Key recommendations
This Exercise and Sports Science Australia-endorsed consensus statement defines the role, scope and best practice integration of exercise physiologists within multidisciplinary mental healthcare. The practice principles outlined provide evidence-informed guidance for implementation in Australian services and offer direction for integrating clinical exercise professionals into mental healthcare internationally.
To effectively support people with lived experience of mental health challenges, exercise physiologists should demonstrate practice that is evidence-based and adopts approaches that are:
Person-centred, strengths-based and recovery-focused: Co-design exercise programmes which align with individual goals and recovery priorities, build on the person’s capacities and motivators, and support meaningful participation in work, study and social life while adapting to fluctuations in mental state or treatment needs.
Culturally responsive and trauma-informed: Respect diverse beliefs and values, collaborate with cultural and community representatives, and create psychologically safe, inclusive environments that recognise distress and respond in a collaborative, non-judgemental way.
Behaviour-change oriented: Use motivational interviewing and evidence-informed behaviour-change strategies to build confidence, self-efficacy and sustained engagement in physical activity.
To ensure safe and recovery-oriented care, exercise physiologists should support people with lived experience of mental health challenges across all core clinical stages by:
Conducting screening and assessment of physical, functional and metabolic health that considers the impacts of mental illness, medication effects and co-occurring physical-health risks.
Tailoring exercise interventions to individual recovery goals and adapting to fluctuations in mental state, symptom severity, fatigue and psychosocial barriers.
Monitoring and reviewing progress to guide progression, modification or transition to community-based physical activity or stepped-care pathways, ensuring safety and responsiveness to mental health needs.
Contributing to service capacity by educating staff, supervising students and leading initiatives that strengthen the response to treatment/management and prevention of physical health conditions within mental health services.
To optimise support for people living with mental illness, exercise physiologists should work collaboratively within multidisciplinary mental health teams by:
Engaging in shared care planning, regular multidisciplinary communication and participation in case reviews, discharge planning and routine physical-health screening.
Promoting exercise as a standard component of mental health care through clear referral pathways, routine documentation and monitoring of functional and metabolic outcomes.
Upskilling clinicians, peer workers and allied staff to strengthen confidence in supporting physical activity as part of mental health recovery.
Building strong connections with primary care and community-managed organisations to support ongoing engagement in physical activity beyond formal mental health services.
Introduction
Physical activity is increasingly recognised as a central component of evidence-informed mental healthcare.1 The World Psychiatric Association’s 2023–2026 Action Plan identifies the promotion of healthy lifestyle choices, including physical activity, as a key priority for the preservation and improvement of mental health.2 Physical activity is defined as people moving, acting and performing within culturally specific spaces and contexts, and influenced by a unique array of interests, emotions, ideas, instructions and relationships.3 Among these, exercise (ie, a structured and purposeful subset of physical activity4) stands out as one of the most robust and well-supported strategies for enhancing mental health across a wide range of diagnoses and presentations.1 5 In this paper, the term exercise is used to encompass both exercise and physical activity, consistent with Exercise and Sports Science Australia (ESSA) terminology for clinical exercise professionals and reflecting their role in delivering structured exercise while also supporting broader physical activity where appropriate. Meta-analyses and umbrella reviews consistently demonstrate moderate to large effects of exercise on reducing symptoms of depression, anxiety and psychological distress, with outcomes comparable to first line psychological and pharmacological treatments.6–8 In people living with severe mental illness (SMI), including schizophrenia and bipolar disorder, exercise improves psychopathology, cognitive function and social participation, with the greatest benefits often occurring when it is undertaken for leisure.1 5 9 Importantly, exercise not only reduces symptoms of illness but also enhances positive aspects of mental well-being, including mood, vitality, self-esteem and quality of life across the lifespan.1 10 These therapeutic effects are underpinned by a convergence of neurobiological, psychological and social mechanisms, including modulation of inflammation, oxidative stress, neuroplasticity, self-determination and social connectedness.1 Furthermore, exercise plays a vital role in improving physical health, mitigating medication-related side effects and reducing cardiometabolic risk factors that are central to addressing the 10–20-year life expectancy gap experienced by people with SMI, largely due to preventable diseases.1 11
Despite the strength of this evidence and the broad acceptability of exercise among people with lived experience of mental health challenges (PWLE),12 13 integration into routine mental healthcare remains limited. In response, several international bodies have called for urgent systems change. The World Psychiatric Association has launched a Healthy Lifestyles Hub to drive implementation efforts.2 The Lancet Commission on the Physical Health of People with Mental Illness highlights the ongoing failure to embed known interventions such as exercise, despite longstanding evidence.11 The WHO’s 2025 Mental Health Policy and Strategic Action Plans advocate for person-centred and rights-based approaches, including the integration of lifestyle interventions such as exercise within mental health systems.14 International Consensus Statements led by ESSA, the American College of Sports Medicine (ACSM), the British Association of Sport and Exercise Science, and Sport and Exercise Science New Zealand similarly call for integrated models that embed exercise professionals within multidisciplinary mental health teams, and emphasise the need for these practitioners such as exercise physiologists (EPs), physiotherapists and kinesiologists to receive training in basic mental health literacy and illness-specific exercise prescription to support effective integration.15 These unified calls to action provide the momentum to close the implementation gap.
To support the translation of this evidence into practice, this paper presents a new Consensus Statement defining the role, scope and integration of EPs within mental healthcare. A consensus approach was chosen because high-quality trial data already demonstrates effectiveness of exercise, but there remains inconsistency in clinical implementation. Consensus methods are well suited to defining scope, principles and integration strategies where evidence exists, but practice standards vary. The aim is to provide nationally relevant guidance for Australian practice, with international utility for exercise professionals, multidisciplinary teams, educators, service users and policy makers.
