REPs Journal - Sept 10

Produced in association with

Journal

September 10 l issue 18

Looking to the future with John GreenwayWhat you think about REPsPre and post-natal exerciseCancer rehabilitationPluS all the latest news

The RegisTeR of exeRcise PRofessionals

Third floor, 8-10 Crown Hill, Croydon, Surrey CR0 1RZ Telephone 020 8686 6464 www.exerciseregister.org

Registrar Jean-Ann Marnoch Registration Manager Alison Frater [email protected] systems manager Rob McGregor [email protected] cPD compliance Manager Dottie Calderwood [email protected]

QualificaTions & TRaining sTanDaRDs skillsactive Castlewood House, New Oxford St London WC1A 1PX Telephone 020 7632 2000

Technical unit [email protected]

eDiToRial Publisher: Tor Davies, sportEX editor: Sarah Owen, REPs [email protected]

aDveRTising enQuiRies Telephone: 0845 652 1908 email: [email protected] Design & PRoDucTion Debbie Asher [email protected] PublisheD by sportex (Centor Publishing Ltd) contact: Tor Davies [email protected] Telephone: 0845 652 1906 Website: www.sportex.net

DISCLAIMERWhile every effort has been made to ensure that all information and data in this magazine is correct and compatible with national standards generally accepted at the time of publication, this magazine and any articles published in it are intended as general guidance and information for use by healthcare professionals only, and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. To the extent permissible by law, the publisher, editors and contributors to this magazine accept no liability to any person for any loss, injury or damage howsoever incurred (including by negligence) as a consequence, whether directly or indirectly, of the use by any person of any of the contents of the magazine. Copyright subsists in all material in the publication. Centor Publishing Limited consents to certain features contained in this magazine marked (*) being copied for personal use or information only (including distribution to appropriate members of the public) provided a full reference to the source is shown. No other unauthorised reproduction, transmission or storage in any electronic retrieval system is permitted of any material contained in this publication in any form. The publishers give no endorsement for and accept no liability (howsoever arising) in connection with the supply or use of any goods or services purchased as a result of any advertisement appearing in this magazine.

www.exerciseregister.org 03

04 Guest Interview: REPs Chair John Greenway shares his hopes for the future

05 What’s new from REPs

07 The latest news from the industry

11 John Searle looks at setting goals

12 REPs Customer Survey - how you think we’re doing

14 A guide to pre and post-natal exercise

17 Exercise for cancer rehabilitation

20 Tax advice on cars

21 Insurance assurance

22 Client leaflet – immediate injury treatment

I know people talk about January being a prime time for exercising but I’m sure, like me, for most people in the fitness industry September always feels like a new year. Perhaps it’s post summer vigour, Leisure Industry Week or even a hang-over from school days but for me it always seems like a good time to take stock of what’s been happening over the previous 12 months.

We’ve been working hard this year on increasing awareness of REPs both amongst the health sector and the public. We’ve produced REPs plaques and boards for clubs and centres to display and have distributed pin badges to our members and are working on other marketing materials.

REPs is now represented on the FIA Exercise Referral Steering Group and FIA Joint consultative forum (a body of six representatives from the fitness industry and representatives from six Royal Medical Colleges) to help bring our sectors closer together in a common bid to improve the nation’s health. We were also involved in the British Heart Foundation Exercise Referral Tool Kit working group ensuring health practitioners know why it is advisable to only refer patients to REPs registered instructors.

Following our presence at the Royal College of Nurses Congress (including exercise classes for delegates!) we’ve now been invited to attend the conferences of both the Chartered Society of Physiotherapists and the British Heart Foundation.

We will, of course, continue to raise standards and professionalise the industry, build the profile and commitment to REPs across the health, exercise and fitness sectors, improve the value of REPs membership and help our members achieve the professional status they so deserve and desire.

Jean-ann Marnoch, Registrar

Welcome

http://www.exerciseregister.org

mailto:[email protected]

mailto://[email protected]






http://www.sportex.net

guest interview

Taking a back seat?

The reps Journal 2010;18(September):404

Journal: So how does it feel to be a man of leisure?Jg: Ironically I’m busier than ever! I’m still doing a lot of work for the Council of europe, I’ve got my commitments with reps and then of course there’s the list of jobs my wife’s written for me including lots of gardening!

Journal: You’ve left British politics at a very interesting time – do you miss it?Jg: What’s happening in Westminster is incredibly exciting at the moment, and totally unprecedented, but much as I’m enjoying watching it I think after 23 years I was ready to step down and concentrate on other things.

Journal: Like reps?Jg: Yes, during my eight years as Chair I’ve seen reps go from a membership of about 3,000 to more than 28,000 we have

After 23 years as the Mp for ryedale in Yorkshire, reps Chair John Greenway has retired from Westminster and is looking forward to spending more time shaping the future of reps, as well as shaping his garden…

today. It has progressed to being the leading brand in the fitness industry, and I’m very excited by our plans to see it to go even further.

recently we have achieved charitable trust status for reps. This is important as, among other things, it means members don’t have to pay VAT on their membership fees, which we try very hard to keep as low as possible.

As well as the reps Charitable Trust, we continue to develop the commercial arm of reps and SkillsActive, called SkillsActive Services Ltd, which is responsible for running the reps insurance services and any other non-charitable functions, such as endorsements, without impacting reps and SkillsActive with the rest of their work.

As Chair of both reps and SkillsActive Services Ltd, it’s partly my job to balance the professional status of the register and SkillsActive’s own charitable status with a commercial approach where appropriate.

Journal: So what are the next steps for reps?Jg: Since Jean-Ann took over as registrar we’ve spent a lot of time re-focusing on why we do what we do and I’d like to see that continue, particularly with the new reps structure and the National Occupational Standards.

I’d also like to see greater recognition and awareness of the Register’s importance to the fitness industry as a means of building confidence in high standards with health service professionals. The fitness industry has the tools to make a fitter, healthier nation and I would love to see that exploited more.


reps news

personal training log for clients

convention update...North of the borderMore than 110 delegates journeyed to Edinburgh for the REPs annual Scottish Convention in June. Keynote presentations were given by Jamie Edwards from Trained Brain and Ryan King from the Scottish Institute of Sport. Delegates could also take part in a series of eight workshops delivered by Fit Pro, Premier International Training, Lifetime Health & Fitness, Later Life Training, YMCA Scotland, The Fitness Industry Academy, EnergyWise Academy, plus our very own Rebecca Weissbort. The workshops covered a variety of topics including training clients with low back pain, working with older adults, exercise after stroke, and a Pilates session.

LIW updateA few remaining tickets are available for the REPs National Convention to be held during Leisure Industry Week on Thursday 23rd September at the Birmingham NEC. The day will include presentations from Dr Cath Sanderson (Leeds Met University) and Jamie Edwards (Trained Brain) and a choice of 10 workshops on subjects including postural analysis, behaviour change, Nordic walking, the ViPR training tool, and community activity. The programme will also allow time for the attendees to experience the industry’s premier trade show. If you’d like to attend see the REPs website www.exerciseregister.org for more details. See you there!

REPs is producing a personal training log book for instructors to give to their clients in order to help them monitor their progress.

Printed in a handy A5 size, the booklet has pages to record fitness levels, exercise programmes, progressive reviews, long, medium and short term goals, weight and measurements, and muscular charts as well as nutritional advice, food diaries, exercise guidance and general health information.

REPs Registrar Jean-Ann Marnoch said: “As part of our drive to professionalise the industry we thought these personal training logs would not only be a useful tool for our members but also get the message out to the general public about the importance of choosing REPs registered instructors.

“As instructors we know the importance of keeping records in order to monitor progress and to help motivate clients to carry on their regimes and hopefully this will help them with that.”

The spiral-bound booklet will be available to all personal trainers from the latter part of this year.


reps news

06 The REPs Journal 2010;18(September):5-7

After consultation with employers and training providers, it was agreed that new level 2 qualifications would include information that would allow level 2 instructors to adapt classes and gym sessions for clients with special population needs – in particular older adults, those with disabilities and pre and post-natal women.

The new online learning will make up this short-fall in knowledge which existing level 2 members may have.

REPs Registrar Jean-Ann Marnoch explains: “As part of the consultation process for the new National Occupational Standards, the employers we spoke to told us it was really important for level 2 members to have enough knowledge to allow them to adapt their teaching

online upskillingto the needs of any occasional clients they may have who fall into the specialist population categories. For example, if a pregnant woman comes along to a class, or an older adult member joins a gym session, they are able to advise them accordingly and adapt their mainstream classes or sessions to allow for their particular needs.

