ESSA APPLICATION FORM · PDF file• Post to Exercise & Sports Science ... This application...

APPLY

ESSA APPLICATION FORM2016 ACCREDITED EXERCISE PHYSIOLOGIST (AEP)

4 YR. NUCAP

• Apply to ESSA for AEP within two years of graduating from a 4 yr. NUCAP qualification. NOTE: This application must be posted within thistwo year period. For example, if the graduation date is 10th of November 2015 an AEP application must be posted to ESSA no later than10th November 2017

• Save a copy of this application form and complete in full

• ESSA forms must be completed in English and all documentation supplied must be in English

• Print the form and attach all relevant documents

• Refer to the checklist on the final page of this application form to ensure you have completed the application form in full

• Post to Exercise & Sports Science Australia (ESSA), Locked Bag 102, Albion DC QLD 4010, Australia

www.essa.org.auLocked Bag 102, Albion DC, QLD 4010

ELIGIBILITY

This form is relevant for to applicants who;

*

* NUCAP is the acronym for a National University Course Accredited Program i.e. a university course approved by ESSA.

OVERVIEW

To be eligible to apply for exercise physiology accreditation (AEP) applicants must;Attach evidence of at least 500 hours of practicum in the form of log books attached to supervisor forms for the following categories;

• At least 140 hours of apparently healthy practicum• At least 360 hours of clinical practicum including;

a. At least 140 hours of cardiopulmonary/metabolic practicumb. At least 140 hours of musculoskeletal/neurological/neuromuscular practicumc.

have completed a NUCAP undergraduate qualification AND

• are applying to join ESSA within two years of graduation

1.

up to 80 hours of ‘other’ clinical health delivery activities IF a total of 360 hours ofpracticum has not been completed in categories a. and b. above

This application form includes several attachments located on screen when opened in Adobe Reader. Some attachments are helpdocuments and provide further information, other attachments are templates for practicum e.g. logbook templates and supervisorforms

•

https://www.essa.org.au/

PERSONAL DETAILS

CONTACT INFORMATION

WORK ADDRESS AND EMPLOYMENT INFORMATION

PRIVACY STATEMENT

2

SECTION A- PERSONAL DETAILS

Title Full Name

DOB

Email

(this is required for your website login)

Postal address

Town/Suburb State/province Postcode /zip code

Country Contact phone number

Name of workplace

Postal address

Town/Suburb State/province Postcode /zip code

Country Contact phone number

Are you of Aboriginal or Torres Strait Islander origin? Yes No

How did you find out about ESSA membership? ESSA Website Colleague Employer University Other

Current Employment

Previous Position/title


Exercise & Sports Science Australia acknowledges and respects the privacy of its members and accredited professionals. All information provided on this form is subject to ESSA’s Privacy Policy, outlined on ESSA’s website www.essa.org.au. ESSA uses and discloses personal information only for our primary functions or a directly related purpose. Primary functions include the release of accredited member information via the Find an Accredited Exercise Scientist/Accredited Exercise Physiologist/Accredited Sports Scientist search function on the ESSA website. Related purposes include release of accreditation information to organisations (such as Medicare Australia, Department of Veterans’ Affairs, private health insurers,

workers compensation authorities, National Health Services Directory, Primary Health Networks); industry information to relevant condition organisations (e.g. Arthritis Australia, Heart Foundation, Diabetes Australia); as well as accreditation information to relevant sports governing bodies (e.g. Australian Sports Anti-Doping Authority (ASADA) and sports integrity unit/s). If you do not wish for your information to be disclosed please provide written notification to ESSA at [email protected]. You have the right of access to and alteration of your personal information in accordance with the Privacy Act.

2016 ACCREDITED EXERCISE PHYSIOLOGIST (AEP) 4 YR. NUCAP


English

Afrikaans

Arabic

Cantonese

Croatian

Dutch

Greek

French

German

Italian

Japanese

Maltese

Mandarin

Polish

Spanish

Tagalog

Turkish

Other

3www.essa.org.au

Locked Bag 102, Albion DC, QLD 4010

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 below:

Please indicate languages you are fluent in by placing a tick in the boxes below:

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 below:

National government organisation

Research/education institution

Sporting club/institution

Regional government organisation

Fitness club/institution

Health care organisation

Hospital

Mining

Private company

Sporting club/institution

Workers compensation agency

Student

Not currently working

On leave

Other

Cancer

Cardiac

Disability services

Ergonomics

Mental health

Metabolic

Musculoskeletal

Neurologic

Older adults

Paediatrics

Primary prevention

Sport enhancement

Testing/screening

Other

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

Other


Complete the first 3 sections of this page IF you are working in the exercise and sports science industry AND complete the languages section. Please indicate your primary, and if applicable your secondary, professional practice sector by placing a 1 (for primary area of employment) and 2 (for secondary area of employment if applicable) in the boxes below:


COURSE NAME COURSE CODE UNIVERSITY YEAR COMPLETED

SECTION B- QUALIFICATIONS

4

SECTION C- FEE AND PAYMENT DETAILS


• An initial processing fee of $40 incl GST applies

• An additional assessment fee of $55 incl GST applies in theevent that an application requires additional information to befinalised i.e. you are asked to supply additional information.Additional assessment fees will be charged prior to anassessment.

• A maximum of two additional assessments are allowed perapplication. If your application is not approved after twoadditional assessments OR if you fail to supply information bydue date your application will be finalised as declined

• Additional information must be supplied within 30 working days

• Additional assessments are processed within 30 working days

• All processing and assessment fees are non-refundable.

ESSA applications incur a processing fee payable upon receipt of your application and the annual membership and/or accreditation fee/s upon approval of your application.

C1.0 PROCESSING AND ASSESSMENT FEES


ATTACH

1. Certified* copy of your official* and final* academic transcript (you may need to order this from the university) NOTE:‘certified’means signed by a suitable notary (see the attachments). *'official' means a hard copy from your university i.e. not downloadedfrom the university website. *'final’ means the transcript verifies that your university qualification has been awarded or conferred

2.For transcripts not in English, attach an officially translated copy of your final academic transcript. NOTE: Transcripts must betranslated to English by a NAATI accredited translator (National Accreditation Authority for Translators and Interpreters Ltd)

3. Copy of current First Aid (code HLTAID003) and CPR (code HLTAID001) certificate/statement of attainment

4. If you have completed Standards and Compliance as part of your qualification please attach your certificate of completion.


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C2.0 PAYMENT AUTHORISATIONS

I authorise Exercise & Sports Science Australia to charge the relevant fee for my initial processing and additional assessment/s if applicable.

Signature:

ESSA accepts credit card and cheques/money orders

C3.0 MEMBERSHIP AND ACCREDITATION FEES

C4.0 PAYMENT METHODS

I wish to become a AEP (inlcuding AES) AND a Full member of ESSA Total fee: $630 incl GST

I wish to become an AEP (including AES) without the benefits of Full membership of ESSATotal fee: $567 incl GST

I am paying by cheque/money order

*Please attach a cheque/money order for your relevant initial processing fee made payable to Exercise & Sports Science Australia.

NOTE: if an additional assessment is required you will need to submit the appropriate fee payment when you supply your additional information.

