Using a Socioecological Approach to Explore the Integration of Exercise Physiologists into Primary Healthcare Teams

Objective: This paper explores the experiences of Clinical Exercise Physiologists (CEPs) and physicians participating in a pilot exercise referral program in Atlantic Canada. Additionally, the study aims to identify the barriers and facilitators that could impact broader integration of exercise professionals into primary healthcare teams. Design: Semi-structured individual interviews were conducted with CEPs and physicians involved in the exercise referral program to explore their experiences with the exercise referral program. The Socio-Ecological Model was used to draft a list of interview topics for discussion. Interviews were audio-recorded, transcribed verbatim, and analyzed using Lichtman’s three Cs approach to qualitative analysis. Setting: Two urban family medicine clinics associated with an Atlantic Canadian university. Participants: Four CEPs and five family medicine physicians who participated in the exercise referral program. Results: Four main themes emerged from data generation: (1) the importance of CEP-led advocacy for exercise referral in healthcare, (2) gaps in training and regulation of CEPs, (3) the unclear role for exercise professionals within healthcare, and (4) policy and organizational changes required to improve exercise referral. Conclusion: Based on our results, to improve exercise counselling services, efforts should be made to improve the ability of CEPs to advocate for their role on healthcare teams, address issues related to CEP training and regulation in Canada, create a more clearly defined role for exercise professionals within healthcare, and improve exercise referral billing and coverage. To our knowledge, this is the first study to qualitatively investigate the integration of CEPs into primary healthcare teams in Canada and could help guide efforts to expand multidisciplinary healthcare moving forward.