“This is different to taking a class specifically for those with special requirements which would require the member to achieve the specific special population qualification giving them the related additional category on the Register. “

She continues: “All new level 2 qualifications written to meet the new national occupational standards will include this additional content but we wanted to be able

offer our existing members the chance to improve their knowledge too.

“We’re now working on information and questions that can be completed for free, online via the REPs website, that will allow this, as well as earning members CPD points in the process.

“We know that the realities of modern gym usage include members with many, and varied, requirements

reps is compiling a special online piece of learning to allow existing members to bring their qualifications in-line with the new national occupational standards.

and hope this additional information will enable our existing members to better meet the needs of their clients.”

contact [email protected] call 0845 652 1908

Produced in

association with

Journal

June 10

● issue 17

Lynne Robinson

interview

REPs career

progression

Speed training

Expert

financial advice

PLUS all the

latest news

Do you want to advertise in the REPs magazine?

reps news


Licence to thrillMeet the membername: Richard Masonage: 29Location: Bicester, OxfordshireMembership number: 0065189Job description: Freelance personal trainerQualifications: Level 3 personal training, Diploma in anatomy and physiologyBest thing about my job: Seeing my clients succeed gives me great personal satisfaction. To help someone achieve their goals, particularly when they have felt they would never reach the finish line, is incredible. Job satisfaction doesn’t come much better than being a PT.Lightbulb moment: Hearing I had passed my level 3 PT course was a life-long dream come true. Later getting some amazing feedback from clients made me believe that this was what I was born to do.

the next step: Pre and post-natal exercise qualification and an exercise for children course, then onto level 4 before hopefully taking my own business to the USA.

name: Jenny Paceyage: 27Location: North LondonMembership number: 0066682Job description: Television Gladiator, Personal Trainer and Fitness Consultant, sports model/presenter, brand ambassador, motivational speaker and athlete!Qualifications: BSC (hons) Sports and exercise science (Loughborough), YMCA Personal Trainer, VTCT: Level 3 Diploma In Sports Massage Therapy, YMCA: Movement to Music- Aerobics/ Aqua Aerobics Instructor, YMCA: Gym Instructor & Advanced Gym Instructor, YMCA: Circuit Training Instructor, YMCA: Advanced Core stability, YMCA: Nutrition, Diet and weight management control, YMCA: Client Appraisal and Fitness Testing, YMCA: Strength and Conditioning Instructor, YMCA: Walking.Best thing about my job: I get to do something different everyday! One day I could be on television, then a photo shoot, or representing Great Britain in long jump, or personal training – which I love. Lightbulb moment: I was at the winter Olympics for bobsleigh and a teammate picked up an injury that took them out of the sport for good. I realised that I needed more than just to be an international athlete, and on my return to the UK started building my company, Pace & Go, which I run with my partner.

the next step:We’re bringing out a number of products and a training system through our company. I would also love to become the GMTV fitness presenter and I am currently training towards the Commonwealth Games long jump later this year.

Want to introduce yourself to the Journal’s 29,000 plus readers? Email a high-resolution picture and your answers to the points above to [email protected]

PPL, the music licensing company which represents performers and record companies, has launched a consultation exercise in partnership with the FIA to determine a fair and equitable tariff for the use of recorded music in exercise classes.

Set up in 1934, PPL is responsible for collecting licence fees due in connection with the playing of ‘sound recordings’, in public places. As the industry representative, the FIA has secured a commitment from PPL to set an equitable industry rate, which reflects the actual use of recorded music in the fitness industry – as opposed to a tariff set by comparison with perceived peer industries. In addition, to protect members’ interests, the FIA has agreed to collate all market sensitive information (such as financial,

membership and usage related data) and only submit aggregated data to PPL for assessment. This will help ensure that PPL can develop a tariff which reflects actual use of recorded music (not based on supposition), whilst protecting FIA members’ privacy.

The consultation is an unprecedented initiative occurring for the first time in the tariff’s twenty year history! The consultation process has started and requires input from operators and instructors alike, to this end a (confidential) questionnaire will be despatched shortly. This needs to be completed and returned to the FIA or emailed to [email protected]


08

industry news

The reps Journal 2010;18(september):8-9

Over the next six months skillsActive and reps will be looking to strengthen the partnership between higher education and the fitness industry. The main activity will be to encourage Higher education Institutions (HeIs) to submit their courses so they give full entry to REPs. HEIs will also be able to provide continuing professional development activities for REPs members. SkillsActive would also like to engage more universities in the delivery of REPs Level 4 courses which currently focus on specific medical areas.

There will also be promotion of REPs and the fitness industry through conferences and articles. Liaison with the key higher education bodies such as British Universities and Colleges sport (BUCS) and British Association of Sport and Exercise Sciences (BASES) will also be vital to this work. It is hoped that going into 2011 the relationship between higher education and the fitness industry will be enhanced and that as higher education is increasingly matched to the needs of the industry, the value of the skills and knowledge gained in higher education will be more fully recognised.

Tom Bell, Endorsement Manager, SkillsActive

More higher education news skillsActive News FIA Fitness

Directory nets top prizeThe FIA, working in partnership with Optimum Fitness Software (OFS), has won the highly prestigious “Outstanding Achievement” Award at the 2010 Interactive Media Awards for the work on ‘The Fitness Directory’.

This consumer driven ‘window to the industry’ provides a web-based platform for qualified personal trainers to speak directly to consumers. It allows personal trainers to promote themselves and signposts consumers to the most appropriate and nearest reps registered trainer to them. The FIA Directory, which is co-branded with REPs, was in elite company at the awards, as only a handful of nominations were deemed suitable for consideration - so strict was the judging criteria for the award. The award offers optimum recognition for the ‘highest standards of excellence in web design and development’.

“Time-starved consumers now use the net to search for services, compare competitors, check out special offers and deals – frankly do their research before they try or buy – that is why we have invested in creating a Fitness Directory to act as a shop window for our members” commented David Stalker, Executive Director at FIA.


industry news

ereps news

repseEuropean Register of Exercise Professionals

European fitness forum

Club Med accreditationClub Med Gyms, the largest operator in France with 22 clubs, has successfully completed accreditation for its own training academy - the Institut des Métiers de la Forme. EREPS presented certificates of registration to the first 40 trainers who completed their personal trainer programme at a gala event at the Adidas Store in Paris in July. There are now members of EREPS working in 28 different countries.

European qualifications framework

The University of Greenwich hosted a top-level technical meeting of experts to further develop the European fitness qualification framework. This references to the new main framework, known as the EQF, which will help exercise professionals to have their qualifications properly recognised and to improve the movement of trainers. The UK Government recently completed its national referencing against the main EQF and all EU countries will have done this within the next year or so. The European Health and Fitness Association recently completed a full update of the level 3 and 4 standards for exercise professionals – better recognised as Fitness Instructor, Group Fitness Instructor and Personal Trainer. SkillsActive, the Sector Skills Council with responsibility for standards and qualifications for fitness training in the UK is now completing a technical comparison to the European standards. Within the next year EHFA will have completed standards for assistant instructors and for working with children and older adults.

EREPS has held its third European annual fitness forum in Madrid attracting exercise professionals, managers, operators, suppliers and training companies from across Europe and the USA. Presenters included Les Mills International, Reebok with their brand new “fit-to-flex” training system developed by Cirque du Soleile and Nic Jarvis who spoke about professionalism and profitability for personal trainers. The forum included a guided tour and dinner at the famous Real Madrid El Estadio Santiago Bernabéu. Next year the Forum will be held in Milan.

The reps Journal 2010;18(Sept):10-1110

news exercise update

The long-term early Bird study has challenged the assumption that a lack of exercise causes children to put on weight. One element of the 11 year old study of more than 200 children in plymouth suggests the effect is the other way around - that getting fatter makes them inactive. The researchers examined the children annually from aged 7-10 years using accelerometers for seven consecutive days at each annual time point.

