VTCT Level 3 Diploma in Exercise
Referral
1 April 2012
Credit value: 38
Total Qualification Time (TQT):
380
Guided learning hours (GLH):
242
Qualification number: 600/4756/2
Operational start date:
Statement of unit achievement
By 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
Mandatory units
UV30536
UV30539
UV31357
UV41356
UV31355
UV31358
AF30401F_v5
Date achieved
Learner
signature
Assessor
initials
IQA signature
(if sampled)
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.
Units in this qualification have been mapped
to the relevant NOS (where applicable). This
qualification is regulated on the Regulated
Qualifications Framework.
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.
This qualification is approved and supported by
SkillsActive, the sector skills council for active
leisure and learning.
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.
Prerequisites
Learners who wish to undertake this
qualification must also achieve the VTCT (ITEC)
Level 2 Award in Infection Prevention
(COVID-19) for Sport and Fitness Sessions
qualification or a regulated equivalent.
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:
•
•
•
2
VTCT Level 2 Certificate in Fitness
Instructing
VTCT Level 3 Certificate in Personal
Training
VTCT Level 3 Diploma in Mat Based Pilates
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.
3
Qualification structure
Total credits required - 38
All mandatory units must be completed.
Mandatory units -
4
38 credits
VTCT unit
code
Ofqual unit
reference
Unit title
UV30536
A/600/9051
UV30539
Credit value
GLH
Anatomy and physiology for exercise and
health
6
43
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
Guidance on assessment
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.
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.
Assessment explained
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.
5
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.
6
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
VTCT unit
code
Unit title
UV30536
Internal
Question
paper(s)
Observation(s)
Portfolio of
Evidence
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


7
Unit glossary
Description
8
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.
Level
Level 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 value
This 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.
UV30536
Anatomy 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
Level
3
Credit value
6
GLH
43
Observation(s)
0
External paper(s)
1
Anatomy and physiology for
exercise and health
Learning outcomes
On completion of this unit you will:
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
Evidence requirements
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.
UV30536
11
Developing knowledge
Achieving knowledge outcomes
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.
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
1 of 1
12
UV30536
Assessor initials
Knowledge
Outcome 1
Understand the heart and circulatory system and its relation to
exercise and health
You can:
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
Portfolio reference /
Assessor initials*
*Assessor initials to be inserted if orally questioned.
UV30536
13
Outcome 2
Understand the musculoskeletal system and its relation to
exercise
You can:
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
*Assessor initials to be inserted if orally questioned.
14
UV30536
Portfolio reference /
Assessor initials*
Outcome 3
Understand postural and core stability
You can:
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
Portfolio reference /
Assessor initials*
*Assessor initials to be inserted if orally questioned.
UV30536
15
Outcome 4
Understand the nervous system and its relation to exercise
You can:
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
*Assessor initials to be inserted if orally questioned.
16
UV30536
Portfolio reference /
Assessor initials*
Outcome 5
Understand the endocrine system and its relation to exercise
and health
You can:
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
Portfolio reference /
Assessor initials*
*Assessor initials to be inserted if orally questioned.
UV30536
17
Outcome 6
Understand energy systems and their relation to exercise
You can:
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
*Assessor initials to be inserted if orally questioned.
18
UV30536
Portfolio reference /
Assessor initials*
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.
Outcome 1: Understand the heart and circulatory system and its relation to
exercise and health
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).
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.
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
UV30536
19
Outcome 2: Understand the musculoskeletal system and its relation to exercise
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).
20
UV30536
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)
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.
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).
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
UV30536
21
Outcome 3: Understand postural and core stability
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,
22
UV30536
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
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 coordination, automatic performance of
movement patterns), methods of motor
skill development (short training duration,
UV30536
23
Outcome 4: Understand the nervous system and its relation to exercise
(continued)
repetition, progressing movement speed,
whole-part-whole, progressive layering
of demands on motor skills, positive
reinforcement and feedback).
Benefits of improved neuromuscular coordination: 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).
24
UV30536
Outcome 6: Understand energy systems and their relation to exercise
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.
