planning exercise referral programmes with patients

Learner name:

Learner number:

D/503/7494

VRQ

UV31355

Planning exercise referral programmes with patients

By signing this statement of unit achievement you are confirming that all learning outcomes, assessment criteria and range statements have been achieved under specified conditions and that the evidence gathered is authentic.

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Assessor number (optional)

Assessor tracking table

Statement of unit achievement

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UV31355Planning exercise referral programmes with patients

The aim of this unit is to develop the knowledge, understanding and skills needed to effectively plan exercise referral programmes for patients. Specifically, you will learn about the importance of long-term behaviour change and how to identify health-related fitness goals with exercise referral patients.

Practically, you will be able to collect patient information, agree goals, and plan, manage and adapt an exercise referral programme.

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GLH

Credit value

Level

Observation(s)

External paper(s)

52

8

3

1

0

On completion of this unit you will:

Learning outcomes

Planning exercise referral programmes with patients

1. Be able to collect information about exercise referral patients

2. Be able to agree goals with exercise referral patients

3. Be able to plan an exercise referral programme with exercise referral patients

4. Be able to manage an exercise referral programme with patients

5. Be able to review progress with exercise referral patients

6. Be able to adapt an exercise referral programme with patients

7. Understand how to prepare for exercise referral programmes

8. Understand the importance of long-term behaviour change for exercise referral patients

9. Understand the principles of collecting information to plan an exercise referral programme

10. Understand how to identify health-related fitness goals with exercise referral patients

11. Understand how to plan an exercise referral programme with patients

12. Understand how to adapt an exercise referral programme with patients

2. Simulation Simulation is permitted in this unit.

3. Observation outcomes Competent performance of Observation outcomes must be demonstrated on at least one occasion. Assessor observations, witness testimonies and products of work are likely to be the most appropriate sources of performance evidence. Professional discussion may be used as supplementary evidence for those criteria that do not naturally occur.

4. Range All ranges must be practically demonstrated or other forms of evidence produced to show they have been covered.

5. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the Knowledge section of this unit. In most cases this can be done by professional discussion and/or oral questioning. Other methods, such as projects, assignments and/or reflective accounts may also be used.

6. Case study You must identify a suitable case study to enable you to design and agree an exercise referral programme. The programme must be at a minimum, six weeks in duration.

7. Tutor/Assessor guidance You will be guided by your tutor/assessor on how to achieve learning outcomes and cover ranges in this unit. All outcomes and ranges must be achieved.

8. External paper There is no external paper requirement for this unit.

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Evidence requirements

1. Environment Evidence for this unit may be gathered within the workplace or realistic working environment (RWE).

Achieving observation outcomes

Achieving range

Achieving observations and range

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Your assessor will observe your performance of practical tasks. The minimum number of competent observations required is indicated in the Evidence requirements section of this unit.

Criteria may not always naturally occur during a practical observation. In such instances you will be asked questions to demonstrate your competence in this area. Your assessor will document the criteria that have been achieved through professional discussion and/or oral questioning. This evidence will be recorded by your assessor in written form or by other appropriate means.

Your assessor will sign off a learning outcome when all criteria have been competently achieved.

The range section indicates what must be covered. Ranges should be practically demonstrated as part of an observation. Where this is not possible other forms of evidence may be produced. All ranges must be covered.

Your assessor will document the portfolio reference once a range has been competently achieved.

4

Case study

A suitable exercise referral patient should be identified who can act as a case study to enable you to design and agree an exercise referral programme. The programme must be at a minimum, six weeks in duration.

Both real and theoretical patients are acceptable. You are encouraged to collect information from real patients, however there is NO requirement for you to instruct a real exercise referral patient through an exercise programme/s; this can be undertaken by one of your peers in a theoretical simulated environment. You should ensure that the real or theoretical patient that you use for the case study does not possess two conditions which make them high risk or outside the scope of a Level 3 exercise referral instructor.

