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Jones H, Crozier A, George K, Miller G, Whyte GP, Rycroft J, Scott A, Buckley JP, McGregor G, Askew CD, Jack S, Birkett S, Broom DR, Tolfrey K, Campbell A, Skelton DA, Steenkamp L, Savage J, Green DJ. Establishment of clinical exercise physiology as a regulated healthcare profession in the UK: a progress report. BMJ Open Sport Exerc Med 2024; 10:e002033. [PMID: 38911478 PMCID: PMC11191777 DOI: 10.1136/bmjsem-2024-002033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
In 2021, a 'call to action' was published to highlight the need for professional regulation of clinical exercise physiologists to be established within UK healthcare systems to ensure patient safety and align training and regulation with other health professions. This manuscript provides a progress report on the actions that Clinical Exercise Physiology UK (CEP-UK) has undertaken over the past 4 years, during which time clinical exercise physiologists have implemented regulation and gained formal recognition as healthcare professionals in the UK. An overview of the consultation process involved in creating a regulated health profession, notably the development of policies and procedures for both individual registration and institutional master's degree (MSc) accreditation is outlined. Additionally, the process for developing an industry-recognised scope of practice, a university MSc-level curriculum framework, the Academy for Healthcare Science Practitioner standards of proficiency and Continuing Professional Development opportunities is included. We outline the significant activities and milestones undertaken by CEP-UK and provide insight and clarity for other health professionals to understand the training and registration process for a clinical exercise physiologist in the UK. Finally, we include short, medium and long-term objectives for the future advocacy development of this workforce in the UK.
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Affiliation(s)
- Helen Jones
- RISES, Liverpool John Moores University, Liverpool, UK
| | | | - Keith George
- RISES, Liverpool John Moores University, Liverpool, UK
| | - Gemma Miller
- RISES, Liverpool John Moores University, Liverpool, UK
| | - Greg P Whyte
- RISES, Liverpool John Moores University, Liverpool, UK
| | | | - Andrew Scott
- Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - John P Buckley
- School of Allied Health Professions, Keele University, Keele, UK
| | - Gordon McGregor
- Sport and Exercise Science, Coventry University, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Christopher David Askew
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Sandy Jack
- Sport and Exercise Science, University of Southampton, Southampton, UK
| | - Steffan Birkett
- Sport and Exercise Science, Manchester Metropolitan University, Manchester, UK
| | - David R Broom
- Sport and Exercise Science, Coventry University, Coventry, UK
| | - Keith Tolfrey
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | - Anna Campbell
- Sport Exercise and Health, Edinburgh Napier University, Edinburgh, UK
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
| | | | - Jude Savage
- The Academy for Healthcare Science, Leicester, UK
| | - Daniel J Green
- Sport and Exercise Science, University of Western Australia, Perth, Western Australia, Australia
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Crozier A, Graves LE, George KP, Richardson D, Naylor L, Green DJ, Rosenberg M, Jones H. A multi-method exploration of a cardiac rehabilitation service delivered by registered Clinical Exercise Physiologists in the UK: key learnings for current and new services. BMC Sports Sci Med Rehabil 2024; 16:127. [PMID: 38849904 PMCID: PMC11162017 DOI: 10.1186/s13102-024-00907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Cardiac rehabilitation has been identified as having the most homogenous clinical exercise service structure in the United Kingdom (UK), but inconsistencies are evident in staff roles and qualifications within and across services. The recognition of Clinical Exercise Physiologists (CEPs) as a registered health professional in 2021 in the UK, provides a potential solution to standardise the cardiac rehabilitation workforce. This case study examined, in a purposefully selected cardiac exercise service that employed registered CEPs, (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective service teams, and (iii) the existing challenges from staff and patient perspectives. METHODS A multi-method qualitative approach (inc., semi-structured interviews, observations, field notes and researcher reflections) was employed with the researcher immersed for 12-weeks within the service. The Consolidated Framework for Implementation Research was used as an overarching guide for data collection. Data derived from registered CEPs (n = 5), clinical nurse specialists (n = 2), dietitians (n = 1), service managers/leads (n = 2) and patients (n = 7) were thematically analysed. RESULTS Registered CEPs delivered innovative exercise prescription based on their training, continued professional development (CPD), academic qualifications and involvement in research studies as part of the service. Exposure to a wide multidisciplinary team (MDT) allowed skill and competency transfer in areas such as clinical assessments. Developing an effective behaviour change strategy was challenging with delivery of lifestyle information more effective during less formal conversations compared to timetabled education sessions. CONCLUSIONS Registered CEPs have the specialist knowledge and skills to undertake and implement the latest evidence-based exercise prescription in a cardiac rehabilitation setting. An MDT service structure enables a more effective team upskilling through shared peer experiences, observations and collaborative working between healthcare professionals.
