vtct level 3 diploma in exercise referral...professionals (reps) at level 3. prerequisites your...

AF30401F_v4

VTCT Level 3 Diploma in Exercise Referral

Operational start date: 1 April 2012Credit value: 38Total Qualification Time (TQT): 380Guided learning hours (GLH): 242Qualification number: 600/4756/2

Statement of unit achievementBy signing this statement of unit achievement you are confirming that all learning outcomes, assessment criteria and range statements (if/where applicable) have been achieved under specified conditions, and that the evidence gathered is authentic.

This statement of unit achievement table must be completed prior to claiming certification.

Unit code Date achieved Learner signature

Assessor initials

IQA signature (if sampled)

Mandatory units

UV30536

UV30539

UV31357

UV41356

UV31355

UV31358

222

The qualification

Introduction National Occupational Standards (NOS)

The VTCT Level 3 Diploma in Exercise Referral will allow you to progress your career in the sport and active leisure industry by specialising in exercise referral.

The demand for exercise referral specialists will continue to grow as diseases such as diabetes and cardiac disease become more prevalent in our society, due to lifestyle factors and an ever increasing ageing population.

Through this qualification you will develop an understanding of anatomy and physiology, medical conditions, professional practice and nutrition. You will develop the skills and knowledge needed to plan and instruct suitable programmes’ for exercise referral patients.

On successful completion of this qualification you will be able to gain employment as an exercise referral instructor and will be eligible for registration onto the Register of Exercise Professionals (REPs) at Level 3.

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Prerequisites

Your centre will have ensured that you have the required knowledge, understanding and skills to enrol and successfully achieve this qualification.

Pre-requisite qualifications needed for progression onto this qualification are: • VTCT Level 2 Certificate in Fitness

Instructing • VTCT Level 3 Certificate in Personal

Training • VTCT Level 3 Diploma in Mat Based Pilates

Units in this qualification have been mapped to the relevant NOS (where applicable). This qualification is regulated on the Regulated Qualifications Framework. This qualification is approved and supported by SkillsActive, the sector skills council for active leisure and learning.

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Progression

On completion of this qualification you may choose to undertake further study; qualifications you could progress to include:• Level 4 specialist instructor qualifications

(i.e. cardiac disease, falls prevention, stroke, mental health, low back pain, obesity/diabetes)

Alternatively, you may wish to seek employment as an exercise referral specialist/instructor.

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Qualification structure

Mandatory units - 38 creditsVTCT unit code

Ofqual unit reference Unit title Credit value GLH

UV30536 A/600/9051 Anatomy and physiology for exercise and health 6 43

UV30539 L/600/9054 Applying the principles of nutrition to a physical activity programme 6 40

UV31357 Y/503/7493 Professional practice for exercise referral instructors 2 14

UV41356 R/503/7492 Understanding medical conditions for exercise referral 7 35

UV31355 D/503/7494 Planning exercise referral programmes with patients 8 52

UV31358 L/503/7491 Instructing exercise with referred patients 9 58

Total credits required - 38

4

All mandatory units must be completed.

5

Guidance on assessment

External assessment (any requirements will be shown in the unit)

Externally assessed question papers completed electronically will be set and marked by VTCT.

Externally assessed hard-copy question papers will be set by VTCT, marked by centre staff and sampled by VTCT external quality assurers.

This book contains the mandatory units that make up this qualification. Optional units will be provided in additional booklets (if applicable). Where indicated, VTCT will provide assessment materials. Assessments may be internal or external. The method of assessment is indicated in each unit.

Internal assessment (any requirements will be shown in the unit)

Assessment is set, marked and internally quality assured by the centre to clearly demonstrate achievement of the learning outcomes. Assessment is sampled by VTCT external quality assurers.

Assessment explained

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VTCT courses are assessed and quality assured by centre staff. Work will be set to improve your practical skills, knowledge and understanding. For practical elements, you will be observed by your assessor. All your work must be collected in a portfolio of evidence and cross-referenced to requirements listed in this record of assessment book.

Your centre will have an internal quality assurer whose role is to check that your assessment and evidence is valid and reliable and meets VTCT and regulatory requirements.

An external quality assurer, appointed by VTCT, will visit your centre to sample and quality-check assessments, the internal quality assurance process and the evidence gathered. You may be asked to attend on a different day from usual if requested by the external quality assurer.

This record of assessment book is your property and must be in your possession when you are being assessed or quality assured. It must be kept safe. In some cases your centre will be required to keep it in a secure place. You and your course assessor will together complete this book to show achievement of all learning outcomes, assessment criteria and ranges.

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Creating a portfolio of evidence

As part of this qualification you are required to produce a portfolio of evidence. A portfolio will confirm the knowledge, understanding and skills that you have learnt. It may be in electronic or paper format.

Your assessor will provide guidance on how to prepare the portfolio of evidence and how to show practical achievement and understanding of the knowledge required to successfully complete this qualification. It is this booklet along with the portfolio of evidence that will serve as the prime source of evidence for this qualification.

Evidence in the portfolio may take the following forms:

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

All evidence should be documented in the portfolio and cross-referenced to unit outcomes. Constructing the portfolio of evidence should not be left to the end of the course.

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7

Unit assessment methods

This section provides an overview of the assessment methods that make up each unit in this qualification. Detailed information on assessment is provided in each unit.

Mandatory units External Internal

VTCT unit code Unit title Question

paper(s) Observation(s) Portfolio of Evidence

UV30536 Anatomy and physiology for exercise and health 1 û

UV30539 Applying the principles of nutrition to a physical activity programme 0 û

UV31357 Professional practice for exercise referral instructors 0 û

UV41356 Understanding medical conditions for exercise referral 0 û

UV31355 Planning exercise referral programmes with patients 0

UV31358 Instructing exercise with referred patients 0

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Unit glossary

8

Description

VTCT product code

All units are allocated a unique VTCT product code for identification purposes. This code should be quoted in all queries and correspondence to VTCT.

Unit title The title clearly indicates the focus of the unit.

National Occupational Standards (NOS)

NOS describe the skills, knowledge and understanding needed to undertake a particular task or job to a nationally recognised level of competence.

LevelLevel is an indication of the demand of the learning experience; the depth and/or complexity of achievement and independence in achieving the learning outcomes.

Credit valueThis is the number of credits awarded upon successful achievement of all unit outcomes. Credit is a numerical value that represents a means of recognising, measuring, valuing and comparing achievement.

Guided learning hours (GLH)

The activity of a learner in being taught or instructed by - or otherwise participating in education or training under the immediate guidance or supervision of - a lecturer, supervisor, tutor or other appropriate provider of education or training.

Total qualification time (TQT)

The number of hours an awarding organisation has assigned to a qualification for Guided Learning and an estimate of the number of hours a learner will reasonably be likely to spend in preparation, study, or any other form of participation in education or training. This includes assessment, which takes place as directed - but, unilke Guided Learning, not under the immediate guidance or supervision of - a lecturer, supervisor, tutor or other appropriate provider of education or training.

Observations This indicates the minimum number of competent observations, per outcome, required to achieve the unit.

Learning outcomes

The learning outcomes are the most important component of the unit; they set out what is expected in terms of knowing, understanding and practical ability as a result of the learning process. Learning outcomes are the results of learning.

Evidence requirements This section provides guidelines on how evidence must be gathered.

Observation outcome

An observation outcome details the tasks that must be practically demonstrated to achieve the unit.

Knowledge outcome

A knowledge outcome details the theoretical requirements of a unit that must be evidenced through oral questioning, a mandatory written question paper, a portfolio of evidence or other forms of evidence.

Assessment criteria

Assessment criteria set out what is required, in terms of achievement, to meet a learning outcome. The assessment criteria and learning outcomes are the components that inform the learning and assessment that should take place. Assessment criteria define the standard expected to meet learning outcomes.

Range The range indicates what must be covered. Ranges must be practically demonstrated in parallel with the unit’s observation outcomes.

UV30536Anatomy and physiology for exercise and health

It is the aim of this unit to develop your knowledge and understanding of the anatomy and physiology underpinning exercise and health.

UV30536_v5

GLH

Credit value

Level

Observation(s)

External paper(s)

43

6

3

0

1

On completion of this unit you will:

Learning outcomes Evidence requirements

Anatomy and physiology for exercise and health

1. Understand the heart and circulatory system and its relation to exercise and health

2. Understand the musculoskeletal system and its relation to exercise

3. Understand postural and core stability

4. Understand the nervous system and its relation to exercise

5. Understand the endocrine system and its relation to exercise and health

6. Understand energy systems and their relation to exercise

1. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the ‘Knowledge’ section of this unit. This evidence may include projects, assignments, case studies, reflective accounts, oral/written questioning and/or other forms of evidence.

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

3. External paper Knowledge and understanding in this unit will be assessed by an external paper. There is one external paper that must be achieved.

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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:

• Observed work performance• Witness testimony/statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion• Employer-provided question papers and

tests• E-assessment.

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Achieving the external paper

The external paper will test your knowledge of all criteria in this section. A pass mark of 70% must be achieved.

Your assessor will complete this table when the 70% pass mark has been achieved.

Paper Date achieved Assessor initials

1 of 1

Knowledge

Outcome 1

Understand the heart and circulatory system and its relation to exercise and health

You can: Portfolio reference /Assessor initials*

a. Explain the function of the heart valves

b. Describe coronary circulation

c. Explain the effect of disease processes on the structure and function of blood vessels

d. Explain the short and long term effects of exercise on blood pressure, including the valsalva effect

e. Explain the cardiovascular benefits and risks of endurance/aerobic training

f. Define blood pressure classifications and associated health risks

*Assessor initials to be inserted if orally questioned.

