Download ALS Criteria

LEICESTER CITY COUNCIL REFERRAL CRITERIA
GENERAL CONDITIONS/ HEART CONDITIONS
UNSTABLE CONDITIONS
All Patients must be clinically stable, be aged 16+ and
fulfil at least one of the following criteria
Contraindication for
Referrals for Exercise
Considered Inactive
 less than 30 minutes twice a
week
Exhibits at least one risk factor
for Coronary Heart Disease e.g.
 Smoking
 Family History
 High Cholesterol >5.2 total
 BMI 25+
 Hypertension (140/90)
 Controlled Diabetes
Exhibits at least one risk factor
for Osteoporosis e.g.
 Family History
 Heavy Alcohol Consumption
 Hysterectomy
 Taking Prescribed
Corticosteroids
 Early Menopause
 History of Dieting or Lacking
in Calcium or Vitamin D
 History of Amenorrhea
Has controlled Asthma/breathing
problems
Suffers from mild to moderate
Rheumatoid Arthritis or
Osteoarthritis
Suffers from mild to moderate
Depression, Stress or Anxiety
Ischaemic Heart Disease
Unstable angina
Cardiac Event or Cardiac
surgery
Systolic blood pressure
> 179mmHg & / or
diastolic blood pressure
> 109mmHg
Post MI
Post CABG
BP drop > 20mmHg
demonstrated during exercise/ETT
Post Coronary Angioplasty
Post Transplant
Resting tachycardia
> 100bpm
Post Valve
Repair/Replacement
Uncontrolled atrial or
ventricular arrhythmias
Stable Angina
Unstable or acute heart
failure
Permanent Pacemaker/
ICD
Unstable diabetes
Stable Heart Failure
Febrile illness
Controlled atrial or
ventricular arrhythmias
Poorly controlled Asthma
Uncontrolled Insulin
dependent Diabetes
Unstable or severe mental
health state
Patients who in the Healthcare
Professionals opinion are not
medically fit to undertake an
exercise programme
Has Chronic Pulmonary Disease
Has Peripheral Vascular Disease
Has Cerebro-Vascular Disease
Suffers with chronic muscle, joint or
bone conditions that does not
greatly impede mobility or require
Physiotherapist treatment
Once these conditions are
completely stabilized
patients can then be referred
onto the Scheme
Please return completed referral forms to: April Alcott (Exercise Referral Officer)
Spence Street Sports Centre, Spence Street, Leicester, LE5 3NW
Created January 2010
Version 2