In this Consensus Statement, the term EP refers specifically to Accredited Exercise Physiologists (AEPs) in Australia, reflecting the Australian regulatory and professional framework. It builds on foundational work, including a 2016 statement that first articulated the potential of EPs to contribute to multidisciplinary mental health teams.16 An update was necessary to reflect major advances in research, workforce development and international policy since 2016. Since then, the profession has expanded significantly in Australia and globally.12 According to the latest ESSA National Workforce Report, published in 2023 and reflecting 2021–2022 data, 17% of EPs reported working with clients experiencing mental health conditions, highlighting the profession’s growing contribution to this area of care. With over 8400 EPs registered nationally and increasing integration across public, private and community sectors, Australia is internationally recognised as a leader in clinical exercise physiology.17 Mental health is now among the top five primary areas of practice for AEPs, as identified in the 2025 ESSA AEP Professional Standards Needs Analysis, further reinforcing the profession’s expanding role in addressing psychological well-being.18 This Consensus Statement reflects advances in research, clinical practice and implementation science. It aims to define the role and scope of EPs in Australian mental healthcare, outline best-practice principles and identify strategies for integrating EPs into multidisciplinary teams. It offers practical guidance aligned with rights-based, lifestyle-oriented models of care, in response to international calls for more integrated mental health services.
Methods
This Consensus Statement used a multistage approach aligned with the ACcurate COnsensus Reporting Document Checklist19 (see online supplemental information table S.1) to integrate evidence, clinical expertise, and key relevant parties’ perspectives on EPs in mental healthcare in Australia and was not prospectively registered. The process is shown in figure 1 and briefly described below. Full detail is available in online supplemental information 2, ‘Detailed Methodology for the Consensus Statement’.
Figure 1
Overview of the consensus development process. This figure outlines the structured, multistage process used to develop the 2026 Consensus Statement on the role of EPs in mental healthcare. The process was guided by a Delphi methodology and informed by current best practice in consensus development. A multidisciplinary Advisory Group comprising experts in clinical exercise physiology, psychiatry, psychology, lived experience, research and service delivery oversaw each stage. EPs, exercise physiologists; ESSA, Exercise and Sports Science Australia.
Summary of consensus statement method
An explanatory sequential mixed-methods design, incorporating focus groups with Advisory Group members and experts alongside structured survey responses, was used to gather and validate contributions at each stage of the Delphi process. A brief overview of the five-stage method is provided below. No incentives or reimbursements were offered, and participation in the consensus process was entirely voluntary.
The process commenced with the formation of a multidisciplinary Advisory Group (stage 1) in early 2024. Stage 2 involved a targeted review of literature and professional guidance published between 2016 and 2025 to identify contemporary research, policy documents and practice recommendations relevant to exercise physiology within mental healthcare.
The Delphi process (stage 3) comprised four steps. First, Advisory Group members drafted content sections using the updated evidence base, practice insights and lived-experience perspectives. Second, this draft underwent anonymous internal review, with items requiring ≥80% agreement to be retained; items below this threshold were refined through follow-up consultation. Third, iterative online focus groups with AEPs, mental health professionals and PWLE assessed the practicality and relevance of the content across clinical and community settings. Fourth, a revised draft was circulated for a second round of anonymous expert review and voting, with items not reaching ≥80% consensus adapted based on feedback.
After completing the Delphi stages, the final draft was submitted to the ESSA Publications Committee for peer review (stage 4). Revisions were made in response to feedback, and ESSA endorsed the Consensus Statement in September 2025. Stage 5 involved submission to BJSM for peer review. Full methodological details are provided in online supplemental information 2.
Patient and public involvement
A lived experience representative was a member of the Advisory Group and was therefore involved across all stages of the research, including shaping the research scope, contributing to study design, interpreting findings and drafting the manuscript. In addition, PWLE participated in stage 3 of the Delphi process as an expert focus group, ensuring that recommendations were practical, acceptable and relevant to service users.
Equity, diversity and inclusion statement
Individuals were intentionally selected to reflect a range of disciplines, lived experience, geographical locations and mental health service contexts. This included professionals from public, private and peer-led sectors, with gender diversity and state-based representation considered throughout recruitment. Efforts were made to balance clinical, academic and lived-experience perspectives to ensure the resulting consensus reflected a broad range of expertise and viewpoints. Data collection methods were designed to enable equitable participation, and interpretation of findings was guided by attention to health inequities faced by people living with SMI.
Results
Timeline of the Delphi process
The Delphi process was implemented between March 2024 and September 2025, progressing through Advisory Group formation (version 1), internal review (version 2), expert focus groups (version 3), expert panel voting (version 4) and ESSA peer review and endorsement (version 5).
Advisory group formation results
The Advisory Group comprised 14 individuals across six states and territories (New South Wales, Queensland, Victoria, Western Australia, South Australia and Australian Capital Territory) representing metropolitan, regional and rural locations. 10 were EPs with clinical and academic experience in mental healthcare. The remaining members included a psychology clinical academic, an academic with lived experience of mental illness and two exercise science academics, all with substantial involvement in research and/or service delivery relevant to EP practice. The group represented a balance of career stages (five early-career, five mid-career and four senior-career researchers) and consisted of eight males and six females. This group met in February 2024 and developed the aforementioned methodology for this Delphi study.
Review of the literature and professional guidance results
Evidence base
A targeted review of literature published between 2016 and 2025 was conducted to inform the development of consensus items. Evidence was appraised using the NHMRC Levels of Evidence framework, with most sources classified as high-level (levels I–III) based on study design and methodological rigour. Level I evidence primarily comprised meta-analyses and systematic reviews demonstrating that structured and supervised exercise interventions delivered by qualified professionals effectively reduce symptoms of depression, anxiety and psychological distress.1 5–8 National and international frameworks increasingly advocate for integrating lifestyle interventions into mental healthcare.2 14 Level II evidence included randomised and controlled trials assessing implementation and efficacy across clinical populations, while Level III evidence encompassed observational studies, translational implementation research and policy guidance examining feasibility, acceptability and workforce integration.20–24 However, gaps remain in EP role clarity, consistency of models, long-term outcome data and culturally responsive delivery. These gaps informed the design of the consensus domains and statements.
