Learner Achievement Portfolio (LAP) Active IQ Level 3 Diploma in Exercise Referral (QCF)

www.activeiq.co.uk Learner Achievement Portfolio (LAP) Active IQ Level 3 Diploma in Exercise Referral (QCF) Qualification Accreditation Number 600/5105/X (QCF) Version AIQ003158

Contents Assessment plan and record of achievement...3 Assessment planning and record of achievement declaration...4 Record of achievement declaration...4 Unit 2 Professional practice for exercise referral instructors...5 Worksheet - Professional practice for exercise referral instructors...5 Unit 3 Understanding medical conditions for exercise referral...11 Worksheet - Understanding medical conditions for exercise referral...11 Unit 5 Planning exercise referral programmes with patients...22 Worksheet - Planning exercise referral programmes with patients...22 Unit 4 Applying the principles of nutrition to a physical activity programme...25 Unit 5 Planning exercise referral programmes with patients...25 Case study guidance...25 Informed consent to act as case study...28 Unit 5 Planning exercise referral programmes with patients...34 Physical activity readiness questionnaire (PAR-Q) and you...34 Session plan...39 Case study checklist...46 Unit 4 Applying the principles of nutrition to a physical activity programme...47 Unit 5 Planning exercise referral programmes with patients...47 Case study mark scheme...47 Unit 6 Instructing exercise with referred patients...49 Worksheet - Instructing exercise with referred patients...49 Formative observed session checklist...52 Assessor s feedback and questions...53 Session and self-evaluation...54 Active IQ wishes to emphasise that whilst every effort is made to ensure accuracy, the material contained within this document is subject to alteration or amendment in terms of overall policy, financial or other constraints. Reproduction of this publication is prohibited unless authorised by Active IQ Ltd. No part of this document should be published elsewhere or reproduced in any form without prior written permission. Copyright 2014 Active IQ Ltd. Not for resale

Active IQ Level 3 Diploma in Exercise Referral (QCF) Assessment plan and record of achievement Centre name: Assessment Plan Record of Achievement Mandatory units Stage of assessment Evidence Assessment method 1 Anatomy and physiology for exercise and health 2 Professional practice for exercise referral instructors Theory paper Externally set multiple choice question paper Worksheet Written Planned Assessment Date Pass/Refer/APA (if claiming APA detail evidence seen) Include % score for MCQ Exams Assessor s signature or initials and date 3 Understanding medical conditions for exercise referral Worksheet Written 4 Applying the principles of nutrition to a physical activity programme Theory paper Externally set multiple choice question paper 4 and 5 Applying the principles of nutrition to a physical activity programme Case study Written Planning exercise referral programmes with patients 5 Planning exercise referral programmes with patients Worksheet Written IV initials (if sampled) Copyright 2014 Active IQ Ltd. Not for resale 3

6 Instructing exercise with referred patients Worksheet Written Formative observed session Session selfevaluation Observation Written Assessment planning and record of achievement declaration Declaration Name Signature Date Learner s agreement I agree to be assessed according to the assessment plan and am happy that any additional support I require has been discussed and a separate plan put in place for this. I declare that all of the evidence (listed in the assessment plan) that will be produced for this portfolio will be my own unaided work. Assessor s agreement I have discussed the planned assessments with the learner and any additional support required has been planned and recorded separately. Record of achievement declaration Declaration Name Signature Date Assessor s 1 agreement Assesor 2 s agreement: (if applicable) Assessor 3 s agreement: (if applicable) Internal verifier s agreement: I declare that all learner evidence (listed in the assessment plan) has been assessed and meets the learning outcomes, assessment criteria and evidence requirements for the qualification. I declare that all learner evidence (listed in the assessment plan) has been assessed and meets the learning outcomes, assessment criteria and evidence requirements for the qualification. I declare that all learner evidence (listed in the assessment plan) has been assessed and meets the learning outcomes, assessment criteria and evidence requirements for the qualification. I declare that all learner evidence (initialled in the assessment plan) has been internally verified and meets the learning outcomes, assessment criteria and evidence requirements for the qualification. 4 Copyright 2014 Active IQ Ltd. Not for resale

