How to Write a Home Exercise Program Patients Follow

To write a home exercise program patients will actually follow, give fewer exercises than you think, each chosen for this patient's main problem and practiced in the room before they leave. Set the dose as a clear starting range with a rule for when to progress, write the instructions in plain words with your own cue and a stop rule, and book the review before they walk out. The rest of this guide goes through each step, with evidence where there is some and common practice where there is not.

If you want the background on why patients drop their programs in the first place, read why patients don't do their home exercises. This guide is about the writing itself.

How many exercises should a home program have?

There is less evidence here than you would expect. The trial people usually quote is small. Henry and colleagues randomly gave 15 older adults 2, 5 or 8 strengthening exercises to do at home. After 7 to 10 days, the group with 2 exercises scored better than the group with 8 on a tool that rated alignment, movement quality and how much cueing they needed.

Self-reported compliance was no different between the groups. So the finding is about how well the exercises were done, not whether they were done at all. That still matters: an exercise done badly for two weeks is not the exercise you prescribed.

Many physios start with 2 to 4 exercises and add more once the first ones look right. That is common practice, not a tested number. If a patient needs seven things, they do not need all seven this week. Pick the ones that matter most now and stage the rest over the next visits.

How to choose the exercises

Start from your assessment, not from a handout folder. Ask which one or two findings are driving the problem, and choose an exercise that works on each of them. For someone whose knee gives trouble on the stairs, a straight leg raise or a step-up might earn its place before any stretch does.

Then run each candidate past a few quick filters:

Can the patient do it correctly today, with you watching? If not, choose an easier version.
Can they do it at home, with the space and equipment they actually have? A band they do not own is an exercise they will not do.
Does it fit into their day? Something done standing at the kitchen counter, like a mini squat, is easier to fit in than something that needs a mat on the floor.
Would they know if they were doing it wrong? If the only feedback is your eye, look for an exercise with a clearer end point.

The Cochrane review by Jordan and colleagues concluded that supervised or individualized exercise therapy may improve adherence in adults with chronic musculoskeletal pain. A program built from this patient's findings is individualized by definition. A photocopied sheet of "knee exercises" is not.

How to set the dosage in a home program

Dosage has two jobs. It has to be enough to cause change, and it has to be clear enough that the patient does the same thing at home on Tuesday as they did in your room on Monday.

The American College of Sports Medicine (ACSM) position stands give the most widely used starting points. They were written for healthy adults. In rehab, how irritable the problem is and where the tissue is in healing set the ceiling, so treat the figures below as general starting ranges that you adjust for each patient, not as a prescription.

Goal	Common starting range	Where it comes from
Strength, in someone new to training	2 to 3 sets, with a load that makes 8 to 12 reps hard, on 2 to 3 days a week	ACSM 2009; Currier and colleagues for ACSM, 2026
Strength, in an older or deconditioned person starting out	A lighter load that allows 10 to 15 reps; 1 set can be enough at first	Garber and colleagues for ACSM, 2011
Muscular endurance	Lighter load, more than 15 reps, short rests	ACSM 2009
Stretching	About 60 seconds in total per stretch, which can be split into shorter holds, on at least 2 days a week	Garber and colleagues for ACSM, 2011

Early range-of-motion work, such as heel slides for a stiff knee, is commonly given little and often, once or several times a day. The ACSM stands do not cover that kind of work, so treat that range as common practice rather than guideline.

At the other end, the 2026 ACSM overview found that heavier loads, 80% or more of a one-repetition maximum, gave more strength gain in healthy adults. Most home programs cannot load that heavily. That is one reason to move a patient on to weighted or gym-based work when they are ready.

Check for anything that changes the dose before you write it down. After surgery, the surgeon's instructions or the local protocol set the limits.

A few conditions change how you set the exercises up. For high blood pressure or heart disease, keep the effort moderate and teach the patient to breathe out on the effort rather than hold their breath. Someone with osteoporosis needs to be shown how to bend and lift while keeping the spine long. If there is a falls risk, choose standing exercises done beside a kitchen counter or a sturdy chair they can hold.

