Exercise After Stroke

The course is based on original research by the University of Edinburgh.

Course Development Team

The development and delivery of the Exercise after Stroke Specialist Instructor Training Course is led by a multidisciplinary course team, which comprises:

* Dr. Gillian Mead (team lead): Reader and Honorary Consultant Geriatric Medicine, Department of Clinical and Surgical Sciences, The University of Edinburgh and Royal Infirmary of Edinburgh.
* Dr. Susie Dinan-Young: Senior Research Fellow Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, Director: Later Life Training Ltd.
* Mr. John Dennis: Physiotherapy Team Lead, Stroke North.
* Mr. Mark Smith: Consultant Physiotherapist, Stroke Rehabilitation NHS Lothian and Leith Community Treatment Centre, Edinburgh.
* Mrs. Sara Paul (nee Wicebloom), Senior Tutor on the Postural Stability Instructor Course, LLT and Lead on the Inclusive Fitness Initiative.
* Prof. Marie Donaghy: Dean, School of Health Sciences, Queen Margaret University, Edinburgh.
* Dr. Frederike van Wijck: Reader in Neurological Rehabilitation, Glasgow Caledonian University (originally from School of Health Sciences, Queen Margaret University).

The course was developed by Queen Margaret University (QMU) and The University of Edinburgh, and validated by QMU

"Exercise and Fitness Training After Stroke"
Vision More people after stroke, more active more often, exercising safely and effectively. Welcome to the Exercise and Fitness Training after Stroke (EfS) Specialist Instructor Training Course. This course has been designed to provide exercise instructors and other suitably qualified practitioners with an accredited qualification, which will enable them to provide exercise classes that are safe, effective, appropriate and enjoyable for people who have had a stroke. This page details information about the background to this course, an overview of the evidenced-based exercises and course content, entry requirements, course assessment and qualification, cost, the original Course Development Team and Reference Group and the original Funders of the course. The course is fully approved at Level 4 status with the Register of Exercise Professionals and has the support of the key Non Governmental Organisations in Stroke. We work in collaboration with ARNI on CPD.
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The course is based on original research by the University of Edinburgh. Course Development Team The development and delivery of the Exercise after Stroke Specialist Instructor Training Course is led by a multidisciplinary course team, which comprises: * Dr. Gillian Mead (team lead): Reader and Honorary Consultant Geriatric Medicine, Department of Clinical and Surgical Sciences, The University of Edinburgh and Royal Infirmary of Edinburgh. * Dr. Susie Dinan-Young: Senior Research Fellow Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, Director: Later Life Training Ltd. * Mr. John Dennis: Physiotherapy Team Lead, Stroke North. * Mr. Mark Smith: Consultant Physiotherapist, Stroke Rehabilitation NHS Lothian and Leith Community Treatment Centre, Edinburgh. * Mrs. Sara Paul (nee Wicebloom), Senior Tutor on the Postural Stability Instructor Course, LLT and Lead on the Inclusive Fitness Initiative. * Prof. Marie Donaghy: Dean, School of Health Sciences, Queen Margaret University, Edinburgh. * Dr. Frederike van Wijck: Reader in Neurological Rehabilitation, Glasgow Caledonian University (originally from School of Health Sciences, Queen Margaret University). The course was developed by Queen Margaret University (QMU) and The University of Edinburgh, and validated by QMU		Reference Group for original development of course The course team is overseen by a multidisciplinary Reference Group, comprising committed individuals who have given their time, effort and invaluable expertise in reviewing the standard, content, organisation and delivery of this course. The Reference Group comprises of more than 30 individuals, including specialists from a wide range of relevant professions: Consultants in Stroke Medicine and Geriatrics, stroke specialists in Physiotherapy, Occupational Therapy, Speech and Language Therapy and Nursing, Exercise Physiology and Exercise Science, Patient and Carer representatives, representatives from Patient Organisations (i.e. Different Strokes, The Stroke Association and Chest Heart Stroke Scotland), The Register for Exercise Professionals, SkillsActive, Health Promotion Officers, representatives from Edinburgh Leisure and Glasgow Leisure, The Scottish Government and senior academics in Stroke Care, Physiotherapy and Exercise & Health, as well as Exercise Science. The expert input from this group has been invaluable and the course team wishes to express their sincere thanks to the Reference Group for their contribution.
The original course development was funded by:

The course is supported by the following key NGO's:


Background There is an increasing need for people who have had a stroke to engage in exercise, as a stroke often results in reduced strength, mobility, fitness and mood as well as social isolation. Many of these problems could be alleviated through exercise, but a stroke may also result in a myriad of additional challenges such as pain, impaired movement or comprehension, which may render it difficult for people with stroke to access exercise facilities. These challenges - as well as other complications - need to be recognised and managed effectively by exercise instructors to enable people to exercise safely. Providing exercise classes for people after stroke can be hugely rewarding – but this requires specialist knowledge and brings with it a considerable responsibility. Although there is an increasing number of exercise referral schemes for people who have had a stroke, there was - until recently - no accredited course for exercise instructors to work with this population. This accredited Exercise after Stroke Specialist Instructor Training Course has been designed to fill this gap. Read an article about the gap in provision following stroke.
Course Overview Aim The overall aim of this course is to enable Specialist Exercise Instructors and other suitably qualified staff (e.g. Physiotherapists) to design, implement and evaluate physical activity programmes for people after stroke that are safe, effective, appropriate and enjoyable, based on current evidence, and in accordance with the relevant clinical guidelines (1) , national service frameworks (2) , national occupational standards (3) (4) and educational standards (5) .
Content This 20-credit course at SCQF Level 8 (comparable to BSc(Hons) Level 2), comprises a total of 200 hours of student work. This includes lectures, tutorials and practical workshops as well as home revision. The Course runs over five teaching days with a final assessment day (six days total). The six days are spread over a period of 8 to 12 weeks to allow sufficient time, between course days, for ‘home' revision and set course work. The course can be run on both weekdays and weekends depending on demand. Each day runs from 9am to 5.30pm (60 contact hours) and there is approximately 200 hours of contact and self-directed learning time. In terms of content, the course follows the patient journey from acute stroke through to rehabilitation and referral into an exercise referral scheme. It concentrates on the role of the specialist exercise instructor in assessing the person with stroke, designing and delivering exercise programmes, evaluating their effects, as well as working as a professional as part of a multidisciplinary team. Along the way, the following topics are covered: pathology of stroke; input of the multidisciplinary team in the management of stroke; fitness levels after stroke and its impact on function; evidence for physical activity after stroke and the impact of physical activity on risk factors in stroke; indications and contra-indications to exercise after stroke; clinical guidelines; implications of co-morbidities and medications on exercise performance; motivation and communication strategies aimed at improving health behaviour; relevant professional standards pertaining to ethical issues including; confidentiality and risk management and national service frameworks.
The course theory examines the different types and causes of stroke, the impact, recovery and co-morbidities, stroke management services and secondary prevention, physical fitness after stroke, the effects of exercise after stroke, assessment and screening tools and referral guidelines. It discusses the role of the exercise professional, including effective communication, goal setting and motivational behaviour change techniques. Finally, it introduces service implementation and evaluation. The course practical uses the evidence based exercises from the evidence based STARTER trial (6) and theory from a recent Cochrane Review (7). Through workshops and case study it educates instructors to introduce, adapt, individually tailor and progress exercises according to the specific and differing needs of this patient/client group. Workshops include teaching in groups and on a one-to-one basis. The course content is delivered through lectures, practical workshops and self-guided learning. The tutor team on each course includes three experienced specialists in exercise after stroke: a consultant, a physiotherapist and an exercise instructor . Resources On day one of the course, all candidates will be supplied with a course manual covering theory and practice, together with a pack of the Powerpoint presentations. Assessment Evidence of current CPR proficiency must be brought to the assessments. Candidates will take a 2 hour theory paper, produce a Session Plan, then teach and self-evaluate their teaching of an exercise after stroke group and one-to-one exercise session. This will include a warm up, followed by functional exercises taught in a circuit, in a group and on a one-to-one basis, and flexibility exercises taught in a cool down. Particular emphasis will be placed on specific adaptations and progressions. A minimum of 40 minutes of teaching will be observed. They will also have to complete a Case Study on a patient after stroke following viewing of a short film clip, and will be required to submit the written Case Study relating to this individual according to the guidelines provided. Tutors The Later Life Training tutor team is made up of physiotherapists and specialised exercise educators, with specific expertise and experience working in exercise after stroke and adult education. In addition to the Later Life Training tutor team, there are lectures given by a local stroke consultant. Certification All successful candidates will receive a Later Life Training Certificate in Exercise and Fitness Training after Stroke. Those taking the first five days of the course and not wishing to sit the assessments will receive a Certificate of Attendance. Level of Certification The course is designed to offer an equivalent level of training to the Postural Stability Instructor and British Association of Cardiac Rehabilitation Courses and successful candidates with appropriate pre-requisite