CLINICIAN-LEADERS IN CARDIAC REHABILITATION: CLINICAL EXERCISE PHYSIOLOGISTS

Abstract

BACKGROUND Clinical exercise physiologists (CEP) are members of the multidisciplinary team in cardiac rehabilitation (CR). CEPs undertake multiple roles, including individualizing patient care to help restore or improve daily functioning in patients with heart disease. CEPs are equipped with a wide range of knowledge and skills for successful patient care and also have the skillset to propel career development to serve in leadership roles. The Million Hearts Cardiac Rehabilitation Collaborative (CRC) is working to achieve the goal of increasing enrollment to 70% CR participation in eligible patients. However, given the critical healthcare staffing shortage, the workforce poses a unique challenge to adequately staff clinics to improve access to CR, especially in historically marginalized rural and urban communities. PURPOSE: Describe the prevalence of CR programs that are solely staffed by CEPs and the job tasks they perform in the United States. METHODS CR program managers in the United States were sent an email invitation to participate in an electronic survey from the American Association of Cardiovascular and Pulmonary Rehabilitation. Depending on the participant’s responses, the final survey could be as few as 11 and up to 44 required multiple choice questions. RESULTS Among 297 CR programs that responded to the survey, 86% (n= 256) stated they staff a CEP and 12% (n= 30) stated their program is run entirely by CEPs. Among the programs run entirely by CEPs, the minimum degree for CEP staff was a bachelor’s in 93% (n= 28) and a master’s in 7% (n= 2). The ACSM clinical exercise physiology credential was preferred or required in 73% (n= 22) of programs. Job tasks performed by CEPs in these CR programs were provided patient education (100%), monitored ECG during exercise (100%), assessed patient symptoms (100%), screened patients entering CR (100%), measured blood pressure via auscultation (97%), measured blood glucose (97%), and administered supplemental oxygen (93%). CEPs can hold a leadership position in 83% (n= 25) of these institutions. CONCLUSIONS Leveraging the CEP practice patterns to serve as CR clinical leaders permits other health care professionals, such as nurses, to be used in other areas of health care. Although no formal framework exists on the educational preparation for a CEP career ladder, findings suggest that CEPs are competent to run and oversee CR programs. Innovative strategies to improve referral, enrollment, and retention of patients with heart disease into CR will require increases in CR capacity which can be filled by CEPs.