2014 Accredited Exercise Physiologist (AEP) Application Form

Transcription

1 2014 Accredited Exercise Physiologist (AEP) Application Form Only graduates who have completed a NUCAP (National University Course Accreditation Program) accredited exercise physiology course within the last 2 years are eligible to apply for exercise physiology accreditation. For a full list of NUCAP accredited courses please refer to universities/accredited NUCAP courses /full accreditation. If you have not completed a NUCAP accredited exercise physiology course within the last 2 years you are not eligible for exercise physiology accreditation. This application form is relevant for applicants applying in Please read this form in conjunction with the 2014 Accredited Exercise Physiologist application guide. General Please note the following requirements in order for your application to be assessed utilising this form: You must be a current exercise science/full member of Exercise & Sports Science Australia. It is a prerequisite for accreditation as an accredited exercise physiologist (AEP) that the candidate has a degree from the field of exercise and sports science, has met all criteria and has become a current exercise science/full member of ESSA. An exercise science/full membership application may accompany this application. The exercise science/full membership application will be assessed before the AEP application. ESSA requires accredited exercise physiologists and sports scientists to maintain their accreditation through continuing professional development (CPD). 20 CPD points per calendar year (1 January 31 December) based on ESSA s CPD guidelines is required by all accredited exercise physiologists/accredited sports scientists. The only exceptions to this requirement are in the calendar year of first obtaining accreditation where there are no CPD requirements, or if accreditation is suspended in which case separate CPD requirements apply. You must have completed a NUCAP (National University Course Accreditation Program) accredited exercise physiology course within the last 2 years. If this does not apply to you, unfortunately you are not eligible to apply. You must provide evidence of a minimum of 500 hours of practicum, meeting all practicum requirements. Applications will not be accepted by fax. Do not bind applications or provide the application in plastic sleeves/folders. Please allow 30 working days (from the date your complete application is received) for your application to be assessed and processed. ESSA assesses applications in order of arrival to the National Office. No applications will be fast-tracked, or assessed ahead of other applications. If further information is required to fully assess your application you will be provided the opportunity to submit further information within 1 month. An additional 30 working days will apply for your application to be re-assessed upon submission of the requested information. If the information is not received within 1 month the application will be deemed declined. A charge of $55.00 applies if your application is declined or if the request for further information is outstanding for more than 1 month. 1

2 Please refer to the following table when completing your application to ensure your application is complete upon submission. ESSA will assess your application using this page. BEFORE SUBMITTING THIS APPLICATION FORM PLEASE READ AND COMPLETE THE FOLLOWING POINTS Are you a current exercise science member? Yes proceed with this form. No Complete the exercise science/full membership application form this application form can be downloaded from the ESSA website. Application page reference & attachments Tick when completed ES app with this AEP application 1. Complete personal details (Section A). Page 3 2. Complete payment details (Section B). Include accreditation fee payment of $ including GST. Either complete the credit card details or attach a cheque or money order made payable to Exercise & Sports Science Australia. Please note: credit card payments incur a merchant fee of 1.5% of the quoted fees. Please also ensure your exercise science/full membership is current. If not, you are able to renew online or contact the ESSA National Office. Page 5 3. Complete professional declarations (Section C). Page 5 4. List university qualifications achieved (Section D). Page 6 5. Provide official and final academic transcript/s. Copies must be signed and authenticated by a Justice of the Peace or notary. Provide a letter of university course completion if required. ATTACH TO APPLICATION 6. Provide current resume. ATTACH TO APPLICATION 7. Supply evidence for first aid (HLTFA311A First Aid or HLTAID003 Provide First Aid) and CPR (HLTCPR211A - Perform CPR or HLTAID001 Provide Cardiopulmonary Resuscitation). Please ensure that your first aid and CPR statement of attainment/s are valid for at least 45 days on submission of your application. 8. Practicum Summary Table (Section E) Complete the practicum summary table and total your hours for each category. ATTACH Statement/s of attainment TO APPLICATION Page 6 9. Complete statutory declaration (Section F). Page Practicum evidence ( Word versions of the following documents are available on the Application webpage) Page 8 i) Complete the clinical practicum reference form for apparently healthy practicum. Page 10 attach this to the apparently healthy logbook ii) Complete the clinical practicum reference form for cardiopulmonary/metabolic practicum. iii) Complete the clinical practicum reference form for musculoskeletal/neurological/neuromuscular practicum. iv) Complete the clinical practicum reference form for other clinical health delivery practicum. vi) Attach Logbooks. Examples of how to complete the logbooks can be found in the 2014 accredited exercise physiologist application guide. Word versions are available on the Application webpage Page 11 attach this to the cardiopulmonary/metabolic logbook Page 12 attach this to the musculoskeletal/neurological/ neuromuscular logbook Page 13 attach this to the other clinical health delivery logbook (if required) Page 9 2

3 Accredited Exercise Physiologist Application Form only applicants who have completed a NUCAP accredited exercise physiology course within the last 2 years are eligible to apply Section A Personal details Title Mr Given Names John Surname Smith smiths@gmail.com DOB 30/09/1986 *This is required for your website login Are you of Aboriginal or Torres Strait Islander origin? Yes No How did you find out about ESSA AEP accreditation? ESSA website Colleague Employer University Other Postal address Address 1 Parwood Road Town/Suburb Brisbane State QLD Postcode 4228 Phone Fax Work address and employment information Address Smyths Gymnasium Town/Suburb State Postcode Phone Mobile Fax Current employment Trainer Previous position/title Swimming Coach Please indicate your primary, and if applicable your secondary, work sector by placing a 1 (for primary area of employment) and 2 (for secondary area of employment if applicable) in the boxes provided: Federal government organisation Research/education institution Sporting club/institution State government organisation Fitness club/institution Health care organisation Hospital Mining Private company Sporting club/institution Workers compensation agency Student Not currently working On leave 3

