Five Important Cues for a Home Exercise Program Handout

You’re in a rush. The clinic is popping, with new and returning patients. There are aides to direct, notes to write, and exams to perform. In all of the chaos, how are you expected to provide effective exercise prescription? With so much going on, it’s easy to forget some of the important cues that help clients succeed with their home exercise programs.

Here are five frequently forgotten cues to include in your HEP instructions:

1. Rest Breaks

Good clinicians and coaches know that effective exercise dosing is important for achieving the desired tissue changes. We write do this exercise for “X” reps, and repeat it for “Y” sets. That’s all good, but how much rest should the client take between sets? If you omit this information, they might be inclined to zip through the sets with minimal breaks.

Not including appropriate rest periods in your HEP handouts is easy to do, but it’s something that you should try to avoid. Why? When a client fails to use adequate rest breaks, they may not be giving their body the time needed to recover and perform at the right intensity. If they aren’t performing at the right intensity, it is harder to achieve the desired changes.

For instance, if you want someone to work on power generation, then they need to be fairly fresh when attempting each set of the skill. Max distance or max height jumps are a good example. When someone is too fatigued from the last set, they can’t get the muscle recruitment for the desired explosiveness. This is the perfect time to remind someone to rest for a few minutes between sets. Have them chill out for a bit, so that they can put in their best effort on each set.

2. Tempo

What rhythm should your client be using during the phases of a movement? Should they pause at the bottom of the skill? Should they be slow through the eccentric phase and explosive during the concentric phase? Maybe you want them to be slow through every rep. Conversely, maybe they should be cranking through them as fast as possible.

Making a blanket statement to simply perform X reps and Y sets without additional cuing can be problematic. Your client might think that you want them to zip through the exercises in minimal time. When in reality, you want them to slow down and be intentional in their movement.

Adding exercise prescription cues about tempo to squats is a classic example. You often want someone to descend into the squat slowly, and then thrust back to the starting position with speed. For even more effort, you might have them stop at the bottom of the movement to eliminate any bouncing or rebound. The important thing to note is that without explicitly calling out the desired rhythm, your client isn’t going to be able to read your mind. You need to be detailed in your home exercise handout about how they should perform the movement.

To be even more direct in your exercise instruction, consider calling out how many counts the eccentric phase should take versus the concentric phase. You might say: “Remember to descend over three counts, and explode upward on one count.” Adding this level of information to a home exercise program ensures that your client is getting the most out their time with you. 

3. Scaling Options

During a physical therapy visit, you hopefully have the chance to determine the best way to scale an exercise for your client. Perhaps they need a pillow or two on the chair seat to help them achieve sit-to-stand squats. Maybe countertop push-ups are too hard, so you have them perform wall push-ups instead. Adjusting the difficulty of an exercise easier or harder ensures that your clients gets the most benefit from their home exercise program. 

Sometimes though, having the exact match for how you scaled the exercise might not be illustrated within the exercise library. The software program may have a similar match, but it isn’t exactly how you had the client perform the skill in the gym. This is a case where you should write in those additional details directly to the HEP handout. By adding specific reminders about how to adjust an exercise, you help ensure that your client achieves his or her goals.

In a similar manner, think about adding tips on how to increase the challenge of an exercise once it becomes too easy for your client. Maybe you don’t plan to see the patient for an extended period. Instead of having them flounder with a HEP that is too simple, provide them with some ideas about how to make the movement harder over time. It could be as simple as increasing the weight. It could also be transitioning from symmetric limb placement, to uneven support, or even single limb use.

You always want to be advancing someone to as much independence as they can achieve. If they are too reliant on you to progress their home exercise program, then that is just another barrier to their success. Don’t forget to add reminders for how to scale the movements in each home exercise program handout.

4. Breathing

Another helpful cue centers upon how and when a client should be breathing during the exercise. Do you want them to inhale at a certain point during the movement cycle? Should they hold their breath for a duration? Maybe they have a medical reason for why they shouldn’t perform a Valsalva maneuver? Should they time their exhale in sync with a given motion?

Yoga teachers are great at coaching students to inhale and exhale in unison with the postures. It’s a skill physiotherapists and trainers should think about implementing more often with their clients. Next time you create a home exercise handout, consider if adding some type of cuing about respiration would be beneficial.

5. Visual Feedback

When you’ve got a client in the gym, correcting their movement is as simple as providing some quick verbal feedback: “It looks like your right shoulder is a little high. Try to be lighter on your feet. Don’t let your knees cave inward too much.”

But what happens when they are working their way through their home exercises without your guidance?

A simple hack is to have the client spot their own movement faults with the use of visual feedback tools. Exercising in front of a mirror is the simplest solution. Using a mirror provides immediate feedback regarding posture and symmetry. For some learners, however, the real-time information can be challenging to integrate.

Another solution is to recruit a friend or family member to watch them during their HEP performance. The observer can provide reminders about sequencing, weight bearing, et cetera.

Perhaps the best visual feedback tool is simply to have the client record themselves. Teach them how to set-up their phone or video camera to record their first set of exercises. Show them how to replay the sequence, and what movement faults they should be looking for. Recording oneself is a great way to improve technique and track progress. Clients can even send you the video for feedback, or show you in person once they return to the clinic.

As you create your client’s home exercise handout, consider if this person would benefit from using visual feedback. Write your recommendations for using a mirror, video camera, or a human “spotter.” This type of home exercise instruction ensures that your in-person feedback has the highest carryover outside of the clinic setting. The better your clients can replicate how you had them perform a movement, the better their outcomes will be.

Hopefully these five cuing reminders are useful to you. There is always so much going on in a busy physiotherapy clinic, that it can be easy to overlook adding these types of cues to you home exercise programs.

If you are a BPM Rx software user, the best way to add these cues is in the ‘Additional Instructions” box of the editing page.

Take care everyone, and let’s get the WORLD MOVING!

bpmrx cues

Where to write cues on a Home Exercise Program Handout