Group exercise programs may be disease specific or have a more generic format (e.g., chronic disease programs).
Programs are often conducted in hospital or community health centre gymnasiums, but if unavailable, other venues such as community halls or local gymnasiums can be considered. The environment should be safe (e.g., in terms of space and floor surface) and preferably air-conditioned. Patient access to the venue should be assessed (e.g., to ensure logistical access into the building/room, as well as availability of lifts, parking access and public transport).
Frequency and duration of exercise session
For group programs, it is recommended that patients attend twice a week for approximately 1 hour. If patient frailty and co-morbid disease precludes attending this frequently or if resources are limited, a weekly session combined with individual home-based exercise is an option.
All individuals should be encouraged to exercise on most days of the week so a home exercise program is an essential adjunct to any centre-based rehabilitation program.
Duration of program
Programs may be time-limited or ongoing in the case of patients wait-listed for cardiac transplantation. Cardiac rehabilitation exercise groups are usually for 4-12 weeks whereas patients with HF usually require at least 8-12 weeks as longer duration may elicit greater physiological effects and slow down decline post program.[#chen-ym-li-zb-zhu-m-et-al.-2012,#collins-e-langbein-we-dilan-koetje-j-et-al.-2004,#willenheimer-r-rydberg-e-cline-c-et-al.-2001]
Entry and exit of a group exercise program
All patients should attend an individual assessment prior to attending any group program. Rolling format allow patients to enter at any week according to availability with patients beginning and ending at different times. A 'stop-start' format has set commencement dates.
- The ‘rolling program’ offers more flexibility for patients who, for example, need to return to work early, and reduces the waiting time for participation in the program.
- The ‘stop-start’ format offers a fixed time limit and strong social interconnection, but limits new membership until the next cycle of sessions commences.
Communication with all health care providers is essential to optimise patient outcomes. Sample letters/templates are available in the Resources section.
Group exercise staffing & ratios
All exercise programs should be run by an exercise specialist such as a physiotherapist or exercise physiologist. Additional support staff may include nurses, allied health professionals or lay people. It is crucial that all staff members are trained in cardiopulmonary resuscitation (CPR) and are familiar with local emergency procedures.
There is no standard ratio of staff to patients. Staffing will depend on the access to medical services, disease severity and numbers in the group. Usually, patients with HF need a staff-to-patient ratio of 1:5. A greater ratio will be required for larger numbers of patients, higher-risk participants or for programs with moderate-intensity exercises. Frail and high-risk patients may require a 1:1 ratio.