The authors emphasise they are not arguing with the benefits of exercise for children but are questioning exercise’s value as a way of tackling obesity. As a result the authors suggest that programmes to tackle obesity may need to focus more on food than exercise. archives of disease of childhood 2010;doi:10.1136/adc.2009.175927 Published online first 23 June 2010 http://bit.ly/bu41h2

Inactivity does not lead to obesity in kids Watching too much TV pushes

up the risk of dieing from heart disease by 7% and the risk is independent of physical activity. The authors conclude that their findings suggest that public health recommendations should consider advising a reduction in TV time, in

Too much TV is bad for the heart

addition to advocating physical activity. The study examined data from the epIC Norfolk population based cohort of 13,197 men and women. International Journal of epidemiology 2010 published online first 23 June http://bit.ly/bt97dd

Exercise benefit for cancer patientsBreast and prostate cancer patients who regularly exercise during and after cancer treatment report having a better qualify of life and being less fatigued, according to researchers. To study how exercise impacts cancer patients, Dr eleanor Walker and her colleagues at Henry Ford’s Josephine Ford Cancer Center and the Henry Ford Heart & Vascular Institute developed a unique programme called exCITe (exercise and Cancer Integrative Therapies and education). This works with patients who are receiving cancer treatment to create individualised exercise programmes. http://bit.ly/ctrypd

http://bit.ly/bu41h2

http://bit.ly/bt97dd

http://bit.ly/ctryPd


exercise update news

Exercising in the open air for just five minutes can lead to an immediate improvement in mood and self-esteem, according to the findings of a study.

Previous studies by the researchers had confirmed the links between nature, exercise in green environments, and health benefits. But this study is the first to quantify the health benefits in terms of the best ‘dose’ of nature.

Their analysis of 1,252 people drawn from 10 existing studies in the UK, showed that activity in the presence of nature (green exercise) led to mental and physical health improvements. The activities analysed were walking, gardening, cycling, fishing, boating, horse-riding and farming.

All natural environments were beneficial, including urban green, although the presence of water generated greater effects. A blue and green environment seems even better for health, the authors stated. Environmental Science and Technology 2010;44:3947-3955 http://bit.ly/aKLWBq

http://liveyoungshop.co.uk/sportex

You now canfor FREE!!!

http://liveyoungshop.co.uk/sportexhttp://liveyoungshop.co.uk/sportex

Ever wanted your own online supplement shop?


● No setup cost● No risk● No need for your own website● No expensive stock to purchase● No complicated site to manage● 1000’s of the most popular brand name

supplements at your disposal● Free delivery● Just the reward of getting commission

on the sales you get.

LiveYoung1/4.indd 1 21/7/10 11:37:27

To fi nd out more call 01943 879816www.pfetraining.co.uk

Specialising in safe and effective poses specifi c tothe mind-body industry:· Focus on physical strength & fl exibility· Courses include Physical Strength 1 & 2 and Flexi-kids· Run by qualifi ed fi tness professionals and Yoga teachers

A mindful approach to fl exibility training

Passionate about PilatesTrain to be a Clinical Pilates Instructor with one of the UK’s leading training organisations:

· Courses include Matwork, Advanced Matwork, Pregnancy, Older Adult, Spinal Conditions, Hip & Knee, Shoulder, Diagnostic Pilates.

· Many more courses available for qualifi ed Pilates teachers

Passionate about PilatesPassionate about Pilatelinical Pilates InstructorTrain to be a Ce UK’s leading training with one of th

organisations:

· de Matwork, Advanced Matwork, CoouC rses includder Adult, Spinal Conditions, Hip PPrePrerePPPrePPPPPPrPrPrerereePPP eeP ePP gnagngg ncy, Ollder, Diagnostic Pilates.&&&&& & KKK& nneee, Shou

· ourses available for qualifi edMMMMMaaaannnMMM yy more coersPPPiPilllPP aattees teache

Specialising in safe and effective poses specifi c tothe mind-body industry:· Focus on physical strength & fl exibility· Courses include Physical Strength 1 & 2 and Flexi-kids· Run by qualifi ed fi tness professionals and Yoga teachers

A mindful approach to fl exibility trainingpp

Career steppers!Push yourself further with our professional courses...

news in brief...l A small study has found that recorded time in moderate to vigorous physical activity and energy expenditure varies substantially among different makes of physical activity monitors. The researchers advise that when comparing physical activity levels among studies it is essential to know the type of physical activity monitor being used. British Journal of Sports Medicine 2010;44:657-664

l A randomised controlled trial on a 12-month culturally sensitive lifestyle intervention aimed at obese Arab women was found to be effective in improving

An outdoor quickie enough to improve the mood

some of the women’s metabolic syndrome components. archives of Internal Medicine 2010;170(11):970-976

l Target interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet could substantially reduce the burden of stroke conclude researchers. Their conclusions were reached following the findings of 22-country case control study that suggest that ten risk factors were associated with 90% of the risk of stroke. The Lancet 2010; 376:112-113

http://bit.ly/aKLWBq

12 The reps Journal 2009;00(Month):00-00The reps Journal 2010;18(september):1212

MeMber Q&A

SkillsActive, REP’s and University accredited, evidence based-exercise courses for experienced instructors wanting to work with highly challenging and

professionally rewarding specialist groups.

Qualifications to deliver, and support the development, implementation and evaluation of evidence based exercise interventions across health and leisure agendas.

Level 4 Specialist Exercise Instructor Training for experienced exercise professionals

(and health professionals)

For our full range of specialist courses visit to www.laterlifetraining.co.uk or telephone 01838 300310

l Postural Stability Instructor (prevention of falls, frailer older adults)

l Exercise for Fitness after Stroke (working with people post-stroke)

Member’s Question Time

Qon-line training guidelines.

“We currently have representatives from most regions of the UK and the Council has the benefit of most of the skill sets that the register accommodates, from gym instructor to cardiac rehab specialist and aqua aerobics instructor to personal trainer.

“Council members also represent the membership at other fitness industry forums including Skills Active’s Technical expertise Group (the body responsible for writing the new National Occupational Standards), the Sport And Fitness employers Group and the reps Board of Governors meetings. I also attend the Joint Consultative Forum (six representatives from the fitness sector and six from the royal Medial Colleges) that aims to build

bridges with the medical professions and boost exercise referrals.

“You can learn more about the Council via our section on the reps website, or feel free to come and speak to us at the reps conventions (a few of us generally attend each one). Remember, it’s our job to take your views forward so let us know what’s on your mind!”

A former serviceman Taff has worked in fitness for 12 years as a group exercise instructor, teaching mostly Cardiac Rehab, Aerobics and Aqua. Living in South Wales, when not working he can be found tending his allotment or running with his dog in the beautiful countryside. Taff also organises Wales’ own Pink Aerobics to raise funds for the Breast Cancer Campaign.

In this issue we’ve asked the REPs Members Council to outline what the Council does and the role it plays within the register. If you have any views on this subject or would like to become involved please get in touch by emailing

[email protected]

Mike O’Donoghue (aka Taff) writes: “Having been involved in the Council since its inaugural meeting in early 2007, it’s great to have an opportunity to explain to the

members the reasoning behind why it exists and exactly what we do.

“I feel that one of the reasons for reps success is that it is a regulatory body that is fair and transparent. In the early days it was decided that members should be involved in decision making processes at all levels. The first meeting was somewhat ad hoc and tagged onto the end of the annual convention in London in February 2007 but it was clear we needed a more members.

“We now meet three times a year and discussions are very much designed to discover the views of the membership and for these to bring some influence to the running and policies of the Register. For example, in the last few years, we have been involved in dialogue surrounding: the new reps structure; CPD requirements; publicity and marketing campaigns, and the new


13www.exerciseregister.org


You now canfor FREE!!!

http://liveyoungshop.co.uk/sportexhttp://liveyoungshop.co.uk/sportex

Ever wanted your own online supplement shop?


● No setup cost● No risk● No need for your own website● No expensive stock to purchase● No complicated site to manage● 1000’s of the most popular brand name

supplements at your disposal● Free delivery● Just the reward of getting commission

on the sales you get.

LiveYoung1/4.indd 1 13/7/10 13:45:21

medical matters


What do you want?FIA Chief Medical Officer John Searle looks at goal setting The first question I ask a new client or patient is, ‘Why have you come to see me?’ Firstly it reminds me that my job is to work with the client to achieve their goals rather than mine. Secondly, it helps the client to think about the goals they want to achieve. Sometimes the answer is very specific, “I want to run a half marathon in six months time”. Often they are more general, “I want to get fit” or “I want to lose weight” or “I want to look good on my summer holiday”.

However, I also have a goal for every client about which I tell them - the day they say to me, “John, I don’t need to see you very much, now”. Does that sound like financial madness, encouraging clients eventually to see me perhaps only three or four times year? (Actually, of course it controls the flow of clients and keeps the number manageable.) The reason I do it is that my wish is for each client to take responsibility for their own health and fitness for the long term – indeed for the rest of their lives. It is great to set short and medium term goals. But do we see those goals as part of a much wider process of staying fit for always?

