Developing the roles to deliver Exercise as Medicine post-C19

EuropeActive Webinar8th June 2020, 15:00 CEST

Initiatives under our 2020 - 2021 strategyRepositioning our sector towards public health policy

(President’s Council)

Initiatives under our 2020 - 2021 strategyThe development of our Knowledge Centre into a European

think tank for fitness and physical activity.

Initiatives under our 2020 - 2021 strategyThe European medical fitness summit

Introduction

• Dr Kade Davison, Program Director for Clinical Exercise Physiology, University of South Australia

• Francis Neric, MS, MBA, National Director of Certification, ACSM

• Dr Andrew Scott, Course Leader, MSc/PgDip/PgCertClinical Exercise Science, University of Portsmouth

• Julian Berriman, Director Professional Standards Committee, EuropeActive

• David Stalker, President, EuropeActive

Francis NericNational Director of Certification, ACSM

Kade DavisonProgram Director for Clinical Exercise Physiology,

University of South Australia

Exercise as Medicine in a post COVID world: An Australian Perspective

Dr Kade Davison

Accredited Exercise Scientist & Accredited Exercise PhysiologistExercise and Sports Science Australia

Senior Lecturer in Allied Health and Human PerformanceUniversity of South Australia

My interest…

• Immediate Past President of Exercise and Sports Science Australia• Appointed Board Director of newly established body:International Confederation of Sport and Exercise Science Practice• Research interest in industry models of exercise as medicine in Aust and across

the world• Passionate educator and practitioner of exercise as medicine

Gym Instructor / Group Fitness InstructorPersonal Trainer

Accredited Exercise Scientist

Accredited Exercise Physiologist(also Accredited Sports Scientist)

Scope of Practice – AusREP

Scope of Practice – Accredited Exercise Scientist

Scope of Practice – Accredited Exercise Physiologist

COVID-19 recovery and exercise as medicine

Key opportunities for suitably qualified exercise practitioners to help!

Longer term impacts of COVID-19

• Impaired Pulmonary function• Cardiomyopathy• Post viral fatigue• Worsening of existing illnesses (CVD, Type 2 Diabetes, Cancer, OA)• Mental Illness• Safe return to exercise facilities• Health system funding

Conclusion

• Advanced level qualifications with clear role delineation and screening / referral systems are needed to support safe and effective Exercise as Medicine

• Significant opportunity for Exercise Practitioners to aid in the recovery from COVID-19 worldwide

• New models of health service delivery may support more cost effective and accessible health care in a peri and post-COVID world

Andrew ScottCourse Leader, MSc Clinical Exercise Science,

University of Portsmouth

Creating a professional standard for the Clinical Exercise Physiologist in the UK and the rest of EuropeDeveloping the roles to deliver Exercise as Medicine post-C19

Dr Andrew Scott, Course Leader, MSc Clinical Exercise Science | Chair, BASES Clinical Exercise Science and Practice Interest Group

School of Sport, Health and Exercise Science, University of Portsmouth, UK

Overview

• Lifestyle-related illnesses

• Research vs vocational education

• Clinical Exercise Physiology

• Specialist Exercise Instructors

• Inter-professional working

Current issues in health care in UK/Europe

• Increasing numbers of patients living to an old age• Increasing numbers of adults experiencing morbidity at a young age• Children presenting cardio-metabolic disorders

• Health professions not consistently prepared/trained to provide exercise

• ‘Sport Scientists’ either not appropriately prepared, or not recognised as being appropriately prepared, to deliver fitness testing, exercise prescription and exercise leadership

• Exercise physiologists generally not part of the medical multidisciplinary team or recognised as health professionals

Current issues in clinical exercise training

•Higher Education vs Vocational Training

•Relative lack of experiential learning opportunities

What is a Clinical Exercise Physiologist?

• Clinical Exercise Physiologists (CEPs) are allied health professionals who specialise in the prescription and delivery of evidence-based exercise services as part of the prevention, treatment and long-term management of injury, chronic disease and complex conditions.

• CEPs work in a range of settings including hospital, aged-care and community clinics as part of multidisciplinary healthcare teams. CEP services aim to optimise physical function and health, and promote long-term wellness through lifestyle modification and behaviour change.

• Level of training• A minimum of 4 years equivalent study up to postgraduate with a relevant undergraduate degree and MSc in

the area of Clinical Exercise Physiology and 500+ hours of supervised/guided experience.

Referral pathways and specialities

• Cancer including but not limited to breast cancer, prostate cancer and bowel cancer .

• Cardiovascular including but not limited to ischaemic heart disease (IHD) / acute myocardial infarction (AMI), chronic heart failure (CHF), arrhythmias and pacemakers, hypertension, peripheral artery disease (PAD), and valve disease .

• Frailty including but not limited to sarcopenia, osteoporosis, falls history or fear of falling, either primary or secondary to any of the conditions above

• Kidney including but not limited to chronic kidney disease (CKD) stages 1-5, common aetiologies – diabetic nephropathy, hypertensive nephropathy, polycystic kidney disease, long-term medication use, infectious kidney disease, acute kidney failure (reversible), and end stage kidney disease .

• Mental Health including but not limited to anxiety disorders, affective disorders, psychotic disorders and trauma, and stressors related disorders.

• Metabolic including but not limited to overweight and obesity, metabolic syndrome, dyslipidaemias (acquired and familial), Type 1 diabetes, Type 2 diabetes, gestational diabetes, sleep apnoea, and polycystic ovarian syndrome.