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Outcome 2

Understand the musculoskeletal system and its relation to exercise


a. Explain the cellular structure of muscle fibres

b. Describe the sliding filament theory

c. Explain the effects of different types of exercises on muscle fibre type

d. Identify and locate the muscle attachment sites for the major muscles of the body

e. Name, locate and explain the function of skeletal muscle involved in physical activity

f. Identify the anatomical axis and planes with regard to joint actions and different exercises

g. Explain the joint actions brought about by specific muscle group contractions

h. Describe joints/joint structure with regard to range of motion/movement and injury risk

i. Describe joint movement potential and joint actions

j. Describe the structure of the pelvic girdle and associated muscles and ligaments


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Outcome 3

Understand postural and core stability


a. Describe the structure and function of the stabilising ligaments and muscles of the spine

b. Describe local muscle changes that can take place due to insufficient stabilisation

c. Explain the potential effects of abdominal adiposity and poor posture on movement efficiency

d. Explain the potential problems that can occur as a result of postural deviations

e. Explain the impact of core stabilisation exercise and the potential for injury/aggravation of problems

f. Explain the benefits, risks and applications of the following types of stretching: • static (passive and active) • dynamic • proprioceptive neuromuscular facilitation


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Outcome 4

Understand the nervous system and its relation to exercise


a. Describe the specific roles of:• the central nervous system (CNS) • the peripheral nervous system (PNS) including somatic and

autonomic systems

b. Describe nervous control and transmission of a nervous impulse

c. Describe the structure and function of a neuron

d. Explain the role of a motor unit

e. Explain the process of motor unit recruitment and the significance of a motor unit’s size and number of muscle fibres

f. Explain the function of muscle proprioceptors and the stretch reflex

g. Explain reciprocal inhibition and its relevance to exercise

h. Explain the neuromuscular adaptations associated with exercise/training

i. Explain the benefits of improved neuromuscular co-ordination/efficiency to exercise performance


UV3053616

Outcome 5

Understand the endocrine system and its relation to exercise and health


a. Describe the functions of the endocrine system

b. Identify the major glands in the endocrine system

c. Explain the function of hormones including: • growth hormone • thyroid hormones • corticosteroids • catecholamines • insulin • glucagon


UV30536 17

Outcome 6

Understand energy systems and their relation to exercise


a. Identify the contribution of energy according to: • duration of exercise/activity being performed • type of exercise/activity being performed • intensity of exercise/activity being performed

b. Identify the by-products of the three energy systems and their significance in muscle fatigue

c. Describe the effect of endurance training/advanced training methods on the use of fuel for exercise


UV3053618

Outcome 1: Understand the heart and circulatory system and its relation to exercise and health

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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Function of heart valves: Heart structure (ventricles, atria, interventricular septum, interatrial septum), atrioventricular valves (tricuspid valve, bicuspid valve, chordate tendinae, papillary muscle), semi-lunar valves (aortic and pulmonary), function of valves (control blood flow through heart chambers, prevent backflow of blood).

Coronary circulation: Circulatory process (superior and inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary semi-lunar valve, pulmonary arteries, pulmonary circulation, pulmonary veins, left atrium, bicuspid valve, left ventricle, aortic semi-lunar valves, aorta, systemic circulation), blood (oxygenated, deoxygenated).

Disease processes and the blood vessels: Structure and function (arteries, arterioles, capillaries, veins, venules), diseases (arteriosclerosis, atherosclerosis), processes (thickening of artery walls, loss of elasticity, endothelial damage, smooth muscle fibre proliferation, lesions formed by fatty plaque).

Blood pressure and exercise: Definition of blood pressure (systolic pressure, diastolic pressure), blood pressure classifications (hypotension, normal, high normal, mild hypertension, moderate hypertension, severe hypertension), associated health risks of hypertension (stroke, coronary heart disease, coronary artery disease, kidney disease, loss of vision), short term effects of exercise (no change in diastolic pressure, progressive increase in systolic pressure), long term

effects of exercise (reduction in resting blood pressure, improved regulation of blood pressure), valsalva effect.

Cardiovascular benefits and risks of endurance/aerobic training: Benefits – increased heart strength and efficiency, increased capillary network, increased elasticity of blood vessels, improved blood flow distribution, improved blood cholesterol profile, reduced blood pressure, improved ability to tolerate heat, reduced risk of cardiovascular diseases.

Risks – overexertion, aggravation of cardiovascular contra-indications to exercise, overtraining, overuse injuries.

Outcome 2: Understand the musculoskeletal system and its relation to exercise

UV3053620

Sliding filament theory: Actin, myosin, cross-bridges, troponin-tropomyosin, complex, depolarisation, calcium ions, adenosine triphosphate, shortening of sarcomere, motor unit recruitment.

Exercise and muscle fibre type: Muscle fibre type characteristics (I – slow oxidative, IIa – fast oxidative/glycolytic, IIb – fast glycolytic), effects of aerobic exercise on type I fibres (increased concentration of aerobic enzymes, increased size and number of mitochondria, increased ability to use fat as an energy source, increased storage of muscle glycogen, increased supply of intramuscular fat, increased myoglobin, increased number of capillaries), effects of resistance training on type II fibres (increase in muscle mass and cross-sectional area, possible increase in number of type II muscle fibres, increased motor unit recruitment).

Structure of muscle: Muscle structure (epimysium, perimysium, endomysium), cellular muscle structure (sarcolemma, myofibrils, sarcoplasm, sarcoplasmic reticulum, sarcomere, actin, myosin, mitochondria, terminal cisternae, t-tubules, troponin, tropomyosin), other microscopic structures (Z lines, A and I bands, H zone, M line).

Axial and appendicular skeleton: Names and locations of axial bones (cranium, cervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, sternum, ribs, coccyx), names and locations of appendicular bones (scapula, clavicle, humerus, ulna, radius, carpals, metacarpals, phalanges, ilium, ischium, pubis, femur, patella, tibia, fibula, tarsals, calcaneus, metatarsals).

Major skeletal muscles and attachment sites: Names and locations of major muscles to include rotator cuff (teres minor, supraspinatus, subscapularis, infraspinatus), shoulder girdle (pectoralis major, pectoralis minor, levator scapulae, serratus anterior, trapezius, rhomboids major/minor, teres major), spinal extensors (erector spinae, iliocostalis, longissimus, spinalis, multifidus, quadratus lumborum), hip flexors (iliopsoas, iliacus, psoas major/minor), adductors (magnus, brevis, longus, pectineus, gracilis, sartorius), abductors (gluteus medius, gluteus minimus, piriformis, tensor fascia latae), abdominals (rectus abdominus, internal and external obliques, transverse abdominus), intercostals, diaphragm, quadriceps (rectus femoris, vastus intermedius, vastus medialis, vastus lateralis), hamstrings (biceps femoris, semitendinosus, semimembranosus), tibialis anterior, sternocleidomastoid, scalenes, deltoids (anterior, medial posterior), gastrocnemius, soleus, tibialis posterior, biceps brachii, brachialis, coracobrachialis, triceps brachii, gluteus maximus, latissimus dorsi, major muscle attachment sites (origin, insertion).

Function of skeletal muscle: Functions (movement, maintain posture and stability, heat generation), principles of muscle work (muscles pull on bones, muscle contract in fibre direction, muscle cross joints, muscles work in pairs), leverage (fulcrum, resistance, effort), types of levers during exercise (first class, second class, third class), muscle contractions during exercise (dynamic concentric, dynamic eccentric, isotonic, isometric), muscle roles during exercise (agonist, antagonist, fixator, synergist).

Outcome 2: Understand the musculoskeletal system and its relation to exercise (continued)

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Anatomical axis and planes: Frontal plane (anterior/posterior axis movements (adduction, abduction, lateral flexion, eversion, inversion)), sagittal plane (bilateral axis movements (flexion, extension)), transverse plane (vertical axis movements (internal rotation, external rotation, horizontal flexion/adduction, horizontal extension/abduction)), associated exercises in different planes and axis.

Joint structure: Fibrous – synarthrosis, immovable, have no joint cavity, are connected via fibrous connective tissue e.g. skull bones are connected by fibrous joints.

Cartilaginous – amphiarthosis, slightly moveable, a joint in which the surfaces are connected by disks of fibrocartilage, as between vertebrae.

Synovial – diarthrosis, freely moveable, all diarthroses have this characteristic space between the bones that is filled with synovial fluid.

Structure of a synovial joint – joint capsule, ligaments, synovial fluid, articular cartilage, bone.

Types and locations of synovial joint – gliding, ellipsoid, hinge, saddle, pivot, ball and socket.

Associated range and stability of motion/movement of synovial joint types – range norms, factors affecting stability (shape of articular surfaces, capsule, ligaments, muscle tone, gravity).

Associated injury risk to joints types and ligaments – e.g. joints must be used in correct plane, joint must be aligned, joints not taken beyond end range, greater

range of movement allows increased risk of injury.

Joint movement potential and actions: Shoulder (flexion, extension, abduction, adduction, horizontal flexion/adduction, horizontal extension/abduction, internal rotation, external rotation), elbow (flexion, extension, supination, pronation), shoulder girdle (elevation, depression, protraction, retraction), spine (flexion, extension, lateral flexion, rotation), hip (flexion, extension, abduction, adduction, internal rotation, external rotation), knee (flexion, extension), ankle (plantarflexion, dorsiflexion, inversion, eversion), significance of joint type and structure for movement potential, associated joints crossed by muscles, associated muscle group contractions, analysis of different multi-joint and single joint exercises.

Structure of pelvic girdle: Structural bones (ilium, ischium, pubis, sacro-iliac joint), associated muscles (iliopsoas, pectineus, rectus femoris, sartorius, adductors, gluteus maximus, hamstrings, hip abductors), ligaments (iliolumbar, sacrospinous, sacrotuberous, anterior and posterior sacroiliac), pubis symphysis articulation, sacroiliac articulation, importance of pelvic girdle for weight bearing exercise, male and female differences (femur angle, injury risk).

Outcome 3: Understand postural and core stability

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Structure of the spine: Vertebrae structure (facet joints, vertebral foramen, spinal cord, spinal canal, cartilaginous discs), specific functions of vertebral regions (cervical, thoracic, lumbar, sacrum, coccyx).

Stabilising ligaments and muscles of the spine: Structure and function, ligaments (ligamentum flavum, anterior and posterior longitudinal ligaments), intrasegmental and intersegmental ligament systems, role of spinal ligaments in core stability, location and role of local postural stabilisers (lumbar multifidus, transversus abdominus, diaphragm, pelvic floor muscles, abdominal aponeurosis, thoracolumbar fascia), location and role of global phasic stabilisers (rectus abdominis, internal obliques, external obliques, transverse abdominis, erector spinae, quadratus lumborum).

Local muscle changes due to insufficient stabilisation: Stabilisation systems, reasons for insufficient stabilisation (heredity, medical conditions, lifestyle, ageing, muscle imbalances), muscle changes (muscles lengthened, muscles shortened, weak/inactive muscles, overactive/strong muscles, imbalanced kinetic chain, compensation patterns, synergistic dominance, inefficient movements).

Effects of abdominal adiposity and poor posture: Inefficient movement patterns, compensation, muscle imbalances, stability, alignment, centre of gravity excursions.

Postural deviations: Deviations (flat back, sway back, kyphosis, lordosis, scoliosis), importance of deviations for exercise safety, potential problems of deviations (muscle imbalances and compensation,

inefficient movement patterns, joint and muscle pain, spinal disorders), methods of identifying deviations (postural analysis form, postural photography, postural analysis computer software), referral to appropriate professionals (GP, physiotherapist), reasons and procedures for referral.

