The Role Of Accredited Exercise Physiologists In Providing Effective Medical Interventions And Improving Health Outcomes

Scope of Accredited Exercise Physiologists‘ Practice

The current assignment focuses upon the role of the accredited exercise physiologists (AEPs). The scopes of practice governing such practices have been further entailed over here. The AEPs provide effective medical interventions catering to the health requirements of a vast majority of population. The change implemented over here covers a comprehensive and holistic plan aimed at bringing about required lifestyle changes within an individual.

The interventions are mostly in the form of daily care exercises with an emphasis on bringing about a positive behavioural change. Some of the targets pathological conditions looked after by the AEPs are cardiopulmonary diseases, metabolic disorders, muscuskelatal disorders, neurological disorders among others. The assignment provides a detailed overview about the scope of AEP practices which further helps in meeting the health requirements of the support users. Further, implementing the scope of practice helps in maintaining the affectivity of the care services.

The scope of practices can be further divided into a number of points as mentioned below:

The AEP professionals need to screen the applied physical interventions in order to ensure that the safety concerns of the support service users are effectively maintained. In this respect, a clinical reasoning cycle may be applied for planning and designing of the care interventions. The clinical reasoning cycle forms a very important evidence based tool for the effective implementation of the AEP scope of practice. The clinical reasoning cycle may be divided into the following components such as analysing the patient situation.  As mentioned by Smart et al. (2016), such analysis helps in designing the effective care plan. Additionally, reviewing the current information of the patient along with gathering new and relevant information could be helpful. This further helps in expansion of the care plans and programmes. The process information helps in interpreting and relating to the effective interventions which could be implemented over here. The next step is the identification of the problem or issues which helps in focussing upon the definitive problem and arriving at a suitable alternative.

One of the most important aspects is the designing of effective goals which helps in provision of person centred approach to the support user. As commented by Soan et al. (2014), such measures places the patients at the centre of care and support services. Further selection of the action depends upon the availability of a majority of options and alternatives. Additionally, the outcomes need to be evaluated and reflected upon before implementing in the concerned scenario. This helps in planning of the suitable alternatives aimed towards the betterment of the support users. The AEP professional needs to undertake a screening process for implementing the correct exercises as per the requirement of the support users. The screening activities which need to be performed before implanting the physical exercises include jotting down medical history of the client. As commented by Cheema et al. (2014), inculcation of physical disabilities along with noting down for the presence of psychosocial complications of the support users helps in designing actual care plans meeting the care needs of the support users. Additionally, assessment of the competencies of the support users helps in designing the effective clinical interventions and physical exercises which can help in addressing the mobility issues of the support user. In this respect, accessing the functional competencies of the support users can help in planning suitable exercises for them. With respect to designing the care plan for fall patients care has to be taken not to include extensive workout sessions within the daily activity sessions of such people. Therefore, the care professional needs to inculcate light stretching exercises for restoring the mobility within such people. Additionally, the support users may be provided with motivational interview sessions in order to find out the different barriers and challenges faced for the implementation of the care plan.

Clinical Reasoning Cycle and Planning Effective Care Interventions

The second criteria within the AEP scope of practise are the measurement of mobility of the support users availing the physiotherapy programs. For this purpose the AEP professionals can use the movement screen app to screen and access the capacity of movement of the support users. The interventions are designed for use by exercise physiologists, fitness professionals and physiotherapists. The app puts forward a well designed questionnaire which helps in understanding the current activity patterns of the care users. The currently approved world health organization disability scores (WHO DAS) to analyse the current physical health attributes possessed by the support users.

The movement screening process helps in understanding the overall health risks possessed by an individual. The evaluation undertaken over here helps in providing a comprehensive care structure to the patients. It helps in conducting an overall risk profiling which helps in highlighting the joint movements which are ore restricted compared to the others. A score may be recorded for each of the nine movements which helps in analysing the risk patterns of an individual. As mentioned by Lederman et al. (2016) conducting such workshops helps in understanding the concern areas of the support users. Additionally, inculcation of effective technologies where a virtual and interactive interface is provided to the patient can be beneficial. The availability of such interfaces helps the fitness professionals to directly interact with the client.

On the contrary, as argued by  Naumann  et al. (2014), the success of the care plans and interventions depends upon the amount of skills and knowledge possessed by the care professional. Thus, the skills possessed by the professionals could be enhanced by focussing more upon the alternate measures. As commented by Cheema et al. (2014), inculcation of a number of alternate methods helps the care professional in enriching oneself in the wide and different ranges of techniques which could be applied over here. In this respect evidence based planning along with the implementation of light stretching exercises within the care plan can help in meeting the criteria of informed decision making and provision of autonomy to the service users. In this respect, a number of evidence based artefacts may be used for presentation of the exercise plans and programs. For the present concern the PICO model has been used to highlight the planning and intervention programs.

