HomeStretch Program Clients Improve Health Through Safe Exercise

Just a few months ago, Jacqueline Franklin suffered from severe back pain which made it difficult for her to get

Jacqueline Franklin works with physical therapy grad students to improve overall strength

around safely in her studio apartment. Now, she manages to get out of her apartment every day and enjoys walking to the store, or just going outside for some fresh air. Her strength and balance have improved so much  that instead of taking her walker, she now reports, “I just take my time.”

Jacqueline credits the HomeStretch Program for improving her strength and flexibility, both of which helped to diminish her back pain and reduce her risk of falling.

HomeStretch is an innovative in-home exercise program for older adults that was developed by Anne Shumway-Cook, Ph.D., of the University of Washington’s Department of Rehabilitation Medicine in partnership with Aging & Disability Services’ Case Management Program. The six-week program uses an intergenerational model which couples young adult graduate students with homebound elderly case management clients. The goal of the program is to help the clients become more active through regular physical exercise so that they can manage their chronic conditions.

HomeStretch participants receive six home visits by a team of two second-year Physical Therapy (PT) graduate students. The first visit includes a comprehensive PT assessment which the students and clients use to develop an individualized program to increase strength, flexibility, cardiovascular fitness, balance and mobility. The PT

This stairstep exercise helps increase leg strength and balance

students conduct four additional home visits to work with the client on a home exercise program. The clients are re-evaluated on a final visit using the same tests and measures performed on the first visit.

HomeStretch includes the same components found in exercise programs for healthy older adults; however, the intensity and duration of the exercises are modified according to the client’s ability and health status. The PT students instruct the clients on how to exercise using proper form, and on creating a safe home exercise environment, both of which help prevent injuries. The students also carefully monitor the client’s response to exercise by checking blood pressure and heart rate before and after the sessions. 

Motivation is a key part of any exercise program, and HomeStretch recognizes and incorporates this important element. Instead of prescribing a standard set of exercises for a particular condition, the PT students work together with the client to create a personalized program that is meaningful for that individual. On a daily basis, HomeStretch clients can choose to modify the exercises based on their own judgment of how they are feeling that day. For example, they may choose to do more exercises sitting or decrease the weights. As a result, clients become more in touch with what their own bodies need.

Jacqueline and the PT students working with her, Rachel Nelson and Crystal Periot, agreed upon three goals for her participation in the program: to increase her walking time to 10 minutes a day; to decrease her back pain; and to increase her leg strength.  Jacqueline exceeded these goals, getting a nearly “perfect” score on her leg strength measure in the final evaluation, and she is continually improving her 

Rachel and Crystal test Jacqueline’s balance and range of motion

fitness level.  She is also delighted to be free of back pain.

Other clients in the HomeStretch program report similarly positive outcomes, including improved physical performance (upper and lower extremity strength, balance and mobility) and a reduction in fall risk of 30%.

The PT students also benefit from the HomeStretch program.  Working in an in-home setting is an eye opening opportunity for many of the students—they get to see the patient in “real life” instead of in the usual medical setting, which helps them better assess the patient’s needs and develop a program that will meet those needs.  They also tend to develop a closer rapport with the client.

While Jacqueline likes to give the credit to HomeStretch, and specifically to Rachel and Crystal, for helping her become more active, the PT students describe her as one of their most committed clients.  Jacqueline never misses her daily exercise routine even though the official six-week program is over. She appreciates being able to exercise in a way that she enjoys, which for her means incorporating “little bits here and there” throughout the day. She often exercises during commercial breaks on TV, or whenever she has a spare moment. “I’m always stretching,” she says. 

Jacqueline has noticed the connection between the exercises that she does and her improvement in everyday activities. Things that used to be hard, such getting up from a chair or getting on a bus, are much easier for her. This is what keeps her going. “I feel great,” she says.

For more information about the HomeStretch Program, contact Janet Epstein, Case Management Wellness Coordinator, at (206) 615-0992 or janet.epstein@seattle.gov.