17/02/2015 Katie Williams Senior Industry Development Officer Exercise & Sports Science Australia

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1 17/02/2015 Katie Williams Senior Industry Development Officer Exercise & Sports Science Australia Re: Stakeholder feedback on AWLC401 Certificate IV in Weight Management. To Whom It May Concern: Thank you for providing Exercise & Sports Science Australia (ESSA) with the opportunity to submit feedback regarding the Certificate IV in Weight Management. ESSA is a professional association (with over 4,500 members) representing university qualified Exercise Scientists, Sports Scientists and Accredited Exercise Physiologists (AEPs). As an industry stakeholder, ESSA has several concerns we would like to table regarding the course content of the Certificate IV in Weight Management. 1. Industry need is currently met by existing qualified professionals The Australian Qualifications Framework (AQF) (2 nd edition, 2013) 3 states: Any organisation may put forward a request for inclusion of a new qualification type, in writing, to the AQF Council following comprehensive consultation with and support from the relevant industry, professional, provider and government stakeholders The AQF Council will make a decision about the addition of a new qualification type based on robust evidence that there is a sound educational reason for its addition and the new qualification type: does not duplicate an existing AQF qualification type, and meets a defined industry, professional or community need ESSA does not believe that there is a defined industry, professional or community need for a Certificate IV in Weight Management. The Exercise Scientist profession already provides weight management interventions for low-moderate risk individuals, as well as improvements in health and disease prevention in the general population. The AEP profession provides weight management and health interventions targeted for individuals at high risk of, or with existing, chronic disease and injury. These interventions are frequently delivered as part of a collaborative approach within a multidisciplinary health care team setting with a specialised focus on physical activity advice, behavioural change and exercise prescription. Accredited Practicing Dietitians and Nutritionists also provide specialist dietary advice as part of weight management services. Evidently, this Certificate does not offer any additional or new skills and knowledge to what is already available in the marketplace. ESSA contends that greater utilisation of the Exercise Science and AEP professions would meet industry, professional and community need for weight management professional services. This is highlighted by the fact that there are currently 36 universities within Australia offering, at minimum, one course in exercise and sports science, equating to ~2250 graduates per year. Courses are based in every state and territory within Australia and produce professionals in 1

2 Sports Science, Exercise Physiology and Exercise Science. 2. Inappropriate pre-requisite course entry requirements The mandatory pre-requisite requirements for undertaking this Certificate is a minimum of 10 years schooling or equivalent. Given that some students may not have completed grade 11 or 12 level science studies, ESSA does not support the use of terminology such as advanced and specialised knowledge and skills throughout the course description. Grade 10 school leavers lack an understanding of many of the basic, yet fundamental, concepts of science (acquired in senior level studies), that would be necessary grounds to build an advanced/specialised level of scientific knowledge. This is highlighted by the fact that exercise and sports science graduates working within the weight management industry have a background of at least 3 years of full time university study, of which a significant proportion is allocated to scientific study units. 3. Inadequate time allocated to course delivery and inappropriate graduate outcomes The vast amount of content described in this course outline cannot be covered adequately within the allocated total nominal hours of delivery for this course (490 hours). Additionally, it is unrealistic to expect Certificate level course delivery can develop advanced/specialised knowledge as claimed in this course outline, due to the limited time allocated to course delivery. For example, AWLPHY404A: Apply anatomy and physiology principles in a weight loss context has been allocated 70 nominal hours of study. Professionals providing personalised weight management services must account for the multiple anatomical and physiological considerations when delivering any lifestyle, dietary or physical activity advice. This will ensure that the client is not exposed to undue risk or adverse health outcomes attributed to an inappropriately tailored weight loss intervention. This is further complicated by the fact that overweight or obese individuals are likely to have underlying chronic health conditions which may sometimes be undiagnosed for a period of time. Specifically, research on the frequency of various chronic diseases across the Australian population, have identified that of individuals aged years, 15% had two or more comorbidities, increasing to 39.2% for those over the age of 60 years 2. Arthritis, mental health conditions, respiratory disease, diabetes, cardiovascular disease and osteoporosis were the most common multi-morbidities in older Australians 2. Obviously, those individuals seeking weight management services are at further increased risk of being part of this population with health comorbidities (being overweight/obese is a risk factor for many of these conditions). Evidently, health professionals must not only be aware of these many complex interacting factors when providing professional advice to these patients, but must also be able to effectively triage which of the chronic diseases need to be prioritised when treating the client, in consultation with the referring physician - a skill that required considerable knowledge and experience. 2

