Outline

Overview

The unit will develop professional, clinical decision making and practical skills for the assessment, design and delivery of physical activity in complex cases with multi-morbidity. Strong emphasis will be placed on student engagement in discussion with instructors and each other in tutorial and practical settings. Clinical scenarios will be used to develop understanding of scope of practise, core principles of case management, professional conduct and the employment of evidence based practise in complex, multi-morbid disease. Students will be challenged to identify contraindications and safety precautions for exercise that is advised from comprehensive client histories and screening, and how to communicate with other relevant stakeholders regarding current and past medical status/history, and when to refer onwards. By the end of the unit, students will demonstrate autonomy and expert judgement in the evaluation and assessment, and prescription of safe and effective evidence-based exercise for clients with complex multiple chronic diseases. The first half of the unit will focus on developing and advancing the fundamental skills of the AEP in the context of complex chronic disease (with clinical case study examples). The second half of the unit will put these fundamental principles into practise using a case study approach.

Unit details and rules

Unit code	EXSS5201
Academic unit	Movement Sciences
Credit points	6
Prohibitions ?	None
Prerequisites ?	EXSS5103 and EXSS5104 and EXSS5111 and EXSS5112 and EXSS5113 and EXSS5114
Corequisites ?	None
Assumed knowledge ?	None
Available to study abroad and exchange students	No

Teaching staff

Coordinator	Yorgi Mavrou, yorgi.mavros@sydney.edu.au
Guest lecturer(s)	Shantel Duffy, shantel.duffy@sydney.edu.au
Lecturer(s)	Maria Fiatarone Singh, maria.fiataronesingh@sydney.edu.au
Lecturer(s)	Yorgi Mavrou, yorgi.mavros@sydney.edu.au

Type	Description	Weight	Due	Length
Presentation	Case conference Present on a case study from your clinical placement.	30%	Formal exam period	20 minutes.
Outcomes assessed:
Skills-based evaluation	OSCE (Objective Structured Clinical Examination Demonstrate clinical competency and autonomy in core skills of the AEP	30%	Formal exam period	60 minutes 3 stations (20 min each)
Outcomes assessed:
Assignment	Sim Case study reports SOAP Notes, assessment, correspondence and Exercise management plan	40%	Week 02	4 case study reports.
Outcomes assessed:
= hurdle task ? = group assignment ?

Assessment summary

Sim Case study reports (40%):
- During Sim Lab, you will be divided into groups of 3 or 4.
- During your interaction with the sim patient, you will create SOAP notes, and begin to formulate an exercise management plan.
- Using these notes, you will:
  - Formalise your SOAP notes
  - Create an exercise management plan
  - Write a letter to the referring practitioner that details your assessment of the patient, your management plan (including goals), and any other pertinent information (this can include possible referrals, other health concerns picked up during the history/assessment, request for more information)
- As a group, you will submit your report for all 4 sim patients. Two of these reports for each group will be marked, at random.

Case conference (30%):
- Students will be required to select a complex case study that they worked with during their final two clinical placements.
- Students will present this case study to colleagues (maximum of 4 colleagues and 2 assessors).
- The presentation will include two components:
  - Part 1: history and background
    - All relevant social and medical history. This includes primary reason for referral, co-morbidities, medications, surgical history, living/social situations, and any other history that is relevant to the case study
    - Objective assessments and interpretation
    - Exercise management plan
  - Part 2: Reflection
    - Students should then reflect on the assessments and exercise management plan. Students should consider if the assessments and exercise were optimal and reflected best practice.
    - Challenges and adverse events. How were these managed/overcome, and what could have been better
- Colleagues will be encouraged to participate in discussion of the case study following the presentation.

OSCE (Objective Structured Clinical Examination) (30%):
- 7 stations will be created for students to demonstrate clinical competency and autonomy in core skills of EP practice
Assessment of aerobic capacity
Assessment of muscular strength
Assessment of functional capacity
Musculoskeletal assessment
Prescription of exercise based on clinical presentation
Modificiation of exercise based on changes in clinical status
Point of care testing Tim
- Students will be assigned 3 stations, at random
- At each station, students will be provided with a short case history
- Students will then be asked to show competency in the skill they have been assigned. Some stations will require practical demonstration, others will be assessed as a viva format.

