Cardiac Rehab UK January 2010

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1 Cardiac Rehab UK Issue 16 January 2010 Gardening for hearts & minds Thrive s Just 30! project is encouraging people to self manage their health, and makes changes to their lives through gardening as part of rehabilitation and recovery after a stroke, or if they have heart disease. In 2008, Thrive published a 34 page, Just 30! gardening for hearts & minds guide which is full of useful tips and techniques on how to use gardening activities to improve strength and mobility just 30 minutes of regular gardening a day can make a big difference. Feedback from healthcare professionals Thrive has now distributed over 15,000 guides to stroke and heart units and GPs. As part of the evaluation of this initiative, Thrive sent questionnaires to healthcare professionals to gather their views about the benefits of the guide. The results showed: Nearly 80% said the guide would encourage their patients to take a greater personal involvement and self management of their rehabilitation. 75% said patients interest in gardening had given them a sense of achievement and progress towards getting their life back. 60% of professionals reported that their patients said they have a healthier lifestyle through the exercise afforded by gardening. 98% of professionals said participation in gardening activities can enhance existing rehabilitation and community programmes. I am very pleased that Thrive has published this guide to set out the benefits of gardening as a means of rehabilitation. I am sure it will help many people at all stages of their recovery and irrespective of the size of their gardening space. Professor Roger Boyle, National Director of Heart Disease and Stroke, Department of Health Workshops The Just 30! project will have delivered a further 15 workshops across England in The workshops for cardiac and stroke groups are practical and give individuals a chance to experience the benefits of garden activities first hand. The workshops for professionals are part theory and part practical, giving the chance to learn more about the benefits of gardening and how to use the guide. The Horticultural Therapy Project at the NHS Hospital in Rugby used the gardening for hearts & minds guide. The project at this hospital is run by a physiotherapy team who use gardening to assist in patient rehabilitation, and was started because so many patients enjoyed gardening. Staff have commented that the level of disability or impairment does not matter, as patients can engage in some form of gardening activity, as it encompasses a variety of different types of activities involving a variety of postures. The successful outcome from this project includes increased motivation, improvements in standing, balance, postural control, weight transference and fine motor control. For further information on Just 30!, workshops or ordering the guide, please contact Gill Bailey on or gill.bailey@thrive.org.uk Gill Bailey, Just 30! Project Manager, Thrive Inside this issue Cardiac rehabilitation online Activate your heart Multidisciplinary cardiac rehabilitation clinics The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

2 Cardiac Rehab UK January 2010 Continuous exercises in the community The Calon Dda (Welsh for good heart), was started in Llandovery Cottage Hospital in West Wales in Having completed the existing Phase 3 programme, patients were keen to continue exercising. As there is no leisure centre or BACR fitness instructor in Llandovery, there was nowhere to refer patients to, which led to the creation, by the CR nurse and myself, of a group which has grown rapidly. The group is run as a self help group, and is funded through subscriptions, fundraising and grants, and the programme is delivered in a community hall in a rural village. I have less aches and pains afterward, feel uplifted by it. The programme is an excellent example of the provision of sustainable cardiac rehabilitation taking support to patients in a remote rural setting. Despite the challenges of working in such an environment, it has demonstrated higher than national average transition from Phase 3 to Phase 4 and higher than national average retention in Phase 4. This may be attributed to the fact that: it is held at the same venue with the same exercise professional as the referring Phase 3 programme it is self governing, providing heightened ownership by attendees the Committee and attendees are actively involved in the organisation patients are instructed on a circuit of exercise in accordance with BACR and ACPICR it has strong links with local cardiac rehabilitation services and BHF. A recent audit has demonstrated a positive impact of the programme in terms of physical, psycho-emotional and social wellbeing. It has made me do exercises at home. Physical benefits Improved fitness, strength, flexibility, balance, co-ordination and exercise tolerance, reduction in symptoms (angina, dyspnoea, muscular skeletal) greater motivation for self directed exercise/activity increased confidence in exercise/activity. I can now cut my own toe nails. Psycho-emotional benefits Positive dynamics within the group facilitate effective peer and professional psycho-emotional support. This reduces stress, anxiety and depression and gives a greater sense of support and belonging especially during sickness and hospitalisation. They have kept me out of an old people s home. Social benefits Effective social networking within the programme provides for opportunities of befriending, participation in social activities, provision of annual excursions, holidays and celebration of special events. Enhancing social