Home Exercise Programs

Home exercise programs (HEP) are lauded as one of the most important tools in a physical therapist’s toolbox from the first semester of physical therapy school. There may be no substitute for the one-on-one expertise and guidance physical therapists provide during a treatment session.

Still, we extend our reach and effectiveness when patients participate in a carefully prescribed HEP.

Summary

• Home exercise programs (HEPs) improve outcomes and accountability. HEPs help patients reach the necessary dosage of stretching, strengthening, and neuromuscular training that cannot be achieved during weekly sessions alone.
• A well-designed HEP accelerates recovery and supports insurance requirements. Patients who adhere to individualized, regularly updated HEPs tend to progress faster, which supports medical necessity and efficient use of benefits. Download my free client home exercise log.
• HEP success depends on clarity, progression, and patient motivation. Poor instruction, lack of progression, or low motivation can reduce effectiveness; regular review and motivational strategies help sustain adherence.
• EHRs like TheraPlatform, integrated with telehealth, enhance HEP delivery. Features like screen sharing, video demos, and real-time form correction make HEPs easier to teach and track remotely.

A home exercise program is a set of exercises or interventions carried out by a client or patient outside of a direct treatment session. Useful for both telehealth and in-person treatment sessions, HEPs have a place in most plans of care. Whether you are a huge proponent of HEPs or aren’t sure if they are worth your time, read on to learn more about the benefits and drawbacks of HEPs and how they can be implemented into your practice.

Benefits of prescribing home exercise programs

One or two 45-60 minute treatments do not stack up well against the over 150 hours spent on non-rehab-focused activities throughout the remainder of a patient’s week. A smart HEP can help close this gap.

Let’s review some of the benefits:

Building accountability

We love spending time with our patients, but we hate to see them return with the same problems over and over again because they didn’t continue their rehab program after discharge.

Participating in a HEP while still under the care of a therapist helps patients build accountability for their own health and recovery. This increases the likelihood they will continue on their own after discharge. It also provides opportunities to review and refine exercises your clients will perform on their own after your care has finished.

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You can’t cheat physiology

Do you remember learning about the importance of dosing for physical therapy interventions? Frequency, duration, intensity, and so forth are all dosing parameters to ensure an intervention is effective. Changing physiology requires a certain amount of work or exposure to a treatment, and the minimum effective dose may be beyond what can be provided in the clinic.

For example, lengthening a shortened muscle requires multiple bouts of stretching a day, most days of the week. If you only prescribe stretching during the once or twice a week clinic visits, your patient won’t meet their goal.

Home exercise programs may incorporate stretching, strengthening, balance and coordination exercises, aerobic training and modalities like heat, ice or electrical stimulation. HEPs help you reach the dosage necessary to effect real change in the tissues you are targeting and promote neuroplasticity.

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Speeding up recovery

Reaching the minimum effective dose for interventions helps your patients get better faster. This is important for maximizing insurance benefits, meeting visit limits and inspiring your patients. Hard-to-treat conditions like frozen shoulder have been found to respond more effectively to a multi-modal program that combines a PT-directed home exercise program with intra-articular steroid injections

Potential drawbacks to home exercise programs

It’s easy to create a long list of how HEPs benefit your patients and your practice, but are there any downsides to prescribing a HEP? A well-thought-out and individualized HEP likely has no drawbacks, but there are some pitfalls to avoid.

Don’t set it and forget it

A home exercise program should mirror the phase of rehab your patient has reached. Failing to progress (or in some cases, regress) a HEP can hamper your patient’s progress. Be sure to keep track of the exercises they are doing at home and advance and replace those exercises as needed to support the work they are doing during their sessions with you.

Getting it wrong

A great HEP performed incorrectly can lead to more harm than good. For better or for worse, you aren’t going home with your patients at the end of the day, which means you can’t actually see how they are performing their exercises outside of your sessions.

Many factors impact how quickly someone learns a new exercise and they may need more than one opportunity to review with you before they can do it correctly at home. Failure to provide sufficient instructions has been found to be a barrier to adhering to a HEP amongst adults with musculoskeletal concerns. Ensure the exercise is safe and appropriate for the patient to perform at home, given that they may not perform it 100% correctly.

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Running low on motivation

Despite their effectiveness, adherence to HEPs can be a challenge for patients. We’ve all experienced a dip in motivation when our lives get busy and no one is watching. Relying heavily on HEPs with minimal in-person visits can result in a lack of progress or a slower recovery if your patient’s motivation runs low.

