Cardiovascular Health and Rehabilitation PGDip

1. The process of rehabilitation (biomedical v bio-psychosocial/psychological determinants of health and behaviour change, patient centred approaches and socio-cultural influences on success)
2. Stages of rehabilitation, standards and case components (BACPR) (rationale, content, benefits & drawbacks)
3. Epidemiological influences and risk factors of cardiovascular disease
4. Pathophysiological influences and processes of cardiovascular disease
5. Procedures for diagnosing disease
6. Diagnosis decision making
7. Treatment selection choices
8. Medications for CVD
9. Metabolic risk factors such as obesity and diabetes and the link with peripheral vascular disease
10. The strength and weaknesses of the evidence base for cardiovascular rehabilitation 

To equip the student with a clinically-based understanding of relevant cardiovascular disorders, investigative techniques and therapeutic strategies.

1. General mechanisms and structures of the cardiovascular system that control circulation
2. The integration of mechanical/histological, electrophysiological, neuro-humoral factors
3. Cardiac metabolism; similarities and differences with skeletal muscle
4. Mechanical, electro-physiological-neuro-humoral factors specifically controlling the cardiac cycle
5. Cardiovascular diseases, including valvular disease, arrhythmia and heart failure
6. Changes in heart rate, stroke-volume, ejection fraction blood pressure, MVO2 (rate-pressure product) during exercise
7. Effects of posture on cardiovascular function during exertion
8. Consideration of electro-physiological, circulatory factors; similarities and differences with between the onset of acute exertion and cessation after prolonged (> 10 mins) exertion
9. Circulatory, arterial-histological, cardiac (electrical-mechanical) adaptations with chronic exercise training
10. “Fick Principle” - central vs. peripheral adaptations in individuals with cardiac disease
11. Evidence-base and rationale for the reduction in morbidity and mortality risk associated with regular exercise and increased aerobic fitness

1. To equip the student with advanced knowledge of cardiovascular anatomy and physiology that is central to the spectrum of cardiovascular and related diseases
2. To equip students with skill competencies for the assessment of cardiovascular function at rest and during exercise.

1. Role of exercise in health and the prevention of cardiovascular disease
2. Pre-exercise health screening and risk stratification
3. Overview of types of exercise testing procedures
4. Lab based assessments (cardio-pulmonary exercise testing and field-based functional capacity submaximal testing
5. Integrated analysis of exercise ECG and respiratory responses; alluding to risk stratification and exercise prescription
6. Designing exercise programmes and guiding physical activity from test results
7. safety and effectiveness
8. Effective use of heart rate and RPE in clinical lab settings
9. Exercise programming from clinica; exercise test results
10. Similarities and differences of programmes for individuals with MI, CABG, PCI, CHF
11. Influence of cardiovascular medications on exercise and physical activity
12. Practical functional tests of aerobic fitness (Step Tests, Cycle Tests, Shuttle Walk Tests)

1.   Analyse critically the physiological evidence base for exercise prescription. 

2.   Develop a comprehensive understanding of clinical exercise testing procedures and critical evaluation of results

3.   Translate test results into effective and evidence-based exercise prescription in a variety of settings

The module will be delivered using an evidence-based, concept-driven approach and will include: 

1.       Dietary agents implicated in development of cardiovascular disease. 

2.       Metabolism of dietary agents implicated in cardiovascular risk.

3.       The historical, anecdotal, evidence and nature of the association between dietary behaviour, lifestyle and cardiovascular disease development.  

4.       Population food and nutrient intake goals designed to reduce cardiovascular risk and improve cardiovascular health. 

5.       Natural history of, and potential influences on, cardiovascular disease throughout the life course. 

6.       Nutritional epidemiology and scientific basis upon which dietary guidelines rest. 

7.       Psychological aspects to dietary adherence, motivation and compliance.

8.       Risk factors for cardiovascular disease that have nutritional determinants eg. diabetes.

1. To consolidate the knowledge and understanding implicating the role of diet and nutrition in primary and secondary prevention of cardiovascular disease.
2. To examine the evidence and relative risk of diet exposure and lifestyle in the development of cardiovascular disease. 
3. To explore the relative strengths of intervention modes (eg. pharmacological) against reducing dietary exposure (eg. fat).

1.      The building blocks of scientific research: types of research (analytical, descriptive, experimental, and qualitative), scientific parlance (hypothesis, concepts, operational definitions, and dependent/independent variables), sampling procedures, and measurement issues (reliability and validity).

