EXERCISES FOR OSTEOPOROSIS

We all need exercise to help our bone health. Exercises for good bone health aim to
(a) strengthen bones, (b) strengthen muscles and (c) maintain good balance and
posture.

Exercises that are good for bones and muscles are those activities that are weight
bearing. This is because these activities stress the bone and promote them to react
by getting stronger. These weight bearing exercises can be graded into low,
moderate and high impact.

You should aim to do a minimum of 30 minutes daily of low or moderate impact

activity. You can split the time up into 10 minute portions if it helps.

Low Impact: Examples are brisk walking, low impact aerobics, stair climbing.

Moderate impact: power walking (brisk walking with vigorous arm movements
and/or use of hand weights.

If you do NOT have osteoporosis you should do some high impact exercise: High
impact aerobics, skipping, jumping exercises, jogging, running. For example hopping
up and down, about five inches off the floor, and landing flat footed, at least 15 times,
daily.

If you have osteoporosis or have fractured a bone in the past, consult a doctor
before embarking on these.

Other forms of exercise that are not weight bearing, such as cycling and swimming,
do not directly strengthen bones, but can be useful in strengthening the muscles and
helping with flexibility.

Weight training exercises, involving lifting light free weights help to strengthen bones
and muscles and should be performed at least three times per week. You should get
some instruction from a physiotherapist or personal trainer before embarking on
these.

Some basic postural and stretching exercises are given below.

1
 EXERCISE PROGRAMME FOR PEOPLE WITH OSTEOPOROSIS

Aerobic activity

DAILY: Walking briskly 30-60 minutes. You may need to build up to this, starting with
just 10 minutes per day.

If necessary you can split this into portions, providing they add up to 30+ minutes
over the course of each day.

OPTIONAL ACTIVITIES built into your week:

Cycling,
Cross trainer machine,
Rowing machine,
Stepping machine
Swimming
Other recreational activities, such as tennis, badminton, golf.

Strengthening:

1. Daily: Balance & coordination exercises

2. Upper and lower limb light weight lifting, 3 times per week, performed oin non
consecutive days.

Additional tools

There are potential tools available now that may help in building bone. One such tool
is Whole Body Vibration (WBV), such as Power Plate. Whole body vibration (WBV)
refers to a machine with a flat plate on which a person stands, that stimulates the
whole body by tilting slightly around an axle. The person who stands on the machine
tries to keep the head and body steady and upright. All the muscles that keep the
body in this position are forced to react to the oscillatory movements provided by the
machine, thus exercising them. Training sessions of only 2-3 minutes twice a week
are claimed to produce measurable effects. More research needs to be performed to
establish whether there are significant benefits from WBV, but some small studies
have shown improved balance, strength, function and bone density in
postmenopausal women.

Some warnings:

If you have Osteoporosis do NOT do exercises which require you to bend forward at
the waist. Spontaneous crush fractures of the spine can occur when coming back up
from this position.

Examples of exercises to avoid: Toe touching, bent over row when weightlifting.

Yoga is often helpful since it lengthens and strengthens muscles, but many poses in
yoga require these forward or bent postions. Avoid them unless you have expert
guidance from someone who understands the risks of spontaneous crush fractures in
persons with Osteoporosis of the spine.

2
Pilates is also wonderfully helpful in developing strength and control of your body, but
you should be careful in performing some exercises as they may ompose load on
areas of your body that are fragile. Ensure you have a well informed Pilates instructor
before you embark on a programme.

Equipment: ensure you wear well cushioned shoes, and you may wish to put some
shock absorbing insoles into them. Examples include sorbothane insoles. You can
get these form a chemist or some sport shops. Make sure you bring your shoes
along and consider that, because they take up space in your shoes, you may have to
buy a slightly bigger size.

When you are performing impact activity some surfaces are more forgiving on the
body than others. The best tennis court surfaces are those that are grass or sand
based artificial surfaces, for badminton sprung floors are best.

3
1. Postural exercises: Perform Daily

Standing posture

Stand with your head, shoulders and

buttocks against a wall, with your heels 2
to 3 inches from the wall.

