spep · 2009-09-15 · play with kids engage children in fast chase games, ball games, or swimming...

Stroke Prevention exerciSe Program

SPEP

Please contact the project manager Brian D Juncker, PhD at 608.263.0432 or [email protected] with any questions.

This information is provided to help you engage in an exercise program. Do not exercise with SPEP until your doctor tells you it is safe to begin or resume a moderate effort exercise program. UW Health cannot be held responsible for and does not assume

any liability for injuries or illnesses that occur as a result of your participation in any exercise activity.

UW Health Rehabilitation ServicesUW Health Comprehensive Stroke Program

All SPEP materials and videos can be found at uwhealth.org/stroke.

Brian D Juncker, PhD (since 2004*) – Project ManagerDr. Juncker is a clinical psychologist who specializes in individual and group intervention, high-stakes assessment, program development, team leadership and consultation, and teaching/training.

Physical and Occupational Therapy TeamColin Grove, PT, MS, NCS (since 1994*)

Mr. Grove is APTA board certified in neurologic physical therapy and is a faculty member for the UWHC and Meriter Hospital Orthopedic Residency Program.

Cheryl Mortag Johnson, OTR (since 1981*)Ms. Johnson is an advanced clinician with a clinical specialty in neurology and neurosurgery. She has been very active in neuroscience service support groups.

Kristen Emily Kehl, BFA, OTSMs. Kehl is completing UW Madison’s occupational therapy Master’s program. She researches lifestyle redesign after neurologic injury and stroke.

Marcy Wright, DPT (since 2007*) – Team Leader Dr. Wright is a graduate of Washington University’s physical therapy doctoral program and specializes in neurology, neurosurgery, gynecology, and ENT.

Shannon Lauersdorf, MPT (since 2005*)Ms. Lauersdorf is a graduate of UW Madison’s physical therapy Master’s program and specializes in neurosurgery, trauma surgery and psychiatry.

Seth Newman, PT (since 2006*)Mr. Newman is a graduate of UW Madison’s physical therapy program and works with persons undergoing inpatient rehab. He enjoys yoga and brisk walks.

Karen Willems, OTR (since 1997*)Ms. Willems is a graduate of Western Michigan University’s occupational therapy program and specializes in neurology, neurosurgery, and burn.

* indicates the year joined UWHC

team memberS

NS-22113-09Please call a UW Physical or Occupational Therapist at 608.263.8060 with questions.

Review SPEP’s Signs of Exercising Too Hard and Exercise Safeguards before all workouts.

How should I get ready for my workout?

• Wear comfy shoes.

• Wear loose, comfy clothing.

• Drink plenty of water.

How often should I exercise?

• 3-7 days per week is advised.

• Begin with 3 days per week.

• Slowly progress to 5-7 days.

• Work up to 5-7 days by week 6.

How long should I exercise?

• 20-60 minutes of moderate effort exercise per workout is advised.

• Begin with at least 10 minutes per workout if you can.

• Slowly increase the time when that begins to feel easy.

• Try to increase your time by about 10% per week.

• Include extra time for warming up and cooling down.

How hard should I exercise?

• Use the Borg Scale to rate your level of effort.

• Exercise in your goal range of 13-14 (somewhat hard).

• Adjust your level of effort to stay in your goal range.

• Do not exercise at or above 15 (hard).

exerciSe guidelineS


the borg Scale of Perceived exertion

How you might describe your effort Rating of your effort Ideas to help you rate your effort

None 6 Reading a book or watching TV

Very, very light 7 to 8 Tying shoes

Very light 9 to 10 Household chores that seem to take little effort

Fairly light 11 to 12Activities that require some effort but not enough to speed up your breathing

Somewhat hard

***your goal range***13 to 14

Workouts that require moderate effort and speed your heart rate and breathing but do not make you out of breath

Hard 15 to 16Workouts that take a lot of effort and get the heart pounding and make breathing very fast

Very hard 17 to 18 The highest level of activity you can sustain

Very, very hard 19 to 20 A burst of effort that you can not maintain for long

Modified from: Borg G.A. (1982). Psychophysical bases of perceived exertion. Medicine and Science in Sports and Exercise, 14, 377-381.


Please call a UW Physical or Occupational Therapist at 608.263.8060 with questions.

How should I warm up?

• Again, use the Borg Scale to rate your level of effort.

