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Exploring activity options The next part of the consultation involves a discussion with the individual on activities they could do to remain active generic pletal 100mg with visa. The individual’s home and work envi- ronment should be reviewed in order to see where they could incorporate activity into their daily routine buy pletal 50 mg overnight delivery. It may be helpful to have information on phys- ical activity opportunities in the local areas that are suitable for CR patients discount 50mg pletal with amex. For example buy pletal 50mg with mastercard, the times and locations of indoor shopping centres for indoor walking, or of phase IV community exercise programmes and the times of adult-only swim sessions. Previous discussions on likes and dislikes of activity, current activity status and barriers to physical activity should also be con- sidered. The recommended amounts of physical activity and exercise required to improve and maintain health and fitness, and ways to achieve these recommendations, should also be discussed. As discussed in Chapter 4 the combination of stage one (accumulated activity) and stage two (structured exercise) should be reinforced and discussed. Goal setting Setting goals for increasing and maintaining activity in CR is important to help individuals stay motivated. The client should be encouraged to set short-term (one month), intermediate (three month) and long-term (six-month) specific 210 Exercise Leadership in Cardiac Rehabilitation activity goals. The consultant should assist the individual with goal setting to ensure smarter goals are set (i. The goals should meet the client’s needs and take into account factors discussed during the consultation, such as solutions to barriers, likes and dislikes, and current activity status. Preventing relapse Relapse prevention training (Simkin and Gross, 1994) is an important com- ponent of the exercise consultation process for patients completing supervised exercise programmes. Relapse prevention training involves teaching individ- uals that a lapse from exercising (e. Individuals should be encouraged to identify high-risk situations that may cause a lapse from activity, for example bad weather, increased work com- mitments or illness. Developing a plan to cope with these risky situations can reduce the likelihood of a lapse in activity and an overall decline in physical activity, for example, having an alternative indoor activity in bad weather, or rescheduling an activity session or engaging in a shorter bout of activity in order to meet increased work commitments. REPEAT EXERCISE CONSULTATIONS Some of the studies evaluating the effectiveness of the exercise consultation have used a repeat exercise consultation at six months. If individuals attend repeat consultations, information recorded during the first exercise consulta- tion should be reviewed. For example, participants should be asked if they achieved the activity goals set during the previous consultation. If clients did not achieve their goals, then the reasons for this should be explored and new goals set. For example, did they encounter any barriers to activity or risky situations that caused a lapse or relapse from activity? Assessing the individ- uals’ current activity levels and comparing them to the first activity assessment can inform individuals if their activity levels have increased, been maintained or declined over the past six months. Individuals who have increased their activity or remained regularly active should be praised for their achievements. However, barriers to activity, problem solving, goal setting and relapse pre- vention strategies should be discussed with all individuals to ensure they have acquired the necessary skills to help them remain active in the future. Maintaining Physical Activity 211 Phone calls can also be used to provide individuals with support for remain- ing active after an initial exercise consultation. The information recorded during the exercise consultation should be used to guide the phone calls. The phone call may involve discussing any problems the individuals are experi- encing in achieving their activity goals, attending community exercise pro- grammes and remaining active. EFFECT OF EXERCISE CONSULTATION TO INCREASE AND MAINTAIN PHYSICAL ACTIVITY Several randomised controlled trials have found the exercise consultation to be effective in promoting and maintaining physical activity in non-clinical and clinical populations (Loughlan and Mutrie, 1997; Lowther, et al. A recent study of sedentary people with type II diabetes found that the exer- cise consultation was more effective than standard exercise information in promoting and maintaining physical activity for 12 months (Kirk, et al.