4 Please indicate your primary, and if applicable your secondary, area of employment by placing a 1 (for primary area of employment) and 2 (for secondary area of employment if applicable) in the boxes provided: Administration/project officer Aged care Chronic disease management Chronic disease prevention Clinical assessments & screening Coaching & athlete development Community health/health promotion Education Fitness industry Hospital Management Occupational health & assessment Rehabilitation case management Rehabilitation service provider Sports science testing Strength & conditioning Workplace health or corporate health Please indicate your primary, and if applicable your secondary, specialty by placing a 1 (for primary area of employment) and 2 (for secondary area of employment if applicable) in the boxes provided: Paediatrics Musculoskeletal Cardiac Metabolic Neurologic Cancer Primary prevention Mental health Ergonomics Sport enhancement Older adults Disability services Testing/screening Other Please indicate languages you are fluent in by placing a tick in the boxes provided: English Greek Cantonese Arabic Vietnamese Italian German Mandarin Spanish Tagalog Croatian Polish Maltese Turkish Netherlandic French Japanese Privacy Consent I acknowledge that ESSA is obliged to observe the strict privacy rules in the Privacy Act (2012) and that for ESSA to support its accredited members, ESSA sometimes needs to provide contact details about me to people who are accessing services and/or providing funded health services. By my taking membership of ESSA, I consent for my work details, including my full name, business company or trading name, address and place of business and contact details to be disclosed on the ESSA website search function, and for those details to be provided to the National Health Services Directory, Medicare Australia, Department of Veterans Affairs, WorkCover authorities and health funds. I also give my consent for ESSA to confirm my accreditation details with the above bodies if needed. 4

5 Section B Payment details Cheque or money order for $ made payable to Exercise & Sports Science Australia is attached OR Card type (Please select) VISA Mastercard Cardholder s name Expiry of card / month/year) Card number I authorise Exercise & Sports Science Australia to debit my credit card for the amount of $ plus a 1.5% merchant fee. Yes No By submitting this application I acknowledge that Exercise & Sports Science Australia will debit my credit card for the amount of $55.00 plus a 1.5% merchant fee (non-refundable) should the application be declined or if the request for further information is outstanding for more than 1 month. Signature J Smith Date 1 May 2013 Section C - Professional declarations Declaration I certify that the information supplied on and with this form, and any additional information supplied, is true and correct. J Smith 1 May 2013 Applicant s signature Date If accepted by the association as an accredited exercise physiologist I agree to abide by the ESSA Code of Professional Conduct and Ethical Practice. J Smith 1 May 2013 Applicant s signature Date If accepted by the association as an accredited exercise physiologist I agree to receive information and updates about ESSA and the industry and to have my services as an AEP searchable on the ESSA website. (note: you can change this at any time once you become accredited by logging into your profile in the members area of the website and removing yourself from the search function) J Smith 1 May 2013 Applicant s signature Date 5

6 Section D University qualifications achieved I have completed the following university qualifications: Degree Code University Bachelor of Human Movement HM286 University of Australia 2012 Master in Clinical Exercise Physiology MR356 University of Australia 2013 Year completed Total years full time equivalent study 4 Attach a certified copy of your final academic transcript (showing evidence of course completion) 6

7 OR 7

8 Attach a copy of your current resume 8

9 Attach a copy of your First Aid and CPR statements of attainment. (HLTFA311A First Aid or HLTAID003 Provide First Aid) and CPR (HLTCPR211A - Perform CPR or HLTAID001) 9

10 JOHN SMITH 10

11 Section E Practicum summary table Please complete the following table to indicate your practicum placements and hours undertaken. Please total your hours for each practicum category. Practicum site Apparently healthy practicum (Minimum 140 hours) Cardiopulmonary/ metabolic practicum (Minimum 140 hours) Musculoskeletal/ neurological/neuromuscular practicum (Minimum 140 hours) Other clinical health delivery practicum (Maximum 80 hours) 1 Average Joe s Gymnasium Malibu Private Hospital Exercise for Rehab Clinic The Wellness Centre 44 5 Community Cardiac Rehab Total 193 healthy clinical

12 Section F Statutory declaration Commonwealth of Australia STATUTORY DECLARATION Statutory Declarations Act Insert the name, address and occupation of person making the declaration I, 1 John Recent Graduate (name), of 12 Greenway Drive, Hamilton, QLD (address) And of Trainer (occupation) make the following declaration under the Statutory Declarations Act 1959: 2 Set out matter declared to in numbered paragraphs 2 The attached documentation accurately indicates how the criteria for necessary and sufficient knowledge, skills and competencies are met in order to fulfil application requirements for accreditation as an accredited exercise physiologist with Exercise & Sports Science Australia. I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular. 3 Signature of person making the declaration 3 John R Graduate 4 Place 5 Day 6 Month and year Declared at 4 University of Brisbane on 5 7th of 6 May 2013 Before me, 7 Signature of person before whom the declaration is made 7 Jane Green 8 Full name, qualification and address of person before whom the declaration is made (in printed letters) 8 (name) Jane Green (qualification) PhD - Full time Tertiary Educator of (address) 1 University Drive, Brisbane, QLD 4000 Note 1 A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment for a term of 4 years see section 11 of the Statutory Declarations Act Note 2 Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959 see section 5A of the Statutory Declarations Act

