Sports Science Australia Research Articles

Exercise and Sports Science Australia updated position statement on exercise for preventing falls in older people living in the community

BackgroundsFalls affect a significant number of older Australians and present a major challenge to health care providers and health systems with over 380 older Australians hospitalised for a fall each day. ObjectivesThis statement seeks to inform and guide exercise practitioners and health professionals in safe and effective prescription of exercise to prevent falls amongst community-dwelling older people. Exercise prescription to prevent fallsExercise is crucial for preventing falls in older age. Research evidence has identified that programmes which include functional balance and muscle strength training are the most effective in preventing falls. It is also important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Additional (non-exercise) interventions are necessary for people with complex medical conditions, recent hospitalisation and/or particular risk factors not improved by exercise. People at a higher risk of falls may need greater support to undertake safe and effective fall prevention exercise. SummaryGlobal guidelines for fall prevention and management recommend that all older adults should receive advice about exercise to prevent falls. Qualified exercise professionals are well placed to prescribe and supervise functional balance and muscle strength training to older people with varied functional abilities, including those with co-morbidities.

Exercise in the management of polycystic ovary syndrome: A position statement from Exercise and Sports Science Australia

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine condition amongst females of reproductive age, leading to lifelong cardiometabolic, reproductive, psychological, and dermatologic symptoms as well as a reduced quality of life. Lifestyle interventions, which can include structured exercise programmes delivered by appropriately trained exercise professionals such as clinical exercise physiologists, are considered first-line strategies in PCOS management due to their therapeutic effects on various health outcomes and quality of life. This position statement builds on the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS and describes the role of the exercise professional in the context of the multidisciplinary care team which includes physicians and allied health professionals. This position statement aims to equip exercise professionals with a broad understanding of the pathophysiology of PCOS, how it is diagnosed and managed in clinical practice, and evidence- and consensus-based recommendations for physical activity and exercise in PCOS management. In line with the physical activity recommendations for the general public, individuals with PCOS should aim to undertake between 150 to 300min of moderate-intensity or 75 to 150min of vigorous-intensity aerobic activity per week, or an equivalent combination of both spread throughout the week. Additionally, muscle-strengthening activities on two non-consecutive days per week are recommended to maintain health and prevent weight gain. For further health benefits and to achieve modest weight loss, individuals with PCOS should aim for a minimum of 250min of moderate-intensity or 150min of vigorous-intensity aerobic activity per week, or an equivalent combination of both spread throughout the week, plus muscle-strengthening activities on two non-consecutive days per week. Adolescents with PCOS should aim for a minimum of 60min moderate- to vigorous-intensity activity each day, incorporating muscle- and bone-strengthening activities three times per week. Finally, exercise professionals should consider the significant psychological burden, including weight stigma, and the high prevalence of comorbidities amongst individuals with PCOS and take appropriate measures to deliver safe and efficacious exercise interventions.

RETHINKING THE MANAGEMENT OF HEALTH IN PEOPLE WITH DIABETES-RELATED FOOT ULCERS FROM AN AEP PERSPECTIVE: AN UPDATE FROM THE DFUEX STUDY