3 Weight Management Consultants must accept the professional liability involved with accepting a referral for an individual with a diagnosed medical condition. ESSA contends that the Certificate does not provide adequate knowledge, skills or training in pathophysiology (and other required areas of study) for a Weight Management Consultant to accept medico-legal responsibility for individuals at moderate-high risk of, or with existing, chronic health condition/s, and thus places patients at risk. 4. Effective controls must be implemented to ensure patient screening, compliance with professional scope of practice and appropriate patient referral ESSA acknowledges that effort has been made to refer to professional boundaries, appropriate referral and screening throughout this course outline. However, we request that these concepts are specifically and explicitly stated within the 'Unit descriptor', 'Application of the unit and Assessment requirements sections within each unit. This will ensure the scope and limitations for the entire unit encompass these crucial principles. Patient screening, professional boundaries and appropriate referral must be central to all Certificate IV units, this need is warranted by the following reasons: - ESSA regularly receives correspondence from our members, industry colleagues and legal sources about certificate trained professionals working outside their professional boundaries within the health and fitness sectors. Expanding content about specific target groups or types of exercise and weight management advice, without due diligence of professional boundaries, will exacerbate this issue and potentially endanger at risk clients and the public s health. - The Certificate IV in Weight Management is not an Allied Health or Clinical qualification. Thus, graduates from this Certificate should not be responsible for the health management or treatment of clients with diagnosed health conditions. This is the role of medical and allied health professionals, such as AEPs. - The Medical Board of Practice states that a medical practitioner must ensure that the person to whom you delegate, refer or handover has the qualifications, experience, knowledge and skills to provide the care required. - The RACGP Guidelines for Preventive Practice (8 th Edition) frequently refers to the use of exercise physiologists for chronic disease and physical activity interventions (not weight management consultants) 1. Within the context of a Weight Management Consultant providing exercise advice, ESSA would like to see more education around consistent application of the industry endorsed adult preexercise screening system (see Appendix 1) which was formed through joint collaboration of ESSA, Fitness Australia and Sports Medicine Australia. Additionally, more education content is required on exercising professional judgement when deciding when to refer a client who presents with risk factors. 5. Reference to working with allied health professionals. Frequently, this course outline documents the ability of students to refer to, or work with, medical practitioners. ESSA requests these statements are expanded to also include or an 3

4 appropriate allied health professional. This also needs to be included within the Employability Skills section on Teamwork. ESSA does not support the direct referral of clients from medical professionals to a weight management consultant for an exercise or lifestyle intervention. A typical referral by a medical practitioner for an exercise program requires a comprehensive assessment to be completed including a risk assessment, subjective and objective assessment (including psychosocial factors), compiling and understanding the implications of a person s medical history for exercise programming (including medication interactions) and subsequently designing an appropriate exercise program to elicit specific clinical outcomes. Weight Management Consultants do not have the knowledge to risk assess or develop exercise programs for individuals with medical conditions or triage clients with multiple conditions. Any reference to collaborating directly with medical professionals with respect to exercise programming should be removed from this unit, as this is the role of an allied health professional. 6. Inappropriate inclusion of moderate-high risk clients within the Range Statement ESSA does not support the inclusion of patients with special needs, chronic disease/injury, eating disorders or antenatal/postnatal patients within the scope of practice for Certificate trained Weight Management Consultants. ESSA s justification for this position with respect to chronic disease/injury is outlined in the discussion points above. Multiple factors determine risk level in antenatal/postnatal patients, whereby women who have a pre-existing gynaecological or medical condition, or present with lifestyle risk factors (i.e. overweight/obese, smoking, lack of physical activity, poor nutrition) require expert care to safely engage in an exercise program. Furthermore, the physiological, vascular and musculoskeletal changes that occur throughout pregnancy require an in-depth understanding of anatomy and physiology to precede learning. ESSA supports initial allied health or medical screening and assessment in pregnancy. ESSA advocates that individuals with eating disorders seek advice from appropriate medical and allied health professionals (such as a Psychologist, Dietitian or AEP), to ensure these patients receive appropriate care. ESSA would also like to note that it may be unsafe for Weight Management Consultants to deliver advice to individuals on medication for their health condition/s, for the following reasons: - The complex interplay of a patient s biology and physiology with pharmacotherapy may result in signs and symptoms exacerbated with physical activity or dietary advice and changes (e.g. fluctuating blood glucose levels, chronotropic incompetence) which must be accounted for within any professional advice. - Individuals requiring medication for the management of their health condition are likely to have multiple comorbidities and risk factors which need to be accounted for in weight management advice. 4