I am paying by credit card

Card type (Please select) VISA Mastercard

Cardholder’s name Expiry of card (Month/Year)

Card number

Signature Date

If my application is approved I authorise Exercise & Sports Science Australia to charge my credit card for the preferred joining option indicated above. NOTE: If paying by credit card a 1.5% merchant fee applies.


Date:

Recognition as an AEP also includes recognition as an Accredited Exercise Scientist (AES). Upon approval for AEP you are eligible to choose from two joining options. Please tick your preferred joining option below;

I wish to take a leave of absence from accreditation. Please contact ESSA on ph: +61 7 3862 4122


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D1.0 ESSA DECLARATIONS

A) I certify that the information supplied on and with this form is true and correct.

B) If accepted as an Exercise & Sports Science Australia member and or an accredited professional I agree to abide by the Exercise & Sports Science Australia Code of Professional Conduct and Ethical Practice

C) As an accredited professional I certify that if I am working with clients/human subjects (no matter the type) that I will have currentprofessional indemnity and public liability insurance and hold current first aid and cardiopulmonary resuscitation (CPR) qualifications

By submitting this application I authorise and acknowledge the following:

Applicant’s signature Date




SECTION D- DECLARATIONS

If accepted by Exercise and Sports Science Australia as an accredited professional I agree to receive information and updates about ESSA and the industry. If I choose to be an ESSA Full member I agree to have my services as an accredited professional searchable on the ESSA website. (Note: you can change this at any time once you become an accredited member by logging into your profile in the members area of the website and removing yourself from the search function).


D) If accepted as an Exercise & Sports Science Australia member and or an accredited professional I confirm that I am a fit and proper person by acknowledging the following:

- I have not been charged with or have any prior convictions for a serious criminal offence, sexual assault, fraud, or other offence of dishonesty;

- I have not been and am not currently under investigation, the subject of complaint, disciplinary proceedings or adverse findings as to fitness to practice by any international regulatory body having jurisdiction over me or any industry in which I have been employed;

- I possess the necessary physical and mental health to deliver a service safely and competently to the public.


https://www.essa.org.au/wp-content/uploads/2014/06/Code-of-Professional-Conduct-and-Ethical-Practice_FINAL2014.pdf


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D2.0 STATUTORY DECLARATION

1.

2.

3.

7.

8.

4.

5.

6.

This statutory declaration covers all information provided to support this application, including additional information submitted for any additional assessments

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 1959.

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 1959.

Insert the name, address and occupation of person making the declaration

Set out matter declared to in numbered paragraphs

Signature of person making the declaration

Signature of person before whom the declaration is made (see over)

Full name, qualification and address of person before whom the declaration is made (in printed letters)

Place

Day

Month and year

I,1 (name) of

(address)

And of (occupation)

make the following declaration under the Statutory Declarations Act 1959:

2 “The attached documentation accurately demonstrates the necessary requirements for this application

with Exercise & Sports Science Australia and is complete, accurate, truthful and supported by evidence"

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.

Declared at 4 on 5 of 6

3

7

Signature

Signature

8 Name

Qualification


Please see the attachment Suitable notary for suitable persons authorised to certify an academic transcript and witness a statutory declaration


https://www.essa.org.au/wp-content/uploads/2015/12/Suitable-persons-authorised-to-certify-an-academic-transcript-and-witness-a-statutory-declaration.pdf

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SECTION E- EVIDENCE OF 500 HOURS OF PRACTICUM

NO. PRACTICUM SITEAPP

HEALTHY HRS

HRS AEP SUP.(TICK)

HRS AEP SUP.(TICK)

‘OTHER’ CLINICAL

1

2

3

4

5

6

7

8

9

10

CARDIO/MET MSK/NEURO

CATEGORY TOTALS

TOTAL PRACTICUM HOURS


Please see the attached documents for the ESSA logbook template and supervisor forms for all practicum categories. Please see the AEP Practicum Guide for further information on logging practicum.

E1.0 ATTACH A COMPLETED LOGBOOK/S FOR AT LEAST 140 HOURS OF APPARENTLY HEALTHY PRACTICUM , THIS MUST BE

E2.0 ATTACH COMPLETED LOGBOOKS FOR AT LEAST 360 HOURS OF CLINICAL PRACTICUM INCLUDING;

a. At least 140 hours of cardiopulmonary/metabolic practicumb. At least 140 hours of musculoskeletal/neurological/neuromuscular practicumc. You can supply up to 80 hours of ‘other’ clinical health delivery activities IF you have not completed a total of 360 hours of practicum

in categories a. and b. aboveProceed to F2.1

a.

b.

ATTACHED TO A SUPERVISOR FORM/S FOR EACH PRACTICUM SITE, THEN PROCEED TO F2.0.

A supervisor form attached to your logbook for each cardiopulmonary/metabolic practicum *at least two hours of the 140 hours

must be supervised by an AEP

A supervisor form attached to your logbook for each musculoskeletal/neurological/neuromuscular practicum *at least two hoursof the 140 hours must be supervised by an AEP

c. A supervisor form attached to your logbook for each of the 'other' clinical practicums * No AEP supervision is required in this

E3.0 ATTACH THE SUPERVISOR FORMS TO YOUR CLINICAL LOGBOOKS. THIS MUST INCLUDE;

E4.0 COMPLETE THE PRACTICUM SUMMARY TABLE BELOW.

*AEP supervisionCOMPLETE THE PRACTICUM SUMMARY TABLE BELOW.


Please note:

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SECTION F- APPLICATION CHECKLIST (TICK WHEN COMPLETE)

1. COMPLETE SECTION A - PERSONAL DETAILS

2. COMPLETE SECTION B - QUALIFICATIONS *ATTACH CERTIFIED COPIES

3. COMPLETE SECTION C - FEES AND PAYMENTS * ATTACH CHEQUES/MONEY ORDERS IF APPLICABLE

4. COMPLETE SECTION D – DECLARATIONS

5. COMPLETE SECTION E – 500 HOURS OF PRACTICUM *ATTACH THE RELEVANT EVIDENCE

• Applications will not be assessed until a complete application and supporting documentation has been received by the ESSANational Office

• Applications are assessed in order of arrival and can take up to 30 working days per application

• You will receive a confirmation email upon receipt of your application. If you have not received this within 20 working days of sendingyour application please contact ESSA on +61 7 3862 4122

• Application forms are not returned to you, please keep a copy for your records

• Do not send original academic transcripts as these will not be returned to you

• ESSA recommends sending your application by registered post and keeping a tracking number for your reference


• I HAVE COMPLETED A SUPERVISOR FORM FOR EACH APPARENTLY HEALTHY PRACTICUM SITE AND ATTACHED TO THELOGBOOKS

• I HAVE COMPLETED A SUPERVISOR FORM FOR EACH CARDIOPULMONARY/METABOLIC PRACTICUM SITE AND ATTACHED TO

THE LOGBOOKS *AEP supervision is included

• I HAVE COMPLETED A SUPERVISOR FORM FOR EACH MUSCULOSKELETAL/NEUROLOGICAL/NEUROMUSCULAR PRACTICUM SITE

AND ATTACHED TO THE LOGBOOKS *AEP supervision is included

• I HAVE COMPLETED A SUPERVISOR FORM FOR EACH ‘OTHER’ CLINICAL PRACTICUM SITE AND ATTACHED TO THE LOGBOOKS


www.essa.org.au

CLINICAL PRACTICUM SUPERVISOR FORM

Supervision for:

Dear Supervisor

The above applicant will be applying for exercise physiology accreditation with Exercise & Sports Science Australia (ESSA). Applicants may choose to undertake up to 80 hours of supervised clinical placement related to 'other'clinical health delivery. The activities approved under this catgeory may occur in isolation (without a related exercise intervention).

