Cardiac Rehab UK Issue 13 January 2009

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1 Cardiac Rehab UK Issue 13 January 2009 Update on the Campaign for Cardiac Rehabilitation 15 September saw the launch of the new National Audit of Cardiac Rehabilitation, and with it a flurry of activity for the national campaign. There are still over 57% of heart patients in the UK who do not receive cardiac rehabilitation. Despite the hard work of frontline cardiac rehabilitation staff, the audit of the programmes that sent in data also failed to find a single programme that was meeting minimum staffing levels. The results of the audit gave us further evidence to back our campaign calls and meant we were able to get some great media coverage for our campaign in September. Our spokespeople, including heart patients, spent many hours speaking to national and local newspapers and radio. Thanks to all the programmes and groups that passed on our call for case studies to heart patients. We received hundreds of stories. Campaign actions: We ve had great success in the past with our online actions, and have some very loyal campaigners, so we have updated our campaign website. Campaigners can take more action for cardiac rehabilitation nationally and in their area. These actions are regularly updated, please look at the We need your feedback! Mike Smith and specialist cardiac exercise nurse. website to get involved further at or tell your patients about the campaign. Heart Support Groups: Heart Support Groups have been a fantastic support to the campaign, and this year we are really looking to build on this. For the first time Heart Support Groups can sign up to be campaigning groups. We ll provide them with a variety of campaigning resources for cardiac rehabilitation. Please encourage any Heart Support Groups you are linked with, to The Cardiac Rehab newsletter is currently being evaluated to ensure we are providing the most important and relevant information to our readers. Please do take the time to fill in the enclosed questionnaire and return to us by 2 February One lucky respondent will win a place at the BACR Annual Conference Many thanks for your continued interest and participation.wishing you all a very happy new year. Anu Mukherjee Editor sign up to be a campaigning group at Resources: We have produced a cardiac rehab poster based on our Patient Entitlement Card to put up in wards and GP surgeries for heart patients to see. If you d like to order copies of the poster please visit the resources section of our website at or If anyone has any further ideas for campaigning resources, or any ideas for the campaign in general, we would love to hear them. Please Across the UK: We are continuing our lobbying work and hopefully this year we will see a tariff for cardiac rehabilitation and the start of more consistent funding for cardiac rehabilitation in England. In October the Campaign s Wales Working Group commissioned three patient focus groups to explore patient and carers views of cardiac rehabilitation services in their locality. This will also help the cardiac clinical networks with their patient and public engagement obligations for the NPHS baseline review currently happening in Wales. Jayne Murray has recently been appointed as the BHF Public Affairs and Communications Manager for Northern Ireland. This continues the good work seen in other areas and moves the campaign forward in Northen Ireland. Inside this issue BACR Annual Conference 2008 Fit for All festival The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

2 Cardiac Rehab UK January 2009 Scottish Campaign for Cardiac Rehabilitation Update The Scottish campaign featured BHF Scotland working closely with Chest Heart and Stroke Scotland (CHSS) and a coalition of health professionals to come up with a bespoke campaign that had the most impact in Scotland. National Media Launch The campaign national media launch in March 2008 was very successful with coverage on the BBC website and a live interview on STV, as well as articles in many national newspapers. Parliamentary Reception The evening reception was held in the Garden Lobby at the Parliament, and along with campaign supporters from across Scotland, we welcomed nearly 30 MSPs who joined us to learn more about the great benefits of cardiac rehab and the experiences of their constituents. The reception was opened by our sponsor Roseanna Cunningham MSP and she was followed by the keynote speaker Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing who delivered an excellent speech and expressed strong support for the campaign. Guests at the reception also witnessed the launch of the campaign vodcast, celebrating cardiac rehab and featuring the Stirling Healthy Hearts Club: Local Press Releases Our local press releases following the Parliament Event were a resounding success, with over 30 local papers covering the campaign; from John O Groats to Dumfries and Ayr to East Lothian. Thank you to all our supporters involved in generating this great press coverage and do let us know if you missed your moment in the limelight (we have copies)! UK Campaign Petition- Scotland You offered your support to the UK Cardiac Rehabilitation Campaign Petition in your thousands, with our current count sitting at 5,475. Signatures have come in from across Scotland and as well as demonstrating Scottish support for cardiac rehabilitation, our total will be added to those collected in England and Wales where the BHF has also been leading campaigns. CHD and Stroke Strategy In a major achievement, the consultation on the new CHD and Stroke Strategy for Scotland featured a section extolling the virtues of the campaign. BHF and CHSS are working with MSPs and the Government to ensure these commitments are delivered. Next