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PRINCIPLES OF EXERCISE PRESCRIPTION IN NEUROLOGY
Liz Dewar
Clinical Specialist Physiotherapist in Neuromuscular Diseases
ACSM Clinical Exercise Specialist
ACPIN Feb 2013
PRESCRIPTION
Assessment ї ŝŶƚĞƌƉƌĞƚĂƟŽŶї ƉƌĞƐĐƌŝƉƟŽŶ(individually prescribed
programme)
Activities that would be light
(white), moderate (light red)
and vigorous intensity (dark
red), along with the
associated metabolic
equivalent of task (MET).
Data from Department of
Health (2004)

GENERAL ADVICE FOR PATIENTS
• Individually prescribed aerobic and strengthening exercises are safe
(following assessment & risk screening)
• Feel comfortably out of breath, but still be able to talk, and the exercise
should make them perspire
• Do not exercise to exhaustion
• Recognise when it is time to stop
• Next day tiredness and fatigue
• May not have enough energy left for essential functional tasks
• Do it in short bouts & build up gradually
• Avoid excessive eccentric activity
• Be aware of ‘over-work weakness’
• Muscle soreness should not last longer than 48 hours
• The gym isn’t the only place to exercise
• If they experience unusual symptoms or experience pain then advised to stop
exercising & to seek physiotherapist or GP advice
• To achieve regular physical activity, people need to integrate physical activity
into their everyday lives
• Make it fun & sociable!
TAKE HOME MESSAGES
• Physical activity is important for improving long term health and well being
• Physical inactivity is highly prevalent in pw disabilities
• The optimal dosage & content of exercise interventions for people with a
range of long-term neurological conditions has not been clearly established

REFERENCES
• American College of Sports Medicine. ACSM's Guidelines for Exercise Testing
and Prescription. Philadelphia: Lippincot, Williams & Wilkins; 2006
• Borg GV. Psychophysical basis of perceived exertion. Medicine and Science in
Sports and Exercise 1970; 14:377-381
• Brazzelli et al (2011) Physical fitness training for stroke patient. Cochrane
Database of Systematic Reviews, Issue 11
• Goodwin et al (2008) The effectiveness of exercise interventions for people
with Parkinsons Disease: a systematic review and meta-analysis. Movement
Disorders Vol. 23, No. 5, pp. 631–640
• Elsworth et al (2011) Supported community exercise in people with long-term
neurological conditions: a phase II randomized controlled trial. Clin Rehabil
2011 25: 588
• Hallal et al (2012) Global physical activity levels: surveillance
progress,pitfalls,and prospects. Lancet Physical Activity Series
• Health Canada (1998) Canada’s physical activity guide to health active living
http://www.hc-sc.gc.ca/hppb/paguide/pdf/guideEng.pdf (PAR-Q)
• Lee et al (2012) Effect of physical inactivity on major non-communicable
diseases worldwide: an analysis burden of disease and life expectancy. Lancet
Physical Activity Series
• Pollard A, Ramdharry G, Moore S, Hallsworth K, Marsden J,Reilly M.
Comparing activity levels between people with Charcot-Marie-Tooth disease
and healthy controls: a pilot study. Journal of the Peripheral Nervous System
2010; 15 (Supplement) p30
• Reitberg et al (2004) Exercise therapy for multiple sclerosis Cochrane
Database of Systematic Reviews, Issue 3
• Sallis R (2009) Exercise is medicine and physicians need to prescribe it! Br J
Sports Med; 43:3–4
• Stroud NM, Minahan C L (2009) The impact of regular physical activity on
fatigue, depression and quality of life in persons with multiple sclerosis
Health and Quality of Life Outcomes, 7:68
• Van Remoortal et al (2012) Validity of activity monitors in health and chronic
disease : a systemic review, International Journal of Behavioural Nutrition &
Physical Activity, 9:84
• Voet NBM, Van der Kooi EL, Rophagen II, Lindeman E, Van Engelen BGM,
Geurts ACH. Strength training and aerobic training for muscle disease
(review). Cochrane Database of Systematic Reviews 2010, issue 1.
• White CM, Pritchard J, Turner-Stokes L. Exercise for people with peripheral
neuropathy (review). Cochrane Database of Systematic Reviews 2009, issue
1.