CHAPTER 11 · FROM MY PT NOTES
The best plan still has to fit their day
Six exercises won’t help much if the person can only fit in two. Before adding anything else, I’d ask what is getting in the way.
1. Ask before calling it noncompliance
Pain, fatigue, uncertainty, cost, work, caregiving and lack of space can all affect follow-through. “I didn’t do it” is the start of a conversation, not a character judgment.
Ask which exercises they tried, what happened and which one felt useful. Watch a demonstration. A missed program may reflect confusing instructions or a task that is too difficult—not lack of motivation.
Readiness to change can vary by behavior and circumstance. Use it to guide the conversation rather than assigning the person a permanent label.
2. Build the smallest useful plan
Keep the exercises that address the priority goal. For chair rising, that might be an assessed strength need plus appropriately dosed chair-rise practice. Remove duplicate tasks unless they have separate useful roles.
Agree on when and where the activity will happen, what equipment is needed and how much to do. A stable chair near the kitchen may be more realistic than equipment stored downstairs.
Ask for a demonstration and an explanation in their own words: what is this for, how will you do it, and what will you do if the response is different from expected? Give clear written or visual instructions to support—not replace—that conversation.
3. Plan for the difficult day, then review
Agree on an appropriate fallback rather than leaving the choice as all or nothing. For example, fewer planned tasks or shorter activity bouts may fit a difficult day if clinically appropriate. Define when symptoms or changes need review instead of exercise.
Use a simple record if it helps: activity completed, amount and relevant response. Avoid turning the log into another barrier. With permission, family support or reminders may help.
At follow-up, review what actually happened and whether function changed. Adjust the plan together. If a goal is met, discuss maintenance and return to meaningful activities rather than indefinitely expanding the exercise list.
Before you move on
The person has ten minutes but the program takes thirty. Add education about motivation?
First address the mismatch. Agree on priorities, a feasible dose and a time and place. Education may help, but it cannot create twenty extra minutes.
They can repeat the instructions correctly. Do they understand the exercise?
Not necessarily. Ask them to demonstrate it and explain its purpose and response plan. Then correct unclear parts together.
Practice this chapter · 2 questions
Sources & learning scope
Based on these uploaded class references: 2 Assessment and Prescription; 3 Functioning and Disability. Original explanations and examples; class slides and licensed assessment forms are not reproduced. Current reference links: NICE PH49: goals, planning, monitoring and support. This is a concise student overview, not a complete treatment protocol. Apply skills within supervision, assessment findings and current precautions. Reviewed October 29, 2026.