steps... CHSS and BHF are working together with Roseanna Cunningham MSP on a proposed CHD & Stroke Cross-Party Group [CPG] at the Parliament. This will be an opportunity to provide a discussion forum on the prevention, care and treatment of heart disease and stroke between Members of the Scottish Parliament, people living with these conditions, charities working in the field, and health professionals. Cardiac rehabilitation is likely to be a theme for the Group in Please send any feedback or contact us for advice on getting involved in the campaign: / or / Nicola Sturgeon MSP with the CEOs of British Heart Foundation & Chest, Heart & Stroke Scotland. National Campaign 2009 will certainly be an exciting year for the National Campaign for Cardiac Rehabilitation and we hope to see some great progress. We need to keep the pressure on commissioners and politicians to ensure that Cardiac Rehab becomes high on their priority list. Katie Rowsell, Ben McKendrick, BHF Scotland Louise Peardon, Chest, Heart & Stroke Scotland 2 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

3 Cardiac Rehab UK Introducing the new President of Heart Care Partnership (UK) Heart Care Partnership (UK) was founded in 2003 to provide patient and carer input into the mechanism of the British Cardiovascular Society. The charity represents the needs of patients and carers and embraces under-represented groups, particularly ethnic minorities and women. C H UK P Heart Care Partnership (UK) HCP (UK) is keen to hear from organisations and individuals who would like to join their membership to work together to improve the treatment of heart disease and, where possible, its prevention. The charity encompasses: national and international cardiac charities; cardiovascular and associated disease charities; regional and local cardiac support groups; cardiac and cardiovascular networks; umbrella groups; patient experts; patient representatives and patients. In recent years Heart Care Partnership (UK) has been able to introduce patient and carer influence into The Society for Cardiothoracic Surgery in Great Britain and Ireland and in line with its parent organisation has been exploring links with stroke groups. Ken Timmins (l), David Geldard and Jane Flint (founder of HCP UK). David H Geldard, the retiring President, is a Founding Trustee of the partnership and has served on a number of national committees during his five years in office as President as well as being a leading light and patient advocate in the Greater Manchester and Cheshire area. He is also a keen President of the Trans Pennine Cycling Club, and over the years David and the cycling club have provided much needed support to the British Heart Foundation by way of sponsorship. David underwent a six way coronary artery bypass graft in 1995 and has a continuing desire to put something back into the system. Although he passes on the baton he remains a very active member of Heart Care Partnership (UK). Ken Timmis MBE JP LCIE, the incoming President, is a church treasurer, a Boys Brigade District Treasurer and Honorary Battalion President. He is Chairman of the Wolverhampton Coronary Aftercare Support Group, which recently gained the Queen s Award for Voluntary Service 2008, the highest accolade available to a group of its kind and equivalent to an MBE. The group, under Ken s leadership, was instrumental in the planning and building of the Heart and Lung Centre at Wolverhampton and is now its sole charity, active in supporting its patients and carers. Ken is patient representative on the Wolverhampton Cardiovascular Disease Local Implementation Team and also on the Black Country Cardiovascular Network Board. He is now finding his feet in the national arena and is keen to point out that he represents both patients and their carers. Ken was a banker for 35 years until he suffered a heart attack in 1990 and, like David, was determined to repay the debt he owed to the doctors and nurses who saved his life. He received his MBE from the Queen in the year 2000 in recognition of his services to the Coronary Care Unit at New Cross Hospital, Wolverhampton, where he was a cardiac patient. Ken Timmins incoming President of Heart Care Partnership. Trustee Board - Through its Board of Trustees, Heart Care Partnership (UK) has direct links with Arrhythmia Alliance (A-A), Grown Up Congenital Heart Patients Association (GUCH), Little Hearts Matter (LHM), Sudden Arrhythmic Death Syndrome (SADS UK), the MINAP Board, Cardiac Rehabilitation Campaign, Cardio and Vascular Coalition (CVC), Women s Heart Health Campaign, Sustrans Action on Active Travel, as well as a number of Cardiac and Cardiovascular Networks and some local hospitals and support groups. For more information on joining HCP (UK) membership please contact: Lulu Ho Tel: Individuals, as well as groups, are welcome to join. The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 3

4 Cardiac Rehab UK January 2009 Developing good partnership working From L to R: Sarah Deacon (Senior Sister CR), Elaine Roles, Michele Lawrence (Senior Sister CR), Sue Wilkins (Revascularisation Sister). In 2001, I completed the BACR Phase IV Instructor course, little realising where this would take me. At the time there was no Phase IV for Dartford, Gravesham & Swanley (DGS) PCT. I started offering Phase IV sessions at a gym in Swanley, membership increased rapidly and two circuit classes were added. I had built relationships working with the cardiac rehabilitation team at Darent Valley Hospital and continued to visit Phase III on a monthly basis, talking to patients about Phase IV and the benefits of exercise. Seven years on, I still attend. As the relationship with the hospital team grew, I was asked to help design their Phase III circuits and write patient information