BACPR Exercise Professionals Group BRITISH ASSOCIATION FOR CARDIOVASCULAR PREVENTION ... ·...

BRITISH ASSOCIATION FOR CARDIOVASCULAR PREVENTION AND REHABILITATION

Friday 13th May 2016Aston University, Birmingham

BACPR Exercise Professionals Group Spring Study Day

2 BACPR Exercise Professionals Spring Group Study Day

The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) is an affi liated group of the British Cardiovascular Society. BACPR is a multi-disciplinary body to represent and serve the interests of all professionals engaged in cardiac rehabilitation and aims to ensure programmes for cardiovascular prevention and rehabilitation are clinically effective and achieve sustainable health outcomes throughout the UK. Membership consists of a wide range of disciplines involved in improving cardiovascular health – typically including cardiologists, GPs, nurses, physiotherapists, dietitians, psychologists, occupational therapists, exercise physiologists and exercise instructors. Members are from both primary care and the acute sectors together with individuals from leisure services and the fi tness industry.

BACPR Education coordinates both the well-respected BACPR Specialist Level 4 Exercise Instructor qualifi cation and a range of short CPD courses for health and exercise professionals involved in cardiovascular prevention and rehabilitation. Delegates receive comprehensive peer reviewed course material and all courses are delivered by specialist professionals from the UK who are currently involved in the area of cardiovascular rehabilitation.

www.bacpr.com @bacpr.com

BACPR Exercise Professionals Spring Group Study Day 3

A very warm welcome to the 10th British Association for Cardiovascular Prevention and Rehabilitation- Exercise Professionals Group (BACPR-EPG) Study day. After the great success of 2015’s ‘Expanding our horizons’ study day, we are delighted to welcome you back again. This year we have pulled together another great programme with fantastic speakers, interesting topics (Diabetes, maintaining muscle mass, assessing fitness, High Intensity Interval training, and sports cardiology) and plenty of practical take home messages.

We have assembled an impressive array of highly acclaimed speakers to deliver the programme today, including our keynote speaker, Professor Andre La Gerche. Andre has come all the way from Australia to be with us today. As well as being an all-round nice guy and decent runner, Andre is also an expert in sports cardiology and exercise physiology and has explored extensively the effects of extreme exercise on the hearts of elite athletes. He has applied these novel discoveries in athletes to patients with diabetes, heart failure and vascular diseases of the lungs. We are delighted that he could make the trip!

The BACPR EPG, as a sub group of the BACPR, is a collaborative venture between three national groups of exercise specialists: the BACPR Exercise Instructor Network (EIN), the Association of Chartered Physiotherapists in Cardiac Rehabilitation (ACPICR) and the British Association of Sport and Exercise Sciences (BASES). We exist as an inter professional forum for the promotion of excellence in the exercise component of cardiovascular disease prevention and rehabilitation. This collaborative body of exercise professionals share

the common goal of ensuring that all client and patient groups, either with cardiovascular disease (CVD) or those at high risk of developing the disease receive quality assured evidence-based services relating to physical activity and exercise. In advance of the day I would like to take the opportunity to thank all of the EPG committee and the BACPR Education team for their tireless devotion to the preparations for today’s event.

So, without further ado, let’s get started. We encourage you to participate fully today by interacting with the speakers at every opportunity, during formal question and answer sessions at the end of their talks and during breaks and lunch. We want you to leave at the end of today with renewed enthusiasm for the great work that you do in cardiovascular disease prevention and rehabilitation and with new ideas and confidence to continually improve the quality of the services you provide. Please use the feedback forms to provide an honest evaluation – we really want to know if the programme has met your expectations.

Enjoy the day!

Brian Begg Chair of BACPR Exercise Professionals Group Study day

Dear Delegate,


Brian Begg BACPR Exercise Instructor Network

Katie Plant BACPR Exercise Instructor Network

Vicky Hatch BACPR Exercise Instructor Network

Dr Gordon McGregor BASES

Mark Campbell BASES

Samantha Breen ACPICR

Laura Burgess ACPICR

Prof John Buckley Founder member

BACPR Exercise Professionals Group Committee


BACPR Exercise Professionals Group Study DayProgramme – Friday 13th May 2016

8:45 – 9:15 Coffee, Registration and Exhibition

9:15 – 9:30 Welcome, housekeeping and BACPR EPG Update Brian Begg, Chair, BACPR EPG

Session 1: Chair: Brian Begg

9.30 – 10.20 Keynote: What does diabetes do to the heart and how much of these effects can be ameliorated by exercise?

