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There are currently around 1,200 exercise referral schemes running in the UK; the new standards will apply to all of these


medicine consultant, for example, or a physiotherapist, REPs Level 3-registered exercise referral instructor, or a number of other professionals. Importantly, by acknowledging the role


of a number of professionals, we hope to establish physical activity as a vital part of numerous care pathways – be that for a type 2 diabetic patient referred by a GP, a patient with non-specific back pain referred by a physio, or a cardiac patient referred by a rehabilitation service.


Inclusion/exclusion In layman’s terms, the patient inclusion/ exclusion criteria – or risk stratification – then determines which patient should see which professionals. Te notable change within these standards is that patients who are identified as at ‘low risk of an adverse event or decline during exercise’ should remain within the exercise referral service, but may undertake a wide range of activities – programmed and monitored, but not necessarily supervised by the exercise referral instructor. Tis development changes the delivery of exercise referral services from one-on-one instruction to participation in any form of physical activity deemed suitable by a Level 3 exercise referral instructor – be that a walking group, a group exercise class, or simple changes to a person’s everyday life. Of course, medium-risk patients


must be entered into an individualised, supervised exercise programme relevant


November/December 2012 © cybertrek 2012


to their condition. Additionally, high- risk cardiac patients must be referred to a Level 4 cardiac rehabilitation professional, and high-risk non-cardiac patients to an appropriate multi-disciplinary team such as a falls prevention unit. Part of a high-risk patient’s exercise


programme can be delivered by a REPs Level 3 exercise referral instructor, but the initial assessment and programming must be undertaken by the relevant multi- disciplinary team.


The first step Lastly, the risk stratification leads me nicely to the goals of an exercise referral service, which fall into two main types – process goals and outcome goals – and also short- and long-term outcome goals. Short-term goals will include


condition-specific or clinical outcomes. However, long-term goals simply involve meeting a minimum threshold of physical activity, as set by the UK’s chief medical officers, aſter a 12-month period. Tis once and for all clarifies that the ultimate goal has to be behaviour change, enabling people to exercise independently. Te biggest criticism of exercise referral services has been that they do not support such behaviour change; this must now be the ultimate goal. I hope this will see a greater number of


low-risk patients being referred to REPs Level 3 exercise referral instructors for all forms of activity, and even simple physical activity counselling.


I cannot of course outline the entire


standards in this short article. However, I hope I have given you a flavour of what is to come, and the opportunity that the standards represent for our professionals and facilities to improve their services and support patients to get more active. Te standards mark the first time


the medical community has supported exercise referral, but the work won’t stop there. I look forward to seeing the FIA Research Institute conducting the first academic review of a scheme adhering to the standards, or possibly the forum developing a kitemark to demonstrate that a scheme is meeting the standards. When the standards are published later this year, please read them, and watch this space.


Membership of the Joint Consultative Forum


n British Association of Sport & Exercise Sciences


n Chartered Society of Physiotherapy n College of Occupational Therapy n Faculty of Public Health n Faculty of Sport & Exercise Medicine n FIA (Fitness Industry Association) n Royal College of General Practitioners n Royal College of Nursing n Royal College of Physicians n Royal College of Psychiatrists n Register of Exercise Professionals


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