Impact of core stabilisation exercises: Definition of core stability (maintaining spinal alignment and pelvic position, statically and dynamically), impact (improved posture, improved motor skill performance, improved power application, muscle balance throughout kinetic chain, injury prevention for spine and shoulder girdle, improved aesthetics), potential for injury and aggravation of problems (improper technique, contra-indicated exercises for specific postural problems and deviations, importance of maintaining neutral spine, importance of maintaining correct spinal curvature).

Benefits, risks and applications of stretching: Types of stretching (static active and passive, dynamic, CRAC, proprioceptive neuromuscular facilitation), benefits (improved range of motion, improved posture, reduced risk of injury, improved functional ability), risks (improper technique leading to overstretching, injury to muscles and tendons, injury to ligaments and joint capsules), applications (general and specific warm up, cool down, flexibility development, functional development, injury rehabilitation).

Outcome 4: Understand the nervous system and its relation to exercise

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Roles of the nervous system: Main functions (sense changes to stimuli, information processing, response to stimuli), central nervous system components (brain, spinal cord), CNS roles (receive messages from peripheral nervous system about environment, interprets information, sends messages back to the peripheral nervous system), peripheral nervous system components (sensory neurons, motor neurons), PNS roles (transmits information from receptors to CNS, transmits information from CNS to muscles and glands), peripheral nervous system divisions (autonomic nervous system, somatic nervous system, sympathetic system, parasympathetic system).

Specific nervous system roles: Somatic system roles (sensory input, control of voluntary muscle), autonomic system roles (sense hormonal balance, internal organ function, control of involuntary muscle, control of endocrine glands), sympathetic division roles (increase heart rate, increase breathing rate, mobilise energy stores, regulation of blood pressure, blood flow redistribution, most active during exercise), parasympathetic division (slows down functions, more active during rest and recovery).

Nervous control and nerve impulse transmission: Role of the brain and spinal cord, nerve impulse, sensory neurones, receptor organs, synapse, motor neurones, axon terminal, acetylcholine, neuromuscular junction, effector organs, action potentials.

Structure and function of a neuron: Structure (dendrites, nucleus, cytoplasm, axon, myelin sheath, nodes of Ranvier,

nerve endings), function (transmit signals to muscles).

Role of a motor unit: In muscle contraction, small motor units (type I), large motor units (type II), size principle, factors affecting recruitment patterns (specific movement pattern, high and low firing threshold, skill and experience of participant), motor unit recruitment.

Muscle proprioceptors and the stretch reflex: Function of muscle spindles (detect changes in muscle length), function of golgi tendon organs (detect changes in muscle tension), stretch reflex (contraction of stretched muscle, reflex arc).

Reciprocal inhibition: Agonist muscle contraction, antagonist muscle relaxation, relevance to exercise (allows appropriate muscle contraction, can be used to promote flexibility development).

Neuromuscular adaptations to exercise/training: Aerobic training adaptations (improved aerobic capacity of trained muscles, glycogen sparing, increased fat utilisation), resistance training adaptations (improved motor recruitment, increased ability to achieve stronger muscle contractions, muscle fibre hypertrophy, muscle fibre hyperplasia, improved recruitment of fast twitch fibres), types of motor skills training (reaction time, balance, co-ordination, speed, agility, spatial awareness), motor skills training adaptations (growth of new nervous system connections, increased frequency of nerve impulses to motor units, improved synchronous motor unit recruitment, improved intermuscular co-ordination, automatic performance of movement patterns), methods of motor skill development (short training duration,

Outcome 4: Understand the nervous system and its relation to exercise (continued)

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repetition, progressing movement speed, whole-part-whole, progressive layering of demands on motor skills, positive reinforcement and feedback).

Benefits of improved neuromuscular co-ordination: Improved movement efficiency and economy, improved accuracy of movement patterns, improved force generation, improved stability, improved spatial awareness, automatic movement patters.

Outcome 5: Understand the endocrine system and its relation to exercise and health

Functions of the endocrine system: Maintains homeostasis, regulation of growth, development and metabolism, production of hormones, close links with nervous system.

Major glands: Location and role to include pituitary, thyroid, parathyroid, pancreas, adrenal glands, kidney, testes, and ovaries.

Functions of hormones: Growth hormone (growth of body cells, protein anabolism, elevation of blood glucose), thyroid hormones (metabolism, growth, development, nervous system control), corticosteroids (regulate metabolism), adrenalin and noradrenalin (control of sympathetic nervous system, ‘fight or flight’ response before exercise), insulin (lowers blood glucose, increases lipogensis, stimulates protein synthesis), glucagon (raises blood glucose, conversion of nutrients to glucose for energy release).

Outcome 6: Understand energy systems and their relation to exercise

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Energy contribution: Energy systems (phosphogen system/ATP-PC, glycolysis/glycolytic system, aerobic system), proportion of energy system contribution (exercise type, exercise duration, exercise intensity), proportion of energy system contribution during different sports and activities (e.g. distance running, football, tennis, weightlifting, sprinting).

By-products: Phosphogen (adenosine diphosphate, phosphate, hydrogen ions), glycolysis (lactic acid), aerobic (water, carbon dioxide), associated significance of by-products in muscle fatigue (limitation of mechanical and biochemical muscle contraction processes, lactate threshold, onset of blood lactate accumulation (OBLA)).

Effects of endurance training: On relative proportions of fuel use for exercise, glycogen sparing, ability to utilise fats at higher exercise intensities, increased lactate threshold, improved ability to tolerate and remove lactate, lower lactate levels following exercise.

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Notes Use this area for notes and diagrams

UV30539Applying the principles of nutrition to a physical activity programmeIt is the aim of this unit to develop your knowledge and understanding of the principles of nutrition. It also aims to develop the skills needed to apply nutrition to an exercise and physical activity programme, in support of client goals.

UV30539_v8

GLH

Credit value

Level

Observation(s)

External paper(s)

40

6

3

0

0



Applying the principles of nutrition to a physical activity programme

1. Be able to collect and analyse nutritional information

2. Be able to apply the principles of nutrition to a physical activity programme

3. Understand the principles of nutrition

4. Understand key guidelines in relation to nutrition

5. Understand nationally recommended practice in relation to providing nutritional advice

6. Understand the relationship between nutrition and physical activity

7. Understand how to collect information relating to nutrition

8. Understand how to use nutritional information

9. Understand the principles of nutritional goal setting with clients

1. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the ‘Knowledge’ section of this unit. This evidence may include projects, assignments, case studies, reflective accounts, oral/written questioning and/or other forms of evidence.


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

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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:

• Observed work performance• Witness testimony/statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion• Employer-provided question papers and

tests• E-assessment.

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Knowledge

Outcome 1

Be able to collect and analyse nutritional information


a. Collect information needed to provide clients with appropriate healthy eating advice

b. Record information about clients and their nutritional goals in an approved format

c. Analyse collected information including nutritional needs and preferences in relation to the clients current status and nutritional goals


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Outcome 2

Be able to apply the principles of nutrition to a physical activity programme


a. Access and make use of credible sources of educational information and advice in establishing nutritional goals with clients

b. Design and agree nutritional goals that are compatible with the analysis, accepted good practice and national guidelines

c. Ensure that the nutritional goals support and integrate with other programme components

d. Agree review points with the clients

e. Review the clients understanding of how to follow the nutritional advice as part of their physical activity programme

f. Monitor, evaluate and review the clients’ progress towards their nutritional goals


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Outcome 3

Understand the principles of nutrition


a. Describe the structure and function of the digestive system

b. Explain the meaning of key nutritional terms including: • diet • healthy eating • nutrition • balanced diet

c. Describe the function and metabolism of: • macronutrients • micronutrients

d. Explain the main food groups and the nutrients they contribute to the diet

e. Identify the calorific value of nutrients

f. Explain the common terminology used in nutrition including: • UK dietary reference values (DRV) • recommended daily allowance (RDA) • recommended daily intake (RDI) • glycemic index

g. Interpret food labelling information

h. Explain the significance of healthy food preparation

i. Explain the relationship between nutrition, physical activity, body composition and health including: • links to disease/disease risk factors • cholesterol • types of fat in the diet


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Outcome 4

Understand key guidelines in relation to nutrition


a. Identify the range of professionals and professional bodies involved in the area of nutrition

b. Explain key healthy eating advice that underpins a healthy diet

c. Describe the nutritional principles and key features of the national food model/guide

d. Define portion sizes in the context of the national food model/guide

e. Explain how to access reliable sources of nutritional information

f. Distinguish between evidence-based knowledge versus the unsubstantiated marketing claims of suppliers


UV3053934

Outcome 5

Understand nationally recommended practice in relation to providing nutritional advice


a. Explain professional role boundaries with regard to offering nutritional advice to clients

b. Explain the importance of communicating health risks associated with weight loss fads and popular diets to clients

c. Evaluate the potential health and performance implications of severe energy restriction, weight loss and weight gain

d. Identify clients at risk of nutritional deficiencies

e. Explain how cultural and religious dietary practices can influence nutritional advice

f. Describe safety, effectiveness and contra-indications relating to protein and vitamin supplementation

g. Explain why detailed or complex dietary analysis that incorporates major dietary change should always be referred to a registered dietician


UV30539 35

Outcome 6

Understand the relationship between nutrition and physical activity


a. Define the role of carbohydrate, fat and protein as fuels for aerobic and anaerobic energy production

b. Explain the components of energy expenditure and the energy balance equation

c. Explain how to calculate an estimate of Basal Metabolic Rate (BMR)

d. Explain how to estimate energy requirements based on physical activity levels and other relevant factors

e. Identify energy expenditure for different physical activities

f. Evaluate the nutritional requirements and hydration needs of clients engaged in physical activity


UV3053936

Outcome 7

Understand how to collect information relating to nutrition


a. Explain why it is important to obtain clients’ informed consent before collecting nutritional information

b. Describe the information that needs to be collected to offer nutritional advice to clients

c. Explain the legal and ethical implications of collecting nutritional information

d. Describe different formats for recording nutritional information

e. Explain why confidentiality is important when collecting nutritional information

f. Describe issues that may be sensitive when collecting nutritional information

g. Explain different methods that can be used to measure body composition and health risk in relation to weight


UV30539 37

Outcome 8

Understand how to use nutritional information


a. Describe basic dietary assessment methods

b. Explain how to analyse and interpret collected information so that clients’ needs and nutritional goals can be identified with reference to the national food model/guide recommendations

c. Describe how to interpret information gained from methods used to assess body composition and health risk in relation to weight

d. Explain how to sensitively divulge collected information and ‘results’ to clients

e. Explain how to recognise the signs and symptoms of disordered eating and healthy eating patterns

f. Explain how to recognise the signs and symptoms of disordered eating and healthy eating patterns

g. Describe the key features of the industry guidance note on ‘Managing users with suspected eating disorders’

h. Explain the circumstances in which a client should be recommended to visit their GP about the possibility of referral to a registered dietician


UV3053938

Outcome 9

Understand the principles of nutritional goal setting with clients


a. Explain how to apply the principles of goal setting when offering nutritional advice

b. Explain how to translate nutritional goals into basic healthy eating advice that reflects current national guidelines

c. Explain when people other than the client should be involved in nutritional goal setting

d. Define which other people could be involved in nutritional goal setting

e. Identify the barriers which may prevent clients achieving their nutritional goals

f. Explain how to apply basic motivational strategies to encourage healthy eating and prevent non-compliance or relapse

g. Explain the need for reappraisal of clients’ body composition and other relevant health parameters at agreed stages of the programme


UV30539 39

Outcome 1: Be able to collect and analyse nutritional information

Unit content


UV3053940

Collect information: Personal goals, specific fitness needs, general health needs, lifestyle (occupation, physical activity), medical history (including body composition), diet history (food and fluid timings, food and fluid types, food and fluid portion sizes/amounts, method of cooking or preparation, mood after eating), food preferences, supplement use, nutritional knowledge, attitudes and motivation, stage of readiness, use methods for collecting information (verbal discussion, questionnaires, audio, video, food diary).

