Accredited Exercise Physiologists Research Articles

UNDERSTANDING THE BARRIERS AND ENABLERS TO ACCREDITED EXERCISE PHYSIOLOGIST’S INTEGRATION WITHIN THE AUSTRALIAN HEALTHCARE SETTING

INTRODUCTION Physical activity (PA) is crucial in managing the high rates of non-communicable disease (NCD) within Australia. Accredited Exercise Physiologists (AEPs) are well-placed to assist individuals in managing symptoms of NCD through PA intervention. However, General Practitioner referral rates to AEPs are very low (< 1%), with a lack of time and education reported as key barriers to their referral practices. Research has yet to explore the underutilization of AEPs from the AEP’s perspective. AIM: To explore the perspectives of Australian AEPs regarding their role and utilisation within the healthcare setting. METHODS Currently practicing AEPs (n=15) participated in audio-recorded, individual semi-structured interviews between May to July 2023. Interviews were transcribed and data were analysed via an inductive, semantic approach to reflexive thematic analysis. RESULTS Four primary themes emerged. The first, understanding is important, identified that a key barrier to AEP practice was the general population’s lack of understanding regarding the role of an AEP. The second, education and support of AEPs is crucial, reflected the perception that some recent graduates required further support to be better integrated within the healthcare setting and to provide a higher quality service. The third, interaction is key, highlighted that AEPs regarded communication with referrers as crucial to improve referral processes. The final theme, systematic and policy barriers impact AEP services, highlighted systematic barrier’s including time-consuming administration tasks and cost, as impacting AEP services. CONCLUSION The findings highlight a need to promote the role of AEPs to the general population. Ongoing support is required to ensure recent graduate AEPs can integrate effectively within the healthcare setting. Enhanced connection between AEPs and referrers may assist in generating referrals and broadening the understanding of the profession. Addressing systematic barriers, such as reducing clients’ financial constraints through increased funding, may help improve AEP service uptake.

THE USE OF OUTCOME MEASURES IN EXERCISE PHYSIOLOGY CLINICAL PRACTICE IN AUSTRALIA

INTRODUCTION AND AIMS Outcome measure (OM) implementation in clinical settings has become a standard in allied health evidence-based practice over the last 20 years, with their use being encouraged by governing and funding bodies. This study investigated the application of standardised OMs by accredited exercise physiologists (AEPs) in Australia. This study aimed to identify commonly used OMs and explore the barriers and facilitators to OM implementation in AEP clinical practice in Australia. METHODS This study utilised a questionnaire-based, cross-sectional, descriptive design to determine the OMs used by AEPs in current clinical practice and investigated trends related to OM use within different AEP demographics and settings. Participants were also asked to identify any barriers and facilitators that affected their use of OMs in clinical practice. The OMs that were most frequently used were identified and the results analysed according to demographic variables, to determine how they influenced OM use in clinical practice. RESULTS Eighty-seven OMs were assessed, with 41% ‘never’ used by most participants. A further 48% of the OMs were identified as being underutilised with over 50% of respondents selecting ‘never’ or ‘sometimes’. Only three OMs were used frequently by most respondents. The most common barriers to OM use identified related to a lack of time, knowledge, and limited perceived value from clinicians. These reflect the barriers identified in prior research related to other allied health professions. CONCLUSIONS AEPs in Australia experience many of the same barriers to OM use as other allied health disciplines. Currently, the standardised OM resource for AEPs is outdated and underutilised in clinical practice. Updated resources for clinicians in the form of educational seminars and a searchable online database with easy access to evidence-based outcome measures are essential to the promotion of OMs to support evidence-based practice for AEPs.

