Exercise physiology

Exercise physiology treatment involves the development and application of specialised exercise programs and interventions to aid recovery and independence after injury or surgery. Exercise physiologists provide information and advice about exercise and develop and monitor individualised exercise programs that are safe, effective and appropriate for the person.

Exercise physiologists aim to equip clients with the necessary skills and knowledge to progress their own exercise program independently. Exercise physiologists do not diagnose injuries or provide hands on treatment. Clients can find an accredited exercise physiologist on the Exercise and Sports Science Australia website.

The TAC can pay the reasonable cost of exercise physiology services provided to TAC clients which are:

• required as a result of transport accident injuries
• for treatment of a condition that has been diagnosed by a medical or allied health professional.

Where a pre-existing condition has become aggravated as a result of a transport accident, the TAC will consider funding treatment for that condition. The level of treatment that the TAC can consider funding will depend on the extent to which the transport accident has exacerbated the pre-existing condition.

For accidents that occurred prior to 14 February 2018 a medical excess may apply.

The TAC will pay for exercise physiology treatment. This includes:

• exercise physiology consultations, which may involve:
  • developing treatment plans for a diagnosed transport accident injury
  • reviewing progress using outcome measures
  • conducting psychosocial screening
  • supervising individual exercise programs
  • developing, monitoring and evaluating a gym or pool program
  • transitioning clients from provider-led treatment to self-management
• group consultations (between two and six patients being treated in the same treatment session) led by an accredited exercise physiologist
• basic exercise equipment prescribed by an accredited exercise physiologist, such as hand weights, therabands and exercise balls
• completion of an Allied Health Treatment and Recovery Plan when requested by the TAC.

The TAC will pay for treatment and services according to the Exercise physiology fee schedule. If a provider’s fee is higher than the TAC rate, the client may need to pay a gap fee to cover the difference. Information about how the TAC pays for services can be found on the Paying for treatment and services page.

The TAC won't pay for:

• services that are not required for the treatment of transport accident-related injuries.
• services provided by individuals who do not meet the provider guideline requirements or comply with the Allied Health Policy
• services that are not evidence based, reasonable, clinically justified and outcome focused.

This includes:

• Exercise physiology provided by a person who is not accredited by ESSA as an exercise physiologist (for example, personal trainers).
• Exercise attire, swimwear and footwear.
• The cost incurred by the exercise physiologist for admission to a gym or aquatic centre.
• Travel time to attend a gym or aquatic centre, as this cost is included in the scheduled fee.
• Concurrent exercise physiology at the same time as physiotherapy, osteopathy or chiropractic treatment unless it is clinically justified in the acute recovery phase or required for a brief handover period as part of a coordinated rehabilitation program. It is expected that physiotherapy, osteopathy or chiropractic treatment will cease as exercise physiology treatment progresses. Concurrent treatment may be approved for clients with severe injury and permanent disability as part of their MyPlan. See the Allied Health policy for further information.

Further information can be found at What we cannot pay for.

Within the first 90 days of a client’s accident, the TAC can help pay for exercise physiology services without the need for prior TAC approval. The TAC may contact clients or their service providers to discuss client progress and ensure that treatment is clinically justified and outcome focused.

If a client needs exercise physiology beyond 90 days after their transport accident, the provider must seek TAC approval before funded treatment can be delivered. Prior approval is also needed if it has been more than 6 months since the client last received TAC-funded treatment.

Exercise physiologists must complete an Allied Health Treatment and Recovery Plan for further treatment. The TAC will use this information to consider if the client is receiving treatment that aligns with the Clinical Framework and continues to be reasonable, clinically justified and outcome focused.  Based on this assessment, the TAC will inform the provider and client about what the TAC will help pay for and for how long.

To provide TAC-funded exercise physiology services, an exercise physiologist must:

• be accredited by Exercise and Sports Science Australia (ESSA) as an exercise physiologist
• comply with the TAC Allied Health policy
• adhere to the principles of the Clinical Framework for the Delivery of Health Services.

Promoting independence and avoiding treatment dependence

In line with Principle 3 of the Clinical Framework, the TAC expects that exercise physiologists promote independence from treatment through early education, setting clear treatment expectations and encouraging active participation in daily activities. Strategies to empower the injured person to manage their condition and discourage overreliance on treatment should be incorporated in all phases of recovery. Further guidance on promoting injury self-management is available in the Clinical Framework.

The TAC uses the following principles to make socially and economically responsible decisions in line with the Transport Accident Act 1986:

1. Entitled

A TAC client is entitled to a treatment or service if the TAC has accepted liability for the accident-related injury that relates to the treatment or service.

2. Reasonable

When deciding if a treatment or service is reasonable, the TAC considers whether the cost of the treatment or service is reasonable in relation to the relevant fee schedule.

3. Clinical justification

When deciding if a treatment or service is clinically justified, the TAC considers whether the following conditions are met:

• The treatment or service is clinically appropriate for the client’s transport accident injuries and presentation.
• The treatment or service complies with the principles of the Clinical Framework in that it:
  • results in a measurable benefit to the injured person
  • reflects the adoption of a biopsychosocial approach
  • empowers the client to self-manage their injury
  • has goals focused on optimising function, participation and return to work and health
  • is based on the best available research evidence.
• The treatment or service has a duration and frequency appropriate to the client’s condition and recovery progress. These factors are assessed on a case-by-case basis.  Treatment or service sessions may be more frequent during the acute recovery phase but are expected to become less frequent over time.
• Clients with severe injury or permanent disability may require longer term allied health supports as part of their MyPlan. Please refer to Treating clients with severe injury or permanent disability section above.
• The treatment or service should be discontinued and the client discharged when either:
  • the client can independently manage their recovery,
  • the client reaches a phase of maintenance and further progress is unlikely with ongoing treatments or services, or
  • there is no measurable benefit on outcome measure scores from continued treatments or services.

4. Outcome focused

When deciding if a treatment or service is outcome focused, the TAC considers whether it is progressing or achieving individualised recovery or participation goals that are meaningful to the client.