There have been some exciting recent developments in exercise after stroke and we are delighted to announce that the specialist instructor training course ‘Exercise and Fitness Training after Stroke’ is now being offered across the whole of the UK.
This course equips health and exercise professionals with the skills and knowledge to deliver exercise and fitness training to people who have had a stroke.
Life after stroke
The proportion of people who survive stroke is rising. Yet around half of stroke survivors do not regain functional independence1 and those who do are often left with long-term post-stroke impairments. After discharge from health care, there is a dearth of community services to support stroke survivors over the longer term and promote transition to self-management and independence. Community exercise after stroke classes could potentially help to fill this gap.
Physical fitness training for stroke patients
There is growing evidence that physical fitness training is safe and effective in improving the physical fitness and function of stroke survivors. The recently updated Cochrane review of physical fitness training for stroke patients found that physical fitness training was feasible and significantly improved walking speed, independence and endurance2. Participants in fitness training after stroke have also reported psychosocial benefits3,4. Importantly, the benefits of physical fitness training demonstrated by research trials are now being replicated in ‘real life’ community exercise services5.
The Department of Health’s National Stroke Strategy6 states that ‘Rehabilitation – support to regain well-being – requires rehabilitation specialists and continuing support from a wide range of community-based services, such as exercise classes…’.
Exercise after stroke may also plausibly play a role in preventing recurrent vascular events (e.g. stroke, acute coronary event) by several possible mechanisms e.g. reducing blood pressure, reducing body mass index and reducing cholesterol levels.
Exercise and Fitness Training after Stroke course
The provision of exercise classes in the community requires that exercise and health professionals are suitably trained and qualified. To meet this need, our team at University of Edinburgh and Queen Margaret University developed the first UK course on exercise after stroke, entitled ‘Exercise and Fitness Training after Stroke’, based on the most up-to-date research evidence in this area.
The ‘Exercise and Fitness Training after Stroke’ course is run over three separate weekends, includes 50 hours of contact teaching and 150 hours of self-directed learning. The teaching is provided in a variety of formats, including formal lectures, tutorials, and practical classes. Throughout the course, the relevance of the theory to the delivery of exercise is emphasised.
Students’ theoretical knowledge and practical skills are formally assessed on the final weekend of the course. We are running our third course; exercise instructors who attended the previous two courses are now delivering exercise to stroke survivors and have been instrumental in developing services.
Importantly,
- the Exercise and Fitness Training after Stroke course is the only one in the UK that is endorsed by Skills Active (the UK Sector Skills Council for Active Leisure, Learning and Well-being) at Level 4 Physical Activity and Health and, therefore, recognised on the national Register for Exercise Professionals (REPS) qualification and training framework at Level 4. This means that instructors working with people with stroke must have this qualification in order to validate their insurance
- It is accredited by Queen Margaret University, Edinburgh
- Students passing this module will gain a qualification at Scottish Qualification Framework level 8/ SHE level 2 in “Physical Activity and Health: Specialist Instructor in Exercise after Stroke”.
- It is aligned with Chartered Society of Physiotherapist Curriculum Framework
- It is supported by the key non-governmental organisations in England and Scotland and Northern Ireland (Chest Heart & Stroke Scotland, Northern Ireland Chest Heart and Stroke Association, Stroke Association and Different Strokes).
Course Roll-Out
In order to meet the rapidly growing demand in the UK for this specialist instructor course, the University of Edinburgh and Queen Margaret University have licensed LaterLife Training to take over the administration and roll-out of the course from April 2010. Four Exercise and Fitness Training after Stroke courses have been scheduled UK-wide from September 2010 (Wigan, Cambridge, Wiltshire and London). A fifth course is being set up in Glasgow for early 2011. Full details are published on the Later Life Training website (www.laterlifetraining.co.uk).
Future developments
The course content will be updated as new evidence emerges. For example, the Cochrane review of physical fitness training after stroke is currently being updated with new trials, and the outcome of this review will be integrated into the course material. We are also working with the Action for Rehabilitation from Neurological Injury (www.arni.uk.com) who provide courses on functional training after stroke to develop ways for exercise professionals to benefit from the complimentary approaches of the two training courses. Our team is also investigating the scope of provision of exercise services for people after stroke in Scotland, and developing best practice guidelines for setting up Exercise after Stroke services (www.exerciseafterstroke.org.uk). More information will follow later this year.
The Vision
Our vision for the Exercise and Fitness after Stroke Specialist Instructor course is that it will enable the development of Exercise after Stroke services that follow 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 programmes7. Exercise instructors who have already attended the Exercise and Fitness after Stroke course have been instrumental in setting up exercise classes for stroke survivors across the UK. The provision of this type of community exercise service by qualified instructors will improve the quality of ‘life after stroke’ and help to redress the previous neglect of long-term stroke survivors living in the community.
Catherine Best, Frederike Van Wijck, Susie Dinan-Young, John Dennis, Sara Paul, Mark Smith, Marie Donaghy and Gillian Mead
References
1. Hankey GJ, Spiesser J, Hakimi Z, Bego G, Carita P, Gabriel S. Rate, degree, and predictors of recovery from disability following ischemic stroke. Neurology. 2007 May 8, 2007;68(19):1583-7.
2. Saunders D H, Greig C A, Mead G E, Young A. Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews 2009; Issue 4(Art. No.: CD003316.):DOI: 10.1002/14651858.CD003316.
3. Carin-Levy G, Kendall M, Young A, Mead G E. The psychosocial effects of exercise and relaxation classes for persons surviving a stroke. Canadian Journal of Occupational Therapy. 2009;76(2):73-6.
4. Reed M, Harrington R, Duggan A., Wood V. A. Meeting stroke survivors' perceived needs: a qualitative study of a community-based exercise and education scheme. Clinical Rehabilitation. 2010;24(1):16-25.
5. Stuart M, Benvenuti F, Macko R, Taviani A, Segenni L, Mayer F, et al. Community-based adaptive physical activity program for chronic stroke: feasibility, safety, and efficacy of the Empoli model. Neurorehabilitation & Neural Repair. 2009 Sep;23(7):726-34.
6. Department of Health. National Stroke Strategy. London: Department of Health 2007.
7. Department of Health ‘Falls and Fractures: Toolkit For Commissioners’. London: Department of Health, 2009.
Acknowledgements
We are grateful to Scottish Government, Chest Heart and Stroke Scotland, Greater Glasgow and Clyde Health Board, and Edinburgh Leisure who funded course development; to Chest Heart and Stroke Scotland, Northern Ireland Chest Heart and Stroke Association, Stroke Association and Different Strokes for supporting the course; and also to our multidisciplinary Reference Group who oversaw course development.
