Core Competences For The Physical Activity And Exercise Component - BACPR
British Association for CardiovascularPrevention and RehabilitationExercise Professionals GroupBRITISH ASSOCIATIONFOR CARDIOVASCULARPREVENTION AND REHABILITATIONCore Competences forthe Physical Activity andExercise ComponentSUMMERfnacac a lem t o rentdimaaMENTDIchHealthbehaviourchange andeducationpi tec t iveesAURAGEpio aCa rd therroTEANhegkPsyG-ialocos t hlr isLONMyle rts ctotaenemMLifefor Cardiovascular Disease Prevention and Rehabilitation ServiceseM fkr i s agnmaT AN D E VA L U AOTINThe Seven Core Componentsfor Cardiovascular DiseasePrevention and RehabilitationThe British Association for Cardiovascular Prevention and Rehabilitation is an affiliated group of the
ContentsIntroduction1A guide to using this document3The Competences5Competency 1:Core knowledge5Competency 2:Professional behaviour8Competency 3:Communication12Competency 4:Prepare, adapt and restore the environmentand equipment14Competency 5:Preparing the individual for supervised exercise16Competency 6:Assessment18Competency 7:Physical activity planning and exerciseprescription21Competency 8:Lead and/or deliver the supervised exercisesession23Competency 9:Forward planning26Competency 10: Managing the unwell individual28Competency 11: Educational materials30Competency 12: Service planning and management32Competency 13: Service evaluation35Glossary 37Acknowledgements 39References 40This document is the intellectual property of the British Association for Cardiovascular Preventionand Rehabilitation (BACPR).
IntroductionThis competency document has been compiled to complement the following:i. The American Association of Cardiovascular and Pulmonary Rehabilitation(AACVPR) Position Statement 2010 Update: Core competencies for cardiacrehabilitation/secondary prevention professionals .ii. The British Association for Cardiac Prevention and Rehabilitation (BACPR)Standards and Core Components for Cardiovascular Disease Prevention andRehabilitation 2012 .iii. The BACPR-Exercise Professional Group (BACPR-EPG) Position Statement(2012) Essential competences and minimum qualifications required to lead theexercise component in early cardiac rehabilitation.The BACPR has launched the second edition of the BACPR Standards and Core Components forCardiovascular Disease Prevention and Rehabilitation (March 2012). The seven core components includePhysical Activity and Exercise as part of Lifestyle Risk Factor Management for which staff leading theexercise component of cardiac rehabilitation (CR) should be appropriately qualified, skilled and competent.The BACPR-EPG has produced a Position Statement which outlines the essential competences andminimum qualifications required to lead the supervised exercise component in early cardiac rehabilitation.Having established the Position Statement, a working party representing the Exercise Professionals ofthe BACPR has now completed a supporting document which provides a framework that encompassesthe knowledge, skills and competences of all professional groups involved in delivery of the exercise andphysical activity component within CR. It is envisaged that this document will inform national practice andenable service providers and managers to ensure appropriate governance and safe and effective servicedelivery. In addition, it can be used as a useful tool to advise employers on standardised recruitment, givinga clear picture of the definition of a suitably qualified practitioner.Competent health and exercise professionals are essential to the successful delivery of a CR servicewhich meets the needs of the patient whilst promoting high quality CR services. This document providesguidance on the key competences required to ensure the use of best practice standards and guidelines forphysical activity and exercise prescription. In total, 13 core competences are outlined, identifying specificknowledge and skills for each core competency and a framework to assess the health professional’sability to demonstrate their competency. This document also serves as a tool to monitor the need forcontinuing professional development for the exercise professional and supporting staff to achieve specificcompetences.Standards and Core Components 2012 (2nd Edition) 1
BACPR Education coordinates the Specialist Level 4 Exercise Instructor qualification and a range of shortcourses for health and exercise professionals involved in cardiovascular prevention and rehabilitation. Tosupport potential staff training and professional development needs, the competences are aligned to theBACPR’s Education and Training courses. For further information visit the website: http://www.bacpr.com/educationThe working party to develop these competences, representing the Exercise Professionals withinCR included: Association of Chartered Physiotherapists with a special interest in Cardiac Rehabilitation (ACPICR),who produced ‘Core Competences for the exercise component of Phase III’ in 2005, revised 2008. BACPR Exercise Instructor Network (EIN) British Association of Sport and Exercise Sciences (BASES)All three representative organisations agreed to work together to produce one single document outliningthe competences required for the physical activity and exercise component of the patient’s journey throughcardiac rehabilitation.2British Association for Cardiovascular Prevention and Rehabilitation