Relax your shoulders and pull in your chin.

Tighten your abdomen and buttocks.

Press your back against the wall, leaving

room for your hand to fit flat behind the
curve of your lower back.

Hold 30 seconds.

Walking posture

Hold your head high. Keep your back and

neck as straight as possible.

Keep your chin parallel to the ground.

Gently tighten your abdominal muscles.

Let your shoulders move freely and

naturally.

Wall arch
Stand facing the wall, arms at your sides, feet
6 inches apart and 6 inches from the wall.

While inhaling, flatten your stomach and

stretch both arms up to touch the wall (1).

Exhale and lower both of your arms to the

starting position.

While inhaling, reach up with your right

arm and stretch down with your left arm
(2).

Exhale and lower your right arm to the

starting position.

Switch arms and repeat. 5 times each arm.

Source: Sinaki M. Postmenopausal spinal

osteoporosis: Physical therapy and
rehabilitation principles. Mayo Clinic Proc. 1982;
57:699-703.

By Mayo Clinic Staff

Sep 22, 2006
© 1998-2006 Mayo Foundation for Medical Education 4
and Research (MFMER). All rights reserved. A single
copy of these materials may be reprinted for
noncommercial personal use only. "Mayo," "Mayo
Clinic," "MayoClinic.com," "Mayo Clinic Health
Information," "Reliable information for a healthier life"
 Chest stretch

Sit with your feet flat on the floor.

Keep your back erect and look
straight ahead.

Stretch your arms out to the side,

keeping them level with your
shoulders (1).

Bend your arms at the elbows and

bring your hands toward your chest
(2).

Repeat five to 10 times.

Chin tuck
To straighten your head and shoulders:

While seated, look straight ahead.

Pull your chin in toward your neck, but

keep looking straight ahead; don't let your
head bend forward. Push your hands down
on your thighs to help straighten your back.

Hold for a few seconds. Repeat five times.

Back posture exercise

Sit in a chair as shown, with your hand

behind your neck (1).

Inhale while gently moving your elbows

backward (2).

Hold the position for a few seconds, breathing

normally, before returning to your starting
position. Repeat five to 10 times..

5
 Shoulder blade squeeze

With your feet flat on the floor, sit slightly

forward in a sturdy chair, keeping your back
and neck straight.

Look straight ahead, bending your arms at

the elbows (1).

Gently move your elbows and shoulder

blades back as far as you can and still be
comfortable (2).

Hold for five seconds while breathing normally.

Return your arms to the starting position.
Repeat five to 10 times.

Upper back lift

Lie facedown on the floor with a pillow under your
abdomen and hips (1). Use a rolled towel to cushion
your forehead, if you wish.

Keep your arms at your sides as you tighten your

abdominal muscles. Keep your head in line with
your neck and torso. Focus on keeping your
shoulders down — don't let them shrug up toward
your ears.

Inhale and raise your head and chest a few

inches from the floor (2).

Hold for five seconds, breathing normally, before

returning to your starting position. Rest for a few
seconds. Repeat five to 10 times.

Back and shoulder stretch

Lie on the floor. Bend your knees,

tighten your abdominal muscles and
stretch your arms above your head
(1).

Keeping your arms straight, spread

them out and lower them until they're
level with your shoulders (2 and 3).

Hold the position for a few seconds while

breathing normally. Then return your
arms to the starting position. Repeat this
exercise five to 10 times.

6
Pelvic tilt

Lie on your back with your knees bent and

your feet flat on the floor (1). Maintain a
normal curve in your back; don't arch your
back. Tighten your abdominal muscles.

Roll your pelvis down to flatten your back

against the floor (2). Avoid using your leg and
buttock muscles.

Hold the position for five seconds while

breathing normally, and then relax. Repeat this
exercise 10 times

Sitting knee extension

Sit with your back straight and your

hands on your thighs. Tighten your
abdominal muscles and look straight
ahead.

Slowly straighten one knee while lifting

your heel a few inches from the floor.
Don't slouch or round your back.