The chosen patient (case study) must have a minimum of TWO conditions from the list below:

• Hypertension • Hypercholesterolemia • Chronic obstructive pulmonary disease • Asthma • Obesity • Diabetes type 1 and 2 • Osteoarthritis • Rheumatoid arthritis • Osteoporosis • Depression • Stress • Anxiety • Simple mechanical back pain • Joint replacement

Outcome 1

Observations

You can:

Observation 1 Optional OptionalDate achieved

Criteria questioned orally

Portfolio reference

Assessor initials

Learner signature

*May be assessed by supplementary evidence.

Be able to collect information about exercise referral patients

a. Establish a rapport with patients

b. Explain own role and responsibilities to patients

c. Collect the information needed to plan an exercise referral programme, using methods appropriate to the patients and their condition/s

d. Show sensitivity and empathy to patients and the information they provide

e. Record the information using appropriate formats in a way that will aid analysis*

f. Treat confidential information correctly*

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Outcome 2

You can:

Be able to agree goals with exercise referral patients


a. Work with patients to agree short, medium and long-term goals appropriate to their needs

b. Ensure the goals are: • specific, measurable, achievable, realistic and time-bound* • consistent with industry good practice*

c. Agree with patients their needs and readiness to participate

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Portfolio reference

Assessor initials

Learner signature

Outcome 3

You can:


Be able to plan an exercise referral programme with exercise referral patients

a. Plan specific outcome measures, stages of achievement and exercises/physical activities that are: • appropriate to patients’ medical condition/s, goals and levels of fitness* • consistent with accepted good practice*

b. Ensure appropriate components of fitness are built into the programme

c. Apply the principles of training which are appropriate to exercise referral patients and their condition/s to help achieve short, medium and long-term goals*

d. Agree the demands of the programme with patients

e. Agree a timetable of sessions with patients

f. Agree appropriate evaluation methods and review dates with patients

g. Identify the resources needed for the programme, including the use of environments not designed for exercise*

h. Record plans in a format that will help patients and other professionals involved to implement the programme*

i. Agree how to maintain contact with exercise referral patients between sessions

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Portfolio reference

Assessor initials

Learner signature

Outcome 4

You can:

Be able to manage an exercise referral programme with patients


a. Monitor integration of an exercise referral programme and wider physical activity

b. Provide alternatives to the programmed exercises/physical activities if patients cannot take part as planned

c. Monitor patients’ progress using appropriate methods

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Portfolio reference

Assessor initials

Learner signature

Outcome 5

You can:


Be able to review progress with exercise referral patients

a. Explain the purpose of reviewing progress to patients

b. Review short, medium and long-term goals with patients at agreed points in the programme, taking into account any changes in circumstances

c. Encourage patients to give their own views on progress

d. Use suitable methods of evaluation that will help to review patient progress against goals and initial baseline data

e. Give feedback to patients during their review that is likely to strengthen their motivation and adherence

f. Agree review outcomes with patients and other professionals

g. Keep an accurate record of reviews and their outcome*

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Portfolio reference

Assessor initials

Learner signature

Outcome 6

You can:

Be able to adapt an exercise referral programme with patients


a. Identify goals and exercises/physical activities that need to be redefined or adapted

b. Agree adaptations, progressions or regressions to meet patients’ needs to optimise achievement

c. Identify and agree any changes to resources and environments with the patient

d. Introduce adaptations in a way that is appropriate to patients, their needs and medical condition/s

e. Record changes to programme plans to take account of adaptations

f. Monitor the effectiveness of adaptations and update the programme as necessary

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Portfolio reference

Assessor initials

Learner signature

Range

*You must practically demonstrate that you have:

Collected all information Portfolio reference

Referral form

Informed consent to participate and transfer medical information

Medical and surgical history

Medication

Physical activity history

Physical activity preferences

Motivation and barriers to participation

Current fitness level

Stage of readiness

Personal and behavioural goals

Physical measurements

Worked with exercise referral patients (where appropriate, healthcare professionals) to consider all factors to identify and agree short, medium and long-term goals

Portfolio reference

Medical management

General health and fitness

Physiological

Psychological

Lifestyle

Social

Functional ability

Provided all information to clients Portfolio reference

Sensitive feedback based on collected information

Relevant healthy lifestyle advice (within limits of knowledge and competence)

It is strongly recommended that all range items are practically demonstrated. Where this is not possible, other forms of evidence may be produced to demonstrate competence.