Delphi process results
Participants
A total of 46 experts were invited to participate in the consensus development process, including EPs with experience in mental health settings, mental health professionals and PWLE. Of these, 67% (n=31) expressed interest and 77% (n=24) contributed via structured focus groups or written feedback (see table 1). The panel included expertise in clinical exercise physiology, psychiatry, psychology, mental health nursing, dietetics, service management and lived-experience workers (ie, peer-support workers) spanning six Australian states and territories (New South Wales, Queensland, Victoria, Western Australia, South Australia and Australian Capital Territory). Participants identified as female (n=13), male (n=9) and non-binary (n=2).
Table 1
Summary of experts and engagement in the Delphi study
Delphi outcomes
The Delphi process achieved strong engagement across all stages. The Advisory Group (n=14) developed initial content, and step 2 feedback (83% response rate) led to revisions, with consensus confirmed after amendment (see online supplemental table S.3). In step 3, 24 experts supported the development of three tailored resources for clinicians, services and consumers (see online supplemental tables S.5-S.6; figures 2 and 3). In step 4, 29 participants completed the final voting round, with 11 of 12 items reaching the ≥80% threshold (see online supplemental table S.4). Further details regarding the outcomes of the Delphi process can be found in online supplemental information 3: ‘Detailed break-down of Delphi outcomes’.
Figure 2
Summary of best practice principles in mental healthcare for EPs. This figure presents the core best practice principles guiding EP practice in mental healthcare as defined by the consensus process. These include person-centred care, culturally responsive practice, mental health and trauma-informed practice, strength-based approaches, recovery-oriented practice and behaviour change using motivational interviewing. All principles are underpinned by evidence-based practice. EPs, exercise physiologists.
Figure 3
Core clinical EP intervention stages. Stages of EP clinical interventions, with connecting lines representing the dynamic and iterative nature of assessment, intervention and adjustment throughout the consumer’s journey. The bold bidirectional line reflects the flexible progression between stages, guided by the consumer’s needs, preferences and readiness for change. The dotted line surrounding the intervention stages represents best-practice principles, which are applied consistently at each stage. EP, exercise physiologist.
Consensus statement outcomes
Outlined below are the finalised Consensus Statement outcomes, structured into three key domains that define EP practice in mental healthcare: best-practice principles, the scope of EP interventions and the integration of EPs within multidisciplinary mental health teams. Here, PWLE are referred to as ‘consumers’, reflecting both the nature of their interactions with EPs and the preferred terminology identified by the lived-experience representatives involved in developing this consensus statement.
EP ‘best practice’ in mental health
EPs working in mental health contexts should apply best-practice principles that are foundational to mental healthcare, ensuring optimal care and recovery (summarised in figure 2). While these practices are aspirational, the level of knowledge and skill may vary among practitioners, and EPs are encouraged to pursue professional development to further develop their knowledge and competencies in these areas. Each is described in detail below, supported by synthesised evidence and examples to enhance practical relevance and application.
Evidence-based practice
EP practice is grounded in evidence-based principles and aligns with the EP Professional Standards outlined by ESSA, requiring EPs to critically evaluate peer-reviewed research and clinical guidelines and engage in ongoing professional development to inform effective decision-making across all aspects of their practice.25
Person-centred care
Person-centred care involves active consumer participation in clinical decision-making and recognises that each individual requires tailored treatment approaches, even among people with similar presentations.26 Person-centred care ensures consumers are treated as individuals by understanding their values, preferences and goals, and tailoring care to meet their unique needs and aspirations. It focuses on the whole person, rather than solely addressing a diagnosis or condition. EPs can adopt person-centred practices by considering the consumer’s personal resources and perspectives, involving them in programme development, setting collaborative goals, providing tailored education and making appropriate referrals. It also involves adopting language and terminology, consistent with the preferences of PWLE that avoids stigmatisation and promotes recovery (see ‘Recovery-Oriented Practice’). This aligns EPs with other health professionals and contributes to the overall shift towards the person-centred model. Person-centred care aligns with collaborative practice, meaning engaging both PWLE and other members of their care team in shared decision-making, ensuring that treatment approaches are informed by the consumer’s values, preferences and goals while integrating the expertise and input of all involved health professionals.27
Person-centred care also requires EPs to modify or manage exercise prescriptions based on the acuity and fluctuations in a consumer’s mental health condition. EPs must remain flexible, continuously assessing and adapting their approach to support the individual’s mental health and recovery journey. For example, in acute psychiatric settings or during periods of heightened symptoms, it may be necessary to adjust the intensity, duration or type of exercise to meet the consumer’s current capabilities. In some cases, exercise may not be appropriate if consumers are at risk of harming themselves or others. See Box 1 for a practical example of person-centred care.
Box 1
Practical example of person-centred care
A practical example of person-centred care in EP practice could involve a consumer living with generalised anxiety disorder who expresses discomfort in group environments. During the initial consultation, the EP engages the consumer in shared decision-making to understand their goals, preferences and perceived barriers. Based on this collaborative discussion, the consumer chooses to begin with 1:1 sessions with the EP in a quiet, familiar environment to help build trust, confidence and routine.
The EP continues to check in regularly, adjusting the programme in line with the consumer’s evolving needs. Over time, and with the consumer’s agreement, sessions may progress to include paired or small group-based activities, supporting a gradual and supported transition. This example demonstrates person-centred care through active consumer participation, individualised planning and flexibility to align with what matters most to the consumer.
In line with ‘person-centred care’, the joint Consensus Statement between Sports Medicine Australia and the Australian Psychological Society28 highlighted the importance of contextual factors including type, physical environment, delivery, domain and social environment. The key recommendations included guiding activity selection by factors associated with adherence and enjoyment, delivering sessions that support autonomy, competence and social connection, and encouraging participation in supportive social environments unless solo activity is preferred. Additionally, it’s advised to incorporate outdoor activities in natural settings and prioritise leisure-time or active travel exercises those individuals personally choose. For those in rural and remote settings, interventions may need to be adapted to include telehealth delivery29 or by using local resources, such as community spaces or natural outdoor areas, to ensure accessibility and engagement. These recommendations can and should be effectively integrated into EP practice.