Professor Andre La Gerche, Baker IDI Heart and Diabetes Institute

10.20 – 10.50 Encouraging everyday exercise for people with Type 1 and Type 2 diabetes

Dr Richard Bracken, Swansea University

10.50 – 11.20 Break and Exhibition

Session 2: Chair: Dr Joe Mills, BACPR President

11:20 – 11.50 Importance of maintaining muscle mass across the lifespan Dr Brendan Egan, University College Dublin

11.50 -12.20 Practical ways to assess aerobic fitness progress within your exercise classes

Professor John Buckley, University Centre Shrewsbury

12.20 – 12.30 Question and Answers to speakers

12:30 – 12:40 Oral Abstract Presentation Percentile values for maximal aerobic power of patients attending MyAction Cardiovascular Prevention and Rehabilitation programme according to gender and age

Neil Lockyer

12:40 – 12.50 Oral Abstract PresentationChanges in 6-minute walk test distance and heart rate walking speed index following a 12- week Imperial Cardiovascular Health and Rehabilitation programme

Tim Grove

12.55 – 13.25 ACPICR AGM

13.30 – 14.00 BACPR Exercise Instructor Network AGM

12.50 – 14.05 Lunch and Exhibition

Session 3: Chair: Laura Burgess

14.05 – 15.00 HIIT (High Intensity Interval Training) in Cardiac RehabShould we or shouldn’t we?

Dr Gordon McGregor Alison WelshStefan Birkett

15:00 – 15.45 When and at what dose does exercise become injurious to the heart?

Professor Andre La Gerche Baker IDI Heart and Diabetes Institute

15.45 – 16.00 Closing Remarks / Tea and Networking opportunity Brian Begg


Arrhythmia Alliance is a coalition of charities, professional medical organisations and industry groups that works to promote the timely diagnosis and effective management of arrhythmias. By raising awareness and campaigning for the improved detection and care of heart rhythm disorders, Arrhythmia Alliance aims to extend and improve the lives of the millions around the world that these conditions effect.

www.heartrhythmcharity.org.uk

The Dairy Council is a non-profi t making organisation with a remit to present evidence-based information on milk, dairy productions, nutrition and health to a range of stakeholders including healthcare professionals, consumers, researchers, the food industry and media. The Dairy Council is staffed by registered dietitians and registered nutritionists. All consumer nutrition materials have received Information Standard certifi cation from the Royal Society of Public Health and our workplace presentations for healthcare professionals have been endorsed by the British Dietetic Association.

www.milk.co.uk

At Human Kinetics, our mission is to produce innovative, informative products in all areas of physical activity that help people worldwide lead healthier, more active lives. We are committed to providing quality informational and educational products in physical activity and health fi elds that meet the needs of our customers.

humankinetics.com

This programme in Preventive Cardiology is delivered by an interdisciplinary team of academic staff from the National Heart and Lung Institute, together with senior clinicians from Imperial College Healthcare NHS Trust and visiting experts in the fi eld of cardiovascular prevention and rehabilitation. This programme is aimed at healthcare professionals with a role in prevention of cardiovascular disease.

www.imperial.ac.uk/medicine/study/postgraduate/masters-programmes/msc-pg-dip-and-pg-cert-preventive-cardiology/

LINC Medical is an established important supplier of medical equipment and devices to UK healthcare providers and operates nationwide. The Company’s mission is to provide excellent customer support and offer cost effective products that enhance the patients’ and medical professionals’ quality of life and working environment.

www.linc-medical.co.uk.

Nihon Kohden are a well-respected Japanese company who design and produce high quality, innovative patient monitoring solutions. We will be showing our unique mobile monitoring devices which are particular suitable for cardiac rehab.

www.nihonkohden.net

Enthusiastic and responsive, the University of Chester is committed to providing the very best in teaching, learning, research, student support and partnerships

www.chester.ac.uk/postgraduate/cvr

BACPR would like to thank the following sponsors, partners and supporters for their valued support of BACPR


Morning Sessions Chairs

Brian Begg

Brian, a Sport and Exercise Science graduate from the University of Limerick (Ireland), has worked in Cardiac Rehabilitation since 2005. He qualified as a BACPR Instructor in the same year, and has been a BASES Certified Exercise Practitioner since 2012.

Brian currently works for the Cardiac Rehabilitation team of Aneurin Bevan Health Board (South East Wales) and the Countryside Service of Caerphilly County Borough Council in an innovative partnership post. Brian is the Chair the Exercise Instructor Network and is the current chair of the BACPR Exercise Professional Group.

Dr Joe Mills

I graduated from Cambridge University with a First Class honours degree in Medicine/Economics in 1992, completed medical training in Cambridge & East Anglia in 1994 and was a British Heart Foundation junior research fellow from 1998 to 2001. I have been a consultant cardiologist at Liverpool Heart & Chest Hospital NHS FT since February 2007. My professional interests include cardiovascular rehabilitation (and it’s promotion), PCI (I am one of ten consultants providing acute/emergency interventions for acute coronary syndrome patients), transcatheter aortic valve implantation, and developing community CVD services – for which I am the clinical lead. I am ALS medical director for my Trust, cardiac lead for the Cheshire & Merseyside Strategic Clinical Network. I am current president of BACPR and relishing the challenges and opportunities that this responsibility affords.


Morning Sessions 9.30 - 10.20

Assoc Prof André La Gerche MBBS, PhD, FRACP, FESC

Andre is Head of Sports Cardiology at the Baker IDI Heart and Diabetes Institute Melbourne and a cardiologist at the Alfred Hospital and St Vincent’s Hospital Melbourne. He is an NHMRC Early Career Fellow and a NHF Future Leader Fellow.

