exercise referral service - cambridge city council · programme on a 1:1 basis. once comfortable,...

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Exercise Referral Service Supported by Cambridegshire County Council Public Health team For more information: www.cambridge.gov.uk/startup [email protected] 07525 800996 Activities up to just £3.00 per session Physical Activity opportunities for adults living with long-term medical conditions in Cambridge Patient details Name: Date of birth: Address: : : Postcode: Contact number: Registered medical practice: Referring professional’s details Name: Profession: Surgery/Department: Telephone: Email: Baseline measurements within previous 6 months (if known) BP: RHR: Medical reason for referral (general fitness not acceptable) Other medical conditions (tick all that apply) Asthma COPD Anxiety Disorder Chronic Back Pain Cancer type: Established CHD, Angina or previous MI (See Point 6) Hypertension Neurological Conditions Type: Osteoarthritis Rheumatoid Arthritis BMI>30 Stroke/TIA – Date: Type 1 Diabetes – Type 2 Diabetes Other: Current medication and dosage (attach prescription list if easier) Cardiac History For patients with a history of cardiac disease or a cardiac event, the patient’s GP MUST complete a British Association of Cardiac Rehabilitation Form. This is available to download from www.cambridge.gov.uk/startup or contact [email protected] Health professional consent & signature/date To the best of my knowledge, the information provided on this form in an accurate representation of the patient’s health and medical background. I have discussed the exercise referral programme with this patient and I believe that the patient is clinically stable and medically safe to participate in a tailored/ prescriptive programme of physical activity. Signature: Date: / / Patient consent & signature/date I agree that the above information is correct and consent for my medical information to be kept within data protection guidelines, by the exercise referral service. Signature: Date: / / Exercise referral form To be completed in FULL by a health professional. ex-ref-form-2019-v5 25/09/2019 14:34 Page 1

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Page 1: Exercise Referral Service - Cambridge City Council · programme on a 1:1 basis. Once comfortable, the client is then able to access the gym in their own time, as regularly as possible

ExerciseReferral Service

Supported by CambridegshireCounty Council Public Health team

For more information: www.cambridge.gov.uk/startup

[email protected] • 07525 800996

Activities

up to just

£3.00per session

Physical Activity opportunities for adults living with long-term medical conditions in Cambridge

Patient detailsName:

Date of birth:

Address:

:

: Postcode:

Contact number:

Registered medical practice:

Referring professional’s detailsName:

Profession:

Surgery/Department:

Telephone:

Email:

Baseline measurements within previous 6 months (if known)

BP: RHR:

Medical reason for referral (general fitness not acceptable)

Other medical conditions (tick all that apply)

Asthma

COPD

Anxiety Disorder

Chronic Back Pain

Cancer type:

Established CHD, Angina or previous MI (See Point 6)

Hypertension

Neurological Conditions Type:

Osteoarthritis

Rheumatoid Arthritis

BMI>30

Stroke/TIA – Date:

Type 1 Diabetes – Type 2 Diabetes

Other:

Current medication and dosage (attach prescription list if easier)

Cardiac HistoryFor patients with a history of cardiac disease or a cardiac event, the patient’s GP MUSTcomplete a British Association of Cardiac Rehabilitation Form. This is available todownload from www.cambridge.gov.uk/startup or contact [email protected]

Health professional consent & signature/dateTo the best of my knowledge, the information provided on this form in an accuraterepresentation of the patient’s health and medical background. I have discussed theexercise referral programme with this patient and I believe that the patient isclinically stable and medically safe to participate in a tailored/ prescriptiveprogramme of physical activity.

Signature: Date: / /

Patient consent & signature/dateI agree that the above information is correct and consent for my medical informationto be kept within data protection guidelines, by the exercise referral service.

Signature: Date: / /

Exercise referral formTo be completed in FULL by a health professional.

ex-ref-form-2019-v5 25/09/2019 14:34 Page 1

Page 2: Exercise Referral Service - Cambridge City Council · programme on a 1:1 basis. Once comfortable, the client is then able to access the gym in their own time, as regularly as possible

Open: 7 days a week access to gym; normal opening hours

Phone: 01223 240271

Email: [email protected]

The exercise referral service here is providedby GLL and is known as ‘Healthwise’.

Services available include:• Tailored gym programmes in small gym• Respiratory rehabilitation• Strength & Balance classes• Long term condition circuit & yoga classes

2. Cherry Hinton Village CentreColville Road, CB1 9EJ

Open: 7 days a week access to gym & pool;normal opening hours

Phone: 01223 240271

Email: [email protected]

The exercise referral service here is providedby GLL and is known as ‘Healthwise’.