Assessment criteria

High distinction	85 - 100	Awarded when you demonstrate the learning outcomes for the unit at an exceptional standard, as defined by grade descriptors or exemplars outlined by your faculty or school.
Distinction	75 - 84	Awarded when you demonstrate the learning outcomes for the unit at a very high standard, as defined by grade descriptors or exemplars outlined by your faculty or school.
Credit	65 - 74	Awarded when you demonstrate the learning outcomes for the unit at a good standard, as defined by grade descriptors or exemplars outlined by your faculty or school.
Pass	50 - 64	Awarded when you demonstrate the learning outcomes for the unit at an acceptable standard, as defined by grade descriptors or exemplars outlined by your faculty or school.
Fail	0 - 49	When you don’t meet the learning outcomes of the unit to a satisfactory standard.

For more information see guide to grades.

Late submission

In accordance with University policy, these penalties apply when written work is submitted after 11:59pm on the due date:

Deduction of 5% of the maximum mark for each calendar day after the due date.
After ten calendar days late, a mark of zero will be awarded.

This unit has an exception to the standard University policy or supplementary information has been provided by the unit coordinator. This information is displayed below:

In accordance with University policy, these penalties apply when written work is submitted after the due date: Deduction of 5% of the maximum mark for each calendar day after the due date. After ten calendar days late, a mark of zero will be awarded.

Academic integrity

The Current Student website provides information on academic integrity and the resources available to all students. The University expects students and staff to act ethically and honestly and will treat all allegations of academic integrity breaches seriously.

We use similarity detection software to detect potential instances of plagiarism or other forms of academic integrity breach. If such matches indicate evidence of plagiarism or other forms of academic integrity breaches, your teacher is required to report your work for further investigation.

You may only use artificial intelligence and writing assistance tools in assessment tasks if you are permitted to by your unit coordinator, and if you do use them, you must also acknowledge this in your work, either in a footnote or an acknowledgement section.

Studiosity is permitted for postgraduate units unless otherwise indicated by the unit coordinator. The use of this service must be acknowledged in your submission.

Learning support

Simple extensions

If you encounter a problem submitting your work on time, you may be able to apply for an extension of five calendar days through a simple extension.  The application process will be different depending on the type of assessment and extensions cannot be granted for some assessment types like exams.

Special consideration

If exceptional circumstances mean you can’t complete an assessment, you need consideration for a longer period of time, or if you have essential commitments which impact your performance in an assessment, you may be eligible for special consideration or special arrangements.

Special consideration applications will not be affected by a simple extension application.

Using AI responsibly

Co-created with students, AI in Education includes lots of helpful examples of how students use generative AI tools to support their learning. It explains how generative AI works, the different tools available and how to use them responsibly and productively.

Weekly schedule

WK	Topic	Learning activity
Formal exam period	WIL Debrief	Forum (4 hr)
Week -01	Preparation for Sim Lab Cases 1 - 3	Workshop (3 hr)
	Preparation for Sim Lab Cases 4 - 6	Workshop (3 hr)
	Sim Lab, cases 1 -3	Simulation laboratory (8 hr)
	Sim Lab, cases 4 - 6	Simulation laboratory (8 hr)
Week -02	Behaviour modification, barriers and goal setting	Lecture and tutorial (4 hr)
	Safe and effective exercise prescription in complex clients	Lecture and tutorial (4 hr)
	Responding to changes in clinical status	Lecture and tutorial (4 hr)
Week -03	Screening, communication and history taking	Lecture and tutorial (4 hr)
	Assessment and monitoring in complex clients	Lecture and tutorial (4 hr)
	Scope of practice and multidisciplinary care	Lecture and tutorial (4 hr)

Study commitment

Typically, there is a minimum expectation of 1.5-2 hours of student effort per week per credit point for units of study offered over a full semester. For a 6 credit point unit, this equates to roughly 120-150 hours of student effort in total.

Required readings

Readings will be made available on Canvas.

Recommended readings that may supplement this unit of study

Textbooks

Brooks G.A., Fahey T.D. and Baldwin K.M. (2004). Exercise Physiology, human bioenergetics and its application. McGraw-Hill. 4th Ed.

Cameron M., Selig S. and Hemphill, D. (2011). Clinical Exercise – a case based approach. Elsevier. 1st edition.