13 Competent Not Competent Not able to comment Apparently healthy clinical practicum reference form iii) Clinical Practicum Reference Forms Reference for: John R Graduate Dear Colleague, Apparently Healthy Practicum The above applicant has applied for specialist accreditation by Exercise & Sports Science Australia (ESSA) as an exercise physiologist (AEP). Requirements of this accreditation include a minimum of 140 hours practicum with apparently healthy clients. Could you please complete the following form based on your experience with the above applicant: Skills and Experience In the following table, please provide evidence of the practicum you have gained in the relevant area of apparently healthy clients: (expand boxes where necessary) Breakdown of Practicum hours (a minimum total of 140 hours) Total hours and dates* Evidence of specific roles and duties completed Site / Location Name and signature of referee Minimum of 60% (at least 84 hours) of face to face delivery i.e. Individualised/group delivery/instruction of an exercise program. *Testing/assessments without intent for prescription cannot be counted Maximum of 35% (up to 49 hours) for preparation for face to face delivery, observation and other activities related to the scope of practice of AEPs Maximum of 5% (up to 7 hours) for administrative tasks 26/06/ hours 120 hours 15 hours Initial assessments for clients Exercise prescriptions for a range of healthy clients including running programs and for clients wanting to increase lean muscle. Instructed group sessions for boxing and pilates 7 hours Program writing Average Joe s Gymnasium As above P La Fleur P La Fleur P La Fleur P La Fleur 9 hours Research P La Fleur Observation of supervisor working with P La Fleur 10 hours clients 7 hours Filing and phone calls As above P La Fleur Total hours at this prac site 193 hours 160 hours face to face + 26 hours preparation + 7 hours administration *E.g. a) Testing sports teams without showing evidence of exercise programming will not be counted. B) An initial consultation involving demonstration of home based exercises will be accepted. * Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact for each placement. Declaration: (To be completed by each referee listed in the table above) I certify that the information supplied is true and correct Signature P La Fleur Date 01/09/2013 Title Mr Name Peter La Fleur Background in exercise physiology (brief summary only): I m an AEP Director of Average Joe s Gymnasium. Cert IV in fitness (PT College of Knowledge 2006), working as a personal trainer for 13 years. Phone Lafleur.P@ajgym.net.au Fax 13

14 Accredited Exercise Physiology Apparently healthy practicum logbook Date Number of hours Case description Description of services F2F- Initial assessment ESSA pre-screening tool. 5 yrs ago ankle injury playing netball, no problems since. No other flags identifiedclient is classed as apparently healthy. Ex history- walking dogs 6 months, gym membership for 3 months 2 years ago. Supervisor name Supervisor s signature Applicant s signature Goals- tone up for wedding in 6 months. 2/3/12 3 hrs (Client 1) 27 yo female New gym membership, using free PT session to design program 1 hr F2F 2 hrs prep Fitness testing- YMCA submax test, push ups- maximal reps in 30 seconds, plank- max time. Prep- Set up tests & reviewed test results. Set a 6 month plan- 2 month program written, fitness tests to be conducted every 2 months for progress. Test results will be use to determine goals for next 2 month block- e.g. increase plank hold to 45 seconds after 2 months, then to 90 seconds after 4 months. Developed and designed next 2 exercise sessions involving combination of machine aerobic and bodyweight resistance exercises. Reviewed programs with supervisor who recommended incorporating more functional compound exercises and reducing the amount of single muscle machine based equipment- e.g. change triceps ext to triceps dip. Reviewed test results with client, explained exercise plan and showed around equipment. J.Doe J Doe F Bueller 5/3/12-5/4/12 4 hrs (4x 1 hour PT sessions weekly F2F) (Client 1) 27 yo female Goal- tone up for wedding F2F- 4 hours Implemented exercise program consisting of treadmill/upright bike warm up followed by intervals. Resistance program consisted of basic bodyweight exercises such as squats, lunges, push ups and crunches. Progression involved adding weight to squats in 3 rd session, and increasing the incline on treadmill intervals. J.Doe J Doe F Bueller Client s motivation wasn t very high, so focussed on positive feedback and education about the purpose of the program. 14

15 Encouraged client to start incorporating jogging intervals when walking dogs to speed up progress. Client increased max plank by 10 seconds, and max push ups by 5 reps. Pre season fitness camp. My role involved performing a series of fitness tests on each player, and collating results to help design group and individual pre-season training sessions. Face to Face- Testing participants on the following activities: height, weight, body composition, agility, vertical jump, flexibility, muscular strength, muscular endurance and aerobic fitness (beep test). I was responsible for performing appropriate warm up and cool down activities across the sessions to prevent injuriesincluding stretching routines. (8 hours) Group of 24 male second division AFL players Aged Preparation- Set up of tests, collation of exercise test results, planning of pre-season training sessions, identifying specific needs from fitness test results and planning for injury prevention in conjunction with senior coach. (6 hours) 10/4/12-11/4/12 14 F2F- 8 hours Prep- 6 hours (Total 14 hours) Example 1, male 30 yo performed in average range for all tests except body composition and sit and reach for flexibility. After questioning client he advised a previous season hamstring strain, followed by no exercise over the off-season. Determined that this season he would need to perform longer warm ups and cool downs to prevent injury, and prescribed a home exercise program of lower body stretches to complement the 3x weekly team training sessions. J.Doe J Doe F Bueller Example 2, male 17 performed above average in agility, flexibility & aerobic fitness, but slightly below average on muscular strength & endurance. This player s gym based program was initially adapted to focus more on strength with machine based upper and lower body exercises predominantly, with a plan set to progress to endurance and power exercises with equipment such as the Smith machine 6 weeks from the start of the season. 15

