GP / Self Referral

An Exercise Referral is a specific and formalised programme whereby a medical professional refers a patient to a fitness programme. An individual can also self refer. The Exercise professional will typically ensure a 12-week supervised programme of physical activity tailored to suit the needs of the referrer and the referred client, with a view to improving their state of health.

Exercise Referral Instructors are able to support clients with the following medical conditions:

Asthma

Many Asthma suffers report that their symptoms become stronger when they engage in exercise or physical activity which unfortunately encourages more sedentary lives.

The benefit of exercise and physical activity for those with asthma include:

  • improved strength of the respiratory muscles
  • improved strength of the accessory respiratory muscles (the muscles crucial for expiration, especially when breathing is laboured and difficult)
  • reduced dead space in the lungs
  • increased lung power
  • improved cardiovascular function

Please always bring your ‘reliever’ inhaler to every session and talk to your teacher about your triggers. If you are unsure of your triggers please do let us know.

Chronic obstructive pulmonary disease (COPD)

The aim of exercise prescription for COPD is primarily to improve lung function, exercise tolerance and symptoms of dyspnea (shortness of breath).

Exercise should be engaged for all, regardless of how low the intensity may be. The primary benefits of exercise in COPD patients include;

  • cardiovascular conditioning
  • the reduced ventilatory requirement at a given workload
  • improved respiratory efficiency
  • reduced hyperinflation of the lungs
  • desensitization to dyspnea
  • increased respiratory muscles strength
  • improved flexibility and mobility of the thorax/spine

Please always bring your ‘reliever’ inhaler to every session.

Osteoarthritis

The primary treatments for arthritis include joint protection strategies, exercise and education for the self-management of symptoms.

We recommend the following advice for those suffering from Osteoarthritis:

  • Maintain a stable and close to ideal body weight.
  • Remain as active as possible to maintain joint stability and muscle tone.
  • Avoid extreme activity or impact.
  • Avoid deep kneeling or squatting positions that may overstressed joints.
  • Wear suitable footwear shock-absorbing insoles or train has designed for exercise.
  • Have a thorough gait analysis to ensure no additional strain is being placed on the joint.
  • Give due consideration to exercise positions that may aggravate affected joints including kneeling and weight bearing on the wrist. These positions should be subsequently avoided.
  • Warm with gentle stretching and mobility activities are crucial. This should also be performed on days when the patient is experiencing symptoms in the active phase or when the structured exercise is not planned.
  • Excessive stair climbing, contact sports, prolonged single leg activities and fast-paced movement should be avoided especially with patients who have hip and knee symptoms.
  • Muscular conditioning should be a priority, using predominantly compound exercises. The muscles surrounding the affected joints should be targeted.

Rheumatoid arthritis

The primary treatments for arthritis include joint protection strategies, exercise and education for the self-management of symptoms.

We recommend the following advice for those suffering from Rheumatoid arthritis:

  • Maintain a stable and close to ideal body weight.
  • Remain as active as possible to maintain joint stability and muscle tone.
  • Avoid extreme activity or impact.
  • Avoid deep kneeling or squatting positions that may overstressed joints.
  • Wear suitable footwear shock-absorbing insoles or train has designed for exercise.
  • Have a thorough gait analysis to ensure no additional strain is being placed on the joint.
  • Refrain from exercise during active phases. The patient should avoid excessive risk petitions, high impact activities and prolonged exercise from the same position.
  • Give due consideration to exercise positions that may aggravate affected joints including kneeling and weight bearing on the wrist. These positions should be subsequently avoided.
  • Warm with gentle stretching and mobility activities are crucial. This should also be performed on days when the patient is experiencing symptoms in the active phase or when the structured exercise is not planned.
  • Excessive stair climbing, contact sports, prolonged single leg activities and fast-paced movement should be avoided especially with patients who have hip and knee symptoms.
  • Muscular conditioning should be a priority, using predominantly compound exercises. The muscles surrounding the affected joints should be targeted.
  • Exercising later in the day more comfortable to avoid symptoms of morning stiffness.

Joint replacement

Structured exercise should only be performed once the clinician has indicated that it’s safe to do so and the acute phase of physiotherapy is complete. This is normally around 6 weeks post-op.