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Affiliation(s)
- Anthony Crozier
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Lee E Graves
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Keith P George
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - David Richardson
- School of Human and Behavioural Sciences, Bangor University, North Wales, UK
| | - Louise Naylor
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Daniel J Green
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Michael Rosenberg
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | - Helen Jones
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK.
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Crozier A, Watson PM, Graves LE, George KP, Richardson D, Naylor L, Green DJ, Rosenberg M, Jones H. Insights and recommendations into service model structure, staff roles and qualifications in a UK cancer specific clinical exercise service: a multi-method qualitative study. Disabil Rehabil 2024; 46:2535-2547. [PMID: 37341512 DOI: 10.1080/09638288.2023.2225879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Clinical exercise delivery in the United Kingdom is disparate in terms of service structure, staff roles and qualifications, therefore it is difficult to evaluate and compare across services. Our aim was to explore, in a purposely selected cancer exercise service that was recognised as effective; (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective services, and (iii) to identify existing challenges from staff and service user perspectives. METHODS The Consolidated Framework for Implementation Research was used as an overarching guide to review the Prehab4Cancer service. Exercise specialists and service user perspectives were explored using a multi-method approach (online semi-structured interviews, online focus group and in-person observation) and data triangulation. RESULTS Exercise specialists were educated to a minimum of undergraduate degree level with extensive cancer-specific knowledge and skills, equivalent to that of a Registration Council for Exercise Physiologist (RCCP) Clinical Exercise Physiologist. Workplace experience was essential for exercise specialist development in behaviour change and communications skills. CONCLUSIONS Staff should be educated to a level comparable with the standards for registered RCCP Clinical Exercise Physiologists, which includes workplace experience to develop knowledge, skills and competencies in real-world settings.
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Affiliation(s)
- Anthony Crozier
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Paula M Watson
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lee E Graves
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith P George
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David Richardson
- School of Human and Behavioural Sciences, Bangor University, North Wales, UK
| | - Louise Naylor
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
| | - Daniel J Green
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
| | - Michael Rosenberg
- School of Human Science (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
| | - Helen Jones
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Pojednic R, O'Neill DP, Flanagan MG, Bartlett A, Carter BL, Kennedy MA. Exercise professional education, qualifications, and certifications: a content analysis of job postings in the United States. Front Sports Act Living 2024; 6:1338658. [PMID: 38313216 PMCID: PMC10835791 DOI: 10.3389/fspor.2024.1338658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Growth in the field of clinical exercise science and the potential impacts on overall health and wellbeing have driven the need for qualified, clinically trained, exercise professionals. And yet, it is not well understood what specific credentials employers are seeking when hiring exercise professionals. Purpose The purpose of the study was to examine the qualification requirements for professionals seeking employment in exercise science, exercise physiology, kinesiology or equivalent fields. Methods Search platforms Indeed.com and USAJobs.gov were examined within a two week period in 2022. Search terms included "Exercise Physiology", "Exercise Science", "Exercise Professional", "Exercise Prescription", "Exercise Specialist", and "Kinesiology". Results A total of n = 739 jobs were retrieved and n = 615 jobs were included: Exercise Science (n = 227), Kinesiology (n = 210), Exercise Physiology (n = 91), Exercise specialist (n = 53), and Exercise prescription (n = 32). Over 70% of the jobs analyzed required a bachelor's degree with the remainder requiring various levels of education. The primary certification required was personal trainer (n = 94), followed by strength and conditioning specialist (n = 33), clinical exercise physiologist (n = 26), group exercise (n = 17), exercise specialist (n = 10), and exercise physiologist (n = 5). Four job focus areas were determined: academic teaching and research, general fitness and worksite wellness, athletic performance and rehabilitation, clinical exercise specialist all with varying levels of degree and certification requirements. Discussion Job postings related to exercise related professions are varied across the United States with wide-ranging education, credentialing and certification requirements. These findings indicate the timely need for outreach to employers to highlight changing credentialing requirements due to evolving accreditation standards.
