Phase IV exercise leaders

The BACR (2002) has also, in recent years, established an accredited qualification for community instructors providing exercise to cardiac rehabilitation phase III graduates.This has allowed CR professionals to consider more safely referral for patients who, in the past, would not have had the phase IV option and who would benefit from supervision at that level. There remains a debate as to whether there should be specialist classes for cardiac patients or whether they should be integrated into mainstream exercise classes. Phase III cardiac classes are likely to be male-dominated whereas mainstream community classes are more likely to be female-dominated. Risk stratification should play the pivotal role in the type of class and supervision the exercise professional recommends to each patient, while taking into account their exercise preferences in order to encourage long-term adherence to exercise.

However, even with a trained phase IV exercise leader the patients with complex cardiac histories, complex co-morbidity or high-risk features may require ongoing clinical supervision at a level that is unlikely to be achieved in a community phase IV environment. There is a clear and vital role for the highly skilled exercise professional providing phase III to provide suitable long-term maintenance options for those patients least suited to exercise in the community (Thow, et al., 2003).

Risk Stratification and Health Screening for Exercise

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