jobsEPcardiacREHAB

Background: One possible employment area for exercise physiologists is to work in the area of cardiac rehabilitation. However, little research has been conducted on the utilization of exercise physiologists in cardiac rehabilitation facilities. Thus the purpose of this study was to determine important occupational information about exercise physiologists working in cardiac rehabilitation. Methods: The present study analyzed the responses of 93 cardiac rehabilitation directors to an employment survey. Each participant completed a survey assessing the utilization of an exercise physiologist and the employment status, education, certifications, internships; patients treated per day, phases of cardiac rehab supported by the exercise physiologist, salary and job responsibilities. Results: Seventy-two of the 93 program directors reported utilizing exercise physiologists. Most facilities employed exercise physiologists full-time, while some facilities employed exercise physiologists part-time. Conclusions: The findings in the current study seem to be in line with previous research conducted in the United States.

Key Words: cardiac rehabilitation, exercise physiologist employment, career opportunity, salary

IN THE PAST DECADE exercise physiologists has become increasingly important in providing healthcare to individuals receiving medical attention for cardiac abnormalities [1]. Thus, many exercise science undergraduate and exercise physiology graduate students have an interest in obtaining employment in cardiac rehabilitation facilities. It is therefore important that the faculty who prepare exercise science students understand the needs of these facilities [2]. But, in general, there are little data to help guide faculty and students understand the hiring practices of program directors in cardiac rehabilitation.

Thompson, Bowman, Kitson, de Bono, and Hopkins [3] analyzed the staffs of 25 cardiac rehabilitation facilities in England and Wales. They found that one program out of 25 employed an exercise physiologist. Roberts [4] conducted a national survey of exercise physiologists working in 208 cardiac rehabilitation facilities in the United States. Questions were asked regarding employment of exercise physiologists, employment status (part-time or full-time), education, and certifications required of exercise physiologists to work in the facility. Roberts found that 60% of the facilities employed exercise physiologists. Also, the average number of exercise physiologists employed was approximately two per facility. Forty-eight percent of the facilities required a master’s degree, and 34% required a bachelor’s degree. Twenty-two percent of the facilities employed individuals with either a master’s or bachelor’s degree. In addition, Roberts [4] found that the ACSM certification was required in 43% of the facilities, and that ACLS certification was required in 45% of the facilities.

In a similar study, Davis et al. [2] analyzed the hiring and staffing practices of program directors in 98 cardiac rehab centers in California. Results indicated that: (a) exercise physiologists were the second most common staff member in the facility with nurses in first place; (b) of the 128 exercise physiologists identified, 48 were full-time and 80 were part-time employees; and (c) the starting salary for exercise physiologists was $18.24 per hour. The authors also reported that the Basic Life Support (BLS) and the Advanced Cardiac Life Support (ACLS) certifications were required for employment along with an internship in cardiac rehabilitation.

Clearly, more studies are necessary in order to provide the faculty and students with useful academic and/or occupational information. Since the Davis et al. [2] study was conducted in California, would the reader expect similar results throughout the United States? More specifically, would a survey of cardiac rehabilitation program directors in the Great Lakes region of the United States produce similar results? Hence, the purpose of this study was to determine the number of exercise physiologists employed in cardiac rehabilitation facilities, employment status (full-time, part-time, consultants), certifications deemed to be important, importance of the internship for entry-level exercise science graduates in order to obtain employment in cardiac rehabilitation facilities, and the minimum starting salary for exercise physiologists.

Additionally, in order to gain information about the training of exercise physiologists, the present study investigated the areas of cardiac rehabilitation supported by exercise physiologists, the main responsibilities of the exercise physiologist, how many patients are treated per day in the facility, and the minimum educational requirements necessary to obtain employment as an exercise physiologist in a cardiac rehabilitation setting.

Methods

Participants
Participants included 93 cardiac rehabilitation program directors in the Great Lakes region, who voluntarily agreed to participate in the study. Each participant was sent: (a) a cover letter, which described the purpose of the study; (b) the survey; and (c) a postage paid envelope to return the questionnaire.

Measures
The questionnaire contained items and questions assessing whether the facilities currently have a full-time, part-time, or consultant exercise physiologist on staff. The survey also contained questions regarding minimum educational training, certifications, internship importance and availability; number of patients treated per day, phases of cardiac rehabilitation treated at the facility, phases of cardiac rehab supported by the exercise physiologist, and approximate starting salary. Administrators were asked to describe basic job requirements of the exercise physiology employees.

Results
Results of the study indicated that exercise physiologists were employed at 72 of the 93 facilities. Of the 72 facilities that employed exercise physiologists, 59 (82%) hired exercise physiologists as full-time employees. Part-time exercise physiologists were employed at 35 of the facilities. Most rehab facilities hired either a full-time, parti-time, or a consultant exercise physiologists. That is, any one facility did not usually hire more than one of either type. The exception was one facility that reported the employment of more than 20 exercise physiologists. In terms of minimum requirements to work as an exercise physiologist, the program directors indicated that 44 required at least the minimum of a bachelor’s degree and 28 required at least the minimum of a master’s degree to work as an exercise physiologist. Eighty-two facilities required ACLS certification, while 66 required CPR/BLS certification. The ACSM certification was required by 25 facilities (27%). The ACE certification was required by five facilities. Fourteen (24%) of the 72 facilities that hired exercise physiologists required the candidate for a position in their facility to complete an internship. Most cardiac rehabilitation facilities in our sample (n = 71, 76%) also provide internships for students.