INTRODUCTION & AIMS Current treatments for people with diabetes-related foot ulcers (DFUs) focus on foot outcomes - potentially at the expense of broader health and wellbeing considerations. There are barriers to exercise for people with DFU and hesitancy in promoting physical activity by clinicians. AEPs may have the clinical skills to help people with DFUs engage in safe and effective exercise. The aim of this study was to examine the impact of AEP supervised exercise intervention on cardiorespiratory fitness, health and wound healing in adults with DFU. METHODS Using a randomised control trial design (ANZTR registration: 12622000885796p) adults aged 18 to 70 years (n=32) with active DFU are being recruited from an interdisciplinary High-Risk Foot Service (iHRFS) at Royal Prince Alfred Hospital Sydney Australia, and randomised to receive 12 weeks of supervised exercise (aerobic and resistance) training (Exercise) with usual care or usual care (Control) Measurements including fitness, metabolic and wound outcomes are acquired at baseline and after 12 weeks. RESULTS Preliminary baseline demographic, fitness and health data will be presented. Consideration for the scope of practice for AEPs in the multidisciplinary management of DFUs will be discussed incorporating observations and guidance on implementing exercise in a high risk DFU population, where there is limited patient and practitioner knowledge about safe and effective exercise options, and historical avoidance of physical activity to lessen the risk of wound deterioration. This will include consideration of aspects around exercise which are unique to people with DFUs, such as working with iHRFS, patient ambulation and transport, wound type and location, diversity of wound offloading devices and individual facilitators and barriers to exercise participation. CONCLUSIONS There is a need for robust evidence concerning the efficacy and safety of exercise intervention, and a need for strategies to engage AEPs into the multidisciplinary care of people with DFUs. Supported by the Exercise and Sports Science Australia Research Grant.

Clinical Exercise Physiology Accreditation: An Audit of Existing Standards

Abstract Background Health professions such as clinical exercise physiology are founded on a set of standards that outline base level knowledge, skills, and competencies to define the roles and scope of practice of the profession. Despite the practice of clinical exercise physiology having many common features regardless of the country in which it is conveyed, a harmonized set of international standards does not exist. The aim of this study was to systematically audit the professional standards for the 5 countries recognized as having existing national certification systems for clinical exercise physiology. Method: The audit process was conducted using a modified scoping review protocol based on the documentation provided by the American College of Sports Medicine, Exercise and Sports Science Australia, British Association of Sport and Exercise Sciences, Canadian Society for Exercise Physiology, and Sport and Exercise Science New Zealand. Two reviewers independently extracted data from the standards documents, and results were cross-checked by relevant experts from each jurisdiction. Results: Commonality of themes was found for 60% of all content extracted. The overall coverage of themes was 60%, 67%, 76%, 88%, and 98% from New Zealand, Canada, the United States, the United Kingdom, and Australia, respectively. Conclusion: A common core of themes is covered by all current national standards for clinical exercise physiology across the 5 nations audited but only variable coverage in the remaining 40%. These findings are important for understanding the differences in current training and certification of clinical exercise physiology professionals and how this might influence the internationalization of the profession.

Exercise & Sports Science Australia (ESSA) updated Position Statement on exercise and physical activity for people with hip/knee osteoarthritis

This Position Statement is an update to the existing statement. It is intended for all health practitioners who manage people with hip/knee osteoarthritis. It synthesises the most recent evidence (with a focus on clinical guidelines and systematic reviews) for exercise in people with hip/knee osteoarthritis, and provides guidance to practitioners about how best to implement exercise in clinical practice. Clinical practice guidelines for hip/knee osteoarthritis advocate physical activity and exercise as fundamental core components of evidence-based management. Research evidence indicates that exercise can reduce joint pain, increase physical function, and improve quality of life in hip/knee osteoarthritis, and that a range of exercise types (both supervised and unsupervised) may be beneficial. Exercise dosage should be guided by the principles of the American College of Sports Medicine. As people with osteoarthritis experience many barriers to exercise, practitioners should take an active role in monitoring and promoting adherence to exercise in order to optimise therapeutic benefits.