16 Conducted pre-screening questionnaires. Tested BP, HR, weight, waist circumference, hip circumference, sit and reach test and 6 minute run test (assessment hours not included in log book) for all clients. I took each member of the group through a FMS and recorded the results. I conducted similar assessments every 5-6 weeks. Fitness testing was conducted over the first 2 sessions. This included 10 minutes run for distance, max push ups in a minute, max squats in a minute, max plank hold, agility course time, 1 km for time. 28/6/12-10/11/12 10 (10x 1 hour sessions) Exercise delivery: Group 1- A group of 5-10 active mothers (41-52 YO) training after kids finish school for 45 min/session during most school weeks. General group aims are to improve pelvic floor, increase cardiovascular fitness and increase strength. e.g. 45 YO female. Long history of sport and exercise. Has lost considerable fitness after latest child. Aims to increase general fitness and improve pelvic floor function. F2F- 10x1 hr PT sessions (total 10 hrs) I took the group through 45 minute sessions during most school weeks of term. Before each session group was asked about any new injuries or issues. Sessions usually include group resting HR taking. Group warm up of a gradual walk to run over 5-8 minutes. The following general mesocycles and example sessions were completed. Weeks 1-3: Walk/run intervals. Boxing. Resistance circuits (20 sec per exercise). Pelvic floor activation and exercises in supine positions. Core stability. E.g. 5 minute walk/run warm up. Boxing circuit 30 secs per station for 10 minutes. Resistance circuit: 1 minute per station battling rope, theraband row, knees on boxing pad, squat, bench dips, dumbbell curl and press, agility course. Pelvic floor/core: PF/TA activations and holds, planks. Stretching 2 x 15 secs per muscle group. Weeks 3-5: Fartlek intervals. Boxing. Body weight resistance circuits. Pelvic floor exercises. Core strength exercises. E.g. 5 minute run/walk. 5 minute Fartlek 30: min boxing circuit 1 minute per station with running in between. Resistance circuit: 30 sec per station, run in between. Battling rope clean and press, horizontal row, high knees, squat jump, bench dips,, agility course. Pelvic floor/core: PF/TA activations and holds, planks. Stretching 2 x 15 secs per muscle group Weeks 5-7: Sprint intervals and long slow runs. Boxing. Functional resistance exercises. Pelvic floor exercises. Core strength. Weeks 5-9: Agility drills. Sprint intervals. Boxing. Pelvic floor exercises. Core stability. Rationale: The above exercise programs were based on groups goals, ability and training preferences. The high intensity cardio and circuit training was included to assist in weight/fat loss. These J.Doe J Doe F Bueller 16

17 30/1/ Female 19 yo Schizophrenia, 6 inpatient clinic stays over last 3 years Goals- increase fitness, lose weight F2F- 2hrs Prep- 1.5hrs Purpose of treatmentincrease fitness methods have been shown to burn large amount of calories which make them suitable for this goal. Resistance/strength exercises were included to aid the client in improving strength. Research shows weights done at 2-5 sets of 6-12 reps will build strength and muscular endurance as well as assist in weight loss. Impact exercises such as jump downs were included to assist in maintaining and increasing bone mineral density. Balance exercises were included to maintain and improve balance. Stretching was included to maintain ROM, prevent injuries and increase flexibility. Sessions and exercises were regressed if individual clients were unable to perform certain exercises with good technique. For example client was unable to perform full push ups so knee push ups were used instead. Sessions were progressed as each client s fitness and ability improved. This included increasing session s intensity (faster drills, heavier weights), decreasing rest periods and increasing difficulty (stability exercises, complex plyometrics, hill sprints). F2F- 2x1 hour PT sessions: Warm up- walking laps of court, progressing to jogging. Main session- fun ball game drills (throwing, catching, sidestepping), walking lunges, knee push ups, bosu jumps etc Cool down- walking laps of court, static stretches. Client was easily distracted, so stations were short, sharp and done to music to keep her attention. Set mini- challenges- e.g. see how many push ups could be completed in 30 seconds. I also observed her posture was poor, but due to time constraints wasn t able to add specific postural training exercises. Instead used regular cues such as keep head up, pull shoulders back or stand tall to reinforce good posture during exercise. Encouraged her to practice these at home when performing ADL s. Prep: Researching schizophrenia, writing exercise program. Discussion with supervisor regarding communication techniquesusing a mix of styles, making exercise fun, positive feedback. Setting up stations in gym s indoor basketball court, recording case notes. J.Doe J Doe F Bueller 17

