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Neuro physio

Why does exercise intensity matter?



Intensity is essentially the amount of work you do in a given period of time using these four components of exercise – Load, Distance, Speed and Time.

For example, with resistance training, this could be measured by how much load/weight you move, how far it is moved, how quickly it is moved and how long that weight was moved for. Using this understanding, a larger load moved more quickly will be recognised as being completed at a higher intensity than if one of those components was less.

Knowing the intensity a client can work at allows you to apply overload which is where you increase intensity to permit a physiological adaptation. 

Tools to track intensity

  • Metrics – measuring how much weight a person lifts, how quickly they push/run or how far/long they move, all provide comparable data to measure progression  
  • Rate of Perceived Exertion (RPE) – this is based on observing the body’s physical signs during physical activity. This can be tracked in a simple 1-10 rating scale. For example, if a client is at a very comfortable level of exertion during physical activity, they’d consider this a 4 or 5/10. However, if they are sweating a lot and feeling breathless, this might be considered level 8 or 9. 
  • Talk Test – this is a very easy test to figure out intensity – you just pay attention to how breathless your client is. If they can easily talk, they’re working at a light intensity.  If they can talk, but it’s a little harder, they’re getting more into the moderate zone. 
  • Wearable technology – the heart rate will increase in proportion to the intensity of the exercise as a natural response. As heart rate monitors and fitness trackers are becoming more and more readily available, they can provide a more accurate way to measure intensity in real time, allowing you to adjust your client’s effort and measure their performance during the session/exercise.  

How hard should you work?

That answer will vary greatly from person to person and the level of intensity should be tailored to the individual. While intensity can range from low to moderate and high, an estimate of a person’s maximum heart rate (MHR) can be calculated as 220 beats per minute (BPM) minus their age.

Target heart rate for moderate intensity activities is about 50-70% of MHR, while for vigorous physical activity it’s about 70-85% of MHR using this formula. 

Understanding your client

Intensity has to be appropriate in terms of what your client can currently do, as well as matching with their goals.

Asking someone to perform something far beyond their current abilities could possibly have a negative effect on implementing progression in the future. You don’t want to be told “I remember when you pushed me too hard!”

Intensity requires a client’s understanding and trust in you as a trainer to use intensity to help them achieve their goals.

How exercise intensity helps those with neurological conditions

Intensity of exercise has been associated with benefits for individuals who have suffered a neurological injury including enhanced stepping for locomotion with individuals with incomplete spinal cord injuries and improved blood pressure control in individuals with spinal cord injury. 

Overall, becoming aware of the intensity of exercise will help you to ensure that you are aligning  your client’s health or fitness goals with exercises/activities to facilitate their progression going forward. 

  • For more information and insight on this topic, speak to the team at Neurokinex

Neuro physio

Define your boundaries or boundaries will define you



How many times have you laughed at someone skidding, tripping, losing their balance or falling flat on their face?

Accidents can be funny, but sometimes they cause serious life-changing injuries in a matter of seconds. In 2019, 47-year-old Tim Jones experienced exactly that.

A Freak Accident

Tim suffered a C5 incomplete spinal cord injury while wakeboarding – an activity he had done 100s of times. His injury resulted in him being paralysed from the neck down and he was hospitalised. Tim was initially admitted to John Radcliffe Hospital where he had an operation to decompress his spine. Two months later he moved to Stoke Mandeville spinal unit where he had four months of rehabilitation.

Stepping up to the challenge

Tim is a family man from Hertfordshire. A lover of outdoor sports, he enjoys a variety of pursuits including tennis, cycling and trekking. He also has a passion for poker and holds poker nights/weekends through his events company Prestige Poker.

Tim struggled to sit still and was always out and about with family and friends. Suffering this type of injury was devastating and Tim wondered whether he would be able to walk again, play tennis or poker, as his arms, legs, and hands were all affected.