The Role of Clinical Exercise Physiologists with Exercise Testing

Exercise testing is a widely accepted procedure that has historically been used in cardiopulmonary settings for the last 40 years (1). The most common use of exercise testing has been to detect latent cardiovascular disease in asymptomatic people undergoing routine medical evaluation or to assess patients after a cardiac event (2). Typical modes for testing include an ergometer or treadmill with 12-lead electrocardiograph (ECG) monitoring. Over the years, the versatility and use of exercise testing has evolved to include assessment of healthy and older adults, children, recreational and elite athletes, and a variety of persons with chronic diseases and conditions (3). In addition to ECG monitoring, additional methods of measurement such as pulmonary gas exchange, pulmonary function, and strength or physical function assessments (e.g., grip strength and 6-minute walk test) have become more common in clinical testing and allow for a comprehensive overview of exercise capacity, disease thresholds, and current fitness level (3). Exercise testing is also indicated when quantifying physical work capacity for occupational medicine, injury risk in sport, determining medical clearance, monitoring symptoms (e.g., dyspnea or syncope), identifying ischemic threshold, or posttesting for treatment or training program effectiveness (1,2).Due to the nature of clinical exercise testing, typically conducted on persons with chronic diseases or conditions, these tests must be administered by a qualified exercise professional (1). As recent as 2014, there has been debate on who are qualified exercise professionals and if it is safe to administer exercise testing without direct physician supervision (1). The most recent American Heart Association Scientific Statement, “Supervision of Exercise Testing by Non-physicians,” provides insight on the most qualified exercise professionals able to administer safe and effective clinical exercise testing (1). In this scientific statement, nonphysician exercise professionals are defined as allied health professionals, including clinical exercise physiologists, physical therapists, nurses, nurse practitioners, and physician assistants (1). Myers et al. (1) references complication rates associated with >2.1 million exercise tests conducted by both physicians and allied health professionals between 1971 and 2012, demonstrating extremely low occurrence of mortality, morbidity, and other complications per 1,000 tests. The tests referenced by Myers et al. (1) were conducted with a combination of asymptomatic adults, athletes, and persons with chronic disease. Although ~75% of the exercise tests were supervised by a physician, no differences in safety or adverse events appeared when comparing physician-supervised exercise tests with allied health professional–supervised exercise tests (1). Even though overlap with academic training and experience exists between allied health professionals, clinical exercise physiologists are highly qualified exercise professionals trained to provide independent supervision of clinical exercise testing. With formal training, the clinical exercise physiologist has strong familiarity with the multiple exercise testing settings, including high acuity units in hospitals, variety of protocols, range of patient conditions who are managing acute and chronic disease, and proficiency with the skills and abilities required for test administration.In a literature review by Warburton et al. (4), the safety and effectiveness of exercise tests conducted by qualified clinical exercise physiologists, with and without physician supervision, is supported. In that paper, they provide general recommendations for the formal training and preparation of the clinical exercise physiologist to work with clinical populations (4). In summary, these recommendations include (a) at minimum, completion of an undergraduate degree in exercise science and passage of a nationally recognized certification assessing entry level proficiencies; (b) training to deliver patient-centered care that is evidence-based and a part of a care team; (c) possession of discipline-specific core competencies (i.e., understanding different clinical populations); (d) completion of clinical rotations and internship hours; (e) direct assessment of clinical exercise testing skills and abilities which may require a specific number of tests (i.e., 50 tests); and (f) participation in continued professional education to maintain competencies (4). The above recommendations are aligned with recent work to advocate for advancement of clinical exercise physiologists being recognized as qualified health care providers (5). These recommendations also support the importance of academic program accreditation by the Commission on Accreditation of Allied Health Education Programs in the United States and available certifications such as the American College of Sports Medicine Certified Clinical Exercise Physiologist (5) or American Association of Cardiovascular and Pulmonary Rehabilitation Certified Cardiac Rehabilitation Professional (6). This also aligns with the standards of practice and continuing professional education as regulated by Exercise & Sports Science Australia (7). It is also important to mention that the clinical exercise physiologist is one component of the care team, and collaboration with physicians and other qualified allied health care professionals is critical for optimizing patient care that includes safe and effective exercise testing.The role of the clinical exercise physiologist continues to build momentum in exercise testing and other clinical spaces. The professional field of clinical exercise physiology has made significant progress over the past several decades and shows promise for continual advancement as a profession.

