Encourage Exercise

Encourage Exercise

AScheme to
Encourage Exercise


Scope of the Scheme 2

Roles and Responsibilities3

Medico-legal considerations


Criteria for Referral4

Risk stratification

Absolute contra-indications for exercise

The Referral Process7

Scheme Evaluation9



Scope of the scheme

The Healthy Life scheme aims to help people living in Mansfield District gain access to a range of activities including gymand swim sessions to help them to maintain a healthier lifestyle.

The scheme involves a systematic individualised process and in order to provide a quality service this scheme will: -

Establish a formally agreed process for the selection, screening and referral of specific patients

Conduct appropriate assessment of patients prior to the programme

Provide a specific range of appropriate and agreed physical activities for a defined period of time, which maximize the likelihood of long term participation in physical activity

Ensure any assessments and the exercise programme are delivered by professionals with appropriate competencies and training which match the needs of the patient being referred

Incorporate a mechanism for the evaluation of the referral process

Facilitate long-term support for patients to maintain increases in physical activity

Ensure the patient is consulted and involved throughout the referral process and is encouraged to take responsibility for their health and physical activity participation

Ensure confidentiality of patient information through secure and appropriate storage of records

Roles and Responsibilities

Medico-legal considerations

When increased physical activity isrecommended by the health professional, the patient or client has responsibility for their own actions when and if they put the recommendations into practice.

The responsibility for safe and effective management, design and delivery of the exercise programme passes to the exercise and leisure professionals. However, clinical responsibility remains with the referrer.


The role of the health care professional is to make a recommendation for the patient or client to join the scheme however they retaining overall clinical responsibility for the individual.

The patient is responsible for providing the exercise professional with the relevant information regarding medication and their condition to enable the exercise professional to tailor a safe and effective exercise programme to the individual’s needs.

The exercise intervention programme is the responsibility of the exercise professional. They are responsible for pre-exercise assessment and any consequent reference back to the clinician.

Responsibility for consenting to take part in the exercise programme and observing the programme design and guidance rests with the participant.

Criteria for Referral

The scheme isintended for adults aged 18+

Research shows that the greatest health gain will be from increasing the activity levels of those who are least active or are sedentary. As such priority should be given to patients who can be classed as sedentary.

Definition:People who do less than 30 minutes in total of moderate intensity physical activity per week.

The schemes will include patients considered to have a low or medium risk stratification.

At the moment we cannot cater for those with a high risk.

There are no clear national guidelines on the issue of risk stratification. There are examples listed below based on the NQAF and the advice given by YMCA/ Gayton Group

Risk Stratification

Low:Adapted physical activity for people with minor, stable physical /mental limitations or two or less CHD risk factors

e.g.Pre-diabetes, Older people; Anti & post natal; People with disabilities; Overweight; Depression, mild anxiety etc. (NQAF)

Those with no medical condition; Overweight but no other apparent problem; Musculo-skeletal problems (Although complicated cases may not be high risk in terms of life threatening events, the risk of exacerbating the condition must be appraised.); Depression, stress, anxiety; Mild asthma (Gayton)

Medium:Adapted physical activity for people with significant physical limitation related to chronic disease or disability

e.g. Phase IV cardiac rehabilitation; Osteoporosis and falls prevention; Arthritis; Back care; Stroke; Parkinson’s; HIV; Depression/ anxiety (integrated); Mental health/ dementia care (integrated) etc. (NQAF)

Well controlled diabetes with no complications; Controlled mild/moderate hypertension; Moderate asthma or other respiratory condition; Obesity; Peripheral vascular disease with no other established vascular condition; Excessive shortness of breath on mild exertion (Gayton)

Not Currently Available within Mansfield District Leisure Trust

High: Highly adapted physical activity with multi disciplinary supervision for people with current severe disease or disability

e.g. Phase III cardiac rehab; Phase III osteoporosis; Falls; Claudication; Stroke; Mental health and dementia care; Palliative care etc. (NQAF)

Myocardial Infarction; CVA or TIA; IHD; Left or right sided heart failure; Any other heart problem/ disease; Chronic and severe respiratory condition; Poorly controlled diabetes with complications; Severe hypertension (Gayton)

Absolute Contra-indications for Exercise

Unstable angina

Resting systolic BP >180mmHg or resting diastolic BP >100mmHg

Ventricular or aortic aneurysm

A significant drop in BP during exercise

Uncontrolled tachycardia >100BPM at rest

Unstable or acute heart failure

Uncontrolled arrhythmia

Febrile illness (temporary)

Referral Process

1. Health Professional determines whether the patient meets the referral criteria

2. Health Professional recommends physical activity

  • Health professional explains the scheme andgives the patient a welcome leaflet. Health professional fills in enquiry form and returns it to the email provided (Paper versions can be used if necessary)

3. Mansfield District Leisure Trust contact the clientsto arrange the initial interview

  • Motivational Interviewing/ exercise counselling/ fitness & boditrax assessment. Client completes initial lifestyle evaluation form
  • Exercise professional helps client to choose appropriate exercise programme and prepare an activity plan

4. Client joins the Healthy Life scheme

  • 12 week programme including: -

Healthy lifestyle advice; Aquafit; Gym; Circuit classes;

  • Longer term goals and motivational strategies are agreed and client completes post-programme lifestyle evaluation form
  • Membership of the scheme includes 6 months reduced price membership for all sites including gym and access to swim and classes
5. Encouragement for long-term adherence
  • Exercise Professional recommends follow on programme/membership


The primary focus of the scheme is to increase physical activity levels. In order to measure this the client will be asked to complete an anonymous lifestyle questionnaire at their initial interview with the referral officer. This will be repeated post programme, at 12 weeks.


The perceptions of the different participants will be measured as follows: -

  • Patient/ client - On completion of the Healthy Life programme
  • Referring professionals – informal feedback