• Musculoskeletal including but not limited to osteoarthritis, rheumatoid arthritis, osteoporosis, acute, and sub-acute and chronic specific and non-specific musculoskeletal pain / injuries /disabilities

• Neurological/Neuromuscular including but not limited to stroke (CVA), Spinal Cord Injury (SCI), Parkinson’s disease, Cerebral Palsy, Multiple Sclerosis (MS), dementia, Traumatic Brain Injury (TBI).

• Respiratory/Pulmonary including but not limited to asthma, chronic obstructive pulmonary / airways disease, and cystic fibrosis.

Scope of practice

Professional practice is influenced by many factors including the context in which practice occurs, individual patient needs, and the practice environment, as well as local and national healthcare policies. The foundational scope of practice that is reasonable for CEPs entering the profession to be involved in is listed below.

• Screening, assessing and applying clinical reasoning to ensure the safety and appropriateness of exercise and physical activity interventions, which includes conducting tests of physiological measures;

• Assessing movement capacity in people of all ages and levels of health, well-being or fitness;• Development of safe, effective individualised exercise interventions;• Provision of health education, advice and support to enhance health and well-being including nutritional information in line

with national nutrition guidelines and information on relevant prescribed medicines;• Provision of exercise intervention and education for those at risk of developing a chronic condition or injury;• Provision of clinical exercise prescription, for those with existing chronic and complex medical conditions and injuries;• Provision of exercise-based rehabilitation and advice for patients in the acute/sub-acute stage of injury, surgical intervention,

or during recovery to restore functional capacity and well-being; and• The above tasks may occur at any level of primary, secondary or tertiary health care, and may include employment or

volunteer work at an individual, community or population health level through various employers or industries.

Clinical Proficiencies

• Standards of Proficiency adapted from the current Academy of Health Care Science and Physiotherapy Proficiency standards regulated by the Professional Standards Authority for Health and Social Care, such as:• Understand the Clinical Exercise Physiologist’s contribution to the delivery of high quality healthcare • Practise safely and effectively within your scope of practice • Practise within the legal and ethical boundaries of your profession as a Clinical Exercise Physiologist

• Draw on appropriate Clinical Exercise Science knowledge and skills required for safe and effective practice • Reflect on, evaluate and review practice• Able to assure the quality of your practice

• Understand the key concepts of the knowledge base relevant to Clinical Exercise Science that underpin the role of Clinical Exercise Physiologist

Clinical Exercise Physiologist competencies

• Professional Practice• Graduate clinical exercise physiologists are able to consider clinical, scientific, ethical and legislative parameters, and the broader healthcare system framework, for

their practice.

• Foundation Knowledge in medical conditions and evidence base for exercise intervention• Apply knowledge of pathophysiological bases for a broad range of medical conditions, and have an understanding of common treatments, interventions and

management.

• Referrals, screening and assessments of exercise and functional capacity• Able to interpret and use referral information, conduct screening and assessments of service users for safe participation in exercise, and perform functional capacity

evaluations.

• Design of exercise interventions• Design safe and effective exercise interventions, and health and wellness interventions to effect behaviour change and increase exercise and functional capacity across

diverse contexts and settings.

• Implementation of exercise and health & wellness interventions• Implement and evaluate safe and effective exercise interventions that considers service users’ clinical status and manage behavioural factors that influence exercise

participation.

Germany - DVGS

•The four pillars of healthcare – licensed Exercise Physiologists:•Cardiac•Respiratory•Diabetes•Osteoporosis•Cancer

Europe – Higher Education

European Masters in Health and Physical Activity:http://www.europeanmasterhpa.eu/

• Rome - University of Rome “Foro Italico”• Cologne - German Sport University• Odense - University of Southern Denmark• Oslo - Norwegian School of Sport Science• Vienna - University of Vienna

International Confederation for Sport and Exercise Science and Practice

Specialist Exercise Instructors in the UK

Scott (2016)

Specialist Exercise Instructor providers

Exercise Professionals Groups

• First started in Cardiac Rehabilitation in 1999

• A group of physiotherapists (ACPICR), exercise scientists (BASES) and fitness professionals (BACPR exercise instructor network) cooperate together to organise training, annual conference and study days

• British Renal Society has a rehabilitation network

• Progress being made to include physiotherapists, exercise scientists and fitness professionals in similar group for:• Cancer• Older people• Mental health• Neuro-rehabilitation• Respiratory diseases

Summary

• Professional Standards and Educational Standards for Clinical Exercise Physiology are available

• The role of the Clinical Exercise Physiologist and Specialist Exercise Instructor are distinct and complementary

• Multidisciplinary teams in the ‘exercise family’ must work together to work with in the varied health care systems in European countries

• Be prepared to work privately in the community

• Above all, create courses and accreditation pathways to gain experience to demonstrate credibility

Q&A

Closing comments

Active Autumn 2020

Activities and Initiatives of our seasonal kickoff in September:• European Week of Sport• EHFF on 30th September (FIBO Week)

• EFAF Roundtable in Cologne• Active Leaders executive training programme• Updating standards for people and places for post-C19• Launching our President’s Council with leading operators

• Podcast series• C19 impact report with Deloitte et al

Thank youwww.europeactive.eu/covid19

www.ereps.eu/covid19

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