Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Register of Exercise Professionals (DD19)


  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 Association[40] and SPRITO[41] 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 analysis.

    —  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[42].


  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:

    —  GP referrals.

    —  Older adults.

    —  People with physical or learning disabilities.

    —  Cardiac Rehabilitation.

    —  Stroke sufferers.

    —  People with osteoporosis, arthritis and back problems care.

    —  HIV positive.

    —  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 professionals who:

    —  Have gained recognised and approved qualifications.

    —  Can demonstrate competence in their working environment.

    —  Are committed to continuing professional development.

    —  Have appropriate insurance for the level at which they are working.

    —  Adhere to the Industry Code of Ethical Practice.


  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 will increase.

  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 team.


  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.[43]

    —  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 stroke—in 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 services.

  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

41   SPRITO is the National Training Organisation for Sport Recreation and Allied Occupations. Back

42   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

43   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

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