Being a multiculturally oriented clinical interviewer involves an orientation toward diversity that is open, af?rming, and appropriately curious. The following information on cultural groups provides barely enough information to whet the appetite and acknowledge basic potential cultural differences among clients. The old adage “The map is not the territory” is especially pertinent here, as these descriptions are meant to simply orient the interviewer. The actual cultural landscape will be unique to the individual and will most likely look quite different from the following map.

THE BIG FOUR In the introduction to Growing up Latino , Ilan Stavans writes: Today, at the center of the con?ict is the Hispanic, the man, woman, or child who speaks Castilian Spanish as his or her mother tongue, or whose ancestors did so. We in the United States often perceive Hispanics as a monolithic or amorphous group. They have divided loyalties, we say, and live between two cultures and two languages. But this is a narrow definition, a ?gment that Americans have created to ?ll our need to make these diverse peoples into a single one that we can then understand.

Multicultural and Diversity Issues 375Stavans was writing about Hispanics, but he could have inserted any of the larger or smaller minority groups in the United States and been equally accurate. Our groupings are huge, with an astonishing amount of diversity within each one. The same can be said for what is often referred to as White culture, or the dominant culture. We would be hard pressed to de?ne White . Would we include Italian Americans? Would we include Jewish Americans? Does the word Anglo communicate more accurately than White? Even if we said “persons of Western European descent,” it would not be clear as to who would be in and who would be out. In what century must the descendence begin to ?t this category? With apologies for these obvious gross generalizations, we make divisions to compare and contrast very broad differences between cultures. For example, we use the word White to refer to the dominant Caucasian culture in the United States. However, we readily acknowledge that our generalities are so broad as to be of limited usefulness. We hope this section stimulates your desire to develop your cultural competency.

The third characteristic of cultural competency is culture speci?c expertise. Culturespeci?c expertise involves the continuous acquisition of information about cultural groups, including sociopolitical dynamics, as well as effective interventions and techniques geared toward speci?c cultural groups. It has been argued that mental health professionals cannot know every nuance of every culture on the face of the earth. Of course, this is true. However, this fact does not excuse cultural ignorance. Learning about the life experiences and belief systems of other humans never ends. Competent mental health professionals seize every opportunity to increase their understanding of the diversity of life around them. Therefore, in some ways, multiculturalism is an attitude or philosophy as much as it is an applied ?eld.

The next section of this chapter contains basic, noncomprehensive coverage of concerns speci?c to groups of people identi?ed by race and/or cultural background. In addition, brief sections addressing persons with different sexual orientations, persons with handicapping conditions, and persons with deep religious convictions are included. An argument could be made for including women, the elderly, and other groups who have experienced oppression or do not ?t the mold of young, White, and male . There are many ways people ?nd themselves grouped together and many ways these groupings affect identity formation, functioning in the world, and quality of life in the dominant culture. As D. W.

Sue et al. state: Each client has multiple cultural identities which most likely do not progress or expand at the same rate. For example, a man may be quite aware of his identity as a Navaho but less aware of himself as a heterosexual or Vietnam veteran. As such, comprehensive multicultural therapy may focus on helping him and others like him become ever more aware of the impact of cultural issues on their being.

All exercises should be rhythmical in nature, moving through a full range of movement and performed at a moderate to slow controlled speed.

The exercise leader and assistants should observe the quality of RE task performed by the patient. Weights should be moved in a slow, sustained, controlled manner with exhalation during the straining part of the lift .

The programme should include eight to ten exercises targeting different muscle groups .The resistance exercises should target all major muscle groups to allow for all round body conditioning: chest, back, biceps, triceps, abdominals, lower back, quadriceps, hamstrings and calves.The ACSM recommends exercising large muscle groups before small muscle groups. In an RE programme, exercises should alternate between upper andExercise Prescription lower body work.This will give each muscle group recovery time .

The number of sets of resistance exercise required for CR patients remains controversial. The AACVPR recommend one set of each exercise.

Pollock, et al. suggest that strength gains are small with further sets.

Additional sets would increase the total duration of the RE session, and this could reduce exercise adherence . Individuals may also be more at risk of rushing to complete exercises, which may detract from technique and increase the risk of injury.However, as seen in the overload section, further sets may be used as a method of progression to achieve overload .

Resistance equipment The type of exercise will depend on both the equipment and space available.

Resistance bands and dumbbells are easily accessible and allow for a gradual progression in resistance or weight. Method of delivery can be either circuittype group sessions or delivered by the exercise leader where the class performs the same exercise.Caution should be used for those with balance or grip problems who may drop weights.

found that women are poorly represented in CR and suggest that in order to improve uptake and adherence in CR, different strategies, including changes to CR programme structure, gender speci?c information, environment and implementing behavioural change, are required to address the speci?c needs of this group.

In trials of CR the ethnic background of patients is seldom reported, but it is likely that trial participants are mainly white Caucasian, though there is no evidence to suggest that outcomes are less favourable for other ethnic groups . Beswick, et al. further suggest that speci?c interventions to encourage attendance of these groups could be individualised classes, buddy systems and inclusion in the programme of a signi?cant other.

It is generally acknowledged that CR should be all inclusive, with no barriers to inclusion. Strategies should be developed to recruit these previously excluded groups.

CONTENT OF CARDIAC REHABILITATION Cardiac rehabilitation is a multifaceted intervention offering education, exercise and psychological support for patients with coronary heart disease andCardiac Rehabilitation Overview their families and involves a variety of specialist health professionals . Cardiac rehabilitation can promote recovery, enable patients to achieve and maintain better health, and reduce the risk of death in people who have heart disease .The challenge of CR, along with all the other aspects of secondary prevention, is the prevention of subsequent cardiovascular events, while maintaining adequate physical functioning and independence and a good quality of life .