Exercise Leadership Characteristics

The exercise leader should have the skills to create a safe, positive, welcoming and non-intimidating rehabilitation environment, so that patients and their partners are encouraged to participate in and benefit from lifelong exercise and activity. It is a real challenge to lead an exercise class while dealing with the wide spectrum of clinical, psychological and behavioural reactions that each individual brings to the group.

The challenge for the CR team involves dealing with CR patients and their families who are experiencing, perhaps for the first time, vulnerability in their physical and psychological health. In addition, they may have misconceptions about the safety of exercise. Thus, all CR health professionals require excellent interpersonal and psychological skills in order to engage patients in exercise, developing their trust, confidence and participation. Health professionals in CR need to establish strong, empathic relationships with patients, dealing with many psychological and emotional responses, including fear, depression, aggression, a cavalier approach, over-dependence, denial, obsessive reaction and poor adherence to exercise and other health behaviours. Good interactive leadership, careful handling of group dynamics, in both small and large group settings, and effective class management can create a positive atmosphere of support and camaraderie resulting in a rewarding 'care of the group by the group' ethos. In addition, leading the whole group during the exercise session provides opportunities to promote general socialising, to introduce teaching points, for example, educating patients on key exercise principles, and to encourage group feedback to reinforce learning.

The exercise leader and team need to combine the art and science of exercise prescription and behavioural change to enhance exercise compliance and promote long-term adherence. The ACSM (2000 p. 245) acknowledge this: unfortunately exercise testing and exercise prescription are often overemphasised in relation to behavioural components of the programme. Effective behaviour change, which optimises secondary prevention, involves engaging people in a commitment to an active lifestyle and generalising the exercise habit beyond the rehabilitation session. Some strategies include integrating personal contracts and one-to-one motivational interviewing (see Chapter 8) into the exercise programme. Although there are many factors that contribute to exercise adherence, there is strong evidence that the qualities of the exercise leader can have an enormous influence on cardiac patient participation (Oldridge, 1988).

A CR exercise leader should be:

• professional, credible, confident and enthusiastic;

• a respected advocate and role model for CR;

• a skilled listener, communicator, facilitator and educator;

• a decision maker, with autocratic or democratic style, as required;

• a motivator with persuasive skills who sets realistic and achievable aims;

• tactful, organised, with a planned, systematic approach, directive as appropriate;

• an excellent manager of time, people and documentation;

• empathic and sincere, an optimist with a strong personality;

• in control of situation creates atmosphere and promotes fun

(Howley and Franks, 1997; Dalgleish and Dollery, 2001).

Many of the leadership characteristics demonstrated in management of the patient groups are also common and equally important to the professional responsibilities and relationship between the exercise leader and the rest of the CR team.

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