Unit 2 Professional practice for exercise referral instructors Unit accreditation number: Y/503/7493 Worksheet - Professional practice for exercise referral instructors There are 49 marks available in this worksheet. You must score a minimum of 40 marks in total to achieve a pass. In addition to achieving the total pass mark, you must also score at least the minimum marks set for each question to achieve an overall pass 1. Please tick the appropriate column to select the industry sector to which the roles of exercise referral most apply The role of exercise referral To increase participation in physical activity and structured/supervised exercise, and develop the role of exercise professionals and the sector. Fitness industry Health sector To offer an intervention that can be used to assist with the prevention and management of health conditions and help to reduce the burden (current and future) of chronic health conditions on the NHS. 2 marks (minimum 1 mark) 2. Give examples of one benefit and one potential risk of exercise that would need to be weighed up before evaluating the general role of exercise in disease risk reduction and condition management. Benefit Risk 2 marks (minimum 1 mark) 3. Name one key health service document or government policy that has impacted on exercise referral and outline one key point from the document or policy that relates to exercise referral schemes. Policy or document Key point relating to exercise referral 2 marks (minimum 1 mark) Copyright 2014 Active IQ Ltd. Not for resale 5

4. Outline two key points from the Professional and Operational Standards that guide practice for exercise referral. 2 marks (minimum 1 mark) 5. Explain the roles (including scope of practice and boundaries) of the following professionals in an exercise referral scheme. Professional Role Scope of practice and boundaries GP Fitness/ Exercise professionals 4 marks (minimum 3 marks) 6. Describe how you would deal with a patient who has a medical condition outside the scope of practice of the exercise referral instructor. 1 mark (minimum 1 mark) 7. Explain how you would determine inappropriate referrals. 1 mark (minimum 1 mark) 6 Copyright 2014 Active IQ Ltd. Not for resale

8. Why is it important not to accept a patient who has been declined a referral for exercise from their medical practitioner or health professional and how you would deal with them? Reason for not accepting: Action to be taken: 2 marks (minimum 1 mark) 9. State one reason why effective inter-professional communication is important within exercise referral? 10. What is the role of Clinical Commissioning Groups? 1 mark (minimum 1 mark) 1 mark (minimum 1 mark) 11. Explain what happens at each of the following stages of the referral process including the role of any professionals involved and any information that needs to be transferred or gathered. Stage of referral process Patient visits GP What happens and professional roles Information that needs to be gathered or transferred Scheme receive referral information Copyright 2014 Active IQ Ltd. Not for resale 7

Initial consultation Programme and monitoring Exit route 10 marks (minimum 8 marks) 12. Outline one medico legal requirement relevant to the exercise referral instructor job role. 1 mark (minimum 1 mark) 13. Explain the concept of data protection and how to maintain patient confidentiality in exercise referral. 2 marks (minimum 1 mark) 14. Give an example of how verbal and non verbal communication including appearance and body language can influence patient perception. Verbal communication Non-verbal communication 2 marks (minimum 1 mark) 8 Copyright 2014 Active IQ Ltd. Not for resale

15. Describe how you would use the following consulting skills. Open questions: Active listening: 2 marks (minimum 1 mark) 16. Explain the term health behaviours. 1 mark (minimum 1 mark) 17. Explain internal and external locus of control. Internal External 2 marks (minimum 1 mark) 18. State why it is important to collect data and monitor and evaluate the success of exercise referral schemes and give an example of an indicator that could be used to monitor the patient and the scheme success. The importance of collecting data: The importance of monitoring and evaluation: An example of a data collection indicator to evidence patient success: Copyright 2014 Active IQ Ltd. Not for resale 9

An example of a data collection indicator to evidence the scheme success: 4 marks (minimum 3 marks) 19. Define the terms validity and reliability and explain how these can be applied to evaluate the quality and reliability of evidence. Validity: Reliability: Quality and reliability of evidence: 4 marks (minimum 3 marks) 20. State the purpose of risk stratification and name two risk stratification tools that have been used in exercise referral. Purpose: Tool 1: Tool 2: 3 marks (minimum 2 marks) Result total required to pass) / 49 marks (40 marks in total, with the minimum set marks achieved for each question Pass / Refer Assessor s feedback: 10 Copyright 2014 Active IQ Ltd. Not for resale

Unit 3 Understanding medical conditions for exercise referral Unit accreditation number: R/503/7492 Worksheet - Understanding medical conditions for exercise referral There are 195 marks available in this worksheet. You must score a minimum of 156 marks in total to achieve a pass. In addition to achieving the total pass mark, you must also score at least the minimum marks set for each question to achieve an overall pass. Glossary of terms used in this unit Pathophysiology - The disease s progression and the associated functional changes i.e. death of tissue. Clinical features - Both signs and symptoms Symptoms - How the disease manifests itself from the patients perspective 1. Please complete the table below. Condition Pathophysiology disease progression and changes Hypertension 4 marks per condition Two clinical signs and symptoms of the condition 2 marks per condition Two common causes 2 marks per condition Result 8 marks per condition (minimum 6 marks required per condition) Hypercholesterolaemia Copyright 2014 Active IQ Ltd. Not for resale 11

