Memorandum by the Register of Exercise
1.1 The Register of Exercise Professionals
(REPs) is a system of self-regulation for all instructors, coaches
and teachers involved in exercise and fitness. In this context,
the register performs the same function for exercise instructors
as professional registers do for other groups of health professionals.
1.2 REPs went live on 1 January 2002. It
is supported by all the principal stakeholders of the fitness
industry. A Board of Trustees appointed by the Fitness Industry
will oversee the strategic development of the Register.
1.3 The development and conception of the
Register involved a number of key organisations:
Department of Health funding to help
support the implementation of the National Quality Assurance Framework.
Sport England funding for a feasibility
The Fitness Industry Association's
assistance in determining industry support.
SPRITO providing technical resources
to develop qualifications and standards.
1.4 REPs welcomes the Health Select Committee's
Inquiry into Delayed Discharges. This paper outlines sets out
the contribution that exercise referrals can make towards rehabilitation
services and the prevention of ill health, therefore helping to
tackle the problem of delayed discharges. It also sets out why
the Register of Exercise Professionals is important in terms of
ensuring high standards of care.
2. WHY HAVE
2.1 The aim of the Register is to create
a framework within which individual instructors can achieve the
highest standards of professionalism linked to best practice in
the health and fitness industry. It operates alongside the National
Quality Assurance Framework for exercise professionals, giving
health practitioners the confidence to utilise the skills that
exercise professionals possess, both in a preventative primary
health care context and in the rehabilitation of patients, allowing
an early discharge from hospital.
2.2 REPs operates three categories of registration,
ranging from Assistant Instructor (Level 1) to Advanced Instructor
(Level 3). Level 3 fitness professionals have the appropriate
skills to work with a number of special population groups including:
People with physical or learning
People with osteoporosis, arthritis
and back problems care.
Sufferers of depression/anxiety.
Those on weight control programmes.
Those on dementia care programmes.
2.3 Registration is achieved and maintained
through the attainment of nationally recognised qualifications.
The Register encourages a properly qualified base of exercise
Have gained recognised and approved
Can demonstrate competence in their
Are committed to continuing professional
Have appropriate insurance for the
level at which they are working.
Adhere to the Industry Code of Ethical
3. WHAT ARE
3.1 The fitness industry has an important
role to play in disease prevention, health promotion, and rehabilitation,
but to date this potential has largely gone untapped. By working
in partnership with appropriately qualified fitness professionals,
primary care teams can now offer patients an extended range of
opportunities for them to participate in safe and effective exercise.
As the fitness industry grows, opportunities for collaboration
3.2 The most common model of exercise referral
takes place in a primary care context. A GP or practice nurse
refers patients to public or private facilities such as leisure
centres or gyms for supervised exercise programmes. There is also
the potential for outreach programmes to be developed in nursing
homes and residential care settings.
3.3 Exercise as a form of rehabilitation
for patients in the highest risk categories, such as Phase III
hospital-based cardiac rehabilitation, the acute phase of osteoporosis,
falls, or severe depression, usually takes place in a secondary
or tertiary setting. Level 3 instructors are qualified to operate
in these environments, working as part of a multi-disciplinary
4. THE CONTRIBUTION
4.1 Supervised fitness has an important
role to play in the rehabilitation of people who have been hospitalised,
allowing as early as possible a discharge:
Standard 12 of the National Service
Framework for Coronary Heart Disease stresses the importance of
rehabilitation. Exercise-based cardiac rehabilitation results
in a reduction in cardiovascular mortality of 25 per cent and
is a relatively inexpensive form of healthcare.
Studies at the Carolinas Heart Institute
and the Sanger Clinic in the US show that older patients with
a higher percentage body fat, and who were classified as physically
inactive, were at risk of at least one serious complication and
a longer post-operative length of stay.
The Department of Health's Saving
Lives: Our Healthier Nation states that physical activity
promotion and participation is relevant to the treatment of cancer
as well as coronary heart disease and strokein primary
and secondary prevention and rehabilitation.
The Inclusive Fitness Initiative
is pioneering unparalleled access for people to participate in
exercise in a controlled and supervised environment, with appropriate
levels of assessment, evaluation, and integration with other opportunities.