Exercise and Sports Science Australia (ESSA) position statement on exercise for people with mild to moderate multiple sclerosis

ObjectivesMultiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. Design and methodsSynthesis of published works within the field of exercise training in MS. ResultsExercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. ConclusionsResistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.

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.

Simulation in Exercise Science and Physiology—No Longer a Luxury but a Necessity

ABSTRACT The depreciation in placement opportunities has placed pressures on university academics for some time now. Today, the coalescence of this supply issue and the global health pandemic have forced the consideration of alternative placement options. Simulation-based learning experiences (SBLEs) is one such approach, providing students with a diverse range of clinical experiences in a safe and well-placed manner. The documented effectiveness of these experiences in preparing the future health care workforce has been strong, but exists largely in medicine and nursing spheres. SBLEs have been recognized in Australia as providing a commensurate education experience to that of a traditional practicum hour resulting in a portion of total practicum hours being accrued by this activity. In March of this year, the Exercise & Sports Science Australia, accrediting body for exercise science, exercise physiology, and sports science, has lifted the restriction on mandated hours that can be apportioned to simulation-based placement. This “green light” will enable more academics to explore the opportunities within simulation-based learning, although the question regarding being able to deliver quality educational experience remains. This commentary provides an overview of key peer-reviewed literature and simulation design recommendations. Despite being founded on nursing simulation best practice standards, the lessons learned could help direct simulation designers in exercise science and physiology curricula as they strive to meet a rapidly changing practicum placement landscape while maintaining quality teaching and learning environments.

A Structured E-Investigation Into the Prevalence and Acceptance of Smartphone Applications by Exercise Professionals

Bromilow, L, Stanton, R, and Humphries, B. A structured e-investigation into the prevalence and acceptance of smartphone applications by exercise professionals. J Strength Cond Res 34(5): 1330-1339, 2020-The primary purpose of this study was to examine the prevalence and acceptance of smartphone applications by exercise professionals when interacting with clients and patients. A 29-item anonymous online survey was designed, containing separate sections on demographics, smartphone proficiency, benefits and barriers to using smartphones, and use of smartphones in a professional setting. Accredited members of the Australian Strength and Conditioning Association, and Exercise and Sports Science Australia received an information sheet through organizational communication channels, inviting them to participate. Two hundred forty-nine exercise professionals completed the survey, with men (71%; n = 176) accounting for most of the respondents. Proficiency using smartphone applications is predominantly-advanced (37%; n = 92), intermediate (33%; n = 82), or expert (14%; n = 35). Identified strategies to find smartphone applications included personal searches (67%; n = 167) and colleague recommendations (55%; n = 137). Reported benefits include fast access to information (67%; n = 167), saves time for record keeping (56%; n = 141), and allows performance tracking (55%; n = 138). Almost all respondents (92%; n = 229) identified barriers, such as inexperience with using particular applications (42%; n = 105). Almost all respondents (96%; n = 239) reported they would recommend smartphone applications to clients and patients, primarily for self-tracking (53%; n = 132). Smartphone use among exercise professionals is prevalent; however, application and sensor technology are reluctantly underused. Increasing acceptance requires embedding within educational curricula, recognition from professional organizations, and collaboration with, to maximize the potential capabilities of smartphone technology within working environments.

Conference Hashtags: A Case of #RTP18 – The 2018 Exercise and Sports Science Australia Conference

ABSTRACT Background: Twitter is increasingly used as a medium to communicate scholarly content and facilitate expedited knowledge translation. Academic conferences typically use event-specific hashtags to promote conferences and move conference-related conversations to the public domain. Like other health disciplines, exercise physiology and exercise science attract global interest, and Twitter used during conferences can promote conference content to a broader audience than attendees. However, despite conferences in these disciplines having previously used hashtags, no published studies have examined their use. This study examined the use of the #RTP18 during the 2018 Exercise & Sports Science Australia Research to Practice Conference. Methods: Freely accessible Twitter data were mined using twdocs. Descriptive statistics were used to report the number of original tweets and retweets. Content analysis was used to differentiate original tweets related to specific conference sessions from tweets related to the conference in general. Data are presented for each day of the conference and overall for the three days of the conference. Results: A total of 262 original tweets were identified using the hashtag #RTP18. Seventy-one percent (n = 187) of the original tweets were related to specific conference content, while n = 75 (29%) of original tweets were related to the conference in general. More than 11,500 retweets were identified across the duration of the conference. The mean retweet rate was 12.7 times and ranged from 0–73. Conclusion: Twitter appears to be a powerful tool to extend the reach of conference activities. The use of social media may enhance organizational and personal networking opportunities for conference delegates.

