Background Adherence is a multi-faceted concept and poorly understood in professional football in relation to rehabilitation and performance programs. To offer best practice to players, an understanding of why players are undertaking such programs (adherence) is important. No research to date has examined adherence in professional football.

Objective This study aimed to examine adherence in both men’s and women’s professional football players in order to better inform practice and program design.

Design Qualitative research design - focus groups and questionnaires.

Setting One English professionall Football Club - men’s U23 team and women’s first team.

Patients (or Participants) 10 men’s U23 players and 11 women’s first team players from one English professional football club.

Interventions (or Assessment of Risk Factors) 10 men’s players and 11 women’s players answered a questionnaire adapted from the Sports Injury Rehabilitation Adherence Scale (SIRAS) to provide an overview of adherence rates. 9 men’s players and 4 women’s players took part in follow-up focus groups to gain a deeper understanding of the players perspectives of their adherence. Thematic analysis was conducted to examine any common themes.

Main Outcome Measurements Adapted Sports Injury Rehabilitation Adherence Scale (SIRAS) with follow up focus groups.

Results This study found that men’s players had a better attendance to their performance programs than women’s players. However, men’s players felt they had less input into their rehabilitation sessions compared to women’s players, despite having a better understanding of the exercises given. Common themes that emerged from focus groups that influenced adherence were financial pressures, experience, perceptions of pain, self-determination and staff relationship – these themes were common in both men’s and women’s players.

Conclusions Despite differences in funding and infrastructure, both men’s and women’s professional football players identify broadly the same factors that influence adherence. Particularly, both groups felt a greater understanding of financial pressures and self-determination would allow for the fostering of an adherence culture and should be considered in future program design.