A LITTLE BIT OF EXERCISE GOES A LONG WAY – INCREASING INDEPENDENCE OF AGED CARE RESIDENTS WITH PARKINSON’S DISEASE

INTRODUCTION & AIMS Supporting people with Parkinson’s Disease to remain active when living in residential aged care (RAC) is assumed to have benefits, such as reducing falls risk, improving ability to transfer independently, and reducing time spent being sedentary. However, many RAC-facilities are under-resourced making it difficult for staff to support residents with exercise. Accredited exercise physiologists (AEP) enable residents to improve or maintain movement through exercise. The aim of this study was to establish feasibility and value of AEP-services for people with Parkinson’s Disease in RAC. METHODS A 12-week AEP-led exercise program was delivered at multiple RAC-sites across Perth. An individualised exercise plan was designed for each participant, comprising 2 x 50-minute supervised group sessions per week, together with a 15-minute unsupervised morning program. Baseline and follow-up testing was undertaken by the AEP, inclusive of balance (mini-Balance-Evaluation-System-Test (miniBESTest)), mobility (2-minute-walk-distance, Actigraph), fatigue (PD fatigue scale) and quality of life. Descriptive analysis will be presented, reflecting the total hours of AEP-training provided, room attendance records from RAC-staff, and changes in pre-post balance, mobility, falls, quality of life, depression, behaviour, and fatigue. RESULTS To date, five participants have enrolled (3 women; 2 men) (recruitment is ongoing). Individual results for baseline testing showed the range of abilities and challenges for these participants (Mini-BESTest range of 5-16 and 2-minute walk distance of range 0-61). Not all tests could be completed by all participants. Post-test and change scores will be presented. CONCLUSION Due to the clinical heterogeneity of the disease, the AEP is required to prescribe according to each individual needs whilst maintaining the fidelity of the exercise intervention. Challenges have been presented with conducting research in this environment including recruitment of participants due to level of cognition, conflicts with participant scheduling, operational needs of the facility and facility closures (Covid- and gastro-outbreak).

ARE THE ATTITUDES AND BELIEFS OF AUSTRALIAN EXERCISE-BASED PRACTITIONERS ASSOCIATED WITH THEIR USE OF, AND CONFIDENCE IN, TREATMENT MODALITIES FOR PEOPLE WITH CHRONIC LOW BACK PAIN?

BACKGROUND Practitioners’ attitudes and beliefs towards chronic low back pain (CLBP) influence their clinical decision making, but few studies have investigated decision making outside the context of patient vignettes, for a range of first- and second-line treatment options for CLBP, or in Accredited Exercise Physiologists (AEPs). METHODS Using an online survey, Australian AEPs and physiotherapists rated their use of different treatments for CLBP (exercise, education, manual therapy, cognitive behavioural therapy) and their confidence in these treatments for reducing pain and disability. Their biomedical and biopsychosocial beliefs were also assessed using the Pain and Attitudes Beliefs Scale for Physiotherapists. Differences between disciplines in treatment use and confidence were analysed using Mann-Whitney U tests and independent t-tests, respectively. Multiple linear regression was used to explore factors associated with treatment choices. RESULTS Two-hundred thirty-three practitioners (n=143 physiotherapists, n=90 AEPs) completed the survey. Most practitioners were confident treating CLBP, had a moderate-high level of confidence in the different treatments, and regularly used them in practice. Practitioners with higher biomedical beliefs had greater use of, and confidence in, specific exercise, manual therapy, and combined exercise and manual therapy. Practitioners with higher biopsychosocial beliefs were more confident in general exercise, cognitive behavioural therapy, pain education and combined exercise and pain education. CONCLUSION Practitioner beliefs influence their use of, and confidence in, different treatments for CLBP. These findings suggest a need for strategies to enhance biopsychosocial beliefs/reduce biomedical beliefs in Australian exercise-based practitioners.

SUPPORTING PEOPLE WITH NEUROLOGICAL INJURY TO ENGAGE IN PHYSICAL ACTIVITY-FROM HOSPITAL TO HOME AND BEYOND

Accredited exercise physiologists are perfectly placed to assist people with neurological injury to reengage or explore new opportunities in physical activity. The benefits of physical activity in this population are well documented, however participation rates are low. Research shows that 75% of Australians living with a disability over the age of 15 do not meet the recommended levels of physical activity. While the need is high, the 2021-2022 ESSA workforce report found only 7% of accredited professionals are working with people living with neurological conditions. This highlights the gap between industry demand, workforce capacity and capability to deliver evidence based best practice. As clinicians with a collective experience of 30+ years, we have identified a need for greater dissemination of knowledge, experience, and practical translation of the evidence in this population. This presentation will explore the perspectives of three experienced AEP’s working from hospital to home and beyond. Each presenter will draw on their unique context and experience to describe the challenges and opportunities for AEP’s in each specific area. Sarah will provide an overview of the hospital setting and transition to community, highlighting the opportunities for early intervention and the role in supporting ongoing meaningful physical activity. Holly will discuss an exercise physiologist’s role in community rehabilitation, and our place in a multidisciplinary team. She will further explore what it looks like to move from exercise for rehabilitation mindset, into exercise for life. Emma will detail the opportunities in sports and competitions such as the Paralympics, particularly around how AEP’s can support performance goals. The team will close with provocative discussion around how AEP’s can contribute to the governments ELEVATE 2042 Strategy and we will invite AEP’s to join us on this journey.

