1. There should be appropriate skill mix of professional staff, with specialist training in cardiology, exercise prescription and emergency procedures.

2. There should be a minimum of two trained staff present at all exercise sessions, with the ratio of staff to patients dependent on the risk stratification of the patients and the level of supervision required by individuals within the group. The current UK recommended ratio is 1:5, cited in British Association for Cardiac Rehabilitation Guidelines (1995), Scottish Intercollegiate Guidelines (SIGN, 2002) and national guidelines for the Association of Physiotherapists in Cardiac Rehabilitation (ACPICR, 2003).

3. All staff should have basic life support training, be able to access and use an automated defibrillator (AED) and to place an emergency crash call to either the hospital resuscitation team or to a 999 ambulance call, depending on exercise venue.

4. Exercise training for high-risk patients should be held in a hospital or venue with immediate access to full resuscitation services and a member of staff trained in advanced life support.

5. There should be a policy to ensure that all staff update resuscitation and AED training annually and hold regular practice drills for emergency procedures.

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