Exercise physiologist’s role in clinical practice

Abstract

The use of exercise testing has expanded greatly to help guide decisions about medical management and prognosis in a broad spectrum of patients. Numerous epidemiological studies in people with and without documented coronary artery disease have identified a low level of cardiorespiratory fitness as an independent risk factor for all-cause and cardiovascular mortality and that exercise capacity is inversely associated with healthcare costs. Accordingly, unfit men and women should be counselled to exercise in home-based or group preventative or rehabilitative programmes. In the era of managed care, the use of specialised exercise professionals for the supervision of exercise testing and training may represent a safe and cost-effective alternative to many hospitals, clinics and private physician practices. Clinical exercise physiologists (CEPs) can play a critical role in favourably modifying clients' level of cardiorespiratory fitness and physical activity habits. We detail the training of CEPs and outline the clinical settings where they have contributed substantially to healthcare delivery. We also outline the role of registered clinical exercise physiologists. It is important that exercise prescription is not left to a few individuals or small groups. It needs a concerted programme with all those in a position to make a difference actively contributing.

Early Exercise Rehabilitation of Muscle Weakness in Acute Respiratory Failure Patients

“…While the physicians and nurses are responsible for the medical management of these patients, the physical therapist and clinical exercise physiologist work together to determine the specific rehabilitation needs of individual patients. Clinical exercise physiologists are trained to identify specific deficits and are knowledgeable as to the modality or type of exercise that can be best utilized based on a patient’s specific needs (22). They are also cognizant of the frequency with which the exercise should be performed, the intensity of the exercise and the duration or time of the exercise.…”

Exercise prescription is not just for medical doctors: the benefits of shared care by physicians and exercise professionals

“…They use individually tailored exercise programmes based on an evidence-based approach that integrates knowledge about the acute and chronic responses to exercise, and chronic disease pathophysiology. In practice, exercise prescription and progression by CEPs is guided by an extensive review of the patient's medical history, a thorough physical assessment including an exercise test, and clinical reasoning,3 and is applied in the context of behaviour change methodology. Performing exercise prescription as their dedicated role allows CEPs to conduct this process more comprehensively than is possible within the confines of a standard physician consultation, which may be 15 min or less 4.…”

The role of community programmes and mass events in promoting physical activity to patients: Table 1

“…An increasingly used model is the exercise scientist or behaviour-change specialist or trained practice nurse who is already in, or visits the practice, to provide exercise prescriptions to patients 12 – 14. GPs should be encouraged to become active role models themselves, in the same way that they led the way in adopting non-smoking behaviour.…”