A reflective practice learning experience with higher education exercise physiology students

ABSTRACT Accredited exercise physiologists are higher education qualified health professionals who prescribe exercise as a preventative and treatment modality for individuals diagnosed with chronic conditions. Reflective practice is integral to the exercise physiology discipline, however its integration into curriculum requires further development and research. Utilising clinically based scenarios, final year students (N = 21), participated in a three-week reflective learning experience using the 6 step SPROUT acronym, represented as Situation, Past experiences, Read and refer, Other influences, Understanding and Taking it forward. Students completed the Reflection in Learning Scale (RLS) and responded to questions about confidence. Reflective scripts were reviewed, and clinical supervisors were interviewed. For the RLS, students scored higher on planning, knowledge integration and mental processing and lower for topic interactions, mindful summarising and coping with negative feelings. Students (75%) indicated that they were mostly or very confident in the use of reflective practice. Qualitative responses showed that using SPROUT did reinforce clinical learning. Time constraints and the separateness of higher education from the ‘real world’ were also points of view. Analysis of student scripts revealed a range of developing reflective ability. Supervisors focused on the importance of reflective practice and the contribution, that SPROUT had made to the overall experience.

Client and Clinician Experiences and Perspectives of Exercise Physiology Services During the COVID-19 Pandemic: Qualitative Study.

The COVID-19 pandemic led to changes in the delivery of exercise physiology services. The lived experience of those who continued to provide or receive exercise physiology services during the heightened public health restrictions of the inaugural year of the COVID-19 pandemic has received little attention to date. Acquiring this knowledge will be fundamental in addressing whether telehealth is a viable option for service delivery in exercise care, research, and policy. This is especially pertinent in the wake of the COVID-19 pandemic and subsequent global interest in digital health delivery of health care services. This study aims to explore the clinician and client experiences and perspectives of exercise physiology services delivered in person or via telehealth during the inaugural year of the COVID-19 pandemic (after January 25, 2020; the date of the first confirmed case in Australia). Eligible participants for this study were adult (aged 18 years or older; capable of understanding and writing in English) clients who received and clinicians who delivered 1 or more exercise physiology sessions in Australia during the first year of the COVID-19 pandemic (June 2020 to June 2021). The data collection period spanned from January 20, 2021, to September 24, 2021. A total of 18 semistructured individual interviews were conducted with accredited exercise physiologists (n=7) and clients (n=11) who engaged with exercise physiology services during this period. All interviews were digitally recorded and transcribed verbatim. Thematic analysis was conducted with themes and subthemes derived using deductive and inductive approaches. A total of 3 dominant themes, each with 2 subthemes, were identified. The first theme was that telehealth enables access to services but limits the use of some clinical tools. Remote access to services was valued by both clinicians and clients, but the exercise clinical environment could not be replicated over telehealth. This was especially true regarding access to exercise equipment. Second, engagement and the "relational space" are limited by telehealth. Perceived challenges regarding social interactions and a sense of community were a limitation for clients, and difficulties fostering clinician-client report were noted by clinicians. Finally, technological challenges are pervasive in the telehealth delivery of exercise services. Both clinicians and clients noted that systems necessary to facilitate telehealth frequently disrupted delivery, and client-based technical issues were influenced by digital health literacy. Shared client and accredited exercise physiologist experiences highlight key considerations for the ongoing implementation of telehealth to facilitate the uptake and effectiveness of exercise physiology services. These findings imply that the co-design of solutions to client-perceived limitations of telehealth delivery is warranted.

Are the attitudes and beliefs of Australian exercise-based practitioners associated with their use of, and confidence in, treatment modalities for people with chronic low back pain?

