Anthony Crozier

Objectives Assess the feasibility of embedding an exercise specialist-led, mHealth-supported physical activity and exercise intervention (MOTIVATE-CEW) into a UK Complications from Excess Weight (CEW) service. Design Feasibility, single-site, parallel-group randomised controlled trial. Setting Participants were recruited from Alder Hey Children’s Hospital (AHCH) CEW service. Patients Young people (12–18 years) receiving care from the AHCH CEW service. Interventions Participants were randomised 1:1 to usual care or usual care and intervention (MOTIVATE-CEW). MOTIVATE-CEW participants codesigned a 3-month, home-delivered, personalised progressive physical activity programme supported by virtual counselling sessions from an exercise specialist and biofeedback from wearable technologies. Main outcome measures The primary outcomes were recruitment rate, retention and adherence to purposeful exercise. Exploratory clinical data on effectiveness were collected at baseline and post-intervention (3 months). Results n=72 young people aged over 12 years were registered with the AHCH CEW service and approached to participate. n=25 were ultimately randomised (age 15±1; 52% female; 84% white), giving a recruitment rate of 27%. Retention at 3 months was 88%. Over the 3-month intervention, heart rate monitor data suggested MOTIVATE-CEW participants completed more exercise sessions (MOTIVATE-CEW 2±2 sessions/week; usual care 0±0 sessions/week; d=1.04) and exercised for longer (MOTIVATE-CEW 80±102 min/week; usual care 8±20 min/week; d=0.99) than usual care. At 3 months, 33% of MOTIVATE-CEW participants were still exercising compared with 8% in usual care. Conclusions The MOTIVATE-CEW intervention showed promising effects on exercise behaviour. Good reach and data availability suggest the study design could be feasible within future trials. Trial registration number NCT04854915.

Registered clinical exercise physiologists (CEPs) are recognised healthcare professionals in the UK and are registered through the Academy of Healthcare Science (AHCS). Their practice is guided by the Clinical Exercise Physiology UK (CEP-UK) standards outlined in their scope of practice and the accompanying curriculum framework. This study aimed to explore the current CEP standards and understand if they are fit for purpose in the UK. Three phases (1) a scoping review of Medline, Web of Science and Cumulative Index to Nursing and Allied Health Literature databases. A survey was phased (2) using a 1–5 rating Likert scale ranking the importance of each component for a UK CEP. Phase (3) consisted of two focus groups to gain a consensus on the current standards and recommendations for future iterations. Overall, academics (n=26), healthcare professionals (n=25), CEPs (n=10), service managers (n=6) and researchers (n=4) were identified through purposive sampling and snowball sampling. Phase (1) identified 24 studies containing relevant knowledge and skills. During phase (2), n=58 (82%) of participants completed the survey and n=25 (35%) attended focus groups in phase (3). All knowledge and skills identified from the scoping review, the CEP-UK scope of practice, curriculum framework and the AHCS standards of proficiency and good clinical practice (n=58) were accepted. For CEP practice, an additional three health conditions were accepted from the previous iteration into the current health condition categories. A knowledge and understanding of nine key health professions was also recommended. The final consensus identified that 58 key knowledge and skills across the current health condition categories were required by CEPs, meaning that the current CEP-UK curriculum framework is fit for purpose with only minimal changes required for the next iteration.

Introduction Development of clinical skills in areas, such as exercise risk stratification, testing, prescription, monitoring and outcome assessment, is vital for patient safety and clinical effectiveness in clinical exercise physiology (CEP). This study explored how current CEP courses are being taught and assessed and to identify potential best practice recommendations from a variety of stakeholders Methods Qualitative methods were employed to explore the thoughts of CEPs, academics and current students regarding the teaching and assessment of CEPs in the UK. Research design involved (1) semistructured interviews with students (n=16) and (2) focus groups with academics (n=8) and CEP (n=5) stakeholders. Data obtained were audio recorded using a portable Dictaphone and transcribed verbatim, then thematically analysed manually. Results Three themes: (1) in situ learning/real-world practice (working with patients and specialist practitioners); (2) programme design (scaffold learning and integrated modules) and (3) teaching approach (simulated learning and research competency) were generated concerning teaching methods and approaches across CEP postgraduate degrees. The current use of simulated tasks for the delivery of taught content was identified as lacking effectiveness, with clinical placements identified as being the most important source of knowledge and skill attainment due to the real-world exposure to patients and practitioners. Clinical placements and simulated learning were recognised as the two main methods of problem-based learning used to develop student knowledge, skills and competency to practice. Two themes (placement tariffs/assessors in situ and role play/simulation) were identified for the assessment of students. Conclusion Clinical placements remain the optimal method for developing the knowledge, skills and competency to practice for student CEPs. However, suitable placements remain limited, and novel approaches such as university-led exercise services require consideration for student competency development. A standardised and accredited training pathway from undergraduate through to postgraduate level should be explored to allow student competency to be developed over a longer period, to enhance knowledge, skills and competency on graduation and registration.