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*You must practically demonstrate that you have:

Planned a programme to integrate all activities Portfolio reference

Appropriate exercises to achieve goals

Appropriate physical activities to achieve goals

Incorporated all factors into plan Portfolio reference

Behaviour change strategies

Long-term health and fitness

Reviewed progress and made all necessary adaptations Portfolio reference

Goals are not being achieved

New goals are identified

It is strongly recommended that all range items are practically demonstrated. Where this is not possible, other forms of evidence may be produced to demonstrate competence.

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Achieving knowledge outcomes

Developing knowledge

You will be guided by your tutor and assessor on the evidence that needs to be produced. Your knowledge and understanding will be assessed using the assessment methods listed below*:

• Projects• Observed work• Witness statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion

Where applicable your assessor will integrate knowledge outcomes into practical observations through professional discussion and/or oral questioning.

When a criterion has been orally questioned and achieved, your assessor will record this evidence in written form or by other appropriate means. There is no need for you to produce additional evidence as this criterion has already been achieved.

Some knowledge and understanding outcomes may require you to show that you know and understand how to do something. If you have practical evidence from your own work that meets knowledge criteria, then there is no requirement for you to be questioned again on the same topic.

*This is not an exhaustive list.

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Knowledge

Outcome 4

Be able to manage an exercise referral programme with patients

You can: Portfolio reference

d. Write a letter to a healthcare professional, communicating appropriate information and using accurate language

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Outcome 7

Understand how to prepare for exercise referral programmes


a. Describe a range of resources required to deliver exercise referral programmes for individuals and groups, including: • environment for the session • portable equipment • fixed equipment

b. Explain how to work in environments that are not specifically designed for exercise/physical activity

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Outcome 8

Understand the importance of long-term behaviour change for exercise referral patients


a. Explain why it is important for patients to understand the health benefits of structured exercise referral programmes

b. Explain why it is important for an exercise referral instructor to work together with patients to agree goals, objectives, programmes and adaptations

c. Explain the importance of long-term behaviour change in developing patients’ health and fitness

d. Explain how to encourage patients to commit themselves to long-term change

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Outcome 9

Understand the principles of collecting information to plan an exercise referral programme


a. Explain the principles of informed consent

b. Summarise the patient information that should be collected when designing an exercise referral programme

c. Explain how to select the most appropriate methods of collecting patient information according to patient need

d. Explain how to interpret information collected from the patient in order to identify patient needs and goals

e. Explain the legal and ethical implications of collecting patient information

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Outcome 10

Understand how to identify health-related fitness goals with exercise referral patients


a. Explain how to identify patients’ short, medium and long-term goals

b. Identify when exercise referral instructors should involve others, apart from their patients, in goal setting

c. Explain how to use specific, measurable, achievable, realistic and time-bound (SMART) objectives in an exercise referral programme

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Outcome 11

Understand how to plan an exercise referral programme with patients


a. Explain the absolute contra-indications to exercise

b. Summarise the key principles of designing exercise referral programmes to achieve short, medium and long-term goals, including the order and structure of sessions

c. Describe a range of safe and effective exercises/physical activities to develop: • cardiovascular fitness • muscular fitness • flexibility • motor skills • core stability

d. Explain how to include physical activities as part of patients’ lifestyles to complement exercise sessions

e. Identify when it might be appropriate to share the programme with other professionals

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Outcome 12

Understand how to adapt an exercise referral programme with patients


a. Explain how the principles of training can be used to adapt the programme where: • goals are not being achieved • new goals have been identified

b. Describe appropriate training systems and their use in providing variety and in ensuring programmes remain effective

c. Explain why it is important to keep accurate records of changes, including the reasons for change

d. Explain when it may be appropriate to share changes to exercise referral programmes with other professionals

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Outcome 1: Be able to collect information about exercise referral patients

Unit content

This section provides guidance on the recommended knowledge and skills required to enable you to achieve each of the learning outcomes in this unit. Your tutor/assessor will ensure you have the opportunity to cover all of the unit content.

