D513.1Design and Agree a Physical Activity Programme for Patients/Clients With

D513.1Design and Agree a Physical Activity Programme for Patients/Clients With

Unit D513 Design, agree and adapt a physical activity programme for adults with obesity and/or diabetes mellitus

Mapping Version

D513.1Design and agree a physical activity programme for patients/clients with

obesity and/or diabetes mellitus

What you must doMapped Against

  1. establish an effective working relationship with your patient/client and appropriate health care professionals

  1. collect, record and interpret information about your patient/client using safe, appropriate and recognised methods

  1. stratify and manage risk according to appropriate guidelines and protocols

  1. follow the correct procedures and protocols for liaising with health care professionals, including those for confidentiality

  1. establish and agree the patient/client’s readiness to participate

  1. plan and agree goals that are appropriate to your patient/clientand their current level of ability

  1. plan and prepare objectives, activities and delivery methods that are appropriate to your patient/client’sgoals and condition

  1. design and agree a programme adapted to your patient/clientusing relevant principles of training

What you must coverMapped Against

Information
1personal goals
2referral form
3informed consent to participate to transfer medical information
4medical history and medication
5current and previous physical activity history and preferences
6social and psychological considerations
methods
  1. reports

  1. interview

  1. questionnaire

  1. observation

  1. functional assessments

Element 2 D513.2Deliver, review and adapt a physical activity programme for

patients/clients with obesity and/or diabetes mellitus

What you must doMapped Against

  1. assess, monitor and manage risk to your patient/clientthroughout the programme

  1. manage medical complications and emergencies until appropriate medical help is available

  1. deliver planned activities to your patient/client, adapting activities according to their individual needs

  1. communicate and consult with your patient/clienton issues to do with their physical activity programme and progress

  1. provide appropriate attention to your patient/client with common co-morbidities

  1. support your patient/client in a way which will promote sustained change in physical activity levels

  1. enable your patient/client in self-management

  1. monitor your patient/client’sprogress against agreed goals and adapt the programme accordingly

  1. provide ongoing reports to communicate outcomes to the appropriate health care professional