Factors	Methods and outcome
Patient , population, problem	82 patient experiencing injuries from fall were selected as participants for the randomized clinical trial.
Intervention factor	Implementation of kinetix personal health and fitness services within the daily care regimen of the patients
Comparison or intervention	Setting up of the fitness goals and measuring the progress of the patients by implementing  cardiovascular fitness and posture maintenance exercises
Outcome	The patient were  subjected to follow up along with motivational interview sessions in order to understand the improving in patient health

Table 1: PICO model for implementing kinetix health assessment

(Source:  Stanton et al. 2017)

AEP’s Screening Process and Designing Effective Goals

In the present context, the PICO model have been used which helps in assessment of the mobility patterns of individuals and community. The PICO model have been divided into a number of parameters such as accessing the problem situation of the patient, development of  suitable intervention strategies along with suggesting alternative exercises which can help in restoring the mobility patterns. The patients were also provided with motivational interview sessions in order to highlight the problem situation of the patient.

 In the first scope of practise kinetix Assessment approach have been applied for implementation of fitness plans and goals within the curriculum of an individual. The assessment could be divided into a number of following types such as the general fitness, body composition and posture assessment. The general fitness goals emphasizes upon the implementation of the cardio and endurance training within the daily care regimen of an individual,  which  helps in the restoring sufficient mobility within the concerned individuals (Stanton et al .2017). The body composition test helps in assessment of excess fat present within the body of an individual and the inculcation of sufficient exercises for reducing the fat content of the body (Naumann et al.   2014). The posture assessment is used for evaluating the body position using 13 different areas as per the New York Posture assessment. 

The Australian health care services are well connected with the rebatable exercise services. As per the guidelines mentioned within the Australian health care context, patient with chronic illnesses are referred to the allied health professionals by the general medicine practitioners. The plan allows a patient to have a minimum of 5 rebetable consultations with an AEP professional. In this context, the government pays the allied health professional $ 50 per visit. As commented by Lawrence & Hobson-Powell (2015), the Australian as well as the worldwide system has realised the importance of exercises and allied medical interventions in patient care.

In the present context, the development of the organization aimed towards the promotion and health advancement of by and large the Australian population has been discussed. Thus, the main aim of the Exercise Is Medicine Australia focuses is the inculcation of allied health professionals within the mainstream care and management process. The EIM further emphasises upon the incorporation of exercises as a compulsory part and processes of the normal care delivery process. It further builds upon the referral system for provision of support services along with restoration of motility in the ones with movement impairments such as rheumatoid arthritis and gout. As mentioned by Naumann et al.  (2014), one of the important parameters over here is achievement of a positive behaviour change within the support service users through motivational interviewing. The action could be further perceived with the implementation of an evidences based model which conducts a systematic review of exercises and its benefits in adult health programs

Measurement of Mobility and Risk Profiling of Patients

Reason for program implementation	For restoring mobility within the target population group
Number of participants enrolled	Around 125 participants were contacted through door to door advertisements by local hospitals along with sending e-mails.
Recruitment strategies	In order to involve maximum number of  participants templates and leaflets detailing the additional benefits provided with the health assessment programs  were distributed to the target group of consumers
Number of participants actually completing the program	However, 90 participants actually turned up for the exercise programs.
Extent of training	The staffs were trained in the relatable areas of functional movement assessment by implementing of the assessment parameters and exercises within the daily schedule of the support care professionals.

Table 2: CHA checklist of systematic review

(Source: Stanton et al. 2017)

The functional movement assessment could be used for evaluating the level of right and left side movements of the clients. The assessment is done based upon a number of tests such as hurdle step, inline lunge, shoulder mobility, impingement clearing test.  The scores are further divided into raw score and final score. The lowest score recorded in the raw score parameter is   used for arriving at the final score. For e.g. a person recording a three on the right and four on the left would be given a final score of three. The compiled data is used for further health assessment and implementation of effective measures.

Application of measures such as rehab lab

The rehab lab is web based technology used for designing and customization of rehabilitation handouts of high professional standards. As commented by Naumann et al.   (2014), the implementation of the same helps in muscoskeletal strengthening programs. The rehab lab helps in the designing of tailor made healthcare policies and interventions for individuals availing the training program.