LeMura L.M. and von Duvillard S.P. (2004). Clinical Exercise Physiology: Application and Physiological Principles. Lippincott Williams and Wilkins.

Ehrman J.K., Gordon P.M., Visich P.S. and Keteyian S.J. (2003). Clinical Exercise Physiology. Human Kinetics

Additional reading

American College of Sports Medicine (2017), ACSM's Guidelines for Exercise Testing and Prescription (10th Ed.), Lippincott, Williams and Wilkins Pub., Baltimore, MD, USA.

American College of Sports Medicine (2016), ACSM's Exercise Management for Persons with Chronic Disease and Disabilities (4rd Ed.), Human Kinetics Press, Champaign, IL, USA

Learning outcomes

Learning outcomes are what students know, understand and are able to do on completion of a unit of study. They are aligned with the University's graduate qualities and are assessed as part of the curriculum.

At the completion of this unit, you should be able to:

LO1. Have an advanced and integrated understanding of the scope of practice, core principles of case management, and professional conduct of the AEP in the context of complex cases with multiple chronic diseases
LO2. Be able to apply their advanced knowledge of pathological and pathophysiological bases for chronic diseases to identify contraindications for exercise, and be able to choose appropriate screening and assessment tools (including point of care testing) in order to risk stratify and assess clinical status before, during and after exercise in complex cases with multiple chronic diseases
LO3. Synthesise knowledge received from multiple sources such as the referring practitioner, other allied health practitioners, the client and their own assessment tools, interpret results, and be able to communicate results back to clients and other stakeholders
LO4. Use expert judgement to design safe and effective exercise plans using available scientific evidence and guidelines that consider client treatment goals and relevant medical history in complex cases with multiple chronic disease
LO5. Show adaptability to changes in clinical status (acute and chronic) such as adverse events (including first aid and emergency responses), co-morbidities, or changes in functional capacity in complex cases with multiple chronic diseases
LO6. Critically assess barriers to exercise and formulate appropriate behavioural interventions to improve client exercise participation or compliance in complex cases with multiple chronic diseases

Graduate qualities

The graduate qualities are the qualities and skills that all University of Sydney graduates must demonstrate on successful completion of an award course. As a future Sydney graduate, the set of qualities have been designed to equip you for the contemporary world.

GQ1	Depth of disciplinary expertise Deep disciplinary expertise is the ability to integrate and rigorously apply knowledge, understanding and skills of a recognised discipline defined by scholarly activity, as well as familiarity with evolving practice of the discipline.
GQ2	Critical thinking and problem solving Critical thinking and problem solving are the questioning of ideas, evidence and assumptions in order to propose and evaluate hypotheses or alternative arguments before formulating a conclusion or a solution to an identified problem.
GQ3	Oral and written communication Effective communication, in both oral and written form, is the clear exchange of meaning in a manner that is appropriate to audience and context.
GQ4	Information and digital literacy Information and digital literacy is the ability to locate, interpret, evaluate, manage, adapt, integrate, create and convey information using appropriate resources, tools and strategies.
GQ5	Inventiveness Generating novel ideas and solutions.
GQ6	Cultural competence Cultural Competence is the ability to actively, ethically, respectfully, and successfully engage across and between cultures. In the Australian context, this includes and celebrates Aboriginal and Torres Strait Islander cultures, knowledge systems, and a mature understanding of contemporary issues.
GQ7	Interdisciplinary effectiveness Interdisciplinary effectiveness is the integration and synthesis of multiple viewpoints and practices, working effectively across disciplinary boundaries.
GQ8	Integrated professional, ethical, and personal identity An integrated professional, ethical and personal identity is understanding the interaction between one’s personal and professional selves in an ethical context.
GQ9	Influence Engaging others in a process, idea or vision.

