New Exercise Program

I mentioned in an earlier post that in late November I was fortunate enough to have a Physical Trainer (PT) work with me in my home twice a week. Over the six weeks he visited me, I was most impressed with the improvements he made to my previous exercise program (Smart Exercise Guide) that I have been faithful to for almost three years now. The gentleman focused many of the exercise routines around using proper posture to enhance the trunk strength as well as work on specific muscles.

In early January I finished writing the new "Smart Exercise Guide - Part II." It explains the exercises developed by the PT. I am amazed at how my self confidence has grown with several of these new exercises and how much more stable I am when standing and walking. I am even using a cane again for short distances.

Of course, everyone with KD is at a different point in their lives (how KD effects their strength, confidence, and capabilities). This guide has specific exercises for those who are wheelchair bound and for those who are experiencing some problems walking with a cane or walker. Many of the exercises have different difficulty levels to ensure they benefit more people. Once a person gains more strength and confidence, he can move to a more difficult level.

Personally, many of my problems with walking were confidence-based as much as muscle weakness and balance related. I had too many falls that ended up with some type of injury. Once I had the strength to perform several of these exercises easily, my confidence also improved and we were able to move to a more difficult level of exercise.

I have included below a few of the exercises that are in the exercise guide. There are a total of 35 exercises in the guide ... most of them are new and not included in the original exercise guide.

The exercise guide has the full instructions including some more advanced exercises once the basic exercise below is mastered.

The Concept – Exercise and Kennedy’s Disease

Several neurologists confirm that light and (I will use the term) ‘smart’ exercising is good for your muscles and motor neurons because it stimulates them and keeps them functioning longer. Another benefit of exercise and stretching is that it can cause ‘cell inhibition’.

However, any type of activity that overly taxes your muscles could be detrimental to your condition. The key is to just do what the body feels comfortable doing. Never exceed your capabilities. The goal is to stimulate the healthy muscles and motor neurons without doing any harm to them.

Instructions

1. These exercises should be performed slowly. Performing an exercise slowly actually helps prevent muscle and joint damage and requires fewer repetitions to gain the same benefit.
2. Use the 70% Rule with every exercise. This rule is meant to prevent any damage to the muscles. The Rule: Only perform about 2/3 of the number of repetitions that you can comfortable perform. Do not attempt to perform ‘just one more’ repetition because that is the one that might cause some damage. As your muscles gain strength and flexibility, add more repetitions without breaking the 70% rule.
3. Do not attempt to perform all of these exercises every day. Break them up into two or three day cycles where you perform certain exercises one day, others on another day, and set aside certain days to rest.
4. Especially in the beginning, use a ‘spotter’. A spotter is someone that will help if you become fatigued or off balance; and can help provide assistance/resistance to your muscles in the performance of an exercise.
5. There are five exercises that should be done every day (they are marked in bold). The remainder of the exercises discussed in this guide should be performed regularly, but not daily. Initially, select those exercises that work for you and that you enjoy doing. This will help you transition into a regular and enjoyable exercise program. You might want to consider doing some of these exercises on one day and another series of exercises on another day. As your strength improves, add more exercises. Example: You may decide to perform biceps and standing leg exercises on one day and shoulder/triceps and sitting leg exercises on another. Recommendation: Develop a checklist (an example is on Page 12) of the exercises you want to include in your weekly program and assign days for each exercise. Also, try to incorporate some stretching exercises into your routine.

Do No Harm

1. Always consult your physician before beginning any new exercise program.
2. Your first concern should be for your safety. Before performing standing and walking exercises, see the “Safety Notes” in each section.
3. Your second concern should be to 'do no harm'. Use the 70% Rule described above.
4. If you feel pain during an exercise, discontinue that exercise for the day.

Disclaimer

To protect the KDA and myself, I need to include the following disclaimer.