Record information about clients: Use approved formats (written, ICT spreadsheet), adhere to data protection legislation, confidentiality, record nutritional SMART goals (healthy eating, weight management, improved fitness, improved self image).

Analyse collected information: Nutritional needs and preferences, in relation to current status and nutritional goals, calculation of energy intake and energy expenditure, calculation of daily calorific intake, comparison of nutrient intakes to recommended amounts, comparison of dietary behaviour to national guidelines and recommendations, comparison of body composition to normative data tables, classification of health risk (underweight, healthy, overweight, obese, moderately obese, and severely obese).

Outcome 2: Be able to apply the principles of nutrition to a physical activity programme

UV30539 41

Access and make use of credible sources of information: Evidence based books, evidence based journals, evidence based websites.

Design and agree nutritional goals: Short, medium and long term, SMART (Specific, Measurable, Achievable, Realistic, Time bound), goals (healthy eating, weight management, improved fitness, and improved self image), agree (use communication skills, use negotiation skills, reach a mutual agreement).

Ensure goals integrate with other programme components: Types of exercise and activity, schedule of exercise and activity, health and fitness development, lifestyle.

Agree review points with clients: Review points (short, medium, long term), agree (use communication skills, use negotiation skills, reach a mutual agreement).

Review the client’s understanding: Summarise the nutritional advice, discuss the advice with the client, question the client about key advice, provide opportunity for the client to ask questions.

Monitor, evaluate and review the client’s progress: Against previous SMART goals, fitness re-assessment, food diary analysis, evaluate client strengths and areas for improvement, set new SMART goals, address barriers, review motivation and support strategies.

Outcome 3: Understand the principles of nutrition

UV3053942

Structure and function of the digestive system: Structure (mouth, oesophagus, stomach, duodenum, pancreas, liver, gall bladder, small intestine, large intestine, rectum, kidneys, digestive juices and enzymes), functions (digestion, absorption, excretion).

Key nutritional terms: Diet, healthy eating, nutrition, balanced diet.

Macronutrients: Carbohydrates – simple carbohydrates (monosaccharides, disaccharides), complex carbohydrates (polysaccharides, soluble and insoluble fibre).

Fats – saturated, unsaturated, cholesterol, fatty acids, trans fats, omega 3, omega 6.

Proteins – essential, non-essential.

Micronutrients: Vitamins – water soluble vitamins C and B, fat soluble vitamins A, D, E and K.

Minerals – calcium, copper, iron, magnesium, phosphorus, potassium, sodium, selenium, zinc, water.

Function of macronutrients: Carbohydrates – energy, digestion, nervous system function.

Fats – provide essential fatty acids, insulation, protection of vital organs, energy, transport fat soluble vitamins, synthesis of nerves and cell membranes.

Protein – muscle growth, muscle repair, oxygen transport, fight disease, energy.

Metabolism of macronutrients: Carbohydrates – glucose stored in the blood as blood sugar, stored as glycogen in liver and muscles.

Fats – glycerol and fatty acids.

Proteins – amino acids.

Function of micronutrients: Vitamins – energy, metabolism, protein synthesis, glycogen synthesis, blood clotting, red blood cell formation, aids growth, maintenance of teeth and bones, aids vision.

Minerals – Bone growth, teeth growth, energy production, enzyme function, nerve and muscle function, water balance, blood clotting, oxygen transport in red blood cells.

Function of water: Maintain hydration, maintain homeostasis, heat regulation, maintain blood plasma volume, removal of waste products.

Main food groups and nutrients: Grains – e.g. bread, pasta, potatoes, cereal and rice, (food group we should eat most often, provide carbohydrates for energy, fibre).

Fruit and vegetables – wide variety should be eaten, provide fibre, vitamins and minerals, low in fat and calories.

Dairy – milk, cheese and yoghurt, best source of calcium for strong teeth and bones.

Meat and protein – fish, nuts, dry beans and eggs, provides us with protein, iron and zinc.

Fats – oils, sweets including cakes, biscuits, pastries etc, provide hardly any nutrition, eat sparingly.

Calorific value of nutrients: Definition of calorie, carbohydrate (4kcal), protein (4 kcal), fat (9 kcal), alcohol (7kcal).

Outcome 3: Understand the principles of nutrition (continued)

UV30539 43

Common terminology used in nutrition: UK Dietary Reference Values (DRV), Recommended Daily Allowance (RDA), Recommended Daily Intake (RDI), Glycemic Index (GI), Glycemic Load (GL).

Food labelling information: Requirement for most packaged foods, name of food, weight of the food, any special storage considerations, a ‘best before’ date, a ‘use before’ date, the name and address of the manufacturer, the place of origin, not a legal requirement to have nutritional information on a product unless a specific claim has been made e.g. low fat, additional information that is usually included (macronutrient amounts in grams, nutritional information provided per 100 grams/per portion of food, total energy value (Kjoules, Kcal), micronutrient % RDA, ingredients, (saturated fats, sugars, sodium, salt, fibre), food standards agency guidelines).

Significance of healthy food preparation: Food preparation (baking, grilling, boiling, steaming, healthy cooking oils, adding salt), significance (healthy levels of fat and salt intake, preserving nutrients in the preparation process).

Relationship between nutrition, physical activity, body composition and health: Links to disease/disease risk factors (e.g. hypertension, CHD, osteoporosis, diabetes, obesity, excessive alcohol intake), cholesterol (effect of intake and physical activity on LDL:HDL ratio, effect of intake on body composition), types of fat in diet (effects of intake on body composition and health).

Outcome 4: Understand key guidelines in relation to nutrition

UV3053944

Professionals and professional bodies: Professionals (dietician, nutritionist, G.P.), professional bodies (British Dietetic Association, Association for Nutrition, Food Standards Agency).

Healthy eating advice: Balanced intake of nutrients, regular timing of food intake, high fibre, low in fat, low in salt, five portions of fruit and vegetables a day, alcohol intake within recommended guidelines.

National food guide: Model (Food Standards Agency Eatwell Plate - Balance of Good Health), nutritional principles and features (food types, balanced intake of macronutrients and micronutrients, food proportions, food choices), portion sizes.

Portion sizes: Balance of good health plate approximate portion sizes, servings per day.

Grains – six to eleven.

Fruit and vegetables – three servings of fruit and three to five servings of vegetables.

Dairy – two to four servings.

Meat and protein – two to three servings.

Fat, oils and sweets – eat sparingly.

Correct proportions of each food group per day: Carbohydrates – 50% to 60%.

Fat – less than 35% from fat, no more than 10% from saturated fat.

Protein – 15%.

Fibre – 18gm of fibre/starch polysaccharides.

Variation of dietary needs – vary according to age, sex, activity levels,

health, body size and genetics.

Reliable sources of information: Evidence based text books, evidence based journals, evidence based websites, Food Standards Agency.

Unsubstantiated marketing claims of suppliers: Advertising has to conform to strict legal guidelines, definitions of low sugar, low fat, light, less than 5% fat, 95% fat free, reduced fat, lite.

Outcome 5: Understand nationally recommended practice in relation to providing nutritional advice

UV30539 45

Professional role boundaries: Code of Ethics, REPS Code of Conduct, scope of practice, when to refer to GP or dietary professional for advice (medical conditions e.g. obesity or CHD, malnutrition, underweight, eating disorders).

Importance of communicating health risks: Reduce risk of diet-related health problems, raise awareness of the dangers of unsubstantiated diets, promote safe and effective dietary practice for weight management and physical activity.

Potential health and performance implications: Severe energy restriction (e.g. exhaustion, skin problems, confusion, loss of muscle mass, reduced muscular fitness, reduced aerobic capacity), weight loss (e.g. fatigue, reduced concentration, weakened immune system, reduced muscular fitness), weight gain (e.g. obesity, diabetes, hypertension, CHD, increased risk of musculoskeletal injury, reduced aerobic capacity, reduced range of motion and mobility, reduced self esteem, negative body image).

Clients at risk of nutritional deficiencies: Overweight/obese clients, older clients, on fad or popular diets, on restricted diets, on vegetarian or vegan diets, on gluten free diets, pregnancy, with medical conditions (e.g. celiac disease, irritable bowel syndrome).

Cultural and religious dietary practices: Cultures and religions (e.g. Muslim, Jewish, Buddhist, Hindu), influence on nutritional advice (e.g. forbidden foods, periods of dietary fasting or restriction).

Protein and vitamin supplementation: Safety (approved, intake within recommended guidelines), effectiveness

(for supplementing restricted diets, for supporting intense training programmes), contra-indications (e.g. abnormalities in liver and kidney function, digestive system problems).

Dietary analysis: Complex or detailed dietary analysis, major dietary change, reasons for referral to registered dietician (potential health impacts, outside professional role boundaries, recognised standard of specialist expertise).

Outcome 6: Understand the relationship between nutrition and physical activity

UV3053946

Fuels for aerobic and anaerobic energy production: Role of carbohydrate (for anaerobic glycolysis, for aerobic energy production during higher exercise intensity), fats (for aerobic energy production during lower exercise intensity), role of protein (used for aerobic energy production during energy depletion), relative contributions of energy substrates during different activities and exercise intensities.

Energy expenditure and energy balance: Components of energy expenditure (Basal Metabolic Rate, physical activity level), energy balance equation (energy intake, energy expenditure, positive energy balance, negative energy balance).