A guide to using this document1.As part of the development process for this competency framework various documentswere utilised by the working group in the early scoping period. Our thanks have beenexpressed to the organisations responsible for the development/publishing of these documentswhich included:a) ACPICR Competences for the Exercise Component of the Phase III Cardiac Rehabilitation (2008)b) BACPR EPG Position statement (2012)c) BACPR Standards and Core Components for CR (2007, 2nd edition 2012)d) British Association of Sport and Exercise Sciences Accreditation Competency Profile (2009)e) Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update:position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation.J Cardiopulm Rehabil Prev. 31(1):2-10. Hamm LF, Sanderson BK, Ades PA et al. (2011)f) Position Statement of the AACVPR Core Competencies for CR /secondary preventionprofessionals (2010)g) Skills for Health National Occupational Standardsh) Skills Active National Occupational Standards (2010):i) Level 4 Unit D518ii) Level 3 Unit D463iii) Level 3 Unit D464iv) Other (no specified level): Full suite of Sports and Exercise Sciencei) Wellbeing South East Exercise Referral Accreditation System “Recognising Excellence” (2010)2.Each competency is laid out in a table format so that the responses can be recorded easilyand can be completed either electronically or on a hard copy.3.Within each competency, there is a series of numbered performance criteria (pc) andcolumns against which to record:a) The date the pc is achieved.b) Whether the pc is essential, desirable or not applicable (E, D, N/A respectively).c) Comments to identify perhaps, where further professional development is required to achieve thepc or to record specific exemplary areas of performance.4.At the end of each competency there is a summary table which records:a) A summary of performance observed: achieved/improvement required with comments/actionsas appropriate.b) Signatures of the reviewee and the reviewer to validate the recorded response and agreedoutcomes.Standards and Core Components 2012 (2nd Edition) 3
5.Evidence to determine success of a staff member to fulfil the criteria can be achievedthrough various methods, e.g.:a) Practical observationb) Verbal communicationc) Questioningd) In-service traininge) Mandatory trainingf) External coursesg) Other resources, e.g. BACPR and ACPICR standards.6.It is not intended that observation and/or achievement of these competences should be atime consuming exercise. It is therefore recommended that reviewers and reviewees considerthis document as a useful tool to monitor performance and subsequent professional developmentrequired over a period of time (to be defined internally) rather than a lengthy process that is timeconsuming and impacts negatively on service delivery.7.As the document relates to the competences required for delivery of physical activityand exercise provision across the patient’s journey through CR, not all competences willbe relevant to each member of staff. Hence, not all 13 competences and relating pc need to beachieved.8.It is the responsibility of the Manager/Reviewer to determine if the competency or pc isessential, desirable and/or relevant to the member of staff.9.Each competency is also mapped against BACPR Education and Training courses to identifyappropriate training for the reviewee if applicable.10. The competences can be linked with the NHS Agenda for Change Knowledge and SkillsFramework (KSF) and therefore used as evidence for the KSF.11. The reviewer ideally should be competent in assessing an individual’s ability according tothe competences outlined and have a sound understanding of the skills required to deliver safeand effective physical activity and exercise prescription in CR. It is recommended however, that areviewer holds a relevant assessor qualification to enable objective assessment of the reviewee’sknowledge and ability.12. After successful completion of the competences, it is recommended that the competences willbe reviewed as part of an annual appraisal to ensure competency is maintained, or in response tonew published evidence and/or changes to national or local guidance.4British Association for Cardiovascular Prevention and Rehabilitation
