EXSC679 - Clinical Assessment and Exercise for Chronic and Complex Conditions

Year

Credit points

Campus offering

Prerequisites

Nil

Unit rationale, description and aim

To be effective allied healthcare practitioners, accredited exercise physiologists must be able to integrate and synthesise clinically relevant information including knowledge of pathophysiology, symptomatology and co-morbidities, multidisciplinary models of clinical care including different treatment modalities, and evidence-based clinical assessment and exercise interventions to inform therapeutic management of individuals with chronic and complex conditions. This unit presents current medical and scientific knowledge of cancer, endocrine and metabolic conditions and other chronic and complex conditions indicated for exercise intervention. An examination of the aetiology, incidence, epidemiology and pathophysiology of the disease processes, as well as the adaptations that lead to multidisciplinary therapeutic management of the relevant conditions, are a major focus of the unit. Current evidence and contemporary guidelines for exercise testing and exercise prescription, in association with conventional treatments and other adjunct therapies, will be explored in detail. Methodological aspects of clinical individual assessment will be discussed and applied in combination with the principles of available exercise prescriptions. This unit aims to encourage students to incorporate learning into clinical reasoning processes to optimise exercise physiology-specific and collaborative, person-centred management of individuals with a range of chronic and complex conditions. 

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Demonstrate advanced coherent knowledge of anatomy, physiology, pathology and evidence-based clinical assessment and exercise interventions relevant to chronic and complex conditions (GA5, GA9)

LO2 - Demonstrate critical thinking and clinical reasoning to design and justify safe and effective person-centred exercise interventions informed by coherent knowledge of holistic clinical management, evidence-based practice and aligning goals and outcomes that matter to clinicians and individuals with chronic and complex conditions (GA4, GA5, GA8, GA9)

LO3 - Selectively apply evidence-based clinical assessments for individuals with chronic and complex conditions and demonstrate critical thinking and clinical decision making to interpret findings, which informs subsequent clinical management (GA1, GA3, GA4, GA5, GA8, GA9, GA10)

LO4 - Apply collaborative interprofessional communication and clinical reasoning that reflects on contemporary evidence-based practice to critically appraise the holistic clinical management of an individual with a chronic and complex condition (GA1, GA4, GA5, GA7, GA8, GA9)

LO5 - Conduct, interpret and provide feedback of safe and effective exercise testing for individuals with chronic and complex conditions integrating advanced and coherent knowledge of holistic clinical management and evidence-based practice (GA1, GA3, GA4, GA5, GA8, GA9)

Graduate attributes

GA1 - demonstrate respect for the dignity of each individual and for human diversity

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

GA10 - utilise information and communication and other relevant technologies effectively.

Content

Topics will include:

• Clinical Assessment and Exercise for Cancer (Module 1)
• Introduction to exercise oncology
• Common cancers: Breast and prostate cancer
• Common cancers: Colorectal cancer 
• Rare and less common cancers Palliative cancers
• Effective patient communication in oncology 
• Clinical Assessment and Exercise for Endocrine and Metabolic Conditions (Module 2)
• Type-2 diabetes mellitus
• Type-1 diabetes mellitus 
• Metabolic syndrome
• Chronic kidney disease
• Obesity
• Clinical Assessment and Exercise for Other Chronic and Complex Conditions (Module 3)

Each module comprises content including: 

• Anatomy and physiology of related systems.
• Aetiology, incidence, epidemiology, pathophysiology and symptomatology of related chronic and complex conditions.
• Common diagnostic testing for pathology and interpretations of relevant tests.
• Roles and interprofessional relationships between respective primary, secondary, tertiary and allied healthcare practitioners. 
• Conventional treatment(s)/treatment phases and associated symptomatology.
• The scientific bases for exercise intervention.
• Exercise Guidelines for relevant chronic or complex conditions.
• Testing & selection of screening tools, outcome measures and clinical assessments to inform prescription and or evaluation.
• Individualising exercise prescription.
• Client engagement strategies to ensure high quality, culturally safe, person-centred and effective exercise.
• Strategies for monitoring a client’s signs and symptoms prior to, during and after exercise.
• Exercise medicine and cancer survivorship.
• Gaps in the literature and latest evidence to inform considerations for individualised exercise prescription.