Practitioners' attitudes and beliefs towards chronic low back pain (CLBP) influence their clinical decision making, but few studies have investigated decision making outside the context of patient vignettes for a range of first- and second-line treatment options for CLBP, or in accredited exercise physiologists (AEPs). Using an online survey, Australian AEPs and physiotherapists rated their use of different treatments for CLBP (exercise, education, manual therapy, cognitive behavioural therapy) and their confidence in these treatments for reducing pain and disability. Their biomedical and biopsychosocial beliefs were also assessed using the Pain and Attitudes Beliefs Scale for Physiotherapists. Differences between disciplines in treatment use and confidence were analysed using Mann-Whitney U tests and independent t-tests, respectively. Multiple linear regression was used to explore factors associated with treatment choices. Two-hundred thirty-three practitioners (n=143 physiotherapists, n=90 AEPs) completed the survey. Most practitioners were confident in treating CLBP, had a moderate-high level of confidence in the different treatments, and regularly used them in practice. Practitioners with higher biomedical beliefs had greater use of, and confidence in, specific exercise, manual therapy, and combined exercise and manual therapy. Practitioners with higher biopsychosocial beliefs were more confident in general exercise, cognitive behavioural therapy, pain education and combined exercise and pain education. Practitioner beliefs influence their use of, and confidence in different treatments for CLBP. These findings suggest a need for strategies to enhance biopsychosocial beliefs/reduce biomedical beliefs in Australian exercise-based practitioners.

How do practitioners prescribe exercise to patients with breast cancer? Professional perspectives on the key considerations for aerobic exercise in patients with breast cancer undergoing chemotherapy

ObjectivesThis study aimed to understand the key factors experienced accredited exercise physiologists (AEPs) and medical professionals consider when prescribing/recommending aerobic exercise to patients with breast cancer undergoing chemotherapy. DesignModified Delphi Survey. MethodsA four-round, two-phase survey was conducted. Following a Delphi approach, four cancer-specific AEPs, four oncologists, and one breast cancer surgeon (median 13-yr breast-cancer-specific experience) completed phase one. Eighty-four AEPs (median 5-yr experience) completed phase two. Phase one participants answered open- and close-ended questions regarding key considerations for aerobic exercise in patients with breast cancer undergoing chemotherapy, and what information should be collected to guide exercise prescription. All questions and considerations agreed upon in phase one (>70 % rating 7–9 on a 0–9 Likert Scale) were rated by AEPs in phase two. ResultsKey considerations for exercise assessment and prescription aligned closely with exercise guidelines for cancer survivors. Common strategies for exercise individualisation were identified by AEPs, including separating aerobic exercise into 5‐to‐–9-minute bouts when required and avoiding exercising to complete exhaustion. Exercise intensity and duration should be adjusted throughout chemotherapy to improve tolerance and adherence. Novel considerations for subjective questioning and objective assessments to tailor exercise prescription were outlined. ConclusionsThis study identifies how professionals approach exercise assessment and prescription in patients with breast cancer undergoing chemotherapy. Findings can guide AEPs in practice when prescribing tailored exercise to breast cancer patients undergoing chemotherapy and inform future guidelines.

The promotion of non-treatment physical activity in physiotherapy and exercise physiology practice in an Australian regional hospital: A mixed-methods study

To describe the frequency of non-treatment physical activity (NTPA) promotion by physiotherapists and accredited exercise physiologists (AEPs) practicing in an Australian regional hospital. To identify factors that influence whether physiotherapists and AEPs promote NTPA to hospital patients. Mixed-methods using sequential explanatory design. Physiotherapists and AEPs working in a regional hospital setting were invited to complete an online clinician survey and participate in semi-structured interviews. Likert scale questions measured frequency and factors influencing NTPA promotion. Qualitative descriptive analysis was used to analyse interview data. In total, 41 clinicians completed the survey. Of the survey respondents, 66% reported always or often promoting NTPA to their patients. In outpatient settings, 72% of respondents always or often promoted NTPA compared to 54% in inpatient settings. Survey respondents reported high levels of knowledge and confidence in NTPA promotion. Confidence promoting NTPA with unmotivated patients was 54%. Eleven clinicians participated in the interviews. The interviews identified three themes that influenced NTPA promotion in hospital practice: (1) clinicians prioritise addressing the presenting condition before NTPA; (2) clinicians believe that the patients’ motivation influences NTPA promotion; and (3) clinicians rely on their professional and interpersonal skills, and exposure to appropriate training, to promote NTPA. Physiotherapists and AEPs frequently promote NTPA, especially in outpatient settings. The results suggest that low patient motivation to be active, the need to prioritise hospital discharge criteria before NTPA promotion and having few resources guiding NTPA promotion might negatively impact clinicians’ ability to promote NTPA as often as they would like.

