title: Exploration of embedding registered Clinical Exercise Physiologists into clinical exercise service provision in the UK.
Creators: name: Crozier, A
Publisher: name: Liverpool John Moores University
Year: 2023

description: There is overwhelming research evidence that targeted regular exercise is vital for the successful management of chronic disease. In the UK, the NHS long-term plan advocates exercise as a key component of clinical exercise services but there was no defined workforce to deliver the services. Recently, Clinical Exercise Physiologists (CEPs) have been recognized and established as a registered health professional in the UK who have the requisite knowledge, skills and experience to deliver clinical exercise services. The overarching aim of this thesis was to explore clinical exercise service provision prior to and following the introduction of CEPs and provide insight and best practice into how to embed CEPs into clinical practice in the UK. Study one (chapter 3) aimed to map clinical exercise provision, prior to the regulation of CEPs, with a focus on who was delivering the services in terms of job titles, roles, and qualifications across services for 5 clinical conditions. An electronic audit was conducted between May 2020 and September 2020. Data were obtained for 731 of 890 eligible clinical services (216 cardiac, 162 respiratory, 129 stroke, 117 falls, 107 cancer). Cardiac rehabilitation services were delivered by physiotherapists, exercise physiologists (exercise specific BSc/MSc) and exercise instructors (vocationally qualified with or without BSc/MSc). Respiratory, stroke and falls services were delivered by physiotherapists and occupational therapists. Cancer services in community exercise service were delivered by vocationally qualified exercise instructors. These findings reinforced the requirement for regulation of exercise job titles and roles for consistent and sustainable provision of exercise in clinical settings. Studies two (chapter 5) and three (chapter 6) used a multi-method qualitative approach (semi-structured interviews, focus groups, face-to-face and virtual observation and field notes) with The Consolidated Framework for Implementation Research as an overarching guide to explore two unique clinical exercise services, that are recognized as successful, over 12-weeks in each service. The first clinical exercise service explored was a cancer service delivered within a community setting and observed between January – March 2022 (applications to become a registered CEPs opened December 2021). This service employed exercise specialists that were educated to a minimum of undergraduate degree level with extensive cancer-specific knowledge and skills, equivalent to that of a registered CEP. Workplace experience and peer learning was essential for staff development. Proficiency in behaviour change and communications skills, including empathy and active listening, were integral to patient-centred care. The second clinical exercise service explored was a cardiac clinical exercise service delivered with secondary care, observed between April - August 2022, and employed registered CEPs. Registered CEPs, through active participation in research, delivered innovative exercise prescription based on real-world findings. Exposure to the roles of a multidisciplinary team (MDT) of health care professionals allowed skill and competency transfer in areas such as clinical assessments. Behaviour change education appeared more effective during less formal conversations than specific education sessions. Study four (chapter 7) compared both clinical exercise services (study two and study three) with the aim of generating common themes that could translate into consistent, evidence-based, and actionable recommendations for both current/new clinical exercise services and universities providing education for CEPs. Registered CEPs with the capacity to deliver highly specialised and individualised exercise prescription based on real-world research were vital. Impactful behaviour change was optimal during informal patient conversations. Supervised peer learning across the MDT, including clinical placements, enhanced CEP knowledge, skills and competencies. In conclusion, exercise specialists delivering clinical exercise service provision in the UK should be educated to a level comparable to a Registration Council for Clinical Physiologist (RCCP) Clinical Exercise Physiologist. The minimum standards for registration include experience/workplace exposure, knowledge of the research evidence base for exercise prescription and behaviour change skills across different complex and clinical conditions.