Levin Protocol – example

Below is an example of the Levine’s Protocol that may be recommended for patients.

The Autonomic Dysfunction Training Guidelines for Cardiovascular Fitness

Undertaking this program is a decision that you must be 100% committed to for yourself and your health. This program should be thoroughly understood by the patient as well as any assistant be it a committed parent, friend or the physical therapist. This program includes 3 to 5 days per week of cardiovascular aerobic training and 2 days per week of strength training. You will need access to a wide variety of gym equipment and therefore it is a good idea for you to join a gym or exercise facility. It is imperitive that patients begin with cardio and strength training exercise in a more horizonatal position and progress over many weeks to upright activity. Each patient does this at their own rate. Attached here is a specific calendar of typical progression over 6 months time.

The Structure of the Training Calendar
Training during the first months should only utilize the following horizontal modes; recumbent bike, rowing (Concept II is preferred), and/or swimming laps or kicking laps with a kickboard. Month 2 is usually when people can begin to use the upright bike and months 3 and 4 is when people can generally incorporate the more upright modes (elliptical and treadmill walking).

Think about the calendars as a weekly guide. You need to complete all the training for that week within each week. You may shift training sessions on the calendar a day or so before or after it is scheduled. However, it is important that all the sessions for that week then are shifted so the order they are preformed is maintained as prescribed and you complete all workouts for that week within that week.

The Basics of Strength Aerobic Exercise
A bit of stretching is recommended before the warm-up and after the cool-down. A 10 minute Warm-up and cool-down can be done on any piece of equipment and should not be skipped. At the end of your warm-up, you should have your heart rate approaching the appropriate heart rate range for your prescribed workout. For the cool-down, simply remove all resistance from the piece of equipment used and slow down.

After all MSS workouts you must always complete a Recovery workout the next day. A Recovery workout can actually be doing anything active so long as your heart rate stays below the zone prescribed. Recovery workouts can be done by slowly cycling at a low level on the recumbent bike, using a kickboard to leisurely kick laps is a pool, taking a walk outdoors, playing in the yard, anything that is active that gets you moving continuously for the prescribed amount of time.

If for some reason you miss a workout, it is best to back up the calendar and repeat cardio workouts. If you miss several workouts, back up and repeat a full week. If you stopped for more than 2 weeks, you may want to start over from the beginning.

The Basics of Strength Training
The weight training sessions prescribed should take you 25 minutes to complete. All weight training should be done on seated equipment and we do not recommend the use of free weights until you have gotten sufficiently strong. The strength training exercises are mainly for the lower body and core.

Recommended Strength Training Exercises

2 sets of 10 reps of the following 2 sets of 10 to 20 reps
Seated leg press Abdominal Crunches
Leg Curls Back Extensions
Leg Extensions Side Planks
Calf Raises Any Pilates-based exercises
Chest Press
Seated Row

You can view the complete example document below – or you can DOWNLOAD as a PDF