The ‘other’ clinical activities can include:

1. Provision of exercise delivery for pathologies related tocancers, mental health, renal, or other pathologies: thepurpose of this is to give students opportunities to strengthentheir 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 healthprograms;

8. Other related clinical activities as described in the AEPgeneric and target pathology criteria (of the evidence basedcriteria table).

OTHER CLINICAL HEALTH DELIVERY PRACTICUM

EXPERIENCE

Please complete the following table.

*Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact foreach placement.

TOTAL HOURS AND DATES* EVIDENCE OF SPECIFIC ROLES AND DUTIES COMPLETED SITE / LOCATION NAME AND SIGNATURE

OF SUPERVISOR

Total hours at this site

www.essa.org.au

Please attach this form to the front of your ‘other’ clinical health delivery practicum logbook


DECLARATION:

I certify that the information supplied is true and correct

Signature Date

Full Name

Professional background (brief summary only)

Phone Fax

Email

Degree:

Experience:

www.essa.org.au


Supervision for:

Dear Supervisor

The above applicant will be applying for exercise physiology accreditation with Exercise & Sports Science Australia (ESSA). Applicants may choose to undertake up to 80 hours of supervised clinical placement related to 'other'clinical health delivery. The activities approved under this catgeory may occur in isolation (without a related exercise intervention).

The ‘other’ clinical activities can include:

1. Provision of exercise delivery for pathologies related tocancers, mental health, renal, or other pathologies: thepurpose of this is to give students opportunities to strengthentheir 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 healthprograms;

8. Other related clinical activities as described in the AEPgeneric and target pathology criteria (of the evidence basedcriteria table).


EXPERIENCE


*Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact foreach placement.

TOTAL HOURS AND DATES* EVIDENCE OF SPECIFIC ROLES AND DUTIES COMPLETED SITE / LOCATION NAME AND SIGNATURE

OF SUPERVISOR


www.essa.org.au

Please attach this form to the front of your ‘other’ clinical health delivery practicum logbook


DECLARATION:


Signature Date

Full Name

Professional background (brief summary only)

Phone Fax

Email

Degree:

Experience:

DATE No. HRS CLIENT/S DESCRIPTION DESCRIPTION OF SERVICES SUPERVISOR’S NAME

SUPERVISORS SIGNATURE

12/5/15,

19/5/15,

26/5/15

2.5

24 yo male, 2 yr hx of chronic LBP, Goal - reduce LBP F2F- 3x 0.5 hr individual training sessions (total 1.5) Prep- 0.5 hours Admin- 0.5 hrs

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, . Increased recommended hamstring stretches from 3x weekly to daily. Prep - prep for sessions, researching core stability exercises & progressions for non-specific LBP Admin- updating SOAP notes, writing report to GP

A.Beast A.Beast

17/5/15 1

Client 5 59 yo male

8/52 post laminectomy surgery Goal – increase strength for ADL’s

F2F- 1 hr

Initial assessment: Gathered medical history, current pain levels and goals discussed. Included the following tests- core activation, STS in 30 sec, glute bridges to failure, and gait assessment. Discussed posture and adherence for home ex program- adherence 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 for client 5

A.Beast A.Beast

17/5/15 1

59 yo male 8/52 post laminectomy surgery

Goal – increase strength for ADL’s Prep- 1 hr

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.

A.Beast A.Beast

27/8/15 &

26/9/15 2

70 yo male approx 6 months post right knee replacement surgery referred by physio to continue

rehab process. Goal – increase knee stabilisation, balance and lower body strength

for ADL’s

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 and balance program developed & reinforced to improve hamstring length & flexibility. Wup: 5 mins on recumbent bike

GR Martin GR Martin

ESSA PRACTICUM LOGBOOK- Category Musculoskeletal/neurological/neuromuscular

Name: Peter Smith

Pec

F2F 1.5 hrs

Prep- 0.5 hrs

Lower body stretches Exercises included: - Seated core activation on fit ball 20 seconds x 3 - Double leg glute bridges 12reps x 2 - Fit ball squats 10reps x 2 - Leg extension machine – 10 reps x 3 - Seated ham curl 10 reps x 3 - Seated calf raises 12 reps x 3 Cool down: Lower body stretches Aerobic Outcomes: improved ROM in affected knee, improved overall mobility and enjoying exercise program Preparation 30 mins: Updated and reviewed case notes

31/7/15-

02/9/15 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

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 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).

GR Martin GR Martin

Functional testing: sit to stand, TUG, gait assessment, balance test (Berg balance scale), grip strength, abdominal strength test. Program design (2 hours): 1st 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 neuro-plasticity and regaining neuromuscular control and function. Ongoing stretching & flexibility is also prescribed. 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.

1/3/15 1

Pain Management Clinic Team Meeting

Admin- 1 hr

Team meeting held 1x week with AEP, Physio, OT, nurse, psych & prac students. Reviewed progress of participants and discussed any barriers to participation. Case study- presentation on CPRS.

A.Beast A.Beast

www.essa.org.au


Supervision for:

Dear Supervisor

The above applicant will be applying for exercise physiology accreditation (AEP) with Exercise & Sports Science Australia (ESSA). Requirements of this accreditation include a minimum of 140 hours practicum in the area of cardiopulmonary/metabolic conditions.

Obesity

Impaired glucose

Dyslipidaemias

Diabetes mellitis

Hypertension

Asthma

Coronary artery disease

COPD

Peripheral vascular disease

Cystic fibrosis

Myocardial infarction

Chronic heart failure

Other

CARDIOPULMONARY/METABOLIC PRACTICUM

EXPERIENCE

CLIENT EXPOSURE

Please tick the types of conditions the applicant has gained experience with:


• Please note at two 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.

Metabolic

Cardiopulmonary

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 SUPERVISOR

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 an AEP

Maximum of 5% (up to 7 hours) for administrative tasks


www.essa.org.au

Please attach this form to the front of your cardiopulmonary/metabolic practicum logbook

DECLARATION:


Signature Date

Full Name

Background in exercise physiology (brief summary only)

Phone Fax

Email

Degree:

Experience:


www.essa.org.au


Supervision for:

Dear Supervisor

The above applicant will be applying for exercise physiology accreditation (AEP) with Exercise & Sports Science Australia (ESSA). Requirements of this accreditation include a minimum of 140 hours practicum in the area of musculoskeletal/neurological/ neuromuscular conditions.

Stroke (CVA)

Spinal cord injury (SCI)

Acquired brain injury (ABI)

Parkinson’s disease

Multiple sclerosis (MS)

Other

Arthrides (esp. OA and RA)

Osteoporosis

Sub-acute and chronic

specific and non-specific

musculoskeletal pain/injuries

Other

MUSCULOSKELETAL/NEUROLOGICAL/NEUROMUSCULAR PRACTICUM

EXPOSURE


EXPERIENCE

Please complete the following table:

• Please note at least two 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.