Major research interests can be summarised as: “exertional symptoms require assessment during exertion” reflecting the fact that resting imaging is a poor surrogate of functional limitation. Andre has developed novel echocardiographic and CMR methodologies for assessment of the right ventricle and pulmonary circulation during exercise. These have been applied to the assessment of heart failure, congenital heart disease, pulmonary hypertension and athletes. He has over 90 peer-review publications and text-book chapters including publications in Circulation and the European Heart Journal.

Andre completed a PhD at the University of Melbourne and 4 years of post-doctoral research at the University Hospital of Leuven, Belgium studying the effect of endurance exercise on the heart. In particular, exercise CMR was used to understand the mechanisms of right ventricular arrhythmias.

ABSTRACT: What does diabetes do to the heart and how much of these effects can be ameliorated by exercise?

Diabetic cardiomyopathy is a controversial entity. Epidemiological data suggests that heart failure is increased 3- to 5-fold in patients with diabetes and yet a clear picture of the pathology remains elusive.

This presentation will discuss the factors in diabetes that may contribute to reduced exercise tolerance and heart failure, taking a perspective that includes peripheral and vascular factors as well as myocardial changes.

The data supporting exercise training to reduce cardiovascular events in diabetes is also lacking. This is perhaps unsurprising given that the cohort sizes required to power for such outcomes is beyond the practical limitations of most training studies. Thus we are forced to assess the effects of training on surrogates. The issue is which surrogates to choose.

Finally, it is important to consider the differential effects of exercise type. Intense exercise has a clearly different impact on glucose control than does low-intensity exercise. This has implications for the patients’ management of hypo and hyperglycemia.


Dr Richard Bracken

Dr Richard Bracken is an Associate Professor of Exercise Physiology at Swansea University. He is a board member and lifestyle lead for the Welsh Government-funded Diabetes Research Unit, Cymru (http://diabeteswales.org.uk/ ). He is Vice-Chair for the Exercise and Physical Activity study group of the European Association for the Study of Diabetes (http://www.easd.org/index.php?option=com_content&view=article&id=216:expas&catid=14:easd). His research aim is to explore the impact of exercise, nutrition and medication in the functional outcomes and energy metabolism of people with type 1 and 2 diabetes. In addition he works closely with the Welsh Institute of Bariatric and Obesity Surgery which similarly aims to improve the lifestyle of those patients recovering from bariatric surgery.

ABSTRACT; Encouraging everyday exercise for people with Type 1 and Type 2 diabetes

Regular exercise can aid in blood glucose management of people with type 1 and type 2 diabetes but many patients fail to reach physical activity minimum standards advocated by UK Department of Health/Chief Medical Officer. The reasons for this are multifaceted and sometimes specific to the type of diabetes. Major reasons include fears around acute disturbance of good blood glucose control whilst issues around time management also are important like the rest of the population. This talk will overview current research in type 1 and type 2 diabetes with a purpose of exploring why and how we should promote exercise for people with diabetes. In type 1 diabetes, insulin adjustment and carbohydrate intake around exercise should be made dependent on the characteristics of exercise (i.e. endurance activities or resistance exercise). The primary goal is to develop an individualised exercise management strategy that reduces glycaemic fluctuations acutely so that regular exercise can contribute to improved longer-term glycaemic control. In type 2 diabetes, given the larger numbers the emphasis is more related to improving physical activity amount and quality. In diabetes the major aim is to improve functional capacity and aid in developing a better quality of life.

Morning Session 10.20 - 10.50


Dr Brendan Egan

Dr Brendan Egan, UCD Institute for Sport and Health, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland. e: [email protected]

Brendan received his BSc in Sport and Exercise Science from the University of Limerick in 2003, and MSc in Sport and Exercise Nutrition from Loughborough University in 2004. His doctoral studies under the supervision of Dr. Donal O’Gorman at Dublin City University focussed on skeletal muscle adaptation to exercise, and in particular the continuity between acute molecular responses to individual bouts of exercise and the adaptations in skeletal muscle induced by exercise training. He was awarded his PhD in 2008, before moving on to the prestigious Karolinska Institute, Stockholm, Sweden where he completed his post-doctoral training in Prof. Juleen Zierath’s Integrative Physiology group at the Department of Molecular Medicine and Surgery. This work utilised animal models and in vitro cell systems to investigate the transcriptional regulation of skeletal muscle development and mechanisms of insulin resistance. He joined the faculty at UCD in 2011, and currently holds a position as Lecturer in Exercise Metabolism in the School of Public Health, Physiotherapy, and Sport Science. His current research investigates the molecular regulation of skeletal muscle function and adaptation with special interest in nutrition and exercise interventions to limit muscle wasting in elderly.