• Start exercising below 11 (fairly light).

• Slowly increase your level of effort over 5 minutes.

• Increase your effort until you are in your goal range of 13-14 (somewhat hard).

How should I cool down?

• Slowly decrease your level of effort over 5 minutes.

• Finish your cool down below 11 (fairly light).

• Stop exercising and take 5-10 minutes to stretch your muscles.

• See the SPEP Pocket Cards for the best muscle stretches for you.

• Drink plenty of water.

Warm uP and cool doWn



What type of workout should I do?Find workouts that you like and have access to. The circled workouts below are advised by your Physical or Occupational Therapist:

Walk/Run

• Outside

• Inside

• Treadmill

• Stair-stepper

• Elliptical trainer

Bike

• Inside

• Outside–wear a helmet!

Pool

• Water Workout

• Lap swimming

• Aerobics class

Home

• Home Workout

• Exercise Videos

• Video games (Wii-Fit, etc.)

Other

• Exercise in Disguise

• Arm bike

• Rowing

• Aerobics class

Workout tyPeS

Review SPEP’s Your County Resources to see what resources may be near you. Review SPEP’s Signs of Exercising Too Hard and Exercise Safeguards before all workouts.


Home Workout Tips:

• Combine the walking, marching, and sitting exercises to create your own home workout.

• Play fast music you enjoy to make your workout more fun.

• Do your workout while watching a TV show you enjoy.

home Workout

Walking:

• Briskly walk around your home while:

• Picking your knees up high.

• Pumping your arms.

• To make walking harder:

• Hold soup cans.

• Hold small weights (use 1-2 pounds at most).

• Walk up and down stairs (use handrails).

Marching:

• March in place or around your home.

• Forward-and-backward

• Side-to-side.

• To make marching harder:

• Use a small step in your home.

• Use a 2-4” high platform (use a rubber mat underneath).

Sitting:

• Start by sitting in a chair.

• Stand up and sit down without using your hands.

• Repeat the motion for your desired length of time.

Your goal range of effort is 13-14 (somewhat hard) on the Borg Scale. Review SPEP’s Signs of Exercising Too Hard and Exercise Safeguards before all workouts.


• Treading water with arms and legs

• Treading water with arms only

• Water “running” while using an AquaJogger

• Kicking your legs while floating on a water noodle

• “Peddling” a bike while floating on a water noodle

Water Workout

Lap Swimming:• Make sure you are still able to do the strokes correctly.

• It can be helpful to take a class.

• Ask a lifeguard to watch you anytime you get tired.

Water Workout Tips:• Combine the shallow and deep water exercises to

create your own water workout.

• Use extra caution when exercising in a pool:

• Alert a lifeguard or partner when you are in the water.

• Keep close to the side or rail until you feel very confident.

• If breathing becomes too hard, move to shallow water.

Shallow Water (waist or chest deep): Deep Water (over your head):

• Brisk water walking

• Stair-stepping (hold onto the side or rail)

• Water marching

• Water running and skipping



All exercises can be done both forward-and-backward and side-to-side.

SOCIAL CHAngeS TO Try:Play with kids Engage children in fast chase games, ball games, or swimming pool games.

Play a position that involves a lot of movement.

Go to the museum or park Take fewer rests. Wear ankle weights.

Have a cookout Be the grill master or server. Place the grill or serving table away from where your guests are sitting so you walk more steps.

Sing in a choir Many choirs practice once a week for a few hours. This gives you a chance to stand for a longer length of time.

Go partner-dancing Stay on the dance floor as much as possible. Go with a partner.

HOBBIeS CHAngeS TO Try:Hike on a nature trail Use two walking sticks for balance and to get your arms moving.

Play golf For as long as you can, walk instead of using the golf cart. Start with 9 holes and build up to 18.

Row or paddle a boat Try to make the boat go faster than normal. If you are paddling a canoe, switch your paddle from one side to the other often.

Go to fitness classes Try walking, biking, or taking the bus instead of driving.

yArD & FArM WOrK CHAngeS TO Try:Haul mulch or potting soil Carry small amounts, and make many trips.

Mow the lawn Use a push-mower instead of a riding mower.

Till or turn earth With a broad stance, use a hand-tiller to work the soil briskly.

exerciSe in diSguiSe

exerciSe in diSguiSeCHOreS CHAngeS TO Try:Walk the dog Walk briskly enough to make your dog walk quickly or trot.