Program directors indicated that the most common phases of cardiac rehabilitation for exercise physiologists to support were phases II, and III, IV. It was not as common to have an exercise physiologist work in Phase I of cardiac rehabilitation. Program directors reported that exercise physiologists worked in 34 of the 38 facilities offering phase IV programs. Exercise physiologists with an undergraduate (UG) degree averaged $15.58 (n = 20), with an UG degree and certification $14.46 (n = 15), with an UG degree and experience averaged $16.70 (n = 15), with an UG degree, certification, and experience averaged $15.64 (n=14), with a master's degree averaged $15.53 (n = 26), with a master's degree and experience $15.97 (n = 18), and with a master's degree, certification and experience averaged $16.73 (n = 19).

Qualitative Analysis of Open-Ended Questions
One open-ended question asked, “If you employ an exercise physiologist at your facility, what are their primary duties?” Seventy-three program directors responded with the following:

A few specific responses referred to the exercise physiologist having the same responsibilities as the registered nurse (RN). For example, program respondents wrote: “Same as RN - except for physical assessments, is supervised by RN.” “Everything, same as RN.” “Everyone has the same responsibilities – RN and exercise physiologist.”

Discussion

The purpose of the present study was to survey program directors about the employment of exercise physiologists in cardiac rehabilitation settings. The results show that, although nurses are the most common employee in cardiac rehab, exercise physiologists run a close second. This finding disagrees with the findings of Thompson et al. [3] who reported that one out of 25 cardiac rehabilitation facilities in England employed an exercise physiologist, but agrees with the report by Davis et al. study [4]. They found that the second most common employee at the cardiac rehabilitation facilities was the exercise physiologist.

The present study also determined the employee status of exercise physiologists. The data indicate that most of the facilities employed more full-time exercise physiologists (n = 124) than part-time (n = 74), or as consultants (n = 10). This finding is not in accordance with the Davis et al. [4] study in which they found that California cardiac rehabilitation facilities employed more part-time (n=80) exercise physiologists than full-time (n = 48). However, in agreement with the Davis et al. [4] study, the ACLS and BLS certifications are important for employment.

Finally, the present study does not seem in agreement with Davis et al. [4] in terms of approximate salary for an exercise physiologist. The present study indicated a lower salary for exercise physiologists than the Davis et. al investigation. But, the salaries reported on average seemed to be similar to the average reported salary for an exercise physiologist ($16.83) working in a Florida Hospital [5], and the salaries reported from the salary survey of exercise physiologists by exercisejobs.com [6].

In analyzing the qualitative responses to the question that asked about job responsibilities of exercise physiologists, a variety of responses were received. The responsibilities for exercise physiologists, according to the program directors, include exercise prescription and patient education. Also, the exercise physiologists were responsible for overseeing exercise testing, which is consistent with the suggestions of Knight, Laubach, Butcher, and Menapace [7]. Thus, it would seem important that university programs training students for a career in cardiac rehabilitation dedicate part of the curriculum to exercise prescription, exercise supervision and monitoring, and exercise testing.

Other areas and competencies that are important for exercise physiologists who plan to work in the cardiac rehab setting is the ability to conduct initial assessments and patient interviews, the monitoring of heart rate, blood pressure, ECG, patient evaluation, and writing program reports. Interestingly, some program directors suggested that working with insurance companies for billing purposes is an important area of study for exercise physiologists.

Final Thoughts

The present study assessed items such as employee status, numbers of exercise physiologists, importance of certifications and internships, and salary of exercise physiologists working in cardiac rehabilitation. In addition, the present study added important data to the literature by assessing the areas of cardiac rehabilitation supported by exercise physiologists, and the primary responsibilities of the exercise physiologist. This research should help shape the curriculum for allied health professionals, including exercise physiologists. Future researchers should continue to the assessment of these areas to further understand the role of exercise physiologists in cardiac rehab and healthcare.

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Author note: Stacey L. Buser is Clinical Instructor, Alan S. Kornspan is Assistant Professor. Both are with the Department of Sport Science and Wellness Education. Address correspondence to: Stacey L. Buser, Department of Sport Science and Wellness Education, University of Akron, 140 Memorial Hall, Akron, OH 44325-5103

References
1. Crosby, O. (2001). You’re a what? Exercise Physiologist. Occupational Outlook Quarterly. 45:46-47.
2. Davis, S. C., Jankovitz, K. and Cooper, J. (2001). California cardiac rehabilitation practitioners and their staff preparation preferences. Clinical Exercise Physiology. 3:94-101.
3. Thompson, D. R., Bowman, G. S., Kitson, A. L., Bono, D. P., and Hopkins (1997). Cardiac rehabilitation services in England and Wales: a national Survey. International Journal of Cardiology. 59:299-304
4. Roberts, S. O. (1999). Do exercise physiologists need advanced cardiac life support training? Clinical Exercise Physiology. 1:100-104.
5. Florida Area Health Education (AHEC) Network. (2004). Exercise
Physiologist. [Online, October].
http://www.flahec.org/hlthcareers/EXERCISE.HTM
6. Exercisejobs.com. (2004). Salary survey. [Online, October]. http://www.exercisejobs.com/salary.htm
7. Knight, J. A., Laubach, C. A., Butcher, R. J., and Menapace, F. J. (1995). American Journal of Cardiology. 75:390-391.