5 ESSA does not support this Certificate providing significant focus on disorders of muscular, nervous, skeletal, circulatory, respiratory, lymphatic systems. Rather, focus should be redirected to adequate screening, recognising appearance of these conditions/symptoms and then referring to a medical practitioner or allied health professional. 7. Inappropriate and misleading use of exercise prescription terminology ESSA does not support use of terminology such as exercise prescription and exercise programming throughout the course outline. This terminology is misleading and inappropriate as these graduates will not be equipped with the skills or knowledge to safely and effectively perform the aforementioned tasks for this population. For example, the following knowledge and skills required for exercise programming, were not described within the course outline: - Principles of overtraining, progressive overload, training specificity - Components of the training session (repetitions, sets, rest, intensity etc.) - Precautions and Contraindications - Principles of Cardiorespiratory, Resistance and Flexibility training 8. ESSA requests removal of all references to 'psychology' and 'biopsychology' Certificate IV qualifications do not have foundational studies in psychosocial sciences, thus ESSA contends that principles of psychology is beyond the scope of student understanding and application. The unit needs to be modified to ensure content reflects the limits of the foundational studies (particularly given that some students may have not completed grade 11 or 12 school level science). It is suggested that any reference to psychology is removed, with focus redirected to motivational techniques or goal setting activities as a more appropriate alternative. 9. Conforming with the job description of a Weight Loss Consultant The ANZSCO description of a Weight Loss Consultant refers to "assisting clients with advice and practical solutions for losing body fat". Many of the elements of this course extend beyond this actual job description of Weight loss consultant. This may equip students with a false knowledge of their professional scope of practice, increasing potential of working beyond professional boundaries and exposing themselves to risk of litigation, or worse still, resulting in adverse health outcomes for their clients. 10. ESSA requests including Exercise Scientist and Sports Scientist professionals within the 'Range statement'. Exercise Scientists are university trained professionals specialising in the design, implementation and evaluation of exercise and physical activity for healthy people and those individuals with low-moderate risk health factors. Sports Scientists are university trained professionals skilled in assisting individual athletes and teams to improve their sporting performance through the use of scientific knowledge, methods and applications in the areas of physiology, biomechanics, psychology and motor control and development. Both of these professionals are appropriate sources of referral for a Weight Management Consultant depending on the patient s needs and goals. 5

6 ESSA also requests consistent use of terminology when referring to Accredited Exercise Physiologists (some Range Statements only referred to Exercise Physiologists ). ESSA welcomes the opportunity to provide additional feedback to ensure that the most appropriate course is delivered to meet the health needs of Australians. Please contact if you require additional information. Kind Regards, Katie Williams Senior Industry Development Officer Exercise & Sports Science Australia Anita Hobson-Powell Executive Officer Exercise & Sports Science Australia References 1. The Royal Australian College General Practitioners, 2013, Guidelines for Preventive Activities in General Practice, 8 th Edition, Accessed online 16/02/ ISBN Taylor C, Ahn D, Winkleby M, Neighborhood and individual socioeconomic determinants of hospitalization. American Journal of Preventive Medicine, (2) p Australian Qualifications Framework 2 nd edition, 2013, Accessed online 16/02/ ISBN

7 Exercise & Sports Science Australia Exercise & Sports Science Australia (ESSA) is a professional organisation which is committed to establishing, promoting and defending the career paths of university trained exercise and sports science practitioners. ESSA s vision is to achieve member excellence in exercise and sports science that will enrich the health and performance of every Australian. As the peak professional body for exercise and sports science in Australia, ESSA s mission is to empower our members by providing strategic leadership in exercise and sports science through advocacy, support of professional networks and the promotion of excellence in education, research and professional practice. ESSA Members Accredited Exercise Physiologists AEPs are federally recognised allied health professionals that specialise in clinical exercise interventions for patients with existing chronic and complex medical conditions or injuries, or those at high-risk of developing these. These interventions are provided by exercise delivery including health and physical activity education, advice and support, and lifestyle modification with a strong focus on achieving behaviour change with the aim of optimising physical function, health and wellness. As part of a multidisciplinary team, AEPs work with clients with a range of medical conditions including cancer, diabetes, cardiovascular disease, mental illness, pulmonary disease, osteoarthritis and obesity. Exercise scientists Exercise Scientists hold an undergraduate degree in the field of exercise and sports science. They specialise in the design, implementation and evaluation of exercise and physical activity for healthy people. They provide programs for improving general health, the prevention of chronic diseases, health promotion and enhanced sports performance. Exercise scientists work in hospitals, community health units, workplaces, gymnasiums and in education. Sports Scientists Sports scientists hold, at minimum, an undergraduate honours degree in the field of exercise and sports science. Many sports scientists have a doctorate and specialise in an area of performance management. They help individual athletes and teams to improve their sporting performance through the use of scientific knowledge, methods and applications in the areas of physiology; biomechanics; psychology; and motor control and motor development. They evaluate research, and they advise on the technical and practical aspects of training, injury prevention, technique, nutritional supplements, performance and recovery practices. Sports scientists work at all levels of sport. 7

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