The information provided below should not to be considered medical advice. The exercises should also not be considered a substitute for the advice of a trained medical professional or physical therapist. It is recommended that you consult with your family physician and neurologist prior to beginning any exercise program. The author has made a reasonable effort to ensure that all information provided is accurate, but as with any living document, errors might occur. It is entirely the responsibility of the reader to determine the validity of any information provided. Any decisions made based upon the information received from this forum are entirely the reader’s responsibility. The author, as well as the Kennedy’s Disease Association, makes no representation or warranties about the information provided below. The author reserves the right to make changes and corrections to these at any time, without notice.
The author and the Kennedy’s Disease Association does not accept any liability for any direct, indirect, special or consequential damages, or any other damages of any kind resulting from any cause through the use of any information obtained either directly or indirectly from these exercises.

This message has been edited. Last edited by: Bruce,

My Exercise Program

The following exercises were recommended by a certified Physical Therapist. Several of these exercises are designed for someone that is having difficulty walking; or feels more comfortable in a wheelchair, but can still stand and transfer without assistance. Most exercises can be modified by adding light weights and by holding a position for a longer period of time. I have personally performed all of these and found them to be very helpful in maintaining and improving my strength and my balance as well as providing me with improved self-confidence.

#1. Stand at Attention

Stand at Attention works the abdomen, back, buttocks, quads, calves, ankles, feet and toes. This is an excellent exercise that will improve your confidence when standing without the support of a cane or walker.

To achieve maximum benefit, this exercise should be done every day.

Stand in front of a counter, railing, or grab bar with your feet placed about shoulder width apart. While holding the grab bar, stand at attention with your shoulders back, chin up, and stomach and buttocks pulled in. Once comfortable with the position, let go of the grab bar (or counter) and continue to hold the position for as long as comfortable. If you feel yourself falling too far forward or backwards, use one hand to steady yourself and then let go once you are comfortable again. Rest and repeat 2-3 times (or whatever is comfortable).

Note: For increased safety while performing these exercises, have someone stand behind you ready to grab your belt should you become fatigued or off-balance.

This message has been edited. Last edited by: Bruce,

#2. Chair Push Ups

Chair Push Ups will works the biceps, triceps, and shoulder muscles. This exercise will help improve your ability to stand up from a chair or commode.

To achieve maximum benefit, this exercise should be done every day.

Sit in an arm chair or wheelchair with your legs as close to the chair as comfortable (knees at a 90 degree angle to the floor, if possible). Place your hands on the arms and attempt to lift your buttock off of the chair by pushing up and straightening your arms. Hold for a count of five and then relax. Perform 5-8 lifts (or whatever is comfortable).

Even if you cannot initially lift yourself off of the chair, the arm biceps and triceps will still be worked.

This message has been edited. Last edited by: Bruce,

#3. Knee Bends

Knee Bends work the quads, calves, and buttock. This exercise will help improve your confidence, the ability to stand up, and the ability to recover should your knees begin to buckle.

Face a kitchen counter (preferably the sink) and stand approximately 3-5” out from the counter with a chair or wheelchair about 3” behind your legs (in case you lose your balance or become tired). While holding on to the sink and keeping your posture upright (do not lean forward), slowly allow the knees to bend forward until they rest against the cupboards below the sink. Straighten the legs. Perform 10-15 reps (or whatever is comfortable). Note: When 3-5” is too easy, move out 3” further. Continue to move out further as the exercise becomes too easy or until you are almost sitting on the chair behind you when the knees are touching the cupboards. To increase the difficulty, hold the knees against the cupboards for a count of five.

This message has been edited. Last edited by: Bruce,

#4. Quad Contractions

Quad Contractions work the quads. This exercise further strengthens the leg muscles.

Sit in a chair with a footstool or another chair in front of you. Straighten the left leg and rest the heal on the stool (or chair). Using your quad muscles only, press down until the leg is perfectly straight. Hold for the count of five and then relax. Perform 10-15 reps (or whatever is comfortable). Switch to the right leg and repeat the exercise.

#5. Step In Place

Step in Place works the quads, calves, and buttocks. This exercise will help improve your balance, the ability to walk heel-to-toe, and to stand more comfortably.