Hold this position for a few seconds while

breathing normally. Relax and return to the
starting position. Repeat five to 10 times
with each leg.

7
2. Strength Exercises
About Strength Exercises

Even very small changes in muscle size can make a big difference in strength,
especially in people who already have lost a lot of muscle. An increase in muscle
that's not even visible to the eye can be all it takes to improve your ability to do
things like get up from a chair or climb stairs.

Your muscles are active even when you are sleeping. Their cells are still doing the
routine activities they need to do to stay alive. This work is called metabolism, and it
uses up calories. That can help keep your weight in check, even when you are
asleep!

To do most of the following strength exercises, you need to lift or push weights, and
you need to keep gradually increasing the amount of weight you use. You can use
the hand and ankle weights sold in sporting-goods stores, or you can use things like
emptied milk jugs filled with sand or water, or socks filled with beans and tied shut at
the ends.

There are many alternatives to the exercises shown here. For example, you can buy
a resistance band (it looks like a giant rubber band, and stretching it helps build
muscle) at a sporting-goods store for under $10 to do other types of strength
exercises. Or you can use the special strength-training equipment at a fitness center.

How Much, How Often

Do strength exercises for all of your major muscle groups at least twice, preferably
three times, per week. Don't do strength exercises of the same muscle group on any
2 days in a row.

Depending on your condition, you might need to start out using as little as 1 or 2
pounds of weight, or no weight at all. The tissues that bind the structures of your
body together need to adapt to strength exercises.

Use a minimum of weight the first week, then gradually build up the weight. Starting
out with weights that are too heavy can cause injuries.

At the same time, remember that you have to gradually add a challenging amount of
weight in order to benefit from strength exercises. If you don't challenge your
muscles, you won't benefit from strength exercises. (The "Progressing" section below
will tell you how.)

When doing a strength exercise, do 8 to 15 repetitions in a row. Wait a minute, then

do another set of 8 to 15 repetitions in a row of the same exercise. (Tip: While you
are waiting, you might want to stretch the muscle you just worked or do a different
strength exercise that uses a different set of muscles).

Take 3 seconds to lift or push a weight into place; hold the position for 1 second, and
take another 3 seconds to lower the weight. Don't let the weight drop; lowering it
slowly is very important.

8
It should feel somewhere between hard and very hard for you to lift or push the
weight. It should not feel very, very hard. If you can't lift or push a weight 8 times in a
row, it's too heavy for you. Reduce the amount of weight. If you can lift a weight more
than 15 times in a row, it's too light for you. Increase the amount of weight.

Stretch after strength exercises, when your muscles are warmed up. If you stretch
before strength exercises, be sure to warm up your muscles first (through light
walking and arm pumping, for example).

Safety

Don't hold your breath during strength exercises. Breathe normally. Holding your
breath while straining can cause changes in blood pressure. This is especially true
for people with cardiovascular disease.

If you have had a hip repair or replacement, check with the doctor who did your
surgery before doing lower-body exercises.

If you have had a hip replacement, don't cross your legs, and don't bend your hips
farther than a 90-degree angle.

Avoid jerking or thrusting weights into position. That can cause injuries. Use smooth,
steady movements.

Avoid "locking" the joints in your arms and legs in a tightly straightened position. (A
tip on how to straighten your knees: Tighten your thigh muscles. This will lift your
kneecaps and protect them.)

Breathe out as you lift or push, and breathe in as you relax. For example, if you are
doing leg lifts, breathe out as you lift your leg, and breathe in as you lower it. This
may not feel natural at first, and you probably will have to think about it as you are
doing it for awhile.

Muscle soreness lasting up to a few days and slight fatigue are normal after muscle-
building exercises, but exhaustion, sore joints, and unpleasant muscle pulling aren't.
The latter symptoms mean you are overdoing it.

None of the exercises you do should cause pain. The range within which you move
your arms and legs should never hurt.

Progressing

Gradually increasing the amount of weight you use is crucial for building strength.

When you are able to lift a weight between 8 to 15 times, you can increase the
amount of weight you use at your next session.

