“The exercise professional

is responsible for delivering regular supervised exercise classes, designing and monitoring exercise programmes and encouraging healthy lifestyle behaviours”

This is normally achieved through the four phases of CR: l Phase I - inpatient. l Phase II - discharge home. l Phase III - hospital-based supervised exercise programme. l Phase IV - long-term community-based exercise programme.

Recent studies show exercise reduces the risk of total mortality, cardiac mortality and the recurrence rate of CHD by 27%, 31% and 38% respectively (2,3). The mechanisms associated with exercise and the reduction in cardiac mortality is not fully understood, although research has identified four key benefits that exercise has on reducing CHD: l Modifies CHD risk factors (4) l Halts and regresses the build-up of atheroma in the coronary arteries (5)

l Prevents thrombus (clot) formation (6) l Enhances vasodilatation of the coronary arteries, which promotes better coronary blood flow to the myocardium (6).

What is the provision of cardiac rehabilitation? According to the National Audit of Cardiac Rehabilitation Project (NACR) there are around 395 programmes throughout the UK (7), a number that has grown enormously over the past decade. However, only 41% of eligible patients are offered CR (7). These figures tend to reflect those who attend a hospital- based programme (Phase III) and it is estimated that around 50% will drop out before the end of the programme with just 30% continuing exercising at one year (Phase IV). Therefore, exercise professionals play a key role in maintaining long-term exercise habits.

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Many hospital-based CR programmes include Phase IV exercise sessions led by an appropriately-qualified fitness professional. It has been estimated that there are over 600 Phase IV CR exercise classes held on a weekly basis with up to 15 to 20 participants in each class (8). This equates to a staggering 10,000-12,000 patients exercising per week in Phase IV CR.

What is the role of the exercise professional in cardiac rehabilitation? The role of the exercise professional is crucial in the long-term management of patients with CHD.

Exercise professionals form part of a multi-disciplinary team, which includes: l Doctors l Cardiac nurses l Practice nurses l Physiotherapists l Dietitians l Psychologists l Occupational therapists l Pharmacists l Counsellors.

The role of the exercise professional within this team is vital in delivering an effective phase IV service, which involves liaising with the primary care team (practice nurse) regarding the patient’s risk factor management and maintaining communication with the Phase III CR team. During Phase IV the exercise professional is responsible for delivering regular supervised exercise classes,

The REPs Journal 2010;19(December):19-21The REPS Journal 2009;00(Month):00-00