Viewing the people who seek our professional advice through this long-term lens is vital for their future health and well-being. We know that inactivity is the biggest single cause of ill health in the western world. The Chief Medical Officer for England has observed that the benefits of regular physical activity on health, longevity, and well-being easily surpass the effectiveness of any drugs on medical treatments. People who are physically active are at about half the risk of having a heart attack compared with those who are inactive. Similarly the risks of diabetes, obesity, colon cancer and osteoporosis are all reduced. Regular exercise is essential for our mental well-being, stress prevention, keeping our brains functioning well and enabling us to enjoy a healthy and independent old age – 30% of people over the age of 65 have a fall at some time and half of these have recurrent falls. Hip and wrist fractures are caused by falls and have huge implications for future independence and cost the NHS billions of pounds each year. Exercise reduces falls significantly in older people.

One of the exciting things about the fitness industry is that we have within it the knowledge and expertise to promote a healthy population. Running a half marathon or having a six pack are good, being fit and healthy for always is better. And if we do become ill, we will handle it much better.


nutrition


spotlight

In the first of a new series the Journal asks training providers who offer courses outside the mainstream how they became involved in

their work and what inspires them…..

Under the spotlight

Christine north-Minchella, Director of professional Fitness & Education

and Co-Director of Modern pilates.name of courses:

Specialist Pilateshow did you get involved in this particular discipline?Before coming into fitness I also trained as a dancer and many of the exercises, unbeknown to me at the time, were Pilates-based. When the Jane Fonda boom started I was inspired to set

up my own classes based on my dance knowledge. I

certainly was not qualified to do this! I went on to train with

the YMCA before becoming a tutor/assessor and then going on to get my

certificate of education and degree in health and exercise studies.

Why are you passionate about it?Pilates has opened the door for many people to enter into exercise, especially those who do not feel comfortable in a gym environment or feel intimidated by high energy classes. Modern Pilates is taught in a slow, controlled and caring way and it appeals to a broad range of men and women including those who are overweight, unfit, recovering from an injury or have been referred by a specialist.How can this benefit REPs members?We have combined the original works of Joseph Pilates with the best modern research and knowledge of fitness, exercise, and core stability, to create a scientific and educationally sound programme for fitness and health professionals. Our programme also has a clinical approach which means our students can develop that as well as teaching in a studio environment.how important do you think it is for different types of exercise to be available for people? Very important indeed. Exercise and movement should be available for everyone at all levels since they enhance wellbeing. Exercise comes in all guises from walking on a day out, attending a dance class, working out in a gym or attending Pilates classes. Many Pilates sessions are now being set up in village and church halls - literally taking exercise into the community.

gill stewart - programme Director of nordic Walking uK/Exercise Anywhere.name of course: Nordic and Fitness Walking Instructorhow did you get involved in this particular discipline?My background is physical activity promotion and health club membership retention and I have always found innovative outdoor programmes helped to inspire people to both start exercising and keep doing so!

Nordic walking is the ultimate discipline in this field because it can be adapted to all markets, it is portable, cost-effective and gets results – it’s the simplest solution to so many issues.Why are you passionate about it?As soon as I tried it in Europe, I knew that if we developed the correct training and programmes for instructors, that this discipline could be used for everything from rehabilitation to advanced coaching for athletes. The results people get really inspire me.How can this benefit REPs members?They will gain the ability to deliver an adaptable discipline that works for all fitness levels and gets rapid results. They will also be inspired by the added benefit of outdoor exercise and how it can engage even the most hardened non-exerciser!how important do you think it is for different types of exercise to be available for people?Absolutely vital, we see hundreds of enquiries a week from people who know they should do something but just can’t relate to traditional exercise offerings - as an industry we have to listen to these messages and provide solutions.

16 The reps Journal 2009;00(Month):00-0016 The reps Journal 2010;18(september):16-17

REPs customer satisfaction survey

earlier this year, reps members were invited to take part in the second annual online customer satisfaction survey. Liz smith looks at the results.

More than 1,110 members took part in the survey (thank you!) and told us that in the past year we have given you better value for money, better customer service and an improved registration process. You said we have also produced a better reps website, journal and e-zine, and registration process, notably for new members. A comparison between 2010 and 2009 surveys (figure 1) shows a significant improvement with new members now reporting they are very satisfied with the information provided (87% compared to 38% last year), simplicity of the application forms (85% compared to 46% last year) and communication with the REPs office (70% compared to 31%). established members also report the online re-registration process is better, 60% said it is very easy to use compared to only 37% in 2009. While 81% said the journal is good (up 16% on last year) and the website is also good for 76% of respondents (up 17% on last year).

Three in five members (62%) had been in contact with REPs in the past year mainly by telephone. Queries were mainly about reps status, registration and CpD. Overall, three-quarters (74%) of members contacting reps said their query was dealt with to their satisfaction, a significant increase on last year (58% in 2009). Those reporting it was not dealt with satisfactorily dropped significantly (from 29% in 2009 to 18% in 2010).

As shown in figure 3, the level of very satisfied customers has increased significantly across the board. The satisfied (very or fairly) range from 79% for getting a satisfactory answer to 85% of respondents reporting good product knowledge. similar increases are also seen in those very satisfied with the manner the query was answered and dissatisfaction was reduced. Overall, 84% or more were satisfied with a polite, friendly service and good customer service. The speed of response to queries was the third area of improvement significantly in those members who were very satisfied with the speed of answering the phone and times of day they are manned (up 13% and 12% respectively on 2009 figures). Overall, you report getting more value for money and this may be due to the improvements seen or a response to the economic climate and a static membership fee. Three-quarters of respondents said the £25 annual fee was good value, a significant increase on last year (78% compared to 65% in 2009). Those who thought it wasn’t good value fell from 28% to 19% this year.

We can still improveWhile these results show improvements in the areas we have targeted to date we know there is still much more to do. Nine in ten (93%) members said that a membership body providing

Figure 1. How satisfied were you with the registration process?

Base: respondents who have been members for 12 months or lessNote: 2010 asked about simplicity of application forms instead of ease of completion asked in 2009

87%

38%

85%

46%

70%

31%

9%

49%

6%

47%

15%

42%

10%

5%

9%

17%

9%

6%

11%

2%

1%

3%

2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2010

2009

2010

2009

2010

2009

Info

rmat

ion

prov

ided

Sim

plic

ity o

fth

e ap

plic

atio

nfo

rms

Com

mun

icat

ion

with

RE

Ps

offic

e

Very satisfied Fairly satisfied Fairly dissatisfied Very Dissatisfied

Figure 2. How would you rate the information that REPs provides on an on-going basis

Base: all members who had looked at or read that product

44%

31%

31%

25%

30%

16%

37%

34%

45%

35%

45%

30%

16%

28%

21%

32%

20%

46%

3%

6%

3%

9%

4%

8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2010

2009

2010

2009

2010

2009

REP

sjo

urna

lR

EPs

web

site

REP

s e-

zine

Very good Fairly good OK Poor (very or fairly)

recognition of professional status is important and it is the main reason for joining the register. Currently, 75% of members think their interests as a fitness professional are well supported (mainly fairly well). Specific improvements that are wanted are in areas of advertising and promoting the register to the public and to members, the length of time taken to respond and to make

17www.exerciseregister.org 17www.exerciseregister.org

REPS SURVEY

CpD easier and more accessible. This is in addition to a need to continue progress in raising satisfaction to the highest levels and reduce dissatisfaction.

The register is considered well promoted by 58% of members (very – 14% or fairly – 44%) whilst 36% think it is not well promoted (not very – 26% or not at all – 10%), this is similar to last year. This appears to be partly caused by a lack of awareness of some of the promotional work by reps. Three-quarters of members (74%) were aware of at least one promotional product but only 62% of those were aware of the members stamp followed by the member’s badge (54%). Otherwise under half reported knowing about representation in the media, information leaflets, supporter boards and glass plaques.