activity. Promotion of friendship with like hearted people. Building a community within a community. Motivating social activities outside the programme. Increased independence. As a physiotherapist I am delighted to see the beneficial effect on long term muscular skeletal problems. There is a strong bond in the group, who even go on holiday together. Last year I joined in, and I was surprised by the level of fitness on the dance floor. This is a well functional group on all levels, and very important in a small rural community. People from all walks of life mix, make friends and keep their fitness. Ase Forder, Cardiac Rehabilitation Specialist Physiotherapist ase.forder@carmarthen.wales.nhs.uk Meeting with other people has encouraged me to get out of the house on a regular basis to maintain order in my life the social interaction is most beneficial almost as much as the exercise. 2 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

3 Cardiac Rehab UK Update on the Campaign for Cardiac Rehabilitation October witnessed BHF Northern Ireland and Northern Ireland Chest, Heart & Stroke (NICHS) joining forces to launch the first ever Northern Ireland Campaign for Cardiac Rehabilitation. Following findings from the 2009 National Audit for Cardiac Rehabilitation, which saw over two-thirds of Northern Ireland heart patients who had a heart attack, angioplasty or bypass fail to receive cardiac rehab, both charities launched the campaign in Parliament Buildings, Belfast on 13 October We told over 60 key stakeholders, including 15 local Assembly Members, leading healthcare professionals, opinion makers and most importantly local heart patients, about the campaign and our call for every heart patient who would benefit from this important life saving and life enhancing service to be offered access to a high quality cardiac rehab programme. With the health budget continuing to be squeezed, both heart charities will be taking the campaign to the Minister of Health and the Health Committee over the next few months. To find out more about our joint campaign in Northern Ireland contact Jayne Murray, Public Affairs and Communications Manager on or murrayj@bhf.org.uk Approaching a general election As part of National Heart Month in February hundreds of heart patients and their families will be speaking directly to decision makers, including MPs, to make sure heart disease remains a priority for them as we approach a general election. Nearly 100 patients and carers will be attending the Houses of Parliament on 3 February to take part in our lobby day. Campaigners will be speaking to their MPs face to face about matters close to their heart, and learning more about our campaigning work. They ll be telling them that heart disease should still be a priority and that cardiac rehabilitation is still unfinished business across the UK. We hope that during National Heart Month you will take the opportunity to encourage other health care professionals, including GPs and cardiologists, to refer patients who could benefit from cardiac rehabilitation. One way to do this is our cardiac rehabilitation patient entitlement cards and posters, which can be ordered from the BHF orderline on and quoting G428 cardiac rehab patient entitlement card and G452 cardiac rehab patient entitlement poster. Rehabilitation getting talked about at the Welsh Assembly In November a debate about cardiac services took place at the National Assembly for Wales, and cardiac rehabilitation played a big part. It was encouraging to hear the Health Minister, Edwina Hart, talking about the enormous postbags of correspondence from Assembly Members and campaigners on cardiac rehabilitation. Over the coming months we will be working hard off the back of this debate to ensure that cardiac rehabilitation is seen as a priority for decision makers on health policy in Wales. Katie Wiggins, campaigns@bhf.org.uk The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 3

4 Cardiac Rehab UK January 2010 BACR Annual Conference October, Jury s Inn, Birmingham In a break with tradition, the BACR Conference moved away from a weekend to a Thursday/Friday format and attracted well over 200 delegates on both days. The following is a very brief summary of the conference. Patrick Doherty, the outgoing president, welcomed everyone to Birmingham and reviewed the substantial achievements over the last year. The keynote address was given by Panteleimon Ekkekakis, who spoke on The pleasure and displeasure people feel when they exercise, focusing on methods, theory and implications for exercise prescription and adherence. Val Billingham spoke on world class commissioning, quoting Salford CR as an example of a PCT development which is embracing core competencies. Elaine Tanner and Lynda Shaughnessy described how to build a successful business case. They indicated that the BHF pack provided a useful reference guide for those wishing to inform commissioners clearly. This was followed by a team from Derbyshire County PCT who recommended understanding the present situation, managing finances, building your case, defining your specifications, getting the right people together, identifying improvements and defining all needs. Hamish Courtney reflected on lowering sugars in diabetes. He provided evidence for the controversy around lowering sugar and gave reasons for the unexpected results from international studies to be associated with certain drugs, hypoglycaemia and weight gains. Bob Lewin reviewed the 2009 NACR report, stating that 72% of CR programmes were now uploading to the NACR database and that the media coverage for key findings had been excellent. Julie-Anne Regan spoke on effective education