Effect of combined exercise training and behaviour change counselling versus usual care on physical activity in patients awaiting hip and knee arthroplasty: A randomised controlled trial

ObjectiveThis study aimed to determine if a novel intervention that combined individualised exercise training with behaviour change counselling based on Health Action Process Approach (HAPA) constructs could elicit long-term increase in physical activity (PA) and reduce comorbidity development among people requiring hip or knee arthroplasty. MethodA pre-registered two arm, parallel group, randomised controlled trial comparing the effect of a 12-week individualised exercise program combined with behavioural counselling delivered by accredited exercise physiologists, versus usual care to Osteoarthritis (OA) patients on public surgery waitlists. Participants were followed up at 6 months after baseline (pre-surgery) and again at 6 months post-surgery. Within and between group differences in post-surgery PA (as measured by ActivPal accelerometer), pain, function, quality of life, HAPA-based behavioural and psychological constructs, and health risk factors were analysed. Results63 participants (34 Female; Mean age ​= ​66.4 ​± ​7.2 ​yrs) consented to participate in this study. At 6 months post baseline and 6 months post-surgery there were significant improvements in PA, pain, function, and quality of life, however there were no significant differences in the between group responses. Significant between group changes were observed in several psychological constructs related to volition at 6 months post baseline; however, these had disappeared by 6 months post-surgery. ConclusionsAn exercise program and HAPA guided counselling intervention can improve psychological constructs related to exercise behaviour; however, these did not result in significant between group changes in PA at the timepoints measured. Further research with larger sample size is required.Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN 12617000357358) Date of registration: 08/03/2017.

The Clinical Exercise Physiologist Revolution is Happening Now

The Clinical Exercise Physiologist revolution for professional recognition in the United Kingdom (UK) turned a corner recently. On December 14, 2021, the British Association of Sport and Exercise Sciences (BASES) and Clinical Exercise Physiology United Kingdom (CEP-UK) announced a partnership with a stated purpose of promoting the role of clinical exercise physiologists to manage those with chronic and complex medical health conditions who are being treated within the UK healthcare system (1). Worldwide recognition by other allied health professionals and patients has been lacking for those who are trained as a clinical exercise physiologist.I have written about this in previous issues of this journal. Currently, Australia has arguably advanced the most in both professional and public recognition, as well as integrating clinical exercise physiologists (known Down Under as Accredited Exercise Physiologists) into the healthcare system (2). In Australia these healthcare professionals are recognized by their nationalized healthcare system, which has allowed them to provide services and independently charge for these services. Additionally, and similar to physical therapy clinics in the United States, privately owned exercise physiology clinics in Australia cater to the exercise physiology needs of those with various chronic diseases who are under the care of their physician. Much of the services provided are partially covered by Medicare Australia or private health insurers.The stated aim of the UK initiative is to “establish and promote the role of Clinical Exercise Physiologists as part of the treatment and management of chronic and complex health conditions within the UK health care system” (1). So, it seems this is a similar goal to what the Australians have developed. This announcement states that clinical exercise physiologists in the United Kingdom are eligible to receive professional registration with the Registration Council for Clinical Physiologists (RCCP). Those who apply for registration and meet the qualifications will be conferred the title of Clinical Exercise Physiologist, if accepted. The registration is designed to ensure that those conferred as a Clinical Exercise Physiologist “are appropriately trained, meet standards of proficiency, have indemnity insurance, are committed to continued professional development, and are deemed ‘fit to practice'” (1).It is exciting to see countries recognize the knowledge and abilities of those who are adequately trained clinical exercise physiologists. Efforts such as this in the United Kingdom are the beginnings of carving out a niche for clinical exercise physiologists. Importantly, recognition and acceptance as a partner in multidisciplinary health care teams appears to be a key strategy. Various efforts continue to evolve in the United States (3). And in addition to the countries already mentioned in this article, both New Zealand (4) and Canada (5) recognize clinical exercise physiologists as an important part of their national approach to treating and preventing many chronic diseases. The momentum of the clinical exercise movement is palpable around the world. As part of this process, we need to continue to provide high-quality evidence of the importance of providing clinical exercise services to patients as delivered by clinical exercise physiologists. Solid research is the best ammunition to make the case for clinical exercise physiologists. The Journal of Clinical Exercise Physiology stands ready and eager to support the publication of this type of original research, reviews, and expert commentary. The time is now!