sheets. In February 2003 another instructor started two Phase IV classes in Longfield, which quickly expanded to four. In 2005 former Dartford, Gravesend and Swanley PCT were successfully awarded a Big Lottery Grant. There were two main objectives, to expand Phase IV provision and offer a home based programme in groups who had traditionally been low users of the service. These included:- Women Ethnic minorities People on low income Disabled Elderly I joined the project in 2005 and within a year became the Phase IV Facilitator working with DGS PCT which had now become West Kent PCT. The PCT considered it paramount, for patient safety, to devise a protocol for Phase IV cardiac rehabilitation providers. The basis of the protocol was formulated from the BACR hand book, alongside West Kent PCT and Dartford and Gravesham NHS trust. It includes safety protocols, paperwork, record keeping, induction procedures and data protection. Following on from the protocol, West Kent PCT and Dartford and Gravesham NHS Trust initiated a fast track program as part of a menu based service. Low risk patients are fast tracked [once risk stratified] from Phase II to Phase IV and offered comprehensive education sessions which Phase IV instructors are encouraged to participate in. September 2007 saw the start of the Asian Cardiac Rehabilitation class. This class was thought to be an integral part of the project. As part of my role, I was very involved which was both rewarding and challenging. In October 2007 I was offered a contract working for West Kent PCT as both their Phase IV Facilitator and Home Based Coordinator, running the BHF Road to Recovery Programme. In November 2007 the Phase IV network gathered together 75 heart patients for a sponsored circuit class to raise money for a portable echo for Darent Valley Hospital. This event was attended by the CR team and cardiologists, and raised a staggering 10,000. A patient satisfaction questionnaire was sent to 200 members in We had an 80% response. 96% felt better and more confident. 73% over the age of % exercising for over a year. 49% exercising for over two years. The Phase IV provision in 2004 was six classes and one leisure centre. West Kent PCT now has 14 classes and four leisure centre providers offering seven day access. Elaine Roles Road to Recovery Facilitator & Phase IV Network Coordinator for West Kent PCT For more information on BACR training please see pages 10 and The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

5 Cardiac Rehab UK BACR Annual Conference 2008 Hosted in the beautiful city of York, the BACR conference provided the opportunity to meet up with old friends, make new ones, share experiences and learn about cardiac rehabilitation issues. Patrick Doherty, BACR President, opened the conference and informed the audience of a busy year working with various organisations to help cardiac rehabilitation gain a higher profile and recognition of its contribution to cardiac patient care. This work was described in more detail by talks on NACR, BHF Campaign, BACR standards and NICE guidelines. It was very useful to be provided with examples of how to translate standards into practice. The practical theme continued in presentations on psychological aspects of care using a CBT self help approach, and psychological interventions in cancer, which provided the opportunity to learn from other clinical fields. The first ever sponsored lunchtime symposium on optimising discharge care was well attended. There was a definite dynamic feel to the session as the importance of communication along the patient s journey was emphasised. The day ended with a light-hearted debate on PCI versus rehabilitation, which was lively, informative, controversial and most importantly caused a lot of laughter. The poster display was excellent, presenting a wide range of relevant aspects of care. There was time for delegates to quickly go shopping, sightseeing or to the bar before the evening dinner commenced. The food, wine, and most importantly company were much enjoyed. Those attending the dinner have to be among the quickest to cover a dance floor and beyond! Anyone feeling tired on the second day at 9 am was soon energised by Betty McBride s presentation on the Cardio & Vascular Coalition, which described how 36 organisations (including BACR) are working together to advise the government on the future direction of cardio and vascular care services. The rest of the day continued with stimulating presentations on health beliefs, mood, exercise and the elderly population. Four high quality abstracts were presented, providing clear take home messages. Finally the conference was brought to close with a session on laughology, providing food for thought on the cardiovascular benefits of laughing. The conference achieved its aims of providing the opportunity to bring professionals together to learn from one another about the many aspects of cardiac rehabilitation. It provided the arena to share and acknowledge the achievements of the BACR, and demonstrated that the BACR is there for and on behalf of its members to continue raising the profile of cardiac rehabilitation to improve patient care. Looking forward to Linda Edmunds, Cardiff & Vale NHS Trust, Photos bytrudi List Optimising discharge care in acute coronary syndromes: lunchtime symposium At the BACR annual conference this year a first ever sponsored lunchtime symposium entitled optimising discharge care in acute coronary syndromes was held. It was a popular meeting attended by over 100 delegates. Aims of this session were to raise awareness of deficiencies which currently exist in discharge care systems and processes across the UK and to launch the Optimising Discharge Care pack. The pack is designed primarily to help cardiac rehabilitation teams to develop a plan to improve discharge care in their area, ultimately improving patient care. It is clear that quality of discharge care is an emotive topic and judging by the lively discussion generated following the meeting, a subject area that many feel passionate about. If you would like to receive a copy of the Optimising Discharge Care Pack or would like someone to contact you to provide further guidance on how to develop a plan for your area, please Bernie Downey at The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 5