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Caregivers often lack time and energy for once-enjoyed activ- ities buy cheap pletal 100 mg on-line, not to mention that they have to worry about whether there will be enough money to take care of expenses buy pletal 50mg fast delivery. If the person with Parkinson’s is married generic pletal 50mg mastercard, the spouse will probably end up being the primary caregiver generic 100mg pletal free shipping, but that role can be filled in a variety of ways, depending on the individual situation. In other situations, perhaps a brother or a sister has taken on the responsi- bility. And for people who have none of the above, there may be a paid person who comes to live in the home as the primary care- giver. Professional help can come from public health services, visit- ing nurses, home health care, physical and occupational therapy, agencies on aging, adult day care, support groups, civic organiza- tions, and churches. Over the years, Blaine and I have found little ways to adjust to the invasion of Parkinson’s into our marriage and our lives. We spouses—special and otherwise 115 have found that we both need to put forth an effort to make life as pleasant and easy as possible. To spouses (and other caregivers), Blaine offers these suggestions: • Put extra medication in the car. CHAPTER 10 Relationships with Our Adult Children You may give them your love but not your thoughts, For they have their own thoughts. You may house their bodies, but not their souls, For their souls dwell in the house of tomorrow which you cannot visit. She is the one who could always make me feel better, just by the touch of her hand, the way she expressed her concern, and the special things she cooked; she is the one who truly pam- pered me. I remember the special meal that Mom would make many years ago for her children when they were ill: homemade bread, toasted on the black woodstove (our only toaster), and cov- ered with butter and cream. When one of her children was hurt- ing, she would say, "If I could bear the pain for you, I would. But I 117 118 living well with parkinson’s know that my tending isn’t what she wants. Sometimes when I visit, she will say so: "I miss Mama," or "I feel as though Mama is here with me sometimes. Putting my mother, myself, and my children into perspective is important as I try to understand what is happening between me and my children since Parkinson’s entered our lives. When I think about my mother’s role in my life, I can begin to understand my children as they adjust to the invasion of an incurable disease into my life. This chapter centers around my children, Susan and Randy, and their spouses, and how they have adjusted to their mother having Parkinson’s disease. I hope it will help other parents to understand their children’s reactions a little better. It seems only a short while ago that Randy and Susan were children, playing ball, playing in the snow with neighborhood kids, or swimming with their friends in our backyard pool. It seems only a short while ago that the children camped with us on summer weekends or snowshoed with us in the winter in the snowy woods behind the house, where we built a fire and toasted frankfurters. She enjoyed sewing and crafts, took dancing and piano les- sons, and liked outdoor life, too. She graduated from the Uni- versity of Maine at Orono with a degree in Health and Family Life and then went back for additional study in early childhood education so that she could teach elementary school. Susan married Keith in 1975, and they have two lovely chil- dren, Bethany and Elissa. Susan teaches kindergarten part-time, which lets her spend time with her children and be involved in their activities. She takes advantage of workshop opportunities on such varied topics as education, dried-flower arrangements, and herbs. She enjoys collecting children’s books and dreams of having her own bookstore one day. Winterport is fif- teen miles from us, so we don’t see Susan every day, but we tele- phone each other about three times a week. In 1988, after ten years of success and stress in the world of big business, Keith brought his business expertise to become a copartner with Blaine and Randy in Atwood Builders. Most of all, doing things as a family is important to both Keith and Susan: one of their favorite activities is spending the day with the children on the Maine coast.

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The category of "abnormal" features of human beings is evidently graded discount 100mg pletal with mastercard, having central members like "armless" or "comatose" which across cultures trusted 50 mg pletal, most situations and subclasses of humans would universally be called "abnormal buy generic pletal 50mg on line," middle members like "hirsute" which vary with cultures purchase pletal 100mg line, age of the person and situations as to whether they arouse suspicions of pathology, and borderline members like "red headed" or "left handed" which are considered normal variants except in unusual circumstances. Disease thus cannot be read off from the mere presence of these other "abnormalities. Items that "cash out" as pathological are selected from the statistically "abnormal" on the basis of experience, not prior to it. But as human creatures who must identify problems and respond to them on a human scale, we find that certain criteria may be perfectly adequate in the particular yet inappropriate for wholesale application. It is necessary to tease out the specifics of problems which lend themselves to the application of the "abnormality" model as opposed to one of the others. HEALTH AND DISEASE 49 When we think of disease as abnormal we think of ourselves as containers or amalgams to which various items need to be added or subtracted. Our abnormalities are often thought of as having been produced from sources which need to be identified and shut off. Sometimes objects have to be transferred into or out of us to "correct" these abnormalities. So treatment involves opening or closing off sources of the abnormal, or facilitating the transfer of objects like thyroid hormone, growth hormone, chemicals or metabolites in or out of the body. Disease Is Disintegration (of a whole) This model is partly literal in that some diseases are manifested by literal loss of cohesion or completeness of bodily structure, but also metaphorical in that our cognition of other literal realms of loss and disintegration is mapped onto disease. Disease is linked in our experience with disintegration, but here they are not merely associated. People are regarded as poorly developed, poorly integrated or incomplete by reference to an ideal which is assumed but rarely made explicit. If the features of this ideal were empirically investigated it would no doubt be discovered that some, such as "two hands" are universally held but others, such as "two hands of the 50 CHAPTER 2 same size" or "two hands of the same strength" are not. The degree to which bodily systems are coordinated or to which various aspects of personality are integrated in the ideal is not articulated, although much language, particularly in the field of mental health, refers to "integration" as though it were well defined and agreed upon. Additionally, little thought has been given to what we mean by treating "the whole person. Still, the idea that the way aspects of a person are unified can be assessed qualitatively, and that health status relates to this quality, is persistent. The prominent causal efficacy of medical treatment involves reassembly according to a structural model, so this is a kind of causation as making. Unity and order are closely related in that feedback mechanisms, intercellular communication, orderly and complete differentiation of tissues, development of organs and their coordinated function require principles and agents of both order and unity. Disease Is Disorder Or Loss Of Control Over Order Health——————————————————-Order Maintained By Control. This is a common manner of speaking about health which presupposes the often unarticulated idea that Health Is Order Maintained By Control. We know that function is dependent upon structure and that structure requires unity and proper order. This implicit knowledge links the concepts of health as wholeness, controlled order and proper function. But at times one of these related concepts is highlighted as central in importance and at times another. Each model in the related cluster of idealized cognitive models contributes to the cognitive structure relating the individual "diseases" in a vast radial category outlined in the second part of this chapter. So in addition to being "mechanical breakdowns" and "losses of integrity" illnesses are commonly thought of as "disorders," as in "disorders of metabolism," "disorders of the kidneys," "of the skin," "of the brain," etc. Schizophrenia is a "thought disorder," scleroderma was called a "collagen disorder," malignant hyper- thermia is a "disorder of temperature control," and bipolar illness is a "mood (control) disorder. Extra Healthy———-Overflowing Or Having Extra Vital Fluid (sometimes Full Of Fluid Under Pressure). Cause of Illness——–Agent Rupturing Fluid Vessel, Decreasing Fluid Production or Using Too Much Fluid Up. Treating an Illness—–Patching A Leak, Stimulating Fluid Production, Refilling With Vital Fluid. Since we observe that people become first weak and then die as they lose blood, and also experience a continuous need for water in order to survive, it comes as no surprise that the capacity to contain a fluid is a central model of health.