He attended daily physio sessions at Stoke Mandeville spinal hospital which included basic Pilates and weight sessions to prevent further deterioration. On December 19, 2020, Tim was discharged from Stoke Mandeville.

Forward-thinking mindset

After leaving Stoke Mandeville, Tim was keen to continue his rehabilitation.

He’d never been to a gym before his accident and didn’t know where to turn to as the NHS does not have an aftercare rehabilitation system in place.

Before his discharge from Stoke Mandeville, one of the consultants recommended Neurokinex. It was important to Tim that after his injury his rehabilitation was tailored to his challenging needs and intense to maximise his recovery. After completing an initial assessment with our training expert Stephen, he was keen to get started.

Road to Recovery

On January 25, 2021, Tim embarked on his road to recovery through the Neurokinex Step-Up Scheme. Designed for newly injured people, it offers six free sessions with a unique rehabilitation approach.

Tim came to Neurokinex with a hunched posture and aching shoulders, limited mobility in his arms and hands and back pain. He was keen on learning some new physical techniques to help his mobility but soon learned the most effective technique was setting small challenges to build up to a realistic goal.

Neurokinex created a tailored activity-based rehabilitation programme that encompassed Tim’s posture issues, mobility and strength.

Fast forward eight months and Tim is now able to drive giving him back his independence. His posture has also improved, irradicating the dull aching sensation in his shoulders that he used to live with. His arms and hands are becoming more mobile and stronger which has allowed Tim to return to playing poker. He even got a compliment from his wife that his back had changed and how muscular it was looking.

Define your boundaries or boundaries will define you

When we think about boundaries, we tend to think of limitations. However, with the right advice and support, those limitations can be changed into adaptations.

Tim combined his competitive nature from sport and outdoor activities with a willingness to better himself to adapt to what he wanted to do. His passion and goals are to be back playing poker, enjoying weekends out with family and friends and resuming his outdoor pursuits. His activity-based rehabilitation goals were to increase mobility and strength in his upper body and to be able to be more independent and less reliant on his wife.

Setting small, achievable targets has helped Tim pick up playing poker again and he is well on his way to ticking off the rest of his goals.

“I am so glad I found Neurokinex and can honestly say without their help, my recovery would be nowhere near where it is now,” says Tim. “Stephen has been amazing at understanding my needs and goals and makes every session fun and different – I didn’t know there were so many ways to work the same muscles!

“For me, Neurokinex is a game changer, and I would recommend them to anyone who finds themselves in an unfortunate position such as my own.”

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Community rehab

Therapy centre pioneers Long COVID study



A community gym is playing a crucial role in supporting patients with Long COVID through a pioneering study into how power-assisted exercise can help in their rehabilitation. 

West Berkshire Therapy Centre is set to support 100 people living with the post-COVID syndrome through a 20-session programme, with its evaluation of their outcomes set to be some of the first research into rehabilitation for the debilitating condition. 

The centre has raised over £19,000 to fund the study, titled ‘The role of power-assisted exercise in the rehabilitation of Long COVID’, with a further £10,000 grant secured by Dr Deepak Ravindran, who runs Berkshire Long COVID Integrated Service, which will enable the study to be bigger than initially planned. 

Dr Ravindran, a pain consultant at the Royal Berkshire Hospital, has referred patients to the physio-led West Berkshire Therapy Centre since its creation in 2014, and its ability to deliver both physical and psychological benefits to its clients has led to it now supporting the rehabilitation of people with Long COVID. 

To date, the centre’s work has been proven to improve client mobility by an average of ten per cent and psychological outlook by 15 per cent, with hopes that may extend into its new cohort of Long COVID patients. 

“For several years we have worked with clients with fibromyalgia and we have the equipment here which can support them, so we wanted to use our experience and equipment to offer some help,” says John Holt, trustee at the centre who was instrumental in its creation.

