Exercise Referral Resources

Exercise Referral Resources

Course Induction

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Learner Assessment Record (LAR)

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Applicable if you are studying the Anatomy & Physiology and/or Nutrition units.

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Your Tutor

Jo Bentley
Email: jo@fit4training.com

Course Induction

You are now successfully enrolled on the YMCA Awards Level 3 Exercise Referral course.

This is an online/distance learning course, so includes elements of home study and online learning.

You have up to 12 months to complete the course. Please see our policy on Course Fees & Timeframes for further information.

If you think you are exempt from completing any of the assessments please read through our Recognising Prior Achievement & Exemption Policy and contact us.

Please also familiarise yourself with our Booking Terms, Appeals Procedure and Applying Reasonable Adjustments & Special Considerations Policy.

Course Topics

During the course, you will learn about:

The role and importance of exercise referral including the role of exercise in disease risk reduction and condition management, and key points from government policies and professional standards;
The roles and responsibility with an exercise referral scheme including the fitness professionals scope of practice and professional boundaries and how to deal with a client who has a medical condition outside the scope of practice;
The current healthcare systems in the UK including key health service documents and policies;
The exercise referral process including initial consultation, monitoring and collecting data and legal requirements;
The principles and procedures of record keeping including confidentiality, data protection, validity, reliability and quality.
The concept of a patient centred approach including verbal and non-verbal communication and health behaviours;
The principles of risk stratification including risk stratification tools;
The clinical features of medical conditions relevant to exercise referral programmes, including the pathophysiology, clinical signs and symptoms;
The accepted methods of treatment and management of the medical conditions including common drugs, surgical or therapeutic interventions, lifestyle modifications, nutrition and physical activity;
The Relationship between exercise and specific medical conditions including the risks and benefits;
How to programme safe and effective programmes for patients with specific medical conditions including guidelines and considerations of co-morbidities;
How to prepare for exercise referral programmes including using equipment and environment;
The importance of long term behaviour change;
The principles of collecting information to plan a programme;
How to identify health related fitness goals;
How to plan an exercise referral programme including contraindications, principles of programme design and ADLs;

If you haven't achieved the following units within the past 3 years, you will also learn about:

Applied anatomy & physiology

Optimal posture, causes of postural deviations and spinal conditions and the impact of exercise,
Structure and function of the skeletal system and the effects of exercise on the musculoskeletal system and disease processes,
Structure and function of the nervous system and the effect of exercise on neuromuscular connections,
Structure and function of the cardio
Respiratory system and endocrine system,
Classification of energy systems and how they are utilised during exercise.
The digestive system,
Implications for special populations.

Nutrition to support physical activity

Principles of nutrition,
The influence of nutrition on health,
Key nutritional guidelines and evidence-based recommendations and how they can be applied to individual clients,
The relationship between nutrition and physical activity,
Collecting and using nutritional information,
Identify and analysing nutritional information to identify client's dietary habits.

Course Units

Unit 1 - Professional Practice In Exercise Referral

Assessment 1 - Open book worksheet

Unit 2 - Understanding Medical Conditions For Exercise Referral

Assessment 2 - Invigilated medical conditions exam (at our centre in Telford or invigilated in your workplace)

Assessment 3 - Invigilated activity guidelines exam (at our centre in Telford or invigilated in your workplace)

Unit 3 - Planning Exercise Referral Programmes With Patients

Assessment 4 - Open book worksheet

Assessment 5 - Client consultation including filmed observation.

Assessment 6 - Exercise referral programme planning

Assessment 7 - Programme review

Assessment 8 - Letter to healthcare professional

Unit 4 - Instructing Exercise With Referred Patients

Assessment 9 - Session planning

Assessment 10 - Observed (filmed) practical session delivery

Assessment 11 - Open book worksheet

*The chosen client for the case study should have a minimum of TWO conditions that have been covered in the qualification;

Cardiovascular disease; hypertension and hypercholesteroleamia

Metabolic/Immunological disease; obesity, diabetes type 1 and type 2

Musculoskeletal disease; osteoarthritis, rheumatoid arthritis, simple mechanical back pain, osteoporosis and joint replacement

Respiratory disease; asthma and chronic obstructive pulmonary disease (COPD)

Psychological/mental health conditions; depression, anxiety and stress

If you are required to complete the Applied Anatomy & Physiology and Nutrition to Support Physical Activity units (Units 5 and 6), the cost of these units are £50 each. They involve a multiple choice exam, and open-book online workbook and also a nutrition case study.

