While group exercise programs may be disease specific or have a more generic format (e.g., chronic disease programs) the program should always be tailored to individual needs and should include education. See Patient education.
Programs are often conducted in hospital or community health centres and local, but if unavailable, other venues such as community halls or local gymnasiums can be considered. The environment should be safe in terms of space and floor surface, and preferably air-conditioned. Patient access to the venue should be assessed to ensure logistical access into the building/room, as well as availability of lifts, parking access and public transport.
Evidence recommends that people commence a cardiac rehabilitation program as soon as practical after discharge from hospital.
With a rolling format, which allows attendees to enter at any week according to availability, patients will begin and end at different times. This type of program offers flexibility for patients who, for example, need to return to work early, and reduces the waiting time for commencement of the program.
By comparison, a 'stop-start' format has set commencement and completion dates limits new membership until the next cycle of sessions commences. Stop – start programs foster strong social connections and group dynamics which may encourage attendance.
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 programs may elicit greater physiological effects.
Program frequency and duration
For group programs, it is recommended that patients attend twice a week for approximately 1 hour of exercise training. If patient frailty and co-morbid disease precludes attending regularly or if resources are limited, less frequent attendance may be an option, with greater emphasis placed upon the home program. Independent home exercise and regular physical activity are essential adjuncts to all group programs and should consist of both resistance and endurance training.
All exercise programs should be run by an exercise specialist such as a physiotherapist or clinical 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 number of patients in the group. Usually, patients with HF need a staff-to-patient ratio of 1:5. Additional staff may be required for larger group sizes and for patients who have a high symptom burden, are considered high risk or those who are frail.