for patients and described the Race Ripple Model as the basis of her presentation. She developed the notion of wanting, needing, doing, making sense and feedback as a learning process, linking these to the health belief model. John Buckley outlined his plans for the future of the BACR, concentrating on the key aims of conference, education, communication and providing a voice for both members and patients. Dawn Skelton spoke on physical activity and exercise for older people, emphasising the importance of balance, strength, posture and the prevention of falls. She reviewed the benefits of back extension exercises, balance training and assisted exercise. Jackie Taylor described the demographics, physiological changes and co-morbidity associated with ageing. She stated that with polypharmacy in the elderly, this would increase the chances of falls. She argued for a comprehensive geriatric assessment, and that even small gains could be very meaningful. Four excellent short presentations were given based on submitted abstracts. A new session was included this year entitled Innovations in Practice and this gave an opportunity to showcase good practice within CR. Topics were Upbeat Health Support, Options Week and MyAction Westminster. Julian Halcox gave a most informative presentation on cardio-protective drugs which included a review of the physiological processes associated with atherosclerosis plaque. He clarified the long term benefits of certain drugs and emphasised that people at greatest level of risk need the best medication, especially statins. Jim McKenna spoke convincingly on providing physical activity advice in primary care. He outlined and gave examples of the seven tenets of behaviour change. Finally, Panteleimon Ekkekakis spoke on Why is it so hard? A hedonistic perspective on the challenge of exercise adherence in obesity. He discussed the difficulties associated with exercise with obese patients within our CR programmes. This presentation finished off what had been two exciting, information filled days in Birmingham. The conference also included a poster display, a conference dinner, followed by the opportunity for delegates to stake their claim for Strictly Come Dancing, an excellent trade exhibition and the opportunity for networking and socialising. Feedback has indicated that it was a great success and plans are well underway for Conference 2010 in Liverpool. David Brodie, Bucks New University, David.Brodie@bucks.ac.uk James McGhie, North Lincolnshire and Goole NHS Trust, James.Mcghie@northlincs.gov.uk 4 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

5 Cardiac Rehab UK Profile of incoming BACR President Dr John Buckley BPE MSc PhD John has been a member of BACR since In this time he s been a regular presenter at conferences and a contributing author, tutor and advisor to many of the BACR education resources. For eight years he served as a founding committee member of the BACR Exercise Professionals Group. John s vision for BACR, which is shared by the new Council and his BACR Executive colleagues, Linda Edmunds (Treasurer), Judith Edwards (Secretary), Jenni Jones (President Elect) and Patrick Doherty (Past President) includes four aims (C.A.R.E): 1. Continuing the campaign to ensure cardiac rehabilitation is recognized as a highly effective and cost beneficial service in the management and prevention of cardiovascular disease 2. Augmenting the professional recognition of the Association 3. Reaching out to the wider group of healthcare professionals now involved in the primary and secondary prevention of cardiovascular disease 4. Engaging more with the members in their Association. He came to the UK from Canada in 1986 to pursue his MSc. in Sport Science at Loughborough University, before starting his own exercise and physiotherapy business in Shrewsbury in1988. He attained BASES Accreditation as an exercise physiologist in 1996 and completed his PhD in 2003 at Keele University, where he was a lecturer from 1989 to He has 15 years of experience in cardiac rehabilitation as a lead practitioner, and since 2006, he has headed up the MSc in Cardiovascular Rehabilitation at the University of Chester. He continues with his lifelong athletic interests of keeping fit and healthy through running and playing tennis for his county senior men s team. He has even been found playing jazz trumpet late in the evening at sports medicine conferences. Dr John Buckley, bacr@bcs.com Cardiac rehabilitation online Activate your Heart Achieving targets set to improve accessibility and availability of cardiac rehabilitation may now be closer through an internet based cardiac rehabilitation programme. A new web-based cardiac rehabilitation programme has been developed at the University Hospitals of Leicester NHS Trust with contributions from a number of experts across the UK ( This web based version has been purposefully designed for patients to carry out from home, a local library or anywhere with internet access. It benefits from being highly accessible, convenient and not time or distance restricted which traditional rehabilitation can often be. It is therefore hoped that this programme will increase access and capacity to rehabilitative services. The programme maintains individuals privacy through a password protected website being located on a secure sever. The programme is stage based (four stages) and designed to complete in six to eight weeks. The participant is set their own personal plan tailored to their specific needs at each stage. Each stage contains individualised advice on physical activity, diet, managing stress and anxiety and smoking cessation. The focus and emphasis of this information