Outcome map

Learning outcomes	Graduate qualities
Learning outcomes

Alignment with Competency standards

Outcomes	Competency standards
	Accredited Exercise Physiologist Professional Standards - 1.3.1. Illustrate the scope of practice of Accredited Exercise Physiologist (AEP) and the scope of roles available for AEP practice. 1.3.2. Employ core principles of case management and appropriate clinical reporting in the delivery of clinical, health and wellness, work conditioning and rehabilitation services within the boundaries of the ESSA AEP scope of practice and the healthcare system framework. 11.4.10. Practise employing pre-screening tools; exercise and functional capacity techniques; and active, passive and resistive assessment tests within the boundaries of the ESSA AEP Scope of practice. 11.4.4. Examine: the scope of exercise physiology practice in rehabilitation and return to optimised function environments; and the use and limitations in use of common diagnostic tests to inform exercise prescription. 11.4.6. Select and employ pre-employment and other screening tools/techniques within the AEP scope of practice to establish client baseline exercise and functional capacity; inform exercise prescription and monitor client progression.
	Accredited Exercise Physiologist Professional Standards - 11.4.10. Practise employing pre-screening tools; exercise and functional capacity techniques; and active, passive and resistive assessment tests within the boundaries of the ESSA AEP Scope of practice. 11.4.6. Select and employ pre-employment and other screening tools/techniques within the AEP scope of practice to establish client baseline exercise and functional capacity; inform exercise prescription and monitor client progression. 11.4.7. Consider medications, surgical, medical and allied health interventions/treatments, clinical and safety risks, co-morbidities, indications, contraindications, exercise setting, treatment objectives and their implications on clinical status, exercise and functional capacity, and the design and delivery of safe and effective exercise and intervention plans for individual musculoskeletal, rehabilitation and pre-employment clients. 3.3.1. Differentiate contraindications for exercise for all target conditions in the musculoskeletal and cardiovascular domains and a broad range of target conditions across the other AEP pathology domains. 3.3.3. Judge clients’ stratified exercise risk including when to refer onwards. 3.3.6. Recognise, interpret, revise and demonstrate in client-centred, multi-disciplinary care models, responses to changing risk factors, safety factors and clinical situations before, during and after assessments and exercise (including first-aid response), for all target conditions in the musculoskeletal and cardiovascular domains and a broad range of target conditions across the other AEP pathology domains. 4.3.2. Design safe and effective exercise plans that consider available scientific evidence, client treatment goals, medical history, clinical status, screening and assessments information and other influencing factors. 7.4.1. Examine cardiovascular pathological and pathophysiological bases; arrhythmias and pacemakers; generic cardiac diagnostic and prognostic procedures and indicators; common cardiac medicines and treatments; and cardiovascular indications and contraindications for exercise. 7.4.7. Consider medications, surgical and medical treatments/complications, allied health interventions/treatments, and clinical and safety risks and their implications on clinical status, exercise and functional capacity in the design and delivery of safe and effective exercise for individual cardiovascular clients. 8.4.1. Explain chronic kidney disease pathological and pathophysiological bases; effective clinical management including early identification, co-morbid disease management, inhibiting disease progression, managing clinical safety risk factors and exercise/equipment modifications; and relative and absolute contraindications for exercise including dialysis, blood pressure and impaired physiological response(s). 9.4.1. Examine the core principles of the mental health legislative framework; standard diagnostic criteria and major classifications; mental health pathological and pathophysiological bases; co-morbid cardiometabolic presentations; diagnostic, screening and outcome tools; and standard treatments and therapies for mental health and mental health target conditions. 9.4.4. Formulate and demonstrate employing, interpreting and responding to prognostic screening tools and identifying, evaluating and reporting exercise capacity and clinical status changes including verbal and written communication with clients, referrer and other relevant stakeholders.
	Accredited Exercise Physiologist Professional Standards - 10.4.5. Revise communication and leadership style to respond to changes in client and other stakeholder needs and manage changes in clinical situation. 11.4.13. Relay and report initial and changed status/progress to key stakeholders including client and referrer, considering good reporting principles and legislative and compensable scheme requirements. 12.4.7. Practise employing tools/techniques to measure client clinical status and interpreting clinical status results and their implications for safe and effective exercise participation for neurological clientele. 12.4.9. Relay and report initial and changed status/progress to key stakeholders including client and referrer, considering good reporting principles and legislative and compensable scheme requirements. 13.4.4. Practise methodologies and using technologies to measure respiratory and pulmonary function and capacity and interpret clinical status results and their implications for safe and effective exercise participation for respiratory/pulmonary clientele. 3.3.6. Recognise, interpret, revise and demonstrate in client-centred, multi-disciplinary care models, responses to changing risk factors, safety factors and clinical situations before, during and after assessments and exercise (including first-aid response), for all target conditions in the musculoskeletal and cardiovascular domains and a broad range of target conditions across the other AEP pathology domains. 3.3.7. Formulate and demonstrate measurement, evaluation and reporting of exercise capacity including verbal and written communication with clients, referrer and other relevant stakeholders. 8.4.5. Revise communication and leadership to respond to changes in client and other stakeholder needs and manage changes in clinical situation(s). 9.4.4. Formulate and demonstrate employing, interpreting and responding to prognostic screening tools and identifying, evaluating and reporting exercise capacity and clinical status changes including verbal and written communication with clients, referrer and other relevant stakeholders. 9.4.7. Revise communication and leadership style to respond to changes in client and other stakeholder needs and manage changes in clinical situation(s).