Exercise Science Graduates in the Healthcare System: A Comparison Between Australia and Switzerland.

Physical inactivity (PI) is a leading risk factor for global mortality worldwide, a major preventable cause of non-communicable diseases (NCDs) and a socioeconomic burden for healthcare systems. Fortunately, evidence shows that exercise interventions delivered by qualified exercise science graduates is an effective way to reduce PI, prevent and treat NCDs. This study compares the integration of exercise science graduates, defined as university graduates with degrees in sport and exercise science, in the healthcare systems of Australia, a commonly cited model in this regard, and Switzerland, a country considered to have an effective but costly healthcare system. For both countries, three domains were reviewed: healthcare system, exercise science graduates' education, and roles played by exercise science graduates in healthcare system. Australia formally recognizes specifically trained exercise science graduates (referred to as Accredited Exercise Physiologists) as healthcare professionals. The exercise interventions they deliver, which were shown to be cost-effective and lead to positive health outcomes, are covered by Medicare, the Australian universal health insurance. However, Medicare covers only a maximum of 5 yearly sessions of all allied-health services taken together. Conversely, Switzerland, despite offering university master's degrees that focus on physical activity delivery to clinical populations, does not recognize the respective graduates as healthcare providers. As a result, their services are not covered by the Swiss health insurances. The latter do, however, cover a generous number of services (not formally limited) delivered by other allied-health professionals. In conclusion, Australia makes a better use of exercise science graduates than Switzerland does. Switzerland would benefit from establishing a clinical profession for exercise science graduates, defining competencies that they should acquire and setting their scope of practice. The very restricted number of therapy sessions covered by Medicare might limit the positive impact exercise science graduates have on the Australian healthcare system. Overall, mutual learning between countries can promote development and global recognition of clinical positions for exercise science graduates.

Education Improves Decision-Making of Exercise Physiologists Regarding Low Back Pain

ABSTRACT Background: To investigate the efficacy of targeted education on clinical decision-making in accredited exercise physiologists. Methods: Fifty accredited exercise physiologists undertook a 4-hour targeted education session aimed to demonstrate why the biopsychosocial model is better suited to the management of chronic low back pain than the biomedical model. The pain attitudes and beliefs scale for physiotherapists and patient vignettes were collected before and after the targeted education to observe changes in beliefs and clinical decision-making. Results: A significant reduction in biomedical beliefs (P < 0.01) with no concomitant change in biopsychosocial beliefs was observed following the targeted education. Clinical decision-making significantly altered on all 8 items associated with the patient vignettes following the targeted education. Conclusion: Following targeted education, a reduction in biomedical beliefs with no concomitant change to biopsychosocial beliefs significantly altered clinical decision-making. The findings of this study support existing literature and demonstrate changes in attitudes and beliefs following education impact clinical decision-making in accredited exercise physiologists. Education interventions should focus on informing practitioners of the benefits of the biopsychosocial model as compared to the biomedical model for management of chronic low back pain rather than simply teaching biopsychosocial theory and application.

Burnout and compassion fatigue among Exercise Physiologists in mental healthcare.

Burnout and compassion fatigue (CF) are common among mental health practitioners. Accredited Exercise Physiologists (AEPs) provide clinical services to individuals experiencing mental illness, increasing their likelihood of experiencing burnout and CF. To examine the prevalence of burnout and CF among AEPs working with people experiencing mental illness. An anonymous online cross-sectional survey of AEPs working with people experiencing mental illness was distributed via the Exercise and Sports Science Australia Mental Health Special Interest Group Facebook page between July and November 2019. In addition to demographics and caseload data, respondents completed the Professional Quality of Life scale and Oldenburg Burnout Inventory (OLBI). Results are reported using descriptive statistics. Sixty-two AEPs (68%, n = 42 female) completed the survey. Most (n = 53, 86%) reported delivering services to consumers with severe mental health conditions. Less than half (n = 27, 44%) reported working in a dedicated mental health facility. Moderate levels of burnout and CF were experienced by 60% and 30% of respondents, respectively. The prevalence of moderate burnout and CF symptoms in AEPs is comparable with other mental health professionals. Strategies to preserve psychological well-being such as enhancing mental health training for undergraduates and formalized supervision structures discussed.

Biomedical Beliefs Explain the Clinical Decisions Made by Exercise-Based Practitioners for People With Chronic Low Back Pain.