Condition Pathophysiology disease progression and changes 4 marks per condition Coronary obstructive pulmonary disease (COPD) Asthma Obesity Diabetes (type 1 and 2) Two clinical signs and symptoms of the condition 2 marks per condition Two common causes 2 marks per condition Result 8 marks per condition (minimum 6 marks required per condition) 12 Copyright 2014 Active IQ Ltd. Not for resale

Condition Pathophysiology disease progression and changes 4 marks per condition Osteoarthritis Rheumatoid arthritis Osteoporosis Depression Two clinical signs and symptoms of the condition 2 marks per condition Two common causes 2 marks per condition Result 8 marks per condition (minimum 6 marks required per condition) Copyright 2014 Active IQ Ltd. Not for resale 13

Condition Pathophysiology disease progression and changes 4 marks per condition Anxiety Simple mechanical back pain Two clinical signs and symptoms of the condition 2 marks per condition Two common causes 2 marks per condition Result 8 marks per condition (minimum 6 marks required per condition) 96 marks (minimum 6 marks per condition) 14 Copyright 2014 Active IQ Ltd. Not for resale

2. Please complete the table below. Condition One medication that may be prescribed and its desired effect 2 marks per condition Hypertension Hypercholesterolaemia Chronic obstructive pulmonary disease (COPD) One side effects of the medication OR effect on the exercise response 1 mark per condition One other intervention (surgical, therapeutic or lifestyle, nutrition) that may be prescribed or recommended and its purpose 2 marks per condition Result 5 marks per condition (minimum 4 marks required per condition) Copyright 2014 Active IQ Ltd. Not for resale 15

Condition One medication that may be prescribed and its desired effect 2 marks per condition Asthma Obesity Diabetes type 1 and 2 Osteoarthritis One side effects of the medication OR effect on the exercise response 1 mark per condition One other intervention (surgical, therapeutic or lifestyle, nutrition) that may be prescribed or recommended and its purpose 2 marks per condition Result 5 marks per condition (minimum 4 marks required per condition) 16 Copyright 2014 Active IQ Ltd. Not for resale

Condition One medication that may be prescribed and its desired effect 2 marks per condition Rheumatoid arthritis Osteoporosis Depression and/or anxiety Simple mechanical back pain One side effects of the medication OR effect on the exercise response 1 mark per condition One other intervention (surgical, therapeutic or lifestyle, nutrition) that may be prescribed or recommended and its purpose 2 marks per condition Result 5 marks per condition (minimum 4 marks required per condition) 55 marks (minimum 4 marks per condition) Copyright 2014 Active IQ Ltd. Not for resale 17

3. Please complete the table below. Condition Two exercise aims, guidelines or benefits 2 marks per condition Hypertension Hypercholesterolaemia Chronic obstructive pulmonary disease (COPD) Asthma Two exercise restrictions, considerations or risks 1 mark per condition Result 4 marks per condition (minimum 3 marks required per condition) 18 Copyright 2014 Active IQ Ltd. Not for resale

Condition Two exercise aims, guidelines or benefits 2 marks per condition Obesity Diabetes type 1 and 2 Osteoarthritis Rheumatoid arthritis Two exercise restrictions, considerations or risks 1 mark per condition Result 4 marks per condition (minimum 3 marks required per condition) Copyright 2014 Active IQ Ltd. Not for resale 19

Condition Two exercise aims, guidelines or benefits 2 marks per condition Osteoporosis Depression and anxiety Simple mechanical back pain Two exercise restrictions, considerations or risks 1 mark per condition Result 4 marks per condition (minimum 3 marks required per condition) 44 marks (minimum 3 marks per condition) 20 Copyright 2014 Active IQ Ltd. Not for resale

4. Name one credible source for gathering further information about prescribed medications. 5. State two considerations for exercise when working with co-morbidities. 1 mark (minimum 1 mark) 2 marks (minimum 1 mark) Result total required to pass) / 195 marks (156 marks in total, with the minimum set marks achieved for each question Pass / Refer Assessor s feedback: Copyright 2014 Active IQ Ltd. Not for resale 21