experience and qualifications are able to apply for Level 4 Specialist Exercise Instructor Status (20 points) with the Register of Exercise Professionals. Students passing this module will gain a qualification at Scottish Qualification Framework level 8 in “Physical Activity and Health: Specialist Instructor in Exercise after Stroke”. This module follows the model of the well-established British Association of Cardiac Rehabilitation and the Department of Health development-funded Exercise for the Prevention of Falls and Injuries programmes. These courses are recognised by both health and exercise professionals as the gold standard in these specialist areas. Additionally, the module is aligned with the following framework and standards: - Chartered Society of Physiotherapist Curriculum Framework - National Skills Active Physical Activity Standards for people after Stroke (Unit D561): Design and agree a physical activity programme with people after stroke 2. Deliver, review, adapt and tailor a physical activity programme with people after stroke Using the Qualification It is anticipated that successful candidates will deliver sessions either working within the therapies in a hospital programme, or leading exercise after stroke sessions in community settings, as part of a local health improvement plan or onward referral from the Rehabilitation setting. The Scottish Government project www.exerciseafterstroke.org.uk gives more information about setting up exercise services for people after stroke.
Entry requirements In order to enter the course, the candidate must be able to demonstrate successful completion of: NVQ Level 3 (and Register for Exercise Professionals (REPS) Level 3) Advanced Personal Trainer or Diploma in Exercise and Physical Activity Instructor Award OR NVQ Level 3 Exercise for the Older Person Advanced Instructor Award, OR NVQ Level 3 Exercise for Pre and post Natal Women Advanced Instructor Award; OR NVQ Level 3 Exercise for Referred Populations Advanced Instructor Award; OR NVQ Level 3 Exercise for People with Disabilities Advanced Instructor Award; OR NVQ Level 2 (REPS Level 2) Physical Activity Instructor Award with equivalent experience through APL (e.g. working with patients). This unit should only be attempted on successful completion of, or in conjunction with, the advanced instructor core units D437 (collect and analyse information to plan a progressive physical activity programme), D438 (plan, review and adapt a progressive physical activity programme), D439 (plan and instruct specific physical activities), C313 (provide motivation and support to clients during a progressive physical activity programme), D440 (apply the principles of nutrition and weight management to a progressive physical activity programme), A318 (manage, evaluate and improve own performance in providing physical activity). Further information on these units can be found on the Skills Active website; OR BSc Physiotherapy BSc Physiotherapy, Occupational Therapy, Nursing, OR BSc Exercise, Sports or Health Science.
Cost of the Course The full course cost is £595 + VAT per applicant and includes the Course Manuals, Assessments and Certification. If you wish to host a course we can offer further discounts if you can provide 12 candidates or more.
How to apply A copy of the Flyer is available here to download. Course dates and venues will be added to the Course dates page as and when we set them, in the meantime please contact us If you are interested in attending or hosting an EfS course, please contact the LLT Stroke Course Co-ordinator Sara Wicebloom Paul using the contact details below: Later Life Training Soapstone Studios Finlarig Road Dulnain Bridge Morayshire PH26 3NU Tel: 01479 780541 e-mail: sara.paul @laterlifetraining.co.uk
References: [1] Intercollegiate Stroke Working Party (2008). National clinical guideline for stroke (3rd edition). London: Royal College of Physicians. http://www.rcplondon.ac.uk/pubs/contents/6ad05aab-8400-494c-8cf4-9772d1d5301b.pdf [2]Department of Health (2001). Exercise Referral Systems: A national quality assurance framework . http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_4009671 [3] SkillsActive. National SkillsActive Physical Activity Standards for people after Stroke (Unit D561) . http://www.skillsactive.com/training/standards/level-4/Physical-Activity-and-Health/ [4] Register for Exercise Professionals: http://www.exerciseregister.org/ [5] Scottish Credit and Qualifications Framework Partnership (2006). Scottish Credit and Qualifications Framework (2001). http://www.scqf.org.uk/TheFramework/The-Framework-Home.aspx [6] Mead GE, Greig CA, Cunningham I, Lewis SJ, Dinan S, Saunders DH, Fitzsimons C, Young A. Stroke: a randomized trial of exercise or relaxation. J Am Geriatr Soc. 2007 Jun;55(6):892-9. Click here to see abstract [7] Saunders DH, Greig CA, Mead GE, Young A. Physical fitness training for stroke patients. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD003316. Review. Click here to see abstract
After the course - CPD: Action on Rehabilitation from Neurological Injury (ARNI) runs a course entitled ‘Functional Training after Stroke’, which is accredited by Middlesex University. ARNI specialises in providing a collection of functional approaches that can be taught to stroke survivors to help them with recovery of action control. The course is grounded in contemporary neurological research perspectives and is experientially-based : the creator (Tom Balchin) is a stroke survivor himself. The course also provides you with an invaluable opportunity to work with recovering stroke patients. (http://www.arni.uk.com/index.html). The two courses have been working together to ensure that exercise instructors and health professionals derive maximum benefit from each course.They have agreed that the Level 4 course (Exercise and Fitness Training After Stroke) will be the prerequisite for entry to the ARNI course. This will ensure sufficient stroke specific exercise and fitness training competence to meet the Skills Active and REPS National Occupational Standards and,thus importantly, entry onto REPS (which is essential for validation of insurance ) prior to working with stroke patients. The ARNI course will provide appropriate CPD in this specialist field.