Neurological / Neuromuscular

Musculoskeletal



TOTAL HOURS

AND DATES


SITE / LOCATION





Total hours at this prac site

www.essa.org.au

DECLARATION:

Please attach this form to the front of your musculoskeletal/neurological/neuromuscular practicum logbook


Signature Date


Full Name


Phone Fax

Email

Degree:

Experience:

www.essa.org.au


Supervision for:

Dear Supervisor

The above applicant will be applying for exercise physiology accreditation (AEP) with Exercise & Sports Science Australia (ESSA). Requirements of this accreditation include a minimum of 140 hours practicum in the area of musculoskeletal/neurological/ neuromuscular conditions.

Stroke (CVA)

Spinal cord injury (SCI)

Acquired brain injury (ABI)

Parkinson’s disease

Multiple sclerosis (MS)

Other

Arthrides (esp. OA and RA)

Osteoporosis

Sub-acute and chronic

specific and non-specific

musculoskeletal pain/injuries

Other


EXPOSURE


EXPERIENCE

Please complete the following table:

• Please note at least two 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.

Neurological / Neuromuscular

Musculoskeletal



TOTAL HOURS

AND DATES


SITE / LOCATION





Total hours at this prac site

www.essa.org.au

DECLARATION:

Please attach this form to the front of your musculoskeletal/neurological/neuromuscular practicum logbook


Signature Date


Full Name


Phone Fax

Email

Degree:

Experience:

www.essa.org.au

PRACTICUM SUPERVISOR FORM

Supervision for:

Dear Supervisor

The above applicant will be applying to join Exercise & Sports Science Australia (ESSA). Apparently healthy practicum is face to face

delivery of an exercise intervention for the purpose of enhancing a client's health and fitness, wellbeing or performance. Exercise

interventions for the purpose of injury rehabilitation for example, are not accepted for apparently healthy practicum.

APPARENTLY HEALTHY PRACTICUM

EXPERIENCE




TOTAL HOURS AND DATES*

EVIDENCE OF SPECIFIC ROLES AND DUTIES COMPLETED SITE / LOCATION






*Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact for each placement.

www.essa.org.au

Please attach to the front of your apparently healthy practicum logbook

DECLARATION:


Signature Date


Full Name


Phone Fax

Email

Degree:

Experience:

D2.0 Statutory Declaration This statutory declaration covers all information provided to support this application, including additional information submitted for any additional assessments

Commonwealth of Australia STATUTORY DECLARATION

Statutory Declarations Act 1959

1 Insert the name, address and occupation of person making the declaration

I,1 (name) , of

(address)

And of (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 demonstrates the necessary requirements for this application with Exercise & Sports Science Australia and is complete, accurate, truthful and supported by evidence"

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

4 Place 5 Day 6 Month and year

Declared at 4 on 5 of 6

Before me,

7 Signature of person before whom the declaration is made (see over)

7

8 Full name, qualification and address of person before whom the declaration is made (in printed letters)

8

(name)

(qualification)

of (address)

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 1959.

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 1959.

Please see the attachment Suitable notary for suitable persons authorised to certify an academic transcript and witness a statutory declaration

John Recent Graduate

12 Greenaway Drive, Hamilton QLD 4007

Fitness Train er

John R Graduate

Jane Green

UQ 7th January 2016

Jane Green

PhD – Full time Tertiary Educator

1 University Drive, Brisbane QLD 4001

1

SUITABLE PERSONS AUTHORISED TO CERTIFY AN ACADEMIC TRANSCRIPT AND WITNESS A STATUTORY DECLARATION

A statutory declaration under the Statutory Declarations Act 1959 may be made before–

1. a person who is currently licensed or registered under a law to practisein one of the following occupations: Chiropractor Dentist Legal practitioner Medical practitioner Nurse Optometrist Patent attorney Pharmacist Physiotherapist Psychologist Trade marks attorney Veterinary surgeon

2. a person who is enrolled on the roll of the Supreme Court of a State orTerritory, or the High Court of Australia, as a legal practitioner (however described); or 3. a person who is in the following list:Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955)

Bailiff

Bank officer with 5 or more continuous years of service

Building society officer with 5 or more years of continuous service

Chief executive officer of a Commonwealth court

Clerk of a court

Commissioner for Affidavits

Commissioner for Declarations

Credit union officer with 5 or more years of continuous service

Employee of the Australian Trade Commission who is:(a) in a country or place outside Australia; and(b) authorised under paragraph 3 (d) of the Consular Fees Act 1955; and(c) exercising his or her function in that placeEmployee of the Commonwealth who is:(a) in a country or place outside Australia; and(b) authorised under paragraph 3 (c) of the Consular Fees Act 1955; and(c) exercising his or her function in that place

Fellow of the National Tax Accountants’ Association

Finance company officer with 5 or more years of continuous service

Holder of a statutory office not specified in another item in this list

Judge of a court

Justice of the Peace

Magistrate

Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961

Master of a court

Member of Chartered Secretaries Australia

Member of Engineers Australia, other than at the grade of student

Member of the Association of Taxation and Management Accountants

Member of the Australian Defence Force who is:(a) an officer; or(b) a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982 with 5 or more years of continuous service; or(c) a warrant officer within the meaning of that Act

Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants

Member of:(a) the Parliament of the Commonwealth; or(b) the Parliament of a State; or(c) a Territory legislature; or(d) a local government authority of a State or Territory

Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961

Notary public

Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service who is employed in an office supplying postal services to the public Permanent employee of:

(a) the Commonwealth or a Commonwealth authority; or(b) a State or Territory or a State or Territory authority; or(c) a local government authority;

with 5 or more years of continuous service who is not specified in another item in this list

Person before whom a statutory declaration may be made under the law of the State or Territory in which the declaration is made

Police officer

Registrar, or Deputy Registrar, of a court

Senior Executive Service employee of:(a) the Commonwealth or a Commonwealth authority; or(b) a State or Territory or a State or Territory authority

Sheriff

Sheriff’s officer

Teacher employed on a full-time basis at a school or tertiary education institution

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2016 Accredited Exercise Physiologist (AEP) Practicum Guide

Table of Contents Preface .................................................................................................................................. 2

Section 1 – Practicum requirements for exercise physiology accreditation .............................. 3

Practicum categories ................................................................................................................ 3

Practicum hours breakdown .................................................................................................... 4

Section 2 – Practicum Supervision .......................................................................................... 8

Practicum sites ....................................................................................................................... 10

Practicum logbooks ................................................................................................................ 11

Section 3 – Finalising practicum forms ...................................................................................13

Completing practicum supervisor reference forms ............................................................... 13

Completing logbooks .............................................................................................................. 13

APPENDICES ..........................................................................................................................14

Appendix 1- Glossary ............................................................................................................14

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Preface

This guide has been designed for university practicum coordinators, practicum supervisors and individuals applying for exercise physiology accreditation (AEP) with ESSA. The guide provides details to assist in understanding the clinical exercise physiology practicum requirements required for an individual to be eligible for accreditation as an exercise physiologist.

Individuals applying for exercise physiology accreditation must satisfy the following:

The exercise science (ES) standards as assessed by ESSA

Have completed a NUCAP exercise physiology qualification and have graduated within the past two years

Demonstrate evidence of a minimum of 500 hours of practicum hours as outlined in Section 1 of this guide

Completed the clinical practicum hours as part of their NUCAP degree

ESSA offers an international pathway for internationally qualified individuals. For more information, please refer to the International Applicants webpage on ESSA’s website.