This, and other similar programmes, provide suitable equipment
and facilities for disabled and disadvantaged people to partake
in supervised exercise. It also provides opportunities for continued
programmes of rehabilitation and preventative care for people
who would otherwise be vulnerable to secondary illness and who
can benefit from wider community activities and integration.
4.2 Regular exercise also has a major contribution
to make in the prevention of ill-health, keeping people out of
hospital and therefore freeing up beds:
Almost two thirds of general and
acute hospital beds are used by people over 65. The National Service
Framework for Older People states that older people who engage
in physical activity are more likely to prevent or delay the onset
of frailty and disability. This has significant benefits for the
individual and for society.
Healthier individuals improve their
resistance to a number of debilitating diseases and conditions
and physically fit and able people recover and rehabilitate faster
from injury and surgery.
One third of all coronary heart disease
cases and a quarter of strokes could be prevented with appropriate
exercise. The National Framework for Coronary Heart Disease identifies
exercise referral schemes as an effective intervention for those
at significant risk of cardiovascular disease but who have not
yet developed symptoms.
There is strong causal evidence for
the impact of physical inactivity on a number of other health
problems, including hypertension, diabetes, cancer of the colon,
falls and accidents, musculo-skeletal problems and mental health
problems (including depression, anxiety, negative mood, low self-esteem).
4.3 The Health Survey for England (Department
of Health 1999) established that 60 per cent of adult men and
70 per cent of adult women are not reaching recommended levels
of physical activity. Furthermore, the recent Committee of Public
Accounts' report Tackling Obesity in England estimated
that, on a conservative basis, obesity costs the NHS £500
million a year. Increased promotion of exercise referral schemes
and wider fitness as a preventative tool could save the NHS significant
sums of money, allowing resources to be diverted to further initiatives
to tackle delayed discharges.
5.1 REPs welcomes the role played by the
Department of Health in publishing the National Quality Assurance
Framework for Exercise Professionals and in providing start-up
funding for the register. This has made an important contribution
towards ensuring that exercise referral schemes are of a high
standard, demonstrating the Government's commitment to promoting
exercise as a means of tackling ill health.
5.2 GPs, practice nurses and other clinicians
need to be encouraged to utilise exercise referral schemes. The
Register and the National Quality Assurance Framework offer high
standards and we would urge the Department of Health to encourage
their use. Primary Care Trusts should be given greater encouragement
to integrate the development and utilisation of exercise referral
schemes, as well as more general physical activity, into their
Health Improvement Plans.
5.3 It is estimated that around 400 exercise
referral schemes exist in England. However there is insufficient
monitoring of the suitability of facilities used for schemes.
The National Quality Assurance Framework offers guidance and recommended
quality standards, but does not propose a national or regional
process for the approval, registration and monitoring of schemes.
REPs recommends that the Department of Health, in partnership
with the fitness industry, publishes agreed criteria for the evaluation
of schemes so that a national analysis of its effectiveness can
take place. This will allow best practice to be spread so that
schemes can fulfill their potential in delivering rehabilitation
5.4 REPs welcomes the opportunity to set
out the benefits of exercise referral schemes within the context
of the growing professionalisation of the fitness industry. We
await the Health Select Committee's Report on Delayed Discharges
with interest. We also look forward to reporting back to the Committee
in due course on the progress of exercise referral schemes in
contributing to the prevention of ill health and the rehabilitation
of those who have suffered illness or accident.
21 January 2002
40 The Fitness Industry Association is the trade body
for public and private fitness and leisure operators in the UK.
Its membership includes more then 1,300 operators and its primary
aims are to encourage best practice, facilitate the growth and
development of the industry and to guide the public towards health
and wellbeing. All FIA member sites are required to adhere to
a Code of Practice, which lays down specific conduct guidelines
covering health and safety, staff training and customer care. Back
SPRITO is the National Training Organisation for Sport Recreation
and Allied Occupations. Back
Unless otherwise stated, technical information in this submission
has been provided by Professor Adrian Taylor of De Montfort University
and the British Association of Sport & Exercise Science. Back
Oldridge NB, Guyatt GH, Fischer ME and Rimm AA (1988) Cardiac
rehabilitation with exercise after myocardial infarction. Combined
experience of randomised clinical trials. Journal of the American
Medical Association 260; 945-50. Back