Wash dishes Wash some or all of your dishes by hand.

Fold laundry Place the basket of laundry on the floor. Bend and straighten your trunk to pick up each item.

Vacuum or mop With a broad stance, reach a bit further than you normally would to push and pull the vacuum cleaner or mop.

Rake leaves Rake at a faster pace than normal.

errAnDS CHAngeS TO Try:Run errands close to home Walk briskly instead of driving.

Quick trip to grocery store Ride your bike to the store and back. Carry items in a backpack.

Commute to work Ride your bike to work. Carry a change of clothes in a backpack.

When you have to run er-rands with your car…

Park in the back of the parking lot and walk. If you ride the bus, leave earlier and walk to a stop farther down the line. Get off the bus several stops before your destination and walk.



SignS of exerciSing too hard

Normal body changes people often notice when they exercise are:• Increased heart rate• Faster breathing• Able to talk in short sentences only• Sweating• Muscle fatigue

Common signs you should decrease your effort are:• Heart pounding• Being out of breath• Having a hard time saying more than a few words at

at time• Being unable to maintain your level of effort for the

whole workout

Stop exercising and call your doctor right away if you have any of these signs: • Severe heart pain • Burning, tightness, pressure, or heaviness in your chest, neck, shoulders, back, or arms • Extreme shortness of breath or being unable to talk • Blurred vision • Frequent, skipped heart beats • Dizziness, light-headedness • Nausea • Cramping in your arms and legs


Balance and Coordination ProblemsIf you have problems with your balance or coordination, take these safeguards to

prevent injuries and falls:

• Exercise with a partner.• Exercise on level, even surfaces.• Hold onto the treadmill.• Ride a stationary bike (instead of a bike outside.)• Alert a lifeguard when in the water.• Use a cane or walker (if advised by your therapist.)• Do not use a elliptical machine.

Strength ProblemsIf you have decreased strength, take these safeguards to decrease your chances of

moving in a way that could cause pain or injury:

• Try shorter, more frequent workouts. Instead of a 30-minute brisk walk:

• Take two, 15-minute brisk walks.

• Take three, 10-minute brisk walks.

• Switch workouts to use other muscle groups.

• Start with walking 10 minutes.

• Switch to biking for 10 minutes.

• Switch to swimming for 10 minutes, etc.

SafeguardS – balance, coordination and Strength


Vision and Perception ProblemsIf you have problems with vision or

perception, including neglect (being less aware of one side of your body or objects around you) take these safeguards to prevent injuries and falls:

• Exercise with a partner.• Exercise on level, even surfaces.• Exercise in a space that is well lit.• Make sure you have enough space around you.• Avoid crowded areas.• Limit distractions during exercise (TV, etc.)• Stay in the center and hold onto the treadmill or

stair-stepper.• Ride a stationary bike (instead of a bike outside).• Alert a lifeguard when in the water.• Wear glasses or eye patch as needed.

Sensation and Body Awareness ProblemsIf you have problems with sensation or body awareness (knowing where your body and

limbs are) take these safeguards to prevent injuries and falls:

• Exercise with a partner.• Exercise on level, even surfaces.• Exercise in a space that is well lit.• Make sure you have enough space around you.• Use a treadmill in front of a mirror to watch yourself

exercise.

SafeguardS – viSion, PercePtion, SenSation and body aWareneSS ProblemS


SafeguardS – thinking and SPeech ProblemS

Thinking and Speech ProblemsIf you have problems with thinking or speech, it may be hard for you to plan, recall parts of your workout, or let others know how you are doing. Take these safeguards while exercising:

• Exercise with a partner.• Limit distractions during exercise (TV, etc.)• Have a partner help you plan your workout.• Use cue cards to remind you about the steps of your workout.• Have a partner help you with your Weekly Workout Log in your stroke binder.• Find other ways to let people know your level of effort and how you are doing if you are not

able to say what you mean.• Point to your effort rating on the Borg Scale.• Write down your effort rating and anything your partner should know.


calf Stretch

Hold 30-60 seconds. Repeat with the other leg. Look at the other side

of this card for full instructions.


calf Stretch




calf Stretch

• Sit with your leg on the couch or a stool.

• Roll up a towel and put it around the ball of your foot.

• Keeping your knee and back straight, pull your toes toward you with both hands until you feel a moderate stretch in your calf.