Performance criteriaDate achieved E,D,N/A*CommentsStandards and Core Components 2012 (2nd Edition) Pathophysiology of cardiovascular conditions andrelated signs and symptoms.Cardiovascular assessments, diagnostictests, interventions and medical and surgicalmanagement.Timescales for recovery after a new cardiacdiagnosis or event.Cardiac arrhythmias (e.g. complex PVCs, atrialfibrillation, SVT) and their influence on physicalactivity and symptoms.Beneficial effects and potential risks of physicalactivity and exercise on CVD.1.31.41.51.61.7* Key: E Essential D Desirable N/A Not applicableProcess of arteriosclerosis and pathogenesis ofcardiovascular risk factors. Physiology AnatomyCardiovascular:1.21.1In relation to physical activity and exercise, the Cardiac Rehabilitation Professional has demonstrated knowledge and understanding of:No.Competency 1: Core knowledgeCompetency 1: Core knowledge5
6Physiological responses (normal and abnormal) toacute exercise and adaptations to chronic exercise.Risk stratification according to assessment of theindividual.1.81.9British Association for Cardiovascular Prevention and Rehabilitation* Key: E Essential D Desirable N/A Not applicable1.14 Current recommendations (FITT) for exercise andphysical activity for individuals with CVD.1.13 Co-morbidities, limiting or otherwise that mayinfluence an individual’s ability to exercise orundertake physical activity.1.12 Absolute and relative contraindications to exerciseand indications to terminate an exercise session.1.11 Exercise prescription methodology forcardiovascular endurance exercise and resistancetraining in patients with heart disease.1.10 Submaximal functional capacity testing.Performance criteriaNo.Date achievedE,D,N/A*CommentsCompetency 1: Core knowledge
Performance criteriaStandards and Core Components 2012 (2nd Edition) Print Name:Print Name:CommentsDate:Date:Date:BACPR Education & Training Course References: (i) BACPR Level 4 Exercise Instructor Training; (ii) Physical Activity & Exercise in the Management of CVD Part 1: Principles & Practicalities & Part II:Advanced Application; (iii) Assessing Functional Capacity; (iv) Adapting Exercise; (v) Monitoring Exercise IntensitySigned Reviewer:Comments:Yes - competency achievedE,D,N/A*(outline as appropriate)Date achievedSigned Reviewee:Agreed ActionImprovement requiredCompetency achieved:* Key: E Essential D Desirable N/A Not applicable1.18 Relevant national standards, policies andguidelines.1.17 Effective behaviour change strategies based oncommon theoretical models and adult learningstrategies.1.16 Pharmacologic therapy for CVD and risk factormanagement.1.15 Metabolic requirements for recreational,occupational, and sexual activities.No.Competency 1: Core knowledge7
8Date achieved E,D,N/A*CommentsBritish Association for Cardiovascular Prevention and Rehabilitation Be respectful of individuals and of theirrights, recognising physical, psychological,environmental, cultural and socio-economicdifferences, adopting good practice inchallenging discrimination and unfairness. Ensure practice in a non-discriminatory manner(in line with the Equality Act, 2010).Equality and diversity work in accordance with evidence based practiceand recognised best practice deliver services which comply with theirprofessional code of conduct & relevant medicolegal requirements practice within legal and ethical boundaries continuing professional development includingrevalidation CRB clearance or equivalent appropriate liability and indemnity insurance current professional body registrationShow evidence of:General* Key: E Essential D Desirable N/A Not applicable2.22.1The Cardiac Rehabilitation Professional is able to demonstrate adherence to the highest standard of ethical and professional behaviour and has demonstrated the ability to:No. Performance criteriaCompetency 2: Professional behaviourCompetency 2: Professional behaviour
Standards and Core Components 2012 (2nd Edition) Ensure the individual’s privacy, dignity, wishesand beliefs are respected, whilst minimising anyunnecessary discomfort. Exercise the professional duty of care and to actin the best interests of the individual at all times.Duty of care Understand the importance of, and be able toobtain informed consent and be compliant withlocal and national policies.Informed consent Provide evidence of comprehensive and accuraterecord keeping in line with local protocols asappropriate.* Key: E Essential D Desirable N/A Not applicable2.52.4Confidentiality and record keeping2.3 Demonstrate compliance with the DataProtection Act, Information Governance andCaldicott principles.Performance criteriaNo.Date achievedE,D,N/A*CommentsCompetency 2: Professional behaviour9
10Working relationships2.6British Association for Cardiovascular Prevention and Rehabilitation* Key: E Essential D Desirable N/A Not applicable you act as a good role model mentor support for colleagues is provided development of the knowledge and practice of others professional boundaries and standards of others are respected work is within your own scope of practice and expertise, and ifnot, you seek advice or refer to another professional integrity and high standards of professional conduct ensuringavoidance of any inappropriate behaviour avoidance of any conflict of interest avoidance of misrepresentation co-operation accuracy honestyConduct professional working relationships with individuals,significant others, colleagues and partners / stakeholders, to ensure:Performance criteriaNo.Date achievedE,D,N/A*CommentsCompetency 2: Professional behaviour
