Home Exercise Programs That Patients Actually Do

You are in the home an hour a week. The other 167 hours are the home exercise programme. If it is not being done, the episode is not working, however good your visits are.

Most HEPs fail for reasons that have nothing to do with motivation.

Why they do not get done

Too many exercises. Eight is a wish; three is a programme.
The handout is generic — a stick figure on a mat, in a position the patient cannot get into.
No cue to start. Nothing in the day triggers it.
It hurts, and nobody explained which discomfort is expected and which is not.
They cannot remember whether they did it, or how many.
They do not see the point — no link to anything they want.
They are afraid of falling or of damaging the surgery.
No equipment, or it is in a cupboard.

Every one of those is fixable, and fixing it is skilled work.

Writing one that gets done

Start with three

Three exercises, done daily, beats eight done occasionally. Add only when the three are established.

Tie it to something they want

The goal is not "increase quadriceps strength". The goal is getting out of the armchair without help, or back to the mailbox. Say the link out loud each visit — see Writing Measurable Goals.

Anchor it to an existing habit

"After breakfast, before you leave the table" works. "Twice a day" does not. Use something already fixed in their day — the morning coffee, the evening news.

Use their own furniture

Prescribe the exercise in the chair they actually sit in, at the counter they actually hold. An exercise that requires getting down to the floor will not be done by someone who cannot get up from it.

Write it in their language

Large print. One exercise per section. A photograph of them doing it, in their own room, is worth more than any diagram — and their phone can take it.

Include sets, reps, how often, and a line on what discomfort is normal.

Leave a tick sheet

A simple log by the chair. It tells them they did it, it tells you whether it happened, and it makes your review at the next visit concrete rather than a yes-or-no question they will answer politely.

Teach the caregiver too

Where there is one, they are the difference between a programme done three times and one done daily.

Every visit

Watch them perform it — do not ask whether they are doing it
Check the technique has not drifted
Review the log
Ask what is getting in the way, specifically
Progress or change it, and say why
Update the written copy so it matches what they are now doing

Asking "are you doing your exercises?" gets a polite yes. Asking them to show you gets the truth, and the truth is usually interesting — a compensation that has crept in, a rep count that has halved, a movement they have quietly dropped because it hurt.

The HEP as evidence of skilled care

This is where therapists lose coverage unnecessarily. A programme handed over and repeated unchanged looks unskilled, because it is.

What makes it skilled is the modification:

Reviewed HEP. Patient completing sit-to-stands but initiating with hands on both armrests and trunk momentum rather than the prescribed anterior weight shift. Retrained the movement pattern with tactile cueing at the tibia; patient achieved 4 of 6 repetitions hands-free. Reduced chair height with cushion removed to increase demand. Log shows 5 of 7 days completed — missed days are Saturdays when daughter is not present, so added a reminder note by the kettle and taught daughter the cueing.

That entry shows assessment, clinical reasoning, modification, and a barrier identified and solved. Compare with "reviewed HEP, patient tolerated well."

See Skilled Language — Writing What You Actually Did.

Safety

State the stop criteria plainly — chest pain, severe breathlessness, dizziness, pain beyond the expected level
Give vital-sign limits where relevant, especially in cardiac and pulmonary patients
Make sure something stable is within reach for any standing exercise
Confirm precautions are reflected in every exercise — hip precautions, weight-bearing status, sternal precautions
Teach what to do if they feel unwell mid-exercise

Handover to discharge

The HEP is what the patient is left with. By discharge they should:

Perform it correctly without cueing
Know why each exercise is there
Know how to progress it themselves
Know what would mean stopping and calling

Document the final return demonstration. See Discharge.