ABSTRACT: The importance of maintain muscle mass across the lifespan

Apart from its essential role in locomotion, muscle is an organ critical to healthy aging and shows remarkable adaptability to use, disuse and nutrition intervention. The loss of muscle mass and function as we age, known as sarcopenia, is a major threat to the health and independence of older adults. This contributes to a decrease in muscle strength and power, which are important predictors of balance, and therefore an increase the occurrence of falls and related mortality. Moreover, muscle wasting is observed in a range of diseases including cancer cachexia, COPD, PAD, heart failure and rheumatoid and osteoarthritis. While physical inactivity increases the likelihood and worsens the outcomes of muscle wasting, outcomes are worsened by enforced bed-rest and immobilisation. Exercise can offset the deleterious effects of aging on muscle mass and function, but the optimal prescription and its combination with nutrition intervention remains elusive. The traditional focus on aerobic exercise (e.g. walking) interventions has changed in favour of combined approaches that include resistance (strength) training. We are presently investigating models of ‘uncomplicated’ resistance training for older adults that focus on increasing whole-body strength and muscle mass, and may have application in other disease states where functional capacity is limited.

Morning Sessions 11.20-11.50


Prof John Buckley BPE, MSc, PhD, CSci, FBASES, FHEA

• ProfessorofAppliedExerciseScience,UniversityCentreShrewsbury

• ProgrammeandResearchLeadforActiveLivingandExerciseMedicine

• FellowoftheHigherEducationAcademy

• FellowoftheBritishAssociationofSport&ExerciseSciences(BASES)

• CharteredScientist;BASESAccreditedExercisePhysiologist

• FoundingChair,InternationalCouncilofCardiovascularPreventionandRehabilitation

• PastPresidentBACPR(2009–2011)

• FoundingCommitteeMemberofBACPR-EPG(2001–date)

• TutorformanyBACPRCourses

• PastChairofBASESDivisionofPhysicalActivityforHealth(2004–2008)

• FoundingChairofBASESExerciseforHealthPractitioners’InterestGroup

• ExercisePhysiologyAdvisortoSkillsActiveLevel4Standards

John’s post-doctoral work has included collaborative published research with Emeritus Professor Gunnar Borg, inventor of the Borg ratings of perceived exertion scales.

His experience over the years in exercise testing and prescription includes performing over 7500 functional capacity tests to clients, patients and athletes for individual exercise programmes. In addition to helping cardiac patients and exercise referral clients, he has helped hundreds of people train for half- and full-marathons following functional testing.

In 1988 John, as a Founding Managing Partner, started the Lifestyle Exercise & Physiotherapy Centre, Shrewsbury. For 21 years this business not only involved a specialist fitness centre and physiotherapy clinic, it provided contracted services in Exercise & Physiotherapy to the local PCT and Hospitals, including John’s front-line work as an Exercise and Cardiac Rehabilitation Specialist at the Royal Shrewsbury Hospital and the University Hospital of North Staffordshire. For 17 years from 1989 to 2006, his work was linked with teaching and research in the Physiotherapy School at Keele University. As Professor of Exercise Science he is a lead lecturer on the MSc Cardiovascular Health and Rehabilitation at the University of Chester and Programme Lead for BSc Health and Exercise Science and MSc Exercise Medicine at the new University Centre Shrewsbury.

For 14 years he was the Exercise Physiology Consultant to the national McArdle Disease and Neuromuscular Clinic now based at the University College Hospital London. John has authored and edited textbooks, numerous chapters in BACPR, BASES, and sports medicine manuals/guidelines, and he has published research in internationally renowned journals in the area of perceived exertion, exercise testing and prescription, and more recently on the effects of sedentary work on cardiometabolic health.

Morning Session 11.50-12.20


ABSTRACT: Practical ways to assess aerobic fitness progress within your exercise classes

The efficacy of cardiac rehabilitation has three core levels: i. for individual patient guidance/evaluation, service/programme outcomes and national audit outcomes. Exercise capacity and changes in function fitness continue to be one of the strongest outcomes influencing future morbidity, mortality and health service costs. In spite of this, a large majority of cardiac rehabilitation programmes continue not to assess or report patient changes in aerobic functional capacity. Yet most programmes, even if they do not perform a formal exercise test, have data on patient levels of fitness which is collected during the exercise training sessions. This presentation provides some key pointers of how information collected during exercise classes/sessions can easily be adapted so as to provide baseline and follow data, which can be used to support and motivate patients, highlight programme outcomes and which could be used to include in the future NACR data base.

Morning Sessions 11.50-12.20


Percentile values for maximal aerobic power of patients attending MyAction cardiovascular prevention and rehabilitation programme according to gender and age

Imperial College Healthcare NHS Trust, Imperial College London

Lockyer N, Grove TP, Edwards J, Harris N, Kovelis A, Jones JL, Connolly SB

Introduction: Normative values for VO2 max are commonly used to compare and rank individuals aerobic fitness in relation to the population average. They are typically expressed in percentiles and the American College of Sports Medicine (ACSM) has constructed tables that rank aerobic fitness levels but for apparently healthy individuals. Therefore, we sought to develop age and gender specific percentile values for cardiovascular patients attending the Imperial cardiovascular health programme (ICHP).

Methods: In total, 2701 patients (27% with cardiovascular disease (CVD), 73% at increased multifactorial risk, 63% male, mean age 62.7±9 years) completed a Chester Step Test at initial assessment, which estimated VO2 max from submaximal heart responses. Patients were divided into age categories; 40-49, 50-59, 60-69 and 70-79. The mean and standard deviation for VO2 max value within each age/sex/diagnostic combination were calculated, and a normal distribution with these properties was used to calculate a selection of percentile values.