Individuals must apply to ESSA with the relevant application form and submit evidence for assessment.

Individuals have responsibility for ensuring all documentation is complete and accurate prior to submission with ESSA. University practicum coordinators have responsibility for ensuring individuals meet practicum requirements as outlined in their NUCAP accreditation Practicum supervisors have responsibility for confirming that practicum has been completed and the information in the logbooks is correct by signing the logbooks and supervisor form. It is recommended that practicum coordinators and practicum supervisors make themselves familiar with the information in this guide to assist individuals in achieving a meaningful and valuable practical learning experience. A glossary of key terms can be found in Appendix 1.

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Section 1 – Practicum requirements for exercise physiology accreditation

Individuals are required to undertake at least 500 hours of practicum in the following categories:

At least 140 hours of apparently healthy practicum

At least 360 hours of clinical practicum including:

a) At least 140 hours of cardiopulmonary/metabolic practicum

b) At least 140 hours of musculoskeletal/neurological/neuromuscular practicum

c) Up to 80 hours of other clinical health delivery activities IF individuals have not

completed a total of 360 hours of practicum in category a) and b) above.

For example:

1. 140 hours apparently healthy + 200 hours cardiopulmonary + 160 neuromuscular;

2. 140 hours apparently healthy + 140 cardiopulmonary + 160 neuromuscular + 60 from other clinical

health delivery category.

Individuals DO NOT need to complete hours from the other clinical health delivery category as long as 360 clinical hours are logged.

Note: Clients with multiple co-morbidities are categorised according to the primary purpose of the treatment.

Practicum categories Apparently healthy practicum hours

Apparently healthy practicum hours are accepted if:

Clients are being seen for the purpose of undertaking an exercise intervention to improve their

health and fitness, wellbeing or performance

Clients are not participating in an exercise intervention for the treatment and/or management of a

clinical condition or injury

Services can be focused on prevention of chronic conditions

Fitness coaching or strength and conditioning coaching are accepted

Activities not accepted include:

Sports coaching (skills-based coaching)

Cardiopulmonary/metabolic clinical practicum hours*

Clients diagnosed with cardiopulmonary and/or metabolic condition/s

Main purpose for seeing the client is to undertake an exercise intervention for the management and

or treatment of a cardiopulmonary/metabolic condition

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Musculoskeletal/neurological/neuromuscular clinical practicum hours*

Clients diagnosed with musculoskeletal, neurological or neuromuscular condition/s

Main purpose for seeing the client is to undertake an exercise intervention for the management

and/or treatment of a musculoskeletal/neurological/neuromuscular condition

Individuals are not required to complete practicum with every listed target pathology in the forms. Rather individuals should have experience from within each main category. It is highly recommended that individuals gain experience across a range of clinical pathologies. *Clients with multiple co-morbidities are categorised according to the main purpose of the treatment. Other clinical practicum hours include:

Provision of exercise service delivery for pathologies related to cancers, mental health, renal or other

pathologies

Diagnostic investigations or procedures (e.g. cardiac, pulmonary or other clinical investigations or

procedures, ECG stress testing)

Health/wellness checks (e.g. point-of-care testing)

Job capacity assessment, functional capacity assessments, pre-employment checks

Laboratory/research testing/screening

Case management

Health promotion, or providing health education or workplace health programs

Practicum hours that include exercise delivery for ‘other clinical conditions’ must adhere to the ‘hour breakdown’. See below under ‘Practicum hour breakdown’. Activities not accepted include:

Apparently healthy practicum hours

Activities outside the AEP scope of practice

Passive therapies including massage, manipulations, McKenzie therapy, dry-needling, ultrasound

therapy etc.

Clinical hours that were not completed as part of a NUCAP exercise physiology course

Practicum hours breakdown Individuals’ practicum hours need to be broken down into the following ratios for each of the logbook

classifications except for the “other clinical” classification:

60% of face-to-face delivery of exercise services (minimum)

35% of preparation for exercise services (maximum)

5% of administration duties (maximum)

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Minimum 60% face-to-face delivery of exercise services

These activities must be related to the delivery or planned delivery of an exercise intervention 1*. Logbooks must clearly demonstrate that there is an intention to prescribe and deliver an exercise intervention.

Accepted activities include: Screening and risk assessment prior to prescribing exercise:

Reviewing referrals

Undertaking risk assessment, based on presentation

Taking histories: medical (including disease, injuries and disabilities), psychosocial, exercise and lifestyle

Recording medical and other interventions Assessment of a client prior to prescribing exercise or to assess the effectiveness of an exercise intervention:

Assessing exercise capacities

Assessing functional capacities (e.g. vocational/occupational, recreational, activities of daily living)

Assessing psychosocial status in relation to lifestyle change and maintenance Planning of exercise interventions (planning undertaken with the client):

Setting of goals: client, practitioner and other health professionals

Identifying barriers and facilitators for exercise and physical activity

Providing solutions for barriers

Designing exercise interventions (in consultation with client)

Motivational interviewing Delivery of exercise interventions (including exercise prescription):

Teaching correct technique and coaching

Assisting clients to achieve self-management

Managing programs: e.g. daily/weekly planner

Maintenance of exercise interventions: retention of clients and adherence to exercise

1* Examples of assessments conducted in relation to the delivery and planned delivery of an exercise intervention include: (i) individual completes an assessment on a client but the clinical placement ends before the client returns for the exercise intervention, (ii) a client undergoes an assessment with the goal to lead onto an exercise intervention but then discontinues the service with the clinical supervisor, and (iii) the individual conducts a follow-up assessment following an exercise intervention without having been involved in the delivery of the intervention themselves.

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Activities not accepted include: Assessments that are conducted with no intention of being used to support an exercise intervention (e.g. healthy heart checks, 12-lead ECG exercise stress test for diagnosis) are not included under this category, but may be included in the ‘other clinical health delivery’ section. Maximum 35% preparation for exercise service delivery, observation and other clinical activities related to

the AEP scope of practice

These activities should generally relate to the provision of face-to-face delivery of exercise services.

Accepted activities include:

Case preparation and planning (planning done outside of client appointments):

Analysis of data including analysis of assessments before and after exercise interventions

Research to prepare for a client service e.g. research of evidence-based practice for the particular

case

Education workshops ONLY if content can be related to one of individual’s clients. This must be

justified by describing how individuals will use this information to provide exercise delivery services

with the client. E.g. a cardiac rehab nutrition session run by a dietician if individuals discuss this in the

following group exercise session. Education sessions NOT related to preparing for an exercise session

are recorded in the administration section

Preparation of “phantom reports” for referrers 2*

Preparation and participation in case meetings and case conferencing (i.e. discussing client cases in

team meeting or with supervisor)

Travel time may also be approved under this category if the individual is able to demonstrate active learning along the lines of the above dot points, and this work is completed during travel (e.g. the supervisor travels with the individual and they discuss cases)

2* Although individuals may prepare “phantom reports” for referrers and clients and this is encouraged for learning purposes, under no circumstances are these reports to be sent to referrers or clients under the name of the individual practitioner. Rather, reports are prepared and submitted according to the AEP scope of practice and these would normally be approved and sent under the name of the AEP or other health professional. Observation:

Practitioners must be providing an actual service for clients

Individuals must engage with supervisors in discussing the client(s) and services provided: this should provide active and problem-based learning situations

