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Services
For some young people, ordinary movement — standing in assembly, walking between classes, sport, even keeping up on a family outing — asks more of the body than is visible. Where orthostatic intolerance, POTS, post-viral patterns or hypermobility are part of the picture, "just do more exercise" is not a neutral recommendation; for some young people it produces crashes that take weeks to recover from.
Exercise physiology in the Child & Adolescent pathway is the work of building movement capacity carefully, against what the actual body is doing. Heart-rate data, perceived exertion, recovery time and symptom patterns inform the next session — not age-predicted targets and not what an unaffected peer can do.
Two clinical pictures sit inside this pathway and need different work. The first is the young person whose deconditioning sits inside an autonomic or hypermobility picture, where careful, often recumbent reconditioning can rebuild capacity over time. The second is the young person whose picture includes post-exertional malaise — long-COVID, ME/CFS, similar post-viral states — where graded exposure causes harm and the work is pacing inside an energy envelope, with stability as the goal. Telling the two apart is the first job of the assessment.
This service is for children and adolescents whose previous exercise approaches have flared symptoms, whose participation in school sport or recreation has become limited, whose post-exertional symptoms have made movement feel unsafe, or who are early in the pathway and want movement built carefully from the start.
The first session maps current capacity against the autonomic, symptom and recovery picture. Parent and young person both contribute. School PE history, recent activity, recovery patterns, sleep, current medication.
The assessment looks at how the body is responding to load now. Heart-rate response, time to symptom onset, recovery curve, post-exertional pattern. Validated PEM screening is used deliberately rather than by impression.
The programme is built around which clinical picture dominates. For the reconditioning picture, graded recumbent or gravity-reduced work, with progression paced against tolerance and recovery. For the PEM picture, pacing inside an energy envelope with stability as the goal — not progression. Where the two overlap, the more cautious strategy is followed first.
Where school PE participation is part of the picture, the programme includes what the school needs to know — accommodations, what the young person can and cannot tolerate, what counts as a session. Family-level pacing strategies sit alongside. The plan is held inside the biio. paediatric record so the rest of the team can see it.
Follow-up tracks what the body actually did, not what the programme predicted. For the PEM picture, gains are measured by the absence of crashes rather than by added activity. Where post-exertional symptoms appear, the load drops back rather than pushing through.
As the young person grows and the picture moves, the plan moves with it. Capacity rebuilds for the reconditioning picture; stability becomes more reliable for the PEM picture. The young person develops a working sense of their own warning signs, supported by family and clinical contact.
When the exercise physiology work is going well for the reconditioning picture, ordinary activity becomes more available. Standing time extends. Recovery from PE or recreation stops costing the next day. Confidence in movement returns.
When the work is going well for the PEM picture, the change looks different. Crashes become less frequent because the envelope is being respected. The week stops being repeatedly tipped over by a single demand. The first measurable improvement is usually stability, not capacity.
Exercise does not cure the underlying autonomic dysfunction, post-viral picture, or hypermobility. For some young people, careful reconditioning is the right work; for others, careful pacing is. The same prescription does not fit both, and offering it as if it did is the most common way movement prescription does harm in young people with these conditions. Telling the two pictures apart, and prescribing accordingly, is where most of the change in this part of the work sits.