FAME Exercises@Home during COVID-19
With COVID-19, many stroke survivors have had their rehabilitation or community exercise activities shut down. We have had many queries on using FAME exercises at home. In the past, we have provided a handout to participants in FAME who want to do some of the exercises at home. We are making this handout available, as well as videos of the exercises. Please read the following important considerations prior to using these exercises.
The University of British Columbia will not be liable to you or any other person or entity (including but not limited to persons treated by you or on your behalf) for any liability, loss or damages caused or alleged to have been cause, either directly or indirectly, by the use of FAME. Without limitation, in no event will UBC be liable for any tort, personal injury, medical malpractice, misdiagnosis, death, product liability, loss of profit or data, or for special, indirect, consequential, incidental or punitive damages, however caused and regardless of the theory of liability, arising out of or related to the use of or inability to use FAME, even if UBC has been advised of the possibility of such losses or damages.
Who is appropriate for undertaking FAME exercises@home?
If you can answer YES to all of these questions, then FAME may be appropriate for you to do at home.
- Have you had a stroke?
- Do you want to improve walking, fitness, and balance?
- Can you stand for 5 minutes without assistance?
- Can you walk for 10 metres with or without a walking aid?
- Can you walk without another person helping you?
- Are you medically stable – for example, your blood pressure or atrial fibrillation is controlled with medication; you do not have chest pain with activity
- Do you have a friend or family member who can assist with the exercises?
How to use FAME@home?
- Download and review the: 1). FAME Instruction Manual and 2). FAME Exercise Manual from fameexercise.com.
- Download the 2-page FAME@Home Exercise Handout.
Review the tips below:
1. Safety First:
We strongly recommend that you seek out a physiotherapist in your local area who could provide some guidance through video or telerehabilitation. Many physiotherapists are now providing this service due to COVID-19. Provide the fameexercise.com link to your physiotherapist.
Confirm with your family doctor that you are safe to undertake moderate intensity exercise that will last one hour. Purchase an automatic blood pressure monitor from your local drug store. Check that your resting blood pressure is within normal ranges before starting exercise each time. Instructions on how to use a blood pressure monitor properly can be seen at the following link: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/multimedia/how-to-measure-blood-pressure/vid-20084749
Your systolic resting blood pressure should be less than 140 mmHg and your diastolic resting blood pressure should be less than 90 mmHg. If you are diabetic, it should be less than 130 mmHg/80 mmHg. If your blood pressure is higher, then visit your family physician before you start an exercise program. Note that resting blood pressure is taken after at least 5 minutes of rest and you should avoid caffeine (coffee, cola, tea), smoking and exercise for at least an hour prior to measuring your blood pressure.
2. Keep the exercise at a moderate intensity level:
Keep the exercise at a moderate level. This means you should be breathing a bit harder than normal, but you should still be able to carry on a conversation comfortably or with a little effort. Take rest breaks if you are getting out of breath. You should not have any chest pain (angina) or be exhausted.
3. Reduce the risk of falls:
Many people after stroke have poor balance and some may not have good judgement about their abilities and can fall. This is why FAME is done with physical therapists or fitness instructors to help supervise or spot the client. It is important to have someone with you while you are doing the exercises. See the Carers and Spotting Participants in Section 5 of the Instructor Manual. If your carer is already helping you with transfers and mobility assistance at home, then they may be appropriate to help spot you during some of the exercises that are more challenging for you. FAME exercises do not require any lifting. Spotters should be providing some physical guidance in helping the person to balance. If heavy lifting is required, the individual is not appropriate for FAME. Any spotter needs to be in good physical shape and be familiar with basic biomechanics when physically assisting others. In particular, a spotter needs to understand how to keep their back straight and bend their knees when spotting a participant. The size of a participant relative to the spotter matters. A small person is not safe to spot a tall or heavy participant. A carer who is the same age as an older participant may not have the physical abilities or attention to assist.
The participant can stand beside a counter or sturdy chair for hand support if required. The spotter needs to stand close to the participant to be an effective spotter and have their hand ready and close to the trunk in case the participant’s balance needs adjustment. If the participant has any shoulder pain from the stroke, the spotter should not grab onto the participant’s stroke-affected hand or arm. A transfer belt may make it easier to spot the participant. A transfer belt is a wide, typically canvas belt often with handles that are easy to grab onto. Do not let the participant grab onto the spotter. Instead the spotter can help the participant balance by lightly supporting the trunk or the forearm and upper arm.
4. Start slow and progress gradually:
From the FAME@Home handout, start with a small amount of exercise. For example, start with 1 warm-up exercise, 1 functional strengthening exercise, 1 balance exercise, 1 agility/fitness exercise and 1 cool down exercise. For the functional strengthening, balance and agility/fitness exercise, progress from 1 set of 5 to 1 set of 10 to 3 sets of 10. This may take days for some people and weeks for others. Select 1 seated exercise to do when a rest is needed. Then gradually progress to three functional strengthening, three balance and three agility/fitness exercises. Repetitions are really important for recovering from a stroke as hundreds of repetitions can improve brain pathways. Thus, the goal is to eventually work up to 5 continuous minutes of each exercise, and to eventually be able to do continuous standing and walking exercise for the hour. It may take weeks or months of short bouts with seated exercise in between before being able to sustain a full hour of exercise. To get in sufficient exercise to meet Canadian and American physical activity guidelines for people living with stroke, exercises should be done at least three times a week.