• Hold 30-60 seconds.

• Back off the stretch if you feel pain.

• Repeat with the other leg.

calf Stretch

• Stand facing a wall or sturdy object with one foot forward and one foot behind.

• Point both feet toward the wall.

• Lean forward with your hands on the wall until you feel a moderate stretch in the calf on the back leg.


• Back off of the stretch if you feel pain.




Quad Stretch




Quad Stretch




Quad Stretch

• Lie on your side and bend the knee of your top leg.

• Grab your foot with your top hand and pull your foot toward your buttocks.

• Keeping your back straight and your thighs even with each other, pull until you feel a moderate stretch on the front of your thigh.



• Roll to your other side and repeat with the other leg.

Quad Stretch

• Stand and hold onto a sturdy object for balance.

• Bend the knee that is away from the wall, grab your foot with your free hand and pull your foot towards your buttocks.

• Keeping your back straight, your thighs even with each other and your knee pointed down, pull until you feel a moderate stretch on the front of your thigh.






hamString Stretch




hamString Stretch




hamString Stretch

• Sit on a chair and place one foot on a chair or stool.

• Keeping both your knee and back straight, slowly bend forward at the hips until you feel a moderate stretch in the back of your thigh.




hamString Stretch

• Stand and place one foot on a chair.

• Keeping both your knee and back straight, slowly bend forward at the hips until you feel a moderate stretch in the back of your thigh.






buttockS Stretch

Hold 30-60 seconds. Repeat with the other leg. Look at the other side of this card for full instructions.


buttockS Stretch

Hold 30-60 seconds. Repeat with the other leg. Look at the other side of this card for full instructions.


buttockS Stretch

• Lie on your back.

• Lift your knee toward your chest and rest your ankle on the outside of your other thigh.

• Use your hands to pull your knee toward the opposite shoulder until you feel a moderate stretch in your buttocks.




buttockS Stretch

• Sit in a chair.

• Lift your knee toward your chest and rest your ankle on the outside of your other thigh.

• Use your hands to pull your knee toward the opposite shoulder until you feel a moderate stretch in your buttocks.






neck Side-bend Stretch

Hold 30-60 seconds. Repeat with the other side. Look at the other side



neck forWard-bend Stretch


Hold 30-60 seconds. Look at the other side of this card for full instructions.

neck forWard-bend Stretch

• Sit with your back straight.

• Tilt your head toward your chest until you feel a moderate stretch in the back of your neck.



neck Side-bend Stretch

• Sit upright.

• Tilt your head to the side, moving your ear toward your shoulder.

• Tilt your head until you feel a moderate stretch on the other side of your neck.



• Repeat on the other side.



Shoulder Stretch

Hold 30-60 seconds. Repeat with the other arm. Look at the other side



tricePS Stretch


Hold 30-60 seconds. Repeat with the other arm. Look at the other side


tricePS Stretch

• Raise one arm over your head and bend your elbow.

• With your other hand grab your elbow and pull back on it until you feel a moderate stretch in the back of your upper arm.



• Repeat with the other arm.

Shoulder Stretch

• Cross one arm across your chest and press it toward your chest with your other hand.

• Press until you feel a moderate stretch on the back/side of your shoulder.



• Repeat with the other arm/shoulder.



cheSt Stretch

Hold 30-60 seconds. Repeat with the other arm. Look at the other side of this card for full instructions.


cheSt Stretch


Hold 30-60 seconds. Repeat with the other arm. Look at the other side of this card for full instructions.

cheSt Stretch

• Sit in a chair in a doorway.

• Keeping your elbow straight, raise your arm 90 degrees and place your hand on the back of the doorframe.

• Turn your body away from that arm until you feel a moderate stretch in your chest muscle.




cheSt Stretch

• Stand in a doorway.

• Keeping your elbow straight, raise your arm 90 degrees and place your hand on the back of the doorframe.

• Turn your body away from that arm until you feel a moderate stretch in your chest muscle.







trunk Stretch



trunk Stretch


trunk Stretch

• Sit in a chair.

• Reach your arms over your head as high as you can.

• Try to lengthen your trunk.



trunk Stretch

• Sit in a chair.

• Bend forward and reach toward your knees and toes with your hands until you feel a moderate stretch in your back.





spep · 2009-09-15 · play with kids engage children in fast chase games, ball games, or swimming...

Documents