UV30536
25
Notes
Use this area for notes and diagrams
26
UV30536
UV30539
Applying the principles of
nutrition to a physical activity
programme
It 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
Level
3
Credit value
6
GLH
40
Observation(s)
0
External paper(s)
0
Applying the principles of
nutrition to a physical activity
programme
Learning outcomes
On completion of this unit you will:
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
Evidence requirements
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
There is no external paper requirement for
this unit.
UV30539
29
Developing knowledge
Achieving knowledge outcomes
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:
•
•
•
•
•
•
•
•
•
•
•
30
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.
UV30539
Knowledge
Outcome 1
Be able to collect and analyse nutritional information
You can:
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
Portfolio reference /
Assessor initials*
*Assessor initials to be inserted if orally questioned.
UV30539
31
Outcome 2
Be able to apply the principles of nutrition to a physical activity
programme
You can:
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
*Assessor initials to be inserted if orally questioned.
32
UV30539
Portfolio reference /
Assessor initials*
Outcome 3
Understand the principles of nutrition
You can:
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
Portfolio reference /
Assessor initials*
*Assessor initials to be inserted if orally questioned.
UV30539
33
Outcome 4
Understand key guidelines in relation to nutrition
You can:
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
*Assessor initials to be inserted if orally questioned.
34
UV30539
Portfolio reference /
Assessor initials*
Outcome 5
Understand nationally recommended practice in relation to
providing nutritional advice
You can:
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
Portfolio reference /
Assessor initials*
*Assessor initials to be inserted if orally questioned.
UV30539
35
Outcome 6
Understand the relationship between nutrition and physical
activity
You can:
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
*Assessor initials to be inserted if orally questioned.
36
UV30539
Portfolio reference /
Assessor initials*
Outcome 7
Understand how to collect information relating to nutrition
You can:
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
Portfolio reference /
Assessor initials*
*Assessor initials to be inserted if orally questioned.
UV30539
37
Outcome 8
Understand how to use nutritional information
You can:
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
*Assessor initials to be inserted if orally questioned.
38
UV30539
Portfolio reference /
Assessor initials*
Outcome 9
Understand the principles of nutritional goal setting with
clients
You can:
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
Portfolio reference /
Assessor initials*
*Assessor initials to be inserted if orally questioned.
UV30539
39
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.
Outcome 1: Be able to collect and analyse nutritional information
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).
40
UV30539
Outcome 2: Be able to apply the principles of nutrition to a physical activity
programme
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.
UV30539
41
Outcome 3: Understand the principles of nutrition
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.
42
UV30539
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)
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).
UV30539
43
Outcome 4: Understand key guidelines in relation to nutrition
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
plate­approximate 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,
44
UV30539
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
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.
(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).
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
UV30539
45
Outcome 6: Understand the relationship between nutrition and physical activity
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.
46
UV30539
Outcome 7: Understand how to collect information relating to nutrition
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).
UV30539
47
Outcome 8: Understand how to use nutritional information
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 nonverbal 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,
48
UV30539
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
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.
UV30539
49
Notes
Use this area for notes and diagrams
50
UV30539
UV31357
Professional 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
Level
3
Credit value
2
GLH
14
Observation(s)
0
External paper(s)
0
Professional practice for exercise
referral instructors
Learning outcomes
On completion of this unit you will:
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
Evidence requirements
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.
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
There is no external paper requirement for
this unit.
UV31357
53
Developing knowledge
Achieving knowledge outcomes
You will be guided by your tutor and assessor
on the evidence that needs to be produced.
Your knowledge and understanding will be
assessed using the assessment methods listed
below*:
•
•
•
•
•
•
•
•
•
•
Projects
Observed work
Witness statements
Audio-visual media
Evidence of prior learning or attainment
Written questions
Oral questions
Assignments
Case studies
Professional discussion
Where applicable your assessor will integrate
knowledge outcomes into practical observations
through professional discussion and/or oral
questioning.
When a criterion has been orally questioned
and achieved, your assessor will record this
evidence in written form or by other appropriate
means. There is no need for you to produce
additional evidence as this criterion has already
been achieved.
