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Who do I need to see if I want exercise advice?

In my last blog I explained all the different Levels of Exercise qualifications.

In this blog I give you various scenarios, where an individual has been advised to do more exercise, by their Health Care Professional (HCP), such as their GP or consultant.

For each scenario I give the following options:

1 - Regular Physiotherapist

2 - Neuro-physiotherapist

3 - Level 2 Exercise Professional

4 - Level 3 Exercise Professional

5 - Level 4 Specialist Exercise Professional

If I miss out a number, please assume the exercise professional does not have the qualifications and/or insurance to teach the stated scenario.

Scenario One

A 55 year old has an arthritic knee and has been advised to do more exercise while waiting for knee surgery.

Who should they seek help from?

Regular physio, yes, but if through the NHS, you might have to wait a while and you may have had your surgery by the time you get your appointment. A private Physio will charge you heaps of money, but will give you the correct exercises to strengthen the muscles surrounding the affected joint, as will an NHS physio.

2. NHS neuro-pyhsiotherapist won’t have the time. Private may take you on, but will charge even more than a regular one.

5. L4 Instructor, if they have the Postural Stability Instructor qualification (PSI) - better known as Falls Prevention.

Scenario Two

A 67 year old who has had a heart attack and bypass surgery.

Regular physios can’t give exercises for the heart! unless of course, they are trained in Cardiac Rehabilitation.

2. If a L3 Instructor has a GP referral qualification, they can teach low risk CHD problems, such as high blood pressure. They are not able to teach medium to high risk individuals, who have had heart attacks, stents, surgery on valves & arteries, etc…

5. Yes, if the Instructor has Cardiac Rehabilitation. Insured and qualified to teach ALL CHD problems.*

*The cardiac rehabilitation (Phase 4) qualification, via BACPR (British Association of Cardiac Prevention & Rehabilitation) trains an Instructor to teach individuals & groups who have had CHD and a Stroke. However, if the individual has had a Stroke only, they must seek the advice of an Exercise after Stroke (EfS) qualified Instructor or Neuro- Physiotherapist. The BACPR qualification does not give the Instructor the skills or insurance to teach Stroke specific exercises.

Scenario Three

A 43 year old has had a stroke as a result of a car crash.

2. Neuro physiotherapist, yes. Again, due to small numbers of trained neurological physios, you may have to wait or go privately. Regular physios don’t have the in-depth knowledge to teach evidence-based neurological exercises.

Scenario Four

An 89 year old with a history of falls, due to the ageing process & osteoporosis, with no obvious underlying health issues.

NHS & Private physios will give muscular-skeletal exercises. They are not routinely trained to Postural Stability Instructor level (PSI). NHS may have Falls Prevention classes in your area, but check they are PSI trained.*

5. Yes if trained in PSI.

*I do know of a situation where the NHS physio, not trained in PSI, teaches a Falls Prevention class, with the help of an assistant and an OT. The local PSI Instructor, who is not recognised by HCP’s despite the better qualification, teaches a Falls Prevention class with no added support.

I will leave it up to you to decide which is more cost effective for the tax payer and which is more cost effective for the individual.

Scenario Five

A 33 year old lady who has developed dastasis recti, postpartum.

In an ideal world a physiotherapist who is trained in pelvic health, would be able to teach this individual. However, these are rare specialists and you will be extremely lucky to find one without a very long waiting list. Regular physios may give some exercises, but don’t have the specific pelvic training.

4. A Pilates Instructor may have this qualification.

Scenario Six

A 62 year old, newly diagnosed with Parkinson’s disease (PD).

2. Yes, as PD is a neurological condition. May have to pay privately if no NHS neuro-physio available.

5. L4 Instructor if they have PSI qualification.

Scenario Seven

A 45 year old with chronic back pain.

NHS & Private physiotherapists

2. L4 Instructor if has Back pain qualification.


It always amazes me that Exercise Professionals, levels 2, 3 & 4, hardly ever mention their qualifications on their websites. Transparency, is a must in this industry - certificates/qualifications along with pricing of sessions - otherwise how are the general public going to know the truth and thus make an informed decision as to who to attend?

Therefore, my conclusion remains the same as my last blog:

“Do your research first and if in doubt, ask the professional for a copy of their relevant qualification.”

A fully qualified professional will be quite willing and happy to provide this information. If not, then walk away!