Southglos.gov.uk

Exercise on Prescription Scheme
South Gloucestershire
Essential referral criteria listed below
Plus at least one below
Inactive (i.e. <30mins moderate activity per week) Hypertension (control ed) Hyperlipidemia Chronic Obstructive Pulmonary Disease Mild to moderate depression NHS Health Check Current and past health problems not mentioned above Lifestyle Factors Current medication
Aspirin
Baseline measures
Resting heart rate
GPPAQ classification Inactive Mod.inactive Mod.active Active I refer this patient to the South Gloucestershire “Exercise on Prescription Scheme”

● By completing this referral you are not assuming responsibility for the administration or delivery of the ● Clinical responsibility rests with the referrer.
● Responsibility for the administration and delivery of the exercise programme rests with the exercise specialist.
● Responsibility for consenting to take part in the exercise programme and fol owing the plan and the exercise specialist's guidance rests with the participant.
Please contact the exercise on prescription team to make an appointment.
Phone: 01454 864384 or fax form to 01454 868535 The Council Offices,
Badminton Road, Yate, South Gloucestershire BS37 5AF
Exercise on Prescription is a physical activity referral scheme that offers support in
developing an activity routine to help improve your health and assist in the management
of your medical condition.
Physical activity has a key part to play in improving health and wellbeing, Exercise on
Prescription will support and encourage you to take the first steps to becoming more
active on a regular basis.
Consultation and assessment
Physical activity programme
● Your care and management is under the Begins with setting realistic goals around guidance of the Exercise on Prescription specialist, and is tailored to your individual ● As the referred patient you will be consulted ● Individual consultations take place in a convenient venue, normally at your nearest ● You will be issued with an Active Card.
● Tailored contact with your Exercise on ● Consultation appointments are available Prescription specialist is normally for a 12 each site. Evening appointments are available on a Friday at Bradley Stoke and ● Monitoring of your individual progress is ongoing, with a formal review at six weeks and 12 weeks.
● Please bring your referral form to the initial consultation and any other information that ● There is a cost attached to your supervised you think is useful to support your referral.
physical activity sessions. The cost is the Circadian concessionary price and is ● The initial consultation takes approximately ● Additional costs at certain Leisure Centres ● There is no physical activity involved at the is required for a Wellness Key, which is ● An appropriate assessment of the patient prior to the physical activity plan will Options on completion of your referral
include: a full past and present medical ● On completion of your 12 weeks all the history, baseline measurements; including baseline measurements are repeated.
blood pressure, height, weight, waist and ● Some individuals may need an extended period with the Exercise on Prescription specialist, this is discussed and agreed under a set criteria.
● Transfer to the Leisure Trust membership is available; options including concessional rates are available for individuals subject to Leisure Trust terms and conditions.
● Low impact mobility classes and aqua sessions are available at certain sites.
● Walk to Health provide a full programme of SGC CREATIVE DESIGN • 6789 | 12 | 12
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Source: http://www.southglos.gov.uk/Documents/Referral%20Form%202012.pdf