Some knowledge and understanding outcomes
may require you to show that you know and
understand how to do something. If you have
practical evidence from your own work that
meets knowledge criteria, then there is no
requirement for you to be questioned again on
the same topic.
*This is not an exhaustive list.
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UV31357
Knowledge
Outcome 1
Understand the role and importance of exercise referral and
related policies and key documents
You can:
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
Portfolio reference
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55
Outcome 2
Understand roles and responsibilities within an exercise
referral scheme
You can:
56
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 interprofessional 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
UV31357
Portfolio reference
Outcome 3
Understand the current healthcare systems in the UK
You can:
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
Portfolio reference
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57
Outcome 4
Understand the exercise referral process
You can:
58
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
UV31357
Portfolio reference
Outcome 5
Understand the principles and procedures of record keeping
You can:
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
Portfolio reference
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59
Outcome 6
Understand the concept of a patient-centred approach
You can:
60
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
UV31357
Portfolio reference
Outcome 7
Understand how to monitor a successful exercise referral
scheme
You can:
a.
Describe techniques to monitor success for the patient and the
scheme
b.
Describe the importance of monitoring and evaluation in exercise
referral
Portfolio reference
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61
Outcome 8
Understand the principles of risk stratification in exercise
referral
You can:
62
a.
Describe the principles of risk stratification
b.
Explain the current use of risk stratification tools used in exercise
referral
UV31357
Portfolio reference
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.
Outcome 1: Understand the role and importance of exercise referral and
related policies and key documents
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.
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Outcome 2: Understand roles and responsibilities within an exercise referral
scheme
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.
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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)
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.
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.
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
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65
Outcome 4: Understand the exercise referral process
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
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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/preexercise 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
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.
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67
Outcome 6: Understand the concept of a patient-centred approach
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, nonjudgmental, 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
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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
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.
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.
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
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Notes
Use this area for notes and diagrams
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UV41356
Understanding 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
Level
4
Credit value
7
GLH
35
Observation(s)
0
External paper(s)
0
Understanding medical
conditions for exercise referral
Evidence requirements
Learning outcomes
On completion of this unit you will:
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
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
There is no external paper requirement for
this unit.
UV41356
73
Developing knowledge
Achieving knowledge outcomes
You will be guided by your tutor and assessor
on the evidence that needs to be produced.
Your knowledge and understanding will be
assessed using the assessment methods listed
below*:
•
•
•
•
•
•
•
•
•
•
Projects
Observed work
Witness statements
Audio-visual media
Evidence of prior learning or attainment
Written questions
Oral questions
Assignments
Case studies
Professional discussion
Where applicable your assessor will integrate
knowledge outcomes into practical observations
through professional discussion and/or oral
questioning.
When a criterion has been orally questioned
and achieved, your assessor will record this
evidence in written form or by other appropriate
means. There is no need for you to produce
additional evidence as this criterion has already
been achieved.
Some knowledge and understanding outcomes
may require you to show that you know and
understand how to do something. If you have
practical evidence from your own work that
meets knowledge criteria, then there is no
requirement for you to be questioned again on
the same topic.
*This is not an exhaustive list.
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Knowledge
Outcome 1
Understand the clinical features of medical conditions relevant
to exercise referral programmes
You can:
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
Portfolio reference
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75
Outcome 2
Know the accepted methods for treatment and management of
medical conditions relevant to exercise referral programmes
You can:
76
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
UV41356
Portfolio reference
Outcome 3
Understand the relationship between exercise and specified
exercise referral medical conditions
You can:
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
Portfolio reference
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Outcome 4
Understand how to programme safe, effective exercise
programmes for patients with specified exercise referral
medical conditions
You can:
78
a.
Outline exercise guidelines and restrictions for patients with
specified medical conditions
b.
Identify considerations for exercise when dealing with comorbidities
UV41356
Portfolio reference
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.
Outcome 1: Understand the clinical features of medical conditions relevant
to exercise referral programmes
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.
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.
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).
