Certificate in Exercise Referral Case-Study Marking Checklist

Candidate Name: Date:

Assessor Name: Date:

IV Name: Date

NB: Candidates must achieve enough passes to show competency across all sections. Candidates are allowed no more than 1 R in any section. An R in a shaded box is an automatic refer.

P Pass Q Question * Pass with comment

R Refer R Referral overall N/A

CLIENT PROFILE

1. Personal factors (age, height, weight, gender, ethnicity)

2. Medical history and medications

3. Other lifestyle factors

4. Likes, dislikes, wants and needs

5. Current activity levels and attitude to exercise and activity

6. Past activity levels and attitude to exercise and activity

7. Risks associated with participation in exercise

8. Identified the stage of readiness to change of the individual

9. List 3 potential barriers to commencing exercise

10. Described an appropriate strategy to help overcome each of the identified barriers

11. Set 1 appropriate long-term goal and 2 appropriate short-term goals that are SMART

12. Stated 2 types of exercise that were suitable for the client and explained why

13. Stated 2 types of exercise that were not suitable for the client and stated why

14. Stated 3 methods/strategies to help keep the client motivated and adhere to the programme

Demonstrated understanding of this section within the viva P

PROGRAMMING

15. Was relevant to the client’s specific controlled condition

16. Related to the client’s long-term goal

17. Contained a comprehensive session outline for 1 week, specifying:

CV exercises in terms of FITT appropriate to the referred client

RT exercises in terms of FITT appropriate to the referred client

Flexibility / mobility exercises in terms of FITT appropriate to the referred client

Appropriate warm-up and cool-down activities

18. Listed the reasons for the choice, the FITT and relevance of the cardiovascular exercises to the client and their specific controlled condition.

19. Listed the reasons for the choice, the FITT and relevance of the resistance, functional and core stability exercises to the client and their specific controlled condition.

20. Listed the reasons for the choice, the FITT and relevance of the flexibility and mobility exercises to the client and their specific controlled condition.

21. Showed in overview how the programme progressed over 10-weeks

22. Progressed logically over time

23. Gave examples of active living and lifestyle advice appropriate to the referred client

24. Identified opportunities for reviewing progress towards goals

25. Described methods of assessment that would be appropriate for the medical condition and medications.

Demonstrated understanding of this section within the viva

IMPORTANT NOTE This plan MUST NOT be implemented with the referred client.

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study

1: CLIENT PROFILE

Client Name: Age:

Address:

Post code: Height:

Gender: Weight:

BMI : Ethnicity:

MEDICAL HISTORY In the space below, provide details of the client’s medical condition, their symptoms and any medications (including dosages) that they are taking:

Client Exercise Profile Using the FITT principle, describe your clients current exercise level.

Frequency:

Intensity:

Type

Time:

Client Physical Activity Profile Using the FITT principle, describe your client’s current physical activity level.

Frequency:

Intensity:

Type

Time:

Exercise Comparison Using the FITT principle, compare your client’s previous exercise history with their current exercise levels.

Activity Comparison Using the FITT principle, compare your client’s previous physical activity history with their current level of physical activity.

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study

If there are any differences between your client’s current & previous level of physical activity / exercise, explain the reasons for these differences.

Describe your client’s current attitude, motivation and outlook towards exercise.

EXERCISE PREFERENCES In the space below, identify the types of exercise your clients like to regularly perform (if any).

PHYSICAL ACTIVITY PREFERENCES Identify the physical activities your client enjoys performing on a regular basis; this should not include information about exercise or sports performance.

LIFESTYLE PROFILE Using the bullets below, provide a brief profile of your clients current lifestyle activities including any recommendations you have made to you client. You may tie these recommendations into your client’s goal setting contract.

Cigarette use: How many do they smoke, how long have they smoked and what are your recommendations?

Alcohol consumption: How many units per day / week, how do they consume these units (binge / evenly) and what do they drink?

RISKS ASSOCIATED WITH PARTICIPATION In the box below, summarise the risks associated with your client’s participation in exercise, where possible making reference to the risk stratification provided in your student manual.

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study

2. READINESS TO CHANGE: Identify the client’s ‘readiness to change’. Pre-contemplation: Contemplation: Preparation: Action: Maintenance: Termination: Relapse: State why you believe the client to be in this stage and provide examples to support your reason:

3. BARRIERS TO PARTICIPATION: From the information gathered, identify 3 potential barriers the client has to commencing an exercise programme.

