In many ways, the exercise protocol is the same as the exercise test evaluation. The participant arrives to the wellness clinic, is encouraged to use the restroom, and has the heart rate monitor placed around the chest. The participant is then asked to relax for 5 minutes to establish a baseline resting heart rate. This is very important because an elevated heart rate may indicate some change in health status that would negatively impact the exercise program. Physical therapy assistants provide individualized attention throughout the entire exercise session to make the experience positive, comfortable, and non-threatening. The physical therapy assistants have all the documentation necessary to run the program and the physical therapists are always on the premises to answer questions or concerns. They know whether a gait belt or harness is necessary and what parameters are indicated for treadmill speed, ramp and time. The heart rate monitor is checked frequently, and rate and incline are adjusted within the guidelines provided by the physical therapist. A 2-minute warm-up and cool-down are always part of the exercise protocol. Documentation is recorded on a log that is used to generate a progress note written monthly by the physical therapist. The progress note is sent to the case manager and primary physician to keep them informed of the program and any concerns that may have arisen. Along with the information in the log, the physical therapy assistants are asked for feedback regarding compliance. The progress note is also used to document the following months' target heart range and other parameters. On an annual basis, repeat body fat, weight, and lipid panel are obtained for comparison and to determine if there have been any changes in the clients' status. The challenge of the program, as with any exercise program, is to maintain the client's enthusiasm and motivation.