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Hopkins-Rosseel D.1,2, Dyck G.1, Hagan S.1, Roos R.3
1Queen's University, School of Rehabilitation Therapy, Kingston, Canada, 2Hotel Dieu Hospital, Cardiac Rehabilitation Centre, Kingston, Canada, 3WITS University, Department of Physiotherapy, Johannesburg, South Africa
Background: Cardiovascular diseases are the primary cause of death globally, causing 31% of all mortality (WHO,2015). Few would dispute the evidence supporting the importance of exercise in the primary and secondary prevention of chronic diseases. It has been well established that there is a linear relationship between physical activity and health status (Warburton, 2006). This relationship remains constant in elderly populations, as increased activity and exercise levels correlate with a decreased incidence of poor health and disability (Paterson, 2010), and 10-year absolute risk (Boon, 2014). A Cochrane review of the effectiveness of exercise-based cardiac rehabilitation concluded it significantly reduces hospital admissions and is effective in reducing cardiovascular mortality (Heran, 2011). In light of the evidence, healthcare professionals of many disciplines are being encouraged to incorporate exercise prescriptions into treatment plans for clinical populations. With appropriate risk stratification, supervision and prescription from qualified exercise personnel, exercise can be performed with a low risk of adverse events in even high risk clinical populations (Thomas et al., 2011). As health care has grown to emphasize the importance of exercise as an integral component of disease prevention and treatment, so have the number of professionals that claim exercise prescription for clinical populations within their scope of practice. This suggests that the minimum clinical competencies, and associated educational requirements, need to be defined.
Purpose: To determine if there are known, evidence-informed clinical competencies required to safely and effectively prescribe exercise for cardiovascular disease prevention and management.
Methods: A scoping review of the literature was performed using the Arksey et al. (2005) method;
Steps:
(1) Identify the research question,
(2) Identify the relevant studies,
(3) Determine and apply Inclusion/exclusion criteria,
(4) Chart the data and
(5) Summarize and report the data.
CINAHL, MEDLINE, and TRIP databases were searched for English publications from 2000-present, excluding articles focusing on nurses and physicians as the sole prescriber. and using the keywords: Exercise prescription, exercise, competence, clinical competence, qualifications, knowledge, skills, cardiovascular disease, and exercise professional. To supplement results, an extensive Google Scholar search was undertaken with the aid of expert knowledge to obtain the available published guidelines, standards and position/competence statements. This search was expanded by identifying key national guidelines and related articles cited within these documents.
Results: The initial search resulted in 44 papers, 23 of which contained sufficient information addressing professional qualifications and competence to analyze and categorize. To this was added the documentation of 16 national associations. Within these documents, thirteen key competences appeared in several, or all, of the published works. Educational and practicum requirements, as well as evaluation methods were also documented.
Conclusion(s): The existing documentation suggests there are some commonly occurring known exercise professional core competences for exercise prescription in chronic cardiovascular populations, yet there is limited research evidence supporting many of the elements of these core components with respect to mitigating patient risk or optimizing patient health, and associated functional outcomes.
Implications: There is a need for prospective studies to determine a minimal competency set for clinical professionals to optimize the safety and outcomes of exercise prescription for cardiovascular disease prevention and secondary prevention.
Funding acknowledgements: This was an unfunded project.
Topic: Cardiorespiratory
Ethics approval: No ethics approval was required by the Queen´s University Health Sciences Research Ethics Board (HSREB).
All authors, affiliations and abstracts have been published as submitted.