Results: Overall, predicted VO2 max was 4.8 ml/kg/min (95% CI 2.7-7.0, p=<0.0001) lower when compared to ACSM percentile categories. VO2 max was 2.45 ml/kg/min (95% CI 2.45- 2.8, p=<0.0001) higher in patients at risk of CVD compared to patients with established CVD and women had a lower predicted VO2 max when compared to men (3.85 ml/kg/min, 95% CI 3.85-4.2, p=0.0001) (table 1).

Conclusion: This is the first study that presents age and gender specific percentile values for aerobic fitness in patients attending CHRP. This information provides useful reference data to enhance patient motivation and reduce the risk of cardiovascular disease.

Cardiovascular Health & Rehabilitation Programme, Imperial Healthcare NHS Trust

Charing Cross Hospital, Fulham Palace Road, London, W6 8RF

[email protected]

Oral Abstract Presentation 12.30-12.40


Fitness Percentiles for High CVD Risk Males

Fitness Percentiles for CVD Males

Age 40-49

Age 50-59

Age 60-69

Age70-79

Age 40-49

Age 50-59

Age 60-69

Age70-79

Percentile Predicted VO2 max Category Predicted VO2 max

99 53.1 48.1 44.2 42.6 49.7 45.0 43.0 39.6

95 47.7 43.3 40.2 38.4 Superior 44.2 40.6 38.3 35.3

90 44.8 40.8 38.0 36.2 41.3 38.2 35.7 32.9

85 42.9 39.1 36.5 34.7 39.3 36.7 34.0 31.4

80 41.3 37.7 35.4 33.5 Excellent 37.7 35.4 32.7 30.1

75 40.0 36.5 34.4 32.5 36.4 34.3 31.5 29.1

70 38.8 35.5 33.5 31.6 35.2 33.4 30.5 28.1

65 37.7 34.5 32.6 30.8 34.1 32.5 29.5 27.2

60 36.6 33.6 31.8 30.0 Good 33.0 31.6 28.6 26.4

55 35.6 32.7 31.1 29.2 32.0 30.8 27.7 25.6

50 34.6 31.8 30.3 28.4 31.0 30.0 26.8 24.8

45 33.6 30.9 29.6 27.6 29.9 29.2 26.0 24.0

40 32.6 30.1 28.8 26.9 Fair 28.9 28.3 25.1 23.2

35 31.6 29.1 28.0 26.1 27.9 27.5 24.2 22.3

30 30.5 28.2 27.2 25.2 26.7 26.6 23.2 21.4

25 29.3 27.1 26.3 24.3 25.5 25.6 22.1 20.5

20 27.9 26.0 25.3 23.3 Poor 24.2 24.5 21.0 19.4

15 26.4 24.6 24.2 22.1 22.6 23.3 19.6 18.2

10 24.4 22.9 22.7 20.6 20.6 21.7 17.9 16.6

5 21.5 20.4 20.5 18.4 17.7 19.4 15.4 14.3

1 16.1 15.6 16.5 14.3 Very Poor 12.2 15.0 10.7 10.0

n =75 n=187 n=423 n=190 n=49 n=165 n=154 n=125

Table 1. itness categories for maximal aerobic power according to age, gender and diagnostic group

12.30-12.40 Oral Abstract Presentation


Fitness Percentiles for High CVDRisk Female

Fitness Percentiles for CVD Females

Age 40-49

Age 50-59

Age 60-69

Age70-79

Age 40-49

Age 50-59

Age 60-69

Age70-79

Percentile Predicted VO2 max Category Predicted VO2 max

99 42.0 40.9 38.6 37.1 39.4 43.1 38.8 33.8

95 38.0 37.0 35.0 33.5 Superior 35.7 38.0 34.4 30.3

90 35.9 35.0 33.0 31.5 33.7 35.2 32.0 28.4

85 34.5 33.6 31.7 30.2 32.4 33.4 30.4 27.2

80 33.4 32.5 30.7 29.2 Excellent 31.3 31.9 29.1 26.2

75 32.4 31.5 29.8 28.2 30.4 30.6 28.0 25.3

70 31.5 30.7 29.0 27.4 29.6 29.5 27.0 24.5

65 30.7 29.9 28.2 26.7 28.8 28.4 26.1 23.8

60 30.0 29.2 27.5 26.0 Good 28.1 27.4 25.2 23.1

55 29.2 28.4 26.8 25.3 27.4 26.5 24.4 22.5

50 28.5 27.7 26.2 24.6 26.7 25.5 23.6 21.8

45 27.8 27.0 25.5 23.9 26.0 24.6 22.7 21.2

40 27.0 26.3 24.8 23.3 Fair 25.3 23.6 21.9 20.5

35 26.3 25.6 24.1 22.6 24.6 22.6 21.1 19.8

30 25.4 24.8 23.3 21.8 23.9 21.5 20.1 19.1

25 24.6 23.9 22.5 21.0 23.0 20.4 19.2 18.3

20 23.6 23.0 21.6 20.1 Poor 22.1 19.1 18.1 17.5

15 22.5 21.9 20.6 19.1 21.1 17.7 16.8 16.5

10 21.0 20.5 19.3 17.7 19.7 15.8 15.2 15.2

5 18.9 18.4 17.3 15.8 17.8 13.1 13.3 12.8

1 15.0 14.6 13.7 12.1 Very Poor 14.0 7.9 9.8 8.3

n =64 n=142 n=263 n=195 n=15 n=22 n=59 n= 56

Table 1. itness categories for maximal aerobic power according to age, gender and diagnostic group



