CLINICAL EXERCISE PRACTITIONER

4. make use of a health and physical activity history eg. PAR-Q tool for basic exercise risk stratification assessment

The publication and dissemination of this document is still awaited but the application of a similar model of competencies to include the secondary and clinical care setting would be a significant step forward.

The National Exercise and Fitness Register Based on the need for accountability and credibility of the exercise professional in delivering safe and effective exercise programmes, the National Register was developed in 1998 by the former Exercise England, and includes: ● a code of ethics and professional conduct ● a complaints and disciplinary system ● requirements for continuing professional and educational development.

The register provides the means of self-regulation of the exercise industry in line with other professional bodies and sets standards for safety and effectiveness for local and health authorities. Following the liquidation of Exercise England in January, the regis- ter is currently in the hands of Sport England and it is hoped will be passed to a newly established consortium involving the Fitness Industry Association and SPRITO, the national training organisation for fitness. The National Quality Assurance Framework (6) recom- mends registration as a pre-requisite for exercise practitioners work- ing in primary health care settings and a similar model of registra- tion should be extended to the secondary care setting.

In effect the clinical exercise practitioner: ● understands patient motivation, barriers and attitudes towards exercise eg. concerns of the older or disabled people that exercise might in fact do them more harm than good (7, 8) ● is able to adapt and modify the principles of specific exercise programming (including frequency, intensity, mode and duration) to meet individual patient needs ● accommodates the physical limitations of special population groups such as frailer older people in a falls management pro- gramme ● will have undertaken additional training relating to a specific chronic disease or disability eg. type II (non insulin dependent) diabetes or asthma

What’s required for the future? Currently valuable experience and qualifications for the clinical exercise practitioner can be obtained through: a) the numerous primary health care exercise referral schemes b) the British Association for Cardiac Rehabilitation training pro- gramme (9) c) the soon to be launched Department of Health commissioned programme on exercise in the prevention and management of falls among older people (5) d) the guidelines for physical activity and hypertension (10)

However the following points indicate some of the processes and steps required to support the work of the ‘clinical exercise practi- tioner’. These include: ● developing evidence based reviews and expert consensus as the starting point for exercise programme design ● increased collaboration between exercise, health and medical professionals ● the development of agreed evidence based protocols and guide- lines for interventions ● an identified professional development route for the clinical exercise practitioner, particularly the development of competencies in applied clinical exercise settings ● ongoing curriculum development for the exercise practitioner leading to closely monitored and evaluated pilot education and training courses ● the provision of nationally accessible training programmes with mechanisms to ensure quality control which will assist in the meet- ing of standards eg. those laid down within National Service Frameworks for coronary heart disease and mental health

Professional education These developments may be more difficult to achieve unless new forms of collaboration and development are undertaken.

Some

areas of need or disease may fall into the domain of a specific national organisation such as the National Osteoporosis Society or Stroke Association. Other high profile needs such as obesity and mental health can be said to be the domain of a number of related topics and areas of interest.

Additionally other areas of development may be undertaken by spe- cific professional interest groups eg. physiotherapists, by alliances and various consortia of professionals and/or individual hospital units or specialist centres. While much evidence of good practice exists, sadly in the United Kingdom there is no single agency through which these developments can be collectively recognised

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