Write the progression rule into the program

The 2009 ACSM stand suggests increasing the load by 2 to 10% once the person can do 1 or 2 reps more than the target. Few patients own a set of weights, so you have to translate that for home.

One common version goes like this. When the top of the rep range feels easy for two sessions in a row, add a few reps or slow the lowering down, or with a band, go up one color. Move to a harder version, such as a single-leg bridge, only once balance and control allow it. Give the patient that rule in one sentence and they can progress between visits instead of waiting for you.

Say when, not just how often

"Twice daily" is easy to write and easy to forget. Agree a time with the patient and write it into the program. The adherence guide covers how to tie exercises to a daily habit.

How to write instructions a patient can follow alone

Your patient will read the instructions at home, alone, probably days after your session. Write for that moment. For each exercise, cover these points:

What it is for, in one sentence.
The starting position.
The movement, with one or two cues at most.
What they should feel, and where.
The mistake you saw in the room, and how to fix it.
The dose, and when in the day to do it.
When to stop.

Here is what that can look like for a glute bridge:

This works the big muscles of your buttock so your back does less of the lifting. Lie on your back with your knees bent and feet flat. Squeeze your buttocks and lift your hips until your body makes a straight line from shoulders to knees.

You should feel it in your buttocks, not your lower back. If your back takes over, lift a little lower. 2 sets of 10, hold 3 s at the top, after your morning tea. Stop and message me if pain spreads down your leg.

The cue should be yours: the words that worked in the room with this patient. If "push the floor away" got a good rep, write exactly that. Drop the jargon: "posterior pelvic tilt" means nothing at home, while "flatten your back into the bed" does. The pelvic tilt page shows the difference in practice.

Before the patient leaves, have them do a few reps of each exercise while you watch. Reading an instruction and doing it are different skills.

What to tell patients about pain

A patient who feels an ache during an exercise and does not know whether it means harm will often just stop. Give them a rule they can check themselves.

One well-known version comes from tendon research: Silbernagel and colleagues used a pain-monitoring model, first described by Thomeé for pain at the front of the knee, with people who had Achilles tendinopathy. Pain during exercise was allowed up to 5 on a 0 to 10 scale. Pain after exercise could also reach 5, but it had to settle by the next morning, and pain and stiffness were not allowed to build from week to week. Patients who kept running and jumping this way did as well as those who rested from those activities, with no negative effects found.

Many physios borrow the same idea for other persistent musculoskeletal pain, but that goes beyond what the trial tested, so use your judgment with each patient. After surgery or a recent injury, follow the surgeon's instructions or the local protocol instead. Whatever rule you choose, write it down in numbers the patient can check.

Red flags to put in every program

Every home program also needs stop rules that have nothing to do with ordinary exercise discomfort. Tell the patient to stop and contact you, or get medical help, if they notice:

Chest pain or tightness, a racing or irregular heartbeat, or shortness of breath out of proportion to the effort.
Dizziness or feeling faint.
New numbness, tingling or weakness.
Sharp pain that does not settle when they stop.
A calf that becomes painful, swollen, warm or red, or a joint that becomes newly hot, red and swollen.

Add any condition-specific warning signs you screened for, such as changes in bladder or bowel control, or numbness around the genitals or buttocks, in someone with back pain. Make clear which signs need urgent help rather than a message to you.

Chest pain, fainting, sudden breathlessness, sudden weakness or numbness on one side of the face or body, trouble speaking, and new bladder or bowel problems or numbness around the genitals or buttocks with back pain all mean calling the local emergency number or going to an emergency department. A painful, swollen calf needs a medical check the same day, and emergency help if breathlessness or chest pain comes with it. A home program is education and practice between visits, and it never replaces a proper assessment when something changes.

Paper, video or app: does the format matter?

Somewhat, though the evidence is mixed. In a randomized trial by Lambert and colleagues, people with musculoskeletal conditions who received their program on an app, with phone calls and motivational text messages, reported better adherence at 4 weeks than those given paper handouts. The authors said the clinical importance of the difference was unclear. Bennell and colleagues found a similar small benefit, along with more confidence to exercise, when physios in private practice prescribed through a web-based exercise system.