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Establishing rapport: Interpersonal communication skills (e.g. empathy, active listening, verbal and non-verbal responses), motivational interviewing, open questions, information gathering, planning and evaluating, problem solving, goal setting, feedback.

Own role and responsibilities: Limitations, expectations, clarity of relationship, relationship management, support, monitor, review, data transfer, feedback to relevant parties.

Using appropriate methods collect information: Verbal, non-verbal, interviewing, collecting physical and psychological measures, lifestyle, activity history, Physical Activity Readiness Questionnaire (PAR-Q), questionnaires.

Show sensitivity and empathy: Non-judgemental, non-prejudiced, language, tone, listening skills, effective use of silence, assertiveness, boundaries, ability to confide.

Record information to aid analysis: Standardised for consistency, objective, subjective, formats (consultation documents, questionnaires, physical and psychological measures, informal conversation), clear, concise, detailed, transparent reporting, PAR-Q, interviews, observation, assessments.

Treat confidential information correctly: Secure collection, storage, transference of data, privacy, adherence to protocol, adherence to legislation.

Outcome 2: Be able to agree goals with exercise referral patients

Work with patients to agree goals: Clarity, transparency, mutual agreement, understanding, responsibilities, roles, supervision, informed consent, goals (health and fitness, physiological, psychological, lifestyle, social, functional).

Ensure goals are: Specific, measureable, achievable, realistic, time-bound (SMART), specific to condition, personalised, target focused, consideration of constraints.

Ensure goals are consistent with industry good practice: Follow accepted

protocols, associated with each medical condition, consult with colleagues/other professionals where appropriate.

Agree needs and readiness to participate: Interpret, synthesise, agreement, use of contracts, signature.

Outcome 3: Be able to plan an exercise referral programme with exercise referral patients

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Planning: Specific outcome measures, stages of achievement, appropriate exercises/physical activities, appropriate to patients’ medical condition/s, goals and levels of fitness consistent with accepted good practice.

Outcomes based on: Client requirements (short and long-term), comments made by the client, feedback received, focused on client learning.

Appropriate components of fitness: Strength, speed, stamina and flexibility, consider functional ability, agility, balance, co-ordination, adherence, apply frequency, intensity, time, type (FITT).

Apply appropriate principles of training: Specificity, adaptability, reversibility, overload, progression, variance, individuality.

Agree demands of programme: Expected outcomes achieved based on frequency, intensity, lifestyle commitments, goals.

Agree timetable: Arrival, departure, length of session, frequency, scheduled, progression, self-management.

Agree appropriate evaluation methods and review dates: Self-awareness, exercise instructor-led tests, norms, progression points, short and long-term goal monitoring, reflection, review dates.

Resources for the programme: Appropriate clothing/footwear, towel, testing equipment, paperwork, portable equipment, fixed equipment, environments not designed for exercise.

Record plans: Aims and objectives, session plans, programme card, transferable (e.g. electronic, clear,

consistent, detailed, coherent, current).

How to maintain contact: Appointments (planned review sessions), training sessions, emails, Skype, telephone, social networks.

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Outcome 4: Be able to manage an exercise referral programme with patients

Monitor integration of an exercise referral programme and wider physical activity: Record lifestyle activities, utilise international physical activity questionnaire (IPAQ) or similar measures, provide a plan for exit strategies.

Provide alternatives: Choice of exercise, sequence of session, level of resistance/sets, rests between sets, frequency, intensity, timings, type of exercise, home exercise guidance, timetable of sessions.

Appropriate methods to monitor: Interview, questionnaire, observation, assessments, measurements.

Letter to healthcare professional: Appropriate information, accurate language, client details, condition, reasons for referral, progress, outcomes, areas for concern/clarification, contact details, programme, readiness, restrictions, recommendations.

Outcome 5: Be able to review progress with exercise referral patients

Purpose of review process: Confidence, effectiveness, clarity, progression, behaviour change, concerns, motivation, preventing relapse.

Review goals: Review short/medium/long-term goals, review changes in circumstances, formal and informal feedback, changes in health or fitness, preferences, needs, client progression/regression.

Encourage patient’s views on progress: Focus groups, agreed feedback methods and times, formal and informal, needs and requirements, preferences.

