wellbeing from somenone with a

neurological condition may vary by as much as 20% from day to day. There may also be times of the day when it is much better or worse for a client to exercise. Typically this will be late morning. For people on medication, exercise is best performed at a fixed time after taking their treatment. As always the client should be able to guide the fitness professional as will health professionals involved in their care.

l Fatigue: Many people with neurological conditions report fatigue as a disabling and overwhelming symptom of their condition. Fatigue is notoriously difficult to define but studies have shown perceived, muscle and central fatigue in a number of neurological conditions. When prescribing exercise in all clients with neurological conditions, care should be taken to start slowly and carefully and slowly progress programmes. It is worth checking with clients that they are not exhausted the following day in order to get an idea of the impact of the exercises.

l Behavioral and emotional symptoms: Some individuals may present with behaviour that may seem at times inappropriate and some individuals may present with extreme emotions such as depression, or swing between opposite emotions. Individuals may be receiving medication for these symptoms. Exercise programmes have been shown to benefit many of these symptoms.

l Cognitive: Some individuals may have a degree of loss of short or long term memory, and the ability to problem solve or dual task. This should be considered when prescribing, as a prompt card for the various exercises may help individuals to independently move around the gym. Please take care chatting to people on the treadmill as they may stop walking!

Exercise programmes that contain flexibility, endurance, skills, coordination and strength training and combined training programmes can benefit mobility, health and wellbeing in people with neurological conditions. Indeed the effects can be really impressive even with only small increases in exercise; one twenty minute session/week has

been shown to benefit mobility, health and wellbeing in some people. In order to access these benefits, people with neurological conditions have expressed a desire to exercise in their locality using local resources and fitness professionals (3.) People with neurological conditions have highlighted the importance of being supported by fitness professionals who have some knowledge of their condition and its symptoms and knowledge of appropriate safe exercises for them. In addition they highlight the importance of appropriate access to facilities in the centre and easy near parking. Such practical support can help individuals to achieve good initiation, maintenance and continuation of exercise (4, 5, 3). Finally, exercise guidance documents have been developed based on available evidence and expert opinion (1, 6) with advice documents available for clients http://bit.ly/vWGsUp and for professionals and people affected by conditions on disease specific charity websites.

References 1. ACSM. American College of Sports Medicine exercise management for persons with chronic

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