6 Cardiac Rehab UK BHF Publications UPDATE Atrial Fibrillation This is the latest addition to the BHF heart information series. Atrial fibrillation is the most common type of abnormal heartbeat.this booklet is for people with atrial fibrillation, and their families and friends. It explains what atrial fibrillation is, how it is diagnosed and the medicines and treatments you may be given to help treat atrial fibrillation. Stock Code HIS 24 Endocarditis warning card Infective endocarditis is a rare condition where the inner lining of the heart becomes infected. The card explains the symptoms associated with endocarditis and how to reduce the risk of contracting it. Stock Code M26 How to order Call the BHF Orderline on , or visit where you can order or download the publications. Heart Matters Heart Matters is a free service designed for anyone who has, or is at risk of developing a heart condition, and for anyone who cares for someone with a heart problem. Members receive personalised information, and can get specialist support from cardiac nurses or heart health advisers, either by phone or .they also get regular issues of Heart health magazine, which includes updates on treatment and research and looks at issues related to heart join Heart Matters, either register at our website or call (a local rate number). News News News News News News Professor Patrick Doherty. Cardiac Rehabilitation acute tariff update What is the new acute CR tariff? The new CR acute tariff is part of the Healthcare Resource Groups (HRGs) referred to as HRG4. The acute CR tariff is for patients with heart disease whilst in hospital only and clarifies the reference costs for the services which can be used by local commissioners to develop a case for funding. It is based on bed days which creates a challenge for commissioners and service providers as it does not cover outpatient attendance, but on the plus side it is unbundled (not tagged to the procedure) and will follow the patients within the hospital. The acute CR tariff will commence from April 2009 and in order to generate this separate unbundled HRG you will need to record the CR elements using the available code which is triggered by discrete CR interventions where the care is delivered on a specific ward where rehabilitation (CR) is known to occur. We will continue to work with the Information Centre and PbR team to clarify the best pathway for developing or adapting new CR HRG codes for all aspects of service across all three phases. There are a number of options: 1. Adapt the general rehabilitation HRG for Acute CR to include the other phases. 2. Try to achieve recognition in the cardiovascular HRG Option for an unbundled tariff which would include inpatient and outpatient care. 3. Define treatment codes by using existing funding information flows within each Trust and PCT and use the common components to inform the tariff. Ongoing work that has come about since the release of the HRG 4 indicates that we need to ensure that the coding guidance used by the Commissioning for Health team has the best possible fit with existing CR delivered.this is fairly urgent and will be taken forward over the next few months. The next large scale aspect of the plan includes writing to directors of finance for each Trust to obtain CR funding information. We plan to follow this up with a coordinated effort from the cardiac networks and Trust boards to facilitate accurate and rapid reporting of CR funding. We will keep you all up to speed with regular updates. Professor Patrick Doherty National Clinical Lead, NHS Improvement Heart, President BACR Fit for All festival Sunday 12 October 2008 Glasgow Caledonian University Over 250 enthusiastic exercisers arrived at the Fit for All exercise festival ready to participate in the launch of Vitality, a new programme of exercise classes designed for people living with long-term medical conditions. Vitality has been developed by NHS staff and professional fitness instructors in partnership with Culture and Sport Glasgow and NHS Greater Glasgow and Clyde. The festival was opened with a Welcome speech delivered by BBC presenter Rhona McLeod who then participated in the main event.the main event was a mass participation class of exercisers involving people already participating in the city s condition specific classes. NHS staff, physiotherapists and leisure professionals with a specific interest in the Vitality programme also joined in. Coloured t-shirts were used to illustrate the ratio of different medical conditions being catered for within condition specific and Culture and Sport Glasgow classes at the moment. Red cardiac conditions, currently exercising within the cardiac rehabilitation classes. 6 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

