e70224. doi:10.1111/1460-6984.70224
Lang S, et al. Do digital interventions increase adherence to home exercise rehabilitation? A systematic review of randomised controlled trials. Arch Physiother. 2022;12(1):24. doi:10.1186/s40945-022-00148-z
Del Lucchese B, et al. The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders: a systematic review. Front Public Health. 2024;12:1295273. doi:10.3389/fpubh.2024.1295273
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Tanner L. User-centered development and usability outcomes of YourSteps: a digital solution for pediatric remote therapeutic monitoring. Presented at: 2025 Pediatric Healthcare Innovation Summit; 2025; Atlanta, Georgia.