18 Competent Not Competent Not able to comment Cardiopulmonary/metabolic clinical practicum reference form Reference for: Dear Colleague Peter SMITH The above applicant will be applying for accreditation with Exercise & Sports Science Australia (ESSA) as an accredited exercise physiologist (AEP). Requirements of this accreditation include a minimum of 140 hours of practical placements in the areas of cardiopulmonary/metabolic conditions. Please complete the following form based on your experience with the above applicant: Client exposure Please tick the types of clients the applicant has gained experience with: Metabolic Obesity Impaired glucose Dyslipidaemias Diabetes mellitis Cardiopulmonary Hypertension Asthma Coronary artery disease COPD Peripheral vascular disease Chronic heart failure Cystic fibrosis Other (please describe) Myocardial infarction Skills and experience In the following table, please confirm evidence of the clinical practice the applicant has gained in the relevant area of neuromuscular/neurological/musculoskeletal clients: (expand boxes where necessary) Breakdown of Practicum hours (a minimum total of 140 hours) Total hours and dates* Evidence of specific roles and duties completed Site / Location Name and signature of referee Minimum of 60% (at least 84 hours) of face to face delivery i.e. Individualised/group delivery/instruction of an exercise program. *Testing/assessments without intent for prescription cannot be counted Maximum of 35% (up to 49 hours) for preparation for face to face delivery, observation and other activities related to the scope of practice of AEPs Maximum of 5% (up to 7 hours) for administrative tasks 26/06/ /08/ hours 90 hours 5 hours 15 hours 7 hours 1 hour 5 hours 3 hours 1 hour Pre and post cardiac rehab testing Assisting with delivering group circuit based exercise sessions within clinic gym. Assisting with delivering one on one circuit based exercise sessions within clinic gym. Observation of the Physio & AEP delivering exercise sessions in clinic gym Research on pathologies, rehabilitation procedures post cardiac surgery and designing home exercise programs for patients who have completed the program. Attended client education session on medication usage. This knowledge was applied to my face to face exercise delivery with clients. Case meeting to discuss patients progress through program. Hospital orientation and induction on emergency procedures, admin meetings. Client education session run by OT on home modifications. 1 hour Observation of cath lab procedure Malibu Private Hospital As above As above As above As above B/Roberts B/Roberts B/Roberts B/Roberts B/Roberts B/Roberts B/Roberts B/Roberts B/Roberts B/Roberts Total hours at this prac site 148 hours 115 hours face to face + 28 hours preparation + 5 hours administration Please note at least some of the hours of supervision within this category must be supervised by an AEP. Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact for each placement. Declaration: (To be completed by each referee listed in the table above) I certify that the information supplied is true and correct Signature B Roberts Date 01/09/

19 Title Ms Name Barbara M. Roberts Background in exercise physiology (brief summary only): I am an AEP Clinical Cardiac Nurse Coordinator at POW Hospital for 15 years overseeing Stage II & III Cardiac Rehabilitation programs. Phone (07) Fax (07) broberts@malibu.com.au 19

20 Cardiopulmonary/metabolic practicum logbook Accredited Exercise Physiology Cardiopulmonary/metabolic practicum logbook Date Number of hours Case description 2/3/ Exercise Delivery - 52 yr obese male, smoker (30 pack-years) with coronary artery stent of circumflex artery, previous angioplasty of LAD, hypertension and Type 2 diabetes. On multiple meds, good compliance. F2F- 1.5 hrs 3/3/12 1 Preparation-- 52 yr obese male, smoker (30 pack-years) with coronary artery stent of circumflex artery, previous angioplasty of LAD, hypertension and Type 2 diabetes. On multiple meds, good compliance. Prep- 1 hr Description of services Performed Initial Assessment took relevant medical and exercise histories, medical and allied health treatments including medication management. Client had completed hospital based cardiac rehab course 1 year ago, and complied with home program well for 3 months before losing motivation. Discussed patient exercise capacities, goals, opportunities and barriers for exercise participation. Identified safe exercise limits and effective exercise ranges via RHR, BP, 6-minute walk test with RPE and HR monitor. Performed 30s sit-to-stand, and 30s wall push-up test. Gave patient National Physical Activity Guidelines for reading, and made a follow-up appointment for 1 wks time. My practicum supervisor gave me the task to research the medications taken by this client and how they may affect his exercise capacity, particularly in regards to how an AEP needs to monitor sessions. Accessed MIMS database. Client was taking atenolol. This is a beta-blocker, which affects heart rate, so I decided to use an RPE scale to measure intensity instead of a HR monitor. Supervisor name Supervisor s signature Applicant s signature A.Beast A.Beast F Bueller A.Beast A.Beast F Bueller Client was also on Novo rapid, which as a synthetic form of insulin tends to increase the likelihood of hypoglycaemic episodes. Education on hypoglycaemia prevention & management will be discussed with client prior to commencing next exercise session- e.g. the importance of having a hypo kit at all times. 20

21 8/4/12 1 Exercise Delivery - 52 year old obese female, smoker with hypertension and Type 1 diabetes. Amputation of Left 2nd digit >1 year ago F2F- 1 hr 4/6/12 1 Preparation - 58 year old female, non-smoker, diabetes. 12/4/12 & 16/5/12 Prep- 1 hr 3 Exercise Delivery - 52 year old obese female, smoker with hypertension and Type 1 diabetes. Amputation of Left Foot, Digit 2 over one-year ago. F2F- 3 hrs (2x 1.5hr sessions) Performed initial assessment - took relevant medical and exercise histories, and previous medical and allied health treatments. Used motivational interviewing to discuss goals and diabetes management strategies including exercise and footwear (3 hours). Provided Diabetes and Exercise Information sheet. Post session sought information from podiatrist re: neuropathy and exercise contraindications. Booked follow-up appointment 1 week to set home exercise program. Reviewed assessment information in client file. Prepared exercises to be prescribed for patient s home program to improve diabetic management. Patient had little home equipment, so designed a 30 min circuit incorporating a combination of cardiovascular exercises (e.g. shadow boxing, step ups, high knees) and major muscle group body weight resistance exercises (e.g. squats, wall push ups, bench dips, calf raises). Reviewed with supervisor. Initial assessment completed on 8/4/12. Initial exercise prescription with monitoring (BP, ECG, HR, RPP, RPE). Home exercise program began with body weight exercises such as fitball squats and modified push-ups and progressed to light resistance band and hand weights exercises in the review for progression. Reviewed motivation and strategies to overcome barriers at each session, along with self weekly goal setting and discussed appropriate rewards once goals achieved. A.Beast A.Beast F Bueller A.Beast A.Beast F Bueller A.Beast A.Beast F Bueller 23/04-10/06/2010 8hrs Exercise delivery- 52 yrs male farmer, type 2 diabetic, smoker. He is active and physical due to work demands. On Diabex medication- reports good compliance Outcome: Client reported increased capacity for ADL s, improved aerobic capacity, increased energy/motivation. Face to Face (5 hours) Exercise prescription- 5 supervised sessions Goals- Improving aerobic capacity to ensure maintaining a physical standard required for work duties, management of diabetes with holistic approach, weight management, stress management. Exercise intervention- prescribed exercises/program- A.Beast A.Beast F Bueller 21

