Improving access to exercise for people with neurological conditions
Submitting InstitutionOxford Brookes University
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Public Health and Health Services
Summary of the impact
The pioneering research carried out by Brookes' Movement Science Group
(under the umbrella of the Centre for Rehabilitation) into the barriers
and benefits of safe community led exercise for people with long-term
neurological conditions, has significantly improved quality of life for
many sufferers. Their research has raised awareness amongst healthcare and
fitness professionals, and led to specific measures being put in place to
facilitate and encourage exercise. These measures include the development
of: clinical exercise and rehabilitation units, web-based physical
activity support system, national occupational standards, and the only
level 4 accredited exercise training course in the UK. The research has
also led to the establishment of a registered charity that aims to
increase exercise participation of people with long-term neurological
conditions across the UK.
The research and impacts reported here originate from the work of the
interdisciplinary Movement Science Group (MSG) based within the Centre for
Rehabilitation at Oxford Brookes University (Brookes) from 2005 to the
present. The Brookes Movement Science Group is principally comprised of
Prof. Helen Dawes, Dr. Johnathan Collett, Dr. Patrick Esser. Since its
inception the following have also contributed: Charlotte Elsworth (PhD
student from Birmingham), Ken Howells (Brookes), Derick Wade (Brookes
& Oxford), Charlotte Winward (PhD student & Physiotherapist),
Meredith Newman (PhD student), Andy Meaney (CLEAR unit director, Brookes),
James Bateman (CLEAR unit staff, Brookes) and Elizabeth Buckingham (user
The work of the MSG has addressed the provision of exercise for people
with neurological conditions, by providing evidence in support of both
appropriate content and safe community delivery exercise interventions,
evaluating systems for delivery and identifying barriers and facilitators
to physical activity. The research has taken the form of experimental
studies investigating the mechanisms of benefit alongside effect of
clinical trials, incorporating both quantitative and qualitative methods,
and falls into two broad themes:
People with neurological conditions approached the MSG and asked them to
develop a system to support their safe participation in exercise and
physical activity, as they felt isolated and unable to exercise in their
local community. This was largely due to the lack of training of fitness
professionals to support people with neurological conditions; a lack of
knowledge of appropriate exercises and a lack of appropriate facilities.
Dawes, Wade and Esser undertook the first study for the Long-term
Neurological Conditions Research Initiative (LTNC), Policy Research
Programme, Department of Health to develop and evaluate a physical
activity support system (PASS) for people with neurological conditions
(Grant no. 0530006, 2005-8). This confirmed that there was no appropriate
cheap delivery model for community exercising for neurological conditions
. The study demonstrated that people with long-term neurological
conditions can safely exercise in community gyms when supported and
achieve similar attendance to standard exercise referral schemes  and
then provided insight on how to deliver and support it .
The evidence for the beneficial effects of exercise is overwhelming and
increasing activity levels is now an important part of government health
policy. The group undertook pioneering research on exercise for people
with neurological conditions. Specifically, Dawes investigated treadmill
walking exercise for people with Multiple Sclerosis (pwMS) and
demonstrated that aerobic treadmill training is feasible and well
tolerated. Improving walking speed and endurance and did not increase
Concerns over fatigue and exacerbating MS symptoms have, in the past, led
to exercise being discouraged in people with MS. Dawes, Collett and Wade
further investigated exercise `dose' for pwMS in a study funded by the MS
society (Grant no. 840/06, 2007-9). The study was the first to look at
high intensity exercise `doses' in people with MS and found that all
intensities improved mobility and leg power. However the results indicated
that greater benefit may be associated with higher-intensity exercise, and
although this may be less well tolerated, it did not cause exacerbations
References to the research
1. Elsworth, C., Dawes, H., Sackley, C., Soundy, A., Howells, K.,
Wade, D., Hilton-Jones, D., Freebody, J. and Izadi, H. (2009). A study
of perceived facilitators to physical activity in neurological
conditions. International Journal of Therapy and Rehabilitation, 16
Izadi; Department of Mathematical Sciences, Oxford Brookes University
Sackley; School of Population Sciences, University of Birmingham
Soundy; School of Health Sciences, University of Birmingham
Hilton-Jones and Freebody; Department of Clinical Neurology, University of
2. C. Elsworth, C. Winward, C. Sackley, C. Meek, J. Freebody, P.
Esser, H. Izadi, A. Soundy, K. Barker, D. Hilton-Jones, C. M. Lowe, S.