Lean (do not bend) forward and place your hands on a grab bar, railing, or counter. Slightly bend and lift your left leg so all of your weight is transferred to the right leg. Hold for a count of five. While holding the position, visualize the tightening of your right buttock muscles. Straighten the left leg. Shift your weight to the left leg and slightly lift and bend your right leg. Hold for a count of five. Again visualize the tightening of your left buttock muscles. Perform 90-100 steps (or whatever is comfortable). The visualization part of this exercise is as important as the weight shifting. When comfortable, increase the hold count to ten before shifting.

This message has been edited. Last edited by: Bruce,

#6. Chop Wood

Chop Wood works the triceps, biceps, and shoulder muscles.

While sitting with your knees apart, clasp both hands together and reach down between your legs. While keeping your arms locked our straight, slowly raise your clasped hands all the way above your head (like lifting an axe above your head). Hold for the count of five and then slowly bring the hands back down between your legs. Perform 12-15 reps (or whatever is comfortable). Alternative: Hold a one-three pound weight or a can of soup or soda in your hands.

This message has been edited. Last edited by: Bruce,

#7. Arm Reach and Twist

Arm Reach and Twist works the triceps, biceps, and shoulder muscles as well as improves flexibility.

To achieve maximum benefit, this exercise should be done every day.

While sitting, reach your left hand down and across your right knee. Your left wrist should be twisted clockwise as far as possible so the fist is facing the left knee. Keeping your arm straight, slowly raise the left arm up. As you begin to raise the arm twist your wrist counter-clockwise on the way up. As you reach high above your left shoulder, continue twisting your wrist as far as possible. Hold for a count of two. Slowly return the arm to the starting position as you twist the wrist in a clockwise motion. While performing the exercise, maintain tension in the arm, wrist, and hand. Perform 12-15 reps (or whatever is comfortable). Switch to the right arm and repeat.

Alternative: Hold a one pound weight or a can of soup or soda in your hand.

This message has been edited. Last edited by: Bruce,

#8. Heel and Toe Raises

Heel Raises Works the calves, ankles, and feet muscles. This exercise further strengthens the lower leg muscles and develops greater flexibility and confidence.

Sit with your feet directly below your knees (at a 90 degree angle to your thighs). Raise your heels as high as possible while keeping your toes on the floor. Hold the position for a count of two and then return your heel to the floor. Perform 15-20 heel lifts (or whatever is comfortable).

Toe Raises Works the ankles, and feet muscles. This exercise further strengthens the lower leg muscles and develops greater flexibility and confidence.

Sit with your feet as far out in front of you as possible while still keeping the feet flat on the floor. Raise your toes as high as possible while keeping your heels on the floor. Hold the position for a count of two and then return your toes to the floor. Perform 15-20 heel lifts (or whatever is comfortable).

This message has been edited. Last edited by: Bruce,

#9. Knee Lifts

Knee Lifts: Works the quads. This exercise further strengthens the leg muscles.

Sit in a chair. Lift the left knee as high a comfortable and hold for a count of five. Relax the left leg. Lift the right knee as high as comfortable and hold for a count of five. Relax the right leg. Perform 10-12 lifts with each leg (or as many as comfortable).

10. Straighten the Leg

Straighten the Leg works the quads. This exercise further strengthens the leg muscles.

Sit in a chair. Straighten and lift the left leg out in front of you as high as comfortable. Hold for a count of five. Relax the left leg. Straighten and lift the right leg out in front of you and hold for a count of five. Relax the right leg. Perform 10-12 lifts with each leg (or as many as comfortable).

#11. Triceps Lifts

Triceps Lifts work the triceps muscles.

While sitting, raise your left arm straight above your should. If needed, use your right hand to support the left arm. Slowly bend the elbow so your left hand touches your ear. Slowly straighten the arm. Perform 10-12 reps (or as many as comfortable). Switch to the right arm and perform the same exercise. Alternative: Hold a one pound weight or a can of soup or soda in your hand.

Practice Walking

Note: The exercises below are designed for those who are having difficulty walking or spending more time in a wheelchair because of strength, balance, and confidence issues, but can still stand comfortably and transfer without assistance.