7 News News News White referrals from osteoporosis currently exercising in Ozone classes. Light Blue breathing difficulties currently attending the Puffers classes. Yellow referrals from Home Falls Prevention Team, recently introduced into the Community Falls Prevention classes. Purple neurological related illnesses, which currently have had no pathway into community based group exercise classes. The main focus of the event was to demonstrate that all exercises during a warm up, core session or cool down can be adapted to suit ability and functional capacities at all levels even if the exercises are performed seated where necessary.this is the main focus of the Vitality programme. After the main Vitality session, all participants joined in a Tai Chi demonstration within the main hall followed by sandwiches and a cup of tea! From analysis of the evaluation forms completed and returned during the refreshments, 90% of participants were aged over 60 and only one participant was aged below 40 years.this is representative of the current age of participants of the condition specific classes. The number of participants wishing to attend next year was 98.5% The Vitality classes will now start to be rolled out across Culture and Sport venues within Glasgow.Where possible, all the present condition specific classes will be integrated into the Vitality class formats. For more details regarding the Fit for All Festival and Vitality please contact Deborah Wylie on or Dr Morag Thow Fit for all Cardiac Rehab UK Update from the NACR team Since our last report in this newsletter we have 230 programmes linked live and sending data to the NACR. The second NACR report has been published and received extensive media coverage. Since May last year, Georgia has been contacting NACR users to find out more about their views of the project. Issues raised included: the data-entering process, access to data, training, design of the database and the response of the York/CCAD teams to enquiries. A major concern for many users was the time required to enter the data (an issue also related to the lack of clerical support). Another was getting information back from their own data. Other problems were the perceived ambiguity of some definitions, the practicalities of questionnaires and cardiac rehabilitation phases. Some of these concerns were historical in nature and have already been fixed. A lack of response from the team in York has, we hope, been overcome, since the recruitment of a larger team.the settingup of electronic data sharing and/or referrals are both fully operational functions now for Lotus users and soon to be for web users. The NACR project team has taken on board all your suggestions and is working towards improving the service including: Access to data / data analysis Our statistician,veronica, has had an enthusiastic response to the first batch of quarterly reports she is now sending to every programme should be receiving these but let us know if you are not or would like additional copies.veronica is also happy to provide additional reports on other aspects of your data, BUT do please give her a couple of weeks warning if you want a special report. Following criticism about a perceived focus on Phase III, our annual paper survey will now incorporate questions on all phases of rehab in an effort to better capture and report rehab activity across all phases. Finally, an MS Access database has been developed and sent out to programmes to assist with access to data. Training/support issues Training sessions take place monthly in York and can be arranged at other sites across the country for a minimum of 15 people. We are also offering telephone training. Please contact Nerina ( ) on all training issues. There is a dedicated helpline and call tracking software installed for enquiries to York.The response time of technical support by the Helpdesk team at CCAD has also been greatly improved. Other issues Finally, a number of user suggestions regarding issues such as the archiving of past data, the elaboration of the list of initiating events, the updating of the medication list, count of patients, and the more efficient production of patient management documents (GP letters, discharge reports etc.) are currently under discussion with members of the project s Steering Group. This year s feedback survey started off as an experiment and, as such, was rather casual in its structure. Due to the positive response on behalf of the users, as well as the insight it provided the NACR team, there are now plans for the feedback survey to become an annual event. Our thanks to all those that participated this year. For further information on NACR please visit Corinna Petre, NACR Project Manager C R National Audit The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 7

8 Cardiac Rehab UK January 2009 BACR Travel Award winner 2007 Last summer I was appointed Cardiac Rehabilitation Co-ordinator for Mid Devon. Before taking up my position, I decided to visit some centres of excellence in cardiac rehab to inspire and guide my practice.thanks to a generous travel grant awarded by the BACR I was able to do this. I discovered that rehab services around the UK are organized very differently. My final decision to go to Dumfries and Galloway was based on the fact that I had read a lot about their work and that their population was similar to that of Mid Devon. I was also keen to visit the Wirral Heart Support Centre, not only to make comparisons between two very different populations, but also because this is where my nursing career started and I feel so proud to have even this most tenuous link to such a dynamic, innovative cardiac rehab service. And so it was on a crisp autumnal morning in October 2007 that I drove up the M5 in the direction of Dumfries and Galloway. Following a calamitous start which included arriving in Scotland on the back of a recovery vehicle, and serious case of debit card lossage, I finally met with Karen McMeeken and the Dumfries and Galloway rehab team (D&G team). The team cover all four phases. Karen explained that in Scotland, leisure centre facilities are very limited, unlike England where even quite small towns have access to sports centres. Consequently Phase III and