Unit 5 Planning exercise referral programmes with patients Unit accreditation number: D/503/7494 Worksheet - Planning exercise referral programmes with patients There are 14 marks available in this worksheet. You must score a minimum of 12 marks in total to achieve a pass. In addition to achieving the total pass mark, you must also score at least the minimum marks set for each question to achieve an overall pass. 1 Explain how you would work in environments that are not specifically designed for exercise / physical activity. 1 mark (minimum 1 mark) 2 Why is it important for patients to understand the health benefits of structured exercise referral programmes? 1 mark (minimum 1 mark) 3 Why is it important for an exercise referral instructor to work together with patients to agree goals, objectives, programmes and adaptations? 1 mark (minimum 1 mark) 4 Explain the importance of long-term behaviour change in developing patient s health and fitness. 5 How do you encourage patients to commit themselves to long-term change? 1 mark (minimum 1 mark) 1 mark (minimum 1 mark) 22 Copyright 2014 Active IQ Ltd. Not for resale

6 What is informed consent and why should this be obtained before collecting information from a patient? Informed consent is: Purpose: 7 How would you select the most appropriate method of collecting patient information? 2 marks (minimum 1 mark) 1 mark (minimum 1 mark) 8 How would you interpret the information collected from the patient in order to identify their needs and goals (short, medium and long term)? 1 mark (minimum 1 mark) 9 Explain how you would use specific, measurable, achievable, realistic and time bound (SMART) objectives in an exercise referral programme. 10 When might you involve others, apart from the patient in goal setting? 1 mark (minimum 1 mark) 11 State one legal and ethical implication of collecting patient information. 1 mark (minimum 1 mark) 1 mark (minimum 1 mark) Copyright 2014 Active IQ Ltd. Not for resale 23

12 Why is it important to keep accurate records of changes including the reasons for change? 1 mark (minimum 1 mark) 13 When might it be appropriate to share any changes made to exercise referral programmes with other professionals? 1 mark (minimum 1 mark) Result total required to pass) / 14 marks (12 marks in total, with the minimum set marks achieved for each question Pass / Refer Assessor s feedback: 24 Copyright 2014 Active IQ Ltd. Not for resale

Unit 4 Applying the principles of nutrition to a physical activity programme Unit accreditation number: L/600/9054 Unit 5 Planning exercise referral programmes with patients Unit accreditation number: D/503/7494 Case study guidance You must either: Identify a suitable exercise referral patient who can act as your case study for six weeks. This will enable you to design, agree, deliver and adapt your programme as necessary. Or your centre will provide you with: Details of a theoretical exercise referral patient which has been approved by Active IQ to enable you to design, agree, deliver and adapt your programme as necessary. When using a real exercise referral patient you should ensure you have the patient s permission to use their personal information in the completion of your case study by asking them to read and sign the informed consent form provided. This should be submitted with your assignment as evidence. The chosen patient must have a minimum of TWO conditions from the following list that have been covered in the qualification. The conditions can come from one sub section but is down to the discretion of the assessor. Cardiovascular Disease Hypertension and Hypercholesterolaemia Metabolic/Immunological Obesity and Diabetes Type 1 and Type 2 Musculoskeletal Osteoarthritis, Rheumatoid Arthritis, Simple Mechanical Back Pain, Osteoporosis and Joint Replacement Respiratory Asthma and Chronic Obstructive Pulmonary Disease (COPD) Psychological/Mental Health Depression, Anxiety and Stress The case study must be no more than 2500 words - a word count and copy of the checklist should be included on the front of the case study. Case studies should ideally be word processed (if this is not possible, written submissions can be made with prior agreement with your assessor). Arial in size 12 font should be used for word processed assignments. Page numbers should be used. Copyright 2014 Active IQ Ltd. Not for resale 25

There are three parts to your case study: Patient details and information Screening Programme Objectives 1. Patient details and information: You should collect and record ALL of the following information about your patient, using the headings/ forms provided in the LAP (Learner Achievement Portfolio). You should carry out an informal interview with your patient to obtain the following required information: Personal details Medical history Current lifestyle Physical activity history Personal, physical and nutritional goals of the patient 2. Screening: You should provide the following: A copy of the referral form. If a referral form is not available (e.g. if you are not in a role which allows this), then you should provide an explanation of why no form was available) A description and/or copy of any pre-exercise screening questionnaires or standard procedures employed A description of any fitness tests / functional assessments employed Condition specific exercise guidelines: You should complete the pro forma documentation in your LAP as appropriate to your patient and the exercise programme 3. Programme objectives: You need to complete the pro forma documentation in the LAP taking into account the principles of training, what the agreed objectives of your 6 week programme are and your patient s medical conditions. You will need to complete the following: Programme objectives Programme session plan Session plan notes Modification summary Summary / feedback letter Programme session plan: You should complete one session/ class plan in your area of expertise, for example: Circuit class Gym-based session ETM class/aqua class for your patient Pilates Yoga 26 Copyright 2014 Active IQ Ltd. Not for resale