The Role of Sport, Exercise, and Physical Activity in Closing the Life Expectancy Gap for People with Mental Illness: An International Consensus Statement by Exercise and Sports Science Australia, American College of Sports Medicine, British Association of Sport and Exercise Science, and Sport and Exercise Science New Zealand

In the general population, the worldwide pandemic of physical inactivity is responsible for an estimated 13.4 million disability-adjusted life-years, costs the worldwide economy an estimated INT$53.8 billion (1), and is the cause of approximately 9% of premature mortality worldwide (2). People experiencing mental illness represent a particularly vulnerable population at high risk for poor lifestyle factors such as physical inactivity and experience an unacceptable level of early mortality of between 15 and 25 yr (3). People experiencing mental illness engage in significantly lower levels of moderate–vigorous physical activity and spend significantly more time engaging in sedentary behavior (4). A growing number of clinical trials (5,6) demonstrate efficacy of lifestyle interventions including exercise, for both physical and mental health in people with mental illness. However, large-scale translation into routine clinical care has not occurred. This international consensus statement aims to delineate the key factors that must be addressed by key decision makers to increase access to appropriate exercise programs for people with mental illness and subsequently contribute to closing the life expectancy gap. CULTURE CHANGE Psychiatric services at all levels of care (acute and long-term inpatient, transition/outpatient, and community care) need to provide holistic care for people with mental illness, addressing the body and the mind simultaneously (7). Typically, psychiatric services have prioritized symptoms of mental illness, whereas physical health care is often disregarded or deemed to be a low priority. Increasingly, people with mental illness are seeking integrated physical and mental health care (8). Exercise practitioners, as members of the multidisciplinary team, have a core role as advocates for positive lifestyle change, addressing all major modifiable risk factors contributing to premature mortality. Embedded within the multidisciplinary team, these exercise practitioners can affect change among staff through staff wellness programs that leads to positive role modeling for patients, increasing the likelihood of long-term behavior change (9). In addition, exercise is a highly acceptable intervention strategy, and dedicated interventions may act as a facilitator to help-seeking or stigma reduction among vulnerable populations such as young people experiencing mental illness. INFRASTRUCTURE Advocating for access to trained exercise practitioners and appropriate exercise facilities across all treatment settings, and for all mental health conditions, regardless of patient age, socioeconomic, or physical health status is a key requirement for ensuring integration within mental health and primary care settings. This must include acute and long-term inpatient settings, community mental health centers, and primary care facilities. Taking into account local health system contexts, it may be necessary to draw on resources from both the general medical and mental health budgets to provide access to necessary infrastructure and human resources. Partnering with nongovernment and not-for-profit community agencies to deliver exercise interventions may aid in providing human and physical resources, while managing health service governance and financial barriers. TRAINING To effectively integrate exercise practitioners within the multidisciplinary mental health team, exercise practitioners (e.g., exercise physiologists, physiotherapists, and kinesiologists) must receive training in basic mental health literacy and in illness-specific exercise prescription considerations. Likewise, to facilitate referral and maximize long-term behavior change, mental health and general medical practitioners working with people with mental illness need to understand the role, scope of practice, and competencies of exercise practitioners working in mental health settings. Ideally, training should take place at the undergraduate level and be reinforced through pragmatic student placements established within functional multidisciplinary mental health teams. Postgraduate courses for exercise practitioners focusing on mental illness (such as those available in Belgium and Scandinavia [10]) should be designed and delivered in consultation with psychiatric services to promote an integrated approach to mental health service delivery. Professional organizations representing exercise practitioners have an obligation to provide opportunity for upskilling and continuing professional development to provide the highest levels of evidence-based exercise prescription to people with mental illness. The organizations that endorse this consensus statement commit to promoting the role of exercise interventions as a key component of a global strategy toward achieving a 50% reduction in the life expectancy gap of people experiencing mental illness by 2032. We believe that enhanced training of our members, facilitating culture change within mental health services, and advocating for the provision of required infrastructure are the cornerstones of achieving this goal.

Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis.

Osteoporotic fractures are associated with substantial morbidity and mortality. Although exercise has long been recommended for the prevention and management of osteoporosis, existing guidelines are often non-specific and do not account for individual differences in bone health, fracture risk and functional capacity. The aim of the current position statement is to provide health practitioners with specific, evidence-based guidelines for safe and effective exercise prescription for the prevention or management of osteoporosis, accommodating a range of potential comorbidities. Position statement. Interpretation and application of research reports describing the effects of exercise interventions for the prevention and management of low bone mass, osteoporosis and osteoporotic fracture. Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, balance and mobility minimises the risk of falls (and thereby fracture), which is particularly relevant for individuals with limited functional capacity and/or a very high risk of osteoporotic fracture. It is important that all exercise programs be accompanied by sufficient calcium and vitamin D, and address issues of comorbidity and safety. For example, loaded spine flexion is not recommended, and impact activities may require modification in the presence of osteoarthritis or frailty. Specific guidelines for safe and effective exercise for bone health are presented. Individual exercise prescription must take into account existing bone health status, co-morbidities, and functional or clinical risk factors for falls and fracture.

Exercise and sports science Australia (ESSA) position statement on exercise and spinal cord injury

Traumatic spinal cord injury (SCI) may result in tetraplegia (motor and/or sensory nervous system impairment of the arms, trunk and legs) or paraplegia (motor and/or sensory impairment of the trunk and/or legs only). The adverse effects of SCI on health, fitness and functioning are frequently compounded by profoundly sedentary behaviour. People with paraplegia (PP) and tetraplegia (TP) have reduced exercise capacity due to paralysis/paresis and reduced exercising stroke volume. TP often further reduces exercise capacity due to lower maximum heart-rate and respiratory function. There is strong, consistent evidence that exercise can improve cardiorespiratory fitness and muscular strength in people with SCI. There is emerging evidence for a range of other exercise benefits, including reduced risk of cardio-metabolic disease, depression and shoulder pain, as well as improved respiratory function, quality-of-life and functional independence. Exercise recommendations for people with SCI are: ≥30min of moderate aerobic exercise on ≥5d/week or ≥20min of vigorous aerobic ≥3d/week; strength training on ≥2d/week, including scapula stabilisers and posterior shoulder girdle; and ≥2d/week flexibility training, including shoulder internal and external rotators. These recommendations may be aspirational for profoundly inactive clients and stratification into "beginning", "intermediate" and "advanced" will assist application of the recommendations in clinical practice. Flexibility exercise is recommended to preserve upper limb function but may not prevent contracture. For people with TP, Rating of Perceived Exertion may provide a more valid indication of exercise intensity than heart rate. The safety and effectiveness of exercise interventions can be enhanced by initial screening for autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, thermoregulatory dysfunction, pressure sores, spasticity and pain.

The development of a subjective assessment framework for individuals presenting for clinical exercise services: A Delphi study.