varies depending which stage the participant is at. There is also guidance available regarding CHD risk factor management and symptom control. Progression along the programme is marked by completing an online exercise diary and quizzes, and once enough exercise has been reported the individual is then able to move onto the following stage. There is also online support available through a weekly chat room which is hosted by a cardiac rehabilitation nurse. Participants using the programme also have direct access to the cardiac rehabilitation team via using the ask our experts link. A PhD research project at Coventry University is investigating the effectiveness of this new web-based programme. This project is a Randomised Control Trial design comparing the programme s effectiveness with usual care for individuals with angina in primary care. This trial gives low risk patients who do not often receive conventional rehabilitation a chance to take part in this preventative intervention. The trial s primary outcome measure is physical activity. This is being measured objectively using a sophisticated activity monitor which calculates step count, energy expenditure, and physical activity duration. Other secondary outcome measures include weight, blood pressure, body fat percentage, diet, anxiety and depression, perceived health status, selfefficacy and quality of life. It is anticipated that the trial will complete data collection by the end of July The overall aim is to widen access and options for those who cannot, or choose not to, attend conventional rehabilitation or provide a website adjunct for those receiving rehabilitation. This web based programme may also help to broaden the range of participants able to take part in cardiac rehabilitation. For more information contact Professor Sally Singh. Reena Devi & Prof. Sally Singh Coventry University s.singh@coventry.ac.uk The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 5

6 Cardiac Rehab UK January 2010 Multidisciplinary cardiac rehabilitation clinics Week 4 A further clinic appointment four weeks post event for review by specialist nurse, and individual consultations with physiotherapist and occupational therapist. The specialist nurse considers ECG, echo, medication and symptom review. The physiotherapist looks at appropriate levels of exercise and encourages cardiovascular exercise. The occupational therapist discusses activities of daily living, return to work, sex, relaxation, anxiety and depression. The Team (L-R): Mel Ellis, Janice Nash, Jo Hayward & Katherine Paterson In April 2009, Norwich became one of three Heart Attack centres in the East of England offering Primary PCI (percutaneous coronary intervention). Primary PCI has resulted in a much shorter length of stay which has impacted on our rehabilitation provision. This, coupled with some additional funding, gave us an opportunity to redesign some of our services for all MI (myocardial infarction) patients. In the past, because of the rural nature of the area, patients received the Heart Manual home based programme in conjunction with outpatient Phase 3 group programme and clinic visits. The Heart Manual was facilitated predominantly whilst the patient was in hospital and supported through clinic visits and telephone. This was mainly nurse led, and only patients who opted to attend the outpatient Phase 3 programme received input from the full multidisciplinary team (physiotherapist, dietician, pharmacist and occupational therapist). The aim of the new system is to bring some of the benefits of a multidisciplinary programme to all MI patients, not just those who can access the outpatient group programme. The aim of the new system is: Day 1 Post Discharge A telephone call to the patients one day post discharge, usually by specialist nurse. Week 1 A clinic appointment one week post discharge for facilitation of the Heart Manual, as appropriate, by specialist nurse and an individual consultation with a dietician. This allows patients 45 minutes with each professional on a one-to-one basis. The specialist nurse reviews events and sequelae, medication, symptoms and fears. Dietetic treatment, which had previously been on the periphery of cardiac rehabilitation, is now a core component for these patients. Following NICE MI guidelines to offer patients individualised dietary advice, patients are helped to improve their omega 3 fat intake soon after MI, move toward a Mediterranean style diet and begin to address other risk factors such as obesity, where diet plays a pivotal role. All the health professionals involved can contribute to the patient s well being and share ideas, information and resources. Patients still have access to the Phase 3 out-patients programme. This allows the majority of patients to receive a comprehensive package of rehab in a cost effective and streamlined way. Reference NICE (National Institute for Health and Clinical excellence) (2007). Clinical guideline CG48. MI: Secondary prevention in primary and secondary care for patients following a myocardial infarction. Jo Hayward, Mel Ellis, Janice Nash and Katherine Paterson jo.hayward@nnuh.nhs.uk 6 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