Course Resources

You will receive the following hard copy resources through the post:

YMCA Awards Exercise Referral manual

Recommended Texts

Lawrence, D and Barnett, L (2013). The Complete Guide to Exercise Referral: Working with Clients Referred to Exercise. London. A & C Black.

As well as the above texts, we urge you to explore some further reads on Amazon (or other book shop). We find if you search for "exercise" and then the name of a condition, this brings up the most relevant books, e.g. "exercise osteoporosis".

If you are studying the Applied Anatomy & Physiology and Nutrition to Support Physical Activity units, you will have access to online elearning. Please use this and the below presentations to prepare for your assessments. Please note that you have access to your elearning modules for 300 days, although you have a full 12 months to complete all the assessment within this qualification.

Assessment Guidance

Assessment 1

In order to pass this assessment, you need to complete the Professional Practice for Exercise Referral Instructors open book worksheet, which you find the in your LAR. You are required to answer all the questions fully to show clear understanding and knowledge. This worksheet can be completed at any time throughout the 12 month period of your course.

Assessment 2 and 3

Please use your manual (as well as your own additional reading and research) to learn the content of this assessment. In order to pass assessment 2 and 3, you need to complete the 'Medical Conditions Table' and 'Activity Guidelines Table', located in your LAR. These tables are required to be sat in 'closed-book, invigilated conditions'. You will complete each of the tables 5 times, for 5 conditions, which will be selected by your assessor at the time of the assessment. You will need to show comprehensive understanding of the 5 conditions given to you. We have also produced some revision notes (below) for some of the medical conditions, which highlights the level of knowledge required for this assessment.

In order to book this invigilated exam, please use our Book an Assessment form to complete it with us in Telford or complete our invigilator approval form if you are unable to attend our assessment centre and would like to complete your exams in your workplace.

Assessment 4

To pass this assessment, you are required to complete the 'Planning Exercise Referral Programmes with Patients' worksheet, which can be found in your LAR. You are required to complete all questions with sufficient details to show clear understanding.

Assessment 5

To pass this assessment, you must complete a client consultation with your patient. Your patient must have a minimum of two of the following conditions*;

Hypertension
Hypercholesteroleamia
Chronic Obstructive Pulmonary Disease
Asthma
Obesity
Type 1 Diabetes
Type 2 Diabetes
Osteoarthritis
Rheumatoid Arthritis
Osteoporosis
Depression
Stress
Anxiety
Simple Mechanical Back Pain
Joint Replacement

*Please refer to Unit 1 'Principles of risk stratification in exercise referral' to ensure your patient is not 'high risk', which is beyond the scope of this qualification. It is important that you get confirmation from us that your client is suitable before proceeding any further.

This consultation must be observed by your assessor either face-to-face or via video submission. You must gain the following information from your patient;

Exercise Referral form
Transfer of medical information documentation
Medical and surgery history
Medications
Physical activity history
Physical activity preferences
Motivation and barriers to participation
Current fitness level
Stage if readiness
Personal and behavioural goals
Physical measurements

You should use the information gathered to discuss and agree short, medium and long-term goals for at least 3 of the following aspects;

Medical management
Functional ability
Psychological
General health and fitness
Lifestyle
Physiological
Social

Please read the 'Patient Consultation Checklist' (which you can find in your LAR) thoroughly before completing and filming your consultation with your patient. This is the criteria your assessor will need you to cover in order for you to pass this assessment. Please see the consultation tips below or feel free to contact your assessor for clarification on any of the assessment criteria before completing the consultation. We also advise that you take some notes or produce a detailed consultation form template, so you do not miss any information. If you do miss any information, then your assessor may be able to use the 'supplementary questions record' in your LAR, should you not cover any of the criteria sufficiently.

Here is some additional tips to help ensure you include all the relevant information within your consultation…..

Consultation Tips:

Using a patient centred approach:

Explain your role and discuss how other professionals will be kept informed of patient progress (e.g. you will be writing a letter to the GP at the mid week stage to keep them up to date). Provide the patient with your contact details and how they could get in touch with you between sessions.