Here is an example of how to progress gradually: Start out with a weight that you can
lift only 8 times. Keep using that weight until you become strong enough to lift it 12 to
15 times. Add more weight so that, again, you can lift it only 8 times. Use this weight
until you can lift it 12 to 15 times, then add more weight.

9
Arm Raise
Strengthens shoulder muscles. Sit in a
chair, with your back straight. Your feet
should be flat on the floor, spaced
apart so that they are even with your
shoulders. Hold hand weights straight
down at your sides, with your palms
facing inward. Take 3 seconds to lift
your arms straight out, sideways, until
they are parallel to the ground. Hold
the position for 1 second. Take 3
seconds to lower your arms so that
they are straight down by your sides
again. Pause. Repeat 8 to 15 times.
Rest; do another set of 8 to 15
repetitions.

Summary:

1. Sit in chair.
2. Feet flat on floor; keep feet even with shoulders.
3. Arms straight down at sides, palms inward.
4. Raise both arms to side, shoulder height.
5. Hold position.
6. Slowly lower arms to sides.

10
Chair Stand
Strengthens muscles in abdomen and
thighs. Sit toward the middle or front of
a chair and lean back so that you are
in a half-reclining position, with back
and shoulders straight, knees bent,
and feet flat on the floor. Be sure to
place pillows against the lower back of
the chair first, to support your back and
keep it straight. Using your hands as
little as possible (or not at all, if you
can), bring your back forward so that
you are sitting upright. Your back
should no longer be leaning against
the pillows. Keep your back straight as
you come up, so that you feel your
abdominal muscles do the work; don't
lean forward with your shoulders as
you rise. Next, with feet flat on the
floor, take at least 3 seconds to stand
up, using your hands as little as
possible. As you bend slightly forward
to stand up, keep your back and
shoulders straight. Take at least 3 seconds to sit back down. Your goal is to do this
exercise without using your hands as you become stronger. Repeat 8 to 15 times.
Rest; then repeat 8 to 15 times more.

Summary:

1. Place pillows against back of chair.

2. Sit in middle or toward front of chair, knees bent, feet flat on floor.
3. Lean back on pillows, in half-reclining position, back and shoulders straight.
4. Raise upper body forward until sitting upright, using hands as little as
possible.
5. Slowly stand up, using hands as little as possible.
6. Slowly sit back down.
7. Keep back and shoulders straight throughout exercise.

Biceps Curl

Strengthens upper-arm muscles. Sit in an

armless chair, with your back supported by
the back of the chair. Your feet should be
flat on the floor, spaced apart so that they
are even with your shoulders. Hold hand
weights, with your arms straight down at
your side, palms facing in toward your body.
Take 3 seconds to lift your left hand weight
toward your chest by bending your elbow.
As you lift, turn your left hand so that your
palm is facing your shoulder. Hold the
position for 1 second. Take 3 seconds to

11
lower your hand to the starting position. Pause, then repeat with right arm. Alternate
until you have repeated the exercise 8 to 15 times on each side. Rest, then do
another set of 8 to 15 alternating repetitions.

Summary:

1. Sit in armless chair, with your back supported by back of chair.

2. Feet flat on floor; keep feet even with shoulders.
3. Hold hand weights at sides, arms straight, palms in.
4. Slowly bend one elbow, lifting weight toward chest. (Rotate palm to face
shoulder while lifting weight.)
5. Hold position.
6. Slowly lower arm to starting position.
7. Repeat with other arm.

Plantar Flexion
Strengthens ankle and calf muscles (also described in
balance section). Use ankle weights, if you are ready to.
Stand straight, feet flat on the floor, holding onto the
edge of a table or chair for balance. Take 3 seconds to
stand as high up on tiptoe as you can; hold for 1 second,
then take 3 seconds to slowly lower yourself back down.
Do this exercise 8 to 15 times; rest a minute, then do
another set of 8 to 15 repetitions. As you become
stronger, do this exercise first on your right leg only, then
on your left leg only, for a total of 8 to 15 times on each
leg. Rest a minute, then do another set of 8 to 15
alternating repetitions.

