Introduction: Exercise rehabilitation/training is integral in the prevention and management of chronic, lifestyle-related diseases. Poor long-term adherence to exercise by patients is a challenging problem for health professionals. Despite the evidence of appropriate supervision with improved exercise adherence, the supervision process is not adequately described in the literature. Further, the co-existing Technical and Cognitive Behavioral components of exercise supervision are commonly described separately.Methodology: The literature search included (a) reviewing the Technical Domain (TD) of exercise prescription; and (b) Cognitive Behavioral Domain (CBD) of exercise adoption and adherence. CB theories were selected based upon their scientific evidence base demonstrating efficacy in intervention trails. The FITTSBALL tool was developed combining TD and CBD identifying multiple interactions. The tool was applied to 3 case scenarios to demonstrate efficacy.Results: "FITTSBALL" combined the technical domain of "FITT" (Frequency, Intensity, Time, and Type of exercise) and the cognitive behavioral domain (combining five theories and additional constructs) explained by "SBALL" (Stage of change, Belief and Ability of the client, Limitations and Life satisfaction). The tool describes the exercise supervision process and its associations as a three dimensional "sphere" traveling in a particular trajectory. Case scenarios on exercise adoption, maintenance, and relapse are described.Discussion: The "FITTSBALL" tool developed and detailed in this article provides both a meaningful description of supervision and a logical, generic framework for exercise prescription, concentrating on adherence and behavior change. The tool could be used by all staff responsible for supervision. This approach describes how the technical "FITT" principle of prescribing exercise can coexist with a range of cognitive and behavioral theories that have been posited to describe approaches to encourage behavior change and support adherence to such changes. Many such approaches have been widely studied over recent decades using interventional trials.Conclusion: "FITTSBALL" is a logical, generic framework for exercise prescription, concentrating on adherence and behavior change. To the best of our knowledge, such a comprehensive and coherent tool has not been presented to date.Implications for rehabilitationExercise training is integral in the management of chronic, lifestyle-related diseases, but long term adherence is a challenge.Exercise supervision improves adherence, but exercise supervision process is not adequately described in the literature.The tool "FITTSBALL" describes the supervision process and provides a logical, generic framework for exercise prescription and maintaining adherence to the behavior.The dynamic tool combines the traditional technical domain of "FITT" with the cognitive behavioral domain explained by "SBALL".
Keywords: Exercise; adherence; behavior change; prescription; supervision.