Cardiac rehabilitation (CR) is now established as part of cardiac care in the UK, and is embedded in many government policies and national guidelines, with structured exercise as a key element. Over the last ten years there has been a radical shift in the provision of exercise-based CR in the UK. Government recommendations and national guidelines encompass the traditional post myocardial infarction (MI) and revascularisation groups, but also the older patient and the more complex cardiac groups, including those with heart failure and angina. The diversity of CR patients puts new and demanding challenges on the exercise leader of CR.

In 20 years of research and development of CR programmes in the UK I have become aware that there is no definitive book that provides physiotherapists and exercise professionals with a comprehensive resource on the exercise components and skills of constructing and teaching CR exercise. The objective of this text is to address the scope of knowledge and skills required of exercise specialists developing, delivering and teaching exercise-based CR programmes. The book is structured on an evidence-based theoretical framework, but also provides practical advice and suggestions based on the clinical experience of the contributing authors, thus providing physiotherapists and exercise professionals with a comprehensive practical text that can be used to plan, develop and deliver exercise-based CR in all phase of CR.

The book starts with a chapter which overviews the historical and contemporary context of CR, including a brief overview of the potential benefits of exercise in the CR patients. This is followed by Chapter 2 on medical aspects and risk stratification for the exercise component for the different groups of CR patients. This leads to Chapter 3 which addresses exercise physiology and monitoring issues. Chapter 4 focuses on exercise prescription and class structures applicable to the spectrum of patients included in exercise-based CR. Chapter 5 deals with design of classes and use of music. Chapter 6 deals with the organisational and management role of the exercise specialist. This is followed by a key chapter addressing the skills of group exercise teaching, which are neglected in other publications on CR. The final chapter is dedicated to adult exercise behaviour and exercise consultation, required to help patients and families adopt and sustain exercise as part of their health behaviour.

Each section, where appropriate, is evidence-based and fully referenced. Furthermore, where appropriate, useful templates and material are provided so that readers can easily transfer the material into their programmes. The book is designed and constructed to be used and read as a whole, but each section and/or chapter can stand alone. Furthermore, there are chapters within the text that are applicable to and can be transferred to other exercise teaching contexts for example, pulmonary rehabilitation (PR).

The physiotherapist and exercise specialist are in a key position within CR to provide exercise, advice and support. This book will help them meet the challenges of the range of cardiac patients in their exercise classes and will help them 'make a difference' in meeting the challenges of exercise leadership in CR.

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