Services available include:• Tailored gym programmes• Recreational swimming• Strength & balance class• Cardiac rehabilitation

1. Abbey Leisure ComplexOff Whitehill Road, CB5 8NT

Open: Thursday 10-11am

Phone: 01223 571431

Email: [email protected]

The service here is provided by HeartbeatFitness and is known as ‘Start-up’.

This venue offers only one class and noother exercise referral gym access currently.

Services available include:• Cancer rehabilitation class (men only).

8. Hills Road Sport & Tennis CentrePurbeck Road, CB2 8PF

Open: 7 days a week access to gym andpool; normal opening hours.

Phone: 07525 800996

Email: [email protected]

The service here is provided by CambridgeCity Council and is known as ‘Start-up’.

Services available include:• Tailored gym programmes• Cardiac rehabilitation• Long-term condition rehabilitation classes• Recreational swimming• Weight management services

3. Chesterton Sports CentreGilbert Road, CB4 3NY

Open: 7 days a week access to gym & pool;normal opening hours

Phone: 01223 240271

Email: [email protected]

The exercise referral service here is providedby GLL and is known as ‘Healthwise’.

Services available include:• Tailored gym programmes,• Recreational swimming.

5. Parkside PoolsGonville Place, CB1 1LY

Open: Daytime usage restricted to Thurs 12-3pm & Fri 9am-12noon only. 7 days aweek access to gym from 4-10pm(Mon-Fri); 9am-5pm (Sat-Sun).

Phone: 07525 800996

Email: [email protected]

The exercise referral service here is providedby Cambridge City Council and is known as‘Start-up’.

Services available include:• Tailored gym programmes.

4. Netherhall Sports CentreQueen Edith’s Way, CB1 8NN

Open: Restricted daytime access Weds 8-10am & Fri 1-3pm. 7 days a weekaccess to gym 6-8am & 5.30-10pm(Mon, Tues, Thurs, Fri); 6-8am & 6-10pm (Weds) & 8.45am-5pm (Sat-Sun).

Phone: 07525 800996Email: [email protected]

The exercise referral service here is providedby Cambridge City Council and is known as‘Start-up’.

Services available include:• Tailored gym programmes

7. Trumpington Sports CentrePurbeck Road, CB2 8PF

Open: Tuesdays 1.15-2.15pm, Fridays 1-2pm

Phone: 01223 571431

Email: [email protected]

The service here is provided by HeartbeatFitness and is known as ‘Start-up’. Thisvenue offers classes only, there is no gym.

Services available include:• Long term condition mobility classes.

For clients with limited mobility (with andwithout walking aids). Suited to thosewith MS, Parkinson’s, stroke survivors,chronic pain, musculoskeletal conditions.

6. The Meadows Community CentreSt Catharines Road, CB4 3XJ

Cambridge’s exercise referral team provide a variety of servicesto support local residents with the following conditions:

• Cardiac and respiratory rehabilitation• Obesity and diabetes• Musculoskeletal problems• Stress, anxiety and depression• Cancer rehabilitation• Dementia• Injury recovery or mobility disorders• Stroke rehabilitation• Chronic Pain disorders• Parkinson’s and Multiple Sclerosis

Activities

up to just

£3.00per session

Do you need help to become more active?The exercise referral team can help you to lead a healthier,more active and better quality of life with a tailored physicalactivity programme to suit your needs. If you are living witha long-standing medical condition, are 16 or over andcurrently lead an inactive lifestyle, then we can offer you arange of services to support you to become more active.

Ask your health professional to complete the form on the back page. This form should them be given back to you, for you to then contactyour most suited venue to register.

In Cambridge, exercise referral services are available at eight venues. Clients arewelcome to attend classes across any of the venues, but are only permitted to attendone venue for gym programmes. Clients are encouraged to register with the venue inwhich they can travel to or access most easily.

All staff members working on the exercise referral service are highly trained fitnessprofessionals. In some instances, clients may be requested to make contact with aspecific member of staff who may be more experienced or have a greater knowledgein a particular rehabilitation field.

Gym programmes will be tailored to each individual who will be taken through theirprogramme on a 1:1 basis. Once comfortable, the client is then able to access the gym intheir own time, as regularly as possible. All classes are taught in a group environmentalongside other exercise referral members. The exercise referral classes are a greatopportunity to meet other people with a similar condition and share experiences.

ex-ref-form-2019-v5 25/09/2019 14:34 Page 4