Instructing exercise with referred patients

Learner name:

Learner number:

L/503/7491

VRQ

UV31358

Instructing exercise with referred patients

By signing this statement of unit achievement you are confirming that all learning outcomes, assessment criteria and range statements have been achieved under specified conditions and that the evidence gathered is authentic.

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Statement of unit achievement

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UV31358Instructing exercise with referred patients

The aim of this unit is to develop the knowledge, understanding and practical skills that you require to prepare, instruct, monitor, adapt and review exercise sessions/programmes for exercise referral patients.

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GLH

Credit value

Level

Observation(s)

External paper(s)

58

9

3

1

0

On completion of this unit you will:

Learning outcomes

Instructing exercise with referred patients

1. Be able to prepare resources for the exercise referral sessions

2. Be able to prepare patients for exercise referral sessions

3. Be able to instruct and adapt planned exercises to exercise referral patients

4. Be able to bring exercise referral sessions to an end

5. Be able to review exercise referral sessions

6. Understand how to instruct exercise to exercise referral patients

7. Understand how to adapt exercise to meet the needs of exercise referral patients

8. Understand how to review exercise referral sessions with patients

1. Environment Evidence for this unit may be gathered within the workplace or realistic working environment (RWE).

2. Simulation Simulation is permitted in this unit.

3. Observation outcomes Competent performance of Observation outcomes must be demonstrated on at least one occasion. Assessor observations, witness testimonies and products of work are likely to be the most appropriate sources of performance evidence. Professional discussion may be used as supplementary evidence for those criteria that do not naturally occur.

4. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the Knowledge section of this unit. In most cases this can be done by professional discussion and/or oral questioning. Other methods, such as projects, assignments and/or reflective accounts may also be used.

5. Instructing exercise You are required to instruct an exercise session/programme. Details are provided in the ‘Guidance for assessment’ section of this unit.

6. Tutor/Assessor guidance You will be guided by your tutor/assessor on how to achieve learning outcomes in this unit. All outcomes must be achieved.

7. External paper There is no external paper requirement for this unit.

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Evidence requirements

Achieving observation outcomes

Achieving range

Achieving observations and range

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Your assessor will observe your performance of practical tasks. The minimum number of competent observations required is indicated in the Evidence requirements section of this unit.

Criteria may not always naturally occur during a practical observation. In such instances you will be asked questions to demonstrate your competence in this area. Your assessor will document the criteria that have been achieved through professional discussion and/or oral questioning. This evidence will be recorded by your assessor in written form or by other appropriate means.

Your assessor will sign off a learning outcome when all criteria have been competently achieved.

There is no range section that applies to this unit.

4

Guidance for assessment

You are required to instruct an exercise session/programme.

There is NO requirement for you to instruct a real exercise referral patient through an exercise programme; this can be undertaken by one of your peers in a theoretical simulated environment. You should ensure that the real or theoretical patient that you use for the case study does not possess two or more conditions which make them high risk or places them outside the scope of a Level 3 exercise referral instructor.

Outcome 1

Observations

You can:

Observation 1 Optional OptionalDate achieved

Criteria questioned orally

Portfolio reference

Assessor initials

Learner signature

*May be assessed by supplementary evidence.

Be able to prepare resources for the exercise referral sessions

a. Select a range of exercises/physical activities to help patients achieve their objectives and goals

b. Obtain and prepare the resources needed for planned exercises/physical activities

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Outcome 2

You can:

Be able to prepare patients for exercise referral sessions


a. Help patients feel at ease in the exercise environment

b. Explain the planned objectives and exercises/physical activities to patients

c. Explain to patients how objectives and exercises/physical activities support their goals and are appropriate to their condition

d. Explain the physical and technical demands of the planned exercises/physical activities to patients

e. Explain to patients how planned exercise/physical activity can be progressed or regressed to meet their goals

f. Assess patients’ state of readiness and motivation to take part in the planned exercises/physical activities

g. Negotiate and agree with patients any changes to the planned exercises/physical activities that: • meet their goals and preferences • enable them to maintain progress

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Portfolio reference

Assessor initials

Learner signature

h. Record changes to patients exercise referral programmes*

Outcome 3

You can:


