Great discussion point! I am a clinical Exercise Physiologist (AEP) through Exercise and Sport Science Australia. To become an AEP you must study under certain accredited University courses that cover in depth education on pathology and evidence-based exercise prescription for any 'higher risk' clients from cardiac, neuro, musculoskeletal, metabolic etc. for at least 4 years. This is separate to our basic exercise and sport science, whereby you can work mainly with healthy populations. There is a similar system in the UK (BASES accredited) and USA (ACSM) however I have not come across such degrees in other places I have lived (Belgium, Spain, Czech). I completely agree that the basic level of education is not sufficient, however its aim is not to target these high risk individuals (in my experience). Those of us that have the further qualifications that is regulated through national bodies are essential to multidisciplinary teams, and I really feel that this field can only expand with all the supporting literature around the benefits of PA.

Personally, I disagree upon the eligibility of Exercise Professionals work in Public or Private Hospitals in performing physical exercise programs for a few reasons.

Firstly, hospital environments accommodate variety of individual health status and spectrum of disease / illnesses among the healthcare seekers & providers. The exercise professionals do not have fundamental knowledge & skills related to Pathology. Hence, one cannot just based on energy consumption and energy expenditure profile or even fitness level to perform physical exercise programs towards them.

Secondly, Physical exercise programs and movements are often designed, adapted and modified according to his or her state of disease progression and / or recovery phase. Hence, such physical exercise programs are addressed as Exercise Therapy. There are many therapeutic approaches with different concepts, aims and targeted population. So, only physical therapist have the ability to acknowledge and clinically reason out the appropriateness of executing those movement exercise.

Thirdly, it is acknowledged that there is big difference in exercise programs prescribed to Healthy and Unhealthy populations. Any exercise program prescribed to a person does required evaluation to examine the effectiveness of the therapy and patient's outcome responds to the exercise. Such evaluation requires context specific objective assessment skill. Again, the exercise professionals do not have such knowledge and skill to do so.

Fourthly, any physical exercise program executed within a healthcare settings or facilities must come from a qualified and licensed healthcare provider since such exercise programs are seen as part of healthcare service - Treatment. At the moment, only physical therapist has the eligibility to practice within healthcare settings.

However, having to say so, Exercise Professionals can perform physical exercise program in non-healthcare settings environment. Such as Yoga, Aerobic exercises and etc in the public parks.

It is important to acknowledge that, once an individual is subjected by means of an injury or diseases or illnesses, responsibility in designing and performing physical exercise program should be accounted by Physical therapist, in which physical exercise interventions are started right from the prevention measures until full recovery.

Dear Saúl Martín Rodríguez, 

Check ACSM for the necessary qualifications, The clinical Exercise Specialist will do good.

http://certification.acsm.org/acsm-certified-clinical-exercise-specialist

http://certification.acsm.org/acsm-certified-health-fitness-specialist

Hope these helps.

And to Mr.Raymond, There are certification, specialization  and accreditation courses available to get qualified. 

Dear Mr. Raymond, I have to agree and disagree with you in some aspects. Firstly, I disagree because Exercise Professionals are the only ones that should have the competence to prescribe and design physical activity programs oriented to physical performance and HEALTH. As Mr. Kumar said, there are international qualifications as ACSM (American College of Sport Medicine) or MSc and Phd courses that offer qualification and specialization to prescribe exercise in the Health environment.

On the other hand, I agree with you in terms that basic formation (BSc Sport Science) is insufficient to accomplish this work but as I told you before, with extra and high quality formation it would be possible. 

I think both clinicians,  physiotherapists and exercise professionals could work in multidisciplinary teams and benefit our education to improve people´s health, because as you may know, hundreds if not thousands of scientific studies support physical activity as a essential means to improve health.

Great discussion point! I am a clinical Exercise Physiologist (AEP) through Exercise and Sport Science Australia. To become an AEP you must study under certain accredited University courses that cover in depth education on pathology and evidence-based exercise prescription for any 'higher risk' clients from cardiac, neuro, musculoskeletal, metabolic etc. for at least 4 years. This is separate to our basic exercise and sport science, whereby you can work mainly with healthy populations. There is a similar system in the UK (BASES accredited) and USA (ACSM) however I have not come across such degrees in other places I have lived (Belgium, Spain, Czech). I completely agree that the basic level of education is not sufficient, however its aim is not to target these high risk individuals (in my experience). Those of us that have the further qualifications that is regulated through national bodies are essential to multidisciplinary teams, and I really feel that this field can only expand with all the supporting literature around the benefits of PA.

We have an exercise science person who monitors and maintains our follow up rehab program. This person is responsible for progressing and monitoring patients with a program in place. We have also had an exercise person in cardiac rehab.  I believe the ability to practice is based more on facility policy and state lisence issues.

