CLINICAL EXERCISE PRACTITIONER

Developing competencies Until recently, most competencies relating to exercise program- ming had been identified by the exercise and fitness industry (3), based on the framework developed by the industry lead body to define competencies and standards in coaching, leading and teaching in sport and exercise. The framework was designed to provide a coherent classification for National Vocational Qualifications (NVQs) and facilitates progression both within areas of competencies and between them.

The continuum (table 1), designed in relation to older people, sets out to identify how levels of competency can be matched with both the needs of the older participant and the intervention setting. At NVQ level 2, the exercise instructor provides activities including exercise to music, weight and circuit training and aqua classes in a variety of supervised community-based settings and particularly importantly to healthy, mostly motivated and paying customers.

It is at NVQ level 3 that the exercise teacher needs to begin to adapt exercise and develop programmes according to the limita- tions of individuals within specific population groups. These tend to be people with low health risks such as healthy but older peo- ple or special but fundamentally healthy populations such as pre and post-natal classes and disabled people. They do not relate to the specific needs of population groups such as the older frailer person or those with specific or chronic conditions such as coro- nary heart disease, stroke or diabetes.

Above NVQ level 3 (+++) the clinical exercise practitioner must operate using competencies that can be found within a range of professional backgrounds (including physiotherapy, occupational therapy and nursing). Here the exercise practitioner will deliver exercise programmes to people with specific chronic disease, dis- abilities or impairments eg. cardiac rehabilitation, falls manage- ment or HIV+ health programmes. Essentially patient groups with medium but significant health risks.

Competencies in primary and secondary care The learning acquired as a result of the growth of exercise refer- ral schemes in primary health care (4) and working with addi- tional targeted population groups (5) has highlighted the need for additional thinking and development around the skills, knowledge and understanding of the exercise practitioner.

Much of this has been distilled in the Department of Health com- missioned Quality Assurance Framework for Exercise Referral Systems which is still in draft format (6). Developed by the British Association of Sports and Exercise Sciences (BASES) and the for- mer national governing body of exercise, Exercise England, the document presents guidelines relating to the competencies of the exercise practitioner in the primary health care setting. Practitioners should: 1. understand and apply a proven model of behaviour change 2. understand the efficacy of exercise in relation to health gain 3. understand the social (economic and cultural) characteristics of patients

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