This session plan should include information regarding: Duration of warm-up and cool-down (they do not need to include a detailed description of these components since this is assumed to be prior knowledge) A range of safe and effective exercises/ physical activities to develop (as appropriate to your patient) Cardiovascular fitness Muscular fitness Flexibility Motor skills Core stability Structure and timing of components (as appropriate) Intensity this should include how you plan to monitor your patient You can use the session plan provided within the L.A.P. or you can design your own as long as all criteria are covered. Session plan notes should include: Adaptations made to session design / individual exercises (group sessions should be designed to enable an inclusive, integrated session that can cater for all individuals) How you intend to set up and manage a safe physical activity environment for your patient A brief explanation as to why you have included certain exercises/equipment and not included others in the session The procedures to be followed in the event of an emergency given your patient s medical conditions Physical activities that could be included as part of the patient s lifestyle to complement the exercise session Modification summary: At the end of week four you should complete the modification summary summarising any feedback from your patient and how they are progressing towards their goals. You should identify at least one aspect of the programme that you need to modify and describe the modifications you intend to make. Summary /feedback letter: You need to provide a summary/feedback letter that could be provided to the Healthcare Professional who referred the patient describing your patient s progress on the exercise referral scheme. Copyright 2014 Active IQ Ltd. Not for resale 27

Unit 5 Planning exercise referral programmes with patients Unit accreditation number: D/503/7494 Unit 4 Applying the principles of nutrition to a physical activity programme Unit accreditation number: L/600/9054 Informed consent to act as case study Exercise professionals who complete the Active IQ Level 3 Diploma in Exercise Referral (QCF) are required to undertake a work-based case study with a patient who has participated in their sessions or for whom they have developed an exercise programme. Individuals who co operate in case studies are asked to give their permission that the information provided to the instructor may be included in the case study. If you agree to become a subject for a case study, your name will not be used on the work submitted by the student. Maintaining high standards of exercise instruction for people who begin a new programme of exercise or who are referred onto a local exercise referral scheme to improve their health, is extremely important. For this reason it will be greatly appreciated if you agree to act as a subject for this case study. Patient consent: I (name of patient) agree to my details being included in a written case study for the purposes of this Exercise Instructor Training Course. Signature of Patient: Date: Signature of Learner/Instructor: Date: 28 Copyright 2014 Active IQ Ltd. Not for resale

1. Collecting information You should collect and record ALL the following information about your patient, using the headings/ form provided. You should carry out an informal interview with your patient to obtain the required information. Patient information Personal patient details Age Sex Family status/ children/ dependants Occupation Hobbies Medical history Established conditions (reasons for referral if applicable) and comorbidities Medication currently being taken Known side effects and implications for exercise BMI and implications Physical activity history / Current activity level Previous participation / experiences Copyright 2014 Active IQ Ltd. Not for resale 29

Activity preferences Current activity level including: Frequency, Intensity, Time/ duration, and Type of exercise (e.g. FITT principle) Patient s perception of fitness or results of fitness tests if known Briefly describe your current eating patterns: What are your personal nutritional goals/ aspirations? 30 Copyright 2014 Active IQ Ltd. Not for resale

Do you have any particular personal circumstances which you feel may affect your nutritional status? (if so, please specify) Goals of the patient What does your patient hope to achieve (personal, physical and nutritional goals) from this 4-6 week programme and in the medium to long term (e.g. in 6 months)? (Please ensure your goals are SMART) Short: Medium: Long: Copyright 2014 Active IQ Ltd. Not for resale 31

Summarise the healthy eating advice you will give to your patient. Identify specific advice you will give your client about their nutrition and hydration needs when participating in physical activity What stage of readiness to change is your patient really at? (Preparation, Action etc.). What did you take into account when reaching this decision? How can you support your patient throughout the programme (i.e. what strategies are appropriate to prevent non attendance or drop out)? What if any social or psychological barriers or other considerations are there that you might need to take into account? Who or where can you go to get further literature related to your patient s medical condition? 32 Copyright 2014 Active IQ Ltd. Not for resale

2. Screening You should include the following: A copy of the exercise referral form from the referring healthcare professional (e.g. G.P., Practice Nurse). If a referral form is not available (e.g. if you are not in a role which allows this) then you should provide an explanation of why no form was available in the space below) A description and/or copy of any pre -exercise screening questionnaires or standard procedures employed. A description of any fitness tests / functional assessments employed. Copyright 2014 Active IQ Ltd. Not for resale 33