Paget, M. Tims, R. Parnell, S. Patel, D. Wade and H. Dawes, (2011), Supported
community exercise in people with long-term neurological conditions: a
phase II randomized controlled trial, Clinical Rehabilitation, 25
(7), 588-598 DOI: 10.1177/0269215510392076
Meek & Patel; Primary Care Clinical Sciences, School of Health and
Population Sciences, University of Birmingham.
Barker & Minns-Lowe; Physiotherapy Research Unit, Nuffield Orthopaedic
Centre, Oxford Paget & Parnell; Department of Clinical Neurology,
University of Oxford
Submitted to REF2014, Oxford Brookes University, UoA3- Allied Health
Professions, Dentistry, Nursing and Pharmacy, P Esser, REF2, Output
3. Winward and LIFE group, (2011), Supporting community-based
exercise in long-term neurological conditions: experience from the
Long-term Individual Fitness Enablement (LIFE) project, Clinical
rehabilitation, 25 (7), 579-87, DOI: 10.1177/0269215510392075. LIFE Group
is collaborative group research group including: Charlotte Winward,
Charlotte Elsworth, Cath Sackley, Charmaine Meek, Jane Freebody, Patrick
Esser, Andy Soundy, Karen Barker, David Hilton Jones, Catherine Minns
Lowe, Sandra Paget, Martin Tims, R. Parnell, Smitaa Patel, Derick Wade and
4. M. van den Berg, H. Dawes, D. T. Wade, M. Newman, J. Burridge,
H. Izadi and C. M. Sackley, (2006), Treadmill training for individuals
with multiple sclerosis: a pilot randomised trial, Journal of
Neurology Neurosurgery and Psychiatry, 77 (4), 531-533, DOI: 10.1136/jnnp.2005.064410'
van den Berg, University of Birmingham; Burridge, University of
5. J. Collett, H. Dawes, A. Meaney, C. Sackley, K. Barker, D.
Wade, H. Izardi, J. Bateman, J. Duda and E. Buckingham, (2011), Exercise
for multiple sclerosis: a single-blind randomized trial comparing three
exercise intensities, Multiple Sclerosis Journal, 17 (5), 594-603.
DOI: 10.1177/1352458510391836. Duda; School of Sport and Exercise
Sciences, University of Birmingham
Submitted to REF2014, Oxford Brookes University, UoA3- Allied Health
Professions, Dentistry, Nursing and Pharmacy, J Collett, REF2, Output
Details of the impact
The Long-Term Neurological Conditions Research Initiative (LTNC) research
initiative produced essential evidence about how effective and affordable
services should be designed. The LTNC initiative was designed to provide
the evidence base for policy-making in the Department of Health . The
research from the LTNC initiative has directly impacted service delivery.
For example, the Cornwall and Isle of Scilly Primary Care Trust (PCT)
commissioned `RENEW' an exercise delivery program based on the research.
As producers of the underpinning research, the MSG were requested to audit
the service in 2011, finding a trend towards reduced clinical service use
in those taking part in the system . Consequently the MSG has also been
requested to audit the Oxfordshire community Physical Activity Care
Pathway for individuals with and without disabilities 
In response to the need at a local level, the Clinical Exercise And
Rehabilitation Unit (CLEAR) was created at Brookes in 2005 to facilitate
exercise for people who require a higher level of supervision due to their
medical condition. The significance of this impact is demonstrated by the
fact that in 2012 there were 3000 total clinic attendances. Patients
referred to the unit have reported improved health and attributed it
directly to the exercises they have undertaken under CLEAR supervision.
One CLEAR unit client said: "The progression I have made in six weeks
has been quite remarkable — noticed by friends and family. Importantly I
feel more confident and capable in my physical abilities." Another
CLEAR client said "If it wasn't for James' [CLEAR staff] dedication I
wouldn't have improved and be able to walk...as much as I now can. CLEAR
has been life changing for me, more than anyone will ever know" .
The unit has also impacted on the practice of healthcare providers (GPs
and physiotherapists), who now refer their patients from Oxfordshire and
as far as Gloucester and Cheltenham. The unit also runs camps for children
in the school holidays, including the Oxford dyspraxia group and the
Oxfordshire paediatric physiotherapy service.
Having established a working model of delivery at a local level the
success of the CLEAR unit has led to the establishment of the CLEAR Trust
a registered charity which aims to;
- Advance the treatment and care of children and adults with long-term
movement disorders and neurological disabilities, through the provision
of affordable sustainable exercise and rehabilitation facilities and
- Support research and education in movement science and movement
Supported by the community physiotherapy service and sports partnership,
Satellite CLEARs have been set up in the Thames Valley to support both
adults and children with neurological conditions at two sites, with plans
to expand to a further three sites in 2013/14 .
