The Home Exercise Program That Actually Works

Every physical therapist has been there: you spend time creating a carefully crafted home exercise program (HEP), only to find out at the next visit that the patient “forgot,” “didn’t have time,” or “wasn’t sure if they were doing it right.” Research consistently shows that adherence rates to HEPs are alarmingly low, with many patients completing less than half of what’s prescribed. The reality is simple, the best HEP is the one patients will actually do. This article breaks down what makes a good HEP, how to approach exercise prescription with clinical reasoning, and how to embed adherence strategies into daily life.

Thoughts on Building a Doable Program

The backbone of a good HEP is simplicity and specificity. Programs should generally include no more than 3–5 exercises, each clearly tied to the patient’s goals. Exercises that feel disconnected from real life rarely stick. Instead of “quad sets to strengthen your legs,” frame it as, “this exercise helps you get up the stairs without stopping.”

HEPs must also be clear and accessible. Written instructions supported with visuals or videos dramatically improve recall. Patients retain less than 50% of what they hear verbally in clinic, so handouts or short demonstrations are essential. Finally, programs must be realistic matched to the patient’s daily routine, environment, and resources. Asking someone to do resistance band exercises three times a day when they don’t own a band isn’t setting them up for success.

Just as important, clinicians must consider the social determinants of health (SDOH). A patient’s financial resources, housing stability, work demands, transportation, and even cultural background can directly affect adherence. For one patient, an HEP may need to be built entirely around equipment-free activities due to cost. For another, exercise may need to be embedded into work breaks or household chores to account for time limitations. Addressing these factors upfront, and individualizing programs accordingly, is essential for creating a HEP that patients can realistically perform. Ask about these factors because if you don’t you can’t plan effectively.

Prescribing With Some Thought

The art of HEP design lies in prioritization. Reps, sets, and loads should be chosen with intention, not by defaulting to “3x10.” Exercises should match the functional demands of the patient’s goals and extend slightly beyond them to build functional reserve. For example, if a patient’s goal is to carry groceries up a flight of stairs, the HEP should challenge their lower body endurance past that threshold to reduce the likelihood of future setbacks from illness or deconditioning.

Evidence shows that even one set of 8–12 reps at 70–80% of a patient’s 1RM can meaningfully improve function when performed with good form. This dispels the myth that progress requires high volumes. For patients with multiple comorbidities, overprescription of exercise intensity can do more harm than good.

HEPs should also take advantage of the general health benefits of exercise improved cardiometabolic health, reduced fall risk, and increased independence across populations. Teaching patients to self-monitor intensity ensures they progress safely. Tools like the RPE (Rate of Perceived Exertion) scale, heart rate tracking, or simple effort descriptors (“you should be working, but still able to talk”) give patients the confidence to adjust intensity without supervision. Providing handouts on how to use these tools empowers patients to become active participants in their recovery.

Make Adherence a Priority

A program only works if it gets done. Unfortunately, research indicates that adherence to HEPs is typically under 50%, and some studies report as low as 35%. This has prompted clinicians and researchers to rethink how we prescribe.

One proven approach to take notes from is the LiFE (Lifestyle-integrated Functional Exercise) protocol, which embeds exercises into a patient’s existing daily routine. Instead of carving out extra time, LiFE encourages patients to transform everyday moments into training opportunities. For example, doing heel raises while brushing their teeth, practicing sit-to-stands when rising from a chair, or balancing on one leg while waiting for the microwave. This approach not only increases adherence but also produces meaningful improvements, such as reduced fall risk and better mobility, without requiring patients to dedicate large blocks of time to exercise.

Case Example: A Pt with MS

Patient: 38-year-old female with relapsing-remitting multiple sclerosis (RRMS).

Goals:

1. Climb a full flight of stairs carrying laundry without stopping.

2. Reduce her risk of falling at home and in the community.

3. Improve endurance so she can walk her children to school without frequent breaks.

Current Status: Patient presents with fatigue, right leg weakness, and poor endurance. She reports eight falls in the past three months, demonstrates wide base of support gait, and loses balance with quick head turns. On functional testing:

• Timed Up and Go (TUG): 15.8 seconds (elevated fall risk).

• 5 Times Sit-to-Stand (5xSTS): 23.2 seconds (below age-matched norms).

• 12-Item MS Walking Scale: 58/100 (moderate limitation).

HEP (designed to be simple, goal-driven, and embedded into daily life):

1. Sit-to-Stand from Chair – 1 set of 10 reps when getting off the couch, 2x/day. Builds strength and endurance for stair climbing and carrying laundry. Progression: add laundry basket weight or increase reps. Regression: use elevated seat or partial stands.

2. Heel Raises at Kitchen Counter – 1 set of 8–12 reps, 1–2x/day. Targets ankle strength for gait stability. Progression: single leg, increase reps. Regression: smaller range or more hand support.

3. Balance Reach (while brushing teeth) – 30–60 sec each side. While brushing teeth, try standing on one leg for 30–60 seconds. Start with both hands on the counter if needed and try to reduce support until both hands are off counter if possible. You can even add a small reach forward or to the side. Improves single-limb balance in a functional, daily routine. Progression: reach further outside BOS. Regression: two-hand support on counter.

Don’t overthink these programs. Complexity kills adherence and results in no change. Be consistent and function driven.

Education: Patient was given an RPE chart and instructed to aim for 11–13 (“light to somewhat hard”) effort. She was educated on thermosensitivity (cooling strategies, avoiding heat) and fatigue management (taking breaks before exhaustion, energy conservation ideas in the home). The HEP was reinforced with written and visual handouts for clarity.

Parting Thoughts

A good HEP isn’t a binder of generic exercises. It’s a short, personalized, and meaningful program that patients can realistically perform in their daily lives. Whether it’s embedding exercises into routines, tailoring reps to match functional demands, or teaching patients how to self-monitor effort, the goal is the same: build adherence. Because in the end, the best HEP is the one that gets done.

Disclaimer

I am a current Doctor of Physical Therapy (DPT) student sharing information based on my formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While I strive to provide accurate and up-to-date information, my knowledge is based on my current academic and clinical rotations and ongoing learning, not extensive clinical practice.