12.40-12.50 Oral Abstract Presentation

Changes in 6-minute walk test distance & heart rate walking speed index following a 12- week Imperial cardiovascular health and rehabilitation programme

Imperial College Healthcare NHS Trust, Imperial College London

Grove TP, Jones J, Edwards J, Connolly SB

Introduction: Improvements in the 6-minute walk test (6MWT) distance is a key outcome measure following a cardiac rehabilitation programme (CRP) and is particularly useful in patients with a low functional capacity. In the absence of a practice test, such changes can be influenced by motivation and/or retest familiarity-efficiency. Therefore, we employed the heart rate walking speed index (HRWSI) to determine if the improvement in 6MWT distance following a CRP is related to a true physiological adaptation.

Methods: 39 patients (21 female), mean age 68.2 ± 9.8 years attended the 12 week Imperial Cardiovascular Health and Rehabilitation programme. Diagnostic groups are presented in table 1. All were assessed using the 6MWT on the initial and end of programme (EOP) assessment. Peak heart rate (HR), rating of perceived exertion (RPE) and the HRWSI were measured. HRWSI was calculated by dividing peak HR by the walking speed (meters per minute) multiplied by 10 to describe heart beats per 10 metres walked.

Results: Following the programme there was a significant improvement in the 6 MWT distance with a non-significant change in peak HR and RPE between the initial and EOP assessments (table 1).

Conclusions: The use of the HRWSI provides transparency on the physiological adaptations following a CRP and can also be used to help patients recognise the benefits of exercise training. For example, the average patient increased his/her 6MWT distance by 50.3 metres and decreased their HRWSI by 5.5, which translates in a saving of 6 heart beats for every 100 metres walked.



Table 1. Diagnostic groups and overall changes in 6MWT measurements

Variable Statistic IA (SD) EOP (SD) Mean change (95% CI) P value

Diagnosis- Angina- *ACS- *PAD- *CVA/TIA- Heart failure- *High CVD risk

7732119

------

------

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Total distance (metres) 290.1 (110.6) 340.5 (89.9) 50.3 (72.9-27.7) 0.0001

Heart walking speed index 24.2 (12) 18.7 (8) 5.5 ( 2- 8) 0.0009

Peak Heart rate (bpm) 98.8 (16.9) 98.4 (16.1) -0.4 (-1.8-2.6) 0.69

Peak ratings of perceived exertion

12.2 (2.4) 12.2 (1.5) -0.07 (0.8-0.7) 0.8

Average walking speed (metres/min)

48.3 (18.4) 56.7 (14.9) 8.3 (12.1-4.6) 0.0001

METs achieved 2.4 (0.5) 2.6 (0.4) 0.2 (0.34-0.1) 0.0001

*ACS= acute coronary syndrome, PAD= peripheral artery disease, CVA/TIA = cerebrovascular accident/transient ischemic attack, high CVD risk = high cardiovascular disease risk

Tim Grove Physical Activity Specialist Imperial Cardiovascular Health Service St Mary’s Hospital, Ground Floor, Acrow West, London, W2 1NY

[email protected]


Lunchtime Meetings

12.55 – 13.25

ACPICR AGM

13.30 – 14.00

BACPR Exercise Instructor

Network AGM


Afternoon Sessions Chair

Laura Burgess

Laura Burgess MCSP MSC works as a clinical specialist physiotherapist and cardiac rehabilitation manager at Wythenshawe Hospital, part of the University of South Manchester NHS Foundation Trust. She is on BACPR -EPG committee, is co chair of the Association of Chartered Physiotherapists in Cardiac Rehabilitation (ACPICR) and is a lecturer for two of the BACPR courses.


Dr Gordon McGregor PhD CSci

Gordon is a Clinical Exercise Physiologist and Research Fellow at University Hospital, Coventry with over 15 years experience in the field of cardiovascular disease prevention and rehabilitation. In his role as a clinical academic, he combines leading NHS clinical rehabilitation services with research into the effects of exercise training in clinical populations. Recent projects have investigated left ventricular remodelling in post MI patients and the role exercise training and electrical muscle stimulation in end stage renal disease and chronic heart failure. Currently he is leading a multi-centre study investigating high intensity interval training in UK Cardiac Rehabilitation programmes (HIIT or MISS UK). He is a BASES Accredited Exercise Physiologist/Chartered Scientist, elected BACPR council member, and is the immediate past Chair of the BACPR Exercise Professionals Group. Finally, he is a director of Atrium Health, a Coventry based Social Enterprise delivering NHS clinical services, maintenance exercise programmes and a wide variety of research initiatives.