Strengths-based practice
Strengths-based practice involves promoting well-being through focusing on consumers’ capacity, skills, knowledge, connections and potential, rather than their deficits, pathologies or problems.30 Strength-based approaches facilitate autonomy, self-efficacy and resilience. A key component to strength-based practice is identifying barriers to exercise engagement or maintenance, guided by aspects of self-determination theory31 and working with the consumer to develop key strategies to overcome their personal barriers.32 Table 2 highlights key examples of common barriers to exercise,33 with examples of strategies to overcome these barriers.
Table 2
Common barriers to exercise, with examples of strength-based strategies to overcome these barriers
Tailored behaviour change with motivational interviewing
Given the high rates of sedentary behaviour and unique barriers faced by PWLE, it is crucial for EPs to integrate evidence-based communication strategies to promote movement.34 Overcoming exercise inertia and amotivation, often due to low self-efficacy and negative past experiences, is a significant challenge. Behaviour change techniques and motivational interviewing are effective tools that can increase intrinsic motivation, help individuals overcome barriers and improve adherence to exercise.35 36 A recent review called for increased education and implementation of behaviour change techniques within mental health services, emphasising the need for these strategies to be embedded in standard care practices to enhance both physical and mental health outcomes.37 EPs are well-positioned to lead this integration, advocating for comprehensive support that addresses both physical and psychological needs. See Box 2 for a practical example of tailored behaviour change using motivational interviewing.
Box 2
Practical example of tailored behaviour change with motivational interviewing
An EP might work with a consumer who feels unsure about increasing their exercise frequency by using a decisional balance approach. Together, they explore what could be gained from making a change, such as an improved mood or having more energy, and what might happen if nothing changes, including ongoing fatigue or a lingering worry that their health could worsen over time. This technique helps the consumer clarify their motivations and barriers, ultimately increasing their confidence to begin exercising and improving adherence.
Recovery-oriented practice
In mental health contexts, recovery is not defined by the absence of symptoms, but rather by the process of living a meaningful and fulfilling life despite the presence of mental health challenges.38 A common understanding of recovery can be represented using the CHIME framework, which describes connectedness, hope and optimism, identity, meaning and purpose, and empowerment as key components.39 Recovery-oriented practice in mental health has been defined as ‘being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issues.40 See Box 3 for a practical example of recovery-oriented practice. EPs can adopt recovery-oriented principles by integrating the principles of recovery-oriented practice within healthcare interactions. This involves supporting consumers in their personal recovery journey, adopting non-stigmatising language, promoting shared decision-making, fostering hope and empowerment, encouraging self-management and recognising the unique strengths and goals of each individual.40 EPs must also be adaptable and responsive to changing mental health presentations while normalising setbacks as a natural part of the recovery process, acknowledging each person’s unique recovery journey.
Box 3
Practical example of recovery-oriented practice
An EP could align an exercise programming with a consumer’s broader recovery goal of ‘returning to work’ by working with the consumer to design a programme that aims to build the functional capacity needed for their specific or desired job, such as improving endurance or walking tolerance, thereby making the exercise more relevant, motivating and supportive of their overall recovery journey.
Mental health and trauma-informed practice
Mental health-informed practices should be embedded across all aspects of care to support early recognition, timely intervention and compassionate engagement with individuals experiencing psychological distress. These practices involve identifying early warning signs of mental health deterioration, creating psychologically safe environments, and responding in a person-centred manner. Practitioners should regularly monitor consumers for changes in mental health presentations (including self-reported symptoms and observable behaviours), and act promptly by referring to appropriate team members or mental health professionals when there is evidence of a decline in mental state or acute risk (eg, emergence of self-harm or suicidal ideation). These approaches are consistent with evidence-informed frameworks such as Mental Health First Aid.41
A major component of mental health-informed practice is trauma-informed care, which recognises and acknowledges that trauma is common, particularly for PWLE.42 Therefore, services should be designed to avoid re-traumatisation and promote safety in physical, emotional, spiritual and cultural aspects.43 EPs can provide trauma-informed care by applying the aforementioned ‘best practice principles’ and engaging with consumers in a collaborative, empathetic, non-judgemental and humble manner to build a strong therapeutic alliance, fostering trust and safety. It is essential for EPs to understand the communities they are working with, respecting social, cultural and historical contexts that shape individual sensitivities and past traumatic experiences. This requires EPs to consider the impacts of trauma at all stages of exercise programme design and delivery (ie, trauma-informed), ensuring safe, engaging and effective methods that promote equitable access to the benefits of exercise.44–46 See Box 4 for a practical example of trauma-informed care in EP practice.
Box 4
Practical example of trauma-informed care and practice
An example of trauma-informed care in EP practice could involve working with a consumer who has a history of interpersonal violence and is particularly sensitive to physical contact. At the outset, the EP might ask, “Is there anything I can do to make you feel more comfortable or ensure the environment feels safe for you?”
This allows the consumer to express preferences, such as avoiding physical contact during posture correction, choosing the gender of the clinician or support person present, or adjusting the session environment. Importantly, the EP maintains a flexible, respectful approach, promoting the consumer’s control, autonomy and sense of safety throughout each interaction.
Culturally responsive practice
Minimising health inequities among communities exposed to intersecting social, economic or political constraints, such as Aboriginal and Torres Strait Islander people and migrant and refugee communities, requires EPs to address the social and cultural determinants of health and adapt care accordingly. Culturally responsive practice involves recognising and respecting diverse cultural understandings of health and adapting care to align with consumers’ cultural beliefs, practices and values.47 In mental health settings, this includes recognising that cultural perspectives shape how mental health and recovery are understood, and that stigma, language and belief systems influence help-seeking and engagement. EPs should be responsive to these cultural frameworks to ensure care is respectful, meaningful and contextually appropriate.48 EPs should reflect on personal biases, use other appropriate professionals where available (eg, interpreters, translators, bicultural workers), and adapt exercise services to be appropriate for a consumer’s cultural values, thus ensuring cultural responsiveness.49 This may, for example, include integrating cultural practices (eg, dance), modifying the environment to consider privacy or religious practices, for example, women-only spaces or playing music of the consumer’s preference. EPs should also undertake further cultural-safety training and maintain currency with relevant resources to ensure they maximise their capacity to deliver culturally responsive practices.50 Practising humility (defined as self-awareness, acknowledgement of limitations and appreciation for others)51 allows EPs to be reflexive and learn from the people they support. This fosters trust and creates respectful and effective engagement with diverse communities.52 See Box 5 for a practical example of culturally responsive practice.