Learning and teaching strategy and rationale

This unit is offered through multi-mode delivery and aims to facilitate learner centred, online and face-to-face learning. Learning and teaching strategies within this Masters level unit are based on a blend of constructivism, social constructivism, and experiential learning. These strategies focus on active participation within a community of inquiry. Purposefully designed online and face-to-face workshop activities, focus on inquiry-based learning principles aimed at encouraging critical thinking, application of knowledge and skills, evidence for practice, collaborative peer learning and self-reflection.

This unit offers the opportunity for students to enhance their theoretical knowledge, augment their applied clinical management skills and increase their appreciation of knowledge and skills of their peers with the aim of translating learning into clinical practice. 

Synchronous and asynchronous activities, purposefully designed for individual and small group participation, will focus on analysis of current practice, to assimilate application of acquired knowledge and facilitate translation of learning into practice. Students will be encouraged to engage in extended dialogues in order to guide students towards a more interprofessional, person-centred practice. Students will attend face-to-face workshops across 12-weeks for spaced practice. 

A blend of case based and problem-based learning activities are provided pre-workshop and used during workshop discussions. These cases are used both to drive learning and as exemplars for learning with the aim of developing higher order thinking and reasoning including: consideration, interpretation, appraisal and critical analysis of data, information and ideas for guiding students towards innovative reasoning and holistic person-centred care. 

Assessment strategy and rationale

Assessment tasks in this unit have been purposefully designed to prepare for and replicate authentic clinical practice, with an “assessment for learning” approach to provide evidence for judgement of learning and to reinforce, facilitate and support learning and its application. The assessment tasks have been designed to provide a broad range of tasks aligned to andragogic principles of adult learning, facilitating choice and self-direction for the postgraduate student. The design enables timely judgement to ensure students have appropriate knowledge and skills prior to workplace application.

The first assessment task enables students to acquire advanced knowledge and understanding of content delivered throughout the unit. The second assessment task enables students the opportunity to use this knowledge and apply clinical reasoning to interpret the findings of a clinical assessment and prescribe an exercise rehabilitation intervention, which is informed by holistic clinical management, evidence-based practice and based on the individual needs and goals of a case study. The third assessment task provides an opportunity for students to critically appraise a peer’s clinical decision making to foster improvement in the future practice of both the appraiser and appraised practitioner. To do this successfully, students must use advanced theoretical and professional knowledge, clinical reasoning and interprofessional communication strategies to probe their peers' knowledge and understanding of clinical case management.   The final assessment task is an Ungraded hurdle exam, requiring students to demonstrate, at a minimum, the essential clinical competencies needed to safely and effectively service a client with a complex condition. Demonstration of these essential clinical competencies is necessary for safe and effective professional practice as an Exercise Physiologist. Students will be given two opportunities to successful complete this assessment with space for provision of individual feedback between opportunities, if required.

Overview of assessments

Representative texts and references

American College of Sports Medicine (2016). ACSM’s exercise management for persons with chronic diseases and disabilities (4th ed.). Human Kinetics.

American College of Sports Medicine (2016). ACSM’s guidelines for exercise testing and prescription (4th ed.) Lippincott, Williams and Wilkins.

Campbell, KL, Winters-Stone, KM, Wiskemann, J, May, AM, Schwartz, AL, Courneya, KS, . . . Schmitz, KH. (2019). Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Medicine and Science in Sports and Exercise, 51(11), 2375-2390. doi:10.1249/MSS.0000000000002116.

Ehrman, JK, Gordon PM, Visich, PS & Keteyian SJ (2018). Clinical Exercise Physiology (4th ed.). Human Kinetics.

Horden, MD, Dunstan, DW, Prins, JB, Baker, MK, Fiatarone Singh, MA, & Coombes, JS. (2012). Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise and Sport Science Australia. Journal of Science and Medicine in Sport, 15, 25 – 31. doi: 10.1016/j.jsams.2011.04.005.

Schmitz, K. H., Campbell, A. M., Stuiver, M. M., Pinto, B. M., Schwartz, A. L., Morris, G. S., . . . Matthews, C. E. (2019). Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: A Cancer Journal for Clinicians, 69(6), 468-484. doi:10.3322/caac.21579.