We may work in conjunction with physiotherapists to develop suitable exercise programs to restore an optimum level of proprioception and joint stability. Once such attributes have been established the strength of the surrounding skeletal muscles and connective tissues will then need to be increased in order to prevent further damage, deterioration and undue stress being placed on the prosthesis and surrounding tissues. Patients should also:

  • perform limited abduction and deduction movements, particularly with hip replacements
  • avoid breaststroke when swimming
  • keep hips above knees when seated
  • perform lower body flexion patterns to a maximum of 90 degrees

If you would like to find out more about one of our students that experienced a double knee replacement please read our blog on Joint Replacements  .

Simple mechanical back pain

We always make sure you are exercising in a safe environment to the level that is suitable for you.

Please always feedback to your teacher if something does not feel right for you so we can advise as required or give you an alternative.

Varied movements in multiple directions are favourable. Any exercise prescription should include many exercises that will develop fitness without undue pressure on the spine such as Pilates, Yoga, walking and cycling. Core stability training and flexibility exercises will strengthen and lengthen the area surrounding the damage or irritated discs and help prevent further damage.

High Impact activity should not be performed on anyone who is recovering, or being treated for lower back disorders.

When symptoms are severe exercises challenging the lower back and hips should be delayed for a period of two weeks, or until symptoms reducing severity. When symptoms are present, patients are encouraged to focus on abdominal hollowing exercises that promote the activation of the TV transverse abdominals and increase the blood flow to the stabilizing tissues.

Generally, those with back pain should;

  • avoid high impact activities
  • refrain from heavy lifting jerking and jarring movements
  • not perform double leg raises or straight leg setups
  • refrain from repeated twisting rotating and bending
  • avoid exercises that load or compress the axial skeleton
  • avoid sustained or prolonged static postures
  • rehearse engaging the abdominals regularly
  • seek opportunities to improve posture

Becki Moore specialised in back pain. If you wish to find out more please visit our back pain page

Osteoporosis

Exercise is important in the prevention and management of osteoporosis. Regular exercise will help to:

  • Increase muscle strength
  • Improve balance
  • Reduce the risk of falls
  • Minimise bone loss
  • Improve well-being
  • Reduce the risk of other medical conditions

Several factors are believed to accelerate the condition and should be managed, including:

  • a sedentary lifestyle
  • smoking
  • a diet lacking calcium and vitamin D
  • Amenorrhoea
  • excessive salt consumption
  • alcohol abuse
  • long term steroid use/therapy

The general role of exercise as a prescriptive factor for osteoporosis is to prevent further deterioration of the condition and to stabilize if not improve bone mass density.

Exercises requiring axial loading, back squats, spine reflection, crunch or extension should be avoided due to the increased risk of factors. Core stabilizing exercises should be used to help stabilize the spine. Contact sports, high impact, ballistic and fast-paced movement should be avoided.

Osteoporosis in the Hip

One should avoid exercises that may put them at risk of falling.

One would benefit from weight-bearing exercise and exercises that increase strength around the hip:

  • Glute Setting
  • Hip Abduction and Adduction
  • Marching
  • Single and Double Knee Folds
  • The Hundred
  • One Leg Stretch
  • Scissors
  • The Roll-up
  • Swimming
  • Hamstring Curls
  • Shoulder Bridge
  • Glute Strengthener with bent knee
  • Side Kick and Side Lying Series
  • Supine Single Leg Lower
  • One Leg Circle

Osteoporosis in the spine

One should avoid lots of flexion and twisting and extreme ranges of flexion and rotation.

Pilates exercises to avoid:

  • Roll Down
  • Rolling Back and other rolling exercises
  • Spine Stretch
  • Curl Ups and the curl up element of any exercise
  • The full Roll-up and oblique version
  • The Oblique Twist
  • The Saw
  • Roll Over
  • Jack Knife
  • Corkscrew
  • shoulder stand position
  • Scissors
  • Bicycle

Pilates exercises that may be suitable:

Small range rotation as in the Spine Twist, Supine Twists, Chest Opener and small range flexion as in the Cat Stretch and Shoulder Bridge may be OK, depending on the client and their bone mass density, so you need to check with their health professional.

The following strengthening exercises are particularly good:

  • Swimming,
  • Leg Pull,
  • Press Up,
  • Swan Dive
  • Back Extension

We would highly recommend at least one Private Session for anyone with osteoporosis in the Spine.