Box 5
Practical example of culturally responsive practice
A practical example of culturally sensitive practice for an EP working with an Aboriginal consumer could involve inviting a trusted Aboriginal health worker or family member to the initial meetings. This supports culturally appropriate rapport building and shared planning, which can help the consumer feel more comfortable, safe and understood from the outset.
Another example may be routinely embedding questions during initial engagement or assessment, about how consumers choose to identify according to their gender, respecting and acknowledging their gender identity, and incorporating this into the care plan to create a safe and inclusive environment.
Scope of practice of exercise physiology interventions
ESSA’s EP Scope of Practice document53 details the minimum activities, roles and professional practice standards for EPs. Below, we detail how the EP scope of practice applies to supporting PWLE (referred to as consumers, in the context of healthcare interactions with an EP), inclusive of those who experience symptoms with low to high impact on their daily functioning. The activities within the scope of practice of the EP are broadly described as:
EP interventions across the healthcare journey
Professional responsibilities beyond consumer interaction, and
Advanced and extended scope of practice for EPs.
EP interventions across the healthcare journey
This has been described in accordance with key stages of an EP intervention (figure 3). Importantly, the extent of assessment, intervention and nature of discharge planning will be largely dependent on the setting in which the EP is working, and consumer is receiving care.
These stages are described in detail below:
Referral and intake
Collaborate with PWLE, health professionals, care coordinators, family, carers and other key relevant parties to facilitate referrals, including self-referrals which are particularly relevant in private practice settings.
Gain an understanding from referrers and other key relevant parties on the consumer’s health literacy level, that is, ability to access, read, understand, interpret and use health information.
Liaise with mental health clinicians, physicians, peer support workers, family, carers and all others involved in care to ensure the consumer’s needs are met, including considerations of their mental health status, symptoms and any potential risks. This helps support mental health-informed practice, including identifying possible symptom exacerbators or environments that create a sense of safety.
Engage in multidisciplinary communications, meetings and clinical handovers to ensure seamless referral process and necessary collateral information is received to ensure effective care.
Engagement
Building trust and fostering engagement with consumers which may involve the inclusion of trusted family members, carers or other health professionals in initial meetings. An example may be inviting an Aboriginal Health Worker or a primary carer for someone living with autism spectrum disorder into initial consultation with the consumer.
Informal assessment of factors relating to consumers’ health literacy and exercise readiness by gaining an understanding of their interests, motivators, hobbies and preferences.
Re-engagement can occur at any stage of care, as consumers may disengage and re-enter the process at different points depending on their circumstances and readiness.
Initial screening and assessment
Conduct pre-exercise health screenings to determine safety and/or risks associated with exercise participation, including obtaining medical history, screening for common comorbidities and medication side effects.54 Screening should be conducted in conjunction with clinical judgement and contextual knowledge to avoid unnecessary exclusion or false positives, which can create barriers to participation among people with mental illness.55
Assess mental health through consumer self-reported experiences, observable behaviours and collateral information from referrers, family and carers. Where appropriate, subjective questionnaires (eg, Depression Anxiety Stress Scales-21 or Kessler Psychological Distress Scale) may be used to monitor progress, support research and evaluation, or assess general well-being. However, the use of psychometric tools such as the K10 should be approached with caution (see Box 6) unless the practitioner is confident in interpreting results and responding appropriately to elevated risk. In many cases, a conversation exploring preferences, barriers, facilitators, mood, well-being and readiness to engage in exercise may be more suitable and within scope. Where elevated scores or indications of psychological distress are identified, practitioners should discuss findings sensitively with the consumer and, with consent, facilitate timely referral or communication with the individual’s treating mental health professional or care team.
Box 6
Appropriate use of mental health symptom-specific questionnaires
Note: Use of mental health symptom-specific questionnaires should be conducted in relation to assessing aspects of engagement, identifying potential barriers and considering individualised factors that may influence exercise participation and intervention planning. These tools should not be used as diagnostic or formal mental health assessment tools. Exercise physiologists should handle results within their professional scope, ensuring any concerns are appropriately reviewed and, with consumer consent, communicated to the mental health team as needed.
Perform an assessment of key health indicators relating to several chronic health conditions (eg, metabolic monitoring for cardiometabolic diseases).56
Screen for other conditions that commonly co-occur with mental health challenges where exercise may be contraindicated or require specific modifications to avoid symptom exacerbation (eg, Long COVID, chronic fatigue syndrome or postural orthostatic tachycardia syndrome57 58).
Formal assessments of exercise readiness, strengths, enablers and challenges.
Perform comprehensive assessments of health-related indicators (eg, current exercise levels, cardiorespiratory fitness levels, muscular strength, functional capacity and relevant mental health or psychosocial risk factors that may influence engagement, readiness or outcomes).
Exercise programme design
Collaborate with consumers, family and carers and mental health team members to design and implement accessible and person-centred exercise programmes that promote exercise and healthy lifestyle change. This may involve integrating consumers’ social supports, and their preferences and enablers within a collaborative programme design.
Design and adapt programmes to ensure they align with individual needs, goals, health status, preferences, social circumstances, cultural considerations and access to resources, and promote autonomy.
Integrate evidence-based exercise practice guidelines to ensure safe, engaging and effective exercise interventions. This may include incorporating play or game-based activities such as dance and sport, to increase enjoyment, motivation and engagement.
