Clinical exercise physiologists: establishment and recognition as healthcare professional in UK

Working with national and international collaborators, Mark Hollands leads a project funded by the Vivensa Foundation, in partnership with the Sanctuary Housing Group, that uses body-worn sensors and computer vision to capture real world behaviour and generate 3D models of older adults’ homes.

The data link gaze, movement, and environmental features to identify risk prone design elements such as lighting, stairs, and layout. These insights will underpin a human centred design tool to guide low-cost modifications and support safer, more independent living in existing and new homes.

Falls during everyday walking can affect anyone but are particularly common among frail older adults and individuals with neurological conditions, often leading to serious injury or death.

These challenges arise when rapid decisions are required about where to step and how to adapt movement, increasing reliance on cortical brain regions and demands on attention and control.

This programme investigates “adaptive walking” using immersive environments (e.g. augmented reality treadmills) alongside mobile brain imaging (fNIRS, EEG). This enables simultaneous measurement of brain activity and movement during realistic tasks involving obstacles, stepping targets, and unexpected changes.

We will quantify cortical activity and examine its relationship with stepping accuracy, balance, timing, and the effects of cognitive load and anxiety.

The approach will be applied to children with developmental coordination disorder (DCD), older adults, and individuals with Parkinson’s disease or stroke. Comparisons with neurotypical controls will identify shared and condition-specific mechanisms, and determine whether increased cortical activity reflects compensation or reduced automaticity linked to fall risk.

Overall, this work will improve understanding of adaptive walking and inform interventions to enhance mobility, safety, and confidence across the lifespan.

Research by Professor Mark Hollands and Dr Neil Thomas funded by the Vivensa Foundation examined how vision and environmental design affect stair safety in older adults.

Falls on stairs are a major risk, partly because ageing alters gaze patterns—older people are less likely to look in the right place at the right time, increasing the chance of misplacing their feet.

Using a laboratory staircase with eye tracking, motion capture, and force sensors, the researchers built a detailed picture of how people look, move, and step. They also measured participants’ confidence under different conditions.

The study found that poor lighting and busy carpet patterns—common in many homes—made stair navigation more difficult. These conditions reduced stepping accuracy, encouraged riskier behaviour, and led people to look fewer steps ahead.

In contrast, plain stair designs improved balance, foot placement, and confidence. Adding clearly highlighted step edges further increased safety.

This research programme investigates how turning movements are coordinated, how this changes with ageing and Parkinson’s disease (PD), and how impairments can be improved.

Early work showed that turning relies on coordinated sequencing of the eyes, head, trunk, and pelvis, typically led by the head–eye system. Constraining vision or head movement disrupts this process, highlighting the importance of sensorimotor integration. Turning strategies also adapt to task demands: faster or more constrained movements promote more rigid, “en bloc” patterns, demonstrating that such behaviour can be functional rather than purely pathological.

With ageing, coordination becomes less flexible, with increased coupling between body segments. In PD, these changes are more pronounced, leading to reduced segmental dissociation, impaired eye–head–body coordination, and greater rigidity. This suggests PD reflects an exaggerated loss of movement adaptability.

The programme also validated wearable IMUs for measuring turning coordination, enabling objective, clinically feasible assessment. Importantly, a randomized controlled trial showed that task-specific training can improve turning performance and reduce “en bloc” movement in PD.

Overall, the work demonstrates that turning impairments are mechanistically understood, measurable, and modifiable, with important implications for rehabilitation and fall prevention.

Turning while standing or walking relies on coordinated whole‑body adjustments. This study shows that different standing turn amplitudes (90°, 135°, 180°) significantly influence how both younger and older adults organise their movements.

Larger turns resulted in longer step durations, slower turn speeds, delayed movement onsets across body segments, and greater angular separation between the head, thorax, and pelvis, with clear differences between age groups.

These findings demonstrate that increasing turn amplitude meaningfully alters turning and stepping kinematics, highlighting the importance of considering turn size when assessing mobility in older or frail adults and when designing exercise‑based fall‑prevention strategies.

Read more on A Comparison of Turning Kinematics

Standing turns become harder when the head can’t rotate freely. This study shows just how much that restriction disrupts whole‑body coordination.

When participants performed 180° turns with their head movement constrained, they showed delayed segment movements, reduced coordination between body segments, smaller and slower steps, and greater overall step duration.

Turning speed also influenced timing and coordination. Together, these findings demonstrate that both speed and limited head–neck mobility significantly impair the mechanics of turning, factors closely linked to increased fall risk during everyday movement.

Read more about The Effects of Constraining Head Rotation