7 Cardiac Rehab UK MyAction An innovative model for delivering cardiovascular disease prevention and rehabilitation Currently, patients with coronary heart disease (CHD) are usually managed in either hospital or community based cardiac rehabilitation programmes, whilst those individuals who are at high risk of developing heart disease (HRI) are largely managed in primary care. The MyAction programme is an innovative nurse led multidisciplinary preventative cardiology model that integrates the care of these priority groups. Family members are included, as it is well recognised that healthy lifestyle change is more likely to occur and be maintained if the family changes together. The programme is evidence based, founded on the principles of the Euroaction study (Wood et al, Lancet 2008) and complies with the core components and minimum standards as recommended by the BACR. The multidisciplinary team (MDT) includes cardiac specialist nurses (nurse prescribers), dieticians and physiotherapists/physical activity specialists supported by a physician. Prior to starting the programme, all patients and their partners have an individual assessment by each member of the MDT including smoking habits, dietary habits, weight and waist circumference, physical activity levels, blood pressure, lipids, glucose, use of cardioprotective medication and psychosocial measures. This baseline assessment forms the starting point for the programme, allowing identification of fixed beliefs and barriers to change whilst motivational interviewing techniques and goal setting are key tools employed for healthy lifestyle modification. The patients and partners medical risk factors are also managed with the prescription of appropriate medication. There is also a weekly supervised exercise programme and educational workshops. Both patient and partner have a repeat assessment at 16 weeks and one year. All data is stored on a secure web based electronic database which allows regular audit of response rates and clinical outcomes in accordance with national targets, and will also contribute to the NACR. Nurse specialist Pracxie Ndebele working with patients at the MyAction programme, Slough The programme was piloted in Bromley, South East London between June 2007 and December patients took part (119 coronary; 87 HRI) with an overall response rate of 67%. Half the patients were accompanied by their partner. By the end of the programme both patients and partners demonstrated improved adherence to the Mediterranean diet, including increased fish consumption, and had a mean weight loss of 1.5 kg (2 kg for partners). Moreover, over two thirds of patients and partners were achieving their physical activity targets compared to just one in five at baseline. There was also a doubling in the proportion achieving blood pressure control, over 60% by the end of programme. There was a similar change seen in lipid control in HRI and nine tenths of coronary patients had lipids controlled. There was also a significant increase in the prescription of ACE inhibitors and statins. Since then, three programmes have been launched in conjunction with East Berkshire PCT in Maidenhead, Bracknell and Slough. More recently, seven programmes have just been launched in four community settings in Westminster, in partnership with Imperial College Healthcare NHS Trust and NHS Westminster. Susan Connolly s.connolly@imperial.ac.uk NB: My Action Westminster has recently joined the NHS Heart Improvement Programme as a National Priority Project. The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 7

8 Cardiac Rehab UK January 2010 BHF Publications UPDATE News News News N Coronary angioplasty (HIS 10) This is about a treatment called coronary angioplasty. It explains who needs to have an angioplasty, what happens, how successful it is and how people help themselves after having the treatment. Pacemakers (HIS 15) This is for people who are about to have or have just had a pacemaker implanted. It explains why a pacemaker is needed, how it is implanted, and the do s and don ts afterwards. Heart rhythms (HIS 14) This includes information on both normal and abnormal heart rhythms. It explains what palpitations are, what ectopic beats are, the different types of abnormal heart rhythms, the tests used to diagnose the problem and the treatments that might be needed. Heart valve disease (HIS 11) This is for people who have a problem with one or more of their heart valves. It explains what heart valve disease is and what types of treatment are available. Heart transplantation (HIS 13) This booklet is for people who have had, or are waiting for a heart transplant. In November 2008, the BHF launched Heart Matters, the free service that helps people live with a healthier heart. As part of our service development, an online lifestyle check will be available to Heart Matters members from January The lifestyle check covers physical activity, diet, smoking, weight and emotional health. Members take the check and receive a detailed, personalised report that highlights areas for them to focus on with suggested next steps and a guide to goal setting. They can `re-take the check to monitor their progress over time. The check can compliment any support they are already receiving from a healthcare professional. The lifestyle check was developed with vielife, an organisation that specialises in wellness & productivity solutions. The lifestyle check is being promoted as part of the BHF's National Heart Month BEAT code: Be active Eat healthily Avoid smoking Take the lifestyle check. For more information, sign up to Heart Matters at bhf.org.uk/heartmatters or visit bhf.org.uk/beat How to order Call the order line on , orderline@bhf.org.uk or visit bhf.org.uk/publications where you can order or download the publications. New BACR Council members meet to agree roles and share visions for the future On 22 October 2009, the five newly appointed BACR council members met at the BCS Offices in London to orient themselves with the running of BACR, review and agree roles & responsibilities, and share their visions. The Who s Who of these officers is impressive and reflects the multidisciplinary