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Maximum 5% administration duties

Accepted activities include:

Record keeping and data input

Using Medical Director or similar practice management software

Setting-up referral forms

Billing ― learning about Medicare, DVA, WorkCover and health funds

In-services and inductions/orientations

Education workshops offering general knowledge that is not specific to a client’s treatment plan

Non-ESSA activities Many practicum sites offer other services and therefore other learning opportunities, including participation in multi-disciplinary care. While these activities cannot be claimed as part of the 500 hours required for exercise physiology accreditation, they are still valuable learning experiences that can benefit the professional practice of the individual. Participation in these activities should be discussed between the individual and practicum supervisor, with input from the university practicum coordinator if necessary. Some examples of activities not accepted include:

Observation of activities outside the AEP Scope of Practice e.g. physiotherapy provided manual therapy (dry needling, massage etc.); nursing assessment

GPS tracking

Sports First Aid

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Section 2 – Practicum Supervision Practicum supervisors must be suitably qualified to deliver the service that they are supervising individuals for. Supervisors for face-to-face delivery of exercise hours must be trained in exercise prescription. Supervisors are required to sign individual logbooks and practicum supervisor forms within two months of individuals completing the practicum placement. A supervisor is deemed suitable if they hold:

A recognized qualification* relevant for the activity they are supervising.

Experience relevant to the activity they are supervising.

*A qualification recognized or endorsed by a regulating authority such as a national association. Supervisors for 140 apparently healthy hours

An accredited exercise physiologist (AEP)

An ESSA exercise science member (ES)

A degree qualified exercise and sports science professional

A personal trainer with a Certificate IV in Fitness with a minimum of 10 years industry experience

A degree qualified physical education teacher

A bachelor degree qualified/trained allied health professional with experience in exercise delivery

(e.g. physiotherapist)

A state, national or international level sports coach

An Australian Strength and Conditioning Association (ASCA) level 2 or 3 coach Supervisors for 360 clinical hours

An accredited exercise physiologist (AEP)

An ESSA exercise science member (ES)

A bachelor degree qualified/trained allied health professional with experience in exercise delivery **

(e.g. exercise physiologist, exercise scientist, physiotherapist, cardiac care nurse, occupational

therapist, doctor, clinical nurse consultant)

** The training must be relevant to the work they are supervising. Please note –

For the cardiopulmonary/metabolic AND the musculoskeletal/neuromuscular/neurological

practicums, individuals need to have at least two hours supervised by an AEP. The number of hours

required is at the discretion of the AEP supervisor in determining the amount of time it takes to

deem the individual competent.

Hours must be signed off by the practicum supervisor within two months of individuals completing

the practicum.

Individual supervisors must sign off the logbooks, however the site supervisor can sign the practicum

supervision form on behalf of the other supervisors within one practicum site.

It is the individual’s responsibility to ensure all forms required within the application are completed

and signed.

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Supervisors for other clinical health delivery activities A degree trained professional with relevant training can sign off on these hours, e.g. if individuals have worked with a podiatrist doing gait assessments. However, if the individual developed exercise interventions, then a supervisor with training in exercise prescription, such as an AEP would need to sign off this portion of practicum. Practicum hours can only be claimed when supervised by an appropriate person. This may mean that individuals will need to travel to source appropriate supervision, or have a supervisor who is willing and capable of providing distance supervision. Distance supervision Delivery of exercise services may incorporate practicum activities that are supervised via internet or telephone-based video conferencing (e.g. web streaming, e-health conferencing). In these instances, it is expected that the individual will conduct the face-to-face delivery of services with a client while being overseen by a supervisor via real-time video conferencing. The video conferencing technology must incorporate real-time video and audio streaming, and must allow for unimpeded communication between individuals and their supervisor. In any case where video supervision is used, due consideration should be given to the safety of the client, and appropriate risk mitigation planning should be undertaken in advance by the supervisor. Video supervision may not be appropriate for use with high-risk clients. It is not appropriate for individuals to complete all clinical practicum hours under video supervision, and individuals are therefore required to undertake some of the clinical practicum hours under direct supervision, preferably preceding the distance supervision. Practicum hours in a research setting Practicum hours gained in a research setting can be accepted for AEP clinical practicum. Research settings refer to the environment and/or structure of the practicum. Practicum can be undertaken in a research setting for:

1) Cardiac/metabolic practicum hours (must involve face-to-face exercise delivery) 2) Musculoskeletal/neurological/neuromuscular practicum hours (must involve face-to-face exercise

delivery) 3) Other clinical health delivery practicum hours (can include activities not related to face to face

exercise delivery OR can involve face to face exercise delivery for pathologies not related to the above categories.)

For example: A PhD student is researching exercise for clients with type 2 diabetes. The research involves a clinical trial where clients exercise three times per week for eight weeks. Exercise physiology students can deliver the exercise sessions for the clients and log the experience in the cardiac/metabolic practicum category.

All of the ESSA practicum guidelines, such as supervision, hour breakdown, activities etc. still applies to practicum in a research setting.

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Practicum sites Some examples of appropriate practicum sites are:

1. Apparently healthy practicum (140 hours)

Health and fitness clubs

Sporting organisations/clubs

Schools 2. Cardiopulmonary/metabolic practicum (140 hours minimum)

Exercise physiology or multi-disciplinary clinics

Hospitals

Aged care facilities

Cardiac care services within public/private hospitals and the community 3. Musculoskeletal/neuromuscular/neurological practicum (140 hours minimum)

Exercise physiology or multi-disciplinary clinics

Hospitals

Aged care facilities

Physiotherapy clinics

Spinal injury clinics

Sporting organisations/clubs

4. Other clinical health activities (80 hours maximum)

Any location listed within the above three areas

Renal clinic

Cancer care clinic/program

Cardiac stress testing clinic/ward

Mental health clinic

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Practicum logbooks Logbooks must clearly demonstrate the following:

Time: The amount of time allocated to each activity.

Case: Case description including age, sex, primary purpose for seeing the client, any co-morbidities

and goals. Breakdown of hours must be included here (e.g. one hour face-to-face exercise delivery,

female 56 year old, diabetes and asthma. Goal: to control blood sugar levels through regular exercise

as per ACSM physical activity guidelines).

Description of services: Type of services delivered, including face-to-face, or preparation for face-to-

face delivery, observation and other, or administrative tasks. Describe what the tasks included.

Signature: The supervisor must sign the logbook. If individuals have the same supervisor for all of

entries, the supervisor can sign a whole page. They do not need to sign every log entry.

Logbook entries

Practicum can be logged per:

individual session

individual client/group consult (if same individual or group is seen on an ongoing basis)

per work task with different clients/groups, if the same task is completed repetitively on the same

day (e.g. multiple ECG stress tests). This is providing sufficient detail is provided about the individual

tasks and any specific modifications that were required for clients.

The description of services must reflect the time

For example, if an eight hour block is logged, the description should reflect what happened across that time period and must include a breakdown of the hours, i.e. the amount of face-to-face, preparation and administration hours. A key must be provided if abbreviations are used. Overall, a logbook should show that individuals have worked with a range of clients and pathologies undertaking activities that fall under the AEP scope of practice e.g. assessments, exercise prescription, research, adherence discussions, progressions and outcomes.