Common causes of specified medical
conditions: Biological and psychological
disorders, risk factors associated with each
specified medical condition.
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.
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.
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.
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79
Outcome 2: Know the accepted methods for treatment and management of
medical conditions relevant to exercise referral programmes
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.
Range of credible sources: Researchbased, 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. angiotensinconverting 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
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of food), high blood pressure medication
etc).
Diabetes type 2 – e.g. meglitinides,
sulfonylureas, dipeptidy peptidase-4 (DPP4) inhibitors, biguanides, thiazolidinediones,
alpha-glucosidase inhibitors.
Osteoarthritis – e.g. opiods, steroids, antiinflammatory drugs, anti-depressants.
Rheumatoid arthritis – e.g. diseasemodifying 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, antidepressants, 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)
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.
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.
Effects on blood – hypoglycaemia.
Psychological effects – impaired memory,
Outcome 3: Understand the relationship between exercise and specified
exercise referral medical conditions
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.
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 selfefficacy and stress management, social
gains.
Practical – ability to achieve normal
function, improved (mobility, balance, coordination, strength, endurance, flexibility).
Evaluate the risks of exercise against
benefits: Individualised evaluation, personcentred, consider risks/benefits, consider
intensity, duration and type.
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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).
Time – minutes per session.
Type – number of exercises, body weight,
resistance machines.
Flexibility:
Frequency – amount of sessions per week.
Intensity – length of hold, active, passive.
Time – minutes per session.
Type – range of movement (ROM)
considerations (e.g. functional), specific
joint focus, static, maintenance,
developmental.
Neuromuscular: Active daily living
exercises, improve balance and coordination, improve vocational potential,
improve self confidence, safety.
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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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Planning 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
Level
3
Credit value
8
GLH
52
Observation(s)
1
External paper(s)
0
Planning exercise referral
programmes with patients
Learning outcomes
On completion of this unit you will:
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
2.
Simulation
Simulation is permitted in this unit.
3.
Observation outcomes
Competent performance of Observation
outcomes must be demonstrated on
at least one occasion. Assessor
observations, witness testimonies and
products of work are likely to be the most
appropriate sources of performance
evidence. Professional discussion may be
used as supplementary evidence for those
criteria that do not naturally occur.
4.
Range
All ranges must be practically demonstrated
or other forms of evidence produced to
show they have been covered.
5.
Knowledge outcomes
There must be evidence that you possess
all the knowledge and understanding
listed in the Knowledge section of this
unit. In most cases this can be done
by professional discussion and/or oral
questioning. Other methods, such as
projects, assignments and/or reflective
accounts may also be used.
6.
Case study
You must identify a suitable case study to
enable you to design and agree an exercise
referral programme. The programme must
be at a minimum, six weeks in duration.
7.
Tutor/Assessor guidance
You will be guided by your tutor/assessor
on how to achieve learning outcomes and
cover ranges in this unit. All outcomes and
ranges must be achieved.
8.
External paper
There is no external paper requirement for
this unit.
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
Evidence requirements
1.
Environment
Evidence for this unit may be gathered
within the workplace or realistic working
environment (RWE).
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Achieving observations
and range
Achieving observation outcomes
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.
Achieving range
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.
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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
Observations
Outcome 1
Be able to collect information about exercise referral patients
You can:
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*
*May be assessed by supplementary evidence.
Observation
1
Optional
Optional
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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Outcome 2
Be able to agree goals with exercise referral patients
You can:
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
*May be assessed by supplementary evidence.
Observation
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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1
Optional
Optional
Outcome 3
Be able to plan an exercise referral programme with exercise
referral patients
You can:
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
*May be assessed by supplementary evidence.
Observation
1
Optional
Optional
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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Outcome 4
Be able to manage an exercise referral programme with
patients
You can:
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
*May be assessed by supplementary evidence.
Observation
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
90
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1
Optional
Optional
Outcome 5
Be able to review progress with exercise referral patients
You can:
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*
*May be assessed by supplementary evidence.
Observation
1
Optional
Optional
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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Outcome 6
Be able to adapt an exercise referral programme with patients
You can:
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
*May be assessed by supplementary evidence.