We can then teach you any alternatives for exercises we may wish to avoid during class and if you wish we can put together a home programme for you to practice at home as well.

Hypertension

The causes of primary hypertension are currently not entirely understood, although several factors are believed to accelerate the condition. These include:

  • a sedentary lifestyle,
  • smoking,
  • stress,
  • obesity,
  • excessive salt consumption.
  • alcohol abuse,
  • and a deficiency in vitamin D.

Stage three hypertensive  >190/110 should not engage in exercise or strenuous physical activity until they have undergone a thorough medical examination by a clinician, and a period of drug therapy that seeks to stabilize blood pressure, only once blood pressure is confirmed as being stable, that it is safe to commence exercise.

Exercises which position, the arms above the shoulders (ie shoulder press/ lateral pull down), or the head below the heart (decline exercises or inversions) should be omitted from the exercise programs. Because the vascular system is somewhat fragile and weekend in hypertensive patients, any exercise which causes the blood pressure to spike can be potentially dangerous and should be avoided.

The Valsalva manoeuvre is a response or technique that involves closing the narrowest part of the trachea, following a maximum inhalation in order to increase intrathoracic pressure. This is used by some exercises during resistance training to increase stability. Under no circumstances should hypertensive patients be encouraged to perform this maneuver during exercise or at rest. Hypertensive patients should use continuous breathing throughout the exercise.
Exercises which caused a spike in interest thoracic pressure should never be performed with hypertensive patients.
Heavy resistance training particularly exercises which load the thorax (back squats, deadlifts, etc) should be avoided.

As a general rule, low, moderate intensity exercises that are continuous in nature are superior with hypertensive patients,
a greater emphasis on increasing the frequency and duration of these activities should be given a less priority to increasing intensity.

Warm up and cool down activity should be prolonged with a greater level of monitoring when intensities are increased or decreased. Activities which require patients to move repeatedly between seated lying or standing postures should also be avoided, because of the fluctuations in blood pressure that they elicit.

Hypercholesterolaemia

Physical Exercise and Lifestyle Strategies are recommended for the management and reduction of Hypercholesterolaemia.

We recommend:

  • A high HDL diet
  • a low LDL diet
  • increase physical activity
  • stop smoking
  • reduce alcohol

If you would like to find out more about Fats and which ones we should eat please read my blog on –Why do we need to eat fats and which ones are good for us.

Depression

At BeMoore we know what it feels like to suffer from Depression and we are here to fully support our members with as much or as little as they want.

We strive to provide:

  • A relaxed and fun environment, where you can feel confident, let go, and be yourself.
  • A push to go that extra mile, or the space to relax and always be there for you when you need it.
  • Suitable, safe, and challenging exercises for all levels under one roof.
  • Support by collaborating with 3rd party healthcare professionals to help.
  • Healthy lifestyle advice whenever you need it.
  • A social environment where you can make more friends.
  • Support for you and your goals.
  • A place to offload and put aside.
  • Increased confidence.
  • A hug when needed.

Exercise will release endorphins and is often prescribed by doctors for depression.

Becki Moore suffered from Depression for many years and has experienced all the psychological, physical and antisocial symptoms that go along with it, as well as the side effects of antidepressants. Please feel free to find out more about her story.

Stress and Anxiety

Chronic levels of stress result in constantly high levels of cortisol circulating in the bloodstream.
This results in a lowered immunity to infection and increases susceptibility to illness, infection and disease.

Because the primary function of cortisol is to increase blood sugar through glucogenesis the metabolism of lean muscle tissue especially from skeletal muscles is inevitable.  This catabolic activity results in a reduced metabolic rate, and increased storage of fat tissue, particularly in the abdominal region.

Thus, chronic exposure to stress can be a contributing factor to a multitude of other medical conditions including obesity, hypertension, cardiovascular disease, and immunosuppression disorders.

Stress and anxiety are closely related. It is often difficult to tell them apart, anxiety can be triggered by stressful situations, or as a result of more complex and deeply rooted issues.

In the Initial management of stress, one should refer to self-help books and information to begin to regain control of their physical responses. Strategies such as relaxation techniques, time management and positive mental attitude are all methods in which patients can self manage the condition.