Cross-sectional survey. This study surveyed the attitudes and beliefs of physiotherapists and accredited exercise physiologists (AEP) toward chronic low back pain (CLBP), in Australia. The objective of this study was to investigate the effect of biomedical and biopsychosocial attitudes and beliefs toward CLBP on clinical decision making in exercise-based practitioners. The attitudes and beliefs of AEPs toward CLBP have not been studied. Literature regarding physiotherapists suggests a biomedical approach leading to more conservative treatment and on occasion, treatment going against practice guidelines. Seventy five AEPs and 75 physiotherapists were surveyed using the pain attitudes and beliefs scale for physiotherapists, which consists of both a biomedical and biopsychosocial subscale. Clinical decision making was assessed using two patient vignettes. AEPs held higher biomedical beliefs compared with physiotherapists. No between-group differences were observed on the biopsychosocial subscale. Indeed, biomedical attitudes and beliefs did explain clinical decision making with higher scores reflecting a more conservative approach. However, biomedical beliefs influenced decision making regardless of profession. Biomedical attitudes and beliefs regarding CLBP influence clinical decision making in exercise-based practitioners, regardless of profession. AEPs reported higher biomedical scores, suggesting more frequent choice of conservative care. Thus, patients may receive inconsistent care and advice from practitioners within the same field. Based on clinical practice guidelines and the positive associations on clinical decision making of the biopsychosocial model, it is necessary to understand how best to provide exercise-based practitioners with education on how to apply a biopsychosocial approach to CLBP.Level of Evidence: 3.

Value And Challenges Of Investigating Real-world Effectiveness Of Exercise Physiology Services For Type-2 Diabetes

PURPOSE: The evidence from randomised controlled trials (RCTs) and meta-analyses supports the use of exercise to manage type 2 diabetes (T2D), and most guidelines propose exercise as a cornerstone of clinical management. However, there is a paucity of evidence for how this translates to real-world practices, specifically the effectiveness of exercise in patients with T2D when delivered as part of complex health service models, rather than in tightly controlled research trials. METHODS: A collaboration of universities and health clinics in Australia is addressing this evidence gap by investigating the effectiveness of services provided by Accredited Exercise Physiologists on a range of outcome measures in people with T2D. The novelty of this approach is the authenticity of 1) the sample population, which excludes no one who is referred to the service; and 2) the type of intervention, which is whatever the individual clinic, clinician and/or patient deem suitable for each situation, subject to any cost constraints. This study is a preliminary analysis of the challenges encountered with this real-world research approach and of the population presenting for exercise physiology services in this context. RESULTS: Key challenges encountered were 1) delays in regional ethics committees, 2) participant recruitment particular to each site, 3) attrition, 4) access to medical records. Sixty-two participants (59% female, 65 ± 10 y.o, HbA1c 7 ± 1%, BP 137/77 including 23% stage 1 and 33% Stage 2 hypertension based on ACC levels) have been enrolled to date. All were on 1 or more hypoglycaemic medication, 88% were on 1 or more cardiovascular medication and 83% were on 1 or more other medication. Of those on additional medications the mean number of medications prescribed was 7.5 per person. CONCLUSIONS: The challenges encountered are consistent with similar approaches of translational research. The sample recruited so far is older with more comorbidity and complex polypharmacy, but has relatively good glycaemic control compared to the typical patient population studied in published RCTs. The difficulty in accrual considered alongside the patient characteristics supports the need for more focus on this type of implementation research to inform the real-world evidence for the benefits of exercise, rather than relying only on RCTs.

Exercise and education for knee osteoarthritis-What are accredited exercise physiologists providing?

Clinical guidelines for the non-surgical management of knee osteoarthritis (OA) recommend exercise and education. This study aimed to evaluate the extent to which accredited exercise physiologists (AEPs) deliver exercise and education for knee OA and how it aligns with clinical practice guidelines. Cross-sectional survey. An online survey targeted to AEPs across Australia to understand the exercise and education content of their interventions for knee OA. Likert scale and multiple-choice questions were used to measure responses relating to exercise prescription. Thematic analysis was used to evaluate the nature of education being delivered by AEPs. The revised neurophysiology of pain questionnaire (r-NPQ) was used to quantify pain neuroscience knowledge. A total of 161 AEPs completed the survey (63 men, 98 women; mean experience 5.8 ± 4.7 years). Exercises commonly prescribed included: strength (99% of respondents), weight bearing (90%) and aerobic (83%), with 98% of AEPs prescribing exercise for the affected and unaffected limb. Only 32% of respondents frequently considered prescribing 'exercise into pain'. The four main education themes were exercise (86%), self-management (61%), weight loss (56%) and pain management (51%). Specific pain neuroscience education (PNE) was provided by only 21% of respondents. Exercise prescription mostly aligned with evidence-based recommendations. The education component of AEP interventions for knee OA focused on the benefits of exercise. However, other education guideline recommendations about the disease, appropriate treatments and self-management were underutilised. The PNE knowledge of AEPs was comparable with other secondary care providers, although only a minority of AEPs provide PNE.