	Accredited Exercise Physiologist Professional Standards - 10.4.3. Consider medications, surgical, medical and allied health interventions/treatments, clinical and safety risks including hypo/hyperglycaemia and their implications on clinical status, exercise and functional capacity, and the design and delivery of safe and effective exercise for individual clients. 11.4.7. Consider medications, surgical, medical and allied health interventions/treatments, clinical and safety risks, co-morbidities, indications, contraindications, exercise setting, treatment objectives and their implications on clinical status, exercise and functional capacity, and the design and delivery of safe and effective exercise and intervention plans for individual musculoskeletal, rehabilitation and pre-employment clients. 12.4.3. Consider medications, surgical, medical and allied health interventions/treatments, clinical and safety risks and their implications on clinical status, exercise and functional capacity, acute and chronic exercise response in the design and delivery of safe and effective exercise for individual neurological clients. 13.4.5. Consider medications, surgical, medical and allied health interventions/treatments, clinical and safety risks, treatment goals and their implications on clinical status, exercise and functional capacity in the design and delivery of safe and effective exercise for individual respiratory/pulmonary clients. 4.3.2. Design safe and effective exercise plans that consider available scientific evidence, client treatment goals, medical history, clinical status, screening and assessments information and other influencing factors. 6.4.2. Consider medications, surgical, medical and allied health interventions/treatments, clinical and safety risks and their implications on clinical status, exercise and functional capacity in the design and delivery of safe and effective exercise for individual clients. 7.4.7. Consider medications, surgical and medical treatments/complications, allied health interventions/treatments, and clinical and safety risks and their implications on clinical status, exercise and functional capacity in the design and delivery of safe and effective exercise for individual cardiovascular clients. 8.4.3. Consider medications; surgical, medical and allied health interventions/treatments including transplant and dialysis; clinical and safety risks and their implications on clinical status; and exercise and functional capacity in particular mobility in the design and delivery of safe and effective exercise for individual chronic kidney disease clients. 9.4.3. Consider medications, medical and allied health interventions/treatments, clinical and safety risks and their implications on clinical status, exercise and functional capacity, and the design and delivery of safe and effective exercise for individual clients.
	Accredited Exercise Physiologist Professional Standards - 10.4.4. Recognise adverse clinical signs and symptoms including hypoglycaemic signs and symptoms; and identify and respond to changes in clinical status, co-morbidities, exercise and functional capacity, inter and intra session. 10.4.6. Identify changes in clinical status that need to be reported/referred onwards to deliver safe and effective client centred care in a multi-disciplinary care environment. 11.4.8. Recognise clinical signs and symptoms of adverse musculoskeletal response and identify and respond to changes in clinical status, co-morbidities, exercise and functional capacity, inter and intra session. 12.4.2. Examine the diagnostic criteria and procedures; comorbid secondary complications and their implications on clinical and safety risks for exercise participation and potential to change clinical status for neurological clientele. 12.4.4. Recognise adverse clinical signs and symptoms and identify and respond to changes in clinical status, co-morbidities, exercise and functional capacity, intra session and formulate response(s) to changing clinical situations. 12.4.9. Relay and report initial and changed status/progress to key stakeholders including client and referrer, considering good reporting principles and legislative and compensable scheme requirements. 13.4.6. Recognise adverse clinical signs and symptoms; and identify and respond to changes in clinical status, co-morbidities, exercise and functional capacity, inter and intra session including initiating first-aid response and/or assisting in administering respiratory reliever medications within professional practice parameters. 13.4.7. Relay and report initial and changed status/progress to key health professionals including client and referrer, considering good reporting principles and legislative and compensable scheme requirements. 3.3.4. Formulate measurement actions, monitoring actions, and strategies to manage client clinical status and changes in clinical status before, during and after assessment and exercise, for all target conditions in the musculoskeletal and cardiovascular domains and a broad range of AEP target conditions across the other AEP pathology domains. 3.3.6. Recognise, interpret, revise and demonstrate in client-centred, multi-disciplinary care models, responses to changing risk factors, safety factors and clinical situations before, during and after assessments and exercise (including first-aid response), for all target conditions in the musculoskeletal and cardiovascular domains and a broad range of target conditions across the other AEP pathology domains. 6.4.3. Identify and respond to changes in clinical status, co-morbidities, exercise and functional capacity, between and during exercise sessions. 7.4.6. Identify and respond to changes in clinical status, co-morbidities, exercise and functional capacity inter and intra sessions. 8.4.4. Identify and respond to changes in clinical status, co-morbidities, exercise and functional capacity, during and between exercise sessions. 8.4.5. Revise communication and leadership to respond to changes in client and other stakeholder needs and manage changes in clinical situation(s). 9.4.6. Identify and respond to changes in clinical status inter and intra session including behaviours non-conducive to exercise participation and/or progression, emergency response triggers including actual or perceived risk of harm to self, to / from others; medication and/or substance misuse; co-morbidities; exercise and functional capacity changes.
	Accredited Exercise Physiologist Professional Standards - 11.4.12. Employ behavioural change strategies and revise communication to facilitate mitigation of cognitive, behavioural and other influencing factors on treatment progression for individual musculoskeletal and rehabilitation clients. 12.4.8. Employ behavioural change strategies and revise communication to accommodate decreased executive function in neurological clients; accommodate changes in neurological client clinical status inter and intra session; and facilitate mitigation of cognitive, behavioural and other influencing factors on treatment progression for individual neurological and rehabilitation clients. 2.3.4. Illustrate fundamental behaviour change determinants, principles, theories and their application to improving client exercise compliance and lifestyle choices including exercise and nutrition. 4.3.1. Formulate strategies to manage negative influencing factors on client behaviours. 5.3.2. Deliver safe and effective exercise interventions to affect positive changes in exercise and functional capacity; health and wellness behaviours and that consider influencing factors including risk, safety, individual and sociocultural/economic factors. 5.3.4. Practise behaviour change techniques and strategies and responses to changes in clinical situation including employing first-aid techniques. 9.4.5. Examine barriers and their implication for exercise participation and/or progression in rehabilitation environment including individual and sociocultural/economic factors; and formulate mitigation strategies. 9.4.6. Identify and respond to changes in clinical status inter and intra session including behaviours non-conducive to exercise participation and/or progression, emergency response triggers including actual or perceived risk of harm to self, to / from others; medication and/or substance misuse; co-morbidities; exercise and functional capacity changes.

