There are exciting developments happening in the professional arena for qualified exercise professionals, such as CSEP-CPTs and CSEP-CEPs, as CSEP continues to engage and collaborate with its international partners to help inform future action plans for Canada.
Recently, Dr. Kirstin Lane (Vice Chair, CSEP Professional Standards) and Zach Weston (CSEP CEO) were invited participants at a series of meetings at the American College of Sports Medicine’s (ACSM) world congress held in Denver. They participated in discussions with the International Confederation of Sport and Exercise Science Practice (ICSESP), the Clinical Exercise Physiology Association (CEPA) and the United States Registry of Exercise Professionals (USREPS).
The Exercise Intervention Algorithm: a new model
Of great interest were discussions with members from USREPS and the Coalition for the Registration of Exercise Professionals on the model they are advancing for qualified exercise professionals. In contrast to the health care regulation model in Canada, the USREPS model has established a hierarchical process of identifying and recognizing different levels of expertise in the industry. This model provides the clarity for understanding which qualified exercise professionals are best suited to work with clients/patients in differing scenarios or living with increasingly complex health issues, medical conditions or diseases.
Credentials recognized in this model are not exclusively from ACSM, but also include those from the American Council on Exercise, the Collegiate Strength and Conditioning Coaches Association, the National Council for Certified Personal Trainers, and the National Strength and Conditioning Association.
The exercise intervention algorithm (Figure 1) integrates the level of supervision required (High, Medium or Low), the practice setting, healthcare involvement, and suggests credential types based on either of the three levels of supervision. This model highlights how occupational credentialing, referrals and coverage determination all fit together.
Moreso, the USREPS model builds on 4 foundational aspects to establish this structure and promote qualified exercise professionals to both the general public and those referring clients/patients:
- Programmatic Accreditation. By 2027, those wishing to be certified with US credentials will need an education from an accredited academic program. Consistency in content and quality is reviewed by the Commission on Accreditation of Allied Health Education Programs and the Committee on Accreditation for the Exercise Sciences. Accreditation is a process by which institutions and programs voluntarily undergo an extensive peer evaluation of their compliance with accepted standards for educational quality. In Canada, medical schools, nursing schools, physiotherapy programs, and engineering programs all follow a model of programmatic accreditation. The Canadian Council of University Physical Education and Kinesiology Administrators (CCUPEKA) offers accreditation of Kinesiology programs in Canada. The main purpose of accreditation is to evaluate whether reviewed programs meet the minimum standards of education and training for graduates and to assure employers that graduates have obtained the necessary education for job performance.
- National Certification. The USREPS model has reviewed and recommended those quality exercise credentials that have been developed and adopted standards of practice supported by evidence. Much like the CSEP Professional Standards Program®, the credentials incorporating high standards supported and informed by scientific evidence are included.
- Continuing Education. New evidence is continually being published and integrated into new standards of care. A requirement for recognition in the framework is the mandatory inclusion of lifelong learning principles aligned to the CSEP Professional Development model. All quality credentials require some form of continuing education as do most professions such as teachers, physicians, nurses, and accountants.
- Registration. The USREPS have built a robust registry of all Qualified Exercise Professionals (QEPs) who meet the criteria above and hold a credential from a recognized certifying organization. Through this approach, an individual holding an ACSM Clinical Exercise Physiologist certification (following graduation from an accredited program) who is in good standing with their membership, can apply and become a Registered Clinical Exercise Physiologist and be listed in the national exercise referral framework.
While this model of registration is different than regulation, it is similarly designed to protect the public but is also intended to establish a referral model that is easy to navigate for physicians to find appropriate QEPs for their patients. An ACSM survey of Physicians found their confidence to refer to a QEP was only 50%, however if they were able to refer to a QEP and program with demonstrated positive key performance indicators, and the capacity to develop appropriate billing codes, the survey results increased to nearly 100%.
The final steps are to leverage this model to clarify the job roles and responsibilities within the industry and identify those who are appropriately trained academically and professionally to perform specific work. An example of this includes cardiac rehabilitation exercise testing, supervision, prescription, progression, and risk stratification. While many nurses are occupying cardiac rehabilitation positions in Canada/USA and tasked with performing work including exercise prescription, supervision and progression, arguably this content is not appropriately covered in nursing educational programs. This model suggests only those who are registered QEPs with credentials in the high level of supervision should be employed in these positions. While this registry is developing, efforts to establish appropriate funding and reimbursement models are underway.
Recognizing the skills of Clinical Exercise Physiologists
Recognizing the education, training and skills that Clinical Exercise Physiologists have has been identified as an integral part of multidisciplinary health care teams. This recently published article highlights the importance of granting privileges to CEPs to work at the top of their knowledge & skills, which will free other health care professionals such as nurses to better use their skills in other areas. Creating better recognition of the skills of CEPs and common job tasks where they have mastery of domain may enhance acknowledgment by other health professionals & improve salary compensation equity
Canadian news that travelled the world
Conversations with CEPA showed great interest in the recent news from Canada where the BC Ministry of Health has recommended the hiring of CEPs to support human resource challenges in the health system and the requirement by the Canadian Sports Institutes to require the CSEP-CEP and High Performance Specialization for those providing physiology services for Canada’s Olympic and Paralympic Athletes.
Updates from abroad
Members from ESSA shared updates on their progress with Exercise Physiology services integrated into the Australian health system and current challenges to improve equitable funding for clinicians in this space. Their challenge is that the reimbursement model is based on intervention without adequately considering the time required for exercise therapy versus other modalities in the physical treatment domain (i.e. modalities).
Lastly, discussions with the ICSESP focused on developing international practice standards to create consistency within the profession across borders to align with agreements to recognize credentials between countries. Participants included representatives from ACSM, BASES and ESSA (Sport and Exercise Science News Zealand was unable to attend), who also reviewed recent work to establish a consistent code of ethics. The objective of ICSESP includes support to influence international policy related to health and fitness, and grow membership for each organization and the number of represented countries through increased recognition and credibility.