If you build it, will they come? Evaluation of a co-located exercise clinic and cancer treatment centre using the RE-AIM framework.

Employ the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the effectiveness of a co-located exercise clinic model in increasing access to exercise for people undergoing cancer treatment in a private clinic in Western Australia. This retrospective evaluation utilised a mixed-method approach to gather feedback from key stakeholder groups involved with the exercise clinic. Questionnaires and workout summary sheets were gathered from 237 exercise clinic participants over the 50-month evaluation period. These were supplemented by survey results from 119 patients who received cancer treatment at the facility, and semi-structured interviews from seven radiation oncologists, eight nurses, and three accredited exercise physiologists involved with the exercise clinic. The co-located clinic demonstrated positive outcomes related to effectiveness and adoption. Participant feedback indicated satisfaction with the exercise programming (effectiveness), and clinicians were receptive to referring patients to the clinic (adoption). However, no clear implementation or maintenance plan was employed and overall reach (12%) remained suboptimal throughout the evaluation period. Co-locating an exercise clinic into a treatment facility does not in itself overcome the logistical challenges of providing integrated exercise services to people during cancer treatment. To enhance its utilisation, an implementation plan needs to accompany the intervention.

Chemotherapy-Induced Sarcopenia.

Sarcopenia is being consistently recognized as a condition not only associated with the presence of a malignancy but also induced by the oncologic therapies. Due to its negative impact on tolerance to chemotherapy and final outcome in both medical and surgical cancer patients, sarcopenia should be always considered and prevented, and, if recognized, should be appropriately treated. A CT scan at the level of the third lumbar vertebra, using an appropriate software, is the more common and easily available way to diagnose sarcopenia. It is now acknowledged that mechanisms involved in iatrogenic sarcopenia are several and depending on the type of molecule included in the regimen of chemotherapy, different pharmacologic antidotes will be required in the future. However, progression of the disease and the associated malnutrition per se are able to progressively erode the muscle mass and since sarcopenia is the hallmark of cachexia, the therapeutic approach to chemotherapy-induced sarcopenia parallels that of cachexia. This approach mainly relies on those strategies which are able to increase the lean body mass and include the use of anabolic/anti-inflammatory agents, nutritional interventions, physical exercise and, even better, a combination of different therapies. There are some phase II studies and some small controlled randomized trials which have validated these treatments using single agents or combined multimodal approaches. While these approaches may require the cooperation of some specialists (nutritionists with a specific knowledge on pathophysiology of catabolic states, accredited exercise physiologists and physiotherapists), the oncologist too should directly enter these issues to coordinate the choice and priority of the treatments. Who better than the oncologist knows the natural history of the disease, its evolution, and the probability of tolerance and response to the oncologic therapy? Only the oncologist knows when it is essential to potentiate any effort to better achieve a control of the disease, using all the available armamentarium, and when the condition is too advanced and hence requires a more palliative than supporting care. The oncologist also knows when to expect a gastrointestinal toxicity (mucositis, nausea, vomiting, and diarrhea) and hence it is more convenient using a parenteral than an enteral nutritional intervention or, on the contrary, when patient is suitable for discharge from hospital and oral supplements should be promptly tested for compliance and then prescribed. When patients are at high risk for malnutrition or if, regardless of their nutritional status, they are candidate to aggressive and potentially toxic treatments, they should undergo a jointed evaluation by the oncologist and the nutritionist and physical therapist to assess together a combined approach. In conclusion, the treatment of both cancer- or chemotherapy-related sarcopenia represents a challenge for the modern oncologist who must be able to coordinate a new panel of specialists with the same skill necessary to decide the priority of different oncologic treatments within a complex multidisciplinary context.