CLINICAL EXERCISE PHYSIOLOGY NEW ZEALAND
COMPETENCY STANDARDS
DOMAIN 1: PROFESSIONAL PRACTICE
STANDARD
A Clinical Exercise Physiologist (CEP) applies their knowledge and skills professionally, ethically, and inclusively across clinical and virtual settings. They demonstrate leadership through advocacy and collaboration, uphold ethical standards, maintain confidentiality, and engage in reflective practice to ensure evidence-based, culturally responsive, and equitable care for all New Zealanders.
1.1 ETHICAL AND LEGAL PRACTICE
Knowledge: Understands the CEPNZ Code of Ethics, CEPNZ Scope of Practice, and all relevant New Zealand legislation (e.g., Privacy Act 2020, Health and Disability Commissioner Act 1994, Health and Safety at Work Act 2015), along with the professional and legal implications of practicing outside these boundaries.
Skills: Identifies and navigates ethical dilemmas, maintains professional boundaries, and ensures ongoing informed consent for all services. Implements appropriate record-keeping, data security, and confidentiality practices.
Application: Consistently upholds professional integrity and accountability, ensuring all documentation is effective, concise, respectful, and legally compliant. Applies principles of safe and ethical digital service delivery for telepractice, including risk management and quality assurance.
1.2 CULTURALLY SAFE AND INCLUSIVE PRACTICE
Knowledge: Demonstrates a working knowledge of the Treaty of Waitangi principles (Tiriti o Waitangi), Māori health models (e.g., Te Whare Tapa Whā, Whānau Ora framework), and the concept of cultural safety. Recognises the impact of diverse ethnicities, cultures, belief systems, and socio-economic factors on health and well-being in New Zealand.
Skills: Critically self-reflects on personal biases, values, and privilege to ensure culturally safe and competent service delivery. Adapts communication strategies to effectively engage with individuals from diverse cultural backgrounds, fostering psychologically safe and trauma-informed environments.
Application: Integrates cultural safety measures and culturally responsive, person-centred practices into all aspects of clinical exercise physiology service provision, ensuring equitable and respectful care, particularly for Māori patients. Makes appropriate referrals to Māori health providers or other culturally relevant services when indicated.
1.3 COMMUNICATION, COLLABORATION, & REFERRAL
Knowledge: Understands effective verbal and non-verbal communication strategies for diverse audiences, including patients, whānau, and other health professionals. Knows the roles and scopes of practice of other health professionals within the broader healthcare system, and appropriate referral pathways.
Skills: Differentiates and selects communication strategies that are contextually appropriate, culturally responsive, timely, and accessible. Identifies when a patient's needs require input or referral to (or from) other health professionals.
Application: Practices collaboratively within multidisciplinary care teams, effectively seeking and providing feedback to inform decision-making, delegation of tasks, and appropriate referrals. Collaborates with patients and their whānau in shared care planning and decision-making, ensuring clear, respectful, and informative communication.
1.4 PROFESSIONAL DEVELOPMENT
Knowledge: Understands the importance of ongoing professional development, reflective practice, and the self-regulated nature of the CEP profession in New Zealand. Recognises the value of continuous learning, critical self-evaluation, and peer feedback for maintaining competence and advancing practice.
Skills: Engages in self-reflection and actively seeks feedback from supervisors, colleagues, and patients to critically evaluate service delivery and outcomes. Stays informed about advancements in clinical exercise physiology practice and relevant research.
Application: Actively participates in continuous learning, teaching, mentoring, and peer learning activities. Models professional behaviours, problem-solving, and contributes to the continuous improvement of personal practice and the profession.
1.5 ADVOCACY AND HEALTHCARE SYSTEMS KNOWLEDGE
Knowledge: Knows the value of advocating for the profession and patient access to services. Understands the structure, funding mechanisms, and referral pathways within New Zealand's primary, secondary, and tertiary healthcare, aged care, and disability sectors, including relevant compensable schemes (e.g., ACC) and their implications for CEP service delivery.
Skills: Identifies opportunities to articulate the role and value of clinical exercise physiology within interprofessional teams and to policy makers.
