Week of __________________________

Strength and Balance Exercises : Daily Record

You might want to make copies of this form. Leave this one blank, so you can copy it as needed. Write in the exercises and activities you plan to do. Create a schedule you think you really can manage. You can change your plan as your fitness improves and you are able to do more.

(Make sure to check with your Doctor before starting any exercise program)

lbs = pounds
reps = number of repetitions

 

  Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Calf Stretch (click on the link for pictures and description of exercise) 2 times each leg              
Chair Stand  (click on the link for pictures and description of exercise) # of Stands              
Biceps Curl (click on the link for pictures and description of exercise) lbs              
reps              
Ankle Stretches (click on the link for pictures and description of exercise) lbs              
reps              
Triceps Extension (click on the link for pictures and description of exercise) lbs              
reps              
Hamstring Stretch (click on the link for pictures and description of exercise) 2 times each leg              
Hip Extension (click on the link for pictures and description of exercise) lbs              
reps              
Shoulder Flexion (click on the link for pictures and description of exercise) lbs              
reps              
Knee Extension (click on the link for pictures and description of exercise) lbs              
reps              
Hip Extension to Improve Balance (click on the link for pictures and description of exercise) lbs              
reps              
Side Leg Raise (click on the link for pictures and description of exercise) lbs              
reps              
Knee Flexion (click on the link for pictures and description of exercise) lbs              
reps              

Source: National Institutes of Health (www.nih.gov)


Last Editorial Review: 7/14/2005