Saúl, the answer to your question is provided by Doug Long's last sentence. Many countries restrict the ability for an exercise professional to work with clinicians in both the public and private sector due to policies and license issues. In North America, I don't think that the health insurance (differs with different states/provinces) covers the consultation of an exercise physiologist. Health insurance however covers for a physical therapist and I have met kinesiology students that take up a MSc in physical therapy in order to have a job working with people to improve their health through physical activity.

More often than not, I believe many clinicians and policy makers have a misguided view of exercise physiologists/professionals and I believe Raymond's reply is a prime example. Qualified and trained exercise/sports science graduates like Katina are able to handle much more than just assess energy usage/consumption and fitness level. They are able to understand medical results and link them to ways on how physical activity are able to assist in treatment, recovery and improved health.

Exercise physiologists takes into account their medical conditions, medication usage, individual health behaviour, physical activity experience and physical ability before they design, advise and monitor physiological changes (blood work, oxygen consumption level, heart rate, bp, insulin and glucose levels, etc.) that are interacting with exercise. Each exercise program needs to be individualized even in people without any medications but may be at high risk for chronic diseases, e.g. obese, prediabetic,  Exercise consultations also covers how a person can actively monitor their own exercise intensity and what they should consider when exercising (weather, medication intake, proper technique, progression, physical restrictions) and in the long run, instill physical activity into their daily lives.

My question would be how are exercise physiologists going to be taken seriously if clinicians and policy makers still thinks a physical therapist does all that an exercise physiologist is trained to do? They are two different professions and roles. And exercise physiologists are definitely not trained to be yoga or aerobics instructors or even fitness trainers but we understand the science behind these different exercise systems, how it interacts and effects the human body (healthy or otherwise).

The literature is out there on the benefits of PA and health/diseases across the lifespan. Up till today, research in nutrition is on-going but nutritionists are acknowledged as health professionals. Time for mindsets and policies to change so that one day, I will no longer have to write long answers like this... ;)

I completely agree with you Vina. We are NOT yoga, aerobics or guide activities trainers, we are more than that because these activities can be performed by a fitness monitor that not necessarily have to have a BSc or higher. I also agree with you in that many clinicians and policy think that we are unnecessary in the health environment, but it is more than scientifically proven that exercise prevents many risk factors. 

The problem lies in that many countries like mine (Spain) has not regulated the Sport Sciences as a health profession and also has none National Oganization which offers qualifications as ACSM (USA), BASES (UK) or AEP (Australia) that allows us to benefit from a certain respect.

This is a very interesting debate....

Yes. In some Brazilian territories physical educator professionals with exercise physiology and prescription specialization have been worked in both private and public hospitals. In some Brazilian states physical educators were incorporated in the Brazilian Public Health System (SUS).  

In France, I'm an adapted physical activity (APA) professionnal (Enseignant en activité physique adaptée en France) or an exercise physiologist - USA, England, Australia or a kinesiologist - Canada (Kinésiologue en français au Canada) and I've worked in private and now I'm in a public hospital.

During my studies, I had the opportunity to develop my knowledge in pathology, the effects of physical activity, the different ways to improve the health status of people with temporary or chronic disability.

There is a big difference between physiotherapists and APA professionnal. Physiotherapists are primarily concerned with disability as we (APA professionnals) seem to have a more comprehensive view of the capabilities of the person in connection with the conditions of physical activity practices.

We are not well recognize in France. it is evolving, and it seems that French physicians are closer to our profession in a public health perspective. But only few physicians in France are actually trained in prescribing physical activity. To be continued.

APA are studied for 3 years at university in the training unit and research in science and technology of physical and sports activities (UFR STAPS in French) in the field of adapted physical activity and health. Then we have the possibility to continue with a master degree, but it is not mandatory to work in the field.

Finally, think about complementarity and the positive impact of interdisciplinary teamwork.

More information about APA: www.sfp-apa.fr

Teamwork APA & physios: http://le-gerar.blogspot.com

Congress APA: http://cnp-apa.sfp-apa.fr

Dear all, we have tio think on competencies achieved and the responsability (e.g. claims, insurances, etc.). There are exercise sciences graduated that add 2-3 years of specialized post-graduated training to prescribe and to apply exercise in special populations (2-3 years: another graduation of high-level? it is difficult thahey could not practice the accredited competencies they achieve in 2-3 years) The law is rapidly changing in all world due to need or increasing market on chrinic diseases. There are published studies (eg in Australia or Spain) that exercise physuologist have similar health results to physiotheapist in low-medium risk, but they are cheaper and could manage well chrinic disease and health promotion (what could happen with a most complicated problem? Exercise physiologist monitors and refers to physician/physiotherapist: mor work for all). The world is changing. E.g. Australia is teaching general health degrees and the postgraduate studies leads you to exercise physiologist, occupatuonal therapy, etc. Do you have accredited competencies -titles are usually natuon-specifific and difficult to understand by others, and new/old titles change-?