Estimate Basal Metabolic Rate: Calculating estimates using equations (e.g. Harris-Benedict), indirect calorimetry.

Estimate energy requirements: Based on physical activity levels (sedentary, moderately active, very active lifestyles), physical activity log, physical activity reference tables, based on other relevant factors (e.g. occupation, lifestyle, physical activity).

Energy expenditure for different physical activities: Energy expenditure (METs, Kcal/h), physical activities (e.g. running, walking, swimming, cycling, gardening, housework).

Evaluate nutritional requirements and hydration needs: Evaluation of needs (goals, body composition, physical activity levels, exercise levels, sports participation, occupation, and lifestyle), requirements pre, during and post-activity.

Outcome 7: Understand how to collect information relating to nutrition

UV30539 47

Importance of informed consent: Law of Tort (Delict in Scotland), REPS Code of Conduct, insurance policies, to ensure clients full understanding, clear up misconceptions.

Information to be collected: Personal goals, lifestyle (occupation, physical activity), medical history, diet history (food and fluid timings, food and fluid types, food and fluid portion sizes/amounts, method of cooking or preparation, mood after eating), food preferences, supplement use, nutritional knowledge, attitudes and motivation, stage of readiness.

Legal and ethical implications: Law of Tort, REPS Code of Conduct, data protection legislation, confidentiality.

Recording nutritional information: Food diary or log (written, ICT spreadsheet), questionnaires, audio record, video record.

Importance of confidentiality: Adherence to the law, follow professional codes of conduct, maintain client’s trust and respect.

Sensitive issues: Weight, body composition, anthropometrical measurements, dietary habits (e.g. over eating, yo-yo dieting), eating disorders, medical conditions, alcohol intake.

Methods used to measure body composition: Body mass index (BMI), waist to hip ratio, visceral measurements, skin-fold callipers, bio-electrical impedance, hydrostatic weighing, classification of health risk in relation to weight (underweight, overweight, obese, moderately obese, and severely obese).

Outcome 8: Understand how to use nutritional information

UV3053948

Dietary assessment methods: food diary (food and fluid timings, food and fluid types, food and fluid portion sizes/amounts, method of cooking or preparation, mood after eating), use of computer software to assess daily caloric intake.

Analyse and interpret collected information: Calculation of energy intake and energy expenditure, calculation of daily caloric intake, comparison of nutrient intakes to recommended amounts, comparison of dietary behaviour to national guidelines and recommendations.

Interpret information gained from methods: Calculations, comparison to normative data tables, classification of health risk (underweight, healthy, overweight, obese, moderately obese, and severely obese).

Sensitively divulging collected information and results: Confidentiality, empathy, calm and relaxed, emphasis on positive action, use of verbal and non-verbal communication skills.

Signs and symptoms of disordered eating: Obsession with body weight, obsessive perceptions of being underweight/overweight, eating a limited or restricted diet, making excuses not to eat, picking at food, using the bathroom immediately after eating, fluctuations in weight, mood swings, excessive or obsessive exercise behaviour, physical and psychological symptoms of anorexia nervosa and bulimia.

Managing users with suspected eating disorders: Institute of Sport and Recreation Management guidance note, key features (recognising warning signs, recognising signs and symptoms,

what to do, operational implications and recommendations).

Circumstances to recommend a visit to a GP: Medical conditions e.g. obesity or CHD, malnutrition, excessively underweight, eating disorders.

Outcome 9: Understand the principles of nutritional goal setting with clients

UV30539 49

Principles of goal setting: Short, medium and long term, SMART (specific, measurable, achievable, realistic, time bound), goals (healthy eating, weight management, improved fitness, improved self image).

Translating nutritional goals: Translate technical terminology into recognised terminology e.g. timings of food intake, quantities and portion sizes, appropriate food choices, balance on the plate, servings of fruit and vegetables.

Others involved in nutritional goal setting: Dietician, nutritionist, GP, family, friends, when others should be involved (health risks or medical conditions, eating disorders, additional motivation and support required).

Barriers to achievement: Time, cost, lack of knowledge, lifestyle, occupation, attitudes and beliefs of family and peers, culture and religion.

Motivational strategies: Goal setting, positive reinforcement, contracting, rewarding achievement, information and education, decision balance, support from others, regular contact.

Reappraisal of body composition: Monitor and review progress and achievement, monitor health status, set new nutritional goals, review energy requirements, provide motivation.

UV3053950


UV31357Professional practice for exercise referral instructors

The aim of this unit is to develop your knowledge and understanding of accepted professional practice for exercise referral instructors, including related policies, risk stratification and roles and responsibilities within an exercise referral scheme.

You will learn about the importance of exercise referral, current healthcare systems/policies in the UK and the exercise referral process. Furthermore, you will explore successful exercise referral schemes.

UV31357_v6

GLH

Credit value

Level

Observation(s)

External paper(s)

14

2

3

0

0



Professional practice for exercise referral instructors

1. Understand the role and importance of exercise referral, related policies and key documents

2. Understand roles and responsibilities within an exercise referral scheme

3. Understand the current healthcare systems in the UK

4. Understand the exercise referral process

5. Understand the principles and procedures of record keeping

6. Understand the concept of a patient-centred approach

7. Understand how to monitor a successful exercise referral scheme

8. Understand the principles of risk stratification in exercise referral

1. 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.



UV31357 53



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.

UV3135754

Knowledge

Outcome 1

Understand the role and importance of exercise referral and related policies and key documents

You can: Portfolio reference

a. Explain the role of exercise referral in both the fitness industry and the health sector

b. Evaluate the general role of exercise in disease risk reduction and condition management

c. Outline the key points of government policies relating to exercise referral schemes

d. Outline key points from the Professional and Operational Standards for exercise referral

UV31357 55

Outcome 2

Understand roles and responsibilities within an exercise referral scheme


a. Explain the roles of the medical, health and fitness professionals in an exercise referral scheme

b. Define the fitness professionals scope of practice and the inter-professional boundaries within an exercise referral scheme

c. Describe how to deal with a patient who has a medical condition outside the scope of practice of the exercise referral instructor

d. Explain when to refer to other professionals including the original referrer

e. Explain how to determine ‘inappropriate referrals’

f. Explain the importance of not accepting a patient who has been declined a referral for exercise from their medical practitioner or health professional

g. Explain the importance of effective inter-professional communication

UV3135756

Outcome 3

Understand the current healthcare systems in the UK


a. Describe the role of Clinical Commissioning Groups

b. Identify key health service documents/policies and their impact on the healthcare system in relation to exercise referral

UV31357 57

Outcome 4

Understand the exercise referral process


a. Explain the process of receiving a referred patient from a healthcare professional

b. Describe the protocol for an initial patient consultation with the exercise referral instructor

c. Describe the principles of patient monitoring and data collection

d. Outline the medico-legal requirements relevant to the exercise referral instructor job role

UV3135758

Outcome 5

Understand the principles and procedures of record keeping


a. Explain how patient confidentiality is maintained in an exercise referral scheme

b. Explain the concept of data protection

c. Explain the meaning of validity and reliability in relation to measurement of techniques and outcomes

d. Explain how to evaluate the quality and reliability of evidence

UV31357 59

Outcome 6

Understand the concept of a patient-centred approach


a. Explain how verbal and non-verbal communication, appearance and body language can influence patients’ perception

b. Describe a range of consulting skills

c. Explain the term ‘health behaviours’

d. Explain locus of control

UV3135760

Outcome 7

Understand how to monitor a successful exercise referral scheme


a. Describe techniques to monitor success for the patient and the scheme

b. Describe the importance of monitoring and evaluation in exercise referral

UV31357 61

Outcome 8

Understand the principles of risk stratification in exercise referral


a. Describe the principles of risk stratification

b. Explain the current use of risk stratification tools used in exercise referral

UV3135762

Outcome 1: Understand the role and importance of exercise referral and related policies and key documents

Unit content


UV31357 63

Role of exercise referral: Use of exercise as part of a person’s treatment plan, intervention, management of condition, decrease speed of deterioration of health.

Role of exercise in condition management: Disease risk reduction, condition management, reduction of clinical signs/symptoms, benefits (physical, psychological, physiological).

Key points of government policies in relation to exercise referral schemes: Recognition of government policy, awareness of policy changes, new resources, familiarity with the context for policy, consideration for how policy is translated to client, understanding how policy impacts on role and responsibilities.

Key points from the professional and operational standards: Exercise referral advisory group (ERAG 2011), reassure patient of the specific standards, compliance with quality assurance (NQAF), defined scope of practice for all persons involved, patient-centred model, consideration of appropriate methods of delivery.

Outcome 2: Understand roles and responsibilities within an exercise referral scheme

UV3135764

Roles of medical and health professionals: Refer patients into quality assured system, maintain clinical responsibility, transfer of information to scheme manager/co-ordinator and exercise professional.

Role of health promotion lead/scheme manager: Set up scheme, establish connections/working partnerships, ensures policies, protocols, procedures in place, recruits/selects appropriately qualified exercise professionals (provides opportunities for continuing professional development (CPD)), ensure scheme is aligned to national standards/industry codes of practice (Fitness Industry Association (FIA)).

Role of scheme co-ordinator/manager: Assignment of patient to exercise professional, referral back to GP/health professional (inappropriate referrals), may be responsible for initial patient assessment, maintain appropriate records, monitor progress and effectiveness of scheme, provide records to GP/health professional.

Role of exercise professional: Work within scope of practice, inter-professional boundaries, working with others, reporting channels, roles include initial assessment (information may come from scheme co-ordinator), referral back to scheme co-ordinator/GP, gain informed consent, responsibility for exercise programme (safe and effective management, design, delivery), act professionally, motivate and support patient, maintain confidentiality, comply with legislation, maintain accurate records, qualified to appropriate levels, member of register of exercise professionals (REPs), not responsible for medical diagnosis, counselling of patient, nutrition or dietary advice.

Patients outside the scope of practice of exercise referral instructor: Referral back to the GP/referrer, based on interview responses, medical history, assessment of contra-indications, avoidance/adaptation around the problem, sound judgment call, consideration of client options.

When to refer to other professionals: Outside of scope of practice, inappropriate referrals, confusion regarding nature of referral, missing information, omissions, inaccuracies, ‘new’ information is forthcoming, including the original referrer.

Determining inappropriate referrals: Persons at high risk (current severe disease or disability), acceptance/inclusion (determined by availability of resources), conversation with service lead/manager/GP, paperwork from health consultation, testing results, data, informal conversations with patient, missing/inaccurate information.