Unit 5 Planning exercise referral programmes with patients Unit accreditation number: D/503/7494 Physical activity readiness questionnaire (PAR-Q) and you (a questionnaire for people aged 15-69) Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO. 1. has your doctor ever said that you have a heart condition and that you should only do YES NO physical activity recommended by a doctor? 2. do you feel pain in your chest when you do physical activity? YES NO 3. in the past month, have you had chest pain when you were not doing physical activity? YES NO 4. do you lose your balance because of dizziness or do you ever lose consciousness? YES NO 5. do you have a bone or joint problem (for example, back, knee or hip) that could be made YES NO worse by a change in your physical activity? 6. is your doctor currently prescribing drugs (for example, water pills) for your blood YES NO pressure or heart conditions? 7. do you know of any other reason why you should not do physical activity? YES NO If you answered YES to one or more questions: Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. You may be able to do any activity you want as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice find out which community programmes are safe and helpful for you. If you answered NO to all questions: If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can: Start becoming much more physically active begin slowly and build up gradually. This is the safest and easiest way to go. Take part in a fitness appraisal this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active 34 Copyright 2014 Active IQ Ltd. Not for resale

DELAY BECOMING MUCH MORE ACTIVE: If you are not feeling well because of a temporary illness such as a cold or a fever wait until you feel better; or if you are or may be pregnant talk to your doctor before you start becoming more active PLEASE NOTE: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan. NO CHANGES PERMITTED. YOU ARE ENCOURAGED TO PHOTOCOPY THE PAR-Q BUT ONLY IF YOU USE THE ENTIRE FORM. NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity programme or a fitness appraisal, this section may be used for legal or administrative purposes. I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction. Name Signature Date Signature of parent or guardian (for participants under the age of majority) Witness Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the seven questions. Copyright 2014 Active IQ Ltd. Not for resale 35

Condition specific exercise guidelines and further considerations for the patient. Condition specific exercise recommendations Exercise recommendations Frequency Intensity Time Type of activity Further considerations (e.g. safety issues, exercise programming issues given the patient s medical conditions). 36 Copyright 2014 Active IQ Ltd. Not for resale

Contraindicated exercises (e.g. inappropriate activity given the patient s medical conditions). Which training system/s would be suitable for your patient and how can this/these be used to provide variety and ensure the programme remains effective? When the patient should be referred back to a healthcare professional (if appropriate). Copyright 2014 Active IQ Ltd. Not for resale 37

3. Programme objectives Taking into account the principles of training, what are the agreed objectives of your 6 week programme given your patient s medical conditions? Remember to set SMART objectives as these make programme reviews easier. 38 Copyright 2014 Active IQ Ltd. Not for resale

Session plan Warm-up (relevant CV exercise, flexibility, mobilisation) Exercise / Activity Instructions (frequency, intensity, timings etc.) Alternatives / modifications for individual exercises and equipment selection Copyright 2014 Active IQ Ltd. Not for resale 39

Main session Exercise / Activity Instructions (frequency, intensity, timings etc.) Alternatives / modifications for individual exercises and equipment selection 40 Copyright 2014 Active IQ Ltd. Not for resale

Cool-down (relevant CV exercise, flexibility) Exercise / Activity Instructions (frequency, intensity, timings etc.) Alternatives / modifications for individual exercises and equipment selection Copyright 2014 Active IQ Ltd. Not for resale 41

Session plan notes Notes: (you should include any adaptations you have or need to make to either the programme design or to individual exercises). How do you intend to set up and manage a safe physical activity environment for your patient? A brief explanation as to why you have included certain exercises/equipment and not included others in the session. 42 Copyright 2014 Active IQ Ltd. Not for resale

The procedures to be followed in the event of an emergency given your patient s medical conditions. Physical activities that could be included as part of the patient s lifestyle to complement the exercise session. Copyright 2014 Active IQ Ltd. Not for resale 43

Modification summary Please complete at the end of week four. Has your patient managed to adhere to the programme? YES / NO If No, state why: What feedback have you received from your patient in relation to the programme? How is your patient progressing towards the agreed physical and nutritional goals? 44 Copyright 2014 Active IQ Ltd. Not for resale

Are there any aspects of the programme that you need to modify or revise? What modifications do you intend to make? Complete a summary/feedback letter that could be provided to the Healthcare Professional who referred the patient describing their patient s progress on the exercise referral scheme. Copyright 2014 Active IQ Ltd. Not for resale 45