The American College of Sports Medicine and Exercise and Sports Science Australia recognise the importance of gathering a client history (subjective assessment) to inform clinical decisions for clients with chronic disease and/or disability. Despite the importance of the subjective assessment in problem-oriented exercise management, there is currently no primary evidence to indicate the important domains that should be addressed during the subjective assessment to guide safe and effective clinical decisions. Modified e-Delphi METHODS: A panel of 32 experts was recruited with a median of 12 years of experience (Q3=15.5 years; Q1=10 years). The panel was asked to rate the importance of each domain in guiding clinical decisions on a 9-point Likert scale with consensus for inclusion or exclusion pre-defined at 80%. The panel of experts elected that best practice for conducting the subjective assessment was a semi-structured approach using a combination of prompts and follow-up questions. The Delphi process resulted in an initial list of 36 domains that was identified by the panel of which 23 domains reached consensus for agreement after Round 3. The subjective assessment is important for Clinical Exercise Physiologists to provide safe and effective services. Best practice for conducting the assessment is the semi-structured approach to prompt the clinician on the domains to include. Twenty three domains have been considered as important for a Clinical Exercise Physiologist to address in a subjective assessment to implement the delivery of safe and effective exercise assessment and/or prescription.

Exercise & Sports Science Australia (ESSA) position statement on exercise prescription for patients with peripheral arterial disease and intermittent claudication

Peripheral arterial disease (PAD) is characterised by atherosclerotic stenosis or occlusion of the arteries of the lower limbs, resulting in an impairment of blood flow to the legs. Patients with PAD have a significant reduction in their physical capacity and are limited during activities such as walking by intermittent claudication. Position stand. Synthesis of published work within the field of exercise training and peripheral arterial disease. Supervised exercise training is considered the most effective treatment for increasing exercise tolerance in patients with PAD, and is also associated with improvements in daily physical activity and quality of life, and a reduction is cardiovascular disease risk. Exercise should be prescribed and progressed for patients individually, taking into consideration their disease severity, exercise tolerance and relevant comorbidities. While walking programs are beneficial and frequently prescribed, other forms of aerobic exercise such as cycling or arm-cranking may also be incorporated as tolerated by patients. Forty minutes of accumulated aerobic activity, three times per week, is recommended for most patients. Patients should be encouraged to commence exercise at a moderate intensity, and should stop and rest if claudication pain becomes severe. Resistance training should also be included on at least two days per week with the goal of improving muscular strength and endurance. Comorbidities such as musculoskeletal complaints, hypertension, diabetes and peripheral neuropathy are common in patients with PAD and may exacerbate their functional limitations. Given the high cardiovascular risk associated with PAD, it is important that patients are appropriately monitored during exercise.

Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease

Chronic kidney disease (CKD) is prevalent, affecting 13% of adult Australians and poses increased risk for cardiovascular morbidity and mortality. This position article provides evidence-based guidelines on the role of exercise training for CKD patients and provides recommendations for prescribing and delivering exercise training. Position stand. Synthesis of published work within the field of exercise training and chronic kidney disease. Exercise training likely to provide benefits to CKD patients, including improvements in cardio-respiratory fitness, quality of life, sympatho-adrenal activity, muscle strength and increased energy intake and possible reduction in inflammatory biomarkers. Existing studies generally report small sample sizes, brief training periods and relatively high attrition rates. Exercise training appears to be safe for CKD patients with no deaths directly related to exercise training in over 30,000 patient-hours, although strict medical exclusion criteria in previous studies resulted in 25% of patients being excluded potentially impacting the generalisability of the findings. Aerobic exercise at an intensity of >60% of maximum capacity is recommended to improve cardio-respiratory fitness. Few data are available on resistance training and it is unclear whether this form of training retards catabolic/inflammatory processes typical of CKD. However, it should be considered important due to its proven beneficial effects on bone density and muscle mass. Due to the high prevalence and incidence of co-morbidities in CKD patients, exercise training programs should be prescribed and delivered by individuals with appropriate qualifications and experience to recognise and accommodate co-morbidities and associated complications.