Importance of not accepting patients who have been declined a referral for exercise: Breach of inter-professional boundaries, breach of duty of care to client, patient may need other specialist care (exercise may not be appropriate), outside scope of practice, may put patient at risk, place the exercise professional/organisation at risk prosecution, negative impact on reputation of exercise and fitness industry/exercise referral, destroy potential for future collaboration (exercise and health professionals).

Importance of effective inter-professional communication: Roles clarified (limits defined), awareness of boundaries, framework for promotion of trust and respect, promotes confidence, positive experience for patient, successful working alliances (efficient/effective), transfer/storage of patient

Outcome 2: Understand roles and responsibilities within an exercise referral scheme (continued)

UV31357 65

records (meet legal requirements), breach of patient confidentiality, when confidentially may be breached (e.g. deterioration or change of symptoms, non-compliance with medication).

Outcome 3: Understand the current healthcare systems in the UK

Role of clinical commissioning groups: Practice-based commissioning (PBC), hold power to control how money is spent, impactful and accountable (on financial and political level), growth of health and wellbeing boards, link between commissioning and evaluation of schemes, aspects of good practice, understanding the impact of outcomes and identifying which outcomes are important, notion of ‘shared outcomes’ (working in partnership), connection between commissioning and the instructor’s role, avoidance of ‘revolving door’ approach.

PBC and exercise referral: Potential/actual savings from scheme, impact of cost savings, savings in other areas of health care expenditure (e.g. medication, visits to GP, support/care workers), concept of return on investment, select to commission/ work with operators/service providers who provide evidence of best practice/value for money.

Department of health (DoH) vision for PBC: Ensure a greater variety of services from greater number of providers, services in setting that are close to home/more convenient to patients, bring decision making process closer to communities, efficient use of services, involve front line

doctors and nurses in commissioning decisions.

Key health service documents/polices: For example, annual reports from Directors of Public Health, National Quality Assurance Framework (NQAF), Public Health Outcomes Framework, Fitness Industry Association (FIA), DoH guidelines for activity, Loughborough University (guidelines for sedentary client care), impact on healthcare system.

Outcome 4: Understand the exercise referral process

UV3135766

Process that the referring health professional will undertake: Inclusion/exclusion criteria – types of clients’ scheme can accept/work with, determined by experience/qualifications of exercise professionals, low risk, high risk, risk stratification.

Transfer of information – information (physical activity readiness questionnaire (PAR-Q)), physical activity readiness medical examination (PARmed-X), how information will be passed between health professional and exercise professional, transfer of information record, gain informed consent.

Contact – transfer information (named contact, scheme co-ordinator).

Process of exercise professional receiving referred patient: Scheme co-ordinator – check information, seek clarification if needed, refer back if any information is not available, contact client, arrange initial consultation.

Information transfer record (to include) – client’s personal details, date, reason for referral, past/present medical history, medications, other treatments, risk stratification (PAR-Q, PARmed-X, risk stratification tools), language, religious, cultural needs, preferred method of contact, health measurements (blood pressure, body mass index (BMI)).

Agreed level of communication – between exercise and health professional, specified intervals, report on (clients adherence, progress, regression, any changes identified).

Protocol of initial patient consultation: Meeting between client and exercise

professional, build rapport, lay foundations for positive relationship, identify most appropriate way to help and support (activity/exercise intervention, other services e.g counseling, dietician etc.), explain the referral process, ensure understanding, obtain informed consent to participation, assess readiness to exercise, establish goals (short, medium, long term), likes and dislikes, development of safe/effective programme (using FITT principles), development of individualised programme.

Principles of patient monitoring and data collection: Patient monitoring – ongoing, before every session, attendance, re-assess readiness to participate, monitor any changes (from initial consultation, previous session), response to previous session (e.g. excessive tiredness, discomfort, chest pain), results of any medical appointments/tests.

Data collection – current health status, medications, social factors, levels of motivation, goal setting, physical activity levels, height, weight, BMI, resting/pre-exercise heart rate, resting blood pressure etc.

Medico-legal requirements for the exercise referral job role: Adequate insurance (personal and organisational), appropriate qualifications (context and level), avoidance of litigation, compliance with NQAF, local policies and guidelines, service level agreements, accountability and individual responsibilities of patient/practitioner and referrer in the process.

Outcome 5: Understand the principles and procedures of record keeping

UV31357 67

Maintaining patient confidentiality: Importance and relevance, litigation, local procedures, understanding of information processing and sharing procedures, reasons to breach confidentiality.

Data protection: Information governance (mandatory training for local education authority (LEA)/statutory body/providers if on contract), quality and standards, impact of getting the process wrong, data sharing and compliance with the data protection legislation.

Validity and reliability of measurement techniques and outcomes: Prevention or minimisation of error, feedback appropriate and accurate, measurement precision.

Evaluate the quality and reliability of evidence: Understanding information quality and recognition of where information is sourced from, use of materials which are within scope of guidance.

Outcome 6: Understand the concept of a patient-centred approach

UV3135768

Patient-centred approach: Patient best expert on themselves, patients in correct environment (make right choices for themselves, find right solution to own problems), correct environment (core conditions, unconditional positive regard, empathy, congruence are present), patient takes responsibility for deciding/undertaking change, exercise professional is a facilitator (use communication and skills to raise clients awareness of own power), client leads and directs the process.

Verbal and non-verbal communication and influence on patients’ perception: Interpersonal skills, rapport building, patient empathy, mirroring, tone of voice, eye contact, appearance and body language.

Consulting skills: Empathy, unconditional positive regard, congruence, non-judgmental, professionalism, skills of facilitation, knowledge of motivational interview techniques, awareness of psychological state of change, appreciation of client preferred communication style, solution-focused therapy, patient input, active listening, reflecting and paraphrasing, multi-culturalism and diversity, appreciation of social situation, emphasis on positives, assets-based approach.

Health behaviours: Lifestyle activities that patients engage in, choices they make (activity levels, diet, smoking, substance use, health screening checks, sexual behaviour), may be determined by belief systems, socio-economic background, peer pressure and media.

Locus of control: Extent to which individual believes in power to influence through own actions, internal locus of

control (believe power to make change), external locus of control (‘fatalisitic’, believe life is chance and luck), self-efficacy, appreciate personal lifestyle context and constraints, self-management of condition(s) and personal wellbeing.

Outcome 7: Understand how to monitor a successful exercise referral scheme

UV31357 69

Techniques to monitor success: Attendance, pedometers, review of goals (achievement/progress), physical assessments, programme cards (progressions, regression), psychological assessments (mood, energy levels, quality of life), medical records, diaries/logs, lifestyle changes.

Techniques to ensure success: Ensure goals have been set, action planning, awareness of ‘risk time’ (e.g. responsive to patient adherence and general behaviour), consideration of barriers, understanding difference between measuring success linked to outcome and impact and success by ‘input’), needs to be outcome focused.

Importance of monitoring and evaluation: Informing intelligent and relevant commissioning, link to commissioning targets, relationship with commissioners and input towards provision and outcomes, monitoring progress, motivation, increasing adherence, prompt and timely record keeping and paperwork submission, programme audit.

Outcome 8: Understand the principles of risk stratification in exercise referral

Principles of risk stratification: Assigning of patient to specific category, estimation of risk attached to being active, identify persons at increased risk of exercise/exertion related incident (specific to disease, risk factor, medical condition), classified (low, moderate, high risk), information from referrer, consideration of risk based on accepted policy or published guidelines.

Objectives of risk stratification: Identify persons at risk, assist with exercise prescription/recommendations, enable development of informed safe, effective programmes, identify appropriate level of monitoring/supervision.

Risk stratification tools used in exercise referral: National Quality Assurance

Framework (NQAF, 2001) for exercise referral, American College of Sports medicine (ACSM), National Occupational Standards (SkillsActive), BHF National centre for Physical Activity and Health Exercise Referral tool kit (2010), Fitness Industry Association (FIA), Exercise Referral Advisory Group.

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UV41356Understanding medical conditions for exercise referral

The aim of this unit is to develop your knowledge and understanding of medical conditions for exercise referral. You will learn the clinical features of medical conditions and the accepted methods for their treatment and management.

You will understand the relationship between exercise and medical conditions and learn how to programme safe, effective exercise programmes for patients with specified exercise referral medical conditions.

UV41356_v6

GLH

Credit value

Level

Observation(s)

External paper(s)

35

7

4

0

0


Learning outcomes

Understanding medical conditions for exercise referral

1. Understand the clinical features of medical conditions relevant to exercise referral programmes

2. Know the accepted methods for treatment and management of medical conditions relevant to exercise referral programmes

3. Understand the relationship between exercise and specified exercise referral medical conditions

4. Understand how to programme safe, effective exercise programmes for patients with specified exercise referral medical conditions

1. 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. For each learning outcome you must cover ALL of the following: • Hypertension • Hypercholesterolaemia • Chronic Obstructive Pulmonary disease • Asthma • Obesity • Diabetes type 1 and 2 • Osteoarthritis • Rheumatoid arthritis • Osteoporosis • Depression • Stress • Anxiety • Simple mechanical back pain • Joint replacement



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Evidence requirements









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Knowledge

Outcome 1

Understand the clinical features of medical conditions relevant to exercise referral programmes


a. Describe the pathophysiology, and clinical signs and symptoms of specified medical conditions

b. Describe how pathophysiology and clinical signs and symptoms change with progression of specified medical conditions

c. Describe the common causes of specified medical conditions

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Outcome 2

Know the accepted methods for treatment and management of medical conditions relevant to exercise referral programmes


a. Using a range of credible sources, identify the common drug, surgical or therapeutic interventions used to treat specified medical conditions

b. Describe the desired effects, and side effects, of common medications on the patients exercise response for specified medical conditions

c. Describe how lifestyle modification, including nutrition and physical activity changes, can be used in addition to medical therapies for specified medical conditions

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Outcome 3

Understand the relationship between exercise and specified exercise referral medical conditions


a. Explain the risks of exercise for patients with specified medical conditions

b. Explain how exercise can benefit patients with specified medical conditions

c. Evaluate the risks of exercise against the benefits for patients with specified medical conditions

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Outcome 4

Understand how to programme safe, effective exercise programmes for patients with specified exercise referral medical conditions


a. Outline exercise guidelines and restrictions for patients with specified medical conditions

b. Identify considerations for exercise when dealing with comorbidities

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Outcome 1: Understand the clinical features of medical conditions relevant to exercise referral programmes

Unit content


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Specified medical conditions: Hypertension, hypercholesterolaemia, chronic obstructive pulmonary disease, asthma, obesity, diabetes type 1, diabetes type 2, osteoarthritis, rheumatoid arthritis, osteoporosis, depression, stress, anxiety, simple mechanical back pain, joint replacement.