Alison Welsh

Alison Welsh is currently a Masters by Research student at Edge Hill University. In collaboration with Liverpool Heart and Chest Hospital, the sole focus of the research is based upon HIIT within cardiac rehabilitation. Alison gained her BSc at the University of Central Lancashire in Sports Science. During this time, work experience at various physio and neuro-therapy centres, combined with voluntary work at a cardiac rehabilitation charity and undergraduate laboratory lead research, all contributed to a broadened interest in the rehabilitation sciences. Alison also studied abroad for one year in Maryland, USA; not only earning a starting spot on the varsity lacrosse team, but also a number of qualifications in Athletic Training. With a projected finish of the MRes in June, Alison will then go on to complete her PhD at the University of East Anglia. The focus will be upon neurophysiology within stroke rehabilitation and cognitive responses to exercise.

14.05-15.00 Afternoon Session


Stefan Birkett

Stefan is a PhD student from the University of Hull and is currently undertaking research in cardiac rehabilitation, specifically focusing on high intensity interval training (HIIT). The research aims to examine the physiological, psychological, safety and tolerability of HIIT in this specialist clinical population. The research will also form part of a large UK multi-centred randomised control trial which will compare HIIT and moderate intensity steady state exercise in UK cardiac rehabilitation programmes.

Previous to joining the University of Hull Stefan spent 6 years working for the NHS in cardiovascular rehabilitation as an exercise specialist, gaining substantial experience in risk stratification and exercise testing and prescription to complex cardiac patients. During his employment Stefan also completed an MSc in Cardiovascular Rehabilitation at the University of Chester. The research investigated oxygen consumption during each stage of the incremental shuttle walk test in cardiac participants with the data collected contributing to a publication in Sports Medicine titled ‘Oxygen costs of the incremental shuttle walk test in cardiac rehabilitation participants: An historical and contemporary analysis’.

ABSTRACT: HIIT (High Intensity Interval Training) in Cardiac Rehab: should we or shouldn’t we?

High intensity interval training continues to attract attention amongst CR practitioners as an alternative to conventional exercise training. Research from around the world highlights the potential for greater benefit with HIIT in clinical populations. However, studies have not been performed in the UK and there are many issues that may prevent HIIT protocols being adopted in CR. Can we recommend the use of HIIT in UK CR, or even, should we? Is it worth it? Is it just a fad? Should all programmes offer it? Most importantly, what are the realities and practicalities of actually doing HIIT in CR? This session aims to discuss these issues and answer some (not all!) of your questions about HIIT. Three practitioners form CR programmes in the UK, who are currently involved in HIIT trials, will offer their thoughts and experiences on work completed to date.

Afternoon Sessions 14.05-15.00


Assoc Prof André La Gerche MBBS, PhD, FRACP, FESC

Andre is Head of Sports Cardiology at the Baker IDI Heart and Diabetes Institute Melbourne and a cardiologist at the Alfred Hospital and St Vincent’s Hospital Melbourne. He is an NHMRC Early Career Fellow and a NHF Future Leader Fellow.

Major research interests can be summarised as: “exertional symptoms require assessment during exertion” reflecting the fact that resting imaging is a poor surrogate of functional limitation. Andre has developed novel echocardiographic and CMR methodologies for assessment of the right ventricle and pulmonary circulation during exercise. These have been applied to the assessment of heart failure, congenital heart disease, pulmonary hypertension and athletes. He has over 90 peer-review publications and text-book chapters including publications in Circulation and the European Heart Journal.

Andre completed a PhD at the University of Melbourne and 4 years of post-doctoral research at the University Hospital of Leuven, Belgium studying the effect of endurance exercise on the heart. In particular, exercise CMR was used to understand the mechanisms of right ventricular arrhythmias.

ABSTRACT: When and at what dose does exercise become injurious to the heart?

The benefits of exercise are undeniable. However, emerging data paints quite a clear picture that large doses of intense exercise is associated with an excess of some arrhythmias, particularly atrial fibrillation.

This presentation will discuss the physiology underpinning athletic heart remodelling and how this may explain the athlete’s predisposition to arrhythmias. The physiological limitations of exercise performance in athletes will be compared with that of heart failure patients and this will be characterised using examples from novel exercise imaging techniques.

15.00-15.45 Afternoon Session


Poster Presentations

Please take time to visit this year’s poster presentations

FICardiac rehabilitation uptake and completion after LVAD implantation: the impact of education for local cardiac rehabilitation teams.