Be able to instruct and adapt planned exercises to exercise referral patients

a. Use motivational styles that: • are appropriate to the patients • are consistent with accepted good practice

b. Explain to patients the purpose and value of a warm-up

c. Provide warm-ups appropriate to the patients, planned exercise and the environment

d. Make best use of the environment in which the patients are exercising

e. Provide instructions, explanations and demonstrations that are technically correct, safe and effective

f. Adapt verbal and non-verbal communication methods to make sure patients understand what is required

g. Ensure patients can carry out the exercises safely on their own

h. Analyse the performance of patients, providing positive reinforcement throughout

i. Correct exercise technique at appropriate points

j. Progress or regress exercises according to patients’ performance

k. Monitor and modify the intensity of exercise appropriate to patients and their conditions

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Portfolio reference

Assessor initials

Learner signature

Outcome 4

You can:

Be able to bring exercise referral sessions to an end


a. Allow sufficient time for the closing phase of the session

b. Explain the purpose and value of cool down activities to patients

c. Select cool down activities according to the type and intensity of physical exercise, patient needs and environment

d. Provide patients with feedback and positive reinforcement

e. Explain to patients how their progress links to their goals

f. Allow patients the opportunity to ask questions and discuss their performance

g. Inform patients about future opportunities for exercise and physical activity

h. Leave the environment in a condition suitable for future use



Portfolio reference

Assessor initials

Learner signature

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Outcome 5

You can:


Be able to review exercise referral sessions

a. Review the outcomes of working with patients including their feedback

b. Identify: • how well the sessions met patients’ goals • how effective and motivational the relationship was with patients • how well the instructing styles matched patients’ needs

c. Identify how to improve personal practice



Portfolio reference

Assessor initials

Learner signature

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Achieving knowledge outcomes

Developing knowledge

You will be guided by your tutor and assessor on the evidence that needs to be produced. Your knowledge and understanding will be assessed using the assessment methods listed below*:

• Projects• Observed work• Witness statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion

Where applicable your assessor will integrate knowledge outcomes into practical observations through professional discussion and/or oral questioning.

When a criterion has been orally questioned and achieved, your assessor will record this evidence in written form or by other appropriate means. There is no need for you to produce additional evidence as this criterion has already been achieved.

Some knowledge and understanding outcomes may require you to show that you know and understand how to do something. If you have practical evidence from your own work that meets knowledge criteria, then there is no requirement for you to be questioned again on the same topic.

*This is not an exhaustive list.

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Knowledge

Outcome 5

Be able to review exercise referral sessions

You can: Portfolio reference

d. Explain the value of reflective practice

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Outcome 6

Understand how to instruct exercise to exercise referral patients


a. Explain the importance of verbal and non-verbal communication when instructing patients

b. Describe how to adapt communication to meet patients’ needs

c. Evaluate different methods of maintaining patients’ motivation, especially when patients are finding exercises difficult

d. Explain the importance of correcting patient technique

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Outcome 7

Understand how to adapt exercise to meet the needs of exercise referral patients


a. Explain why it is important to monitor individual progress if more than one patient is involved in the session

b. Describe different methods of monitoring patients’ progress during exercise, including groups of patients

c. Explain when it may be necessary to adapt planned exercises to meet patients’ needs

d. Explain how to adapt exercise/exercise positions as appropriate to individual patients and the environment

e. Explain how to modify the intensity of exercise according to the needs and response of the patient

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Outcome 8

Understand how to review exercise referral sessions with patients


a. Explain why exercise referral instructors should give patients feedback on their performance during a session

b. Explain why patients should be given the opportunity to ask questions and discuss their performance

c. Explain how to give patients feedback on their performance in a way that is accurate but maintains patient motivation/commitment

d. Explain why patients need to see their progress against goals

e. Explain why patients need information about future exercise and physical activity, both supervised and unsupervised

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Unit content

This section provides guidance on the recommended knowledge and skills required to enable you to achieve each of the learning outcomes in this unit. Your tutor/assessor will ensure you have the opportunity to cover all of the unit content.