2) Explain the purpose of this initial consultation – which is to:

a. Go through the initial referral form (if applicable) and check there’s no changes and all data is correct since referral

b. Gather initial monitoring information – height/weight/BP, waist circumference, etc.

c. Discuss conditions and symptoms, medications

d. Chat about previous exercise experience

e. To work in partnership with the client and use the information to design a tailor made programme of exercise

f. To check that the client is happy with the consultation and information gathering process before going ahead

Explain how records will be maintained and treated confidentially in line with DPA. Ask the client if they are happy for you to share confidential information with health care provider. Is the patient agreeable with this procedure before recording any information?

THEN…

4) Go through the Referral form, check name, address, age etc and that all data is correct.

5) Confirm medical and surgical history and medications – clarify the conditions and discuss any health changes since the referral.

6) Discuss physical activity history and preferences, current fitness levels .

7) Discuss lifestyle behaviours .

8) Discuss motivation and barriers.

9) Discuss readiness and goals, explain the term SMART and ask the client for their input.

10) Take Physical measurements and clarify that all is correct since the referral. Your assessor will observe you taking height, weight, BMI, blood pressure, resting heart rate etc.

11) ** Assessments/measurements if applicable to the conditions, perhaps you can do a postural assessment and or joint range of movement assessment. ** Some clients may find the prospect of an exercise assessment a barrier so this is not always necessary in an initial consultation, this can be omitted but should be considered as could be useful for some referral clients.

12) Based on your findings and the referral form, and your programme (although it might not be complete) explain about a proposed timetable – e.g. once a week and explain the type of exercises and demands that that the patient will do with you. Let the patient know that the planned sessions with you will be in the gym, or at home.

13) Explain informed consent, show the form to the patient – and that when they signing the informed consent form and that they are aware of the risks and benefits to the proposed exercise sessions.

14) Explain other physical activities will complement the planned sessions that you will do with the patient and discuss the environments

15) Discuss how the programme will be reviewed – eg initial assessment, mid term (6-8 weeks) and end review (12-16 weeks) – give dates. Will there also be ongoing assessment and evaluations by your weekly screening and checks? Yes. Explain you will ask about their response to the previous exercise session and ask questions if there are any changes in health.

16) Thank the patient for attending this consultation

Please submit your session via You Tube link. We recommend you upload your video to YouTube as a private video giving access to jo@fit4training.com. Submit your video link using our coursework submission form (link to form below). There is guidance on uploading your video to You Tube on your course page.

Assessment 6

In order to pass this assessment, you need to design a structured exercise programme for your patient. Your programme needs to last a minimum of 4 weeks and needs to detail;

the resources required, including equipment and environment
specific outcome measures, stages of achievement, and exercise which are:
- appropriate to patients goals, medical conditions and fitness level
- consistent with accepted good practice
appropriate components of fitness and principles of training to help achieve short, medium and long term goals.

Please read the 'Exercise referral programme assessment checklist' found in your LAR, so you are aware of what you assessor is looking for when assessing your programme. It is advised that you create your own programme card template appropriate to your patient.

Assessment 7

In order to pass this assessment you are required to review your patients programme with your patient after the 4 weeks (minimum). This can be done remotely or face-to-face, but before submitting the questionnaire to your patient, you must complete the sections in your LAR which state the reason why you are requesting a review and you will also need to insert 4 of your patients goals in point 4 on the review questionnaire document (found in your LAR).

Upon receipt of the completed questionnaire, use your patients responses to detail your recommendations to them (in the last column on the questionnaire document) and also complete the 'Adaptations to programme' document found in your LAR.

Please read the 'Patient review assessment checklist' found in your LAR, so you are aware of what your assessor will be looking for when assessing your review.

Assessment 8

In order to pass this assessment, you are required to compose a letter to a healthcare professional informing them of your patients progress in meeting their goals. Please refer to the 'Letter to healthcare professional assessment checklist' for guidance on what your letter must include.

Assessment 9

In order to pass this assessment, you must produce a session plan for an Exercise Referral Patient, which will then be used for the purposes of the observed practical assessment.

Ideally, you should use the same patient who you have been working with, however in the event they are unavailable, you may use a hypothetical patient.