Observation
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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1
Optional
Optional
Range
*You must practically demonstrate that you have:
Collected all information
Portfolio reference
Referral form
Informed consent to participate and transfer medical information
Medical and surgical history
Medication
Physical activity history
Physical activity preferences
Motivation and barriers to participation
Current fitness level
Stage of readiness
Personal and behavioural goals
Physical measurements
Worked with exercise referral patients (where appropriate,
healthcare professionals) to consider all factors to identify and
agree short, medium and long-term goals
Portfolio reference
Medical management
General health and fitness
Physiological
Psychological
Lifestyle
Social
Functional ability
Provided all information to clients
Portfolio reference
Sensitive feedback based on collected information
Relevant healthy lifestyle advice (within limits of knowledge and
competence)
It is strongly recommended that all range items are practically demonstrated. Where this is not
possible, other forms of evidence may be produced to demonstrate competence.
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*You must practically demonstrate that you have:
Planned a programme to integrate all activities
Portfolio reference
Appropriate exercises to achieve goals
Appropriate physical activities to achieve goals
Incorporated all factors into plan
Portfolio reference
Behaviour change strategies
Long-term health and fitness
Reviewed progress and made all necessary adaptations
Portfolio reference
Goals are not being achieved
New goals are identified
It is strongly recommended that all range items are practically demonstrated. Where this is not
possible, other forms of evidence may be produced to demonstrate competence.
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Developing knowledge
Achieving knowledge outcomes
You will be guided by your tutor and assessor
on the evidence that needs to be produced.
Your knowledge and understanding will be
assessed using the assessment methods listed
below*:
•
•
•
•
•
•
•
•
•
•
Projects
Observed work
Witness statements
Audio-visual media
Evidence of prior learning or attainment
Written questions
Oral questions
Assignments
Case studies
Professional discussion
Where applicable your assessor will integrate
knowledge outcomes into practical observations
through professional discussion and/or oral
questioning.
When a criterion has been orally questioned
and achieved, your assessor will record this
evidence in written form or by other appropriate
means. There is no need for you to produce
additional evidence as this criterion has already
been achieved.
Some knowledge and understanding outcomes
may require you to show that you know and
understand how to do something. If you have
practical evidence from your own work that
meets knowledge criteria, then there is no
requirement for you to be questioned again on
the same topic.
*This is not an exhaustive list.
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Knowledge
Outcome 4
Be able to manage an exercise referral programme with
patients
You can:
d.
96
Write a letter to a healthcare professional, communicating
appropriate information and using accurate language
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Portfolio reference
Outcome 7
Understand how to prepare for exercise referral programmes
You can:
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
Portfolio reference
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Outcome 8
Understand the importance of long-term behaviour change for
exercise referral patients
You can:
98
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 longterm change
UV31355
Portfolio reference
Outcome 9
Understand the principles of collecting information to plan an
exercise referral programme
You can:
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
Portfolio reference
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Outcome 10
Understand how to identify health-related fitness goals with
exercise referral patients
You can:
100
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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Portfolio reference
Outcome 11
Understand how to plan an exercise referral programme with
patients
You can:
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
Portfolio reference
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101
Outcome 12
Understand how to adapt an exercise referral programme with
patients
You can:
102
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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Portfolio reference
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.
Outcome 1: Be able to collect information about exercise referral patients
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: Nonjudgemental, 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.
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.
Ensure goals are consistent with
industry good practice: Follow accepted
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Outcome 3: Be able to plan an exercise referral programme with exercise
referral patients
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,
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consistent, detailed, coherent, current).
How to maintain contact: Appointments
(planned review sessions), training
sessions, emails, Skype, telephone, social
networks.
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.
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.
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
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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.
Record changes to plans (adaptations):
Programme card, client records.
Monitor effectiveness of adaptations:
Client feedback, achievement of outcomes,
client preferences or needs.
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.
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.
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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.
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 longterm 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.
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.
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.
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.
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Specific, measurable, achievable,
realistic and time-bound (SMART)
objectives: Progression, regression,
keeping focus, individuality, target
orientated.
