Graduated Exercise Rehabilitation Programme

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Mildred Porter
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1 University Teaching Trust Graduated Exercise Rehabilitation Programme Why is Exercise Important Irving Building Physiotherapy Page 1

2 Exercise is important for lots of reasons. Even if you are taking up exercise later on in life, you can reap enormous benefit. It is good for your heart and lungs. Exercise is essential to maintain the ability to perform activities of daily living and keep your joints mobile. How much exercise should I do" Ideally, you should exercise for at least 1 / 2 hour, 5 times a week. If you want to try something different; swimming, cycling, aqua-aerobics, yoga or Tai Chi can be beneficial. Even a walk to your local shop or park at a good pace is valuable exercise. It is important to maintain your mobility. Don t do so much exercise that you feel exhausted. Stop if you are excessively short of breath, feel nauseous or get any chest pain. Is it safe to start exercising and what are the risks You have been carefully assessed by your physiotherapist, who is satisfied that it is safe for you to start a graduated exercise programme. There is a small risk of temporarily flaring up your symptoms, including increased pain. However, this is greatly reduced when exercise is completed with guidance from your physiotherapist. Why do I sometimes feel pain the day after I exercise Is it normal to get some soreness after exercising especially when you are new to it, but the soreness will lessen as your body gets used to it. By gently warming up and cooling down, your muscles will become more supple and you decrease the risk of injury. What if I choose not to exercise If you choose not to exercise you will probably find your symptoms do not change. There is no substitute for exercise. Page 1

3 The best way to decide on what you want to achieve or aim for is to set yourself goals or targets. You can chose a goal which may be something you have never done before. You could chose something you have either stopped doing or are doing less. You have to decide what is important to you. We want you to set a fitness related goal. Goals can be exercise related or be related to an aspect of your household activity, social or leisure pursuits or work. You just need to decide what you want to achieve - this will be your long term goal. LONG TERM GOALS To be able to Setting Yourself Notes Goals and Targets in 3 months time. One of the best ways of achieving a long term goal is to break it down into short term goals that you can review weekly. What aspects of your fitness do you need to work on to be able to achieve your goal (e.g. fitness, flexibility or strength). Ask the physiotherapist if you require help. SHORT TERM GOALS To be able to 3 times a week for 30 minutes The best goals are SMART :- S M A R T pecific easurable chievable ewarding ime limited Say exactly what you want to achieve Decide how much and how often Given your current circumstances and ability Gives you a sense of achievement Set a deadline to achieve your goal Page 2

4 Before you begin make sure you have a clear area to exercise in. Wear something comfortable that allows free movement. Please do not exercise if you are feeling unwell, have just eaten a meal or if you have been drinking alcohol. Warm-up Routine This is to prepare you for exercise by increasing your body temperature and heart rate. The warm up should last for 2 to 3 minutes. Start by marching on the spot, lifting your knees high and swinging your arms. Then step touch to the left and right. At the same time lift your arms up and down to the sides. Keep a good pace going. You may also like to include some gentle stretching exercises. You should now be feeling warmer and you will have raised your heart rate. It is normal that you may feel a little short of breath at this point. Exercise Circuit Work through each exercise on the circuit for 1-2 minutes. Start with 1 circuit and progress to 3 circuits as your fitness improves and work at the right intensity level for your ability. The circuit is designed so that you can exercise at home with or without special equipment. If you do not have an exercise bike, march on the spot instead and consider improvising using tin cans if you do not have any hand weights. Page 3

5 Squats These exercises will strengthen the powerful leg muscles which are important in lifting and bending. 1 Sit to stand. Stand straight with your feet shoulder width apart. Slowly squat to a sitting position on the chair. Then stand and repeat. Remember to tighten your abdominal muscles. 2 Squats. Squat to the level of the chair but stand again without sitting down. Remember to tighten your abdominal muscles. 3 Squat and Hold. Squat to the level of the chair but without sitting down. Hold squat position just above the chair for 5 seconds before standing again. Remember to tighten your abdominal muscles. Page 4

