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