22 F2F- 5 hrs Prep- 3 hrs Exercise sessions comprised of a warm up, followed by 30 minutes moderate intensity, steady state cardiovascular exercises (e.g. 20mins jogging, 10mins rowing) and up to 30 minutes of general conditioning (particular focus on upper body as his low body was fairly strong due to work tasks). Upper body exercises included push ups; low row, bicep curl, and chest fly variations using mainly free weights. Other areas of importance worked on included core and lower back strengthening- exercises included prone/supine bridges, abdominal crunch variations, exercise ball back extensions, lifting variations. Pt program was progressed/changed every 2 weeks- e.g. increased reps from 8-12 for most ball based core strength exercises, and increased upper body weights by 1 bar in the final session. Client vitals checked (BP, HR and blood glucose) before, during and after sessions to ensure safe exercise limits. Provided education on hypoglycaemia prevention & management. No adverse incidents experienced. Preparation (3 hours) Assessment of client- completed health consultation including health screening/checks, medical & exercise histories, anthropometrical evaluation, fitness test, muscular strength & endurance assessments, exercise goal setting, diabetes management strategies discussed. 16/11/09-20/11/09 4 Cardiac Rehabilitation Phase II Clients present with conditions such as: Angioplasty/Stent/ICD/CABG/Valve replacement. Majority were diagnosed with CAD. Age ranges 40-80, mostly male Client #1: 53yo male, angioplasty, At reassessment every 2 weeks retook anthropometrics, fitness testing, and reviewed exercise goals. Phase II- cardiac patients attend hospital gym for 45 min sessions 3xweek following a 1 hr education session. Exercises consists of gentle aerobic ex on equipment, followed by resistance program using body weight, hand weights, theraband. All patients are monitored pre, during & post ex with BP & ECG. Client 1: Followed client through circuit style program. Monitored ECG & BP, used talk test & RPE to ensure A.Beast A.Beast F Bueller 22

23 ex smoker, knee arthritis, obese Client #2: 67 yo female mitral valve replacement, hx of frozen shoulder Client #3: 68yo male, 4x CABG, spinal stenosis, plated R forearm from # 25 yrs ago (decreased pronation/supination) Client #4: 75 yo male, 2x stents, IHD, LBP F2F- 4 hours intensity was appropriate. Client has been attending for 3 weeks, and performed with good technique. No changes to program required this session. Client 2: Followed client through circuit style program. Client has never performed resistance training before so spent more time on technique and providing education on the benefits of regular resistance exercise- client was interested in affects on bone mineral density as her mother suffered osteoporosis. Client 3: Followed client through circuit style program. Resistance training adapted to account for decreased shoulder pronation/supination - e.g. unable to perform full bicep curl, so program adapted to hammer curls. Only used recumbent bike due to back pain from spinal stenosis. Client 4: Client was in final session of phase II, so program was modified to include more compound exercises in readiness for phase III. Focussed on cardio equipment today, trialling 2% incline for 2 mins on treadmill. RPE within acceptable ranges so changed program card to reflect. 16/11/09 1 Observation of Phase II Cardiac rehab program education session Food labels Admin- 1 hr Dietitian ran session explaining how to read food labels. Participated in group activity analysing popular breakfast cereals and rating them according to fat, sugar & salt content. A.Beast A.Beast F Bueller 23