Summary:

1. Stand straight, holding table or chair for balance.

2. Slowly stand on tiptoe, as high as possible.
3. Hold position.
4. Slowly lower heels all the way back down.

Variation, as strength increases:

Do the exercise standing on one leg only, alternating legs.

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Triceps Extension

(If your shoulders aren't flexible

enough to do this exercise, see
alternative "Dip" exercise, below.)

Strengthens muscles in back of upper

arm. Sit in a chair, toward the front.
Your feet should be flat on the floor,
spaced apart so that they are even
with your shoulders. Hold a weight in
your left hand, and raise your left arm
all the way up, so that it's pointing
toward the ceiling, palm facing in.
Support your left arm by holding it just
below the elbow with your right hand.
Slowly bend your left arm so that the
weight in your left hand now rests
behind your left shoulder. Take 3
seconds to straighten your left arm so
that it's pointing toward the ceiling
again. Hold the position for 1 second.
Take 3 seconds to lower the weight
back to your shoulder by bending your
elbow. Keep supporting your left arm with your right hand throughout the exercise.
Pause, then repeat the bending and straightening until you have done the exercise 8
to 15 times with your left arm. Reverse positions and repeat 8 to 15 times with your
right arm. Rest; then repeat another set of 8 to 15 repetitions on each side.

Summary:

1. Sit in chair, near front edge.

2. Feet flat on floor; keep feet even with shoulders.
3. Raise one arm straight toward ceiling.
4. Support this arm, below elbow, with other hand.
5. Bend raised arm at elbow, bringing hand weight toward same shoulder.
6. Slowly re-straighten arm toward ceiling.
7. Hold position.
8. Slowly bend arm toward shoulder again.

Alternative "Dip" Sit in a chair with armrests. Lean slightly forward, keeping your
Exercise For back and shoulders straight. Hold onto the arms of the chair.
Back of Upper Your hands should be level with the trunk of your body, or
Arm: slightly farther forward. Place your feet slightly under the chair,
with your heels off the ground and the weight of your feet and
legs resting on your toes and the balls of your feet. Slowly lift
yourself up, using your arms, as high as you can. This pushing
motion will strengthen your arm muscles even if you aren't yet
able to lift yourself up off of the chair. Don't use your legs or
feet for assistance, or use them as little as possible. Slowly
lower yourself back down. Repeat 8 to 15 times. Rest; repeat
another 8 to 15 times.

13
Summary:

1. Sit in chair with armrests.

2. Lean slightly forward, back and shoulders straight.
3. Grasp arms of chair.
4. Tuck feet slightly under chair, weight on toes.
5. Slowly push body off of chair using arms, not legs.
6. Slowly lower down to starting position.

14
Knee Flexion

Strengthens muscles in back of thigh.

Use ankle weights, if you are ready to.
Stand straight, very close to a table or
chair, holding it for balance. Take 3
seconds to bend your left knee so that
your calf comes as far up toward the
back of your thigh as possible. Don't
move your upper leg at all; bend your
knee only. Take 3 seconds to lower
your left leg all the way back down.
Repeat with right leg. Alternate legs
until you have done 8 to 15 repetitions
with each leg. Rest; then do another
set of 8 to 15 alternating repetitions.

Summary:

1. Stand straight; hold onto table

for balance.
2. Slowly bend knee as far as
possible.
3. Hold position.
4. Slowly lower foot all the way back down.
5. Repeat with other leg.

15
 Hip Flexion

Strengthens thigh and hip muscles. Use

ankle weights, if you are ready to. Stand to
the side or behind a chair or table, holding it
with one hand for balance. Take 3 seconds to
bend your left knee and bring it as far toward
your chest as possible. Stand straight
throughout, without bending at the waist or
hips. Hold position for 1 second, then take 3
seconds to lower your left leg all the way
down. Repeat with right leg; alternate legs
until you have done 8 to 15 repetitions on
each side. Rest; then do another set of 8 to
15 alternating repetitions.