6 Pelvic tilts on gymball l Sit up tall on gym ball Abdominal Core Exercises These exercises strengthen the stomach muscles that maintain our posture. 1 l Slowly roll the ball backwards as far as you can whilst staying sitting up as tall as possible, hold for 5 seconds l Then reverse and roll the ball as far forward as you can whilst staying sat up as tall as possible Anterior pelvic tilt Posterior pelvic tilt 2 Heel slides l Laying on back, knees bent, spine in a neutral position l Flatten lower back to floor l Once holding the above contractions, slide one heel out until your leg is straight, then alternate 3 Alternating scissors l Lay on your back with knees bent to approximately 90 degrees. l As you breath in, keep knee bent and lift up to point at the ceiling, hold 5 seconds l As you breath out slowly lower raised foot to the floor l Repeat alternating legs Page 5

7 Shuttle Walk or Run 1 Walk 2 Brisk walk 3 Light jog Page 6

8 Press-ups These exercises strengthen the muscles of the chest and arms. 1 Wall press-up. Lean against wall with elbows straight and hands slightly wider apart than shoulder width. Perform a pressup against the wall remembering to tighten your abdominal muscles as you do so. 2 Box press-up. Start on all fours. Hands under shoulders and knees under hips. Perform a press-up in this kneeling position. 3 Floor press-up. Hands on floor slightly wider apart than shoulder width. Feet shoulder width apart with toes in contact with the floor. Perform a full press-up, remembering to tighten your abdominal muscles as you do Page 7

9 Star Steps and Jumps These exercises help to improve balance and co-ordination. 1 Star step. Step and touch to the left and right. Hands on hips. Remember to tighten your abdominal muscles. 2 Star step with arms. Step and touch to the left and right. At same time lift your arms up and down to the sides. Remember to tighten your abdominal muscles. 3 Star jump. Start with feet together and arms down by your sides. Then jump up, land in a star shape, with feet apart and arms outstretched to the side. Remember to tighten your abdominal muscles. Page 8

10 Arm Exercises These exercises strengthen the muscles of the arms which help us lift and carry. Alternate between: Shoulder Press. Stand or sit holding weights at shoulder level. Push elbow straight to lift the weight high above your head. Alternate between left and right hand and remember to tighten your abdominal muscles. Shoulder Fly s. Stand or sit holding weights at arms length by your side. Lift the weights up and out to the side. Keep your elbows straight but not locked and remember to tighten your abdominal muscles. Bicep Curls. Stand or sit with weights at arms length by your side. Bend your elbow to lift the weight to shoulder level in front of you. Remember to tighten your abdominal muscles Light Weight Medium Weight Heavy Weights Page 9

11 Step-ups Low step Medium step High step Glute extension Back Exercises These exercises strengthen the muscles of the back. l Face the wall, Loop band round ankle l Pull leg with band attached behind maintaining tall upright posture, l Pause 1 second, then slowly return to start position l Repeat for desired number or reps 1 2 Spinal stability bridge l Laying on back, knees bent, l Tilt pelvis backwards l hold the above while you gradually push hips up towards the, hold for up to 5 seconds, then lower point kneeling l Start on hands and knees, all at 90 l Lift one leg out behind to horizontal l Slowly return to start position and swap legs maintaing back in neutral position Page 10

12 Exercise Bike or Marching on the Spot Light resistance Medium resistance High resistance Cool Down Stretches Cooling down by stretching after exercise helps prevent injury and reduce stiffness. Also regular stretching increases flexibility. Perform all stretches slowly and try to relax into the stretch positions. Standing Backward Stretch Stand with feet shoulder width apart with hands on hips. Bend backwards from the waist. Repeat 5 to 10 times Standing Side Stretch, Arm by Side Stand with feet shoulder width apart with hands by your side. Bend to the side from the waist. Repeat 5 to 10 times Standing Side Stretch, Arm Overhead Stand with feet shoulder width apart with one hand by your side hips. Bend to the side from the waist with the other hand reaching overhead. Repeat 5 to 10 times Page 11

