West Midlands - Clinical Exercise Physiologists : Important (but not new Members of the Multidisciplinary Team

Clinical Exercise Physiologists: Important (But Not New) Members of the Multidisciplinary Team

Author : Dr R Leslie, C Scordis, and Dr N Eddison Trust: RWT

Long-term chronic conditions are the largest financial burden on public healthcare, furthermore, longer lives will affect the total amount of ill-health and disability in the population, resulting in a major shift in the allocation of NHS resources. A vast body of evidence demonstrates the efficacy of targeted exercise interventions for the prevention and management of ageing longterm conditions.By embedding exercise into clinical services, we can ensure that ageing and long-term conditions are appropriately managed, reducing long-term healthcare utilisation.

October 2022

hysiotherapists working in NHS services have long delivered exercise interventions, with some physiotherapists choosing to undertake postgraduate study in exercise prescription and physiology to complement their physiotherapy practice. As with many NHS services, the demand for exercise rehabilitation services is growing rapidly and the current workforce cannot meet this demand. In some NHS Trusts, such as The Royal Wolverhampton NHS Trust (RWT), physiotherapists work alongside exercise physiologists, particularly in services such as pulmonary and cardiac rehabilitation. Having appropriate educational, professional, and regulatory standards for healthcare professionals is crucial for the delivery of safe, high-quality care.

The British Association of Sport and Exercise Sciences (BASES) has recently been working in partnership with Clinical Exercise Physiology UK (CEP-UK) to establish and promote the role of clinical exercise physiologists (CEPs) in the treatment and management of chronic and complex health conditions within the UK healthcare system. In December 2021, BASES, the professional body for sport and exercise sciences in the United Kingdom, and CEP-UK announced that CEPs had become eligible for professional registration.

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TTheir collaborative work resulted in exercise physiologists being eligible for professional registration with the Registration Council for Clinical Physiologists (RCCP) which holds a voluntary register regulated by the professional standards authority for Health and Social Care. Enforcing high standards of practice and maintaining a public database9. This means that appropriately qualified individuals can apply to become registered and will be awarded the title of clinical exercise physiologist upon successful acceptance on the register. These newly registered CEPs, working as part of a multi-disciplinary team of healthcare and rehabilitation providers, will be qualified health professionals. Proficient in exercise testing, exercise prescription and delivery of evidence-based interventions for the prevention, treatment, and long-term management of acute, subacute, chronic, and complex conditions.

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Who Are CEPs? CEPs require a minimum of 4 years of equivalent study up to Level 7 with a relevant undergraduate degree and Master’s degree in the area of clinical exercise physiology, such as cardiovascular health and rehabilitation. This training results in an excellent understanding of acute and chronic responses and adaptations to exercise in healthy and unhealthy individuals, as well as special considerations such as the influence of comorbid conditions and medications. CEPs working in NHS settings will often be responsible for conducting exercise tolerance tests, designing exercise programmes, and formulating individualised exercise prescriptions for patients with chronic diseases. Additional competencies include patient counselling and education regarding risk factor management, including addressing barriers to maintaining exercise compliance.

The Scope of Practice for a UK clinical exercise physiologist clearly outlines the role of a CEP, provides examples of the conditions a CEP can work with, and suggests areas of employment. To ensure patient safety the outline of the scope of practice for CEPs, based upon knowledge and skills from an RCCP-accredited Master’s degree includes the criteria outlined in figure.

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Figure 1: Outline of the scope of practice for CEPs

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The document also describes core rules, regulations and boundaries and reminds CEPs that they must practice in accordance with the RCCP standards of Professional Conduct & Ethical Practice.

Exercise Physiologists at The Royal Wolverhampton NHS Trust

There are currently several exercise physiologists employed by the physiotherapy department at RWT, some working in cardiac and pulmonary rehabilitation whilst others are employed as physiotherapy support workers. Chris Scordis, who has recently applied for CEP accreditation, is a specialist exercise physiologist and lead for cardiac rehabilitation. Chris completed an undergraduate degree in sports science with physical education and chemistry and worked for two years in the fitness industry, while he completed a spin qualification and advanced personal trainer (with GP referral) qualification. This led him to start an applied sport and exercise science post-graduate diploma, with the link between Wolverhampton University and RWT’s cardiac rehabilitation service affording him an invaluable work experience opportunity within the department. Invaluable in that it resulted in RWT deciding to explore the benefits of recruiting exercise physiologists.

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Throughout his two decades working at RWT, Chris has worked alongside physiotherapists and feels that the two professions complement each other well. Being a clinical educator for physiotherapy students, Chris is aware that there are aspects of exercise physiology and behavioural change that are not covered in detail in traditional physiotherapy degree courses. Thus, as an experienced exercise physiologist, Chris can share his knowledge with students whilst on placement in cardiac rehabilitation.

Figure 2: Chris Scordis in his role as a clinical exercise physiologist

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Chris feels that professional registration is an important step towards creating workforce capacity and professional standards that will help integrate the fitness sector into healthcare pathways whilst recognising the knowledge and skills of CEPs. If you are an exercise physiologist with an interest in healthcare, Chris advises you to approach NHS Trusts for work experience/shadowing opportunities and keep up to date with vacancies. CEP accreditation and registration have received mixed reactions from the physiotherapy profession, with some physiotherapists championing the role of exercise physiologists whilst others have expressed concern that the Chartered Society of Physiotherapy (CSP) council is in support of the development of CEPs13. As physiotherapists and CEPs, we must understand each other’s roles and value the knowledge and skills that each profession contributes to the delivery of safe and high-quality patient care. Ensuring that rehabilitation is accessible to all who need it.

Chris Scordis is a Clinical Exercise Physiologist

Dr Nicky Eddison is an Associate Professor and AHP Research Lead. Dr Ros Leslie is the Non-Medical Research Lead and Chief AHP

October 2022