Studies indicate that patients with greater self-efficacy, self-motivation and social support, among other predictors, are more likely to adhere to their HEP. Setting up check-ins and helping your patient plan ahead for dips in motivation or demands on their time can help them get back on track.

Telehealth and home exercise programs

Telehealth physical therapy services arose out of necessity during the COVID-19 pandemic and have stuck around in many practices due to their convenience and ability to target a larger client network.

A recent systematic review (2023) found that patients with chronic shoulder pain reported good adherence and satisfaction to a digital therapy program that included a home exercise program and had similar outcomes in function, analgesic intake, mental health and pain compared to those participating in a conventional in-person therapy program.

The benefits and drawbacks of prescribing HEPs do not change in the telehealth scenario, but you may find there are some other advantages.

First, you can evaluate a patient's home setup and equipment in real time thus better tailoring exercises to their space and available resources.

Telehealth platform features like screen sharing, whiteboards and videos can allow you to demonstrate the HEP more effectively. These tools may act as ongoing resources for your patient when they need to review the instructions.

You can also evaluate their form live from their home and provide immediate feedback. All of these advantages allow you to focus more on complex tasks during the 1:1 telehealth sessions while delegating simpler exercises to their HEP.

Cash pay clients and insurance companies

Home exercise programs result in better patient outcomes. In a world of decreasing insurance reimbursement rates and claim denials, showing progress and medical necessity is essential.

Prescribing a great HEP and educating your patients on why it is important will help them to reach their goals faster. This, in turn, is more likely to generate payment for these services.

Additionally, a home exercise program

differs from a general fitness program in that it is intended to treat a medical condition. A well-crafted HEP helps show payor sources why physical therapists are a necessary part of the healthcare system.

Cash pay clients can reap additional benefits from a HEP. Not only does a solid HEP help them reach their goals, it will help them do so faster. It is easier to see the value of investing in your services when a patient sees positive results in fewer visits. They will also build better health and wellness habits and enhanced self-efficacy making them more likely to choose you again when they need PT in the future.

Put some thought into your home exercise program

Now that you understand the value of prescribing a solid HEP, it’s time to put some thought into how you achieve that.

Here are some tips to help maximize the utility of your home exercise programs.

1. Set realistic goals and intentions: The most effective HEP is the one your patient will do regularly. Take the time to craft a HEP that will fit into your patient’s routine and support their goals.
2. Use motivational interviewing techniques: Studies show motivational interviewing strengthens client motivation for behavior change and promotes treatment adherence. It can be used to optimize therapy interventions and promote HEP participation in otherwise ambivalent patients.
3. Consider digital tracking software, text or email reminders: We can all use a little help staying accountable to our goals. Digital technology provides a myriad of tools to help your patient regularly check their HEP off their to-do list.
4. Encourage journaling or video logging of home practice: Asking your patient to keep a journal or video log of home practice builds accountability but also creates opportunities for the therapist to review their performance and identify areas for feedback, regression and progression more quickly.
5. Target behaviors: Consider adding in interventions to support your patient’s self-efficacy, self-motivation and social support in order to improve the likelihood they will participate regularly in their HEP.
6. Celebrate milestones and small wins: Your clients have goals in mind and the journey to accomplish them can feel long. Celebrating small wins and milestones along the way will help motivate them to keep working hard.

Home exercise program tools and tracking

If HEP development and review feels like one more thing to squeeze into a busy schedule, leveraging tools to improve delivery and tracking can ease that burden.

Below are some examples of tools to make HEP management easier:

• Client portals for viewing and logging exercises
• Apps that provide video demonstrations and progress tracking
• AI-enhanced tools for customizing exercise programs based on diagnosis, age, and goals

Many healthcare technology and AI tools offer free trials and the chance to meet with a customer success team to help you know if their tool is right for you and your clients.

Hooray for home exercise programs

If you can’t tell, we love HEPS and with a little planning you and your patients can too. Home exercise programs can be a powerful extension to your therapeutic interventions. Improving outcomes, enhancing cost-efficiency and promoting both autonomy and self-efficacy amongst patients are all benefits of prescribing good home exercise programs. Today is a great day to review your HEP practices and amplify this tool for success.

Streamline your practice with One EHR

• Scheduling
• Flexible notes
• Template library
• Billing & payments

• Insurance claims
• Client portal
• Telehealth
• E-fax

Learn More

Resources

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