Outcome 1: Be able to prepare resources for the exercise referral sessions

Select range of exercises/physical activities: Personalised based on needs, as relevant to programme/preferences/availability/environment/past history experiences, condition-based limitations, variety of exercise equipment.

Obtain and prepare resources: Ensure environment safe to exercise, equipment in place, provision of water, medication available (patient’s responsibility to administer), session-based information, referral form, programme card, personal record card, exertion levels card.

Outcome 2: Be able to prepare patients for exercise referral sessions

Help patients feel at ease: Meet outside of environment, induction, tour of training environment, introduce to staff, health and safety procedures, gradual consultation, comfortable environment, offer alternatives.

Explain planned objectives: Session content, subsequent sessions, format, purpose, outcomes, use appropriate language.

Explain how objectives/physical activities support goals: Linking the exercise to the condition/goal, how objectives relate to improvement of health, how planned session(s) fit(s) needs of condition(s), justification for choice/timing, format/structure etc.

Explain physical and technical demands: Linking the exercises with intensity monitoring, expectations of effort.

Progression/regression: Change to meet goals, importance of monitoring, progress/decrease, record changes.

Assess state of readiness and motivation: Verbal questioning (e.g. exercise history, stages of change model, apply motivational interview techniques), physical signs (e.g. posture, coughing), appropriate clothing, referral documentation, levels of support required.

Negotiate and agree planned changes: Change in preferences, goal review.

Record changes: Programme card, activity planners, diary, evaluation (formative), inform relevant stakeholders if appropriate.

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Outcome 3: Be able to instruct and adapt planned exercises to exercise referral patients

Motivational styles: Empathy, instruction and technique based on personal preferences, enhance relationship, agreed approaches, appropriate to patients, consistent with accepted good practice.

Purpose and value of a warm-up: Physiological (synovial joints), blood flow, muscle preparation, energy systems, neuromuscular (practice), psychological readiness to exercise.

Provide warm-ups appropriate to patients, planned exercise and environment: Condition-based intensity and duration, adaptable to the environment (availability of equipment, space, etc.), temperature, time constraints (not all conditions).

Make best use of environment: Risk assessment, safety, comfort, ventilation, temperature, familiarity, sequenced, effective use of space.

Provide instructions, explanations and demonstrations that are technically correct, safe and effective: Instructions/explanations (clear, correct, stress key points, reinforce technique), information (name exercise, area of body worked, muscles utilised), demonstrations (technically correct, broken down), intensity levels and progression, reasons based on programme and condition.

Adapt verbal and non-verbal communication: Hearing-related issues, disability (mental), English as a second language (use of an interpreter), ensure instructor can be seen, adapt as appropriate to the patient.

Ensure patients can carry out exercises safely on own: Provide

feedback mechanisms, demonstrate ability effectively, monitoring, clear written guidance information.

Analyse performance of patients: Compare against goals and baseline, chart progress, feedback, physical and psychological measures.

Correct exercise technique at appropriate points: Poor posture, alignment, capacity, reinforce instruction and teaching points, sensitively.

Progress or regress exercises according to patients performance: Respond to visual and verbal feedback, consider the original condition, suitability of progression/regression of exercise.

Monitor and modify intensity of exercise: Speed, resistance, frequency, reduce rest time, change the order of the exercises.

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Outcome 4: Be able to bring exercise referral sessions to an end

Allow sufficient time for closing phase of session: Structure/timings of cool down (appropriate to patients/conditions), make time for feedback (from patient, instructor), best delivered in comfortable environment, social aspect (interaction with group).

Purpose and value of cool down activities: Prevent blood pooling, enhance flexibility, safe reduction in blood pressure and heart rate, lactate removal, psychological end point.

Select cool down activities: Condition-based intensity and duration, need for enhanced monitoring, adaptable to the environment (availability of equipment, space etc.), temperature, time constraints (not all conditions).

Provide feedback and positive reinforcement: Outline benefits, relate to condition, praise.

Explain to patients how progress links to their goals: Physiological and psychological changes associated with the planned session, social benefits, effects on condition.

