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History of
A.C.P.E.T
The ‘topic’ of exercise
therapy in British Physiotherapy, and healthcare in general, has received
increased attention from a variety sources over the last 12-24 months. In
fact, the current interest and debate surrounding exercise therapy in all
aspects of patient healthcare has been such that several articles,
letters, and comments have been published in both Physiotherapy
Frontline (see Vol. 12, No. 7, pp 18-19, 5th April 2006)
and iCSP. There has even been recent debate with regards to
‘ownership’ of exercise therapy within the Chartered Society of
Physiotherapy (CSP) and its Clinical Interest Groups (CIG). In view of
this, the Executive Committee believes it is essential that visitors to
this website are aware of the fact that ACPET has existed since 2001.
As such, the following is a brief history of ACPET, which is summarised
from a platform presentation delivered at the ACPET Inaugural Meeting at
the CSP in July 2006.
The core skills of
physiotherapy include manual therapy, exercise therapy, and electrotherapy
(CSP. 2004. Information Paper PA44. CSP. London). In an article
entitled ‘What All Physiotherapists Should Know, But Don’t…’ (2006,
Sports Injury Bulletin, Issue 57), Sean Fyfe, a Sports
Physiotherapist, stated that Physiotherapists are ill-equipped to devise
rehabilitation training programmes since they possess no understanding of
exercise training principles. Well in advance of this, in 1999, Jackie
Pattman, Superintendent Physiotherapist at The Princess Royal Hospital
in West Sussex, published a letter in Physiotherapy Frontline proposing
that a CIG in ‘Fitness’ was formed. At that time, three Members of the
CSP
were committed to taking such a CIG forwards: Jackie Pattman,
Nicholas Clark, and Caroline Gallehawk. All three were fully
qualified Exercise Instructors.
According
to Jackie Pattman, the conception of an exercise therapy /
fitness CIG was prompted by the publication of the ‘Exercise Referral
Systems: A National Quality Assurance Framework’ (NQAF) by the
Department of Health (www.dh.gov.uk).
This document considered exercise therapy in the care of ‘high-risk
populations’ such as patients experiencing falls, stroke, claudication,
Phase III cardiac rehabilitation, and Phase III osteoporosis
rehabilitation. However, there was virtually NO physiotherapy input. The
document was authored by sports physicians, sports scientists, exercise
instructors, and health and fitness industry representatives, was highly
complex, and yielded unclear role delineation, professional
responsibility, and multiple medicolegal ‘holes’ with regard to patient
care. Chartered Physiotherapists are strongly advised to download this
document.
Between 1999 and 2001,
preliminary support for an exercise therapy CIG was gained from the
Association of Chartered Physiotherapists in Sports Medicine (ACPSM), and
the ACPSM sub-group ‘Chartered Physiotherapists Who Provide Exercise in
the Community’ (CPEC) was formed, Chaired by Caroline Gallehawk.
Preliminary initiatives included meetings with the British Association of
Sports and Exercise Sciences (BASES) regarding the NQAF, and the
CSP
Professional Advisors regarding wider implications for the entire
physiotherapy profession. In July 2001, CPEC was changed to ACPET, and the
first version of ACPET’s Mission Statement, Aims, and Objectives were
approved by the CSP. In August 2001, following an invitation from the CSP,
ACPET drafted recommendations for the Undergraduate Curriculum Framework
Review Steering Group regarding the minimal content for exercise therapy
syllabi in the United Kingdom.
By April 2002, Jackie Pattman and Caroline Gallehawk were, unfortunately, unable to continue in
their voluntary roles in ACPET. In view of this, Nicholas Clark was
interviewed by Physiotherapy Frontline (see Vol. 8, No. 8, pp 9-10,
17th April 2002), when an invitation for interest and
involvement in ACPET was offered, and it was stated that “exercise therapy
was bigger and broader than just sports medicine”. This invitation
resulted in more than 100 supportive enquiries and messages from
throughout the United Kingdom, but, unfortunately again, no appointment of
voluntary committee members. This situation persisted until Autumn 2003,
when the CSP recommended that ACPET temporarily be abandoned.
In January 2006,
Physiotherapy Frontline (Vol. 12, No. 1, pp 26-29, 4th
January 2006) published an article regarding “staking a claim” in exercise
therapy and the role of the physiotherapy profession. In response to this
article, Nicholas Clark wrote a letter to the Editor (see Vol. 12, No. 7,
pp 18-19, 5th April 2006) outlining the history of ACPET.
Following this, the ACPET Inaugural Meeting was convened at the
CSP in
July 2006, and the first Executive Committee was elected. In September
2006, the first ACPET Executive Committee Meeting was held at University
College London, and an action plan agreed. This action plan included the
conception and planning of the first ACPET Exercise Therapy Study Day ‘Moving
Forward - Skeletal Muscle Performance and the Role of Strength Training in
Physiotherapy Practice’,
which was
successfully held on Friday 9 March 2007 at University College London.
To summarize, an informal
exercise therapy CIG was conceived as CPEC circa 1999. ACPET has
existed since 2001, and has been working to represent the wider
physiotherapy profession since before 2001. However, ACPET was temporarily
abandoned in 2003 due to the absence of a sufficient number of voluntary
committee members. In July 2006, a full Executive Committee was elected at
the CSP, and is now working voluntarily to support and develop the ability
of the Chartered Physiotherapist to appropriately apply exercise therapy
in all areas of their clinical practice and health promotion.
Finally,
it is worth noting that many individuals are now claiming that they
are able to provide ‘exercise therapy’ or ‘exercise rehabilitation’. These
individuals include health and fitness instructors
(e.g.
www.chekinstitute.com;
www.originhealth.co.uk), personal trainers (e.g.
www.nasm.org), sports therapists (e.g.
www.activehealthgroup.org.uk), and sports
rehabilitators (e.g.
www.basrat.org). It is not ACPET’s intent to
offer opinion on whether such individuals should or should not be
practicing exercise therapy with patients experiencing conditions ranging
from rheumatoid arthritis, muscular dystrophy, Parkinson’s Disease,
stroke, asthma, and sports injuries. However, it is ACPET’s intent to
support the fact that exercise therapy is a physiotherapy core skill.
Especially since some organizations, such as the British Association of
Sports Rehabilitators and Trainers (www.basrat.org),
are now seeking Health Professions Council (HPC) registration, which, if
successful, potentially allows such organizations and their members to,
theoretically, bid for outpatient rehabilitation services funded by
Primary Care Trusts (PCT). This scenario is not limited to musculoskeletal
physiotherapy, but also poses implications for the provision of ‘medical’
outpatient physiotherapy provision. So, the question is raised ‘how
relevant is exercise therapy to physiotherapy practice?’
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