Weekly Newsletter

August 21, 2024

Getting Somewhere: The Power of Baby Steps

This guide is meant for helping caregivers and care receivers, working together, to progress from lying in bed to beginning to stand and walk. One step at a time, of course. But all these exercises are basic and useful even as the level of skill and confidence improve. Bed exercises (or floor exercises) are effective for all levels of skill. Likewise, sit-to-stand exercise is a fantastic exercise for older adults to continue at all levels. Most of these exercises can be progressed by using weights or resistance bands.

FIRST STEP:

Getting out of bed

Beginning and Advanced bed exercises

Steps to go from laying down on your back to sitting at edge of bed and exercises to support that process.

While lying in bed:

1) Turn your head from side to side.

2) Bend one knee up, so that foot flat is on the bed; then the other leg into the same position.

3) In Hook-lying position (with both knees up and feet flat bring the knees held together) and move the knees (together) from one side to the other. Small movement, and gradually larger.

4) Bridging:

With both knees up and feet flat (hook-lying position) try to lift your hips. Lift only slightly, Try a little higher. Repeat, the lift if it’s easy. Increase to 10 reps as able. (Intermediate level exercise)

5) Roll onto each side. Once you can get both knees up and can rock them side to side, you are ready to get all the way onto your side. First roll your knees to the side, then reach with the top arm to help roll the rest of your body till you’re on your side.

6) Side leg lifts. While on your side: Side leg lift (intermediate level exercise). If you can do one, then try 2. Goal of 10 times. Each side

7) Straight leg raise: On your back, with one knee in hook lying, lift the other leg (the straight leg) up off the bed. Not high, but keep the knee of the leg you are lifting straight! Lift 1” or 10” but keep the leg straight! Do 1 lift. Gradually increase the number up to 10. Work on both sides. (intermediate-level exercise)

SECOND STEP:

Getting to sitting up at the side of bed:

1) While lying on your side (close to the edge of the bed), drop your feet and knees off the side of the bed (even touch the floor with your feet). If you are on your right side, press your right elbow into the mattress to help lift your upper body off the bed. (Hopefully you are now sitting up at the edge of your bed.)

2) Try the same on your other side: On your other side, again drop your feet off the side of the bed. Press the elbow you are lying on into the bed to start to lift your upper body. Again, with the weight of your feet and lower legs and a little help from your arm, which is on the bed, you will be sitting up before you know it.

You may need some guidance and/or assurance that you won’t end up falling out of bed. Always helpful to start with someone who knows what’s going on—standing in front of you (a trained family member, a nurse, or a therapist).

THIRD STEP:

Exercises to do while sitting at the side of the bed.

If you can keep your balance while sitting at the edge of the bed,

you are ready for the next exercises.

1) Sitting balance exercises: reaching with your arms from side to side or forward and backward. (Beginning)

2) Sitting up taller: With hands on either side of your legs, bend and straighten your elbows (you should feel like you are pushing yourself up)—making yourself a little taller, even taking a little weight off your bottom.

3) Scooting up and down the bed: (beginning/intermediate). Hands next to your thighs on the bed. Feet on the floor, sitting as close to the edge of the bed as you comfortably can. Lean forward, press your hands into the bed, straighten your elbows as you do this, and try to lift your hips slightly off the bed. Continue this exercise to gradually gain strength and confidence.

Check out this exercise video — very helpful!

(Intermediate) The next step will feel possible once you are becoming confident with lifting the hips, even a little. Now try to move sideways either up or down the bed. This is a great exercise in itself. Start slow and small. Get bigger movement. Go farther up and down the bed, scooting this way.

4) Using a sliding board to get from bed to w/c or bedside commode: Once you can scoot, you can get from one seat to another. From bed to wheelchair, etc.

Getting up from sitting

More advanced exercises to do from sitting to progress to standing.

1) When trying to progress to standing from sitting on a bed or any surface (chair), it is helpful to raise the surface you are sitting on. For example, if you have a bed that goes up and down, get the height of the bed up so that you’re already part way to standing. Or put a cushion on a chair to lift you up a little higher (see drawing below).

2) Beginning to lift hips off chair or bed: Similar to scooting sideways on the bed, use your arms to help you lift your hips by straightening your elbows (see diagram of chair with armrests.

With your hands on armrests (assuming you are in such a chair), lean forward to get the weight of your body more over your feet. Just leaning forward will shift your weight forward more onto your feet and off your bottom. As you shift your weight forward this way, try to push down with your hands on the armrests, straighten your elbows, and see if you can lift your hips a little. If you got anywhere, keep going. Repeat. Lift the hips a little higher. Repeat. But keep your hands on the armrests (or bed) for now. Goal might be 10 lifts—without too much straining.

3) From hips off bed or chair to standing with support (counter, walker, friend): Once you can repeatedly lift your hips up from chair, couch, or bed, you could be ready for standing.

4) Now using your legs and your arms to come to stand: As you can begin to lift your hips with your arms, you will begin to also push down with your feet. Your weight must be truly over your feet, and then you can begin to straighten your knees and hips and stand up. (Your feet need to be under your knees or even bent a little more, back under your knees and thighs.)

The alignment challenge: Bend forward at your hips until your shoulders are over or almost over your knees. Then you must bend your knees so your knees over your feet. (Or you could say, your feet are under your knees!) Picture this in your mind before you stand. It’s like an accordion. It will feel right and doable once you have this alignment. No amount of strength or skill will get you on your feet, standing—if your shoulders, hips, and knees aren’t lined up.

Standing

Once standing with walker, counter, or other stable support surface:

1) Weight shifts in standing with support. Turn on the music and move like this (side to side) to the music. Get tired, sit down. After resting, do some more. (See video below)

(Lateral weight shifts)

Only need to see the first 14 seconds from start to 30 seconds.

Don’t forget the music!

2) Do the same without support or with light support (like another human being in front of you, holding their hands). (With some music, this could feel like dancing with a partner!)

3) Now you might be ready to move forward with your walker or helper.

And you’re on your way. (Come to “GET YOUR ZOOM ON” once you’re on your feet to continue these types of exercises.)

Susan Musicant, PT, DPT

Senior Injury Prevention Coordinator