There may also be low awareness of the products and services offered through membership which could be improved. The main product used is the reps journal (67% of members) followed by insurance services (54%), registration certificate / card (47%) and

Figure 3. Satisfaction with the way the query was dealt with

Base: Members who had contacted REPs

44%28%

41%26%

42%28%

47%32%

34%

41%

43%

46%

39%45%

36%

41%

14%17%

10%16%

13%16%

10%14%

8% 15% 6% 12% 6% 12% 6% 13%

0%10%20%30%40%50%

60%70%80%90%

100%

2010 2009 2010 2009 2010 2009 2010 2009

Providing a satisfactoryansw er

Good product know ledge Accuracy Professionalism

Very satisfied Fairly satisfied Fairly dissatisfied Very dissatisfied

58%39%

51%39%

50%35%

31%

41%35%

41%33%

37%

7%11% 7% 10% 10%

16%

5% 10% 8% 10% 6%13%

0%10%20%30%40%50%60%70%80%90%

100%

2010 2009 2010 2009 2010 2009

Polite and friendly manner on thetelephone

Clear and polite email / letter Good customer service

Very satisfied Fairly satisfied Fairly dissatisfied Very dissatisfied

Figure 4. Satisfaction with the manner of answering your query

Base: Members who had contacted reps

Figure 5. Are you aware of the work that REPs has undertaken to raise public awareness?

Base: all members who had awareness of at least one promotional product

62%

54%

47% 46%

20%

9%

0%

10%

20%

30%

40%

50%

60%

70%

Members stamp(member logo)

Members badge Representation intrade journals / media

Inf ormation leaf lets Cardboard supporterboards

Glass plaques

THE AUTHORLiz joined SkillsActive in December 2004. Her research career started at the South East England Regional Development Agency (SEEDA) as a Research Assistant and continued

into the South East England Skills Research Unit – Skills Insight where she developed her expertise in labour market intelligence.

e-zine (41%). Otherwise between 12% and 28% of members are using the other services. Those who have used services identify the legal advice helpline as the most important and highly rated service, followed by insurance services, registration certificate/card and members stamp. There are indications throughout the survey that CpD access and awareness can be improved. The lowest rated item in the registration pack by new members is information on CpD, only 57% think it is good (very or fairly) and 17% think it is poor (very or fairly). As seen earlier on, queries are received about CpD and respondents say it is the least easy to use aspect of the reps website, notably updating CpD online.

Although response times have improved to queries and the majority of members are receiving their registration documentation within the 28 day standard there has been no improvement on last year in satisfaction. Where queries were not dealt with to a customer’s satisfaction (18% of members with queries) it commonly related to a slow response. No more than 75% of new members are satisfied (very or fairly) with the length of time taken to process each registration element. Feedback from members highlighted any delay in receiving registration and insurance impacts upon their work and therefore 28 days may be considered too long. In summary, significant improvements have been seen on last year but there is still scope for improving on current levels of satisfaction.

The next stepOur job is to now work on these results and address the areas of concern. In the meantime if you would like to comment on these findings or have any other issues you would like to see raised let us know via [email protected]. The full results from the survey will be published on the reps website and the reps team will be using them to form the basis of a Next steps and Action plan report.


18

Exercise during pregnancy

During an uncomplicated pregnancy exercise is actively recommended for a host of associated maternal and foetal benefits. (1, 2) Sadly, a recent study (that surveyed over 1000 subjects’ physical activity during pregnancy) showed the majority of women did not reach the recommended activity levels (3).

Many pregnant women said they felt anxious about exercise and were unsure of safe levels and modifications to their normal routine. In addition to this, feelings of nausea, fatigue, discomfort during exercise or simply being too busy, are described as limiting factors (4). As exercise professionals, in conjunction with other health care providers, we have an important role in educating and encouraging exercise during pregnancy.

What are the physiological changes during pregnancy?One of the biggest and most rapid changes is a huge increase in cardiac output. Blood volume increases by 50% and heart rate by about 20 beats per minute. Despite the increase in cardiac output, there is an overall decrease in blood pressure.

This is primarily due to smooth muscle relaxation of blood vessel walls caused by relaxin and progesterone (5,6). This smooth muscle relaxation can produce postural hypotension, slow down peristalsis in the gut affecting digestion and even affect bladder tone.

The role of relaxin during pregnancy is not clear, and is beyond the scope of this discourse. Suffice to say that the theory that it stretches ligaments to facilitate foetal descent and exit is not completely satisfactory, not least because peak levels occur at 12 weeks (7).

The effects of these issues as well as changes in hormone levels and a growing foetus mean that these changes vary as time progresses. Giving the woman advice as to what she could expect and how to cope with this can be very helpful.

Addressing biomechanical changes during pregnancy

The changes that occur in muscle balance, control and posture during pregnancy are generally caused by the foetus moving in a ventral direction as it grows, moving the centre of gravity forwards and changing the overall equilibrium of the spine (8).

Part of a fitness professional’s assessment must take into account how a woman’s body adapts to this.

Muscle and ligament length tension relationships alter as

a consequence. The abdominals lengthen, the pelvic floor has to deal with increased weight and glutei inhibition produces

the characteristic waddling gait in late pregnancy as the

body problem-solves and widens the base of support to cope (9).

Training balance and control, such as that developed with

Pilates training, can be very helpful throughout pregnancy. This

can help counteract the negative influence of some of these changes, assist in general activities of daily

living (ADLs) as well as exercise and possibly helping with pain syndromes.

What are the key benefits of exercise during pregnancy?

The Royal College of Obstetrics and

Pregnancy is an exciting but anxious time for many women. Here Rachele Quested helps make sense of the latest research and brings a common sense approach to pre and post-natal exercise.

The RePs Journal 2010;18(September):18-2018


Gynaecology (10), lists a host of benefits including maintenance of cardiovascular fitness, muscle length and flexibility, a healthy weight, improved circulation, co-ordination and body awareness and assistance in post-natal recovery. It may also help in the preparation for labour and has been linked to a reduced rate of gestational diabetes.

These benefits can only be good for the baby as well. Studies to date show no increase in adverse neonatal outcomes associated with maternal exercise (11). Furthermore clinical evidence of stress in newborns (e.g. APGAR scores, baby heart rate) is less in women who exercised at around 50% of preconception level throughout pregnancy. Simply exercising or attending a class may also be beneficial psychologically. Exercise participation has been linked to an improved subjective pregnancy experience, self confidence and body image (12).

It is too often forgotten that a pregnant woman still benefits from the commonly described effects of exercise! These benefits include improved oxygen transfer to the heart and brain, as well as exercising muscles, boosts to the immune system, maintenance of good posture and general wellbeing.

What precautions should be observed?The best advice should be practical, useful, individual and adaptable. General exercise should be conducted in a cool, well-ventilated environment, with access to water and while wearing natural fibre clothing to allow the skin to sweat (13). These recommendations are to help avoid overheating, as a maternal core temperature of > 39.2oC Celsius has been considered teratogenic (could lead to abnormalities).

The RCOG (14) guidelines are quite prescriptive, instructing women to keep their heart rate to 60-70% of their age-adjusted max. This could be difficult if the woman did not know her HR maximum and/or if she was previously fit, as she may find this level produces no effect. They also state to begin with 15 minutes x 3 a week, progressing to 30 minutes daily.

First trimesterDuring the first trimester, reduced blood pressure can increase the risk of fainting. Tiredness and nausea are also common. Hormones are already having an impact. Warning about the effect of these changes is necessary.

The foetus however is still protected by the pelvic ring meaning most sports and exercise positions are considered safe.

Second trimesterWomen are often beginning to feel better now. Nausea and tiredness (usually) wear off and blood pressure may return to more normal limits. The foetus is higher and larger now and has to be considered with exercise prescription and position.

Third trimesterWomen generally feel more cumbersome and tired. Fluid retention may become pronounced and restrictive particularly in the extremities. Prolonged standing can become a problem, fluid can pool in the feet and lead to an increased risk of fainting, dizziness and falls. The focus for women may become more about relaxation,

gentle stretching, regularly changing positions and following the adage ‘little and often’.

Who should NOT exercise in pregnancy?While most women can, and should, exercise safely throughout pregnancy there are some who may need extra monitoring and guidance (relative contraindications) and those who should not be allowed to continue (absolute contraindications).

Relative contraindications to exercise in pregnancyl Severe anaemia l extreme morbid obesityl Unevaluated maternal l extremely cardiac arrhythmia underweightl Chronic bronchitis l History of an extremelyl Poorly controlled type sedentary lifestyle

1 diabetes

Absolute contraindications to exercise in pregnancyl Haemodynamically significant heart diseasel Restrictive lung diseasel Incompetent cervixl Multiple gestation at risk for premature labourl Persistent 2nd or 3rd trimester bleedingl Placenta previa (low lying) after 26 weeks gestation l Premature labour during current pregnancyl Ruptured membranesl Pre-eclampsia or pregnancy induced hypertension

What should we be prescribing?Gentle cardiovascular exercise is important. What is chosen should reflect the woman’s past history and current desires. Walking and swimming are commonly advocated as safe and beneficial from the beginning to the end of pregnancy.