IV programmes are held in community hospitals albeit Phase IV is mainly run as a self-help group with minimal input from the nursing staff. Our day started in the Coronary Care Unit to see any new referrals, and then moved out into the community to do a Phase II home visit.the person we saw had recently been discharged from hospital following bypass surgery. We spent an hour with them, allowing time for their story to be told, questions answered, a comprehensive assessment of risk factors and promotion of a Phase III programme. In a rural area a good Phase II experience is imperative for the patient, as in reality it is often impossible for them to attend a Phase III programme due to poor public transport or financial limitations. In an ideal world a home based programme could be offered to these people but many rehab services don t have the resources to support this provision. During my few days with the D&G team we did four home visits. Each person felt appreciative of the support offered at a stage in their recovery when they perceived they most needed it. Likewise, it appeared that the value of a Phase II home visit was mutually beneficial, as each of the four people we saw accepted a place on a Phase III programme. As rehab practitioners it seems that our effectiveness is mainly measured by what we achieve in Phase III. It is a shame that more recognition isn t given to the valuable health promotion work that happens in Phase II. The other area of Dumfries and Galloway s work which interested me was the introduction of Patient Held Cardiac Records. I learnt that this was a multidisciplinary record and was used by the whole cardiology team including the patient.this is something I hope we will be able to introduce in Devon. After leaving Dumfries and Galloway, I travelled south to the Wirral Heart Support Centre (WHSC) in the North-West of England. The two areas could not have been more different. Whilst D&G team covered a vast sparsely populated area, WHSC served a population over three times greater but a fraction of the geographical size. I was completely blown away by the facilities available at the centre. They included a large fully equipped gym, incorporating equipment suitable for people with exercise limitations, a room specifically for exercise testing, another for circuit training and a separate space for relaxation. In addition to this, a suite of offices and catering facilities for staff make this a very special place to work. However, it is the people who make a good rehab service and the team at WHSC are truly dedicated to cardiac rehab. Serving a larger population means that staff numbers are great enough to have more variety of skill-mix and disciplines available to the service. Consequently WHSC are able to offer cardiac rehab to a wider group of people as a prophylactic measure rather than just secondary prevention. Most of their time and energy is channelled into the Phase III programme as the service is so well known by its population that it needs little in the way of explanation or promotion. This is largely due to the support of an excellent team of volunteers who not only raise funds to provide equipment but also act as a support group. They are instrumental in the efficient running of the Phase IV programmes which are held in community fire station gyms. Using this local resource in an area with quite high levels of deprivation makes Phase IV more accessible to many people. Visiting two contrasting services has taught me that there is more than one recipe for cardiac rehab. It appears that the success of a service lies in its ability to adapt to the needs of its population.this may account for the many innovative projects around the UK ranging from Tai Chi to bowling. I take my hat off to all the teams who have used their creativity to enhance their service as I now know how difficult it can be just to provide a basic facility. Jane Walford, Cardiac Rehabilitation Nurse Specialist The Culm Valley Integrated Centre for Health If you would like to apply for a travel award please contact Lulu Ho, The award is up to 1,000 for up to two awards. 8 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

9 Cardiac Rehab UK Looking at cardiac rehabilitation in South Africa (with emphasis on the Western Cape) Leslene Titus (biokineticist and manager) Cornelia Saxby (client) Desiree Maartens (Biokineticist) Cardiac rehabilitation team at the Sports Science Institute of South Africa (SSISA) in Cape Town. At first glance, cardiac rehabilitation (CR) is invisible in South Africa (SA). The first comment received about CR in SA was from Dr Conrad Greer (PhD) a Cape Town biokineticist, who said Unfortunately in SA the medical aids (private health insurers) are not very pro-active, in first of all preventing heart attacks, as they are under the illusion that it costs too much, but they are prepared to pay for all the costs once the patient is my mind, they all are quite happy to function on the curative side and are not interested as much in the preventative side. Also, to a large extent here in SA, once the patient is through the surgery and discharged, the rehabilitation is not as optimal as it can be. Once again, medical aids are not willing to pay and, quite frankly, rehabilitation is seen as a luxury and not a necessity. So most patients are obliged to pay for it themselves, and not all can afford it. CR has been around since Dr Christiaan Barnard s pioneering heart transplant, but has recently been eclipsed by the AIDS/HIV pandemic. Government funding for CR exists in some military hospitals but is rare elsewhere. With further inquiry, well developed programmes emerged from under the banner of rehabilitation for chronic diseases of lifestyle.three CR programmes and a local cardiac support