18. Big Three Level I

Level I is designed for older adults who can’t stand or who have difficulty standing for at least six minutes with or without support, such as a walker, due to limitations in strength, balance, or energy.

All exercises for Level I are performed while lying on your back.

I don’t recommend performing these exercises on the floor because getting up again may be difficult or dangerous.

You’ll be ready for Level II once you can stand for six minutes without too much difficulty.

Exercise 1: Straight Leg Raise

The first exercise in Level I is the straight leg raise. This exercise primarily works the large muscles on the front of the thighs, called the quadriceps. Known as antigravity muscles, these muscles work to oppose the effects of gravity, helping you maintain an upright and balanced posture in standing. The quadriceps are important muscles that help you go from sitting to standing and maintain your body in the standing position.

Equipment

Required

• A firm surface to lie down on; a softer bed or couch will work if a firm surface is not available.

To decrease challenge (optional)

• None.

To increase challenge (optional)

• Ankle weights.

Performing the straight leg raise

Starting position

• Lie on your back with one knee straight and the other knee bent with the sole of your foot flat on the surface.
• Ensure that the toes of your straight leg are pointed straight up and not turned to either side.
• Tighten the front thigh muscles of your straight leg.

Movement to ending position

• Lift the straight leg while keeping the front thigh muscles tight, the knee straight, and the toes pointed straight up. Make sure to breathe throughout the movement.

Ending position

• The straight leg is lifted so that the heel is two to three feet above the surface. Hold for a half second.

Return to starting position

• Lower the leg back to the starting position with control while keeping the front of the thigh muscles tight, the knee straight, and the toes pointed straight up.

Repetitions

• Repeat the movement at a moderate pace on the same leg up to 15 times. Repeat this exercise on the opposite leg once you’ve completed your repetitions on one side.

Points to consider

• Make sure you’re lying relatively flat while performing this exercise. The more your body is inclined, the less range of motion your leg gets, which means less work for your muscles, making the exercise less effective. You can have your head elevated on a pillow if you find that more comfortable.
• Make sure the toes of the straight leg are pointed straight up throughout this exercise. We tend to have our toes turned outward an inch or more, which can create muscle imbalances.
• Make sure the front thigh muscles of the lifting leg stay tight and the knee is straight throughout the exercise. This ensures the muscles get as much work as possible.
• Make sure the bottom of the heel is no higher than three feet from the surface when the leg is in the ending position. We tend to lift the leg too high, which actually takes the work off the muscle and reduces the effectiveness of this exercise.

To decrease challenge

• If you’re not strong enough to lift your leg to the correct height, lift it to wherever you can manage right now. You’ll get stronger over time.

To increase challenge

• Modify the starting position so that the heel of the straight leg is hovering a half-inch above the surface. Perform the exercise so that your heel doesn’t touch the surface at any time.
• Add an ankle weight to your leg. Start by placing the weight above your knee, lowering it to your ankle as you get stronger. This helps to gradually increase the torque around your hip and knee to protect you from injury.

Exercise 2: Single-Leg Tuck

The second exercise in Level I is the single-leg tuck. Like the straight leg raise, this exercise primarily works the large antigravity muscles at the front of the thighs, but it also works the hip flexor muscles that lift your legs from the ground.

Weakness in the hip flexor muscles can make the legs feel heavy and is a common reason why older adults drag their feet when they walk; this altered gait results in a high risk for falls. Strengthening the hip flexor muscles will make your legs feel less heavy and help you pick up your feet to clear the ground.

Equipment

Required

• A firm surface to lie down on; a softer bed or couch will work if a firm surface is not available.

To decrease challenge (optional)

• None.

To increase challenge (optional)

• Ankle weights.

Performing the single-leg tuck

Starting position

• Lie on your back with one knee straight and the other knee bent with the sole of your foot flat on the surface.
• Ensure that the toes of your straight leg are pointed straight up and not turned to either side.

Movement to ending position

• Lift the straight leg about 12 inches off the surface. Then bring the knee of the lifted leg toward your chest until the hip and the knee are both bent at a 90-degree angle. Make sure to breathe throughout the movement.

Ending position

• The leg that you lifted is bent 90 degrees at the hip and knee. Hold for a half second.

Return to starting position

• Straighten the lifted leg while lowering it back to the starting position with control and ensuring that the toes are pointed straight up.

Repetitions

• Repeat the movement at a moderate pace on the same leg up to 15 times. Repeat this exercise on the opposite leg once you’ve completed your repetitions on one side.