The unit employs a mutually beneficial arrangement whereby clients are
supported to exercise by exercise and health trainees, an average of
twenty per annum, which include a proportion of visiting students and
To widen the impact further, based on the MSG research that provided the
first evidence of the need for specific training of fitness professionals,
it was realised that in order to facilitate impact at a national level,
two key things were required; a National Occupational Standard (NOS) and
an accredited training course. MSG research was presented to the Register
of Exercise Professionals (REPs) to make a case for the development of a
course and the NOS written by Dawes and endorsed by Skills Active .
REPs were sufficiently convinced of the need and expertise in the group,
that they agreed to work with the researchers to develop the `Exercise
Prescription for Long-Term Neurological Conditions' course in 2011 .
It is the only level 4 accredited course (20 Level M CATS points) in the
UK for healthcare and fitness professionals who are required to deliver
exercise to people with a range of long-term neurological conditions .
Since 2011, 36 people all over the UK have completed the course, some
sponsored by MS Society . Dawes has incorporated the research findings
into invited articles and training workshops as part of a specialist
registrar course (Nottingham) to medical students (London) and
Physiotherapists (New Zealand).
A key finding of the research was that people with long-term neurological
conditions should be enabled and empowered to manage their exercise
according to their wishes and in response the PASS system of informing and
empowering people to achieve a physically active lifestyle was developed.
The PASS handbook  contains information to empower people with
neurological conditions to exercise and participate in physical activity
in the community. 4000 printed booklets have been distributed since 2009,
with 2000 funded by the MS society  and it is available on the group's
website, which since September 2011 to July 31st 2013 has had
8534 unique on-line viewings and the booklet downloaded 688 times. MSG
research has been extensively incorporated into resources for exercise
delivery in neurological conditions including a neurological and
neuromuscular chapter for Churchill Livingstone in their Exercise
Physiology in Special Populations title.
In addition the researchers have undertaken a variety of activities to
ensure that research findings reach relevant practitioners and patients.
This has included speaking at events for practitioners such as the
Association of Chartered Physiotherapists interested in neurology (ACPIN)
group, Oxford Universities Hospital (OUH), NZ national physiotherapy
conference, MS Frontiers conference 2009, REPs National Convention
(Birmingham, 22 Sept 2011) Birmingham, Physiotherapy UK National
conference (Liverpool, 10 October 2012), reaching an estimated 1200
professionals face to face. They have also reached out to professionals
through print media including Dawes' report in the REPs journal  (Jan,
2012) that is distributed to 35,000 exercise professionals. Collett's
report on exercise `dose' in pwMS for the Wayahead newsletter , which
is produced quarterly by the MS trust for nurses and health professionals
who work with pwMS. (Jan 2009).
They have also been able to meet with approximately 700 patients and work
with them through attending meetings of local groups including Parkinsons
UK, MS Society , Stroke Association, and Huntingdon's Disease
Association, therefore ensuring that the message about the possibilities
of safe and beneficial exercise is heard by the potential beneficiaries
Sources to corroborate the impact
- Deborah Matthews (2011) `Refresh and re-invigorate your patients
with gentle exercise' Primary Health Care. 21, 6, 28-30, DOI:
10.7748/phc2011.07.21.6.28.c8605. A Report on the success of the RENEW
programme in Cornwall and Isles of Scilly.
- CLEAR website: http://www.shs.brookes.ac.uk/clear,
including testimonials from patients and practitioners: http://www.shs.brookes.ac.uk/clear/testimonials
- CLEAR Trust website; http://cleartrust.org.uk/
- National Occupational Standard;
- Course handbook for the REPS accredited course `exercise prescription
for long-term neurological conditions' available at;
- Corroborative statement author 1, formerly REPs advisory panel.
Available on request.
- Corroborative statement author 2, National Lead — Physiotherapy, MS
society. Available on request.
- Dawes, H. (2012) Working with Neurological Conditions, REPS
Journal, January 2012, pages 23-25 http://content.yudu.com/A1qkok/REPs/resources/index.htm?referrerUrl=
REPS Journal is a practitioner magazine.
- Collett, J. (2009) Investigating safe and effective exercise for
people with MS Way Ahead Newsletter, January 2009, Volume 13, part
The Wayahead Newsletter is the specialist MS practitioner newsletter
produced by MS Trust