Becki Moore suffered from Stress and Anxiety for many years, she now has a CBT Coaching diploma and can support you through this process.

Counselling may be offered for many who have elevated stress levels which are combined with other risk factors, such as depression or post-traumatic stress disorders. This process allows one to identify the cause of stress,
as well as the symptoms and possible coping mechanisms that can be used to improve their condition. A progression of counselling (which may be cognitive behavioural therapy) gives the patients more specific support to focus on their stresses and how to deal with it.

Exercise and increase physical activity is extremely useful for patients who are suffering from stress, and it provides a distraction from common stresses.

Exercise allows the patient to manage their adrenal cortisol responses and can provide a clear release for negative emotions. A structured exercise program will also help to prevent the onset of other stress-related conditions like hypertension and atherosclerosis in addition to its protective effects from other health-related elements.

Diabetes Type I and Type 2

Exercise has long been considered an important element in diabetes treatment, especially with a type 2 diabetic because of its positive influence on insulin resistance.

Appropriate footwear is important, due to the risk of peripheral neuropathy, and ulcers. Those who are exercising alone should be aware of the importance of self-examination and advised how to conduct this by their healthcare or medical professional.

Before exercise participation blood glucose levels should be measured to determine the stability of blood glucose levels, and their stability suitability to participate. In cases where hypoglycemia is a risk, 15 to 30 grams of carbohydrate should be consumed to help stabilize blood glucose concentrations. It is also extremely important to monitor blood glucose post-exercise because patients are far more likely to experience hypoglycemia during this period, due to the replenishment of muscle glycogen.

A carbohydrate drink or meal within 60 minutes of the exercise session is strongly recommended.

It is also important that one does not exercise too close to bedtime, especially when living alone. If one were to experience post-exercise hypoglycemia while sleeping, the likelihood of detection, unless somebody tried to wake them would be slim. In these circumstances, the patient could slip into a diabetic coma.

There are many psychological benefits associated with regular participation in exercise. These benefits are equally applicable to a diabetic patient because the burden of diabetes can have a detrimental effect on psychological well being.

The frequency, intensity and mode of exercise appropriate to the patient will largely depend on individual capabilities and requirements.

Patients with type 2 diabetes should seek exercise every second or third day to maintain improvements in glycemic control.

Because type 1 diabetics are likely to need to adjust their insulin usage around exercise and physical activity. It may be more appropriate to exercise daily and maintain a structured routine whereby insulin is taken at the same time each day. This will help to improve the management of the condition.

To avoid hypoglycemia one should inject insulin in the sites, away from the muscles, they will be using most during exercise. Additionally, insulin injection sites should be rotated regularly, whether exercising or not.

Diabetics that significantly increase their level of lean mass are unlikely to observe a reduction in their exogenous insulin requirements. Because muscle tissue is insulin dependent such patients will require more insulin to supply the new tissues with glucose.

A patient should not exercise if:

  • If they have an active retinal haemorrhage
  • illness or infection is present,
  • blood glucose levels exceeding 13.8 with unary ketones
  • blood glucose levels lower than 4.4. due to the risk of hypoglycemia.

The following caution should be taken:

  • have a source of carbohydrate available during the exercise session that does not contain fat (ie fruit, vegetables, cereal)
  • consume fluids before during and after exercise
  • practice good foot care by wearing proper training shoes and cotton socks. A thorough examination should also be conducted.
  • ensure medical identification with details of the condition is carried.
  • ensure any other medications being prescribed are at hand.
  • ensure all medications have been taken as part of the management or treatment plan for the day.

Obesity

Weight-bearing exercises or those environments involving high impact are likely to add considerable strain to both the skeleton and that increase the risk of osteoarthritis and back pain

Low impact and non-weight bearing exercises might be more suitable in the early stages of exercise programming.
Once a base level of strength has been established and when body weight reduces, high impact activities can then be incorporated

Emphasis on fat burning during exercise is not as important as total energy expenditure. Often, too much emphasis is placed on keeping in the fat burning zone. The ACSM recommends between 1250 to 2000 calories per week or 200 to 300 minutes per week of physical exercise.

Exercises in a prone or supine position should be avoided due to the adverse effects on blood pressure and should be performed in a seated or standing position instead.

As Nutrition Advisors, we may also monitor Nutritional intake.