The patient (real or hypothetical), must have two of the following conditions:

Hypertension
Type 2 diabetes
Type 1 diabetes
Obesity
Asthma
Chronic obstructive pulmonary disease
Hypercholesterolaemia
Osteoarthritic
Rheumatoid arthritis
Joint placement
Osteoporosis
Stress
Depression
Anxiety
Simple mechanical back pain

Please refer to Unit 1 (principles of risk stratification in exercise referral' to ensure the patient does not possess 2 conditions which makes them high risk and beyond the scope of the Level 3 Exercise Referral qualification.

The session must be based on your own area of expertise, for example, circuits, gym-based exercise, pilates, exercise to music...

You can use the session plan template provided within your LAR, or you are welcome to design your own as long as it includes the following;

purpose of session
environment/equipment required
proposed activities/exercises
methods of monitoring
adaptations
progressions/regressions
components of session (warm up, main activities, cool down)

We strongly advise that you submit your work so far for marking, prior to you moving on to the practical observation for Assessment 10.

Assessment 10

In order to pass this assessment, you must instruct your patient through the planned session, following which you will conduct a patient feedback session and explain to your assessor how this information could be used to improve your own personal practice.

Please read through the 'observation assessment checklist' within your LAR prior to your assessment, so you are aware of what you assessor is looking for. You may want to take your own notes on your session plan to ensure you cover every criteria. Please note, you need to answer the Mandatory Question at the end of the observation checklist before submitting your work.

In order to book your assessment in person, please complete our book an assessment form (link below). Please note, the client you bring doesn't have to be your case study client, but you still need to instruct the session you planned for your case study client.

If you would like to film your session and send it to your assessor, please following the following guidelines:

The whole session should be filmed NON-STOP from start to finish
You and you client(s) should remain in camera shot at all times
The video should not be edited in any way
We must be able to hear you throughout the video (if music is playing, make sure it is not next to the camera)
Photo-id should be sent with the video to prove authenticity (passport or driving licence)

Assessment 11

In order to pass this assessment, you are required to complete the 'Instructing Exercise Referral Programmes with Patients' worksheet. The questions need to be fully completed in order to show sufficient understanding and knowledge.

Assessment 12

This assessment is used to assess the knowledge required for the ‘Applied anatomy and physiology’ and ‘Nutrition to support physical activity’ units. Please use the relevant elearning modules, presentations and mock exams to prepare for this exam.

It is a multiple choice exam set by YMCA Awards. The paper will comprise of 2 sections:

Section 1 of the paper has 20 questions and will relate to the syllabus for the Applied anatomy & Physiology unit;
Section 2 of the paper has 10 questions and will relate to the syllabus for the Nutrition to Support Physical Activity unit.

The entire exam paper will comprise of 30 questions and the time allocated is 40 minutes. Each question will be worth 1 mark. You must achieve a minimum of 14 marks (70%) to pass Section 1. You must achieve a minimum of 7 marks (70%) to pass Section 2.

Should you not obtain sufficient marks to pass one of the sections then you need only resit that section. Time allowed to resit Section 1 is 25 minutes. Time allowed to resit Section 2 is 15 minutes.

Book your exam here.

Assessment 13

You will need to complete an online Assessment Workbook, which you can access via your elearning platform login. There are two sections to this workbook. Please use the relevant elearning modules and presentations to revise and prepare to complete this workbook.

All questions must be answered correctly but you get unlimited attempts. This is an open book assessment, but work must be your own, and the questions refer to the content covered on the elearning modules. The questions are auto-marking, so you will receive an instant result upon completion. You will be directed back to any questions answered incorrectly so you can have another go.

You can complete these workbooks at any point during your course, however you will need to request access to this once you feel ready to complete it. Please email Michelle.

Additional Resources

Exercise Referral Toolkit

Exercise Referral Quality Assurance Framework

Motivational Interviewing

Guidance for Exercise Referral Scheme Coordinators

For Instructors Setting up a Class

Exercise Referral Schemes to promote physical activity

Guidance for Exercise Professionals

Medical Conditions Revision Notes

Hypercholesterolaemia

Please note, for Assessment 2 and 3 you could be assessed on any of the 15 conditions. The above 5 documents have been produced so you can see an example of the level of detail required.