In randomized controlled trials, high levels of adherence and compliance are necessary to demonstrate the positive impact of exercise on health outcomes. The overarching aim of intervention implementation is to determine the feasibility of utilizing such a program as the mode of delivery for lifestyle change. Feasibility and success can be measured by compliance (the quantity of exercise sessions attended compared with prescribed) and adherence (the quantity of exercise dose completed compared with the total prescribed). Barriers to participation such as motivation, goal achievement, and satisfaction can negatively affect engagement and participation. Monitoring adherence throughout the study intervention is important to address barriers and problems. To maximize retention in the intervention for HART-D, we employed a variety of strategies including facilitating access to the center, maximizing staff availability, providing participants tangible support and emotional support, and providing appropriate information to participants. When unpreventable problems arise, various strategies were utilized to keep a participant engaged, including but not limited to more frequent contact, face-to-face counseling, alternative team member requested to build rapport, or a consultation with behaviorist or psychologist. In addition, essential aspects of maximizing participation and promoting retention include carefully screening and assessing barriers to adherence and retention prior to randomization, carefully monitoring adherence problems, trying to identify these problems early before participants refuse further study contact, and applying specific strategies to address these problems. High levels of adherence to a study intervention are important to address the research question and approve or disprove the hypothesis.