Case study checklist Section Criteria assessed Included Page Patient details and Personal details information Medical history Current lifestyle Physical activity history Goals of the patient Screening Referral form or explanation Screening forms Screening information Condition specific exercise guidelines Programme objectives Programme objectives Programme session plan Session plan notes Programme review and modification summary 46 Copyright 2014 Active IQ Ltd. Not for resale

Unit 4 Applying the principles of nutrition to a physical activity programme Unit accreditation number: L/600/9054 Unit 5 Planning exercise referral programmes with patients Unit accreditation number: D/503/7494 Case study mark scheme There are 74 marks available in this case study. The learner must score a minimum of 62 marks in total to achieve a pass. In addition to achieving the total pass mark, the learner must also score at least the minimum marks set for each section to achieve an overall pass. Patient s details and information - Did the learner: Possible marks Actual marks 1. Provide the patient s personal details? 1 (minimum 1 mark) 2. Establish the patient s conditions and co morbidities? 2 (minimum 1 mark) 3. Identify any medications being taken by the patient? 1 (minimum 1 mark) 4. Identify any known side effects and their implications 2 (minimum 1 mark) for exercise? 5. Identify the patient s BMI and its implications for 2 (minimum 1 mark) exercise? 6. Identify the patient s physical activity history? 1 (minimum 1 mark) 7. Identify the patient s preferences to exercise? 1 (minimum 1 mark) 8. Establish the patient s activity levels? 1 (minimum 1 mark) 9. Establish the patient s perception of fitness? 1 (minimum 1 mark) 10. Identify the patient s personal, physical and nutritional 6 (minimum 4 marks) SMART goals for the 4 6 week programme? 11. Establish the patient s current eating patterns? 1 (minimum 1 mark) 12. Give appropriate healthy eating advice? 2 (minimum 1 mark) 13. Give specific advice on the nutrition and hydration needs 1 (minimum 1 mark) when the client is participating in physical activity? 14. Identify the patient s stage of readiness to change? 2 (minimum 1 mark) 15. Identify strategies to support the patient through the 2 (minimum 1 mark) 4 6 week programme? 16. Identify any social or psychological barriers that may 2 (minimum 1 mark) affect their patient? 17. Identify appropriate sources of literature on their patient s condition/s? 1 (minimum 1 mark) Section total 29 (minimum 24 marks) Screening - Did the learner: Possible marks Actual marks 18. Include a copy of the exercise referral form or provide 1 (minimum 1 mark) an explanation of why no form was available? 19. Provide a description of any pre-exercise screening 1 (minimum 1 mark) questionnaires or standard procedures employed? 20. Provide a completed PAR- Q screening form? 1 (minimum 1 mark) 21. Provide a description of any fitness tests or functional assessments employed? 2 (minimum 1 mark) Copyright 2014 Active IQ Ltd. Not for resale 47

22. Complete the condition specific exercise recommendations as appropriate to their patient and programme? 10 (minimum 8 marks) 23. Identify any further considerations (safety issues etc.)? 2 (minimum 1 mark) 24. Identify any contraindicated exercises? 2 (minimum 1 mark) 25. Identify when the patient should be referred back to the health care professional? Section total 1 (minimum 1 mark) 20 (minimum 16 marks) Programme objectives - Did the learner: Possible marks Actual marks 26. Set SMART programme objectives appropriate to their patient? 27. Include one detailed session plan appropriate to their patient and area of expertise? 28. Include relevant health and safety information on the session plan? 5 (minimum 4 marks) 1 (minimum 1 mark) 1 (minimum 1 mark) 29. Provide a suitable warm up? 1 (minimum 1 mark) 30. Select appropriate exercises for their patient s condition? 1 (minimum 1 mark) 31. Detail appropriate timings and sequences of exercise? 1 (minimum 1 mark) 32. Provide an appropriate cool down? 1 (minimum 1 mark) 33. Provide appropriate stretches? 1 (minimum 1 mark) 34. Identify appropriate adaptations to the programme design and or individual exercises? 35. Identify how they will manage the exercise environment for their patient? 36. Give a summary of the programme explaining why certain exercises and equipment have been included? 37. Detail the procedures to follow in the event of an emergency based on their patient s condition? 38. Include physical activities that could be included as part of the patient s lifestyle to complement the exercise session? 39. Provide an evaluation and modification report at the 4 week point? 40. Complete a summary/feedback letter that could be provided to the Healthcare Professional who referred the patient describing their patient s progress on the exercise referral scheme? Section total 1 (minimum 1 mark) 1 (minimum 1 mark) 1 (minimum 1 mark) 1 (minimum 1 mark) 1 (minimum 1 mark) 4 (minimum 3 marks) 4 (minimum 3 marks) 25 (minimum 22 marks) Results total required to pass) / 74 marks (62 marks in total, with the minimum set marks achieved for each question Pass / Refer Assessor s feedback: 48 Copyright 2014 Active IQ Ltd. Not for resale