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Affiliation(s)
- Rachele Pojednic
- Department of Health and Human Performance, Norwich University, Northfield, VT, United States
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute of Lifestyle Medicine, Harvard Medical School, Boston, MA, United States
| | - Devin P O'Neill
- Department of Health and Human Performance, Norwich University, Northfield, VT, United States
| | - Molly G Flanagan
- Department of Health and Human Performance, Norwich University, Northfield, VT, United States
| | - Alexis Bartlett
- Department of Health and Human Performance, Norwich University, Northfield, VT, United States
| | - Byron LaGary Carter
- College of Health & Human Services, Troy University, Troy, AL, United States
| | - Mary A Kennedy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute of Lifestyle Medicine, Harvard Medical School, Boston, MA, United States
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Gluchowski A, Bilsborough H, McDermott J, Hawley-Hague H, Todd C. Exercise instructors are not consistently implementing the strength component of the UK chief medical officers' physical activity guidelines in their exercise prescription for older adults. BMC Public Health 2023; 23:2432. [PMID: 38057809 PMCID: PMC10699034 DOI: 10.1186/s12889-023-17289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
Strength training recommendations have been embedded within the UK's Chief Medical Officers' physical activity guidelines since 2011. There is limited evidence that these recommendations are used by exercise instructors in the community to underpin strength training prescription in the older adult population. This study aimed to explore exercise instructors' awareness and utilisation of the guidelines when prescribing strength training to older adults. Fifteen exercise instructors working with older adults in the UK participated in one online interview. A general inductive approach was conducted and thematic analysis allowed for major themes to be identified from the raw data. We found that most exercise instructors (n = 9), but not all (n = 6), were aware of the guidelines. Only one instructor (n = 1) had reportedly implemented the guidelines into their practice; other instructors reported that the guidelines were irrelevant. Instead, each of the instructors had their preferred sources of information that they relied on to underpin their exercise prescription, and each had their own interpretation of 'evidence-based strength training.' This individualised interpretation resulted in exceptionally varied prescription in the community and does not necessarily align with the progressive, evidence-based prescription known to build muscular strength. We suggest that (i) more detail on how to build muscular strength be embedded within the guidelines, (ii) a handbook on how to implement the guidelines be made available, (iii) theoretical and practical teaching materials and courses be updated, and/or (iv) a re-(education) of exercise instructors already in the field may be necessary to bring about a consistent, evidence-based strength prescription necessary for the best possible health and longevity outcomes for our ageing population.
