Relationship between health literacy and adherence to exercise classes in health care facilities

Background/Purpose: Promoting physical activity and maintenance of adherence to exercise are required for healthy aging. Previous studies showed the relationship between health literacy and health outcomes including physical function. The aim of this study was to investigate the relationship between adherences to exercise classes in health care facilities and health literacy. Methods: This cross-sectional study was conducted in January 2015. Participants were recruited from two health care facilities for functional training in the Tokyo metropolitan area. Adults who had participated in exercise classes for more than 3 months were included in this study. The dependent variable was the percentage of the participants’ attendance to the exercise classes during the past 3 months, which was defined as adherence to the exercise classes. Health literacy was assessed using the 14-item health literacy scale for Japanese adults, which consists of three sub-scales: functional health literacy, interactive health literacy, and critical health literacy. Results: The median level of the adherence was 0.92. Participants whose adherence was < 0.92 had significantly higher critical health literacy than participants whose adherence was ≥ 0.92 (12.0 ± 3.5 vs 9.5 ± 3.5, P = 0.049). In a multivariate analysis, a 5-point increment in critical health literacy was associated with an odds ratio of high adherence of 0.34 (95 % confidence interval 0.15 - 0.75). Conclusions: High critical health literacy was associated with low adherence to exercise classes. Future qualitative studies are needed to investigate the reason of negative effect of critical health literacy to adherence to exercise classes.