Specifically excluded sports (15) include heavy weights, scuba diving, downhill skiing, horse riding, gymnastics and martial arts. Limited contact sports are considered safe in the first trimester and possibly into the second (e.g. netball, racquet sports), while potentially unlimited contact sports are safe only in the first trimester (e.g. basketball, soccer). Impact sports such as running also carry a theoretical increased risk to the joints, secondary to increased ligamentous laxity. Again my advice usually centres around the woman’s enjoyment, pain and comfort levels.

Post-natal exerciseThe first question, usually, is when can I resume exercising? The answer is dependent upon the woman, the events of labour and a medical all-clear at 6 weeks. As a fitness professional, it is vital to ascertain the method of delivery and any complications that had arisen, to mother or baby. Testing for a rectus diastisis is also easy and important. In crook lying, instruct her to lift her head


PREgNANcy

“The best advice should be practical, useful, individual and adaptable”

20 The REPS Journal 2009;00(Month):00-00The RePs Journal 2010;18(September):18-2020

and neck off the bed/mat, while palpating the join between the rectus abdominis muscles (RA). A normal separation is 2-3 cm for 2-5 cm of the length of the muscle. The separation, if identified, should be measured, recorded and checked on subsequent visits. Walking, even post Caesarean, can also be commenced immediately. Swimming should wait until the post-natal bleeding has stopped (usually around 6 weeks) and if a Caesarean has been performed time for wound healing should be allowed. Comfort, fitness and strength levels should also be the deciding factor with running although it is essential to have good TA/PF control, good single leg balance and small knee bend ability to cope with its physical demands. An exercise programme can begin similarly to where the ante-natal program left off. The obvious change now however is that a client may feel comfortable exercising prone and supine again (commonly a lovely sensation!). Helping clients to get back in touch with good TA and PF is vital. Once TA control is good, if the RA separation is >2cm, oblique retraining can begin. RA retraining should begin only when the separation is <2cm.

conclusionExercise pre and post-pregnancy, if permitted, should be an integral part of a woman’s approach to a healthy lifestyle for her and her baby. The choices of what and when should take into consideration past history, personal skill and preference and the presence of pain or other complications. If you wish to take specialist pre and post-natal classes you will need to take a REPs recognised pre and post-natal course. Details of these can be found via the REPs training portal on the REPs website.

References1. American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 267. (2002) American College of Obstetricians and Gynecologists. Obstet gynaecol 2002; 99: 171—1732, 10, 13 & 14. Royal College of Obstetrics and Gynaecology (RCOG 2006). Statement No. 4. January 20063. Borodulin KM, Evenson KR, Wen F, Herring AM, Benson AM (2008) Physical Activity Patterns during Pregnancy. Medicine & Science in Sports & Exercise, Official Journal of the American College of Sports Medicine. 2008; Nov; 40 (11):1901-19084. Duncombe D, Wertheim EH, Skouteris H, Paxton SJ, Kelly L (2009) Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercised during pregnancy. Midwifery- Elsevier. 20095. Lumsden M.A, Hickey M. Royal College of Obstetricians and gynaecologists Complete Women’s Health. Thorsons. United Kingdom, London Hammersmith. 20006. Stables D, Rankin J.(Eds) (2005). Physiology in Childbearing: with anatomy & related biosciences (2nd ed). Edinburgh: Elsevier 7. Kristiansson P, Svardsudd K, Schoultz B (1996) Serum relaxin, symphyseal pain, and back pain during pregnancy. Journal of

Obstetrics and gynaecology. 1996 Nov (5): 1342-78. Selby, A. Pilates for Pregnancy. Thorsons. United Kingdom, London, Hammersmith. 20029. Vleeming A, Snijders C, Stoeckart R, Mens J (1997) The role of the sacro-iliac joint in coupling between spine, pelvis, legs and arms, in Vleeming A, Mooney V, Dorman T, Snijders C, Stoekart R (eds) ‘Movement, stability and low back pain’ churchill Livingstone, Edinburgh chap 3:53-73 12. Horns PN, Ratcliffe LP, Leggett JC, Swanson MS (1996) Pregnancy Outcomes among active and sedentary primiparous women. Journal of Obstetric, gynaecological and Neonatal nursing 25(1):49-54 11. Kardel KR (2004) Effects of intense training during and after pregnancy in top level Athletes. Scand J Med Sci Sports. 2005 Apr;15(2):79-8615. Sports Medicine Australia. Women in Sport. Fact sheet No. 2 2002 Sports Medicine Australia. Exercise and well being after pregnancy. Fact sheet. 2005.

THE AUTHORRachele Quested is a physiotherapist who trained at the University of Queensland and has subsequently completed a Masters in sports physiotherapy. Rachele is also a

senior presenter for the Australian Physiotherapy & Pilates Institute (APPI), and regularly presents courses for the APPI throughout the UK. She has also trained with Body control Pilates. For more details visit: www.ausphysio.com

NB. Do not attempt to answer the questions in the interactive version of this magazine

ANSWER THE FOLLOWINg QUESTIONS ONLINE TO EARN cPD POINTS Please login to the members area of the REPs website to give your answers

Q1 What physiological change do the hormones relaxin and progesterone cause? Is it: a. Cartilage softening b. Smooth muscle relaxation c. Lumbar extension

Q2 What is the suggested heart rate percentage of age adjusted maximum that pregnant women should keep to? Is it: a. 40-50 per cent b. 50-60 per cent c. 60-70 per cent of their age adjusted maximum

Q3 What is the normal width to length ratio of a post-partum rectus diastisis? Is it: a. 1-2cm width to 2-5cm length b. 2-3cm width to 2-5cm length c. 3-4cm width to 2-5cm length

Freephone 0800 612 6096 www.myarribaclub.com

Run your own clubMake extra cashGet more clients!

Arriba1_12.indd 1 14/7/10 08:12:04

http://www.ausphysio.com

21www.exerciseregister.orgwww.exerciseregister.org 21

rehabilitation

by Dr anna Campbell

Who are the two million cancer survivors?Of the two million survivors, 28% were diagnosed with breast cancer, 12% with colorectal (bowel) cancer and 11% with prostate cancer. Breast cancer is the most common cancer diagnosed in the UK and the five year survival rate is 82%. Encouragingly, the predicted twenty-year survival rate for breast cancer patients is now 64%. Although lung cancer is the second most commonly diagnosed cancer, only 4% have a five year survival rate mainly because more than two-thirds of lung cancers are diagnosed at a late stage.

rest is not bestIn the past it was assumed that the best advice to give anyone diagnosed with cancer was to rest as much as possible. However, research has shown that too much rest may result in loss of stamina, muscle tone and bone strength. Attitudes to exercising after a cancer diagnosis also shifted due to the amazing achievements of athletes such as Lance Armstrong and Jane Tomlinson.

In 1996 world-class cyclist Lance Armstrong was diagnosed with testicular cancer that had spread to his brain and lungs. Although his prognosis was originally poor he recovered and proceeded to win the Tour de France each year from 1999 to 2005.

Exercise-based cancer rehabilitationAccording to the charity Macmillan, there are at least 2 million people living with, or beyond, cancer in the UK. Findings also show there are more than three quarters of a million people of working age with cancer and that 10% of people over 65 have a cancer diagnosis.

Jane Tomlinson was an amateur English athlete who became well-known for raising millions of pounds for charity by completing the London Marathon three times, the London Triathlon twice, the New York Marathon once and cycled across Europe and the United States, despite suffering from terminal breast cancer before dying in 2007 aged 43. With more people living longer with a diagnosis of cancer it could be considered a chronic condition. Thus as with other long term conditions such as cardiac disease, diabetes and chronic obstructive pulmonary disease (COPD) it is time to provide cancer rehabilitation as part of a cancer care package and make a policy

“A recent review of more than 60 high-quality studies on the effects of exercise on cancer survivors concluded that regular exercise appears to help with confidence and self esteem”

22 The rEPS Journal 2009;00(Month):00-00The rEPs Journal 2010;18(September):21-2322

shift towards recommending physical activity during and after cancer treatment.

Side effects of cancer treatments Treatment for cancer depends on a number of factors – the cancer type, location, the size of the cancer and how far it has spread. Cancer therapies usually consist of one or more of the following: surgery; chemotherapy; radiotherapy; hormonal therapy and/or immunotherapies. These treatments can cause a number of physical and psychological side effects that affect the quality of life for cancer survivors. Some symptoms such as fatigue, depression, lymphoedema (swelling of arm or leg) or osteoporosis can still be present or suddenly appear years after treatment. Even among cancer survivors who are at least five years post-treatment more than half report physical performance limitations including crouching/kneeling, standing for 2 hours, lifting/carrying 4.5kg and walking 0.4 km. Exercise-based cancer rehabilitation may play a role in helping to treat or prevent these side effects.

