Instructions

For the initial selection of exercise categories during the exercise period, a hierarchical model based on walking ability has been developed. The model should be seen as a guide for the physical therapist (PT) in the choice of specific exercise categories. The participant’s need for personal support is estimated when walking a short distance (5-10 meter) without walking aid.

Model for selection of exercise categories

 

Physical function group

Recommended categories in the collection of exercises

1. Walking without any physical support or supervision

A. Static and dynamic balance exercises in combination with lower-limb strength exercises
B. Dynamic balance exercises in walking

2. Walking with supervision or minor physical support from one person

A. Static and dynamic balance exercises in combination with lower-limb strength exercises
B. Dynamic balance exercises in walking
C. Static and dynamic balance exercises in standing

3. Walking with major physical support or not able to walk

C. Static and dynamic balance exercises in standing
D. Lower-limb strength exercises with continuous balance support
E. Walking with continuous balance support

 

Within each exercise category, the PT selects exercises for each participant according to her or his functional deficits. The PT decides for each participant how much time within the session will be spent on each exercise category. It is recommended that the participant performs at least two lowerlimb strength exercises and two balance exercises in two sets each session. In order to maximize the number of exercises during a session, the participants should not rest more than necessary. The exercises are preceded by a five-minute warm-up for upper and lower extremities while sitting.

The intensity of the exercise is self-paced, although the participant is encouraged by the PT to exercise progressively with a high intensity. The exercises are adjusted for each session according to changes in health and functional status.

Definition of high intensity:
       1) strength exercises in sets of 8-12 repetition maximum (RM)
       2) balance exercises performed near the limits of maintaining postural stability

For the first two weeks, 13-15 RM is recommended for the strength exercises, as a build-up period.

The collection of exercises includes exampels of how the PT can increase the load in the strength exercises and the difficulty in the balance exercises. The load of the leg-extensor muscle groups is increased by adjusting the performance of the exercise, for example, by deeper squats or doing stepups on to a higher step board, or by using a weighted belt worn around the waist, loaded with a maximum of 12 kg. The load shold not be increased if this significantly impairs the quality of the movement during the exercise. The aim is that the exercise is performed in a controlled manner throughout the entire range or movement, including the eccentric phase, e.g. when sitting down. The difficulty of each balance exercise is increased, for example, by standing or walking with a narrower base of support, or on a more challenging surface, e.g. a soft mattress.

For safety reasons, the participant uses a belt with handles worn around the waist so that the PT can more easily prevent the participant from falling when challenging the postural stability. It is important that the participant does not get balance support unnecessarily.

Intensity scales

The intensity scales have been developed to describe the intensity in the exercises. The intensity for each participant is estimated by the PT for lower-limb strength exercises and balance exercises separately, as an average for each exercise session.

 

High intensity

Medium intensity

Low intensity

Lower-limb strength
exercises

Sets of 8-12 RM

Sets of 13-15 RM

Sets of > 15 RM

Balance exercises

Postural stability
fully changed*

Postural stability not fully challenged or fully challenged in only a minority of   the exercises

Postural stability in no
way challenged

*Postural stability fully challenged = balance exercises performed near the limits of maintaining postural stability

Warm-up

The participants can, for example, perform the exercises while sitting for approximately five minutes.

Examples of exercises:

  • Walking on the spot

  • Opposing arm-swings at the side of the body

  • ”Sewing-machine” steps

  • ”Picking apples” in various directions (upwards, sideways, downwards)

  • Knee stretches with right and left leg alternately

  • Steps to the side and back with right and left foot alternately