needs of BACR. Jenni Jones (President Elect) a Chartered Physiotherapist, with more than 12 years experience in cardiac rehabilitation and cardiovascular disease prevention. She is based at Imperial College London as Course Leader of the MSc in Preventive Cardiology. She has been instrumental in the development of most BACR CPD courses, including being a course leader, tutor and/or working party member. Gill Furze (Chair and Scientific officer of the Conference Committee) a specialist cardiac nurse with many years experience and a PhD in the psychology of cardiovascular disease. She is a senior member of the BHF Care & Education Research Group and a lecturer at York University. Her special interests include The Angina Plan. Paul Smith (Chair of the Membership Services and Communications Committee) is a CR specialist nurse and clinical lead for the Mid & South West Wales Cardiac Network. He has been Chair of the All Wales Cardiac Rehabilitation Group. Linda Speck (Education Committee Liaison Officer) is a Clinical Health Psychologist leading up the Health Psychology Services for Cardiac Rehabilitation (East) at the ABM University Health Board. In 1985 she was part of setting up Wales first cardiac rehabilitation programmes in Bridgend. James McGhie (Exercise Instructor Rep of the Membership Services and Communications Committee) is a BACR qualified CR exercise professional in 8 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

9 Cardiac Rehab UK ews News News News News News News News News Scunthorpe, where he has been involved in setting up community programmes to complement existing hospital based services. Dr John Buckley, Cardiac rehabilitation booklet wins award in 2009 BMA Medical Book Competition Oxford Radcliffe Hospitals (ORH) NHS Trust s Cardiac Rehabilitation Team has been awarded first prize in the BMA Patient Information Awards (NHS Trust) at the 2009 BMA Medical Book Competition. The award was presented to Marion Elliot, Helen Nolte and Carol Schofield on behalf of the cardiac rehabilitation team at BMA House, London. The booklet originated following the amalgamation of two cardiac rehabilitation teams within ORH NHS Trust. The aim was to facilitate an equitable county wide rehabilitation service by producing a high quality booklet that was specific to Oxfordshire patients. The Information Booklet and Personal Plan provide a complete range of written information. They are also designed to enable patients to record their own health details and individual targets for lifestyle changes. A number of different health professionals, with specialist knowledge, contributed to the booklet including a dietician, clinical psychologist, diabetic specialists, exercise physiologists and cardiac nurses. BMA judges stated: This is an extremely comprehensive resource with clear headings and information divided up into appropriate sections. It contains a wealth and range of information, original and links to other sources or services. Additionally, it has excellent potential for record keeping with clear instructions, particularly with regard to healthy eating and exercise. It seems to cover all bases well. The booklet is supported and funded by various sources including ORH NHS Trust, Gibson Fund, Roger Cherry (patient), Solvay Healthcare and cardiac rehabilitation charitable funds. Marion Elliot, Senior CR Nurse Marion.Elliot@orh.nhs.uk How cardiac rehabilitation patients can benefit from a One day stress management workshop A one day stress management workshop has been a successful menu based option for CR patients at the Luton & Dunstable Hospital for approximately 10 years. Stress is a well recognised risk factor for people with coronary heart disease. The mechanism believed to be responsible for this risk is the changes to the endothelial cells that cause further atherosclerosis within the coronary arteries (Muller et al, 1999). Stress negatively affects health related quality of life (Karlsson. I and Berglin. E, 2000). Stress: the adverse reaction that people have to excessive pressures or other demands placed on them. It arises when they worry that they cannot cope (Health & Safety Executive 2000). Stress management is included to help patients make the psychological adjustment required following a cardiac event. Approximately eight workshops are run per year by the senior occupational therapist and a clinical psychology assistant. The workshop is designed for patients, but there is a local support group available for patients and partners. The workshop is structured to include the theoretical autonomic response to stressors, helping patients to understand how and why stress affects their body, mind and behaviour and to teach a variety of coping strategies to manage stress more effectively, such as; changing unhelpful thoughts, breathing & relaxation techniques. The Hospital Anxiety & Depression Scale (HADS) and in house written evaluation questionnaires are used to evaluate the intervention. Written handouts are provided so that patients can refer back to what they have learnt at the workshop. An audit for this aspect of the service was completed in 2006, using data from 2003 to The outcome of the audit was very positive and the findings clearly showed that it was highly valued by the patients who participated. Key findings: 94% patients reported delivery of the workshop was just right 93% responded length of the session was just right 90% felt that their knowledge of stress management had improved as a result of the workshop. A two month follow up survey found that participants still valued the workshop: 93% reporting that they still used the ways of coping identified on the day 88% reporting that these ways of coping helped them manage their stress more effectively. Over the last year 94 patients have attended the workshops. The feedback remains consistent with the original audit findings. In addition, after two months, 80% HADS scores have reduced, 20% significantly. Future plans include, a follow up day for patients, a professionally printed manual to support content covered in the workshop as a reference for patients to continue to use for effectively managing their stress, and offering a similar stress management session to partners and other family members. For more information and a list of references used for this article contact: Katrina Fisher, Senior Occupational Therapist Katrina.fisher@ldh.nhs.uk The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 9