Pathophysiology – diseases progression and the associated functional changes i.e. death of tissue, pathophysiology of specified medical conditions (cardiac, respiratory, vascular, metabolic, systemic, body composition, orthopaedic, hormonal, psychological).

Clinical signs – of specified medical conditions (e.g. blood pressure, blood tests, respiratory, anthropometric, X-rays, magnetic resonance imaging (MRI), physical measures/observations, movement), GP diagnosis.

Symptoms – how the disease manifests itself from a patient’s perspective, changes in, for example, breathing, sleep, lethargy, urination, vision, swelling, weight loss/gain, appetite, fractures, pain, aches, behaviour, concentration, heart rate, sweating, development of headaches, fever, dizziness, stomach disorders.

Changes in pathophysiology with progression of specified medical conditions: Cardiovascular disease, heart attack, stroke, respiratory impairments, excess fat accumulation, blood abnormalities, organ damage.

Change of clinical signs and symptoms with progression of specified medical conditions: Comparison against established norms, physical abnormalities, deterioration of joints and bone deformation, reduced movement, fractures, interference with daily functioning, psychological disorders, pain.

Common causes of specified medical conditions: Biological and psychological disorders, risk factors associated with each specified medical condition.

Modifiable risk factors – smoking, hypertension, hyperlipidaemia, physical inactivity, type 2 diabetes, obesity, stress, fibrogen levels.

Non-modifiable risk factors – age, gender, family history, ethnic origin, type 1 diabetes.

Outcome 2: Know the accepted methods for treatment and management of medical conditions relevant to exercise referral programmes

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Range of credible sources: Research-based, peer reviewed.

Treatment and interventions: Oral and injected medications, surgery, psychological interventions, dietary interventions (reduction in alcohol, salt, caffeine), exercise, weight loss, lifestyle intervention, relaxation therapy, smoking cessation, education.

Common drugs, used to treat each specified medical condition: Hypertension – e.g. angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, betablockers. Hypercholesterolaemia – e.g. statins, niacin, bile acid sequestrants, cholesterol absorption inhibitors, fibric acid derivatives. Chronic obstructive pulmonary disease – e.g. bronchodilators, corticosteroids, phosphodiesterase-4 (PDE4) inhibitors, expectorants, methylxanthines. Asthma – e.g. anti-inflammatory drugs, corticosteroids, bronchodilators. Obesity – e.g. appetite suppresants, anorexiants, orlistat (blocks digestion and absorption of fat).

Diabetes type 1 – e.g. insulin (rapid, long acting, intermediate options), oral medications (pramlintide (slows movement

of food), high blood pressure medication etc). Diabetes type 2 – e.g. meglitinides, sulfonylureas, dipeptidy peptidase-4 (DPP-4) inhibitors, biguanides, thiazolidinediones, alpha-glucosidase inhibitors. Osteoarthritis – e.g. opiods, steroids, anti-inflammatory drugs, anti-depressants. Rheumatoid arthritis – e.g. disease-modifying antirheumatic drugs, oral or biologic (DMARDs), non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, analgesics. Osteoporosis – e.g. antiresorptive agents, bisphosphonates, selective estrogen receptor modulators (SERMs), calcitonin, teriparatide, denosumab. Depression – e.g. anti-depressants (selective serotonin reuptake inhibitors (SSRI’s) – fluoxetine, citalopram), serotonin and norepinephrine reuptake inhibitors (SNRI’s – venlafaxine, duloxetine), tricylic anti-depressants. Stress, anxiety – e.g. barbiturates, benzodiazepines, SSRI’s, SNRI’s. Simple mechanical back pain – e.g. NSAIDs, topical analgesics, muscle relaxants, opioids, corticosteroids, anti-depressants, and anti-convulsants.

Joint replacement – e.g. opioid pain relievers (morphine, fentanyl), NSAIDs. Desired effects and side effects of common medications: Desired effects of drugs – cardiac, respiratory, vascular, metabolic, systemic, body composition, bone, cartilage, joint, hormonal, psychological.

Outcome 2: Know the accepted methods for treatment and management of medical conditions relevant to exercise referral programmes (continued)

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Side effects (cardiac) – bradycardia, tachycardia, arrhythmias and palpitations, blood pressure, postural hypotension.

Effects on capacity – aching legs, dehydration, co-ordination, drowsiness, fatigue, balance, reaction, blurred vision, dizziness.

Effects on respiratory system – hyperinflation, breathlessness, improvements, oedema, postural, weight gain.

Effects on muscle – fatigue, muscle discomfort/cramps, muscle atrophy, myopathy.

Effects on vascular system – hypotension.

Effects on blood – hypoglycaemia.

Psychological effects – impaired memory,

Outcome 3: Understand the relationship between exercise and specified exercise referral medical conditions


Risks of exercise for patients with specified medical conditions: Orthopaedic, cardiac, pulmonary, dehydration, considerations of medications and effect on exercise.

How exercise can benefit patients: Psychological – reduced fear, anxiety and depression, improved mood, improved self-efficacy and stress management, social gains.

Practical – ability to achieve normal function, improved (mobility, balance, co-ordination, strength, endurance, flexibility).

Evaluate the risks of exercise against benefits: Individualised evaluation, person-centred, consider risks/benefits, consider intensity, duration and type.

low self-esteem, slowed reactions, concentration, lethargy.

Effects on gastrointestinal – constipation, nausea, vomiting, diarrhoea, indigestion.

Exercise response: Impairment and improvement, decreased risk of mortality, alleviating or lessening of activity related symptoms, limiting the progression of disease, reversing the process.

Lifestyle modification: Weight loss (if overweight), alcohol consumption, drug use, salt intake, fruit, low fat dairy and saturated fats, calorie restrictions, reduced smoking levels, increased exercise, reduced sedentary behavior.

Outcome 4: Understand how to programme safe, effective exercise programmes for patients with specified exercise referral medical conditions

Exercise guidelines and restrictions: Follow guidelines for each medical condition, set realistic goals, progressive, gradual, individualised, involve/consult other professionals, constant monitoring/ evaluation.

Aerobic:Frequency – amount of sessions per week.

Intensity – volume of maximal oxygen uptake (VO2 max), volume of peak oxygen uptake (VO2 peak), heart rate reserve (HRR), heart rate maximum (HR Max), rating of perceived exertion (RPE), calorie expenditure.

Time – minutes per session.

Type – weight bearing.

Resistance:Frequency – amount of sessions per week.

Intensity – repetitions (reps)/sets, % 1 rep maximum (1RM).


Type – number of exercises, body weight, resistance machines.

Flexibility:Frequency – amount of sessions per week.

Intensity – length of hold, active, passive.


Type – range of movement (ROM) considerations (e.g. functional), specific joint focus, static, maintenance, developmental.

Neuromuscular: Active daily living exercises, improve balance and co-ordination, improve vocational potential, improve self confidence, safety.

Other: Extremes in temperature and humidity, fluid consumption, foot care, carrying medical identification, keep carbohydrates available, tailored to fit age, comorbidities, medication schedule, fitness level, current activity levels, skill, confidence, severity of condition, preference and goals.

Considerations for exercises when dealing with comorbidities: Physical – sedentary lifestyle leading to coronary artery disease (CAD), hypertension and peripheral artery disease, low lactate thresholds, blood glucose levels, respiratory disorders.

Psychological – increased anxiety, depression, low self-esteem and fear.

Deformities – add stress to joints, affects movement, gait, foot pressure, restricted breathing due to kyphosis.

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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.

UV31355_v7

GLH

Credit value

Level

Observation(s)

External paper(s)

52

8

3

1

0


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.


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.


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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.

86

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 achievedCriteria questioned orallyPortfolio referenceAssessor initialsLearner 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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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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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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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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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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Range

*You must practically demonstrate that you have:

Collected all information Portfolio referenceReferral 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 referenceSensitive 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 referenceAppropriate exercises to achieve goals

Appropriate physical activities to achieve goals

Incorporated all factors into plan Portfolio referenceBehaviour change strategies

Long-term health and fitness

Reviewed progress and made all necessary adaptations Portfolio referenceGoals 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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Knowledge

Outcome 4

Be able to manage an exercise referral programme with patients


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


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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.

UV31358Instructing exercise with referred patients

The aim of this unit is to develop the knowledge, understanding and practical skills that you require to prepare, instruct, monitor, adapt and review exercise sessions/programmes for exercise referral patients.

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GLH

Credit value

Level

Observation(s)

External paper(s)

58

9

3

1

0


Learning outcomes

Instructing exercise with referred patients

1. Be able to prepare resources for the exercise referral sessions

2. Be able to prepare patients for exercise referral sessions

3. Be able to instruct and adapt planned exercises to exercise referral patients

4. Be able to bring exercise referral sessions to an end

5. Be able to review exercise referral sessions

6. Understand how to instruct exercise to exercise referral patients

7. Understand how to adapt exercise to meet the needs of exercise referral patients

8. Understand how to review exercise referral sessions with patients

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

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.


5. Instructing exercise You are required to instruct an exercise session/programme. Details are provided in the ‘Guidance for assessment’ section of this unit.



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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.

There is no range section that applies to this unit.

114

Guidance for assessment

You are required to instruct an exercise session/programme.

There is NO requirement for you to instruct a real exercise referral patient through an exercise programme; 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 or more conditions which make them high risk or places them outside the scope of a Level 3 exercise referral instructor.