Application: Advocates for equitable patient access to CEP services and justifies the integration of exercise physiology as a sustainable healthcare solution within the NZ health system. Effectively explains the health system and compensable scheme frameworks to patients and other stakeholders to facilitate appropriate access to services.
2.1 INTEGRATED SCIENTIFIC UNDERSTANDING
Knowledge: Possesses integrated knowledge of functional anatomy, physiology, pathophysiology, biomechanics, motor control/learning, and behaviour change theories. Understands how acute and chronic diseases, injuries, and impairments (across cardiac, pulmonary, metabolic, musculoskeletal, neurological, oncological, immune/haematological, and psychological/mood disorders) impact physiological responses and adaptations to exercise across the lifespan.
Skills: Systematically analyses complex patient presentations, integrating knowledge from multiple scientific disciplines.
Application: Applies foundational scientific knowledge to inform clinical decision-making, ensuring person-centred care approaches and safe, effective exercise programming for diverse patient needs.
2.2 MEDICAL MANAGEMENT
Knowledge: Understands the effects of commonly prescribed medications, diagnostic procedures, medical and surgical interventions, and other treatments on resting and exercise-related physiological responses.
Skills: Critically evaluates and interprets medical information from various sources to understand its implications for exercise safety and prescription.
Application: Utilises this knowledge to tailor exercise interventions, manage potential interactions, and effectively collaborate within multidisciplinary and interdisciplinary care teams.
2.3 EVIDENCE BASED PRACTICE
Knowledge: Understands the principles of evidence-based practice, research methodology, and the hierarchy of scientific evidence.
Skills: Accesses, critically evaluates, and interprets scientific literature from credible sources.
Application: Applies research findings to develop evidence-informed and safe recommendations and exercise interventions that optimise health status, function, recovery, independence, and participation.
DOMAIN 2: FOUNDATIONAL CLINICAL KNOWLEDGE
STANDARD
A CEP critically evaluates and applies the clinical exercise physiology evidence base, integrated scientific knowledge, and patient safety considerations to develop effective exercise-based interventions in a range of healthcare settings for individuals with chronic health conditions.
3.1 SCREENING & RISK STRATIFICATION
Knowledge: Understands the principles and components of health appraisal, risk stratification, and prognosis evaluation for individuals of all ages and with various chronic health conditions. Knows infection control principles.
Skills: Applies appropriate screening processes to evaluate, stratify, and manage risk for participation in assessments and interventions. Formulates safe, inclusive, and effective communication strategies to collect relevant social, cultural, historical, and health information.
Application: Differentiates between normal deconditioning and abnormal physiological responses requiring medical evaluation. Utilises this information to plan and justify safe assessment protocols, ensuring patient safety across the full health spectrum.
3.2 ASSESSMENT & INTERPRETATION
Knowledge: Understands the methodology, contraindications, and interpretation of various clinical functional tests and exercise assessments, including ECG, gas analysis, strength, aerobic capacity, and body composition evaluations.
Skills: Conducts accurate and safe exercise tests using appropriate protocols, identifies absolute and relative contraindications, and expertly interprets results. Assesses movement patterns, major joints for stability/functionality, and identifies when clinical evaluations (e.g., ECG, expired gas analysis) are warranted.
Application: Evaluates, records, and interprets assessment outcomes in a timely and accurate manner to inform clinical reasoning. Recognises abnormal test results or signs/symptoms inconsistent with expected health status and refers for medical assessment or calls emergency services if appropriate. Documents findings accurately using structured notes (e.g., SOAP).
3.3 MONITORING
Knowledge: Understands the physiological and symptomatic indicators of patient change, deterioration, or improvement during exercise and throughout a programme.
Skills: Systematically monitors patients before, during, and after exercise for changes in status, including vital signs, O2 saturation, dyspnoea, pain levels, glucose/ketone levels, and mental state.
Application: Recognizes and responds appropriately to changes in patient status by identifying, recording, and managing emerging risk factors or adverse signs/symptoms. Modifies exercise prescriptions or initiates emergency procedures as necessary.
3.4 PATIENT MANAGEMENT
Knowledge: Understands factors affecting patient engagement, motivation, adherence, and self-management, including health and digital literacy, and accessibility barriers.