group exercise session were visited in the Western Cape.Two are associated with university sport science/biokinetics/sports medicine clinics the Biokinetics Centre at Stellenbosch University and the Sports Science Institute of South Africa at the University of Cape Town. The third programme, located at the Panorama Medical Centre, attached to a Medi- Clinic private hospital Heart Unit, is small but effective. Its name suggests the stunning view that the CR participants have of Table Mountain while they are exercising. Financial situations taint all programmes, although George Harris, Panorama Medi-Clinic Hospital Manager is confident that by marketing CR as part of the healthcare package instead of an add-on-extra, a larger population could benefit. Ella, SSISA gym, the running track circles the pool on the first biokineticist and level with the exercise equipment in back. manager of the Panorama CR, uses a holistic approach, including not only exercise but health promotion. She involves the cardiologist/ specialist, physiotherapist, biokineticist and dietician, as well as the psychologist.the Healing Hearts Support Group gathers once a month for follow-up sessions and the Helderberg Heart Beats meet every Thursday evening for support and exercise. The exercise programme at the Sports Science Institute is a prime example of the high quality that exists in this field of health care. It is medically supervised and begins with EliteCare 12 weeks of individualized, carefully monitored exercise and therapeutic education. Preceding the OptiHealth phase, the client is reassessed and invited to the second 12 weeks, during which physical fitness and further risk reduction are emphasised. A third option, called FastTrack, is a 6-week programme for clients who have previously been physically active or part of the programme. An outreach and development programme called CHIPs extends this programme into the community by introducing healthy lifestyle opportunities. Programme names like Healthnutz, OptiFit Outreach, Live It Up and Fit For Work skilfully describe the fun, noncompetitive activities planned for clients of all ages, together with their families. The Stellenbosch CR programme is a work in progress. It intends to follow the Cape Town model, but aims to provide more comprehensive community programmes, reaching all cultural groups. CR in South Africa is currently overshadowed by other health priorities, but has great potential and is expected to blossom in the near to medium future. Trudi List, Rehabilitation gym at Stellenbosch. The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 9

10 January 2009 Training opportunities BACR Phase IV Exercise Instructor Training Specialist training for exercise professionals who want to prescribe and deliver exercise programmes as part of the overall long-term management of individuals with heart disease.this is an assessed course and therefore has a strict qualification and experience entry criteria. Recognised by the Register of Exercise Professionals (REPs). Cost: 595 (includes assessment). Duration 5 days. A Practical Approach to Physical Activity and Exercise in the Management of Cardiovascular Disease This two-day course was previously titled An introduction to exercise for health professionals working with cardiac patients. It aims to explore the principles of exercise and physical activity in cardiovascular disease prevention and rehabilitation and how to apply these principles to design and delivery, using an evidence-based approach. It has a practical emphasis and aims to assist health professionals with useful tips and suggestions regarding physical activity and exercise advice, exercise prescription, planning and delivery that can be implemented in future service developments. For any health professional delivering/advising cardiac patients in primary/secondary health care setting Cost: 280 ( 250 to BACR members). Duration 2 days. Exercise Prescription: New Insights and the Management of the Complex Patient This course aims to encourage all professionals delivering the exercise component of cardiac rehabilitation to explore current practice and guidelines. Clinical reasoning skills will be encouraged through facilitated workshops to enable practitioners to interpret and adapt evidence in order to manage patients whose status falls outside the recommended guidelines. The exercise implications and practicalities of the more complex patient groups will be explored. Consolidation of existing knowledge and further understanding will give confidence in future practice. For exercise and health professionals who deliver the exercise component of cardiac rehabilitation. Provides an excellent follow on from the A Practical Approach to Physical Activity and Exercise in the Management of Cardiovascular Disease course. Cost: 280 ( 250 to BACR/ACPICR members). Duration 2 days. Introduction to Psychological Issues for Health Professionals working in Cardiac Rehabilitation An evidence and practice-based course designed to help multidisciplinary team members increase their confidence in identifying psychological issues, and to explore ways of incorporating psychological principles within cardiac rehabilitation programmes. This course is designed for cardiac rehabilitation professionals who already have experience of working in cardiac rehabilitation settings. For any health professional working in cardiac rehabilitation setting. Cost: 280 ( 250 to BACR members). Duration 2 days. A Practical Course in Assessing Functional Capacity in Clinical Populations This one-day practical study day aims to increase the knowledge and skills in implementing a number of functional capacity tests used in population groups such as cardiac and respiratory patients (e.g. Incremental Shuttle Walk Test, 6-Minute Walk Test, Chester Step Test, Cycle Ergometry) as well as practically apply the results to exercise prescription. Cost: 130 ( 145 to BACR members). Duration 1 day. 10 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

