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    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




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