That's a fair point: if study subjects can't/won't adhere to the protocol why would we expect real world participants to do so? Either the study subjects adhere

That's a fair point: if study subjects can't/won't adhere to the protocol why would we expect real world participants to do so? Either the study subjects adhered to the program and the results showed (little to) no improvement OR real people won't adhere to the program anyway and results will show (little to) no improvement.