Exercise Referral

1
Exercise Referral

• AKA
• Exercise on prescription
• GP Referral
• Rationale
• Many diseases are less apparent in active
  populations
• Hypertension, NIDDM2, Coronary Disease,
  Osteoporosis
• Activity is in decline due to mechanisation
• Therefore - promoting activity may improve the
  health of the population
• What about those who are already suffering from
  disease ?

2
Exercise Referral History

• Oasis Programme began 1991
• One of the first
• Link initially between 1 GP surgery and 1 leisure
  centre
• GPs aimed to use exercise as an adjunct to
  treatment
• Centre manager aimed to use spare daytime
  capacity
• Successful pilot schemes (Oasis and others)
• GP referral became a hot topic in the leisure
  industry
• Schemes expanded rapidly in the early 1990s
• Size of existing schemes
• Numbers of new schemes starting
• Quality control issues raised

3
Training Programmes

• East Sussex Health Authority
• Provided a driving force and some funding to
  develop a training programme for staff.
• Developed in conjunction with University of
  Brighton
• First run 1996
• Targeted specific client groups
• This course is based on former GP referral course
• Acknowledge broader perspective
• Changes in Health Provision
• PCG, Healthy Living Centres, Quality Assurance
  Document
• Need to fit into modular structure

4
Terminology

• Duration - How long a bout of activity lasts
• Intensity - The effort or physiological strain
  needed to perform the activity
• Frequency - How often the activity is performed
• Volume - Summarises the total training load

5
Specificity

• Changes due to an exercise programme are
  specific
• Location of changes
• Arms/legs
• Central/peripheral
• Type of changes
• Strength training
• Endurance training

6
Intensity

• Relative intensity is important
• Work intensity
• Speed
• Power
• Physiological intensity
• Heart rate (HRmax or HRR - often estimated)
• Rate of perceived exertion (RPEmax)
• Minimum intensity for changes to occur
• Maximum intensity for safe practice

7
Duration - intensity relationship

• General principles
• High intensity exercise can only be performed for
  short durations (interval training)
• Greater than 30 min may require an intensity less
  than 60 max aerobic capacity (lt 60 HRR or lt RPE
  13)
• Individual differences
• 60 HRR may only be possible for a few minutes if
  client is severely deconditioned
• 90 HRR may be possible for over an hour in an
  elite endurance athlete
• The effects of medical conditions must be a
  primary consideration

8
Frequency

• The appropriate exercise frequency depends on
• Duration / intensity of each training session
• Level of exercise capability of each client
• Individual differences in recovery speed
• Diet and nutritional status
• Other lifestyle factors (physical and
  psychological)
• Generally 1 day on - 1 day off is a safe
  recommendation
• Motivated clients tend to overtrain (high
  frequency)
• Unmotivated clients tend to undertrain (low
  frequency)

9
Progressing Volume

• Training volume is a combination of the exercise
  Duration, Intensity and Frequency.
• Training progression is achieved by manipulating
  each factor which contributes to the volume
• eg.
• Increase duration whilst temporarily decreasing
  intensity
• Maintain the new duration whilst raising
  intensity back to the original level.

10
Adaptation

• General processes
• General adaptation syndrome
• Supercompensation
• Recovery time and quality
• Progression
• Reversibility
• Maintenance
• Specific processes
• Peripheral (skeletal muscle, bone, tendon)
• Central (heart, blood)

11
Adaptation - supercompensation

• Performance
• Time

12
Progression and Reversibility

• Progression
• Exercise programmes must be progressive for
  adaptations to continue
• Rapid progression predisposes to illness and
  injury
• Generally a 10 volume increase / week is safe
• Exceptions to this may be sensible or enforced.
• Reversibility
• Adaptations to exercise will be swiftly lost
  (reversed) if the exercise regime is curtailed
• Adaptations may be maintained on a considerably
  lower volume of exercise than was needed to
  produce them.