Clients with multiple co-morbidities

Practicum hours for people with multiple co-morbidities should be categorised according to:

the primary purpose for seeing the client and/or

at the discretion of the supervisor – please provide a description of the rationale For example: 1. Client Red is a 50 year old diabetic and has had a recent hip replacement. The exercise intervention considers the diabetes, but because it is successfully managed and controlled with diet/medication the exercises are more focused on rehabilitation for the hip replacement. This client would therefore be classified under musculoskeletal rather than metabolic. Client Red cannot be logged under both categories.

2. Client Yellow is an 82 year old who suffers from chronic heart failure. The client also has mild hypertension, diabetes and had a knee replacement two years ago. Client Yellow has been referred to the

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cardiac rehab phase 3 program. The exercise intervention would consider the previous knee replacement. However, the client has been referred for the purpose of treating the chronic heart failure and would therefore be classified as a cardiopulmonary client.

Refer to the ESSA website for a variety of examples to assist individuals in providing logbooks with the required detail.

Still have questions?

Individuals or supervisors should contact the university practicum coordinator with queries relating to practicum.

Practicum Coordinators: Any questions on practicum issues relating to acceptance of sites, supervisor or activities should be directed to the ESSA office 07 3862 4122 or [email protected]

mailto:[email protected]

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Section 3 – Finalising practicum forms

Completing practicum supervisor reference forms Supervisor forms are a summary of the practicum completed by the individual at one site with one client target group e.g. cardiopulmonary/metabolic clients.

Individuals should fill complete the form and request the site supervisor to sign the form at the completion of the practicum.

The site supervisor must:

sign the form, preferably within two months of practicum completion

provide details about their own qualifications and experience to confirm they are a suitable

supervisor *

Individuals are to attach each clinical practicum reference form to the front of the relevant logbook.

*Please refer to the list of suitable supervisors within this guide (page 8)

Completing logbooks Individuals are required to keep logbooks of activities they perform on the practicum. The activities are to be categorised according to the ESSA AEP target categories (i.e. cardiopulmonary/metabolic, musculoskeletal/neurological/neuromuscular, and ‘other’).

Practicum supervisors must:

Review logbook entries for authenticity and accuracy of information

Sign the logbook entries relating to the activities they directly supervised only to confirm

Supervisors can sign across each page of the logbook rather than each

Signatures cannot be electronic signatures that were copied and pasted across the entries, but can include an onscreen signature for each page

Signatures must be handwritten or if electronic must be signed on-screen

Please note: all supervisors signing the logbooks must meet the requirements of a ‘suitable supervisor’

Note: Blank supervisor forms and logbooks are available on the ESSA website.

Examples of completed supervisor forms and logbooks are also available on the ESSA website

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APPENDICES

Appendix 1- Glossary

Administration Activities completed by individuals that do not specifically relate to planning or delivering exercise services

AEP supervision Practicum activities where an AEP is the supervisor. For the purposes of accreditation individuals must complete at least 2 hours under AEP supervision in both the cardiopulmonary/metabolic and musculoskeletal/neurological/neuromuscular AEP practicum categories.

Apparently healthy practicum Activities completed for non- clinical treatment purposes; i.e. the main aim of treatment is general health, fitness, wellbeing or performance. Activities can include prevention.

Cardiopulmonary/Metabolic practicum Activities completed for clinical treatment purposes

of cardiopulmonary/metabolic conditions; i.e. the

main goal of the activity is management and or

treatment via an exercise intervention

Face to face exercise delivery Activities completed with the client present for the purpose of including assessment, planning (e.g. goal setting) and delivery of exercise interventions. Observation of an activity performed by the supervisor is not considered a face to face delivery activity (see ‘Preparation’).

Individual The person who is applying for exercise physiology accreditation. The individual must be a student enrolled in a NUCAP clinical exercise physiology course when completing clinical practicum hours.

Musculoskeletal/neurological/neuromuscular practicum

Activities completed for clinical treatment purposes

of musculoskeletal/neurological/neuromuscular

conditions; i.e. the main goal of the activity is

management and or treatment via an exercise

intervention

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National University Course Accreditation Program (NUCAP)

ESSA’s program that accredits university courses that

have met the association’s high quality standards for

accreditation at the exercise science and/or exercise

physiology level

‘Other’ clinical health delivery practicum Activities related to the AEP scope of practice that do

not fall into the cardiopulmonary/metabolic or

musculoskeletal/neurological/neuromuscular

categories. This includes activities completed for the

clinical treatment purposes of other pathologies

including but not limited to cancer, mental health and

renal conditions.

Practicum Site The organisation/workplace where the practicum is completed. This may be across multiple locations so long as the activities completed remain part of the same organization.

Suitable supervisor A supervisor with a recognised qualification and/or experience in the activities being completed by the individual, and deemed appropriate by ESSA

Preparation Activities completed for the purposes of preparing for face to face activities i.e. delivery of an exercise intervention. Activities accepted include, research, planning interventions and observation of interventions.

Primary purpose of treatment The main aim or goal of an intervention/activity. This may change across sessions based on a number of factors including but not limited to goals, current status of conditions, and comorbidities. Where clients have co-morbidities the primary purpose of treatment will be decided by the supervisor. The primary purpose of treatment must be stated clearly in the case description of each logbook entry.

Primary site supervisor The main supervisor at the practicum site, whose responsibilities include sign off of the supervisor reference form at the completion of practicum

Supervisor A person who directly supervises the activities being completed by the individual



2/3/15 1.5 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. Goal –Weight loss, exercise intervention for the purpose of initially managing obesity F2F- 1.5 hrs

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.

A.Beast A.Beast

3/3/15 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. . Goal –Weight loss, exercise intervention for the purpose of initially managing obesity Prep- 1 hr

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. 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.

A.Beast A.Beast

4/6/15 1 Preparation - 58 year old female, non-smoker, diabetes. Goal – Diabetes management

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

A.Beast A.Beast

ESSA PRACTICUM LOGBOOK- Category Cardiopulmonary/Metabolic

Name: Peter Smith

c

Prep- 1 hr

(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.

23/04-10/06/2015

8hrs

Exercise delivery- 52 yrs male farmer, type 2 diabetic, smoker. He is active and physical due to work demands but has gained 10kg due to poor diet. On Diabex medication- reports good compliance Goal- to manage diabetes and weight. Refer to dietitian F2F- 5 hrs Prep- 3 hrs

Face to Face (5 hours) Exercise prescription- 5 supervised sessions Exercise intervention- prescribed exercises/program- 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.

A.Beast A.Beast

At reassessment every 2 weeks retook anthropometrics, fitness testing, and reviewed exercise goals.

16/11/15-

20/11/15

4

Cardiac Rehabilitation Phase II Clients present with conditions

such as: Angioplasty/Stent/ICD/CABG/Valv

e replacement. Majority were diagnosed with

CAD. Age ranges 40-80, mostly male

Main purpose for exercise – cardiac rehab

Client #1: 53yo male, angioplasty, 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

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 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.

