To evaluate the effects of an exercise and education programme on primary outcomes of exercise efficacy and activity levels; and on secondary outcomes including quality of life, mood and physical disability. Randomized, single blind trial. Specialist neurosciences centre. Forty-four patients with acquired neurological pathologies. Twenty-one participants undertook a four-week exercise and education programme alongside standard follow-up care. Twenty-three participants underwent standard follow-up care alone. Primary outcome measures included the Exercise Efficacy Scale and Human Activity Profile. Secondary outcomes were evaluated by the Short Form 36 Health Survey, Hospital Anxiety and Depression Scale, UWIST Mood Adjective Checklist, Motricity Index, Frenchay Arm Test, Rivermead Mobility Index, 10-metre timed walk and a visual analogue scale. Data were collected at baseline and at 6, 12 and 24 weeks. At six weeks, significant improvements in exercise efficacy were found following the treatment but not the control (P= 0.001). Moderate improvements in activity levels were noted for both study groups with no between-group differences. Short Form 36 physical health and general health domains showed trends towards increased positive change following the intervention, but these did not reach significant levels. Mood, physical impairment and physical disability remained unchanged within either study group. Longer term follow-up revealed that the improvements noted in exercise self-efficacy, activity levels and quality of life were maintained. The intervention resulted in improved exercise efficacy and may positively influence the physical and general health dimensions of health-related quality of life.