Opportunity for patients to ask questions and discuss performance: Structure session to allow for interaction before or after, feedback from patients about session (formal, informal), feedback to patients about performance (e.g. encouragement, praise), allow alternative communication approaches (e.g. blog, email, text, face to face, written, adopt open door policy).

Inform patients about future opportunities: Directory of opportunities, exit strategies to maintain a relationship, opportunities to build on existing levels, tailored approach.

Leave environment suitable for future use: Clear away equipment, confidentiality maintained, check floor surface.

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Outcome 5: Be able to review exercise referral sessions

Review/sessions: Feedback from patients (face to face, after sessions, phone calls, emails, questionnaires, standard questions (based on initial questions), user satisfaction scales, evaluation of patient outcomes), other feedback (peer observation, appraisals, secret shopper, spot checks, focus groups).

Identify: How well the session met patients’ goals, how effective and motivational the relationship was with patients, how well the instructing styles matched patients’ needs, goal achievement.

Improve personal practice: Areas for improvement, reflection, continual professional development, education.

Value of reflective practice: Personal development, service improvement, self-awareness.

Outcome 6: Understand how to instruct exercise to exercise referral patients

Importance of verbal and non-verbal communication:

Verbal communication – tone of voice, emphasis of teaching points, reinforcement of technique, effective explanations (clear and concise), appropriate language and metaphor, avoid jargon, be more empathetic, show patience (especially if fitness levels are low), praise, feedback on performance, show interest (training, progress, patient).

Non-verbal communication – demonstrations, correct technique, observation skills, body language (open, positive, enthusiastic), issues around physical handling, cueing.

Importance – building relationships (trust, rapport), safety, clarity, ensure working within personal limits, address negativity, motivate, encourage, promote adherence, allay fears, solutions to barriers, reduce

pressure on patients, to empower patient (locus of control), ensure safe and effective training sessions.

Adapting communication: Hearing-related issues, disability (mental), English as a second language (use of an interpreter), demonstrate empathy, show sensitivity, response to body language, response to individual needs.

Evaluate methods to maintain motivation: Feedback, review, motivational interviewing, patience, appropriate language, empathy, allay fears.

Importance of correcting technique: Safety, prevention of injury, effectiveness, confidence.

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Outcome 7: Understand how to adapt exercise to meet the needs of exercise referral patients

Importance of monitoring individual progress if more than one patient involved in session: Tailored to needs based on varied health conditions, different stages of experience or condition (e.g. beginners), safety, enhances confidence, personal service, patient feels valued, motivational, enables progression.

Methods of monitoring progress: Verbal (talk test), physical signs (breathing, colour, sweating), rate of perceived exertion (RPE), rating scale (Borg, 0-5, cardiac-based), heart rate monitors, self-monitoring.

Reasons to adapt planned exercises: Returning from an absence (e.g. illness or injury), based on feedback from the monitoring systems (progression and regression).

Adapting exercises/modifying intensity: Ensure changes meet objectives of programme, exercise guidelines for patients’ medical condition(s), negotiate and agree changes with patient, meet individual needs, personalised approach.

How to adapt exercise/exercise positions: Alternatives based on changing environment, offer adaptations/modifications and alternatives/overload, progression, regression, seated alternatives, change (frequency, intensity, time, type of exercise (FITT)).

How to modify the intensity: Speed, resistance, lever length, frequency, reduce rest time, change the order of the exercises.

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Outcome 8: Understand how to review exercise referral sessions with patients

Reasons why instructors should give feedback to patients: Confidence, motivation, increase understanding, educating, outlining benefits to improve adherence.

Reasons why patients should have opportunity to ask questions/discuss performance: Increase understanding and learning, enables knowledge transfer, enhances relationship e.g. trust.

How to give patients feedback on performance: Established measures, providing a positive focus, outlining clear reasons for changes, personalising feedback on goals, with empathy and sensitivity.

Why patients need to see progress: Enhances motivation, personal responsibility, progress monitoring and feedback.

Information about future exercise and physical activity: Progression from the programme, self-responsibility, transition, maintenance of activities, lifestyle changes, enhances social changes, prevent an accumulation of patients on the programme.

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Documents

Instructing exercise with referred patients