24 Competent Not Competent Not able to comment Musculoskeletal/neurological/neuromuscular clinical practicum reference form Reference for: Dear Colleague Peter SMITH The above applicant will be applying for accreditation with Exercise & Sports Science Australia (ESSA) as an accredited exercise physiologist (AEP). Requirements of this accreditation include a minimum of 140 hours practicum in the area of musculoskeletal/neurological/ neuromuscular conditions. Please complete the following form based on your experience with the above applicant: Patient exposure Please tick the types of clients the applicant has gained experience with: Neurological / Neuromuscular Musculoskeletal Stroke (CVA) Multiple sclerosis (MS) Arthrides (esp. OA and RA) Other (please describe) Spinal cord injury (SCI) Other (please describe) Osteoporosis Acquired brain injury (ABI) Sub-acute and chronic specific and nonspecific musculoskeletal pain/injuries Skills and experience In the following table, please confirm evidence of the clinical practice the applicant has gained in the relevant area of neuromuscular/neurological/musculoskeletal clients: (expand boxes where necessary) Parkinson s disease Breakdown of practicum hours (a minimum total of 140 hours) Total hours and dates* Evidence of specific roles and duties completed Site / location Name and signature of referee Minimum of 60% (at least 84 hours) for face to face exercise program delivery i.e. individualised/group delivery/ instruction of an exercise program. *Testing/assessments without intent for prescription cannot be counted Maximum of 35% (up to 49 hours) for preparation for face to face delivery, observation and other activities related to the scope of practice of AEPs Maximum of 5% (up to 7 hours) for administrative tasks 14/09/ /12/ hours 86 hours 25 hours Assisting AEP in assessing exercise capacity for musculoskeletal and neuro clients. Prescribing one on one exercise interventions for the range of chronic conditions ticked above. Observation of the AEP prescribing services, research on pathologies and designing exercise programs. 7 hours Case meeting to discuss client progressions. 1 hour 2 hours 3 hours Attended client education session on medication usage. This knowledge was applied to my face to face exercise delivery with clients. Attended staff in service session on clients with multiple co-morbidities and how exercise can be prescribed. Client bookings by phone, filing etc. Staff orientation and induction, admin meetings. 1 hour Staff in service for fire safety. 1 hour Client education session on nutrition. Exercise for Rehab Clinic Exercise for Rehab Clinic Exercise for Rehab Clinic R. Martin R. Martin R. Martin R. Martin R. Martin R. Martin R. Martin R. Martin R. Martin TOTAL Hours at this site 142 hours 102 hours face to face delivery + 35 hours preparation + 5 hours administration Please note at least some of the hours of supervision within this category must be supervised by an AEP. Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact for each placement. Declaration: (To be completed by each referee listed in the table above) I certify that the information supplied is true and correct Signature R. Martin Date 14/12/

25 Title Mr Name Ron Martin Background in exercise physiology (brief summary only): I am an AEP Bachelor of Applied Sci (Ex rehab), 5 years as clinical AEP in private practice Phone (03) Fax (03) rmartin@exrehab.com.au 25

26 Musculoskeletal/neurological/neuromuscular practicum logbook Accredited Exercise Physiology Musculoskeletal/neurological/neuromuscular practicum logbook Date Number of hours 10/5/ /5/13, 19/5/13, 26/5/ Case description 89 yo female, 4 year history of L THR. Hx of 2 falls during night in last 2 months with decreased mobility and greater reliance on walker as a result Meds- coplavix, Diabex F2F- 1 hr 24 yo male, 2 yr hx of LBP, overweight, neuropathy R calf post swine flu, foot surgery Sees physio fortnightly & chiro 2x weekly for pain management. F2F- 3x 0.5 hr individual training sessions (total 1.5) Description of services Supervised home exercise session. Purpose of session: GP requested review of gait, gentle mobility exercises and falls prevention training. Client described fear of falling, stiffness and soreness across surgical site. Warm up of walking laps on walker- deceased knee and ankle flex observed. Provided cueing to improve posture and improve foot clearance, positive reinforcement & education on importance of good posture in balance. Ex Rx 2x10 each- seated knee ext, seated ab rollbacks, chair squats, calf raises, seated scap retraction, bridging, standing hip abduction. Client maintained capacity to perform 100sec supine bridge, and was very pleased as a result. Client reported commencing 30 min cycling 5x week, with increased LBP at same time. Assessed for supine bridge capacity- reduced 10 sec in 1 month. Regressed program to Pilates style core activation exercises, introduced DNF work and prone scap retraction. Increased recommended hamstring stretches from 3x weekly to daily. Minimal progression noted over sessions, but chiro tx reduced to 1 weekly by final session and client reported reduced morning pain levels as monitored by VAS. Supervisor name Supervisor s signature Applicant s signature A.Beast A.Beast F Bueller A.Beast A.Beast F Bueller Prep- 0.5 hours Admin- 0.5 hrs Prep - prep for sessions, researching core stability exercises & progressions for non-specific LBP Admin- updating SOAP notes, writing report to GP 17/5/13 1 Client 5 59 yo male 8/52 post laminectomy surgery Initial assessment: Gathered medical history, current pain levels and goals discussed. Included the following tests- core activation, STS in 30 sec, A.Beast A.Beast F Bueller 26

27 17/5/ /10/ /8/13 & 26/9/13 2 F2F- 1 hr 59 yo male 8/52 post laminectomy surgery Prep- 1 hr 68 yo female. Previous radium therapy caused muscle wastage secondary to cancer cell destruction Observation- 1 hr 70 yo male approx 6 months post right knee replacement surgery referred by physio to continue rehab process. F2F 1.5 hrs glute bridges to failure, and gait assessment. Discussed posture and adherence for home ex programadherence was identified as potentially being low. Identified home options for exercise e.g. client has stairs. Have initiated the next 4 sessions over 10 days to assist with motivation. Please see attached session outlines in Appendix. Preparation: Supervisor suggested I review the surgery protocol post laminectomy and become familiar with timeframe for rehab. Reviewed referral letter from orthopaedic surgeon and physio progress notes. Observation: Supervisor had performed the initial assessment 1 week beforehand. Observed initial exercise program set up. I reviewed case notes prior to the session. A resistance program was developed to improve remaining muscle strength and maintain existing muscle bulk in rotator cuff & left trapezius. Poor posture was a result and therefore core strength, posterior muscle groups and overall upper body exercises were implemented in the clinic based program. Face to Face 3x30 min: Gym program developed and reviewed at 2 & 4 weeks. Ex Rx goal was to stabilize knee through improvement of quad, particularly VMO. Stretching program developed & reinforced to improve hamstring length & flexibility. Weight loss was also targeted (central adiposity), along with strengthening of core to relieve lower back pain and exercise development to meet requirements of home ADL s. Aerobic exercise at first session was still limited by pain and decreased ROM, with only short bouts (<10 mins) of recumbent cycling tolerated initially. A.Beast A.Beast F Bueller GR Martin GR Martin F Bueller GR Martin GR Martin F Bueller Prep- 0.5 hrs Outcomes: 3kg weight loss over 4 weeks, improved ROM in affected knee, improved overall mobility. Preparation 30 mins: Updated and reviewed case notes, and gym card. 27