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 contraindications – 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 contraindications – 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, coordination, 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.
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Instructing 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.
UV31358_v6
Level
3
Credit value
9
GLH
58
Observation(s)
1
External paper(s)
0
Instructing exercise with referred
patients
Learning outcomes
On completion of this unit you will:
Evidence requirements
1.
Environment
Evidence for this unit may be gathered
within the workplace or realistic working
environment (RWE).
1.
Be able to prepare resources for the
exercise referral sessions
2.
Be able to prepare patients for exercise
referral sessions
2.
Simulation
Simulation is permitted in this unit.
3.
Be able to instruct and adapt planned
exercises to exercise referral patients
3.
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
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.
8.
Understand how to review exercise referral
sessions with patients
4.
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.
5.
Instructing exercise
You are required to instruct an exercise
session/programme. Details are provided
in the ‘Guidance for assessment’ section of
this unit.
6.
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.
7.
External paper
There is no external paper requirement for
this unit.
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Achieving observations
and range
Achieving observation outcomes
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.
Achieving range
There is no range section that applies to this
unit.
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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.
Observations
Outcome 1
Be able to prepare resources for the exercise referral sessions
You can:
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
*May be assessed by supplementary evidence.
Observation
1
Optional
Optional
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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Outcome 2
Be able to prepare patients for exercise referral sessions
You can:
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
h.
Record changes to patients exercise referral
programmes*
*May be assessed by supplementary evidence.
Observation
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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1
Optional
Optional
Outcome 3
Be able to instruct and adapt planned exercises to exercise
referral patients
You can:
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
*May be assessed by supplementary evidence.
Observation
1
Optional
Optional
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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Outcome 4
Be able to bring exercise referral sessions to an end
You can:
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
*May be assessed by supplementary evidence.
Observation
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
118
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1
Optional
Optional
Outcome 5
Be able to review exercise referral sessions
You can:
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
*May be assessed by supplementary evidence.
Observation
1
Optional
Optional
Date achieved
Criteria questioned orally
Portfolio reference
Assessor initials
Learner signature
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Developing knowledge
Achieving knowledge outcomes
You will be guided by your tutor and assessor
on the evidence that needs to be produced.
Your knowledge and understanding will be
assessed using the assessment methods listed
below*:
•
•
•
•
•
•
•
•
•
•
Projects
Observed work
Witness statements
Audio-visual media
Evidence of prior learning or attainment
Written questions
Oral questions
Assignments
Case studies
Professional discussion
Where applicable your assessor will integrate
knowledge outcomes into practical observations
through professional discussion and/or oral
questioning.
When a criterion has been orally questioned
and achieved, your assessor will record this
evidence in written form or by other appropriate
means. There is no need for you to produce
additional evidence as this criterion has already
been achieved.
Some knowledge and understanding outcomes
may require you to show that you know and
understand how to do something. If you have
practical evidence from your own work that
meets knowledge criteria, then there is no
requirement for you to be questioned again on
the same topic.
*This is not an exhaustive list.
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Knowledge
Outcome 5
Be able to review exercise referral sessions
You can:
d.
Portfolio reference
Explain the value of reflective practice
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Outcome 6
Understand how to instruct exercise to exercise referral
patients
You can:
122
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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Portfolio reference
Outcome 7
Understand how to adapt exercise to meet the needs of
exercise referral patients
You can:
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
Portfolio reference
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Outcome 8
Understand how to review exercise referral sessions with
patients
You can:
124
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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Portfolio reference
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.
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.
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.
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.
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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
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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.
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).
Leave environment suitable for future
use: Clear away equipment, confidentiality
maintained, check floor surface.
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: Conditionbased 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.
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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).
Improve personal practice: Areas
for improvement, reflection, continual
professional development, education.
Value of reflective practice: Personal
development, service improvement, selfawareness.
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.
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
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pressure on patients, to empower patient
(locus of control), ensure safe and effective
training sessions.
Adapting communication: Hearingrelated 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.
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, selfmonitoring.
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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