Suitable methods of evaluation: Physical/psychological/health-based tests, using norms, progression points allied to short and long-term goals, references to initial assessments.

Feedback likely to strengthen motivation and adherence: Regular/realistic/achievable feedback, adhere to

client preferences/needs/habits/history, provide alternate exercises, objective and goal focused, goal orientated, empower client to take ownership, identify benefits, identify potential relapses.

Agree review outcomes with patients and other professionals: Short/medium/long-term goals, programme progress and associated changes.

Keep accurate records of reviews and their outcomes: Programme card, client records.

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Outcome 6: Be able to adapt an exercise referral programme with patients

Redefine/adapt goals/activities: Identify changes to goals/exercises/physical activities, re-evaluate programme design, content, structure.

Agree adaptations, progressions or regressions: Timings, intensity, frequency, alternative exercises, exercise position, lever length, increase/decrease tempo, rest time and number of sets.

Agree changes to resources and environments: Indoor (e.g. gym, studio, sports hall, client’s home), outdoor portable equipment, fixed equipment.

Introduce adaptations appropriate to patients’ needs and medical conditions: Revised aims and objectives, revised goals, amended programme design, follow national/international guidelines for chronic diseases.

Record changes to plans (adaptations): Programme card, client records.

Monitor effectiveness of adaptations: Client feedback, achievement of outcomes, client preferences or needs.

Outcome 7: Understand how to prepare for exercise referral programmes

Range of resources for exercise referral programmes:

Environment – gym/studio/enclosed space/outdoors, risk assessment, access considerations, confidentiality, appropriate setting for the client, non-threatening environment.

Testing equipment – sphygmomameter, stethoscope (digital, manual), spirometer, scales, height, weight, bioimpedance, skinfold callipers, blood-based measures, goniometers, condition-based questionnaires, heart rate monitor.

Paperwork – PAR-Q, informed consent, rate of perceived exertion (RPE) scales, lifestyle questionnaire, IPAQ.

Portable equipment – free weights, therabands, stability balls, medicine balls, mats.

Fixed equipment – resistance machines, cardiovascular machines.

Working in environments not specifically designed for exercise/physical activity: Risk assessment, enhanced planning to maximise setting, prepared for the environment, appropriate clothing/footwear, climate consideration, enhanced supervision (ratio of instructor to patients), permission, limitations.

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Outcome 8: Understand the importance of long-term behaviour change for exercise referral patients

Importance of patients understanding health benefits of exercise referral programmes: Motivation, adherence, goal achievement/setting, consequences, to engage, self-management of condition.

Importance of working with patients to agree goals, objectives, programmes and adaptations: Compliance, responsibility, ownership of plan, to reduce misconceptions, agreeing achievable (SMART) goals, stages of change.

Importance of long-term behaviour change: Maintenance, prevention of relapse, effectiveness, time wasting of professionals, maximum use of resource, identifying barriers.

How to encourage commitment to long-term change: Benefits (social, physical, mental), feedback, support mechanisms, incentives, consequences (positive/negative).

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Outcome 9: Understand the principles of collecting information to plan an exercise referral programme

Principles of informed consent: Risks, benefits, questions, full understanding, freedom to withdraw, acknowledgment, permission for information transfer, welfare, decision making, ethics.

Patient information to collect: Referral form, informed consent to participate and transfer medical information, medical and surgical history, medication, physical activity history (past/present), physical activity preferences, motivation and barriers to participation, current fitness levels, stage of readiness, personal and behavioural goals, physical measurements.

Appropriate methods of collecting patient information: Verbal/non-verbal cues, feedback from client, reluctance to engage, type of condition, guidance from referrer, medical information, setting/environment, involvement of second party (e.g. chaperone, parent), consent form, PAR-Q, assessments, measurements.

How to interpret collected information: Norm values, accepted protocols, comparisons of subjective and objective, quantification of risk.

Legal and ethical implications of collecting patient information: Implications of inappropriate data interpretation and handling procedures (e.g. liability, litigation, loss of trust), professional indemnity, code of practice for handling data, keep up to date with medico-legal aspects of exercise referral.

