# Co-development and implementation of a group-based arm-crank exercise programme in the community for individuals with neurological impairments

## TL;DR

A group-based arm-crank exercise program was co-developed with people with neurological impairments and successfully implemented in community settings, improving their health and satisfaction.

## Contribution

The study introduces a co-developed, accessible arm-crank exercise program tailored for individuals with neurological impairments, successfully implemented in community settings.

## Key findings

- High adherence rates (77% in MoveWell, 54% in Greenbank) were observed with no serious adverse effects.
- Participants reported significant improvements in health-related quality of life and high satisfaction with the program.
- Qualitative feedback highlighted physical and mental benefits, social connection, and accessibility as key factors for engagement.

## Abstract

Group-based exercise classes are popular ways to promote engagement in regular exercise. However, such opportunities are limited for individuals with neurological impairments, who often are more physically deconditioned, require disability-specific instructions and specialised, accessible equipment.

This study aimed to co-develop a group-based, community-delivered arm-crank exercise (ACE) programme with individuals with neurological impairments and to evaluate the feasibility of implementing the programme in community settings.

A pragmatic ACE programme was developed with five participants with a long-term neurological impairment, followed by a pilot, implementation of the programme in a university-based wellbeing centre (MoveWell) and in a local gym (Greenbank) across multiple iterations. The classes were held twice a week for 8–12 weeks, guided by music and real-time heart rate monitoring to maintain moderate-to-vigorous intensity exercise. A mixed-methods evaluation assessed adherence, participant satisfaction, health-related quality of life (HRQoL), and physical function. Focus groups were conducted to explore perceived benefits, challenges, and recommendations for future implementation.

Ten participants (mean ± SD age 45 ± 14 years; 2 females) with diverse neurological impairments (spinal cord injury, stroke, hereditary spastic paraplegia, cerebral palsy, and Chiari malformation) completed a minimum of one iteration of the programme. Adherence was high (MoveWell: 77 ± 17%; Greenbank: 54 ± 7%) and no serious adverse effects were reported. Participants reported increased of 10 points (SD = 12) in both physical and mental component summaries of HRQoL, with high self-perceived satisfaction and effectiveness with the programme. Qualitative data highlighted that self-perceived physical and mental benefits, social connection, and accessibility as key facilitators for engagement.

The programme, co-developed with the participants, was feasible, acceptable, and safely delivered in real-world community settings. Findings support the potential for inclusive, group-based ACE to promote health and wellbeing in people with neurological conditions and inform future community-based exercise initiatives.

The online version contains supplementary material available at 10.1186/s13102-025-01507-6.