Exercise helps prevent or reduce the following side effects:l Cancer related fatigue. This is one of the most common and debilitating side effects of cancer treatment. It has been shown that by incorporating some physical activity daily both during and after treatment significantly reduces fatigue levels and builds up energy levels.l Weight gain/weight loss. Some cancer survivors gain weight due to medicines given during treatment. Regular exercise combined with a healthy diet can control weight gain. Similarly loss of muscle mass due to cancer treatment has been shown to be reversed with an appropriate exercise programme.l insomnia, anxiety and depression. Exercise has been shown

to produce a shift to a more positive mood during breast cancer treatment and to reduce levels of anxiety and depression after treatment. l osteoporosis. The risk of osteoporosis is increased due to hormonal treatments prescribed for certain cancers and being inactive during and after treatment. Weight bearing exercise has been shown to increase bone density in susceptible cancer survivors.l lymphoedema. It was originally thought that repetitive activity with the effected limb could initiate or exacerbate lymphoedema (swelling of arm or leg). However studies looking at progressive weight-training programmes and exercise aiming to improve range of movement have shown that this is not the case.l other symptoms. Pain, nausea and constipation also appear to be improved with physical activity.

A recent review of over 60 high-quality studies on the effects of exercise on cancer survivors concluded that regular exercise appears to help with confidence and self-esteem as well as improving physical activity levels, aerobic fitness, muscular strength, and overall quality of life. It was shown to be a positive step in giving patients back a sense of control and with few exceptions, the exercise was well tolerated during and post treatment without adverse events.

Can exercise reduce the risk of the cancer coming back?Cancer patients often ask: “What can I do to stop the cancer coming back?” A number of studies in America have followed thousands of breast cancer and colorectal cancer survivors and monitored the amount of physical activity they undertook on an

“cancer survivors who walked an average of 3 – 5 hours per week at a moderate intensity significantly reduced the risk of the cancer coming back”


rehabilitation


the aUthorDr anna Campbell trained as scientist in immunology and biochemistry at the universities of Glasgow and St andrews and is currently an

honorary research fellow in the Department of Surgery, University of Glasgow. She is director of Canrehab – a company specialising in training health and fitness professionals in the UK interested in exercise-based cancer rehabilitation and she also teaches undergraduates in sports biomedicine at Dundee University.

● New

for 2010 a

level 4 Cancer

Rehabilitation

Qualifi cation

● Earn CPD credits

● Increase

your GP referral

potential

CanRehab leads theway in providing cancer rehabilitation

seminars, workshops and training programmes in the UK. Get in touch with us to fi nd out more about our courses in your

area.

Call:0845 4594618 or visit our website www.canrehab.co.uk

Are you interested in providing safe and effective exercise

classes for clients with cancer and becoming a specialist in

exercise and cancerrehabilitation?

CancerRehad_REPs17Quarter_v2.indd 1 3/8/10 09:56:53

average weekly basis. The studies showed that cancer survivors who walked an average of 3 – 5 hours per week at a moderate intensity significantly reduced the risk of the cancer coming back and thus improved their survival. The reasons why staying active and exercising appears to have a “protective effect” post-cancer diagnosis is not yet known. It is probably due to a combination of effects such as helping to maintain a healthy weight, controlling circulating hormone levels and other growth factors in the body and boosting the immune system.

Current guidelinesBecause of the diversity of this clinical population it is not possible to recommend one exercise prescription for all cancer survivors. There are over 200 different types of cancer and each person’s treatments will vary depending on what kind of cancer, where it is located in the body and whether it has spread. To date, there is an absence of expert consensus or position statements on the safety of exercise training in people with cancer.

Nevertheless, a set of guidelines based on existing evidence and clinical experience have been published in ACSM’s Guidelines for Exercise Testing and Prescription (8th edition 2010). These are compatible with the American Cancer Society’s recommendation of 30 to 60 minutes of moderate to vigorous intensity physical activity at least 5 days a week for cancer survivors.

Here in the UK, Skillsactive has recently completed the National Occupational Standards for all training programmes to provide qualifications in Level 4 Cancer Exercise Specialists. It is hoped that more exercise professionals will now be able to confidently and safely prescribe exercise programmes to assist the large number of cancer survivors keen to start an activity programme or return to exercise as a positive set back to recovery.

anSWer the folloWinG qUeStionS online to earn CpD pointS Please login to the members area of the REPs website to give your answers

Q1 how long after treatment do people still report physical limitations? is it: a) two years b) five years c) nine years

Q2 how many different types of cancer are there? is it: a) over 200 b) over 300 c) over 400

Q3 What is the recommended level of activity for cancer survivors?

a) 20-40 mins 5 x a week b) 40-50 mins 5 x a week c) 30-60 mins 5 x a week

24

The VibroGym helps tol Attract new membersl Retain membersl Set up new classesl Increase your revenuel Keep staff interestedl Sell more personal trainingl Gain an advantage over

your local competitors

VibroGymThe oRIGInAl plATe

If you are a Club Owner, Gym Manager or Personal

Trainer interested in investing in a VibroGym

visit www.vgymuk.com or join the VibroGym UK

Facebook group

Come and find me at LIW – stand no IOU1

special discounT for reps members

‘With continued support from scientific research, Vibration training is now widely accepted in the

fitness industry. I want to use my 10 years of vibration training experience to help Gyms, Health Clubs and Personal Trainers get the best out of their vibration machines and take their business to the next level using the VibroGym’.

established for over 10

years

dan fiVey New VibroGym UK MD Tel: 07709 169997

VibroGym1/4.indd 1 13/7/10 13:44:15

By Ian Hayter, operations manager, JLT – REPs insurance providers

A recent enquiry from a REPs member highlights some of the confusion that can exist regarding who should be responsible for any accidents that may occur when using hired premises, such as a village hall.

The member wrote:I have a potential class to run in a church hall. The church insists that public liability insurance from the users covers not only the class (i.e. while the class is running), but also the rest of the grounds, so that if someone has an accident moving from the car to the front door and they have a fall, then insurance covers that too. My insurance is through REPs, and I am interested in understanding whether it would cover this kind of eventuality?

From our interpretation of the question, it appears that the church is insisting public liability insurance extends to include the grounds in addition to the hall and immediate area where the class is taking place. The example supplied requires that insurance is in place to cover the eventuality of an attendee sustaining some form of injury in a fall while walking from their vehicle to the door of the premises. It has to be remembered that any liability insurance will only provide an indemnity if the insured is legally responsible for the injury or damage sustained. The fact that the

Insurance issuesInsuRAncE

● Whole body workout for Group Ex or PT

● Ideal for GP referral and rehabilitation

● NEW studio and Aqua concepts

To fi nd out about training, programmes and support call Gill on 0845 260 9339 or visit www.nordicwalking.co.uk

16

Become a Nordic & Fitness walking Instructor with the UKs leading provider

● Instructor training● Marketing support● Discounted equipment● Additional cpd modules

Pre written programmes for all markets complete with manuals, lesson plans

and promotional materials

18REPsNordicWalkingUK_1-4.indd 1 16/7/10 16:21:28

member is hosting a class at the church hall does not absolve the church of its responsibility to all visitors as the owners or “occupiers” of the hall and its grounds.

If an attendee tripped and suffered an injury as a result of a damaged paving slab then the REPs member could not be held liable if he/she was unaware of the hazard, as the member has no control over the condition of the paving nor any responsibility for its maintenance. The church could, however, be held liable. One would assume that the church has its own liability insurance arrangements in place but it is nevertheless important to check this.

The member could be deemed liable if he/she was aware of the hazard and removed any warning sign that had been placed by the church. Similarly liability could attach to the member if he/she put up signs directing the attendees to the class so that they directly passed a known hazard. Ultimately this could be a decision for the Courts - rest assured, however, that if the member was found liable then the REPs Insurance Scheme would engage as the liability has arisen during the course of his/her activities as an exercise professional. The fact that the incident occurred while the attendee was making their way to the class, rather than during the class itself, is irrelevant in these circumstances.

