Mike Gascoigne

Exercise Referrals

Qualifications:

REPs Level 2:

• Anatomy and Physiology
• Gym Instructor

REPs Level 3:

• Personal Trainer and Advanced Instructor
• Nutrition and Weight Management
• Exercise Referrals

Continuing Professional Development:

• Torso Training and Core Stability
• Circuit Training
• Psychology of Behaviour Change
• Nutrition for Sport and Exercise

First-aid and cardio-pulmonary resuscitation.

This page is mainly of interest to GPs, practice nurses and other health professionals who wish to refer their patients to an exercise instructor. However I have tried to write it in a user-friendly style so that it is also of interest to patients.

Level of Service

The following services are provided to patients who are referred for exercise:

• Personal consultations in the patient’s home or other familiar surroundings.
  
  
• Health screening and assessment of the patient’s ability to exercise.
  
  
• Lifestyle evaluation, including activity history, work and family circumstances, and any barriers to exercise.
  
  
• Motivational interviewing, to assess the patient’s readiness to change and help them make their own decisions.
  
  
• Evaluation of short-term and long-term goals.
  
  
• Fitness testing, including body composition, range of movement, cardiovascular output, and muscular strength and endurance. Tests to be repeated periodically to monitor improvement.
  
  
• Postural analysis.
  
  
• Exercise programme design. Exercises to be carried out at a suitable venue such as a leisure centre or gym, or in local parks and recreational spaces, or the patient’s own home.
  
  
• Migration of the programme to a familiar environment for long-term adherence. For example a programme that starts off in a gym might be migrated to the patient’s home, with suitable adaptations.
  
  

The service is available to patients with a wide range of health conditions, including the following:

• Stable and long established coronary heart disease, but not recent CHD. Patients with recent CHD should be referred to an instructor with the BACR phase IV qualification.
  
  
• Risk of CHD associated with other conditions (hypertension, hyperlipidaemia, etc.)
  
  
• Hypertension
  
  
• Peripheral arterial disease
  
  
• Obesity
  
  
• Diabetes type I and II
  
  
• Osteoporosis
  
  
• Arthritis (osteo and rheumatoid)
  
  
• Joint replacement
  
  
• Asthma and chronic lung disease
  
  
• Stroke
  
  
• Parkinson's disease
  
  
• Multiple sclerosis
  
  
• Common mental health problems (anxiety, stress and depression)
  
  

Patients requiring nutritional advice will be referred to a registered nutritionist, normally by referral back to the GP. I am qualified to give nutritional advice to healthy clients, including athletes, but not to patients on referral.

Empathy With the Patient

I had a heart attack and stent and now I’m running marathons. It means a lot to my clients who need to be motivated into exercise.

No Waiting Lists

Free initial consultation, then £35 for each one-hour session. Blocks of 5 sessions payable in advance. No NHS funding (nice if I could get it).

Why Not Refer to a Leisure Centre or Gym?

The majority of GP exercise referrals are to local leisure centres, run by the Council, where they have a gym, swimming pool and studios for group exercise sessions. Privately-owned leisure centres are also sometimes used, and there are referrals to walking groups and other outdoor leisure organisations.

The popularity of referrals to Council-owned leisure centres is for two reasons:

1. A wide variety of activities are available under one roof.
   
   
2. The NHS and the Council are similar organisations, operating from public funds, and they often make joint financial contributions to exercise referral schemes.

The disadvantage of referral to a leisure centre is that they are expensive places to run. Even in a Council-owned leisure centre that has the benefit of taxpayers' money, the most highly valued members of staff are those with marketing skills who can bring new people into membership. This means that patients arriving on exercise referral are often seen as potential long-term members, which might not be in their best interests.

Exercise referrals are normally intended for a limited period, usually about 12 weeks, with the intention that patients should be encouraged to make their own choices about long-term adherence to a healthy lifestyle. That's how it should work in theory, but in practice the process is influenced by the economics of running the leisure centre. At the end of the referral period, the patient is interviewed by an instructor who goes through the choices available, all listed in the leisure centre brochure, complete with timetable and pricing structure. No mention of local parks and recreational spaces, or walking clubs, running clubs, football clubs, or exercises to be done at home using low-cost equipment

The advantage of using independent instructors is that we are not involved in the economics of running a gym and are in a better position to help the patient to make the right choices. Normally I would take a patient to a gym for the first few sessions because it's the best place to establish an exercise routine and find out the patient's capabilities. Some patients might genuinely want to continue long-term at the gym, but for most of them it's not the right place and they tend to drift away. In particular, those with obesity problems feel embarrassed among the much slimmer and fitter regular gym clients. So it becomes necessary to migrate their gym exercises to other environments such as the local park and the patient's home, and there are ways to achieve the same results without using expensive equipment. Long-term adherence is achieved by incorporating the exercise routine into the patient's current lifestyle, taking account of employment, leisure time, home environment and personal and family circumstances.

Visiting Your Surgery

I am available for visits to surgeries and health centres in our local area including Blackwater, Camberley, Wokingham, Bracknell, Farnborough, Fleet and Aldershot. Please contact me if you would like to talk about the referral process and the services I have to offer, or if you would like to arrange a meeting with your practice manager.

Mike Gascoigne

(This page is under development, some photos will appear in this space)