Summary:

1. Stand straight, holding tall, stable object for balance.

2. Slowly bend one knee toward chest, without bending waist or hips.
3. Hold position.
4. Slowly lower leg all the way down.
5. Repeat with other leg.

Shoulder Flexion

Strengthens shoulder muscles. Sit in a chair, with

your back straight. Your feet should be flat on the
floor, spaced apart so that they are even with your
shoulders. Hold hand weights straight down at
your sides, with your palms facing inward. Take 3
seconds to lift your arms in front of you, keeping
them straight and rotating them so that your palms
are facing upward, until your arms are parallel to
the ground. Hold the position for 1 second. Take 3
seconds to lower your arms so that they are
straight down by your sides again. Pause. Repeat
8 to 15 times. Rest; do another set of 8 to 15
repetitions.

Summary:

1. Sit in chair.
2. Feet flat on floor; keep feet even with shoulders.
3. Arms straight down at sides, palms inward.
4. Raise both arms in front of you (keep them straight and rotate so palms face
upward) to shoulder height.
5. Hold position.
6. Slowly lower arms to sides.

Knee Extension

16
 Strengthens muscles in front of thigh and
shin. Use ankle weights, if you are ready to.
Sit in a chair, with your back resting against
the back of the chair. If your feet are flat on
the floor in this position, you should place a
rolled-up towel under your knees to lift them
up. Only the balls of your feet and your toes
should be resting on the floor. Rest your
hands on your thighs or on the sides of the
chair. Take 3 seconds to extend your right leg
in front of you, parallel to the floor, until your
knee is straight. With your right leg in this
position, flex your foot so that your toes are
pointing toward your head; hold your foot in
this position for 1 to 2 seconds. Take 3
seconds to lower your right leg back to the starting position, so that the ball of your
foot rests on the floor again. Repeat with left leg. Alternate legs, until you have done
the exercise 8 to 15 times with each leg. Rest; then do another set of 8 to 15
alternating repetitions.

Summary:

1. Sit in chair. Put rolled towel under knees, if needed.

2. Slowly extend one leg as straight as possible.
3. Hold position and flex foot to point toes toward head.
4. Slowly lower leg back down.
5. Repeat with other leg.

Hip Extension

Strengthens buttock and lower-back muscles.

Use ankle weights, if you are ready to. Stand 12
to 18 inches away from a table or chair, feet
slightly apart. Bend forward from the hips, at
about a 45-degree angle, holding onto the table
or chair for balance. In this position, take 3
seconds to lift your left leg straight behind you
without bending your knee, pointing your toes,
or bending your upper body any farther forward.
Hold the position for 1 second. Take 3 seconds
to lower your left leg back to the starting
position. Repeat with right leg. Alternate legs,
until you have repeated the exercise 8 to 15
times with each leg. Rest; then do another set of
8 to 15 alternating repetitions with each leg.

Summary:

1. Stand 12 to 18 inches from table.

2. Bend at hips; hold onto a table.

17
 3. Slowly lift one leg straight backwards.
4. Hold position.
5. Slowly lower leg.
6. Repeat with other leg.

Side Leg Raise

Strengthens muscles at sides of hips and thighs.

Use ankle weights, if you are ready to. Stand up
straight, directly behind a table or chair, feet slightly
apart. Hold onto the table to help keep your balance.
Take 3 seconds to lift your right leg 6 to 12 inches
out to the side. Keep your back and both legs
straight. Don't point your toes outward; keep them
facing forward. Hold the position for 1 second. Take
3 seconds to lower your leg back to the starting
position. Repeat with left leg. Alternate legs, until
you have repeated the exercise 8 to 15 times with
each leg. Rest; do another set of 8 to 15 alternating
repetitions.

Summary:

1. Stand straight, directly behind table, feet slightly apart.

2. Hold table for balance.
3. Slowly lift one leg to side, 6-12 inches.
4. Hold position.
5. Slowly lower leg.
6. Repeat with other leg.
7. Back and both knees are straight throughout exercise.

18
BALANCE & COORDINATION EXERCISES

There is a lot of overlap between strength and balance exercises; very often, one
exercise serves both purposes.