Health education helps in providing sufficient amount of awareness regarding diseases and the conditions and factors contributing towards the development of the same. In this respect, a health care professional has to face a number of challenges in the provision of optimum care services to the ones receiving the care services. As commented by Elcock & Lewis (2016), some of the cultural paradoxes faced by an individual and within communities have severe implications on the lifestyle habits and health approaches of an individual.  However, as argued by Garfield (2017), some of the social determinants play a crucial role in the education and health literacy of individuals and community.

 In this respect, the social determinants which can have profound effect on the health literacy and habits of an individual are possessing sufficient amount of education along with economic stability. It has been found that many individuals do not want to consult a healthcare professional as they are not aware of their present conditions of health.  As mentioned by Kane et al. (2016), economic concerns often prevent an individual from availing of the health care services.As mentioned  by Elcock & Lewis (2016), such referral systems also helps in spreading awareness regrading health issues and practices  which helps in maintaining good health of an individual.

In this context, organising workshops educating the masses about the health benefits of exercises and specific diets for catering to the complex health concerns of the ones suffering from chronic illnesses such as diabetes could be helpful. The workshops help in providing sufficient information about eating right and balancing the blood sugar level. As commented by Brodie  et al. (2017), implementation of evidence based tools  for the promulgation of the health objectives of the chosen or specific group of population needs to be highlighted here. Additionally, a number of restrictions could be followed for the maintaining exaggeration of the symptoms of diabetes mellitus. Some of the precautionary measures are lowering the intake of sugarated drinks or beverages, limiting the intake of alcohol along could help controlling important parameters such as obesity, which have been found to possess direct relation with diabetes (Freeman  et al. 2013).

Incorporating Alternate Measures for Enhanced Care Practices

In this respect, a suitable intervention method needs to be provided to the ones who are at the risk of development of long term or chronic disease conditions. Thus, some of the long terms diseases which could be mentioned over here are diabetes, rheumatoid arthritis. Both the diseases often affect the motor skills and competencies possessed by an individual. However as argued by Tiedemann  et al.(2015), the comprehensive care plan differs for both also depending upon the severity and the level of awareness professed by an individual regarding the same. The rheumatoid arthritis arises due to the triggering of autoimmune reactions within the body of an individual. This develops in severe gout often impairing the movement capabilities in an individual. As mentioned by Freeman  et al.(2013), chronic and unmanaged diabetes also results in severe consequences such as leg amputations.  Therefore, the AEP professionals need to be trained suitably in the areas of comprehensive management and care.

Factors	Methods and results
Population	A target population group of 85 participants had been taken for the present study
Intervention	Community development and training programs for inculcation of light walking and stretching exercises at the centre of the care management
Background	The participants had been suffering from long term and chronic disease conditions such as diabetes and arthritis which has resulted in severe locomotors impairments within the population. Moreover subjecting them to additional levels of dependency and care concerns, thus disturbing the normal course of life.
Outcome	The measures have been beneficial in bringing about positive health results by reducing the dependency within the target population on different aides for moving around normally.
Study design	The study design is qualitative in nature where diabetes information sheet are provided to the patients highlighting the importance of special dietary programs and further data collected for evaluation of the improvements within the health standards of the community.
Other	The participants have been provided with effective feedbacks which help in the incorporation of self-managerial skills within the target population group.

Table 3: PIBOSO evidence based model

(Source: Brodie et al. 2017)

The  model implemented over here helps in the management of long term and chronic conditions within an individual. In this context, a target population group with chronic conditions such as diabetes and arthritis has been taken into consideration. The inculcation of community development and training programs have been found to be instrumental in making exercises a compulsory part of the  daily activities of the individual. Additionally, implementation of the diabetes information sheet can help in keeping a tab over the regular health condition of the patient (Elcock & Lewis, 2017). As commented by Tiedemann  et al (2015), the organising of such community development programs puts emphasis  upon patient centred approaches and places the  patients at the centre of the care giving process. This helps in providing empowerment to the support users alongside implementation of self managerial skills for controlling the rate of diabetes. This also exposes the AEP care professionals to diverse treatment and care giving areas which further helps them in enhancing the personal skills.

A clinically accepted prescription and standards needs to be designed for the ones undergoing long term care and treatment process. The clinical prescription helps in maintaining the requisites of the medical procedures which are aimed towards the provision of optimum care and support services to the ones in need of long term care and management. However, for the purpose of designing a clinical exercise prescription for the ones in need of chronic care management an effective collaboration is needed between a numbers of health care channels. As argued by Sivan et al. (2014), for the treatment and management of diabetes and rheumatoid arthritis exercises alone cannot do the needful. Therefore, involvement from a multiple channels is requires along with sufficient supervision from general medical practitioners. Designing a clinical exercise prescription requires high degrees of specialisation for dealing with multidisciplinary domains such as cardio respiratory, muscoskeletal and neurological conditions.