To find out more about the REPs Insurance Scheme please call 020 8686 6464 or visit www.exerciseregister.org

for members

The REPs Journal 2010;18(September):24-2524


fInAncE

If number crunching’s not your style don’t worry, financial expert Jamie Crampton’s here to help

THE AuTHORJamie Crampton qualified as a CharteredManagement Accountant in 1995 and in 2008 set up Accounting 4 fitness, dealing primarily with clients in the fitness industry. In addition

to this he advises personal training students on premier training courses on self employment, and also does freelance work with accounting students at the university of Bedfordshire.

If your business involves you having to be mobile then the choice of vehicle is vitally important, not least in financial terms. It may look nice to have a Hummer to ride around in between appointments but it can cost you a substantial amount of money, and in these belt-tightening times do you really want – or need - a car that drains your wallet, and not just at the service station?

In taxation terms you can claim back the cost of running a vehicle for business use, i.e. petrol/diesel, servicing, tyres, tax and insurance. This can also be adjusted for any “private use” an offset against your business income. What you can also claim is a percentage of the actual purchase cost of the vehicle each year – known as a Capital Allowance. This varies according to the type of vehicle that you use, from 100% of the cost of the vehicle to as little as 10%. The new rules (from April 2009) are based around the principle of the ‘greener the car - the more you can claim’. Greenness is measured by the amount of CO2 your car produces per kilometre.

The table below gives examples:-

Does your financial fitness match your personal fitness?

Accounting4 Fitness

12 Boxgrove Priory, Bedford MK41 0TQ. Registered with the Chartered Institute of Management Accountants as a Member in Practice.

Whether you are an established or newly formed business, or thinking about starting, we can help you.

We provide advice on Accounting, Self Assessment, Income & Corporation Tax, VAT, PAYE and many other financial services at extremely competitive rates, which can be paid monthly.

We are experts in all aspects of Leisure & Fitness industry accounting and can easily arrange personal consultancy sessions that fit in with your schedule, anytime and anywhere in the UK.

For more information call Jamie Crampton, ACMA (T) 01234 267860 (M) 07830 225612 (E) [email protected].

There is a full list of petrol and diesel cars with CO2 emissions under 110g/km available from http://www.vcacarfueldata.org.uk. You can also search for CO2 emissions for other vehicles which are not on that list.

So if you were to buy a car costing £10,000 with a CO2 emissions rating of less than 110g/km, then you could claim all £10,000 against your profits in the corresponding tax year, whereas a similar value car with emissions over 160g/km would only


nice wheels – but do they come with extras?

give you a £1,000 claim. At a tax rate of 20% that could cost you £1,800 in additional tax – if you are a 40% tax payer that goes up to £3,600. If you were to buy a van, however, no matter what the emission rating you, could claim the full value in the year of purchase. Please remember that the exact figures may differ according to your particular circumstances.

Armed with this information you may want to consider your next business vehicle carefully – remember, vanity can be extremely costly!

car type Allowance available per annum

CO2 Emissions less 100% of the cost of the than 110 g/km vehicle in year of purchase

CO2 Emissions between 20% of vehicle cost per annum 111 – 160 g/km

CO2 Emissions over 10% of vehicle cost per annum 160 g/km

Van 100% in year of purchase


http://www.vcacarfueldata.org.uk

client leaflet

The reps Journal 2010;17(June):2626

Immediate treatment of injuries

Why immediate treatment is important The success of injury healing can be boosted by appropriate, effective and timely action particularly in the the first 72 hours after injury.

Any ‘soft-tissue’ is subject to injury including ligaments (which join bones to bones), tendons (which join muscles to bones) and to muscles themselves. The immediate reaction of the body to injury is similar irrespective of the soft tissue structure and is known as an inflammatory reaction.

Injuries can be caused by over-stretching, bruising or crushing. A strain describes overstretching of a muscle, while a sprain describes overstretching of a ligament or tendon.

the inflammatory reactionTissue injury usually involves damage to small blood vessels that results in bleed-ing at the site of injury. This bleeding leads to the four main signs of inflammation:

1. Heat – chemicals released from the damaged tissue causes dilation of surrounding blood vessels to bring healing agents to the area. The result is more blood and therefore heat2. Redness – is due to the increase in blood to the area3. Pain – is caused by the chemicals released from the injured tissues as well as the increased tissue pressure from the fluid acting on nearby nerve endings 4. Swelling – is the result of this accumulation of extra fluid.

This inflammatory reaction is necessary as it is part of the natural healing process. However the body tends to overreact to sudden traumatic injury and as a result more inflammatory fluid accumulates than is necessary for healing. This fluid contains a protein that turns into replacement ‘scar’ tissue. If too much is allowed to form it may prevent thestructure returning to normal function with reduced flexibility and increased risk of re-injury.

PRice protocolAnyone experiencing an injury should benefit from the following recommend- Want more free client handouts? See next page

NEW LAUNCHFREE LEAFLETS

TO GIVE YOUR CLIENTS

20%OFF FO

R REPs

MEMBERS

ACT SOON OFFER ENDS

30 SEPT 2010

ENTER CODE 2088/R

TO GET YOUR

DISCOUNT

■ Handouts for members of the public

■ Free version and premium booklets available

■ Recommended by NHS■ Endorsed by medical charities■ Paste the page-turning free

version on your website■ Free and Premium versions

available

FOR MORE INFORMATION AND TO ACCESSTHE FREE LEAFLETS VISIT

HTTP://BIT.LY/SPORTEXEPALS

sportEXePAlsAdv3.indd 24 21/7/10 14:25:13

ations which should be carried out immed-iately and for up to 3-5 days after injury. These are remembered by the acronym prICe.

Protectaim: To protect the injured tissue from undue stress that may disrupt the healing process and/or cause further injury. How: This could include splinting or bandaging by a medical professional or simply rest, slings or crutches. Complete immobilisation isn’t usually necessary or desirable. Make sure the method of protection can accommodate swelling.When and duration: Immediately and for 3-5 days depending on injury severity.

Restaim: rest reduces the energy requirements of the area, avoids any unnecessary increase in blood flow, ensures protection of the area andoptimises healing.How: Use slings, crutches or static rest (ie. sitting or lying down).When and duration: Immediately after injury and for 3-5 days depending on injury severity. Complete rest isn’t desirable but any movement needs to be carefully controlled.

iceaim: Ice is used to limit the body’s over-reaction by reducing the temperature of the injured tissue and therefore the energy requirements and subsequent influx of blood. The ice helps constrict the blood vessels thereby limiting bleeding and reducing the accumulation of unnecessary tissue protein.How: Crushed ice wrapped in a damp towel or cloth is best (ice cubes can be wrapped in the cloth and smashed against a wall to crush them). Alternatively ice in a plastic bag, a frozen gel pack, or a packet of frozen peas is a cheap and practicalsubstitute. A

damp towel must be placed between the ice and the skin to avoid ice burn.When and duration: The sooner ice can be applied the better. Ice should be applied for between 20-30 minutes every 3-4 hours. If the area is very bony such as the elbow, reduce this time to around 10 minutes. Do not return to activity immediately as the ice will have an analgesic ‘numbing’ effect.

compressionaim: Compression limits an unnecessary accumulation of inflammatory fluid and ultimately over-production of scar tissue.How: Simple off-the-shelf compression bandages such as Tubigrip™ and adjustable neoprene supports are best for self-application. The area should be compressed a minimum of six inches above and below the site of injury. It should be flexible enough to accommodate initial swelling and continue to apply pressure as this reduces. The application of bandages and strapping is best left to a medical practitioner. Loosen the compression if you feel pins and needles around the compressed area.When and duration: As soon as possible following injury and continue for the first 72 hours.

elevationaim: To lower the blood pressure and therefore help limit bleeding and encourage drainage of fluid through the lymphatic system.How: Using pillows, foot stools, slings etc.When and duration: As soon as possible following injury and for the first 72 hours.

NEW LAUNCHFREE LEAFLETS

TO GIVE YOUR CLIENTS

20%OFF FO

R REPs

MEMBERS

ACT SOON OFFER ENDS

30 SEPT 2010

ENTER CODE 2088/R

TO GET YOUR

DISCOUNT

■ Handouts for members of the public

■ Free version and premium booklets available

■ Recommended by NHS■ Endorsed by medical charities■ Paste the page-turning free

version on your website■ Free and Premium versions

available

FOR MORE INFORMATION AND TO ACCESSTHE FREE LEAFLETS VISIT

HTTP://BIT.LY/SPORTEXEPALS

sportEXePAlsAdv3.indd 24 21/7/10 14:25:13

Date post:	14-Mar-2016
Category:	Documents
Upload:	tor-davies
View:	229 times
Download:	3 times

REPs Journal - Sept 10

Documents