11 Cardiac Rehab UK Physical Activity and Exercise Advice for the Heart Failure Patient Nursing Professionals Day This course is aimed at nursing professionals with experience of heart failure patients to increase the awareness of the impact of physical activity and exercise in this patient group.the day has both a case study and a practical emphasis and aims to assist health professionals with useful tips and suggestions regarding physical activity and exercise advice for all NYHA status patients, whether seen in the traditional cardiac rehabilitation setting or in their own homes. For nursing professionals with experience of heart failure patients. Cost: 145 ( 130 to BACR/ACPICR members). Duration 1 day. Assessing, Prescribing and Delivering Physical Activity and Exercise for the Heart Failure Patient Exercise Professionals Study Day This course aims to develop understanding of the relationship between baseline functional assessment, risk assessment and subsequent exercise prescription. For exercise professionals involved in assessing/prescribing physical activity for heart failure patients. Cost: 145 ( 130 to BACR/ACPICR members). Duration 1 day. Knowledge and Skills update study day for BACR Exercise Instructors This study day is run by BACR Phase IV course directors and aims to update and consolidate on areas which are relevant to everyday practice for BACR Phase IV instructors. It also includes a practical session to discuss the principles of exercise and physical activity delivery. It is envisaged that it will be good preparation for revalidation and that there will be plenty of opportunity to discuss Phase IV service delivery issues. Cost: 90 ( 85 to BACR members). Duration 1 day. Practical Skills in Delivering Effective Group Exercise in Cardiac Rehabilitation This one-day practical study day aims to develop practical exercise delivery skills and competences for delivery of group based cardiac rehabilitation. Cost: 145 ( 130 to BACR members). Duration 1 day. Rating of Perceived Exertion Study day This one day course is aimed at all health and exercise professionals working in cardiac rehabilitation to ensure the appropriate, consistent and valid use of Borg's RPE scales. An evidence based approached is used in a day that mainly involves practical workshops of exercise assessment and prescription. Cost: 145 ( 130 to BACR members). Duration 1 day. For dates, venues and details of all the above courses please visit or contact the BACR Education Office. We are also interested in hearing from anyone who has local interest in any of the above courses and would like more details on hosting a course. Education Office The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 11

12 Cardiac Rehab UK January 2009 Events, courses and conferences BACR Exercise Professionals Group Study Day Friday 27 March 2009, Birmingham NEC Cardiovascular Exercise Programming: There is life beyond the FITT Principle KEYNOTE SPEAKER : Dr John Porcari, University of Wisconsin, USA Topics to include: Warm-up phenomenon, heart failure, practice tests for functional assessments, managing the breathless patient, link between exercise and mental health and dealing with those difficult-to-answer exercise questions Cost 110 (BACR, ACPICR or BASES members) 130 non-members For further details contact: Vivienne Tel: Cardiovascular Risk Course March 2009, University of Warwick, Coventry, UK Contact: Dr Steve Hicks, Dept Biological Sciences, University of Warwick, Coventry CV4 7AL Tel: Web: Tai Chi training for use in cardiac rehabilitation We are planning to run open training courses in 2009 to enable staff to deliver a suitable and tested Tai Chi programme in their locality. We have also been asked to provide training courses around the country, so if you are interested in arranging or attending a course please contact us on or The course will include Tai Chi, Chi-kung, relaxation techniques and NLP/CBT techniques to deal with motivation, fears and phobias associated with cardiac conditions. Balanced Approach regularly run specific Tai Chi programmes for falls prevention, pulmonary care, fibromyalgia and other conditions. The Cardiac Rehab UK Editorial Team Content Managers: Linda Binder, National Improvement Lead - Heart (NHS Heart Improvement Programme) Diane Card, Heart Health Co-ordinator (British Heart Foundation) Linda Edmunds, Council Member (British Association for Cardiac Rehabilitation) Editor: Anu Mukherjee, Project Officer, British Heart Foundation Cardiac Rehab UK is a free newsletter aimed at health professionals either working in or with an interest in cardiac rehabilitation. To subscribe, submit an article or contact the editorial team, Deadlines for submissions Issue 14, May February 2009 To access the Newsletter online The current issue and back copies are available to download from The current issue is also available via the BACR website This is the official newsletter of the British Heart Foundation (BHF) and the British Association for Cardiac Rehabilitation (BACR).Views or opinions that appear or are expressed in articles and letters by an individual do not necessarily represent those of the BHF or the BACR and neither do the organisations endorse any products or services advertised. BHF and BACR do not accept liability for its contents or for consequences which may result from the use of information or advice given. M British Heart Foundation 2009, a registered charity in England and Wales (225971) and in Scotland (SCO39426)

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