Evaluating the influence of different modes of administration of a pre-exercise screening tool

ObjectivesExercise participation is important in overall health, but is not without risk, particularly when exercising at vigorous intensities. Pre-exercise screening procedures such as the Sports Medicine Australia Pre-Exercise Screening System (SMA PESS) aim to minimise risks while maximising benefits from physical activity. The purpose of this study was to evaluate the SMA PESS as it might be used within commercial fitness centres and to determine the effect of point of care blood analysis on risk identification. DesignConvenience sample of participants attending fitness centres for exercise classes. MethodsParticipants were recruited from commercial fitness centres and completed the PESS via self-administration and interview with an Exercise & Sports Science Australia Accredited Exercise Physiologist. Blood related risk factors obtained from the CardioChek® point of care blood analyser were compared to those obtained from laboratory analysis. ResultsFindings indicated that approximately 54% of participants would be required to seek medical clearance with a further 17% restricted to moderate intensity exercise. The identification of risk in Stage 2 of the SMA PESS improved with increasing rigour of application, with the number of participants classified as moderate risk increasing non-significantly from 37% to 50% (p=0.40). ConclusionsIncreasing the rigour of administration of the SMA PESS influences risk identification and results in a higher number of clients being excluded from participation in vigorous intensity exercise.

Exercise is medicine for chronic disease management

We have now accumulated extensive evidence, both research and clinical, demonstrating physical exercise as a powerful medicine for the prevention and management of all chronic diseases. As a result a multi-organisational, multi-national initiative was launched by the American College of Sports Medicine and the American Medical Association in 2007 to promote integration of exercise prescription into mainstream medical care. In 2011, Exercise is Medicine® was launched in Australia by Exercise and Sports Science Australia. This presentation details current knowledge and practice of exercise medicine in a range of diseases. For example, being physically active results in a 20%, 30%, 50%, and 70% reduction in risk of lung cancer, breast cancer, colon cancer and prostate cancer respectively. Up to 50% of patients could be prevented from progressing to Type II diabetes if they met physical activity guidelines. Dementia and in particular Alzheimer's disease progression is markedly slowed by appropriate exercise. Exercise is now deemed a critical adjuvant treatment in the management of cancer. Breast cancer survivors halve their risk of dying if they can meet a relatively modest exercise dosage and colorectal cancer patients can increase their disease free survival by 55%. Researchers recently reported 61% lower risk of prostate cancer death if men completed more than three hours per week of vigorous activity. It is now well established that cardiorespiratory fitness is the principal predictor of all-cause mortality and that neuromuscular fitness (strength) is an important predictor of metabolic syndrome and functional ability. The current focus on overweight and obesity by government and the health professions is misguided and not supported by the research evidence. Physical inactivity and the resulting low fitness should be our greatest concern and the target of our research and clinical efforts to stem the increasing incidence of chronic disease. “Fitness not fatness” should be our mantra as rigorous research clearly demonstrates that normal weight people who are sedentary are at far greater risk of morbidity and mortality than overweight people who are physically active and fit. We will explore these research studies and their implications in depth.

Exercise & Sports Science Australia Position Statement on exercise training and chronic heart failure

Chronic heart failure (CHF) is a complex syndrome characterised by progressive decline in left ventricular function, low exercise tolerance and raised mortality and morbidity. Regular exercise participation has been shown to be a safe and effective treatment modality in the majority of CHF patients, partially reversing some of the maladaptations evident in myocardial and skeletal muscle function, and resulting in improvements in physical fitness and quality of life, and perhaps reduced mortality. The volume and intensity of exercise that is recommended depends on the syndrome severity, however in most patients it should consist of a combination of low-to-moderate intensity aerobic (endurance) exercise on most days of the week and individually prescribed low-to-moderate intensity resistance (strength) training at least twice per week. Additionally, all patients should be closely monitored prior to and during exercise for contraindications by an appropriately trained health professional. The purpose of this statement is to inform and guide exercise practitioners and health professionals in the safe and effective prescription and supervision of exercise for patients with CHF.