Responding to student feedback

This section outlines changes made to this unit following staff and student reviews.

N/A

Disclaimer

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Current students

Overview

Overview

Unit details and rules

Teaching staff

Assessment

Assessment

Assessment summary

Assessment criteria

Late submission

Academic integrity

Learning support

Learning support

Simple extensions

Special consideration

Using AI responsibly

Weekly schedule

Weekly schedule

Study commitment

Required readings

Learning outcomes

Learning outcomes

Graduate qualities

Outcome map

Alignment with Competency standards

Responding to student feedback

Responding to student feedback

Disclaimer

On this page

Useful links

Media

Student links

About us

Connect

Current students

EXSS5201: Exercise in Chronic and Complex Cases

Semester 1, 2021 [Normal day] - Camperdown/Darlington, Sydney

Overview

Overview

Unit details and rules

Teaching staff

Assessment

Assessment

Assessment summary

Assessment criteria

Late submission

Academic integrity

Learning support

Learning support

Simple extensions

Special consideration

Using AI responsibly

Weekly schedule

Weekly schedule

Study commitment

Required readings

Learning outcomes

Learning outcomes

Graduate qualities

Outcome map

Alignment with Competency standards

Responding to student feedback

Responding to student feedback

Disclaimer

On this page

Useful links

Media

Student links

About us

Connect