If your patient is doing very well in her maximal daily exercises, what should you do?

When a patient demonstrates substantial progress in their maximal daily exercises, it is essential to ensure that the exercise regimen continues to provide an adequate challenge to promote ongoing improvement. Increasing repetitions, adding weight, or incorporating dual task challenges are effective strategies to enhance the intensity and effectiveness of the workout. This approach is grounded in the principles of progressive overload, which suggests that to continue gaining strength and functional abilities, the difficulty of exercises must increase over time.

By increasing the complexity or resistance of exercises, the patient remains engaged and motivated while also pushing their physical limits. This can lead to further improvements in strength, coordination, and overall motor performance, which are critical components of the LSVT BIG program designed for individuals with Parkinson's disease or similar movement disorders.

Maintaining the current level of challenge, reducing exercise duration, or switching to less challenging activities would not adequately support the patient’s development and may lead to plateauing in their progress. Therefore, to foster continued gains and prevent stagnation, introducing more demanding elements into their exercise routine is the most appropriate action.