The Role of Exercise Is Medicine Australia in Promoting Health Advancement

The designing of effective frameworks such as the Vincent scapattura framework helps to differentiate the exercises into acute, subacute, chronic, stable and unstable conditions. The designing of the prescription act as precautionary measures, which  further help the patients in self-managing their conditions (Cheema et al. 2017). An effective strategy could be designed highlighting the importance of a number of exercises and types which could help in meeting the health requirements of the fitness enthusiast. The framework involves a number of different practices and exercises which could help in provision of sufficient flexibility and agility to the concerned individuals. Some of the effective exercises which could be implemented over here for addressing long term care needs of the patients are treadmill walking, dumbbell and biceps training and running on a elliptical walker. These exercises could be undertaken simultaneously or repeated one after another depending upon the requirement and the instructions of the fitness coach (Brooks et al 2017). As commented by Tiedemann  et al (2014), following up the exercises one after the another can help in the improvement of some of the long term conditions of the patients such as  pain in the joints and the tennis  elbow.

Factors	Methods and outcome
Patient, problem	The ones suffering from diabetes and chronic arthritis condition have developed  severe disabilities  or chronic amputations
Intervention	Designing of clinical prescription can help in maintaining an effective supervision on diabetes management and care along with implementing effective exercise sessions
Comparison or intervention	Regular health checkups may also help in controlling the rate of diabetes and triggering of autoimmune conditions such as rheumatoid arthritis.
Outcome	Effective control measures can be implemented which can help in regulating the progression of the diseases.

Table 4: PICO model

(Source: Brooks et al. 2017) 

The provision of exercise based rehabilitation along with sufficient counselling can help in relieving the acute stage of movement restriction or impairment. The rehabilitation program focuses upon implementation of community development programs along with inculcation of light exercises within the care plan of the individuals and community (Freeman et al. 2013). However, for the implementation of the rehabilitation programs community support and participation from a number of health care channels is required. As commented by Beauchamp  et al. ( 2017),initiatives and support programs from state and federal level governments such as the EIM guidelines helps  in keeping the patients at the centre of the care services.

An evidence based tool which could be implemented over here for the rehabilitation of the patients undergoing long term care plan and treatment is the Lumbar rehab framework (Reddy et al. 2014). The frame work can be divided into a number of outcomes such as accessing the patient environment, setting of strategies for provision of effective care and treatment plan to the support users. The rehab program could be divided into a number of light stretching exercises such as quadriceps, calves which helps in restoring the movement of the fitness program undertaker. This could be followed up with an effective feedback or evaluation where sufficient details are collected from the fitness support user regrading the methods and the attached benefits. Some of the chronic and long term conditions such as diabetes and rheumatoid arthritis also affect the daily movement patterns of an individual (Compostella et al. 2017).  This results in increased dependence on community services and health care communities. Thus, rendering one useless of self managing daily set of activities can often result in the triggering of mental depression within an individual (Stanton et al. 2017). Therefore, implementation of effective counselling sessions can help in provision of motivation to the programs.

The AEPs are professionally trained individuals looking after the care concern of the support uses with varied levels of health impairments. As mentioned by Salisbury et al. (2015), the role of the AEPs is to properly implement exercise, behaviour modification programs by bringing about positive lifestyle changes. In this context, there is a need to follow some of the important codes of practise and regulations governing physiology and care. Thus, extending the codes of practise through incorporation of extended training programs or certification via adjunct therapies may be helpful. However as argued by Prüss-Üstün & Neira (2016), such extended services are seen as a violation of the Exercise and Sports Science Australia (ESSA). The AEP scope of practise needs to be in accordance of the association’s national code of professional conduct and & ethical practise. As mentioned by Behm  et al. (2014), the standards through legislation and ethical law also needs to be respected. The ESSA guidelines for professional development are based on requirements of national standards for registration of allied health professionals.

Conclusion

The current assignment focuses on the concept of AEP scope of health practices for looking after the care needs or concerns of one with certain physical impairments. The AEP scope of practices consists of a comprehensive care plan which needs to be incorporated in order to cater to individual care needs. However, a number of challenges are faced in the concurrent area due to the lack of training and sufficient support from the end of the support users. The assignment emphasises upon each and every goals which had been out forward in the scope of practices. However for the effective implementation of the guidelines certain policies and effective guidelines need to be followed.  In the case of violation of the guidelines legal obligations may be binding on the health care professionals. Some of the measures which could have been implemented by the exercise physiologists include organising community development programs   along with maintaining the optimum standards of the care services. 

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