L. McGarrigle, University Hospital of South Manchester NHS Foundation Trust

F2 The effects of group-based exercise rehabilitation in stroke survivors

R., Sullivan, S., Meadows. School of Sport and Exercise Sciences, University of Kent

F3Evaluation of nutritional knowledge, understanding and practice of patients who attend a cardiac rehabilitation program in Preston

April Melia PhD student, Dr Stephanie Dillon (DoS) Professor Nicola Lowe (Supervisor) Dr Jonathan Sinclair (Supervisor) International Institute of Nutritional Sciences and Applied Food Safety Studies, College of Health and Wellbeing, University of Central Lancashire

F4

The efficacy of high intensity interval training compared with moderate-intensity interval training for patients undergoing cardiac rehabilitation

Welsh, A., Roose, A., Matata, B., Mills, J., Midgley, A.W. Knowsley Community Cardiovascular Service, Liverpool Heart and Chest NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, EnglandDepartment of Sport & Physical Activity, Edge Hill University, Saint Helens Road, Ormskirk, Lancashire

F5Percentile values for maximal aerobic power of patients attending MyAction cardiovascular prevention and rehabilitation programme according to gender and age

Lockyer N, Grove TP, Edwards J, Harris N, Kovelis A, Jones JL, Connolly SB. Imperial College Healthcare NHS Trust, Imperial College London

Expanding our Horizons 23


Poster PresentationsPlease take time to visit this year’s poster presentations

F6An investigation into METS expenditure during circuit exercise

S. Meadows, A. Mccrann, S. Sidoli, S. Wheeler, A. Bell School of Sport & Exercise Sciences, University of Kent

F7The effect of cardiac rehabilitation on the functional capacity of patients with different cardiac conditions

Kapsali E., Heffernan S., Byng A., Price D., Matthews A., Knight A., Marston D., Knowles K., Scott W., Wyatt L., Marsh H. Cardiac Rehabilitation, Nottingham University Hospitals NHS Trust

F8Changes in 6-minute walk test distance & heart rate walking speed index following a 12- week Imperial cardiovascular health and rehabilitation programme

Grove TP, Jones J, Edwards J, Connolly SB Imperial College Healthcare NHS Trust, Imperial College London



British Association for Nursing in Cardiovascular CareBritish Association for Cardiovascular Prevention and Rehabilitation

British Society for Heart Failure

Joint Affiliates DayWednesday 8th June 2016

‘Developing models and practice to enhance prediction and prevention’

Annual ConferenceManchester Central, 6th – 8th June 2016

Session 1 09.00 – 10:00 (Exchange 8, 9 ,10)Service Design Models

Keynote session Maximising quality and safety of care for people with heart failure

Professor Sandra Dunbar Charles Howard Candler Professor of Cardiovascular Nursing and Associate Dean at the School of Nursing, Emory University, United States Professor Dunbar is a cardiovascular nurse researcher whose programme of research has focused on improving outcomes for complex cardiovascular patients and their families

Session 2 10.45 – 12.15 (Main Auditorium)MDT Heart Failure Session

13.15 – 13.30 Hot Topic (Education Hall)Developing psychological skills amongst cardiovascular practitioners - Dr Angela Busuttil

Session 3 13:45 – 15:15 ( Exchange 8, 9 ,10)Advanced Practice RolesThe development of the extending roles of nurses and AHPs in cardiovascular care– Dr Jill Riley Developing a new role ………nurse sedation – Dr Stephen FurnissThe impact of non-medical prescribing – Jacqui CliffAdvanced practice roles …….a medical perspective – Professor Andrew Clark


Notes

Association of Chartered Physiotherapists in Cardiac Rehabilitation (ACPICR)

The Association of Chartered Physiotherapists in Cardiac Rehabilitation (ACPICR) is a professional network of the Chartered Society of Physiotherapy. Formed in 1995, the ACPICR welcomes professionals who are working in or interested in the exercise/physical activity components of cardiac rehabilitation.

The ACPICR provides, in association with the British Association for Cardiovascular Prevention and Rehabilitation high standard education via well established and well evaluated post graduate courses. ACPICR also develop and produce documents and resources to facilitate and support clinical excellence in cardiac rehabilitation. More information on the ACPICR and ACPICR publications can be found at www.acpicr.com

British Association of Sport and Exercise Sciences

BASES stands for the British Association of Sport and Exercise Sciences. BASES is the professional body for sport and exercise sciences in the UK. BASES is a Company Limited by Guarantee Registered in Cardiff No. 5385834.

Sport and Exercise Science is the application of scientific principles to the promotion, maintenance and enhancement of sport and exercise related behaviours.

Our Mission: Promoting excellence in sport and exercise sciences.

Our Vision: The professional body leading excellence in sport and exercise sciences through evidence-based practice

BACPR Exercise Instructor network

The Exercise Instructor (EIN) network is a formal subgroup of the BACPR, to support graduates from the BACPR Exercise Instructor Qualification. The EIN group is led by a committee of dedicated BACPR Exercise Instructors. Members of the EIN committee contribute to the BACPR Exercise Instructor training steering committee and the BACPR Exercise Professional Group.

BACPR Exercise Professionals Group

“Promoting excellence in cardiovascular disease prevention and rehabilitation”

www.bacpr.com

AffiliatedgroupoftheBritishCardiovascularSocietyCompanylimitedbyguarantee.RegisteredinEngland5086964

RegisteredCharityNo.1135639Registeredoffice9FitzroySquareLondonW1T5HW

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BRITISH ASSOCIATION FOR CARDIOVASCULAR PREVENTION AND REHABILITATION

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