2.      Research and data collection methods: experimental research (developing hypotheses, independent/dependent variables, controls, sample selection, study designs, and experimental validity); descriptive research (questionnaires and interviews, case studies); qualitative research (characteristics, procedures, methods of data collection, data analysis, and internal/external validity).

3.      The nature of research; scientific methods of enquiry, pure versus applied ways of problem solving. Developing the research problem; identifying a topic area, devising specific questions, discovering what is already known (reviewing the literature), determining feasible ways to answer the questions.

4.      Ethics in research.

5.      Introduction to data analysis software (SPSS for Windows). Establishing an SPSS database. Defining and transforming variables; data storage and retrieval.

6.      Data analysis for descriptive and experimental research; descriptive statistics. Describing data; measures of variability, correlation and scatter plots. inferential statistics. Selecting an appropriate statistical test (parametric or non-parametric), and types of statistical tests (chi-square; t-tests; one-way ANOVA & post-hoc tests; Wilcoxon, Mann-Whitney U). Worked examples in SPSS. Repeated Measures ANOVA; Factorial ANOVA, Limits of agreement analysis for method comparison and test retest reliability. Worked examples in SPSS.

1.      To expose students to the essential elements in the process of conducting sound scientific research.

2.      To develop students’ skills in the key aspects of data handling and statistical analysis.

General 

1.       Choose an appropriate case-study: a patient for whom the student has been responsible in the position of exercise rehabilitation or secondary prevention

2. Workshops to support 

a.       Writing an evidence based critically appraised case-study report

b.       Review of evidence searching and information technology

c.       Review of lab-based exercise techniques that under-pin the scientific rationale of practice based functional assessments

Specific case-study information

1. Patient history that is directly related to the acute or chronic cardiovascular event from which an exercise-based rehabilitation programme will be developed

2. Assessments, invesitgations and treatments

3. Risk stratification

4. Applied health psychology and exercise physiology priniciples that under-pin a safe and effective exercise rehabilitation plan that lead to the patient pursuing a physically active lifestyle and/or participation in long-term structured exercise programmes

5. Reflection on professional practice and service delivery related to the programme in which the patient case is enrolled

This module aims to: 

1.       Analyse critically the psycho-social and physiological evidence base for exercise testing, prescription and patient programme design using a single case-study approach 

2.       Demonstrate that exercise testing and prescription knowledge, skills and competencies are at an advanced practice level which is supported by an equivalent level of post-graduate learning

The module will focus on individual student research into the agreed cardovascular rehabilitation related topic.

The module is designed to allow students to study a cardiovascular rehabilitation related topic of their choice.  The study will be subject to individual negotiation and agreement between the student and the module tutor.

The Core Content will be delivered in conjunction with the British Association for Cardiovascular Prevention and Rehabilitation's (BACPR) and aligns with their Exercise Instructor Training. 

1. Overview of Cardiac Rehabilitation and the Cardiac Rehabilitation Process
2. Review of cardiovascular anatomy and physiology related to the responses and adaptations to exertion, physical activity and exercise training.
3. Cardiovascular disease pathology, presentation, investigation and diagnosis
4. Overview of medical and surgical interventions for cardiovascular disease
5. Muscle structure and function and movement analysis related to cardiac rehabilitation exercises
6. Theory and practice of safe and effective warm-up (and cool down)
7. Theory and practice of the conditioning component to exercise programming
8. Risk factors and risk stratification
9. Monitoring intensity
10. Special considerations to managing and adapting activity to typical co-morbidities
11. Health and functional fitness assessment tools and outcome measures 
12. Changing behaviour & motivational interviewing

This module aligns with the BACPR Phase IV Exercise Instructor Training. It aims to add academic rigour and assessed module credits to the UK's most popular professional development courses on physical activity for cardiac rehabilitation professionals which is delivered independently but currently not assessed by the BACPR. It provides the opportunity for International students to receive both University academic credits and certificates from the UKs leading organisation on Cardiovascular Rehabilitation (the BACPR) The module, delivered over four days, takes students from the rudiments of physical activity and exercise in managing people with cardiovascular disease, to managing patients of higher risk and more complex, lower functional capabilities. The tutors include representation from the three professional groups that are typically involved in delivering the exercise component of cardiac rehabilitation, which are physiotherapists, sport & exercise scientists (exercise physiologists) and advanced exercise instructors. All of this provides a clear demonstration to students of the inter-disciplinary and inter-professional approach to delivering exercise to people with CVD. This module, taking an exercise class based approach in Part I, adds a practical dimension to the more in-depth theoretical, clinical and laboratory based module entitled Clinical Exercise Testing and Prescription, that also includes the use of exercise machines and specified tests of fitness testing.