4. STRATEGIED FOR OVERCOMING BARRIERS: Suggest an appropriate strategy to help overcome each of the barriers identified above.

5. CLIENT MOTIVATIONS: Identify a minimum of 1 client motivation the client may have to commence an exercise programme.

6. CLIENT GOALS: From the information provided, set 1 long term goal and 2 short term goals for the client using the SMART principle.

Long Term Short-Term Short-Term

S:

M:

A: R:

T:

S:

M:

A: R:

T:

S:

M:

A: R:

T:

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study

7. SUITABLE EXERCISES: From the information supplied, identify 2 types or modes of exercises that would be appropriate to the client and provide reasons to support why.

8. UNSUITABLE EXERCISES: From the information supplied, identify 2 types or modes of exercises that would not be appropriate to the client and provide reasons to support why.

9. MOTIVATION STRATEGIES: State 3 methods or strategies that you could use in order to help the client stay motivated and adhere to their exercise programme.

WARM-UP

WARM-UP 1 WARM-UP 2 WARM-UP 3 WARM-UP 4

MOBILITY / PULSE-RAISER Joint Mobility

Joint Mobility

Joint Mobility

Joint Mobility

Pulse-Raising

Pulse-Raising

Pulse-Raising

Pulse-Raising

Pre-Stretch

Pre-Stretch

Pre-Stretch

Pre-Stretch

COOL-DOWN Pulse-Lowering Pulse-Lowering Pulse-Lowering Pulse-Lowering

Flexibility

Flexibility

Flexibility

Flexibility

EXERCISE PROGRAMME OVERVIEW

RESISTANCE Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10

Frequency

Inte

ns

ity

Sets

Reps

Rest

%1RM

Time

Type

CARDIO Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10

Frequency

Intensity (%HRR &

RPE)

Time

Type

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study

MOBIILITY EXERCISES

MOBILITY Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10

Frequency

INT

EN

SIT

Y

Sets

Reps

Rest

Time

Type

(list exercises)

EXERCISE REFERRAL PROGRAMME CARD

Patient Name: Programme Start Date: Programme End Date:

WARM-UP

Mob/Pulse-raiser:

Pre-Stretches:

RESISTANCE TRAINING CARDIOVASCULAR TRAINING

Frequency:

Frequency:

Exercise Sets Reps Rest Load Exercise Mode(s):

Intensity-Heart Rate:

Intensity- RPE

Intensity- METS

Time / Duration:

Alternative:

Adaptation:

Progression:

PHYSICAL ACTIVITY GROUP EXERCISE

Frequency:

Frequency:

Intensity: Circuit Training:

Exercise to Music: Step:

Indoor Cycling:

Aqua:

Pilates:

Yoga:

Other.........................

Time / Duration:

Type:

Walking: Stair Climbing: Dancing: Cycling: Gardening: Housework: Other: ......................................

Class Level:.................................................................. Considerations:..............................................................

......................................................................................

ADDITIONAL EXERCISE / ACTIVITY GUIDELINES

Details:

COOL-DOWN

Pulse-lowering:

Post-Stretches:

Activity Plan Acknowledgement: I understand that my participation in the physical activity referral scheme is entirely voluntary and that I am free to withdraw at any time. I have read this form and I understand what I will be asked to do and consent to participating in the physical activity referral scheme. I will undertake to keep the exercise referral professional informed about any changes in my condition and/or medication.

Patient Signature: Exercise Professional Signature:

Date: Date:

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study

PROGRAMME RATIONALE

1. List the reasons for inclusion of the CV exercises chosen in terms of FITT and why they are appropriate to the referred client and their medical condition?

2. List the reasons for inclusion of the resistance training and core stability exercises chosen in terms of FITT and why they are appropriate to the referred client and their medical condition?

3. List the reasons for inclusion of the flexibility exercises chosen in terms of FITT and why they are appropriate to the referred client and their medical condition?

4. Provide examples of active living advice you will give the referred client and why they are appropriate to their medical condition?

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study

5. Which techniques would be used to monitor and review client progress towards their goals and how frequently will these reviews be conducted?

6. Which methods of assessment would be appropriate for the client and their medical condition and medication? Provide information on assessments you would conduct at the beginning, middle and end of the programme and provide information about assessments you would exclude.

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study

NOTES / ADDITIONAL JUSTIFICATIONS Use the space below if you feel that you need to further support or justify any of the content within the progressive exercise programme for your referred client.

© Innervate Training: CYQ Level 3 Certificate in Exercise Referral Case-Study