Scope of Practice, Code of Conduct, Professional Concepts, Proper Record Keeping

Question 1

What is CSEP?

Answer 1

Originally known as the Canadian Association of Sport Sciences (CASS) – officially announced at the Pan Am Games in Winnipeg in 1967
>55 years ago!

CSEP is a “national voluntary organization composed of professionals interested and involved in the scientific study of exercise physiology, exercise biochemistry, fitness, and health.”

Question 2

What is CSEP’s Vision & Mission?

Answer 2

The recognized authority in exercise science and prescription,integrating research into best practice.

CSEP is the resource for translating advances in exercise science research into the promotion of fitness, performance, and health outcomes for Canadians. CSEP sets the highest standards for qualified exercise professionals through evidence-based practice and certification.

Question 3

What are CSEP’s Goals?

Answer 3

1) To be the national and international voice for exercise science and prescription in Canada, and to represent and advance CSEP positions.

2) To pursue the vision and mission in an ethical, effective, and financially responsible manner.

3) To provide members working in exercise physiology and health and fitness with timely, relevant products and services.

4) To increase awareness of CSEP in Canada and internationally with funders, within the exercise physiology sector, and among the general public.

5) To promote evidence-based practice through the development of standards, policies, guidelines, and research related to exercise physiology and health and fitness.

6) To define, develop, and implement effective knowledge translation activities related to CSEP’s evidence-based body of knowledge and advancing certification in a timely manner.

Question 4

What is a CSEP certification?

Answer 4

CSEP certified members are a community of qualified exercise professionals (QEP) who recognize the need to improve the health outcomes for all Canadians

CSEP is the Gold Standard in exercise science and personal training

Question 5

What are the CSEP Certifications?

Answer 5

CSEP certified professionals provide clients with individualized exercise programming that supports lasting lifestyle changes

Basic Level:
CSEP-Certified Personal Trainer (CSEP-CPT)
Advanced Level:
CSEP-Clinical Exercise Physiologist (CSEP-CEP)

Question 6

What is the CSEP-CPT?

Answer 6

Introductory health and fitness practitioner certification

Administer the CSEP-PATH to apparently healthy populations

Develops and implements tailored physical activity, fitness, and lifestyle plans

Represents the ‘minimum’ acceptable standard in the industry

Question 7

What is the CSEP-CEP?

Answer 7

Advanced health and fitness practitioner certification

Works with asymptomatic and symptomatic populations

Advanced assessment and exercise therapy to those with MSK, CV, metabolic conditions, etc.

Accepts referrals from licensed health care professionals

Question 8

What is the CSEP-PATH Foundation Knowledge?

Answer 8

Section 4 is the CSEP-PATH – it covers the 6 A’s (the first two [Ask, Assess] we will focus on for over half this course)
Section 4 [CSEP-PATH] builds on information covered in other chapters:
-Basic Anatomy & Physiology
-Lifestyle Behaviors and Health

Candidates are strongly encouraged to become familiar with the above chapters in addition to the behaviour change section and the sections on training with certain populations when moving through the 6 steps of the CSEP-PATH sequence

Question 9

What are the Basic Anatomy & Physiology of the body? (Systems and what they do)?

Answer 9

These systems (nervous, cardiovascular, respiratory, energy, musculoskeletal) all work together to get the body moving, to provide the oxygen and nutrients required for such movement, and to remove metabolic waste that are produced as a result of the movement (i.e., carbon dioxide, heat, and waste products such as lactic acid)

Question 10

What does CSEP-CPT Scope of Practice mean?

Answer 10

“Actions and activities that CSEP-CPTs are qualified and insured to perform under their defined certification”

Question 11

What is involved in the CSEP-CPT Scope of Practice?

Answer 11

Conducts pre-participation health screening assessments on all clients using evidence-informed tools, and gathers information about PA and lifestyle behaviors (Lab 1)

Administers various fitness assessments on clients including submaximal aerobic fitness, MSK fitness (strength, endurance, power, flexibility, balance), and anthropometry (Labs 2-6)

Gathers and applies information about the PA, fitness, and lifestyle of a client or group of clients to design, implement, and monitor client-tailored submaximal exercise programs for healthier living (your term assignment)

Recognizes their own area of expertise and refers clients who fall outside that expertise to a CSEP-Clinical Exercise Physiologist (CSEP-CEP), physician, or other appropriate health care provider

Question 12

A CSEP-CPT is NOT sanctioned by CSEP to?