Health and safety2.7Standards and Core Components 2012 (2nd Edition) Print Name:Print Name:E,D,N/A*BACPR Education & Training Course References: (i) BACPR Level 4 Exercise Instructor Training; (ii) BACPR Standards and Core Component Study DaySigned Reviewer:Comments:Yes - competency achieved(outline as appropriate)Date achievedSigned Reviewee:Agreed ActionImprovement requiredCompetency achieved:* Key: E Essential D Desirable N/A Not applicableBe aware of and compliant with, applicable health and safetylegislation, including incident reporting and be able to actaccordingly.Performance criteriaNo.CommentsDate:Date:Date:Competency 2: Professional behaviour11
12Date achieved E,D,N/A*CommentsBritish Association for Cardiovascular Prevention and RehabilitationUse interpersonal skills and active listeningtechniques to encourage understanding,cooperation, informed decision-making and activeengagement with individuals.Select, use and adapt communication methodsin a format and at a level that is based upon theindividual / group needs and abilities (e.g. verbaland non-verbal).3.23.3* Key: E Essential D Desirable N/A Not applicableCommunicate effectively in consideration ofindividual differences: culture, age, ethnicity,gender, religious beliefs, socio-economic status,physical, emotional, psychological, educational andenvironmental factors.3.1The Cardiac Rehabilitation Professional is able to communicate effectively with the individual, relatives, carers & professional others, and has demonstrated the ability to:No. Performance criteriaCompetency 3: CommunicationCompetency 3: Communication
Establish and maintain effective communicationwith and between team members, health careprofessionals and partners / stakeholders, exploringdiffering perspectives to reach consensus onrequired future action.Provide timely and accurate reports and handovers(communicating current status, progress andphysical activity / exercise outcomes) to ensureseamless transition between agencies / serviceproviders.3.53.6Standards and Core Components 2012 (2nd Edition) Print Name:Print Name:BACPR Education & Training Course References: BACPR Level 4 Exercise Instructor TrainingSigned Reviewer:Comments:Yes - competency achieved(outline as appropriate)Date achieved E,D,N/A*Signed Reviewee:Agreed ActionImprovement requiredCompetency achieved:* Key: E Essential D Desirable N/A Not applicableShow sensitivity and empathy when respondingin a non judgemental manner, to concerns andquestions raised by individuals, giving clear,concise and accurate information (verbal andwritten).3.4No. Performance criteriaCommentsDate:Date:Date:Competency 3: Communication13
14Date achieved E,D,N/A*British Association for Cardiovascular Prevention and RehabilitationIdentify potential risks and minimise any resultinghazards in the environment where the sessionwill take place, e.g. inadequate heating, lighting,ventilation, humidity.Ensure that any necessary equipment, furnitureor resources are prepared, available, in a fit stateand ready for use, and if not, take any necessaryremedial action.Follow the correct procedures and protocols toreport and record problems with the environment,equipment and materials.Ensure availability of appropriate resuscitationequipment which is checked and ready for use.4.24.34.44.5* Key: E Essential D Desirable N/A Not applicableApply national health & safety guidelines and localoperational policies when conducting environmentalhealth and safety assessments.4.1The Cardiac Rehabilitation Professional has demonstrated the ability to:No. Performance criteriaCommentsCompetency 4: Prepare, adapt and restore the environment and equipmentCompetency 4: Prepare, adapt and restore the environment and equipment
Move and handle equipment and resources in anappropriate, safe manner which is consistent withcurrent legal and organisational requirements.Return equipment, furniture and resources tothe correct location for storage or transportationafter use and leave the environment in a conditionsuitable for future use.Ensure compliance to current organisationalinfection control requirements.4.74.84.9Standards and Core Components 2012 (2nd Edition) Print Name:Print Name:BACPR Education & Training Course References: BACPR Level 4 Exercise Instructor TrainingSigned Reviewer:Comments:Yes - competency achieved(outline as appropriate)Date achieved E,D,N/A*Signed Reviewee:Agreed ActionImprovement requiredCompetency achieved:* Key: E Essential D Desirable N/A Not applicableAdapt exercise equipment and the environmentduring exercise sessions as appropriate4.6No. Performance criteriaCommentsDate:Date:Date:Competency 4: Prepare, adapt and restore the environment and equipment15