Exercise programme delivery and monitoring
Develop exercise prescriptions in consultation with the consumer as a means of behavioural activation or acute management of low mood states/increased psychosocial distress.
Deliver and supervise individual or group-based exercise programmes.
Monitoring and adapting exercise programmes based on dynamic factors such as levels of motivation, changes in physical health parameters, identifying risk factors for chronic disease or fluctuations in mental health symptoms and referring appropriately.
Regularly monitor consumers for changes in mental health presentations (including self-reported symptoms) and behaviours, and promptly refer them to appropriate team members or mental health professionals in the event of a deterioration in mental state or a mental health crisis (eg, the onset of self-harm or suicidal ideation), in line with Mental Health First Aid principles.41
Education and health behaviour change
Adopt behaviour-change counselling and motivational interviewing techniques to promote sustainable lifestyle modifications, including assessing a person’s readiness to change and tailoring strategies accordingly.
Offer evidence-based guidance on healthy lifestyle behaviours, such as diet and sleep, in line with current recommendations and guidelines, particularly in the absence of specialists.
Apply such strategies to empower individuals and their caregivers towards independence and self-management of health, thereby improving long-term health outcomes.
Deliver tailored education (individual or group) to family members, carers and other health professionals, building their capacity to safely support and encourage exercise for the consumer, promoting their engagement in regular exercise.
Reviewing and reporting on progress
Regularly assess progress towards negotiated goals to determine the effectiveness of interventions, evaluating changes in health, functional capacity and exercise outcomes. Assessments will typically reflect those performed in the initial assessment in order to accurately detect changes. For a full list of relevant EP assessments, see McMahen et al.56
Communicate progress and updates to the multidisciplinary team or care providers, ensuring that all team members are informed about the consumer’s developments and any adjustments needed.
Maintain detailed records of consumer progress, including health improvements and challenges, and provide comprehensive reports to consumers, carers and other healthcare professionals to facilitate ongoing care and support, using language tailored for key relevant parties.
Make recommendations to the referrer, appropriate compensable schemes and treating teams regarding ongoing care and support, tailored to the consumer’s specific needs.
Discharge and follow-up planning
Encourage engagement in physical activities that promote social enjoyment and social interaction, such as group exercise classes, sports clubs or community wellness programmes, to enhance social support and overall well-being.
Refer consumers to community-based services or other relevant mental health friendly support systems to ensure continuity of care, addressing both physical and mental health needs.
Refer consumers to other health professionals or make recommendations as such to the referrer, ensuring continuity of care once consumers have completed their package of care or are no longer eligible, whether they are moving geographically, require additional supports or have progressed to need less intensive services.
Provide a comprehensive handover (with appropriate consent from the consumer) to relevant healthcare providers, ensuring they have detailed information about the consumer’s progress, current status and ongoing needs.
Supply consumers with resources and tools to support exercise maintenance, such as exercise plans, access to local facilities, information on free or low-cost programmes like Get Healthy (NSW Government), or liaise with funding managers (ie, support funding providers) about support for exercise services.
Professional responsibilities beyond consumer interaction
Professional responsibilities beyond consumer interaction are defined by activities that EPs may engage in routinely, which do not specifically relate to the consumers’ journey and interaction with the EP. Examples of such activities include, but are not limited to:
Documenting clinical interactions using structured formats like Subjective, Objective, Assessment, Plan notes.
Delivery and supervision of student practicum placement.
Delivering and/or receiving professional development training and educational seminars (eg, ESSA Continuing Professional Development opportunities or mental health education providers like the Black Dog Institute).
Providing and/or receiving clinical supervision (individual or group).
Engaging in advocacy, leadership and training activities to support EP integration and referral.
Collaborate with consumers, healthcare providers and other key relevant parties to consult, co-design or ‘re-design’ programmes and services.
Engage in or lead quality improvement initiatives to assess and enhance service provision.
Support research initiatives, for example, supporting with participant recruitment data collection.
Advanced and extended scope of practice for EPs
EPs with an advanced scope of practice may engage in roles that extend these core clinical activities, requiring additional training and experience in areas such as skills-based practice, leadership, advocacy, clinical advanced practice and research. Examples of these are covered below.
Skills-based practice
With appropriate training and certification, EPs can incorporate therapeutic strategies within their scope, enhancing service offerings while adhering to their professional boundaries. For instance, EPs with additional qualifications in yoga can integrate yoga-based movement practices into their exercise programmes to promote physical and mental health outcomes. However, these activities must align with the EP’s scope of practice, focusing on exercise prescription and delivery rather than broader therapeutic domains exclusive to other professions.
EPs may undertake training or have extensive experience in working with specific consumer groups, making them well-equipped to tailor interventions to address specific needs of these subpopulations. Examples may include children and adolescents, or those with intellectual disabilities.
Health promotion and leadership
Health promotion—EPs may deliver educational seminars and training to PWLE, their families, friends, caregivers, the public and members of the multidisciplinary care team. For example, this may include training allied health assistants or peer support workers in the promotion and support of exercise programmes that are safe and therapeutic.
Team leadership—EPs with experience or training may assume leadership roles within health services, providing leadership and coordination of multidisciplinary teams.
Service management—EPs with appropriate experience and training may oversee service delivery, ensuring quality control and programme development across healthcare settings.
Advocacy and policy
EPs may collaborate and engage in advocacy on matters relating to their expertise, liaising with government agencies, professional bodies and policymakers, such as State Health authorities.
EPs may also contribute to policy development, helping shape healthcare policies that pertain to their knowledge and expertise as exercise professionals within mental healthcare. This can include advising ESSA on relevant practice matters, such as developing guidelines, resources and advocacy strategies that enhance the care of PWLE.
Research and quality improvement
This advanced scope allows EPs to contribute significantly to mental healthcare through specialised skills, leadership, advocacy and research.