28 Initial assessment (1 hour): Includes medical questionnaires, discussion re: medications, personal goals, barriers to exercise, access to facilities. Main goal is to achieve neuromuscular development and assist client to perform ADL s independently. Secondary goal is to reduce weight. Left side is impaired, client feels uncomfortable holding glass this side, now using walking stick & is avoiding stairs. Performed the following tests 31/7/13-02/9/13 7 Female, 72 yo Primary reason for tx: suffered stroke 8 weeks ago. Co morbidities: Hypertension, OA, RA, obesity F2F- 1 hr Prep- 2 hrs Baseline girth measurements: Including waist measurement (110cm). Sub maximal test: Graded walking test noting any foot drag, tracking & posture. Flexibility & ROM tests: include modified sit and reach, shoulder flexibility, hip flexion (mod Thomas test). Functional testing: sit to stand, TUG, gait assessment, balance test (Berg balance scale), grip strength, abdominal strength test. Program design (2 hours): 1 st macro cycle is designed to develop safe correct technique with compound exercises to mobilise large muscle tissue and develop aerobic CV system. Increase muscle strength/joint stability and ROM with particular emphasis on left side. Emphasis will be on targeting core abdominals and posture control, as well as improving sensory feedback using mirrors, sense of touch & sequential learning tasks to assist in neuroplasticity and regaining neuromuscular control and function. Ongoing stretching & flexibility is also prescribed. GR Martin GR Martin F Bueller Undertook 4x1 hr sessions with client. Each session consisted of the same exercises- please see attached program. Client progressed in technique and stability over the 4 sessions. Client was monitored with RPE & VAS scale during every exercise. BP was recorded pre & post session. Also referred client to dietitian. Program will be reviewed after 3 more sessions. 28

29 1/3/13 1 2/3/ Pain Management Clinic Team Meeting Admin- 1 hr Pain Management Clinic Research Prep- 1.5 hrs Team meeting held 1x week with AEP, Physio, OT, nurse, psych & prac students. Reviewed progress of participants and discussed any barriers to participation. Case studypresentation on CPRS. New participant is due to start next week with Complex Regional Pain Syndrome. Supervisor suggested I research recent journal articles on pathophysiology and treatment options. Discussed my findings with supervisor about how this would affect exercise prescription. A.Beast A.Beast F Bueller GR Martin GR Martin F Bueller 29

30 Competent Not Competent Not able to comment Other clinical health delivery clinical practicum reference form Reference for: Dear Colleague Peter SMITH The above applicant will be applying for accreditation with Exercise & Sports Science Australia (ESSA) as an accredited exercise physiologist (AEP). Applicants may choose to participate in 80 hours supervised clinical placement of other health delivery. The activities approved under the 80 other clinical hours may occur in isolation (without a related exercise intervention). The other clinical hours can include: 1. Provision of exercise delivery for pathologies related to cancers, mental health, renal, or other pathologies: the purpose of this is to give students opportunities to strengthen their knowledge and develop competencies in these areas; 2. Diagnostic investigations or procedures (e.g. cardiac, pulmonary or other clinical investigations or procedures); 3. Health checks (e.g. point of care testing); 4. Job capacity assessments, functional capacity assessments; 5. Laboratory/research testing/screening (in isolation); 6. Case management; 7. Health promotion, health education or workplace health programs; 8. Other related activities as described in the AEP generic and target pathology criteria (of the evidence based criteria table). Please complete the following form based on your experience with the above applicant: Skills and experience In the following table, please confirm evidence of the clinical practice the applicant has gained in the relevant area of other health delivery: (expand boxes where necessary) *Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact for each placement. Total hours and dates* Evidence of specific roles and duties completed Site / location Name and signature of referee 26/06/2013 to 30/08/ hours 14/09/2013 to 14/12/ hours 14/09/2013 to 14/12/ hours TOTAL Hours at this site Delivered 12 education sessions on self-monitoring physical activity for cardiac clients. 2 hours research for development of an educational manual used with clients 15 hours face to face delivery of exercise sessions with breast cancer client in clinic. 5 hours research into cancer treatment & exercise recommendations, designing exercise program, updating SOAP notes. Assisting physiotherapist perform FCE s and ergonomic workstation assessments as part of pre-employment screening 44 hours The Wellness Centre The Wellness Centre The Wellness Centre *Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact for each placement. Declaration: (To be completed by each referee listed in the table above) I certify that the information supplied is true and correct Signature K.Williams Date 25/12/2013 K. Williams K.Williams K. Williams K.Williams K. Williams K.Williams Title Miss Name Katie Williams Background in exercise physiology (brief summary only): I am an AEP BEx &Sp Sci, Masters Clinical Exercise Physiology, working as an AEP for 3 years in private practice. Phone (03) Fax (03) k.williams@twc.com.au 30