This L4 Specialist Exercise and Fitness Training after Stroke Instructor qualification (EfS) is the first and only evidence‐based, accredited and endorsed L4 stroke qualification available in the UK. Delivered by a multidisciplinary team, it is also the only qualification to be developed by a reference group of national experts in stroke research, clinical and exercise science practice. The course (incl. assessment) uses a blended learning approach, of face to face learning and an online training portal, to teach students to apply knowledge, through problem solving, to the practice of tailoring the STARTER research programme to the diverse range of functional impairment (physical, sensory and cognitive) met in stroke survivors. All approaches are aligned with the 2010 Exercise After Stroke Guidelines.

Accredited and Endorsed Qualification

The EfS Level 4 Exercise Qualification is accredited by Queen Margaret University, endorsed by the UK Stroke Forum and by Skills Active, recognised by the Register of Exercise Professionals (REPs) (20 points) and aligned with the benchmarks of the Chartered Society of Physiotherapy and the Quality Assurance Agency for Higher Education. Additional resources are available on the LLT Student Pages during and following the course.

EfS Evidence

EfS is underpinned by current evidence (Cochrane Reviews, STARTER Exercise Programme) and recommended by the National Advisory Committee For Stroke: Best Practice Guidance for the Development of Exercise after Stroke Services in Community Settings. Improvements demonstrated in research trials (see website) include:

• Improvements in walking economy

• Improvements in comfortable walking speed

• Improvements in leg extensor power (affected leg)

• Improvements in general health/mental health/vitality

• Improvements in timed up and go

• Improvements in functional reach


Who is the EfS Course For

• L4 Specialist Exercise Instructors*

• L3 Exercise Referral Instructors*

• Physio/Occupational Therapists

• Rehab/T1 Assistants (in NHS services)

• Sports/Exercise Scientists

• Exercise Rehabilitation Instructors (MoD)*

• Personal Trainers ( pre-requisite of L3 Exercise Referral )*


EfS Settings

• NHS Physiotherapy Depts

• Leisure Centres / Health Clubs

• GP practice

• Health Centre Gyms

• Community Halls / Centres

• GP Referral Services

• Stroke‐Specific Services


Key Learning Outcomes

• Understanding of stroke and its impact

• Understanding of the exercise evidence

• Competent design, delivery  of safe, effective exercise

• Competent outcome measures/evaluation.

• Specialist instructor skills

• Competent therapy led, functional exercise tailoring

• Competent group and one to one approaches

• Risk stratify and refer appropriately to health/exercise professionals

• Effective communication with stroke survivors/colleagues

 Cost: £650+VAT