Not every trial agrees. In people recovering from stroke, Emmerson and colleagues found that programs filmed on a tablet with automated reminders were no better for adherence than paper. The Nicolson review, in older adults with back pain or hip and knee osteoarthritis, found that audio or video exercise cues did not significantly improve adherence.

Video shows the patient what the exercise should look like, and the phone is where many patients will look for it. It does not replace a well-chosen exercise or a dose the patient understands, and someone still has to check in. If you use PocketPhysio, every exercise in the library has a video and a spoken voice guide, you set the sets, reps and hold times and add your own cue, and the program reaches the patient by link, SMS or email, in the Pocket Physio Care app or on WhatsApp. The principles in this guide apply whatever you use. If you are still choosing, our guide to choosing home exercise program software sets out what to compare.

Follow-up is where programs succeed or fail

One of the better-supported strategies is also the simplest: see the patient again. The Nicolson review found moderate-quality evidence that booster sessions with a physiotherapist helped people with hip or knee osteoarthritis stick with their exercise. The 2011 ACSM position stand also lists supervision and behavior change strategies among the things that can improve adherence to a prescribed program.

What that looks like in a normal week:

Book the review before the patient leaves. For a new program, a gap of 1 to 2 weeks is a common choice, though the right gap depends on the patient.
Check in by message in the first few days, as the adherence guide describes.
At the review, watch every exercise again before you change anything. Technique drifts at home.
Ask how often they managed it, in a neutral way that makes an honest answer easy.
For each exercise, decide whether to progress it, keep it, change it or drop it.

Drop the exercises that are not being done rather than piling new ones on top. Two exercises done well are more use than a longer list that lives in a drawer.

A checklist for your next home exercise program

A short list, often 2 to 4 exercises, each linked to a finding from your assessment.
Every exercise practiced in front of you before the patient leaves.
A dose written as sets, reps or hold time, with a time of day.
A one-sentence progression rule.
One or two cues in your words, plus the mistake to watch for.
A pain rule in numbers, and the red flags that mean stop and call.
The program on the patient's phone, where they will see it.
A review booked, and a message in the first week.

None of this takes long once it is routine. Write a home exercise program this way for the next patient you see, then check at the review which parts made the difference for them.

References

Henry KD, Rosemond C, Eckert LB. Effect of number of home exercises on compliance and performance in adults over 65 years of age. Physical Therapy. 1999;79(3):270-277. doi:10.1093/ptj/79.3.270
Jordan JL, Holden MA, Mason EEJ, Foster NE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews. 2010;(1):CD005956. doi:10.1002/14651858.CD005956.pub2
American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and Science in Sports and Exercise. 2009;41(3):687-708. doi:10.1249/MSS.0b013e3181915670
Currier BS, D'Souza AC, Singh MAF, et al. American College of Sports Medicine position stand. Resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: an overview of reviews. Medicine and Science in Sports and Exercise. 2026;58(4):851-872. doi:10.1249/MSS.0000000000003897
Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and Science in Sports and Exercise. 2011;43(7):1334-1359. doi:10.1249/MSS.0b013e318213fefb
Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. American Journal of Sports Medicine. 2007;35(6):897-906. doi:10.1177/0363546506298279
Thomeé R. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Physical Therapy. 1997;77(12):1690-1703. doi:10.1093/ptj/77.12.1690
Lambert TE, Harvey LA, Avdalis C, et al. An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy. 2017;63(3):161-167. doi:10.1016/j.jphys.2017.05.015
Bennell KL, Marshall CJ, Dobson F, Kasza J, Lonsdale C, Hinman RS. Does a web-based exercise programming system improve home exercise adherence for people with musculoskeletal conditions? A randomized controlled trial. American Journal of Physical Medicine and Rehabilitation. 2019;98(10):850-858. doi:10.1097/PHM.0000000000001204
Emmerson KB, Harding KE, Taylor NF. Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial. Clinical Rehabilitation. 2017;31(8):1068-1077. doi:10.1177/0269215516680856
Nicolson PJA, Bennell KL, Dobson FL, Van Ginckel A, Holden MA, Hinman RS. Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(10):791-799. doi:10.1136/bjsports-2016-096458

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-28.