Article by Sally Hinton BACPR Education Director & Tim Grove M.Sc

According to latest BHF statistics cardiovascular disease (CVD) is the main cause of death in England. In 2010, there were over 147,000 deaths from CVD, nearly a third of all deaths. The main component of CVD is coronary heart disease (CHD), which causes more deaths in England than any other single disease. In 2010, around 38,000 men and 27,000 women died from CHD.

What is CHD?

CHD is an umbrella term for several cardiac pathologies, including myocardial infarction (MI), coronary artery disease (CAD), heart valve disease and heart failure. The underlying cause of CHD is normally a result of atheroma (fatty plaque), which builds up in one or more of the coronary arteries resulting in poor blood flow to the myocardium. The build up of atheroma is normally caused by several risk factors such as inactivity, smoking, diabetes, high blood pressure, high cholesterol, family history and advancing age.

Over the past 30 years the mortality rate in CHD patients has fallen due to the advances in medical and surgical interventions. However, there are a large number of people living in the UK with CHD, which causes significant disability.

Can exercise help manage CHD? 

Exercise-therapy forms an integral component of the management of patients with CHD. CHD patients are encouraged to take part in cardiac rehabilitation (CR), which aims to reduce disability, reduce CHD risk factors and empower healthy lifestyle changes through physical activity, diet, medication, education and counselling. This is normally achieved through the four phases of CR (phase I inpatient, phase II discharge home, phase III hospital-based supervised exercise programme and phase IV long-term community-based exercise programme).

The benefits of exercise-based CR have been well documented in two recent meta-analyses, which demonstrated that exercise reduces the risk of total mortality, cardiac mortality and the recurrence rate of CHD by 27%, 31% and 38% respectively. The mechanisms associated with exercise and the reduction in cardiac mortality is not fully understood, although research has identified four key benefits that exercise has on reducing CHD;

  • Modifies CHD risk factors
  • Halts and regresses the build-up of atheroma in the coronary arteries
  • Prevents thrombus (clot) formation
  • Enhances vasodilatation of the coronary arteries, which promotes better coronary blood flow to the myocardium

What is the provision of Cardiac Rehabilitation?

The National Audit of Cardiac Rehabilitation Project (NACR), believe that there are around 335 programmes throughout England, Wales and Northern Ireland. The number of CR programmes has grown enormously over the past decade; however, only 44% of eligible patients are offered CR. These figures tend to reflect those who attend a hospital-based programme (Phase III) and it is estimated that around 50% will drop out before the end of the programme and only 30% will continue exercising at one year (Phase IV). Therefore, the exercise professional plays a key role in maintaining long-term exercise habits.

The usual paths of care following a hospital-based CR programme are community based exercise sessions. These community sessions are known as Phase IV and they are normally led by an exercise professional who has undergone specialist training provided by the British Association for Cardiovascular Prevention and Rehabilitation (BACPR).

What is the role of the exercise professional in cardiac rehabilitation?

The role of the exercise professional is crucial in the long-term management of patients with CHD. Exercise professionals form part of a multi-disciplinary team, which includes:

  • Doctors
  • Cardiac Nurses
  • Practice Nurses
  • Physiotherapists
  • Dietitians
  • Psychologists
  • Occupational Therapists
  • Pharmacists
  • Counsellors

The role of the exercise professional within this team is vital in delivering an effective phase IV service, which involves liaising with the primary care team (Practice Nurse) regarding the patient’s risk factor management and maintaining communication with the Phase III CR team. During Phase IV the exercise professional is responsible for delivering regular supervised exercise classes, designing and monitoring home exercise programmes and encouraging healthy lifestyle behaviours.

What qualifications does the exercise professional need?

To prescribe exercise programmes to clients with CHD the exercise professional should hold a level 4 qualification in exercise and cardiac disease e.g. the BACPR exercise instructor qualification. To gain access to the BACPR exercise instructor course you must hold a level 3 qualification in Exercise and Fitness including an exercise referral qualification and have gained at least 150 hours of teaching adults land-based exercise within the last 2 years. For more information visit www.bacpr.com  01252 854510

Final words

Working as an exercise professional in Phase IV CR is an interesting and exciting area to work in. It provides opportunities to be part of a multi-disciplinary team, which enhances networking with health professionals. Furthermore, it is also a very rewarding role as it promotes the health and longevity of patients who suffer from CHD.

Tim Grove M.Sc. Exercise Specialist in Cardiovascular Prevention and Rehabilitation. MyAction, Imperial College London Healthcare NHS Trust.

 

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