Outcome 1

Observations

You can:



Be able to prepare resources for the exercise referral sessions

a. Select a range of exercises/physical activities to help patients achieve their objectives and goals

b. Obtain and prepare the resources needed for planned exercises/physical activities

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Outcome 2

You can:

Be able to prepare patients for exercise referral sessions


a. Help patients feel at ease in the exercise environment

b. Explain the planned objectives and exercises/physical activities to patients

c. Explain to patients how objectives and exercises/physical activities support their goals and are appropriate to their condition

d. Explain the physical and technical demands of the planned exercises/physical activities to patients

e. Explain to patients how planned exercise/physical activity can be progressed or regressed to meet their goals

f. Assess patients’ state of readiness and motivation to take part in the planned exercises/physical activities

g. Negotiate and agree with patients any changes to the planned exercises/physical activities that: • meet their goals and preferences • enable them to maintain progress

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h. Record changes to patients exercise referral programmes*

Outcome 3

You can:


Be able to instruct and adapt planned exercises to exercise referral patients

a. Use motivational styles that: • are appropriate to the patients • are consistent with accepted good practice

b. Explain to patients the purpose and value of a warm-up

c. Provide warm-ups appropriate to the patients, planned exercise and the environment

d. Make best use of the environment in which the patients are exercising

e. Provide instructions, explanations and demonstrations that are technically correct, safe and effective

f. Adapt verbal and non-verbal communication methods to make sure patients understand what is required

g. Ensure patients can carry out the exercises safely on their own

h. Analyse the performance of patients, providing positive reinforcement throughout

i. Correct exercise technique at appropriate points

j. Progress or regress exercises according to patients’ performance

k. Monitor and modify the intensity of exercise appropriate to patients and their conditions

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Outcome 4

You can:

Be able to bring exercise referral sessions to an end


a. Allow sufficient time for the closing phase of the session

b. Explain the purpose and value of cool down activities to patients

c. Select cool down activities according to the type and intensity of physical exercise, patient needs and environment

d. Provide patients with feedback and positive reinforcement

e. Explain to patients how their progress links to their goals

f. Allow patients the opportunity to ask questions and discuss their performance

g. Inform patients about future opportunities for exercise and physical activity

h. Leave the environment in a condition suitable for future use


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Outcome 5

You can:


Be able to review exercise referral sessions

a. Review the outcomes of working with patients including their feedback

b. Identify: • how well the sessions met patients’ goals • how effective and motivational the relationship was with patients • how well the instructing styles matched patients’ needs

c. Identify how to improve personal practice


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Knowledge

Outcome 5

Be able to review exercise referral sessions


d. Explain the value of reflective practice

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Outcome 6

Understand how to instruct exercise to exercise referral patients


a. Explain the importance of verbal and non-verbal communication when instructing patients

b. Describe how to adapt communication to meet patients’ needs

c. Evaluate different methods of maintaining patients’ motivation, especially when patients are finding exercises difficult

d. Explain the importance of correcting patient technique

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Outcome 7

Understand how to adapt exercise to meet the needs of exercise referral patients


a. Explain why it is important to monitor individual progress if more than one patient is involved in the session

b. Describe different methods of monitoring patients’ progress during exercise, including groups of patients

c. Explain when it may be necessary to adapt planned exercises to meet patients’ needs

d. Explain how to adapt exercise/exercise positions as appropriate to individual patients and the environment

e. Explain how to modify the intensity of exercise according to the needs and response of the patient

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Outcome 8

Understand how to review exercise referral sessions with patients


a. Explain why exercise referral instructors should give patients feedback on their performance during a session

b. Explain why patients should be given the opportunity to ask questions and discuss their performance

c. Explain how to give patients feedback on their performance in a way that is accurate but maintains patient motivation/commitment

d. Explain why patients need to see their progress against goals

e. Explain why patients need information about future exercise and physical activity, both supervised and unsupervised

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Unit content


Outcome 1: Be able to prepare resources for the exercise referral sessions

Select range of exercises/physical activities: Personalised based on needs, as relevant to programme/preferences/availability/environment/past history experiences, condition-based limitations, variety of exercise equipment.

Obtain and prepare resources: Ensure environment safe to exercise, equipment in place, provision of water, medication available (patient’s responsibility to administer), session-based information, referral form, programme card, personal record card, exertion levels card.

Outcome 2: Be able to prepare patients for exercise referral sessions

Help patients feel at ease: Meet outside of environment, induction, tour of training environment, introduce to staff, health and safety procedures, gradual consultation, comfortable environment, offer alternatives.

Explain planned objectives: Session content, subsequent sessions, format, purpose, outcomes, use appropriate language.

Explain how objectives/physical activities support goals: Linking the exercise to the condition/goal, how objectives relate to improvement of health, how planned session(s) fit(s) needs of condition(s), justification for choice/timing, format/structure etc.

Explain physical and technical demands: Linking the exercises with intensity monitoring, expectations of effort.

Progression/regression: Change to meet goals, importance of monitoring, progress/decrease, record changes.

Assess state of readiness and motivation: Verbal questioning (e.g. exercise history, stages of change model, apply motivational interview techniques), physical signs (e.g. posture, coughing), appropriate clothing, referral documentation, levels of support required.

Negotiate and agree planned changes: Change in preferences, goal review.

Record changes: Programme card, activity planners, diary, evaluation (formative), inform relevant stakeholders if appropriate.

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Outcome 3: Be able to instruct and adapt planned exercises to exercise referral patients

Motivational styles: Empathy, instruction and technique based on personal preferences, enhance relationship, agreed approaches, appropriate to patients, consistent with accepted good practice.

Purpose and value of a warm-up: Physiological (synovial joints), blood flow, muscle preparation, energy systems, neuromuscular (practice), psychological readiness to exercise.

Provide warm-ups appropriate to patients, planned exercise and environment: Condition-based intensity and duration, adaptable to the environment (availability of equipment, space, etc.), temperature, time constraints (not all conditions).

Make best use of environment: Risk assessment, safety, comfort, ventilation, temperature, familiarity, sequenced, effective use of space.

Provide instructions, explanations and demonstrations that are technically correct, safe and effective: Instructions/explanations (clear, correct, stress key points, reinforce technique), information (name exercise, area of body worked, muscles utilised), demonstrations (technically correct, broken down), intensity levels and progression, reasons based on programme and condition.

Adapt verbal and non-verbal communication: Hearing-related issues, disability (mental), English as a second language (use of an interpreter), ensure instructor can be seen, adapt as appropriate to the patient.

Ensure patients can carry out exercises safely on own: Provide

feedback mechanisms, demonstrate ability effectively, monitoring, clear written guidance information.

Analyse performance of patients: Compare against goals and baseline, chart progress, feedback, physical and psychological measures.

Correct exercise technique at appropriate points: Poor posture, alignment, capacity, reinforce instruction and teaching points, sensitively.

Progress or regress exercises according to patients performance: Respond to visual and verbal feedback, consider the original condition, suitability of progression/regression of exercise.

Monitor and modify intensity of exercise: Speed, resistance, frequency, reduce rest time, change the order of the exercises.

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Outcome 4: Be able to bring exercise referral sessions to an end

Allow sufficient time for closing phase of session: Structure/timings of cool down (appropriate to patients/conditions), make time for feedback (from patient, instructor), best delivered in comfortable environment, social aspect (interaction with group).

Purpose and value of cool down activities: Prevent blood pooling, enhance flexibility, safe reduction in blood pressure and heart rate, lactate removal, psychological end point.

Select cool down activities: Condition-based intensity and duration, need for enhanced monitoring, adaptable to the environment (availability of equipment, space etc.), temperature, time constraints (not all conditions).

Provide feedback and positive reinforcement: Outline benefits, relate to condition, praise.

Explain to patients how progress links to their goals: Physiological and psychological changes associated with the planned session, social benefits, effects on condition.

Opportunity for patients to ask questions and discuss performance: Structure session to allow for interaction before or after, feedback from patients about session (formal, informal), feedback to patients about performance (e.g. encouragement, praise), allow alternative communication approaches (e.g. blog, email, text, face to face, written, adopt open door policy).

Inform patients about future opportunities: Directory of opportunities, exit strategies to maintain a relationship, opportunities to build on existing levels, tailored approach.

Leave environment suitable for future use: Clear away equipment, confidentiality maintained, check floor surface.

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Outcome 5: Be able to review exercise referral sessions

Review/sessions: Feedback from patients (face to face, after sessions, phone calls, emails, questionnaires, standard questions (based on initial questions), user satisfaction scales, evaluation of patient outcomes), other feedback (peer observation, appraisals, secret shopper, spot checks, focus groups).

Identify: How well the session met patients’ goals, how effective and motivational the relationship was with patients, how well the instructing styles matched patients’ needs, goal achievement.

Improve personal practice: Areas for improvement, reflection, continual professional development, education.

Value of reflective practice: Personal development, service improvement, self-awareness.

Outcome 6: Understand how to instruct exercise to exercise referral patients

Importance of verbal and non-verbal communication: Verbal communication – tone of voice, emphasis of teaching points, reinforcement of technique, effective explanations (clear and concise), appropriate language and metaphor, avoid jargon, be more empathetic, show patience (especially if fitness levels are low), praise, feedback on performance, show interest (training, progress, patient).

Non-verbal communication – demonstrations, correct technique, observation skills, body language (open, positive, enthusiastic), issues around physical handling, cueing.

Importance – building relationships (trust, rapport), safety, clarity, ensure working within personal limits, address negativity, motivate, encourage, promote adherence, allay fears, solutions to barriers, reduce

pressure on patients, to empower patient (locus of control), ensure safe and effective training sessions.

Adapting communication: Hearing-related issues, disability (mental), English as a second language (use of an interpreter), demonstrate empathy, show sensitivity, response to body language, response to individual needs.

Evaluate methods to maintain motivation: Feedback, review, motivational interviewing, patience, appropriate language, empathy, allay fears.

Importance of correcting technique: Safety, prevention of injury, effectiveness, confidence.

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Outcome 7: Understand how to adapt exercise to meet the needs of exercise referral patients

Importance of monitoring individual progress if more than one patient involved in session: Tailored to needs based on varied health conditions, different stages of experience or condition (e.g. beginners), safety, enhances confidence, personal service, patient feels valued, motivational, enables progression.

Methods of monitoring progress: Verbal (talk test), physical signs (breathing, colour, sweating), rate of perceived exertion (RPE), rating scale (Borg, 0-5, cardiac-based), heart rate monitors, self-monitoring.

Reasons to adapt planned exercises: Returning from an absence (e.g. illness or injury), based on feedback from the monitoring systems (progression and regression).

Adapting exercises/modifying intensity: Ensure changes meet objectives of programme, exercise guidelines for patients’ medical condition(s), negotiate and agree changes with patient, meet individual needs, personalised approach.

How to adapt exercise/exercise positions: Alternatives based on changing environment, offer adaptations/modifications and alternatives/overload, progression, regression, seated alternatives, change (frequency, intensity, time, type of exercise (FITT)).

How to modify the intensity: Speed, resistance, lever length, frequency, reduce rest time, change the order of the exercises.

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Outcome 8: Understand how to review exercise referral sessions with patients

Reasons why instructors should give feedback to patients: Confidence, motivation, increase understanding, educating, outlining benefits to improve adherence.

Reasons why patients should have opportunity to ask questions/discuss performance: Increase understanding and learning, enables knowledge transfer, enhances relationship e.g. trust.

How to give patients feedback on performance: Established measures, providing a positive focus, outlining clear reasons for changes, personalising feedback on goals, with empathy and sensitivity.

Why patients need to see progress: Enhances motivation, personal responsibility, progress monitoring and feedback.

Information about future exercise and physical activity: Progression from the programme, self-responsibility, transition, maintenance of activities, lifestyle changes, enhances social changes, prevent an accumulation of patients on the programme.

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vtct level 3 diploma in exercise referral...professionals (reps) at level 3. prerequisites your...

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