In 2021, a ‘call to action’ was published to highlight the need for professional regulation of clinical exercise physiologists to be established within UK healthcare systems to ensure patient safety and align training and regulation with other health professions. This manuscript provides a progress report on the actions that Clinical Exercise Physiology UK (CEP-UK) has undertaken over the past 4 years, during which time clinical exercise physiologists have implemented regulation and gained formal recognition as healthcare professionals in the UK. An overview of the consultation process involved in creating a regulated health profession, notably the development of policies and procedures for both individual registration and institutional master’s degree (MSc) accreditation is outlined. Additionally, the process for developing an industry-recognised scope of practice, a university MSc-level curriculum framework, the Academy for Healthcare Science Practitioner standards of proficiency and Continuing Professional Development opportunities is included. We outline the significant activities and milestones undertaken by CEP-UK and provide insight and clarity for other health professionals to understand the training and registration process for a clinical exercise physiologist in the UK. Finally, we include short, medium and long-term objectives for the future advocacy development of this workforce in the UK.

Introduction Cardiac rehabilitation (CR) can reduce cardiovascular mortality and improve health-related quality of life. In the United Kingdom, patient uptake of CR remains low (52%), falling well short of the target in the 2019 National Health Service long-term plan (85%). Mobile health (mHealth) technologies, offering biometric data to patients and healthcare professionals, may bridge the gap between supervised exercise and physical activity advice, enabling patients to engage in regular long-term physically active lifestyles. This randomised controlled trial (RCT) will evaluate the feasibility of mHealth technology when incorporated into a structured home-based walking intervention, in people with recent myocardial infarction. Methods and analysis This is a feasibility, assessor blinded, parallel group RCT. Participants will be allocated to either CR standard care (control group) or CR standard care+mHealth supported exercise counselling (mHealth intervention group). Feasibility outcomes will include the number of patients approached, screened and eligible; the percentage of patients who decline CR (including reasons for declining), agree to CR and consent to being part of the study; the percentage of patients who enrol in standard CR and reasons for drop out; and the percentage of participants who complete clinical, physical and psychosocial outcomes to identify a suitable primary outcome for a future definitive trial. Ethics and dissemination The trial was approved in the UK by the Northwest—Greater Manchester East Research Ethics Committee (22/NW/0301) and is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. Results will be published in peer-reviewed journals and presented at national and international scientific meetings. Trial registration numbers NCT05774587

Clinical exercise delivery in the United Kingdom is disparate in terms of service structure, staff roles and qualifications, therefore it is difficult to evaluate and compare across services. Our aim was to explore, in a purposely selected cancer exercise service that was recognised as effective; (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective services, and (iii) to identify existing challenges from staff and service user perspectives. The Consolidated Framework for Implementation Research was used as an overarching guide to review the Prehab4Cancer service. Exercise specialists and service user perspectives were explored using a multi-method approach (online semi-structured interviews, online focus group and in-person observation) and data triangulation. Exercise specialists were educated to a minimum of undergraduate degree level with extensive cancer-specific knowledge and skills, equivalent to that of a Registration Council for Exercise Physiologist (RCCP) Clinical Exercise Physiologist. Workplace experience was essential for exercise specialist development in behaviour change and communications skills. Staff should be educated to a level comparable with the standards for registered RCCP Clinical Exercise Physiologists, which includes workplace experience to develop knowledge, skills and competencies in real-world settings.

Objectives In the UK, the National Health Service long-term plan advocates exercise as a key component of clinical services, but there is no clearly defined workforce to deliver the plan. We aimed to provide an overview of current UK clinical exercise services, focusing on exercise staff job titles, roles and qualifications across cardiovascular, respiratory, stroke, falls and cancer services. Methods Clinical exercise services were identified electronically between May 2020 and September 2020 using publicly available information from clinical commissioning groups, national health boards and published audit data. Data relating to staff job titles, roles, qualifications and exercise delivery were collected via electronic records and telephone/email contact with service providers. Results Data were obtained for 731 of 890 eligible clinical services (216 cardiac, 162 respiratory, 129 stroke, 117 falls, 107 cancer). Cardiac rehabilitation services provided both clinical (phase III) and community (phase IV) exercise interventions delivered by physiotherapists, exercise physiologists (exercise specific BSc/MSc) and exercise instructors (vocationally qualified with or without BSc/MSc). Respiratory, stroke and falls services provided a clinical exercise intervention only, mostly delivered by physiotherapists and occupational therapists. Cancer services provided a community exercise service only, delivered by vocationally qualified exercise instructors. Job titles of ‘exercise physiologists’ (n=115) bore little alignment to their qualifications, with a large heterogeneity across services. Conclusion In the UK, clinical exercise services job titles, roles and qualifications were inconsistent. Regulation of exercise job titles and roles is required to remove the current disparities in this area.