10 Chest, Heart & Stroke Scotland affiliated support groups Background Chest, Heart & Stroke Scotland (CHSS) aim to improve the quality of life for people in Scotland affected by chest, heart or stroke illness, through medical research, advice, information and support in the community. The 2007 review of Scottish Intercollegiate Guidelines Network [SIGN] 57 Guidelines on Cardiac Rehabilitation concluded that Greater emphasis is required on the role of the patient led support groups. These groups are beneficial to many thousands of cardiac patients and their partners, and are leading the way in self-management of cardiac conditions. Support in the community There are currently 42 cardiac support groups affiliated to CHSS, benefiting over 1600 people across Scotland, and run by people with experience of heart disease. Aims include: ongoing rehabilitation, emotional and social support, secondary prevention, signposting and education. The groups provide a wide range of activities, and offer members ongoing support, stimulation and companionship in a friendly and relaxed environment within the community. A new Affiliated Groups leaflet has been produced to provide more information on these groups, and includes space for them to add specific details about their group. Copies can be downloaded from or can be obtained by contacting the Health Information Dept. Challenges In supporting the groups to maintain a high standard of operation, CHSS encourage them to exercise. However, this can be a challenge, due to resource and cost implications. One ideal model involves our nine affiliated groups in Dumfries and Galloway, which were initially supported by the CR team and are now mainly patient led. Over the years it became impossible for the nurses to continue supporting the groups on a weekly basis due to increasing workload. Initially it caused quite an upset to these groups, but after discussion and planning, Big Lottery Fund money was used to fund the production of an Exercise Manual. Consequently, the nurses gradually began to withdraw, handing over to exercise leaders from within the groups membership. Nurse support is still offered should any problems arise, and once a year, the exercise leaders are invited to attend an update by the local cardiac physiotherapist. The review of SIGN 57 also states: The ideal setting for the self help group is an option in the menu of cardiac rehab in each area. Groups are only as strong as their membership and in areas where the local health professionals have supported the setting up of such groups, the referral process is more effective. However, there are many groups who do not have established protocols in place for the local health professionals to refer to. CHSS are actively working to resolve this by encouraging local CR teams to signpost patients, where applicable, for continued reinforcement of the lifestyle changes learnt through formal rehabilitation, and to benefit from the excellent social support offered by patient led groups. Nicola Cotter nicola.cotter@chss.org.uk BACR Phase IV Exercise Instructor Training (20 REPS CPD points) The aim of this one day is to explore the latest trends for all components of cardiac rehabilitation including service delivery. Reflection on practise will be encouraged allowing practitioners to assess how their service maps to current national guidelines including BACR Standards. Reducing the risk of cardiovascular disease and managing weight: A dietary and behavioural approach This one day course aims to explore the assessment and prescription of dietary and weight management advice for the CVD group.the course focuses on assessing dietary intake, converting dietary evidence into practical and usable strategies for helping patients and their families to make appropriate changes to their diet to reduce their risk and help with weight management. The practical focus of the day will provide useful tips and suggestions that can be implemented into clinical practice. Psychological issues for health professionals working in cardiac rehabilitation An evidence and practice based two day 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. 10 The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement

11 Training opportunities Exercise and physical activity courses A Practical Approach to Physical Activity and Exercise in the Management of Cardiovascular Disease (PART I) Open to exercise and health professionals advising on or delivering physical activity and exercise to cardiac patients This two day course explores the principles of exercise and physical activity in cardiovascular disease prevention and rehabilitation and applies 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. Advanced Application to Physical Activity and Exercise in the Management of Cardiovascular Disease (PART II) Open to exercise and health professionals, and all BACR instructors and provides an excellent follow on from the Practical Approach to Physical Activity and Exercise in the Management of Cardiovascular Disease Part I course. This two day course aims to encourage all professionals involved in the delivery of exercise to cardiac patients who wish to expand their knowledge to include the more complex patients groups. 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 implications and practicalities of different modes of exercise, such as water based and resistance training, will also be explored. The following one day courses are open to BACR Exercise Instructors and exercise and health professionals advising on or delivering physical activity and exercise to cardiac patients Assessment, Prescription and Delivery of Physical Activity and Exercise in Heart Failure This course focuses on heart failure pathology and relates exercise physiology, medications and devices to the principles of exercise training in this population group.the day will include a case study approach to discuss physical activity and exercise management and prescription. A Practical Course in Assessing Functional Capacity in Clinical Populations This 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. Practical Skills in Delivering Effective Group Exercise in Cardiac Rehabilitation This practical study day aims to develop practical exercise delivery skills and competences for delivery of group based cardiac rehabilitation. Rating of Perceived Exertion Study day This 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 approach is used in a day that mainly involves practical workshops of exercise assessment and prescription. Physical Activity and Exercise Advice in Heart Failure This one day course is open to heart failure and cardiology nurses who wish to develop their knowledge of physical activity and exercise advice in heart failure and will relate exercise physiology to the principles of exercise training in this population group.the day will include a case study approach to discuss physical activity and exercise management and includes practical teaching techniques. Applicants should have prior knowledge of heart failure pathology.this course is not aimed at professionals who have the relevant qualifications to prescribe exercise to the cardiac population. For REPS level 3 exercise instructors only BACR Phase IV Exercise Instructor Training (20 REPS CPD points) Level 4 Qualification recognised by SkillsActive and the Register of Exercise Professionals. 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 strict qualification and experience entry criteria. Please contact the BACR Education Office for application forms, course dates, venues and costs or details on hosting any of the above courses: , enquiries@bacrphaseiv.co.uk The production of this newsletter was supported by the NHS Heart Improvement Programme - Part of NHS Improvement 11

12 Cardiac Rehab UK January 2010 Courses and conferences BACR Annual Conference 2010 The 2010 BACR Annual Conference will take place on 7-8 October in Liverpool. Full details to follow in the May newsletter. Cardiovascular Risk April 2010 The Warwick University Postgraduate Award in Cardiovascular Risk is approved at Masters level under the Credit Accumulation and Transfer Scheme (CATS) and carries 20 CATS points at M-level. It is a specialist option of the University of Warwick Masters in Health Sciences degree programme. The course aims to provide a complete overview of the pathogenesis and evidence-based medical management of atherosclerotic diseases, including coronary heart disease, cerebral and peripheral vascular disease. Closing date for applications: 21 March 2010 Enquiries to: Dr. Stephen Hicks (Short Courses) Department of Biological Sciences, The University of Warwick, Coventry CV4 7AL. Tel: (024) Fax: (024) s.j.hicks@warwick.ac.uk CR UK is very sorry to say goodbye to Diane Card who will be leaving the newsletter editorial team from January Diane has been a valuable member of the team since January 2007, and has been a very strong proponent for cardiac rehab. However, due to an increased workload in other areas, and a change of focus in her work, Diane feels she is not able to devote sufficient time for such an important publication. She will be greatly missed, but will continue to support the newsletter. We are, however, delighted to welcome Ian Painter to the CR team in Diane s place. Ian trained as a registered general nurse in He took up the role as a cardiac rehabilitation nurse in 2001, working with partner organisations to develop a business proposal, and a bid for New Opportunities funding. This led to the setting up of the Flintshire Health Project, a scheme offering a community based service to people discharged from Wrexham Maelor, Glan Clwyd and the Countess of Chester Hospitals. They have now obtained long term, permanent funding from the Local Health Board. Ian commenced his current role as a BHF HCP Project Manager in June 2009, covering the North of England and the Midlands. We wish Diane and Ian every success in their new roles. Anu Mukherjee Editor The Cardiac Rehab UK Editorial Team Content Managers: Linda Binder National Improvement Lead - Heart NHS Heart Improvement Programme Diane Card Community Development Manager 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, cardiacrehabuk@bhf.org.uk Deadlines for submissions Issue 17, May February 2010 Access the Newsletter online The current issue and back copies are available to download from bhf.org.uk/publications 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 The British Heart Foundation is a registered charity in England and Wales (225971) and in Scotland (SC039426).