PARS Referral Form

Referral Contraindications

These conditions may prevent eligibility for the programme.

• People who are already active – UK Chief Medical Officers’ guidelines 150 mins moderate 75 mins vigorous.
• Unhealed surgical wounds.
• Uncontrolled or unstable angina
• new onset and not established for longer than 1 month, angina at rest or increase in angina (frequency/severity/occurrence on lower levels)
• Deteriorating exercise performance/functional capacity despite apparent compliance with exercise regimen and medication
• Resting systolic blood pressure 180mmHg & / or diastolic blood pressure 100mmHg
• Uncontrolled resting tachycardia > 100bpm
• New and uncontrolled atrial or ventricular arrhythmias
• Unstable or acute heart failure
• Unstable diabetes
• A recent (within last 6 months) significant change in a resting ECG, recent myocardial infarction or other acute cardiac event.
• Experiences pain, dizziness or excessive breathlessness during exertion.
• Any hypoglycaemic episodes in the last 2 weeks or patients not able to monitor when hypoglycaemic episodes occur.
• Febrile illness
• Symptomatic hypotension/significant drop of blood pressure when exercising
• Any unstable/uncontrolled condition
• A recent (within last 3 months) Stroke/TIA
• Advanced cancer & end of life
• People who have accessed the referral programme with Manchester Active in the previous 12 months. After 12 months, if the reason for referral has changed the client may be eligible for further support on the scheme

Where possible, high risk patients should be referred to specialist exercise rehabilitation e.g. Cardiac or Pulmonary Rehabilitation. Otherwise, the procedure for dealing with high risk clients is as follows: All conditions must be stable and controlled.

Each client and their conditions will be triaged on an individual basis. Only when sufficient information has been received can an informed decision be made on the individual’s case. The GP remains medically responsible for the client.