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Affiliation(s)
| | - Helena Bilsborough
- Healthy Ageing Research Group, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jane McDermott
- Healthy Ageing Research Group, School of Health Sciences, University of Manchester, Manchester, UK
| | - Helen Hawley-Hague
- Healthy Ageing Research Group, School of Health Sciences, University of Manchester, Manchester, UK
| | - Chris Todd
- National Institute for Health and Care Research, Applied Research Collaboration-Greater Manchester, School of Health Sciences, University of Manchester, Manchester, UK
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Singh V, Pollard K, Okasheh R, Percival J, Cramp F. Understanding the role of allied health professional support workers with exercise qualifications in the delivery of the NHS Long Term Plan within allied health professional services in England. BMJ Open Sport Exerc Med 2023; 9:e001625. [PMID: 37654513 PMCID: PMC10465888 DOI: 10.1136/bmjsem-2023-001625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
Demand modelling for the allied health professionals (AHPs) workforce showed that significant expansion would be needed to successfully deliver on the National Health Service (NHS) Long Term Plan. The aim was to explore the use of AHP support workers with exercise qualifications in AHP services and to understand their current and potential role in NHS commissioned AHP services in England. The project had two phases and took place between October 2020 and January 2021. In phase one, an electronic survey was carried out to identify the scope and variation of exercise professionals working in AHP support roles in NHS commissioned services. Semi-structured interviews were conducted in phase two to gain further understanding about the experiences of those involved in AHP commissioned services. Survey data were analysed using descriptive statistics and interview data were qualitatively analysed using thematic analysis. Recorded interviews were transcribed and initially coded. Coding was then refined and themes were identified. Support workers with exercise qualifications made a valued contribution to AHP services and were considered cost-effective in delivering a specialised exercise intervention. AHP support workers contributed to a range of tasks relating to clinical exercise prescription. Collated data highlighted inconsistency in the way AHP support workers with exercise qualifications identified themselves, despite similar roles. Variation existed in the level of autonomy for AHP support workers with exercise qualifications, even within the same NHS Agenda for Change band. Attempts to manage this disparity involved numerous governance processes to ensure safe, high-quality healthcare in the context of delegation to support workers. Limited training and development opportunities and the lack of career progression for support workers were consistently acknowledged as a source of frustration and hindrance to individuals fulfilling their potential. AHP support workers with exercise qualifications have potential to positively impact service delivery providing added value to the NHS workforce.
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Affiliation(s)
- Vincent Singh
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Katherine Pollard
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Rasha Okasheh
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - John Percival
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Fiona Cramp
- College of Health, Science and Society; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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Woodhead G, Sivaramakrishnan D, Baker G. Promoting physical activity to patients: a scoping review of the perceptions of doctors in the United Kingdom. Syst Rev 2023; 12:104. [PMID: 37355661 PMCID: PMC10290366 DOI: 10.1186/s13643-023-02245-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND The physician-patient encounter presents an ideal opportunity for physical activity (PA) promotion. This review aims to (i) explore the breadth and depth of existing literature investigating doctors' perceptions of PA promotion in the United Kingdom (UK) and (ii) identify factors influencing the extent to which doctors engage in PA promotion during patient interactions. METHODS A five-stage scoping review methodology and the PRISMA-ScR guidance were followed: Stage 1-research questions specified; Stage 2-relevant studies identified by searching five electronic databases and manual screening of references; Stage 3-studies screened using Covidence™; Stage 4-study data extracted and charted; and Stage 5-findings from included studies were analysed, summarised and reported using (i) descriptive numerical analysis to provide insight into study characteristics and (ii) narrative summary of the evidence categorised by factors that influence doctors' engagement with PA promotion. RESULTS In total, 16,961 studies were screened. Nineteen studies were included in the review with most conducted in primary care focusing on the perceptions of general practitioners. Seven influencing factors were identified: knowledge and training, personal interest and PA level, time, resources, confidence, the perceived role of the doctor and patient relevance. CONCLUSION This review provides new evidence that historical barriers and influencing factors have a persisting impact on the ability and willingness of UK doctors to engage with PA promotion with patients. Previous efforts to address these factors would appear to have had limited success. Further intervention efforts are required to ensure more widespread and effective PA promotion to patients.
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Affiliation(s)
- Gemma Woodhead
- Edinburgh Medical School, University of Edinburgh, Scotland, UK
| | - Divya Sivaramakrishnan
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Sciences, University of Edinburgh, Scotland, UK
| | - Graham Baker
- Physical Activity for Health Research Centre, Moray House School of Education & Sport, University of Edinburgh, Scotland, UK.
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