Any of the lower-body exercises for strength shown in the strength section also are
balance exercises. They include plantar flexion, hip flexion, hip extension, knee
flexion, and side leg raise. Just do your regularly scheduled strength exercises, and
they will improve your balance at the same time. They can improve your balance
even more if you add the following modifications: Note that these exercises instruct
you to hold onto a table or chair for balance. Hold onto the table with only one hand.
As you progress, try holding on with only one fingertip. Next, try these exercises
without holding on at all. If you are very steady on your feet, move on to doing the
exercises using no hands, with your eyes closed. Have someone stand close by if
you are unsteady.

Don't do more than your regularly scheduled strength-exercise sessions to

incorporate these balance modifications; remember that doing strength exercises too
often can do more harm than good. Simply do your strength exercises, and
incorporate these balance techniques as you progress.

Also do the knee-extension exercise shown in the strength section. It helps you keep
your balance by increasing muscle strength in your upper thighs.

19
Plantar Flexion

Plantar flexion is already included in your

strength exercises (described in previous
section). When you do your strength
exercises, add these modifications to plantar
flexion as you progress: Hold table with one
hand, then one fingertip, then no hands; then
do exercise with eyes closed, if steady.

Summary:

1. Stand straight, holding onto a table or

chair for balance.
2. Slowly stand on tip toe, as high as
possible.
3. Hold position.
4. Slowly lower heels all the way back
down.
5. Repeat 8 to 15 times.
6. Rest a minute, then do another 8 to 15
repetitions.
7. Add modifications as you progress.

Knee Flexion

Do knee flexion as part of your

regularly scheduled strength
exercises, and add these modifications
as you progress: Hold table with one
hand, then one fingertip, then no
hands; then do exercise with eyes
closed, if steady.

Summary:

1. Stand straight; hold onto table

or chair for balance.
2. Slowly bend knee as far as
possible, so foot lifts up behind
you.
3. Hold position.
4. Slowly lower foot all the way
back down.
5. Repeat with other leg.
6. Add modifications as you progress.

Hip Flexion

20
 Do hip flexion as part of your regularly
scheduled strength exercises, and add
these modifications as you progress:
Hold table with one hand, then one
fingertip, then no hands; then do
exercise with eyes closed, if steady.

Summary:

1. Stand straight; holding onto a

table or chair for balance.
2. Slowly bend one knee toward
chest, without bending waist or
hips.
3. Hold position.
4. Slowly lower leg all the way down.
5. Repeat with other leg.
6. Add modifications as you progress.

Hip Extension

Do hip extension as part of your

regularly scheduled strength exercises,
and add these modifications as you
progress: Hold table with one hand,
then one fingertip, then no hands; then
do exercise with eyes closed, if steady.

Summary:

1. Stand 12 to 18 inches from

table.
2. Bend at hips; hold onto table.
3. Slowly lift one leg straight
backwards.
4. Hold position.
5. Slowly lower leg.
6. Repeat with other leg.
7. Add modifications as you progress.

21
Side Leg Raise

Do leg raise as part of your regularly

scheduled strength exercises, and add
these modifications as you progress: Hold
table with one hand, then one fingertip,
then no hands; then do exercise with eyes
closed, if steady.

Summary:

1. Stand straight, directly behind table

or chair, feet slightly apart.
2. Hold table for balance.
3. Slowly lift one leg to side, 6-12
inches.
4. Hold position.
5. Slowly lower leg.
6. Repeat with other leg.
7. Your back and knees are straight
throughout exercise.
8. Add modifications as you progress.

Anytime/Anywhere

These types of exercises also improve your balance. You can do them almost
anytime, anywhere, and as often as you like, as long as you have something sturdy
nearby to hold onto if you become unsteady.

Examples:

• Walk heel-to-toe. Position your heel just in front of the toes of the opposite
foot each time you take a step. Your heel and toes should touch or almost
touch. (See Illustration.)
• Stand on one foot (while waiting in line at the grocery store or at the bus stop,
for example). Alternate feet.
• Stand up and sit down without using your hands.

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