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CR exercise leaders should also consider the necessity and effectiveness of a piece of equip- ment to fulfil the exercise objective and assess its suitability for the proposed patient group buy generic pletal 50 mg online. Safety Considerations The safety of exercise equipment should be evaluated in terms of its design purchase pletal 50mg with amex, ergonomics cheap pletal 50mg amex, biomechanics and electrical circuitry pletal 100mg visa. Design of seats and supports should accommodate various body types and sizes, with weight restrictions as appropriate. Apparatus must be constructed to maintain joint movement within normal range, and emergency cut-off switches must be easily accessible (e. With electrical equipment, all cables and plugs must be secured, covered and sited so that patient traffic is not compromised around equipment. Equipment Maintenance A maintenance programme is important in extending the life of equipment, providing regular safety checks and ensuring the validity and calibration of outcome measures. Leadership, Exercise Class Management and Safety 177 LOCATION FOR DELIVERING CARDIAC REHABILITATION PROGRAMME The goals of CR are to provide the patient and family with the individualised exercise prescription, counselling, education and support they need to resume an independent, active lifestyle. The majority of patients choose to participate in a clinically supervised phase III programme. They then progress into a long- term phase IV CR programme once they are stable and knowledgeable in self- monitoring and CHD risk factor modification. They may choose to exercise at home because they do not wish to participate in a group, or because of problems of accessing the venue, incon- venience of the venue or programme timing, or because of the cost and time to travel to the programme. In order to overcome the absence of direct super- vision and associated peer support, some CR services offer regular telephone contact and mail, fax or internet communication to support, monitor and advise patients through a home-based programme. Although there is good evidence for the advantage of supervised exercise (Wenger, et al. A review of well-conducted ran- domised trials and observational studies supports findings that Low to moderate intensity exercise for low to moderate risk patients can be pro- vided as safely and as effectively in the home or community as well as in the hos- pital setting. Patients at high risk and those undergoing high intensity training should only exercise at venues with full resuscitation facilities and staff trained in advanced life support. Phase III can also be structured to be sited in the hospital for the first half, and in the community for the second half of phase III CR (Armstrong, et al. This design helps to introduce patients early to a community setting, where phase IV will be based, thus exposing them to a less medical environment and using community facilities. In addition, these may be run as outreach programmes by hospital- based CR professionals, to improve access to services for patients and to overcome space and equipment limitations in hospital sites, or they may be staffed by community health professionals. Recommendations from a British Heart Foundation survey of all CR programmes in England and Wales (Fearnside, et al. SUMMARY The leadership characteristics and roles of the exercise leader and assistants have been described for the first time focusing on a UK context. Safety in the delivery of the exercise session and in the use of different equipment is the responsibility of the exercise leader. Protocols for care and use of equipment are also required to be developed by the CR team. Should any medical inci- dent occur, this chapter provides a template for actions to be taken. REFERENCES American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) (2004) Guidelines for Cardiac Rehabilitation and Secondary Prevention Programmes, 4th edn, Human Kinetics, Champaign, IL. American College of Sports Medicine (ACSM) (2000) ACSM’s Guidelines for Exercise Testing and Prescription, 6th edn, Williams and Wilkins, Baltimore, MD. American College of Sports Medicine (ACSM) (2001) ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 4th edn, Williams and Wilkins, Baltimore, MD. American Heart Association (AMA) (1998) Operation Heartbeat Implementation Guide, American Heart Association, Dallas, TX. American Physical Therapy Association (2003) Minimum eligibility criteria for cardiovascular and pulmonary physical therapy. Association of the Chartered Physiotherapists Interested in Cardiac Rehabilitation (ACPICR) (2003) Standards for the Exercise Component of the Phase III Cardiac Rehabilitation, The Chartered Society of Physiotherapy, London. Association of the Chartered Physiotherapists Interested in Cardiac Rehabilitation (ACPICR) (2005) Competencies for the Exercise Component of Phase III Cardiac Rehabilitation,CSP, London. British Association for Cardiac Rehabilitation (BACR) (1995) Guidelines for Cardiac Rehabilitation, Blackwell Science, Oxford. British Association for Cardiac Rehabilitation (BACR) (2002) BACR Exercise Instruc- tor Training Module,3rd edn, Human Kinetics, Leeds.

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