“If you go back to March 2020, myself and the team were stuck at home feeling useless, but now all of a sudden, we have this opportunity to help clients living with this new condition.

“People tell us it helps them and that’s all we need to know, but now through our evaluation, we hope this could mean something to researchers. We’re completely geared up for it, our staff are all on a high. 

“We will be referred 100 Long COVID clients with a variety of complexities, they may have mental effects or heart impairment or reduced mobility, some will have mild disability and for others that will be more significant. We will look at all of that and then do our assessments to see what is safe. 

“We will be guided by the clients – we know a bit, Dr Ravindran knows a lot, but they know most about this condition. We may discover our service makes no difference to Long COVID – we’re not trying to set out to show what a brilliant service we offer, we want to continue to make a difference to people’s lives through finding out what can work.”

The project is being part-financed by the fundraising of the team at the centre, with John himself using the power-assisted equipment to cycle the last stage of the Tour de France and climb the world’s tallest building. The first £5,000 they raised was double match funded by Greenham Trust. 

“I climbed the world’s tallest building in an hour – the world record is six hours. One of my colleagues rowed the English Channel. It shows the impact our equipment can have on exercise and rehabilitation without the physical exertion,” says John. 

The centre, which was founded in 2014 to bridge a gap in community resources, undertook various fundraising activities last month to finance the project, has grown significantly to play a role at the heart of its community. 

Initially open for 20 hours a week with ten items of equipment, it has since expanded into premises twice the size of its initial home, with 17 items of equipment which clients can access for 35 hours each week.

While the centre was forced to close during lockdown periods, the investment in its offering has continued, with a further £17,500 being spent to upgrade equipment. It has now re-opened, but at 60 per cent capacity and social distancing and the wearing of PPE will remain in place even beyond July 19. 

“We are keeping the two-metre distancing, even though that means some of our equipment is out of commission, and the wearing of PPE will continue,” adds John. 

“We will have a very slow relaxation and are happy to lag behind the rest of the country. We want our clients to be confident this is one of the safest places they can go to – people deserve that.”

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Case management

Changes at neuro-physio provider Neurocare Physiotherapy

Two prominent NR businesses will now work together in the UK.



Neurocare Physiotherapy and A Chance for Life Ltd will now work together.

Neuro-physio provider Neurocare Physiotherapy, based north west England, is now part of complex case management and rehabilitation specialist A Chance for Life Ltd.

For almost two decades, Neurocare Physiotherapy has treated patients across the North West for neurological conditions such as stroke, MS, Parkinson’s, foot drop, head injury and other disorders.

For much of that time, A Chance for Life Ltd has worked in a similar space, providing rehabilitation support, case management, physiotherapy, occupational therapy and medico-legal reporting for clients who often have a variety of social, physical, mental and vocational needs.

A Chance for Life Ltd founder Louise Chance saw an opportunity to bring them together to offer a deeper, broader suite of support for people dealing with life-changing conditions.

Now, the two organisations will work side by side to help clients across the north of England and southern Scotland.

“I’ve long been an admirer of the work of Neurocare Physiotherapy,” said Louise. “It was so obvious to us that the two businesses complemented one another, so it made complete sense to bring our skills and capabilities together.”

Although each company will retain a distinct identity and continue to care for its own clients with existing staff, the relationship will enable both organisations to do more for their clients.

“Really, this is about offering a wider service for our clients,” Louise explained. “Their needs are complex and the more support they can access from a single source, the better. With this relationship, we’re making it easier for clients to access the full range of help they need.”

Ian Watson of Neurocare Physiotherapy said: “Caring for clients across the North is our passion and vocation. Becoming a part of A Chance for Life will give many more people the chance to benefit from the skills and experience of our team.”

Neurocare Physiotherapy clinics are located in Wigan, Preston (Penwortham & Grimsargh), Blackpool, Garstang, Lancaster, Carnforth, Kendal, and Barrow in Furness. At-home treatment is also provided.

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