13 Standing Twist Stand with knees bent, as if preparing to sit down. Twist around from the waist. Repeat 5 to 10 times Standing Roll Down Stand with feet hip width apart. Knees soft and abdominal muscles tightened. Breath out. Drop your chin to your chest and allow the weight of your head to make you slowly roll forward, arms hanging down. Then slowly come up to stand tall Repeat 5 to 10 times Lying Knee Rolling Lie on your back with your knees together and bent, with your feet on the floor. Slowly roll your knees side to side keeping your upper trunk still. Repeat 5 to 10 times Lying Knees to Chest Lie on your back with knees bent and feet on the floor. Lift one knee towards your chest. Place your hands behind the knee and draw it to your chest. Repeat 5 to 10 times Page 12

14 Lying Hamstring Stretch Lie on your back, lift your knee towards your chest. Place your hands behind your knee and straighten your knee while pointing your toes towards the ceiling. You will feel a stretch behind your thigh. Hold for 30 seconds Lying Calf Stretch Lie on your back, lift your knee towards your chest. Place your hands behind your knee and straighten your knee while pointing your toes towards your face. You will feel a stretch in the back of the knee and your calf. Hold for 30 seconds Lying Thigh Stretch Lie on your front. Bend your knee behind you, grasp your ankle with your hand and pull your foot towards your bottom until you can feel a stretch in the front of your thigh and hip. Hold for 30 seconds Lying Back Stretch Lie face down with hands level with shoulders. Push elbows straight to lift your upper trunk as far as you can. Keep your pelvis and legs relaxed. Repeat 5 to 10 times Page 13

15 What do I do if Notes my Pain Flares up? Take control by : DON T PANIC!!!! 1. Assess the pain, is it the same or different? If it is a different type of pain seek advice from your physiotherapist or GP If this is the same pain remember that it is usual to have flare-ups and continue with the action plan 2. Take sufficient medication to help get the pain under control If you are unsure as what to take seek advice from your pharmacist If you need more tablets or further advice see your GP or pharmacist. Remember that medication is more effective if you take it regularly as prescribed and not just when you remember to take it. Keep some pain killers at home so you can get to them as soon as you need them When your pain settles decrease the amount of tablets you are taking, so that you can increase them again during a flare-up 3. Distraction techniques Try to keep busy and occupied Try not to worry. Remember that you have had flare ups before and the pain will settle down 4. Rest This is a difficult one as we are always reminding you to exercise and keep active When you have a flare-up it is sensible to rest from some of your normal activities but don t be tempted to rest completely After a couple of days you need to start gradually increasing your activity as you 5. Stay positive Don t get into the trap of thinking the worst and allowing your thoughts to run away with you. Your pain will improve and things will get better 6. Get back to your exercises As you get better think back to your goals and adjust your exercise to get back on track. Remember to increase the amount gradually and pace yourself as you have learnt. Page 14

16 Tips for Keeping up with Exercise 1. Keep this booklet at hand and refer to it if things get worse 2. Write an action plan of things you want to remember when you have a flare up 3. Always set yourself goals or targets and remember to make them SMART 4. Set long term goals that are important to you and will give you a sense of achievement 5. Set short term goals which are achievable for you 6. Set weekly targets and record what you have done 7. Chose exercise and activities which you find enjoyable 8. Reward yourself for sticking to your plan 9. Pace your activity, increase sensibly and learn how to manage your problem to minimise the effect a flare up may have Below is some space to write down an action plan of things you want to remember when you have a flare up. Keep it at hand and refer to it if things get worse. Copies of this information are available in other languages and formats upon request. In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. If you need this interpreting please telephone InterpretationandTrans@srft.nhs.uk Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone If you would If you have any like to become suggestions as to a Foundation how this document Trust Member could be improved please visit: in the future then please visit: nhs.uk/formembers nhs.uk/for-patients Page G W. Design Services, Salford Royal NHS NHS Foundation Trust. All All Rights Reserved This This document MUST NOT NOT be be photocopied. Unique Identifier: CS CS (16). (16). Review Date: February

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