16Date achieved E,D,N/A*British Association for Cardiovascular Prevention and RehabilitationIdentify and respond to any information about theindividual’s response to the previous session or anychange in physical condition, through pre-exercisescreening and appropriate use of clinical measures.Negotiate, agree and record with the individual anychanges to the planned activities.Ensure individuals have all necessary medicationplus blood glucose management requirements asappropriate.5.25.35.4* Key: E Essential D Desirable N/A Not applicableEnsure the individual understands the purpose,structure, procedures and objectives of the sessionand how these link to their goals.5.1The Cardiac Rehabilitation Professional has demonstrated the ability to:No. Performance criteriaCommentsCompetency 5: Preparing the individual for supervised exerciseCompetency 5: Preparing the individual for supervised exercise
Date achieved E,D,N/A*Ensure individuals are appropriately dressedand equipped for exercise, e.g. footwear, loosecomfortable clothing, heart rate monitor if required.5.6Standards and Core Components 2012 (2nd Edition) Print Name:Print Name:CommentsDate:Date:Date:BACPR Education & Training Course References: (i) BACPR Level 4 Exercise Instructor Training; (ii) Physical Activity & Exercise in the Management of CVD Part I: Advanced Application.Signed Reviewer:Comments:Yes - competency achieved(outline as appropriate)Signed Reviewee:Agreed ActionImprovement requiredCompetency achieved:* Key: E Essential D Desirable N/A Not applicableReinforce the rationale for a safe and effectiveexercise session and the way in which this can beachieved.5.5The Cardiac Rehabilitation Professional has demonstrated the ability to:No. Performance criteriaCompetency 5: Preparing the individual for supervised exercise17
18Date achieved E,D,N/A*CommentsCollate and interpret information prior to theassessment.Welcome the individual and explain the assessmentprocess.Ascertain:6.26.36.4British Association for Cardiovascular Prevention and RehabilitationIdentify current medications and the implications forphysical activity / exercise.Ascertain previous and current levels of physicalactivity / exercise through discussion and usingappropriate validated tools.Assess the individual’s readiness to participate:adopt appropriate behavioural change strategiesand motivational interviewing techniques toestablish and agree physical activity / exerciseshort and long term goals.6.66.76.8* Key: E Essential D Desirable N/A Not applicableIdentify inappropriate referrals includingconsideration of any absolute / relativecontraindications to exercise (in line with BACPRguidelines) and deal with these according to localprocedure.6.5 current symptoms co-morbidities and functional impairment past and current cardiac status relevant past medical historyObtain an approved referral document containingsufficient and meaningful information.6.1The Cardiac Rehabilitation Professional has the ability to assess the individual’s needs and abilities before planning exercise and physical activity, and candemonstrate the ability to:No. Performance criteriaCompetency 6: AssessmentCompetency 6: Assessment
Conduct and record appropriate serialmeasurements of:6.9Standards and Core Components 2012 (2nd Edition) * Key: E Essential D Desirable N/A Not applicable Other: 6 min walk test Cycle ergometer test Incremental Shuttle Walk Test Chester step test6.12 Select and conduct an appropriate sub-maximalfunctional capacity assessment, in line withprotocols:6.11 Undertake comprehensive risk stratification forexercise in line with recognised guidelines (e.g.BACPR and AACVPR guidelines).6.10 Conduct and record an ECG in line with availableequipment Pulse oximetry Blood glucose RPE heart rate (palpation and heart rate monitoringdevices) blood pressure (automated and manual)Performance criteriaNo.Date achieved E,D,N/A*CommentsCompetency 6: Assessment19
20Performance criteriaBritish Association for Cardiovascular Prevention and RehabilitationPrint Name:CommentsBACPR Education & Training Course References: (i) BACPR Level 4 Exercise Instructor Training; (ii) Assessing Functional Capacity; (iii) Monitoring Exercise IntensitySigned Reviewer:Print Name:Comments:Yes - competency achieved(outline as appropriate)Date achieved E,D,N/A*Signed Reviewee:Agreed ActionImprovement requiredCompetency achieved:* Key: E Essential D Desirable N/A Not applicable6.14 Ensure the time taken to conduct the assessmentreflects the process and information to becollected. exercise prescription physical activity plan6.13 Critically evaluate the information collected todetermine:No.Date:Date:Date:Competency 6: Assessment
Date achieved E,D,N/A*Prescribe and adapt safe and effective exerciseappropriate to the individual’s needs in line withguidelines and the FITT principle for:7.2* Key: E Essential D Desirable N/A Not applicable other e.g. balance, coordination flexibility resistance exercise cardiovascular endurance exercise warm up and cool downAgree an individualised physical activity plan withSMART goals including activities of daily living anda home / unsupervised programme.7.1The Cardiac Rehabilitation Professional has demonstrated the ability to:No. Performance criteriaCommentsCompetency 7: Physical activity planning and exercise prescriptionCompetency 7: Physical activity planning and exercise prescriptionStandards and Core Components 2012 (2nd Edition) 21