I am not going to discuss about who arrives first to health care, in some countries physiotherapist were not a degree few years ago while exercise sciences yes and the reverse.Thee are EU Master in Physiotherapy in Sports. It seems also a new fight, but I read the cimpetencies and pe4spective and it is quite complementary to sports sciences. Reciprocaly, It is difficuktt to see anregukar  exercise physiologist oractising therapeutic massage or other specific electro-devices that physiotherapist are teorically usually trained but exercise physiologist not. (Tere are always crazy professionals in all sectors).

On the other hand, related to future ckaims, etc. I think that the problem will come from low levels. We are discussing physio vs exercise sports, but there is a big issue: some industries and governments are primoting 3 to 6-weekend courses to practice physical activity to special populations (cheaper and they cintract their own former students).

I can't speak to the European process, but I am both a licensed physical therapist and have a PhD in exercise physiology and continue to see patients as a physical therapist in a hospital setting.

The licensure of health professionals in the states is regulated by the individual states. As a general rule, to accept a consultation for rehabilitation from a referring practitioner in a hospital, you have to have licensure in that state as a physical therapist. In order for the facility to be paid for the rehabilitation activity, physical therapist generally has to do an initial evaluation to identify the problems and plan the treatment course. All of the insurance companies that we deal with require that the evaluation be completed by a licensed therapist and in some cases the physical therapy license number has to be included with the signature.

Once treatment is initiated, the patient's response to treatment has to be recorded and treatment adjusted accordingly. Different insurance companies have different standards for the number of visits they will allow, assuming the patient is continuing to make progress. It is fairly common for physical therapist to be assisted by rehab aides or in some cases physical therapist assistants (licensed) to oversee the actual exercise activities. Physical therapy assistants are generally not permitted to complete the initial evaluations or discharge summaries.

I believe some states have licensed clinical exercise physiologists, but I don't think they are licensed in the state of Florida. You'll find that health care in the states is pretty much a "closed shop" and is restricted to licensed individuals. It is possible for the licensed PT to delegate some of the activities to an unlicensed individual, but some insurance companies will not pay for that type of treatment.

Clinical exercise physiologist are probably more involved with outpatient cardiac rehab programs than any other healthcare setting. These programs are typically billed as “cardiac rehabilitation”, and the exercise physiologists work under supervision of the program’s medical staff.

I frequently recommend some of our pre-lung transplant patients exercise at commercial gyms under the supervision of exercise specialists because most rehab pulmonary rehab programs don't have adequate strength training equipment and commercial gyms are more cost-effective.

As you indicate, licensure and supervision requirements vary widely from state to state in the USA. Thank you for clarifying the implementation of the statutes in Florida.

Hi there,

From a South African perspective, Biokineticists are the equivalent of Clinical Exercise Specialists abroad and the Health Professions Council of South Africa together with the Biokinetics Association are in the process to develop and encourage the need and use of Biokineticists in the hospitals, especially in the public health settings.

My take on Sports Scientists is that they are able to provide exercise programme but would be limited in the scope from a clinical perspective. That is where the Biokineticists comes in and they would be more appropriate to the Lifestyle disease prevention or Quality of life enhancement sections.

Hope this helps.

Regards,

Habib

With the continuing evolution of Exercise Prescription or Exercise Referral schemes in the UK from the 1990's there was a parallel development in the professional accountability of exercise professionals who were expected to deliver the physical activity component of such programmes. In 2001 national standards for the delivery of exercise referral schemes were established through the NHS National Quality Assurance Framework (attached) and a minimum qualification for exercise professionals agreed with BASES and others for Competencies within the National Occupational Standards for Coaching, Teaching and Instructing Exercise and Fitness Level 3. Since then additional Level 4 competencies have been developed to work with special populations i.e. higher risk groups such as patients with specific conditions such as respiratory disease. The Welsh National Exercise Referral Scheme has been delivered over the last 7 years by over 120 exercise instructors all of whom have Level 3 qualifications and most have more than one level 4 qualification. What is often overlooked by commissioners and evaluators of programmes of this type is the added value of training exercise instructors to this standard who apply their skills and knowledge throughout their practice, not just in the confines of a specific programme.

Thank you all for your contributions. 

its clear from discussions that there is a need for those that can prescribe ,design and deliver exercise appropriately to different populations. Training to handle the different groups is the gist of the matter. Given the need for exercise today in light of current desire toward preventive and rehabilitation schemes exercise scientists are more of a necessity than anything less. Currently there is unnecessary friction between many exercise related professions that needs to be streamlined. Licensing should take center stage for those who need to practice exercise prescription, design and delivery for people of different but related exercise professions. This can help screen for those that will practice in public or hospitals.

Saúl Martín Rodríguez have you some report or document about European and World situation of exercise specialist or clinical exercise specialist. In Italy, the government start a reform about the sport and the specialist of sport and exercise. I know that there are many different situation around the world and I'd like to know the better point of view to propose in assembly through representative committee. I'm clinic exercise physiologist and PhD in sport science