Walkers: The walker height should be set so that your posture is upright and your forearms are bent at a 25-30 degree angle when grasping the walker. The walker is meant for balance, not for holding up your weight. For better balance while walking, look straight ahead of you (not down). Tennis balls placed on the end tips help improve traction on slippery surfaces.

Canes: The cane should be adjusted to the proper height so that your forearm is bent at a 25-30 degree angle when the cane is parallel with your leg (straight down your side). The cane should have a grip that is easy to hold on to and an end-tip that does not slip.


Heel-to-Toe Walk With Walker: Heel-to-Toe Walk works the quads, calves, ankles, hips, and feet muscles. This exercise further strengthens the leg muscles and develops greater flexibility and confidence.

To achieve maximum benefit, this exercise should be done every day.

Begin to walk by taking a step forward making certain that your heel hits the floor first and your toe is up (do not shuffle). Then roll the foot forward and end the step with your toe pushing off the floor. It should look and feel like a normal step. While walking, keep the shoulders straight and head up. Look straight out in front of you (not down at your feet).

Begin slowly and initially have someone walk behind you with their hand in your belt in case you lose your balance. Walk this way as long as comfortable and then take a break. Once comfortable, perform two or three walks a day.

Three-Point Walk With Cane: (See Safety Note below) Use this method when using a walker regularly to improve your strength and balance.

Stand next to a counter (or railing) and use your left hand, if needed, for balance by touching the counter top (or railing). With your cane in your right hand, move the cane out in front of you about 18-24 inches (or whatever length is comfortable). Lift the left foot up and step forward so it is in line with the cane tip. Now step forward with your right foot until the cane and both feet are together. Do not shuffle your feet. Continue forward and try to make the steps as smooth as possible. Walk to the end of the counter.

Rest if needed and then reverse direction using the cane in the left hand. Perform as many trips as safely comfortable. While walking, keep the shoulders straight and head up. Look straight out in front of you (not down at your feet).

Two-Point Walk With Cane: (See Safety Note below) As strength and balance improves, move to this method for a more natural gate and improved balance.

Stand next to a counter (or railing) and use your left hand, if needed, for balance by touching the counter top (or railing). With your cane in your right hand, move the cane out in front of you about 18-24 inches (or whatever length is comfortable) while stepping forward with the left foot so it comes down in line with the cane tip at the same time. Now step forward with your right foot … stepping through and beyond the left foot and cane (like a normal step). The cane and left foot are now behind the right foot. Continue forward with the left foot and cane again stepping beyond the right foot 18-24 inches. Try to make the movement as smooth as possible. Walk to the end of the counter.

Rest if needed and then reverse direction using the cane in the left hand. Perform as many trips as safely comfortable. While walking, keep the shoulders straight and head up. Look straight out in front of you (not down at your feet).

Once you are comfortable with your balance and strength, try walking next to a wall. Once that is comfortable, extend out further until you do not have anything on the opposite side of your cane.

Safety Note: For increased safety when performing these exercises, have someone stand behind you or to your side ready to grab your belt should you become fatigued or off-balance.

This message has been edited. Last edited by: Bruce,

The full exercise guide is finished. It is in a PDF format and can be found on the KDA web site by following this link: Smart Exercise Guide - Part II. Click on the link to download the guide.

I would be interested in how others feel about these exercises or your modifications to them. Are the instructions clear enough or do I need to amplify on them? Do they work for you? Let me know. And, if you see any mistakes or improvements needed, please also let me know. Thanks, Bruce

Updated Guide: On January 22, I added five more exercises to the guide. I am amazed at how well I am doing walking again. I haven't been this comfortable walking in 3½ years.

This message has been edited. Last edited by: Bruce,

February Update On My Progress

I continue to exercise every day. The renewed strength in my legs amazes me. Just as important is that I am not experiencing any pain or aches even though I have increased the duration of my exercises. Even the arthritis in my left knee is better. My arm and shoulder strength is also improving, but not at the same rate as my legs and balance. What I am most excited about is that I can stand without having to grab something or brace myself against the counter.