Skills: Formulates appropriate patient support strategies tailored to individual needs, preferences, and cultural background.
Application: Develops strategies to facilitate engagement with CEP services, considering patient needs, preferences, health and digital literacy, and factors related to accessibility (including for virtual care). Integrates health technology, mobility aids, and appropriate equipment to allow patients to safely achieve physical activity goals.
3.5 EMERGENCY RESPONSE AND RISK MANAGEMENT
Knowledge: Understands common medical emergencies and adverse events that may occur during exercise assessment and intervention (e.g., cardiac arrest, stroke, hypoglycaemia, severe asthma exacerbation, anaphylaxis). Knows emergency response protocols, the appropriate use of emergency equipment (e.g., AED, supplemental oxygen), and the chain of command for medical assistance. Possesses knowledge of infection control principles in emergency situations.
Skills: Holds and maintains a current First Aid/Basic Life Support/AED certification. Rapidly assesses emergency situations, identifies critical signs and symptoms, and initiates appropriate first responder actions. Implements safety protocols to minimise risk during assessments and interventions, including pre-screening for contraindications and establishing clear emergency action plans.
Application: Responds effectively and immediately to medical emergencies, following established protocols (e.g., activating emergency services, performing CPR, using an AED). Manages risk by consistently applying safety guidelines, adapting interventions in real-time based on patient status, and clearly documenting all incidents and responses. Communicates effectively with emergency personnel and the patient's care team during and after an adverse event.
DOMAIN 3: CLINICAL ASSESSMENT & PATIENT MANAGEMENT
STANDARD
A CEP conducts comprehensive screening, assessment, and evaluation of patient function, capacity, and health status to inform safe, effective, and tailored clinical exercise-based interventions, appropriate onward referrals, and robust patient support strategies.
4.1 PROGRAMME DESIGN
Knowledge: Understands the principles of exercise prescription modification for all clinical populations (e.g., elderly, those with specific chronic conditions, pre/post-surgery, amputees, neurological impairments, cancer) and all stages of training. Knows the relationship between oxygen cost, biomechanical efficiency, and performance.
Skills: Designs evidence-based exercise interventions and recommendations that effectively address health and treatment-related patient needs, preferences, goals, abilities, and assessment findings. Formulates incremental goal setting using the SMART guide.
Application: Develops case-specific exercise prescriptions, providing clear rationale for modifications based on a patient's requirements, functional limits, medical status, and identified limiting factors. Accurately plans and implements work/sport-specific and occupational rehabilitation programmes, adapting for post-surgical vulnerabilities or assistive device use.
4.2 PROGRAMME DELIVERY
Knowledge: Understands the importance of appropriate supervision levels, safety protocols, and outcomes monitoring for clinical populations, including emergency procedures and the use of supplemental oxygen.
Skills: Delivers, monitors, and adapts safe and effective movement, physical activity, and exercise-based interventions for patients with complex presentations, multi-morbidity, and varying levels of deconditioning. Provides appropriate supervision and instruction.
Application: Implements exercise programmes safely and effectively, consistently monitoring patient responses, using symptom limits, and making immediate adjustments or initiating emergency procedures as necessary. Counsels individuals on warning signs and symptoms and the proper use of medication related to their condition.
4.3 PROGRAMME ADAPTATION
Knowledge: Understands methods for evaluating programme effectiveness, selecting appropriate outcome measures, and continuously adapting interventions based on patient progress.
Skills: Formulates and applies strategies to manage risk, evaluate progress using specific outcome measures, and adapt recommendations and interventions based on evolving patient needs and measured outcomes.
Application: Consistently evaluates the quality and effectiveness of exercise interventions through follow-up testing and patient-reported outcomes, reporting results to patients, care teams, and other health professionals. Collaborates with patients to adapt exercise prescription and health behaviour strategies to increase engagement and empower self-management.
DOMAIN 4: EXERCISE PRESCRIPTION & DELIVERY
STANDARD
A CEP designs and delivers safe, effective, and tailored evidence-based clinical exercise interventions in collaboration with patients and relevant others. CEPs continuously evaluate the effectiveness of their services and employ continuous improvement measures.