What you must know and understandMapped Against

K1The nature of obesity as a disorder and the various causes of obesity including the individual’s genetic background, energy intake and energy expenditure.
K2The main causes of obesity.
K3The components of energy expenditure including resting metabolic rate (RMR), the thermic effect of food or dietary-induced thermogenesis (TEF or DIT) and the energy cost of movement or physical activity.
K4The comparative variability of the components of energy expenditure.
K5What is meant by “obesogenic” environments.
K6The incidence and prevalence of obesity.
K7Accepted definitions of overweight and obesity and their methods of measurement and assessment.
K8How to identify overweight and obese individuals from BMI.
K9The limitations of using BMI as a measure of obesity.
K10Other frequently used and simple methods for assessing excess body fat, for example – skinfolds and bioelectrical impedance.
K11The clinical complications that frequently accompany obesity, including:
-Cardiovascular disease
-Type 2 diabetes mellitus and metabolic syndrome
-Hypertension
-Sleep Apnoea
-Non-alcoholic fatty liver disease
-Gallstones
-Osteoarthritis
-Lower back pain
-Certain cancers (endometrial, breast, colon, prostate and gallbladder)
-Female reproductive complications and polycystic ovarian syndrome
K12Common predictors of associated clinical complications.
K13Why waist girth measurement is a useful addition to BMI for assessing obesity.
K14The suggested waist girth cut-off points that identify increased disease risk for men and women of different racial backgrounds, for example, Caucasians and Asians.
K15The physiological effects of insulin.
K16How insulin affects glucose uptake by skeletal muscle.
K17How GLUT 4 mediated glucose uptake is affected by skeletal muscle contraction, independently of insulin.
K18How the sensitivity of skeletal muscle, liver and adipose tissue to insulin can vary from individual to individual.
K19How obesity, especially visceral obesity, affects insulin sensitivity.
K20Accepted definitions of metabolic syndrome, including those provided by the main expert organisations.
K21The principal components of the metabolic syndrome including:
-Hypertension
-High triglycerides
-Low HDL-cholesterol
-Abdominal obesity (increased waist girth reflecting increased visceral fat)
-Insulin resistance, impaired glucose tolerance and/or impaired fasting glucose or type 2 diabetes mellitus
K22Trends in the incidence and prevalence of metabolic syndrome.
K23The impact of physical activity and/or physical fitness and/or weight loss on the risk of metabolic syndrome, a cardiovascular event in people with metabolic syndrome and each individual component of the syndrome.
K24How physical activity affects obesity, the components of metabolic syndrome and insulin sensitivity.
K25What is diabetes mellitus.
K26The two major forms of diabetes mellitus
K27The incidence and prevalence of type 1 diabetes and type 2 diabetes in the UK population.
K28Accepted definitions of type 1 and type 2 diabetes.
K29Accepted treatments for type 1 and type 2 diabetes, including different insulins, oral medication and lifestyle therapy.
K30Drugs currently licensed for the treatment of obesity in the UK
K31Pharmacological treatments of the individual components of metabolic syndrome i.e. hypertension, high triglycerides, low HDL-cholesterol, and obesity, may be treated pharmacologically with specific agents.
K32How to risk stratify the individual on the basis of their weight and metabolic status.
K33Appropriate dietary advice for patients with obesity and/or diabetes and/or metabolic syndrome and how to recognise when the individual requires more specialised dietary advice and intervention.
K34The physiological responses to exercise of patients with type 1 and type 2 diabetes.
K35Specific guidelines for avoiding certain complications of exercise in patients with diabetes – for example, wearing proper footwear, monitoring blood glucose to avoid hypoglycaemia and ensuring adequate hydration.
K36Potential adverse effects of exercise in patients with diabetes, including the following:
-Cardiovascular
-Cardiac dysfunction and arrhythmias due to ischaemic heart disease
-Excessive increments in blood pressure
-Post-exercise orthostatic hypotension
-Microvascular
-Retinal haemorrhage
-Increased proteinuria
-Acceleration of microvascular lesions
-Metabolic
-Worsening of hyperglycaemia and ketosis
-Hypoglycaemia in patients on insulin or oral hypoglycaemic agents
-Musculoskeletal and traumatic
-Foot ulcers (especially in the presence of neuropathy)
-Orthopaedic injury related to neuropathy
-Accelerated degenerative joint disease
-Eye injuries and retinal haemorrhage
K37Contraindications to exercise participation in patients with diabetes and/or metabolic syndrome and/or obesity.
K38The exercise prescription for patients with diabetes and/or obesity and/or metabolic syndrome.
K39National and local strategies for the treatment and prevention of obesity and diabetes, for example, NICE guidance, the NSF for diabetes and care pathways.
K40Awareness of national agencies, organisations and literature relating to obesity, metabolic syndrome and diabetes.
K41Relevant medico-legal requirements
K42How to interact appropriately with general practitioners, other health care professionals and personnel involved in the treatment and management of obesity and diabetes.
K43Ensure the patient/client’s information and consent, meeting recommended guidelines, is received prior to advising, prescribing or instructing exercise.
K44Understand the importance of an agreed link with a named specialist from the hospital and/or the community diabetes care team.
K45Barriers to communication with the referred patient/client and the communication skills needed to overcome these.
K46How to identify when the patient/client needs to consult another health care professional.
K47Ethical considerations involved in ongoing maintenance of exercise behaviour, including respecting inter-professional boundaries and patient/client confidentiality.
K48Methods of information collection and interpretation, appropriate storage of confidential records and management processes encountered in running ongoing maintenance of exercise behaviour.
K49Current relevant structures of the National Health Service, the names and functions of different relevant medical organisations and service providers.
K50Initial assessment including appropriate assessment of exercise level using recognised sub-maximal tests.
K51On going screening process prior to each exercise session.
K52How to set up and manage a safe physical activity environment relevant for a patient/client with obesity and/or metabolic syndrome and/or diabetes.
K53Both group and individual exercise programming principles for the patient/client with obesity and/or metabolic syndrome and/or diabetes.
K54How to manage the dietary and fluid intake needs in and around the exercise session.
K55How to determine and adapt appropriate progressive physical activity appropriate to the condition using results from the physical/exercise assessments, medical information, national guidelines, consultation and patient/client aims.
K56The motivational processes, models and techniques involved in behavioural change for the referred patient/client to encourage beneficial lifestyle changes and providing appropriate support to sustain such changes.
K57How to communicate and consult effectively with the referred patient/client about their programme and progress.
K58How to manage medical complications e.g. angina or hypoglycaemia until appropriate medical help is available.
K59The management, evaluation and reporting of information, in verbal and written formats.
K60How to use and adapt a system for monitoring and recording the patients/clients progress and updating their physical activity programme.

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