Answer 12

*Utilize assessment protocols or design exercise programs requiring max aerobic or anaerobic effort

*Assess muscular strength using max 1RM or design programs based on resistance loads >90% predicted 1RM

Use ECG for any purpose

Administer fitness assessments, or design, implement and monitor client-tailored exercise prescription strategies for populations with unstable medical conditions or more than one medical condition, or that the CSEP-CPT feels ill- equipped to address.

Question 13

What is the high performance specialization?

Answer 13

if the CSEP-CPT has successfully completed the CSEP High Performance Specialization™, they may use maximal assessment protocols (including maximal 1RM) and design programs that require maximal aerobic or anaerobic effort for apparently healthy clients.

Focuses on performance and occupational testing and training for QEPs working with elite athletes, emergency services personnel, armed forces, and high performance clients

Question 14

Core Competencies of the high performance specialization?

Answer 14

Sport & occupational biomechanics, physiology, and performance psychology

Sport and occupational performance assessment

Sport and occupational exercise design & prescription

Energy intake for sport and occupational performance

Professional & ethical practice

Question 15

Clientele for CSEP-CPT may include?

Answer 15

Apparently healthy individuals

Individuals of all ages

Individuals with a stable health condition who are able to exercise independently

Question 16

What is the pre/post natal specialization?

Answer 16

Provides QEPs with the background knowledge to actively encourage a physically active lifestyle in their clients prior to conception, throughout pregnancy, and into the postpartum period

Both CPT and CEP certified CSEP members are eligible to pursue this credential

Once achieved it renews annually with your CPT/CEP without any additional fees

Question 17

Core Competencies during pregnancy?

Answer 17

Physiological adaptations to pregnancy

Components of a healthy pregnancy

Common pregnancy complications

Myths & misconceptions about exercise

Trimester by trimester exercise prescription

Sleep during pregnancy

Labor and delivery

Question 18

Core Competencies in the postpartum period?

Answer 18

Physiological changes

Future chronic disease risk and role of PA

Postpartum sleep

Breastfeeding

Considerations for beginning exercise

Promotion of active living

Question 19

What is the CSEP Code of Conduct?

Answer 19

Applies to all individuals who hold any CSEP certifications or Specializations

Does not give guidance on how to act in every situation, rather it provides a standard on making ethically responsible decisions

Also keep in mind relevant provincial and federal regulations

If a situation presents and it is unclear how to proceed, reach out to colleagues or CEP for clarification

Founded on principles of integrity, competence, devotion to service and achievement of human welfare – this concept should guide conduct at all times

Your actions will enhance the dignity and status of the profession

Through your practice, enhance the public understanding of the exercise profession and offer knowledge, skills, and abilities when it may be of benefit to the public

Question 20

CSEP Code of Conduct:Responsibilities to the Client

Answer 20

Act in a respectful manner and provide services without discrimination

Practice in a professional, competent, and responsible manner

Protect confidentiality, privacy, and security of client’s personal information

Apply only accepted evidence-informed principles and professional practices when providing services

Maintain professional boundaries

Avoid any real or perceived conflict of interest

Provide virtual services only when the same professional standards can be safely met as they do in-person

Continue professional development

Question 21

CSEP Code of Conduct:Responsibilities to the Profession?

Answer 21

Share only evidence-informed best practices and scientific knowledge to clients, students/mentees, the public, and to other healthcare providers

When opinion is given which is contrary to the general scientific opinion, it must be indicated as such

Develop reputation on basis of merit of service performed or offered

Accurately represent qualifications and competence

Refrain from offering or accepting covert payment

Contribute to development of profession through volunteering, research, mentoring, student supervision

Question 22

What are the CSEP Professional Concepts?

Answer 22

Understanding how adherence to CSEP-CPT Scope of Practice and Code of Conduct provisions will help mitigate risk of adverse events and liability exposure.

Question 23

In the context of providing clients with professional physical activity and fitness assessments as well as training services, the QEP needs to understand the following legal concepts?

Answer 23

1) Nature of injury related to physical activity

2) Liability exposure, negligence, standard of care

3) Risk management

Question 24

What is Nature of Injury Associated with PA?

Answer 24

From a legal standpoint, there are four potential causes of injury of concern to the QEP:

Inherent risks

Ordinary negligence

Gross negligence

Product defects / product liability

Question 25

What are Inherent risks?