Integration of EPs within the multidisciplinary mental health team
Effective integration of EPs into mental healthcare requires the alignment of clinical approaches to meet the health needs of consumers as well as the adoption of specific strategies that facilitate effective interdisciplinary practice. This ensures EPs are valued as core members of the mental health team. Below, we describe strategies for effective integration through activities related to:
EP approaches that contribute to mental health service delivery
Implement best practice principles, that is, person-centred, strength-based and recovery-oriented, mental health (including trauma-informed) and culturally sensitive practices.
Apply a holistic and integrated approach to care that considers the bidirectional relationship between biological, psychological and social factors and one’s health status/experiences.
Recognise that PWLE possess strengths and resilience that can be leveraged to adopt healthy lifestyle behaviours. While they may encounter challenges such as mental and emotional distress, sleep disturbances, mental health symptoms, social disadvantages or comorbid physical conditions, they also bring valuable personal resources, including coping strategies and support networks, that can be harnessed to overcome these barriers.
Incorporate evidence-based strategies to support engagement, such as supportive communication, barrier identification, promoting social support, motivational interviewing, health literacy education and individualised goal setting.
Consider the impact of psychotropic medications and mental health symptoms on exercise programming, including vital signs (eg, heart rate and blood pressure), dizziness, drowsiness, fatigue, balance and coordination.
Support in cardiometabolic risk screening, adopting the Positive Cardiometabolic Health Algorithm.59
Identify changes in mental health presentations and make timely referrals to appropriate professionals, ensuring prompt and effective care.
Assess and monitor physical health, such as cardiovascular health, metabolic or gastrointestinal issues, and liaise with the broader medical teams to ensure these are addressed.
Deliver evidence-based exercise interventions as an effective adjunct to mental healthcare.
Collaboration
Work collaboratively and respectfully with the multidisciplinary mental health team to provide a holistic and integrated approach to person-centred care, including contributing to comprehensive assessments and monitoring of mental health and psychosocial functioning.
Facilitate joint appointments with universities, or linkages with general practitioners, allied health professionals, peer support workers, community gyms and sports teams to provide a holistic approach to health and well-being.
Advocating for the consumer to ensure outcomes pertaining to exercise physiology assessment (eg, metabolic outcomes) are being routinely collected and managed appropriately.
Develop partnerships between mental health organisations and services (including government, non-for-profit/community managed, primary care and private practice) to improve the integration and delivery of lifestyle programmes using principles such as co-facilitation, co-location and data sharing (if appropriate).
Capacity building
Advocate for regular physical health screening and metabolic monitoring performed as part of routine care.
Offer education and supervision to university exercise physiology students on practicum placements, contributing to capacity-building efforts in mental health settings.
Deliver training and education to upskill other mental health clinicians and other key relevant parties, including allied health assistants, peer support workers, family and carers, to be confident in promoting basic exercise interventions and exercise advice, including understanding of current physical activity guidelines. This may involve leveraging existing training programmes such as the ACSM ‘Exercise Is Medicine’ Online Course.
Partner with universities, primary healthcare services and other research institutions across different health disciplines to support quality improvement and research initiatives.
Advocate for greater healthcare and research investment in mental health services, which would support capacity and capability building.
Build the capability of EPs by providing necessary training at the undergraduate, postgraduate and professional practice levels (eg, CPD training), to effectively deploy the aforementioned best-practice principles while also recognising common presentations in mental healthcare and appropriately providing support within their scope of practice.
Discussion
This consensus presents nationally endorsed, evidence-informed guidance on the role of EPs in mental healthcare. Using a five-stage, Delphi process involving EPs, mental health professionals and PWLE, we generated high-level agreement on practice principles, integration strategies and scope of practice.
The final consensus defined EP Best Practice in mental healthcare as evidence-based, person-centred and strengths-based. EPs are expected to tailor exercise programmes to individual needs, values and recovery goals while using behaviour change strategies such as motivational interviewing.25 26 30 35 Additionally, recovery-oriented, mental health (including trauma-informed), and culturally responsive practices ensure safe, collaborative and inclusive care by fostering empowerment, preventing re-traumatisation and respecting diverse cultural values to support PWLE of mental illness.39 44 47
The defined scope of practice includes conducting physical and metabolic assessments, designing person-centred exercise programmes, and monitoring progress to align care with individual needs and recovery goals, while preserving autonomy.53 Broader professional responsibilities include clinical documentation, education, advocacy and contributing to research and quality improvement. EPs with advanced training may engage in leadership roles, policy development and/or skills-based practices to support targeted populations or those with complex care needs. Delphi participants emphasised that mental health assessment and diagnosis are outside the EP scope of practice unless the practitioner holds appropriate credentials. For EPs without such training, their role is not to formally assess or diagnose mental health conditions but rather to observe symptoms, particularly any changes or signs of crisis, and facilitate referral to appropriate mental health services with the client’s consent.
For effective integration of EPs within multidisciplinary mental healthcare teams, collaboration, capacity building and the adoption of holistic clinical approaches are essential. Through aligning interventions with mental health best practices by addressing biopsychosocial factors, performing cardiometabolic screenings and contributing to comprehensive care planning. Integration strategies included the fostering of partnerships with key relevant parties, advocating for routine physical health monitoring and providing education to upskill other mental health professionals. These efforts position EPs as integral members of the mental health team, enhancing recovery outcomes and ensuring the delivery of safe, effective and evidence-based care.