Points to consider

• Make sure you’re lying relatively flat while performing this exercise. The more your body is inclined, the less range of motion your leg gets, which means less work for your muscles, making the exercise less effective. You can have your head elevated on a pillow if you find that more comfortable.
• Make sure the toes of the straight leg are pointed straight up throughout this exercise. We tend to have our toes turned outward an inch or more, which can create muscle imbalances.
• Make sure the knee does not bend too much during the movement portion of this exercise. The tendency is for the heel to drop toward the buttocks, which bends the knee too much and reduces the work on the muscles, making the exercise less effective. The movement should look like you’re marching in place on one leg while lying on your back.
• In the ending position, make sure the hip and knee of the moving leg are bent 90 degrees. The body should be in the shape of a lowercase letter h, or a chair, with your lower legs making the legs of the chair, your upper leg perpendicular making the seat, and your body making the backrest. We tend to overshoot the movement so that the hip and knee are bent too much in the ending position. This is a coordination issue that will improve with practice.

To decrease challenge

• If you’re not strong enough to perform this exercise with the proper form, have someone help you by placing one hand on your knee and one hand on your ankle to lightly guide you through the motion.

To increase challenge

• Modify the starting position so that the heel of the straight leg is hovering a half-inch above the surface. Perform the exercise so that your heel doesn’t touch the surface at any time.
• Add an ankle weight to your leg. Start by placing the weight above your knee, lowering it to your ankle as you get stronger. This helps to gradually increase the torque around your hip and knee to protect you from injury.

Exercise 3: Hip Raise

The third exercise in Level I is the hip raise. This exercise primarily works the powerful muscles of your buttocks, commonly referred to as the glutes. The glutes are important muscles that help you go from sitting to standing and also oppose the effects of gravity to help you maintain an upright and balanced posture when standing.

Equipment

Required

• A firm surface to lie on; a softer bed or couch will work if a firm surface is not available.

To decrease challenge (optional)

• None.

To increase challenge (optional)

• Ankle weights.

Performing the hip raise

Starting position

• Lie on your back with your hands folded together on your stomach, both knees bent at slightly less than 90 degrees, feet flat on the surface with toes pointed straight forward, and feet and knees about six inches apart.
• Tighten your buttocks and abdominal muscles.

Movement to ending position

• Lift your hips up by pushing down on your feet while keeping your abdominal muscles tight. Make sure to breathe throughout the movement.

Ending position

• Your hips are lifted so that your body is in a straight line from your knees to shoulders, and your knees are bent at about 90 degrees. Hold for one to two seconds.

Return to starting position

• Lower the hips back to the starting position with control while keeping your abdominal muscles tight.

Repetitions

• Repeat the movement at a moderate pace up to 15 times.

Points to consider

• Make sure you’re lying relatively flat while performing this exercise. You can have your head elevated on a pillow if you find that more comfortable.
• Make sure the toes of both feet are pointed straight forward and not turned outward or inward. Also, ensure your feet are aligned so the toes of one foot are not ahead or behind the toes of the other. This will avoid creating muscle imbalances.
• Make sure that both knees are bent to slightly less than 90 degrees in the starting position. You can accomplish this by bending your knees to 90 degrees and then sliding both heels about two inches toward your buttocks. This is so that your knees will be at a 90-degree angle when your hips are fully raised in the ending position, which optimizes the work on your glute muscles while also protecting your lower back.
• Make sure to keep the feet and knees six inches apart during this exercise. You may tend to collapse the knees inward during movement, which may place strain on your joints.
• Your hands should be resting on your stomach so you avoid the temptation of using them to assist with the movement.

To decrease challenge

• If you’re not strong enough to lift your hips to the correct height, lift to wherever you can; you’ll get stronger over time.

To increase challenge

• Place ankle weights on top of your pelvis to increase the resistance.

In this chapter, you learned the nuts and bolts of performing Big Three Level I. The next chapter provides detailed instructions for Big Three Level II.

Key Takeaways

• Level I is designed for older adults who can’t stand or who have difficulty standing for at least six minutes with or without support, such as a walker, due to limitations in strength, balance, or energy.
• Level I exercises are the straight leg raise, single-leg tuck, and hip raise.
• You’re ready for Level II once you can stand for six minutes without too much difficulty.

Action Steps

• If this is the right level for you, spend some time going through the steps of each exercise until the movement feels natural. Try to cultivate an experimental mindset, and slow things down to learn the movements correctly. It’s okay if your performance is less than perfect at first. Notice what “right” feels like in your body as you start to get the hang of each exercise.
• If you haven’t done so already, get the exercise illustrations for this level, included in the free bonus resources at www.sixminutefitness.com/bonus . Post the illustrations on the wall in the room where you’ll be exercising so you can see them easily.
• If you’re a family member or a caregiver for an older adult you’d like to help with exercise, assist them with the above action steps.