This study assessed predictors of long-term adherence to pelvic floor muscle exercise (PFME) therapy including a health education programme among women with urinary incontinence. Sequential multiple regression analyses revealed several significant predictors that predicted 50% of variance in long-term adherence behavior. Short-term adherence significantly predicted long-term adherence. Further, women with frequent weekly wet episodes before and 1 year after therapy were more likely to have high adherence levels 1 year after therapy than women with fewer weekly losses. Thus, women seemed to adapt long-term adherence behavior to their symptoms. Adherence to PFME therapy was very high. The protocol checklist for the PFME therapy developed to standardize treatment among physiotherapists had structured therapy content, which may have optimized adherence behavior in this study. Implementation of this protocol checklist in clinical guidelines is suggested.