Limitations
This Consensus Statement has several limitations. This Consensus Statement was developed through an Australian-based Delphi process and is therefore most applicable to the Australian health and mental health service context. While efforts were made to ensure diverse representation, limited data were collected on participant cultural identity and language background. For example, the Advisory Group members acknowledge the need to further improve cultural and Australian First Nations representation. Future efforts will seek to describe how Aboriginal and Torres Strait Islander peoples and migrant and refugee communities are included in both the implementation and refinement of consensus recommendations. The contributions of lived-experience representatives across the Advisory group and Expert panel were highly valued and directly shaped the consumer-facing resource. However, the Delphi process included a small number of lived experience contributors. A greater number and diversity of lived experience voices may have further enhanced the relevance, inclusivity and representativeness of the recommendations. Future research should explore mechanisms for broader and ongoing engagement of both exercise professionals and PWLE to further strengthen co-produced guideline development. Given the relatively small pool of contributors, we sought to minimise the risk of inadvertent re-identification and therefore did not capture additional individual characteristics. Additionally, despite multiple Delphi rounds designed to refine and clarify items, the process remains inherently influenced by the perspectives and experiences of the selected expert panel and lived-experience representatives, which may not fully capture the diversity of views within the broader field and collective experiences of all service users.60 Future directions should include broader and more inclusive consultation, co-design and partnership approaches with service users and other key relevant parties, particularly those from underrepresented groups and lower resourced settings in Australia such as rural and regional areas. In addition, implementation-focused research should evaluate the transferability, acceptability, feasibility and equity of the recommendations across diverse service contexts.
While the Delphi methodology draws on the collective expertise of experienced contributors, consensus does not guarantee clinical adoption or effectiveness. This is particularly relevant given the variability in individual and systemic factors that influence the implementation of exercise interventions across diverse settings. Furthermore, while efforts were made to ensure clear and comprehensive items, the iterative nature of the process may introduce response fatigue, potentially influencing engagement and decision-making in later rounds. Given the evolving nature of mental healthcare and exercise physiology, it is recommended that this statement be reviewed and updated every 10 years, or earlier if substantial new evidence or policy developments emerge.
Clinical implications
This Consensus Statement provides a nationally endorsed, evidence-informed framework to guide the integration of EPs into mental healthcare. It has significant implications across clinical practice, workforce development, professional training and policy reform, both within Australia and internationally.
Clinical practice and workforce integration
This Consensus Statement offers practical guidance for embedding EPs into multidisciplinary mental health teams across inpatient, community, primary care and psychosocial support settings. It clarifies EP roles, outlines scope-aligned practice and promotes principles such as person-centred care, recovery orientation and trauma-informed practice. Service providers and their staff can use the Consensus Statement and its accompanying resources to design or refine service models, design position descriptions, facilitate referral pathways and support staff induction and training.
Professional development and education
This Consensus Statement can inform undergraduate curriculum development and clinical placement preparation for exercise physiology students. It can also support the design of interdisciplinary continuing professional development aimed at enhancing exercise professional capability in mental health contexts. The best-practice principles and scope outlined can be used by clinical supervisors and academic educators to embed mental health competencies into training and assessment processes. Mental health is now specified content within EP training under the revised ESSA Accredited Exercise Physiologist Professional Standards,18 and this Consensus Statement complements these standards by supporting continued professional development in mental health practice.
Informing professional standards and policy
This Consensus Statement can inform the review and development of national professional standards, accreditation requirements and regulatory frameworks. It may also assist peak bodies like ESSA in defining future credentialing or endorsement pathways for EPs working in mental health. This Consensus Statement is well positioned to support advocacy efforts aimed at policy makers and service commissioners, providing a clear articulation of how EPs contribute to consumer-centred mental healthcare and how exercise services can be formally integrated and funded. It can also assist in drafting position descriptions and service design documents that define and resource the role of EPs within mental health teams.
International and transdisciplinary relevance
While AEPs are an Australian-regulated profession, the practice principles outlined here align with EP roles internationally. Equivalent services are delivered by clinical exercise professionals under different titles. For example, EPs (as recognised by the ACSM in the USA and the Canadian Society for Exercise Physiology in Canada), kinesiologists, physiotherapists, physical therapists and psychomotor therapists. In the UK and New Zealand, similar roles are governed by the British Association for Sport and Exercise Sciences and Sport and Exercise Science New Zealand, respectively. To support global consistency, the International Confederation of Sport and Exercise Science Practice has developed international standards for EP.61 This Consensus Statement complements such efforts and may serve as a useful model in countries where the integration of clinical exercise professionals into mental health services is still developing. It also holds transdisciplinary value, offering shared language and principles to support collaboration between exercise professionals and mental health professionals across a range of service settings.
Conclusions
There is now clear and compelling evidence supporting the inclusion and promotion of exercise as part of routine mental healthcare. This includes integrating exercise alongside other components of mental healthcare and using them for educational purposes. EPs are uniquely positioned to provide evidence-based exercise interventions to PWLE across various settings. The inclusion of EPs or their international equivalents within multidisciplinary mental health teams enhances holistic healthcare integration and improves both physical and mental health outcomes for PWLE. This Consensus Statement gathers expert opinions from experienced EPs, academics, mental health professionals and PWLE representatives. Collectively, we provide key practice principles and define the role and scope of EPs in providing care to PWLE. Importantly, the key results from the Delphi study informed the development of three independent resources to ensure utility and relevance for key relevant parties, including PWLE. These resources should be publicly available, offering accessible guidance to support the integration of exercise into mental healthcare practices. Beyond the Australian context, this Statement has broader clinical, policy and international implications. It can inform professional standards, support training and workforce development, guide policy makers and serve as a model for countries where clinical exercise professionals are increasingly being integrated into mental healthcare.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by the University of Technology Sydney (UTS) Human Research Ethics Committee (HREC), Approval ID: ETH24-9171. Participants gave informed consent to participate in the study before taking part.
Acknowledgments
The authors extend their gratitude to Exercise and Sports Science Australia (ESSA) for their review and endorsement of this work. With prior consent, the authors would like to recognise the significant contributions to this study and its findings, from members of the expert panels; Abbey Pearson, Alastair McGorm, Andrew Padayachy, Angela Douglas, Caleb McMahen, Dr Caroline Robertson, Cassandra Butler, Catherine O’Donnell, Devlin Higgins, Georgia Frydman, Isabella Sierra, Jade Ellings, James Isles, Jeanette Cudmore, Law Edwards, Matthew Wall, Dr Mridula Kayal, Dr Nicky Korman, Patrick Gould, Professor Philip B Ward, Rachel Morrell, Dr Ruth Wells, Sarah Kearney and Dr Scott Teasdale.