Answer 25

risks inseparable from the activity

Question 26

What is Ordinary negligence?

Answer 26

fault can be attributed to either facility or QEP (e.g., failure to meet ’standard of care’) or the participant (e.g., misuse of exercise equipment)

Question 27

What is Gross negligence?

Answer 27

deliberate or reckless conduct (e.g., where QEP has prior knowledge of risks and does not take steps to correct it)

Question 28

What is Product defects / product liability?

Answer 28

manufacturer of a product (e.g., fitness equipment used for training purposes) is at fault due to defect in product design or manufacture, or due to inadequate warnings about their use

Question 29

What is Client Safety and Injury Prevention?

Answer 29

Consider benefits vs. risk

Err on the side of caution

Avoid high-risk / contraindicated exercises (E.g., sit-ups with hands behind neck, full squats, back hyperextension, full neck rolls, standing toe touch, etc.)

Question 30

What is Considering benefits vs. risk?

Answer 30

Relative risk is low, especially when compared to the health benefits associated with physical inactivity

Lowest among young adults

Question 31

What is Erring on the side of caution?

Answer 31

Mild-to-moderate exercise intensity at the start of a program

Excessive intensity, frequency, and duration offer very little additional benefic in terms of health status

Question 32

What is Liability Exposure?

Answer 32

QEPs typically work in situations where there is a risk of injury. While some risk is inherent, liability exposure occurs in situations where an injury is attributable to the actions of the QEP; e.g.:

-Injury as result of improper instruction and/or supervision of a client’s exercise

-Severity of an injury is greater due to the QEPs failure to carry out proper emergency procedures in the face of an adverse incident

Question 33

General categories for liability exposure?

Answer 33

Employment issues

Pre-exercise health screening

Exercise prescription

Facility and equipment issues

Emergency action plan (EAP)

Question 34

What are Employment issues?

Answer 34

inadequate staff training or recruitment procedures by employer

Question 35

What is Pre-exercise health screening?

Answer 35

failure to provide adequate client pre-exercise screening or assessment

Question 36

What is Exercise prescription?

Answer 36

client sustains an injury or exacerbates an existing injury due to inappropriate exercise instruction by the CPT

Question 37

What are Facility and equipment issues?

Answer 37

slip or trip hazards in a facility, or failure to properly maintain/service or secure equipment resulting in an injury

Question 38

What is an Emergency action plan (EAP)?

Answer 38

failure to have a proper EAP in place, the failure to properly train staff in its execution or the failure of staff to follow procedures which are in place

When proper pre-screening (discuss next class) and monitoring of client (discuss throughout course) is done – the risk of an adverse event or injury is unlikely

HOWEVER – establishing an EAP and practicing it on a regular basis is very important

Conduct emergency drills and practice CPR scenarios on a routine basis

EAP should be clearly defined and posted in a visible location

Question 39

What is Liability Exposure: Negligence?

Answer 39

Failure to do something that a reasonable/prudent professional would have done OR
Doing something that a reasonable/prudent professional would not have done

In other words - CPT did not meet ‘standard of care’

Question 40

Typically, if a legal case is pursued against QEP, their conduct will be examined from these perspectives?

Answer 40

a. What was the standard of care owed to the claimant by the QEP?

b. Did the QEP breach his/her standard of care?

c. Did the breach cause the harm in question?

d. What damages will the defendant owe to the claimant if negligence is proved?

Question 41

What is the Standard of Care?

Answer 41

Generally speaking, the standard of care for any QEP in Canada is to provide ‘reasonably safe’ programs and services for their clients

‘Reasonably safe’ implies taking precautions such as following proper risk screening procedures and taking all recommended precautions to prevent ‘foreseeable’ health and injury risks

‘Foreseeable’ health risks include medical conditions and/or risk factors that can lead to problems such as cardiac arrest, stroke, or an insulin reaction

Injury risks are conditions or situations that can lead to problems such as a back injury, bone fracture or joint sprain

Question 42

What is Liability Exposure: Confidentiality & Record Keeping?

Answer 42

Clients may share sensitive personal or medical information with a QEP

Clients trust that the QEP will use it only to inform their assessment and exercise prescription

QEPs shall keep records and reports clearly and concisely for the information of clients, professional colleagues, legal purposes, and to record physical activity, fitness, and health services

Question 43

What is Risk Management & Mitigation?