Unit 6 Instructing exercise with referred patients Unit accreditation number: L/503/7491 Worksheet - Instructing exercise with referred patients There are 17 marks available in this worksheet. You must score a minimum of 14 marks in total to achieve a pass. In addition to achieving the total pass mark, you must also score at least the minimum marks set for each question to achieve an overall pass. 1 Explain the importance of communication and give an example of how you would adapt verbal and non-verbal communication to meet patients needs. The importance of communication: How would you adapt verbal and non-verbal communication to meet needs? 2 marks (minimum 1 mark) 2 Evaluate two different methods of maintaining patients motivation, especially when patients are finding exercises difficult. Method Strengths Weaknesses 3 Why is it important to correct patient technique? 6 marks (minimum 4 marks) 1 mark (minimum 1 mark) Copyright 2014 Active IQ Ltd. Not for resale 49

4 Explain why it is important to monitor individual progress if more than one patient is involved in the session. 1 mark (minimum 1 mark) 5 Describe two different methods of monitoring patient progress during exercise, including groups of patients. 2 marks (minimum 1 mark) 6 Give one example of when it may be necessary to adapt planned exercises to meet patients needs. 1 mark (minimum 1 mark) 7 Explain why exercise referral instructors should give patients feedback on their performance during a session. 1 mark (minimum 1 mark) 8 Explain why patients should be given the opportunity to ask questions and discuss their performance. 9 Explain why patients need to see their progress against goals. 1 mark (minimum 1 mark) 1 mark (minimum 1 mark) 50 Copyright 2014 Active IQ Ltd. Not for resale

10 Explain why patients need information about future exercise and physical activity, both supervised and unsupervised. 1 mark (minimum 1 mark) Result total required to pass) / 17 marks (14 marks in total, with the minimum set marks achieved for each question Pass / Refer Assessor s feedback: Copyright 2014 Active IQ Ltd. Not for resale 51

Unit 6 Instructing exercise with referred patients Unit accreditation number: L/503/7491 Formative observed session checklist Key: Competent mark a tick (P) Not competent mark a cross (x) Competent with a comment mark a bullet point ( ) Question mark a Q Date: Starting the session (A) the learner has: P/X 1. Prepared the environment and checked equipment for the session 2. Welcomed the patient appropriately 3. Explained all necessary health and safety information 4. Carried out verbal screening and PAR-Q giving appropriate advice to the patient based on prior information 5. Outlined the purpose and structure of the session, explaining to the patient how objectives and exercises/ physical activities support their goals and are appropriate to their condition Delivering the exercise session ( B ) the learner has: Warm-up P/X Main section P/X 1. Demonstrated correct technique and safe use of equipment and exercises Cooldown P/X 2. Explained the physical and technical demands of the planned exercises and components 3. Given clear and accurate explanations to the patient 4. Selected safe and effective exercises appropriate to patient s objectives and condition 5. Used supportive and motivational behaviour with the patient 6. Communicated with patients clearly and accurately in a non-judgemental manner 7. Used verbal and non-verbal communication methods to ensure the patient understands what is required 8. Adapted the exercise appropriately for the patient when necessary 9. Given appropriate alternatives to the patient when necessary 10. Monitored and modified intensity appropriately for the component and patient 11. Used/ reinforced key instruction points to improve patient s performance and encourage independence 12. Used appropriate teaching position to enable observation/correction of patient 13. Made best use of the environment 14. Gained feedback from the patient to check understanding of their performance 15. Managed the timings of the session effectively 16. Explained to patients how their progress links to their goals 17. Left the environment in a condition suitable for future use Result: Delete as appropriate Competent Not competent 52 Copyright 2014 Active IQ Ltd. Not for resale

Unit 6 Instructing exercise with referred patients Unit accreditation number L/503/7491 Session and self-evaluation Review the outcomes of working with patients and any feedback gained from the patient How well did the exercises meet your patient s needs? How effective and motivational was the relationship with your patient? How well did your instructing style match the patient s needs? How would you adapt the exercises to progress or regress according to your patient needs? Identify how you could improve your personal practice 54 Copyright 2014 Active IQ Ltd. Not for resale

www.activeiq.co.uk Westminster House, The Anderson Centre, Ermine Business Park, Huntingdon, PE29 6XY T: 01480 467950 F: 01480 456283 E: info@activeiq.co.uk Copyright 2014 Active IQ Ltd. Not for resale