A.Beast A.Beast

ESSA PRACTICUM LOGBOOK- Category (please type here)

Name (please type here):

c



23/12/2015

3

Cardiac Stress Test: 3x 1 hr appointments Client 1: 55 yo female with 3 week hx of intermittent chest pain. Client 2: 69 yo male 2 years post non-STEMI. Reviewed yearly. Client 3- 72 yo male w/ 5 yr hx atrial fibrillation well controlled by medication until 3 months ago. F2F- 3 hrs

Located at XYZ Hospital. Test purpose – determine cardiovascular function through treadmill based cardiac stress test. The test protocol I implemented for all clients was as follows - Height, weight and BP were taken and recorded in chart. -Protocol explained, and explained reasons why we may stop the test. -Applied electrodes for 12 lead ECG to client. -Placed client on treadmill & attached to equipment. -Manual Bruce protocol implemented. -Client disconnected from all equipment -Test results collated & presented to cardiologist. Client 1: Test was completed fully with no aberrant rhythms detected. Client 2: Test was ceased at 6 min mark by client due to claudication. Heart rate was not increased enough to achieve clinically significant test results. Client 3: Test was stopped by medical staff at 10 min mark upon marked dyspnoea and increased run of AF. Emergency procedures implemented and client admitted overnight for observation & cardiologist review.

Dr B Honeydew

Dr B Honeydew

9/4/15 - 11/5/15

5

60 year old female, 6 months remission from breast cancer Wrote to GP for clearance prior to commencing.

Reviewed physiotherapy exercise program given at hospital during admission. Client reports completing this at home unsupervised regularly for last 6 months, but wishes to progress in strength & endurance.

A.Beast A.Beast

ESSA PRACTICUM LOGBOOK- Other Clinical Hours

Name: Peter Smith

c

F2F- 4 hrs exercise delivery,

Prep-

1 hr writing to GP

Client is attending 2 x 30 min supervised sessions per week in a gym setting. Ex Rx: Sessions focus on upper and lower body strength mainly using compound exercises. Exercises included- 5 min upright bike warm up, FB squats, calf raises, FB crunches, leg press, and hamstring curl. Client encouraged to perform 5-10 minute cardio cool down and generic stretching sheet post session. Extra care taken with chest exercises, started initial sessions with therabands (e.g. low row & chest press) and graduated to machine weights (seated row & chest press machine) in the final session as the client tolerated additional resistance. Monitored using RPE regularly throughout session. Good compliance and adherence to program. Regular lifestyle advice given throughout sessions re: general healthy eating guidelines and encouraged client to start own cardio exercise starting with walks around her block – using the talk test as her gauge and starting with 5 mins. Recorded home based progress in PA diary which was reviewed weekly to discuss barriers, motivation and progress. Outcomes: Client built to 3x15 min walks per week at the end of the block of sessions. Commenced with 2x8 for most resistance exercises, able to increase to 2x12 after 4 weeks.

4/6/15-9/11/15

3.5

2 x job capacity assessments with supervisor.

Client 1: 32 yo female on leave

from work on GP medical certificate due to anaemia. Previous hx of MVA causing

chronic cervical degeneration and significant adjust disorder w/ mixed anxiety & depression.

Supervisor is registered with DEEWR. Assessing individual’s ability to perform tasks and duties through a work capacity assessment to assist matching the individual up with suitable employment. JCA’s refer people with disabilities and other barriers to work to appropriate employment and support services, and their reports are used for Centrelink decisions about capacity to work. We completed a comprehensive assessment of people’s ability to work and participate in programs of assistance including: • identifying barriers to participation, • recommending interventions to help overcome these barriers, • assessing the impact of medical conditions on ability to work, • identifying any employment support requirements, and • direct referral to programs of assistance wherever possible.

A.Beast A.Beast

Client 2: 20 yo male hx of chronic fatigue and non-specific low back

pain.

F2F- 2 hrs Prep: 1.5 hrs

Client #1- Significant barrier to work was psych issues, so client referred to counselling services. Client #2- Client referred to work hardening program with AEP to improve core strength and general endurance to cope with part time retail work. Prep- review of testing procedures including questionnaire norms, familiarisation with assistance programs to refer to; setting up testing room.

www.essa.org.au


Supervision for:

Dear Supervisor

The above applicant will be applying for exercise physiology accreditation (AEP) with Exercise & Sports Science Australia (ESSA). Requirements of this accreditation include a minimum of 140 hours practicum in the area of cardiopulmonary/metabolic conditions.

Obesity

Impaired glucose

Dyslipidaemias

Diabetes mellitis

Hypertension

Asthma

Coronary artery disease

COPD

Peripheral vascular disease

Cystic fibrosis

Myocardial infarction

Chronic heart failure

Other


EXPERIENCE

CLIENT EXPOSURE



• Please note at two 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.

Metabolic

Cardiopulmonary



TOTAL HOURS

AND DATES


SITE / LOCATION






www.essa.org.au

Please attach this form to the front of your cardiopulmonary/metabolic practicum logbook

DECLARATION:


Signature Date

Full Name


Phone Fax

Email

Degree:

Experience:




2/3/15

3 hrs

(Client 1) 27 yo female

New gym membership, using free PT session to design program

1 hr F2F 2 hrs prep

F2F- Initial assessment – ESSA pre-screening tool. 5 yrs ago ankle injury playing netball, no problems since. No other flags identified- client is classed as apparently healthy. Ex history- walking dogs 6 months, gym membership for 3 months 2 years ago. Goals- tone up for wedding in 6 months. 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 used 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.

J.Doe J Doe

5/3/15-5/4/15

4 hrs (4x 1

hour PT sessions weekly

F2F)

(Client 1) 27 yo female

Goal- tone up for wedding

F2F- 4 hours

Reviewed test results with client, explained exercise plan and showed around equipment. 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.

J.Doe J Doe

ESSA PRACTICUM LOGBOOK- Category Apparently Healthy Practicum

Name: Peter Smith

c

Progression involved adding weight to squats in 3rd session, and increasing the incline on treadmill intervals. Client’s motivation wasn’t very high, so focussed on positive feedback and education about the purpose of the program. 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.

10/4/15-

11/4/15

14

Group of 24 male second division AFL players Aged 17-32

Goal- Increase fitness for

upcoming season F2F- 8 hours (testing and delivery of warm up & cool down with intention to prescribe exercise intervention) Prep- 6 hours (writing programs) (Total 14 hours)

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 injuries- including stretching routines. (8 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. 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.

J.Doe J Doe

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)

28/6/15-

10/11/15

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)

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. 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 30:30. 5-10 min boxing circuit 1 minute per station with running in between. Resistance circuit: 30 sec per station, run in between. Battling rope clean and

J.Doe J Doe

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 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).

ESSA PRACTICUM LOGBOOK- Category (please type here)

Name (please type here):

c

www.essa.org.au

PRACTICUM SUPERVISOR FORM

Supervision for:

Dear Supervisor

The above applicant will be applying to join Exercise & Sports Science Australia (ESSA). Apparently healthy practicum is face to face

delivery of an exercise intervention for the purpose of enhancing a client's health and fitness, wellbeing or performance. Exercise

interventions for the purpose of injury rehabilitation for example, are not accepted for apparently healthy practicum.


EXPERIENCE




TOTAL HOURS AND DATES*

EVIDENCE OF SPECIFIC ROLES AND DUTIES COMPLETED SITE / LOCATION






*Clinical supervisor: student ratios may be up to 1:5, with the proviso that there must be some 1:1 contact for each placement.

www.essa.org.au

Please attach to the front of your apparently healthy practicum logbook

DECLARATION:


Signature Date


Full Name


Phone Fax

Email

Degree:

Experience:

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