Answer 43

The best risk management strategy is to avoid risks!

A QEP can manage and mitigate risks of personal injury to their clients (and potential risks of negligence claims associated with injuries) by ensuring their conduct is always consistent with CSEP’s ‘standard of care’ as documented in:

-Scope of Practice
-Code of Conduct
-Certification procedures and requirements
-Procedures outlined in CSEP-PATH

Question 44

Take simple steps to avoid risks of personal injury to your clients such as?

Answer 44

Ensure clients are using proper technique and form

Use proper spotting techniques

Check facility’s floor is free of slips and fall or tripping hazards (e.g., promptly clean up water spills, ensure equipment is not left on floor when not in use, make sure clients are wearing appropriate footwear)

Mirrors, walls, exits, storage areas, lighting, etc. are maintained

Environmental factors are regulated (stereo volume, air temperature, etc.)

Safety & policy signs are in clear view

Equipment is maintained (cleaned, functionating, intact, calibrated) – CHECKED DAILY!

Keep proper records to monitor progress

Question 45

What is Professional Liability Insurance?

Answer 45

While most common risks can be successfully avoided, not all risks are foreseeable or avoidable

For risks that cannot be avoided (including inherent risks of PA) insurance is a common strategy to manage risk

QEPs have Professional Liability
Insurance that includes coverage for professional and commercial liability risks

Question 46

How to do proper Client Record Keeping?

Answer 46

Be well-organized & keep records of your client’s history, assessment results, training programs and progress

Records must be kept in a secure environment (e.g., password-protected files if on a computer or in locked cabinets if on hard copy)

Clear and concise records helps to provide clients with client-centered service over time and in the case of any legal proceedings

Question 47

What sort of records should you keep?

Answer 47

Keep records of:

Cleaning & maintenance,
Safety procedures,

Manufacturer’s warranties and guidelines

Personnel credentials

*Signed informed consent, Get Active Questionnaire, etc.

*Injury report forms

*Client data

*SOAP notes

*must be kept in a secure environment

Question 48

What are SOAP notes?

Answer 48

SOAP notes are a basic record keeping method employed by doctors and other health care providers

Informed consent should state that personal health information will be collected as part of the assessment

Question 49

What does SOAP Notes stand for?

Answer 49

S - Subjective Data
O - Objective Data
A - Assessment
P - Plan of Action

*Used in addition to the Client Information Sheet and other relevant paperwork

Identify all problems and needs; then follow each problem in its own appropriate time frame

Question 50

What is S: Subjective Data?

Answer 50

Subjective data obtained from the client

Use client’s own words to capture subjective data & incorporate your own subjective observations of the client

Question 51

What type of subjective data is important to collect?

Answer 51

Reason for visit

Relevant past medical history including medications or history of surgery

PA history: Did it work in the past? Why or why not? What are the limitations/barriers now?

Psychosocial factors (time/facility availability, job demands, etc.)

Question 52

What is O: Objective Data?

Answer 52

Objective data obtained by observations, pre-participation screening information, and the fitness assessment

Include a synopsis of the data collected that is relevant to the specific session being charted

Other paperwork like Get Active Questionnaire or client information sheet, etc. can be appended

If able, also gather appropriate information from allied health care team (e.g., physio, family dr.)

Question 53

What is A: Assessment?

Answer 53

Client’s status based on the interpretation of the subjective and objective information gathered

What are the clients strengths and weaknesses?

Did client have any adverse responses to exercise (physiologically or psychologically)?

Are further assessments needed?

Use assessment to guide plan of action
When doing the assessment, keep in mind your Scope of Practice as the SOAP note is a legal document.

Question 54

What is P: Plan of Action?

Answer 54

Client’s physical activity, exercise or lifestyle intervention

Goals?

Design individualized, client-centered exercise program to meet goals

E.g., Prescription Card

Note date of next appointment and schedule re-assessment (used to see improvements/progress)

Question 55

Where is SOAP Notes documented?

Answer 55

SOAP note information is documented in the CSEP-PATH Physical Activity and Exercise Prescription Card which is shared and discussed with the client in Step 4-AGREE

Question 56

Why make SOAP Notes?

Answer 56

Clarify the thinking process and the rationale for a course of evaluation, action or both

Unique needs and concerns are identified

Intervention is documented

Follow-up evaluations can be compared to earlier visits

Success or failure can be fairly judged