22British Association for Cardiovascular Prevention and RehabilitationUse objective physiological measures to informindividualised exercise prescription, e.g. METs, HR,RPE.Encourage effective use of appropriate resourcesto help the individual achieve agreed goals andobjectives, e.g. self help manuals, activity diariesetc.Educate and support individuals on safe andeffective independent physical activity / exerciseincluding appropriate warm up and cool down,signs and symptoms of over-exertion or underachievement and activities to avoid.Review and adapt the physical activity plan andexercise prescription in response to the individual’smotivation, needs and ability, and progress /regress the prescription accordingly.7.37.47.57.6Print Name:Print Name:CommentsDate:Date:Date:BACPR Education & Training Course References: (i) BACPR Level 4 Exercise Instructor Training; (ii) Assessing Functional Capacity; (iv) Adapting Exercise; (iii) Monitoring Exercise IntensitySigned Reviewer:Comments:Yes - competency achieved(outline as appropriate)Date achieved E,D,N/A*Signed Reviewee:Agreed ActionImprovement requiredCompetency achieved:* Key: E Essential D Desirable N/A Not applicablePerformance criteriaNo.Competency 7: Physical activity planning and exercise prescription
Date achieved E,D,N/A*Standards and Core Components 2012 (2nd Edition) * Key: E Essential D Desirable N/A Not applicableProvide individuals with warm up and cool-downexercises that are appropriate to their clinical statusand ability.8.5Utilise other members of staff appropriately duringthe exercise session to ensure safe and effectiveclass management.8.3Structure and lead exercise sessions in line with theFITT principle appropriate to individual needs andfunctional abilities.Establish and justify the staff / patient ratio basedon supervision requirements and risk stratification.8.28.4Teach, review and adapt individual and groupexercise in response to changing circumstancesand individual’s response to exercise.8.1The Cardiac Rehabilitation Professional has demonstrated the ability to:No. Performance criteriaCommentsCompetency 8: Lead and/or deliver the supervised exercise sessionCompetency 8: Lead and/or deliver the supervised exercise session23
24British Association for Cardiovascular Prevention and RehabilitationProvide instruction, explanations and exercisedemonstrations that are technically correct andappropriate to the individual’s / group’s needs.Monitor the individual’s exercise performance by:8.78.8Effectively use verbal instruction, demonstration,audio and visual cues, and motivational techniqueswhen delivering group exercise. Adapting the monitoring method as determinedby the individual’s progress and theirunderstanding of self-monitoring. Observing individuals throughout the exercisesession and taking appropriate action asrequired. Determining how and when to effectively monitorindividuals. Being aware of the individual’s response toexercise and taking appropriate action asrequired.* Key: E Essential D Desirable N/A Not applicable8.9Provide a conditioning component which isindividualised according to the needs of theindividual.8.6 Using subjective (e.g. RPE) and objective (e.g.HR, BP) methods to effectively monitor exerciseintensity.Performance criteriaNo.Date achieved E,D,N/A*CommentsCompetency 8: Lead and/or deliver the supervised exercise session
Observe and analyse individual’s exerciseperformance and correct their technique atappropriate points providing positive reinforcementthroughout.Teach and monitor the performance of allindividuals within a group setting.Provide individuals with an appropriate period ofpost exercise supervision.8.108.118.12Standards and Core Components 2012 (2nd Edition) Print Name:CommentsDate:Date:Date:BACPR Education & Training Course References: (i) BACPR Level 4 Exercise Instructor Training; (ii) Physical Activity & Exercise in the Management of CVD Part I: Advanced Application.Signed Reviewer:Print Name:Comments:Yes - competency achieved(outline as appropriate)Date achieved E,D,N/A*Signed Reviewee:Agreed ActionImprovement requiredCompetency achieved:* Key: E Essential D Desirable N/A Not applicablePerformance criteriaNo.Competency 8: Lead and/or deliver the supervised exercise session25
26Date achieved E,D,
Absolute and relative contraindications to exercise and indications to terminate an exercise session. 1.13 Co-morbidities, limiting or otherwise that may influence an individual's ability to exercise or undertake physical activity. 1.14 Current recommendations (FITT) for exercise and physical activity for individuals with CVD. * Key: E
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