Outcome 10: Understand how to identify health-related fitness goals with exercise referral patients

Identify patients’ short, medium and long-term goals: Results, level of conditioning, readiness to change, consideration of referral paperwork, patient commitment, goals based on medical management, general health and fitness, physiological, psychological, lifestyle, social and functional ability.

When to involve others in goal setting: When outside of scope of practice, clarity, assurance, inconsistencies.

Specific, measurable, achievable, realistic and time-bound (SMART) objectives: Progression, regression, keeping focus, individuality, target orientated.

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Outcome 11: Understand how to plan an exercise referral programme with patients

Absolute contra-indications to exercise: Unstable condition (deterioration in condition in last month, need to change medication), uncontrolled condition (conditions not currently being effectively managed with medication/treatment), contra-indication (risks attached outweigh any benefits).

British Association for Cardiac Rehabilitation (BACR) and American College of Sports Medicine (2005) guidelines for absolute contra-indications – unstable angina, resting systolic BP ≥ 180 mmHg/diastolic BP ≥ 100 mmHg, symptomatic hypotension (blood pressure drop > 20 mmHG demonstrated during exercise tolerance tests (ETT)), resting or uncontrolled tachycardia > 100 bpm, unstable or acute heart failure, new or uncontrolled arrhythmias (atrial or ventricular), valvular heart disease/aortic stenosis, unstable diabetes, febrile illness, acute systemic disease (such as cancers), disorders exacerbated by exercise (neuromuscular, musculoskeletal, rheumatoid), unmanaged pain.

British Heart Foundation’s (2010) guidelines for absolute contra-indications – significant change in resting ECG, recent myocardial infarcation, other acute cardiac event, symptomatic severe aortic stenosis, acute pulmonary embolus, pulmonary infarction, acute myocarditis, pericarditis, suspected or known dissecting aneurysm, resting systolic blood pressure > 180mmHg/DBP > 100mmHg, uncontrolled/unstable angina, acute uncontrolled psychiatric illness, unstable or acute heart failure, new or uncontrolled arrhythmias, other rapidly progressing terminal illness, experiences significant drop in blood pressure during exercise, uncontrolled

resting tachycardia > 100 bpm, febrile illness, experiences pain/dizziness/excessive breathlessness during exertion, any unstable/uncontrolled condition.

Key principles of designing exercise referral programmes: FITT principles, training principles, structure (warm-up, main session, cool down), monitoring, evaluation, feedback.

Range of safe and effective exercises/physical activities to develop:

Cardiovascular – rhythmic continued exercise involving large muscle groups, structured, unstructured (e.g. walking, cycling, running).

Muscular fitness – resistance training (isometric, isotonic), structured (free/fixed/body weight), unstructured (activities of daily (ADL)).

Flexibility – as part of structured warm-up/cool down session (static, dynamic, PNF), maintenance, developmental, unstructured (everyday activities).

Motor skills – balance, proprioception, co-ordination, structured (sport), unstructured (everyday activities), functional activities.

Core stability – posture, Pilates, stability balls, instability training.

Physical activities to complement exercise sessions: Recommendations for active lifestyle, government directives, education, lifestyle assessment, exploring creative options.

Sharing programme with other professionals: To clarify appropriateness of programme, as indicated by risk protocol, address questions/concerns, where treatment is multidisciplinary.

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Outcome 12: Understand how to adapt an exercise referral programme with patients

Principles of training: Specific adaptable, reversible, overload, progression, variance, individuality.

Using principles of training to adapt programme: Goals are not being achieved, new goals have been identified, based on client progression/regression, review/revise, implement changes in frequency, intensity, time, type of exercise (FITT), benchmark.

Appropriate training systems: Periodisation, implementation, planning, creative exercise solutions, to provide variety, to ensure effectiveness.

Importance of keeping accurate records of changes: Monitor, evaluation, rationale, legal reasons, reporting back to referrer, team-based working, multi-disciplinary.

When appropriate to share changes to exercise referral programmes: Where more than one instructor is involved, where multiple interventions are taking place, where progress is ineffective.

planning exercise referral programmes with patients

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