Occupations and Terms of Reference › Exercise and fitness instructor (clinical)
Universal terms of reference · POS-106 · version 1.0 · status: draft · next review 2027-10-27
Exercise and fitness instructor (clinical)
To lead safe, supervised exercise for people with health conditions, so that clients get safe, effective and well-coordinated care.
Each part of this page links to the related trainings, competencies and policies. The links are the same for every facility, so an organisation can see at a glance what a role requires and what it is trained in.
Job description
Job summary. You are a exercise and fitness instructor (clinical). You lead safe, supervised exercise for people with health conditions, record your work, and report changes in the client's condition and needs to the team.
Reports to: Head of rehabilitation.
Leads or supervises: No direct reports.
What you do on a typical day
- Deliver supervised exercise programmes for clinical groups.
- Assess the client and agree goals with them.
- Deliver the plan within protocol.
- Obtain consent and explain the plan.
- Refer and communicate results promptly.
Working conditions and demands
- Caseload and time pressure.
- Exercise that is too hard for the client's condition.
- Shift and weekend work in some settings.
What good looks like
- Clients have a clear assessment and plan.
- Progress is recorded and reviewed.
- Concerns are referred the same day.
Place in the organogram
Reporting line, from the top: see the organogram on the Occupations page. The lines above and below this role are listed in section 3.
1. Golden rules
These rules apply in every setting.
- Every client or patient is assessed before they start any service, and the service is adjusted to their needs.
- Services stay within the scope of training and licence; anything beyond it is referred.
- Consent is informed and recorded before any procedure or programme.
- Adverse events and complaints are reported the same day and learned from.
- Clients' privacy and records are protected at all times.
- Prices, claims and promotions are honest and match what is delivered.
- Staff are trained and competent for their role before they work alone.
- Where the client's health or safety is at risk, work stops and the right person is called.
2. Identification
| Item | Detail |
|---|---|
| Position code | POS-106 |
| ISCO-08 | 3423 (skill level 4) |
| ESCO | to map |
| Department | Allied health |
| Facility types | Fitness, Hospital |
3. Reporting line and working relationships
Reports to: POS-038. Supervises: .
| Works with | Nature of the relationship |
|---|---|
| Head of department (per specialty) | Referrals, plans and outcomes. |
| Head of department (per specialty) | Service standards and rota. |
4. Key accountabilities
| Domain | Accountability | Evidence of delivery | Checked | Linked competencies | Linked trainings | Linked policies | Standards |
|---|---|---|---|---|---|---|---|
| Assessment | Assesses each client in clinical exercise and agrees goals with them. | Assessment records at standard | Monthly | C-01 | T-05 | POL-SAFEG | 2 |
| Intervention | Delivers the plan within protocol and reviews progress. | Progress review audit at standard | Monthly | C-02 | T-05 | POL-SAFEG | 2 |
| Safety | Reports risk and incidents the same day. | Incidents and risks logged same day | Daily | C-03 | T-05 | POL-INC | 2 |
| Records and consent | Obtains consent and keeps complete, accurate records. | Records and consent audit passed | Monthly | C-02 | T-05 | POL-DATA | 2 |
5. Decision rights
| The post holder decides | Consults or escalates |
|---|---|
| Intervention and goals for each clinical exercise client, within protocol | Needs outside the clinical exercise scope (head of rehabilitation) |
| Session timing and frequency within the agreed plan | Serious incidents and complaints (service lead) |
6. Qualifications and experience
| ID | Qualification | Mandatory | Validity |
|---|---|---|---|
| Q-01 | Clinical exercise instructor certificate | Yes | Lifetime |
| Q-02 | First aid and CPR certificate | Yes | Lifetime |
| ID | Experience | Minimum years | Mandatory |
|---|---|---|---|
| E-01 | Practice in clinical exercise | 2 | Yes |
7. Training requirements
Recommended common practice. Each facility adapts the list to its national law. Essential items apply in every setting; recommended items apply where resources allow.
| ID | Training | Tier | When | Validity | Linked policies | Linked competencies |
|---|---|---|---|---|---|---|
| T-01 | Facility induction | essential | at_entry | Once | POL-WHISTLE · POL-EQUAL · POL-DATA | – |
| T-02 | Safeguarding adults | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-03 | Safeguarding children | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-04 | Data protection and confidentiality | essential | annual | Every 1 year(s) | POL-DATA | – |
| T-05 | Incident reporting and open disclosure | essential | periodic | Every 2 year(s) | POL-INC | C-01 · C-02 · C-03 |
| T-06 | Governance, accountability and assurance | recommended | periodic | Every 3 year(s) | – | – |
| T-07 | Emergency and major incident command | essential | annual | Every 1 year(s) | POL-INC | – |
| T-08 | Speaking up, inclusion and equality leadership | essential | periodic | Every 2 year(s) | POL-WHISTLE · POL-EQUAL | – |
8. Health, fitness and language
| ID | Requirement | Frequency | Tier | Minimum in low-resource settings |
|---|---|---|---|---|
| H-01 | Immunity to vaccine-preventable diseases relevant to the setting, documented at entry | At entry or as set | essential | Documented hepatitis B status at entry |
| H-02 | Tuberculosis screening at entry, then as the national rule requires | At entry or as set | essential | Symptom screening at entry and after exposure |
| H-03 | Fitness-to-work assessment at entry and after serious illness or injury | Every 12 months | recommended | Fitness check at entry |
| Language | Level | Mandatory |
|---|---|---|
| Official language of the country of practice | professional | Yes |
| English | working | Yes |
9. Competencies by level
| ID | Competency | Foundation | Practitioner | Expert | Assessed by | Revalidate | Linked trainings |
|---|---|---|---|---|---|---|---|
| C-01 | Assessment and planning in clinical exercise | Assesses routine clients under supervision | Assesses and plans independently | Leads complex assessment and teaches others | Case review audit | Every 12 months | T-05 |
| C-02 | Intervention and treatment in clinical exercise | Delivers routine interventions within protocol | Adapts interventions to complex needs | Designs intervention protocols | Intervention audit | Every 12 months | T-05 |
| C-03 | Safety, consent and escalation | Recognises and reports risk | Manages risk and escalates | Leads safety and learning review | Safety audit | Every 12 months | T-05 |
10. Performance evaluation
- Probation: 6 months, with a sign-off review (recommended value).
- Appraisal: every 12 months against the competencies and indicators below.
| ID | Indicator | Target | Data source | Frequency |
|---|---|---|---|---|
| PI-01 | Assessments recorded | 100% | client records | Monthly |
| PI-02 | Progress reviewed on time | 95% or more | review log | Monthly |
| PI-03 | Concerns referred same day | 100% | referral log | Daily |
11. Career ladder and promotion
| Level | Role | Minimum experience to move on | Qualifications | Competency minimums | Trainings required | Assessment |
|---|---|---|---|---|---|---|
| Executive | Exercise and fitness instructor (clinical) | 2 years (recommended) | Q-01, Q-02 | C-01 practitioner, C-02 practitioner, C-03 practitioner | T-05 | Executive appointment and performance review |
12. Policies the post holder follows
Each policy is a standard template that the facility adopts and adapts. Templates are maintained centrally, so every facility works from the same version.
POL-SAFEG · Safeguarding adults and children
Purpose: Protect patients from abuse, neglect and harm, and make sure every concern is recognised and acted on.
Scope: All staff, volunteers and contractors.
Key rules:
Scope: All staff, volunteers and contractors.
Key rules:
- Recognise signs of abuse and neglect and record them factually.
- Report every concern to the designated safeguarding lead the same shift.
- Do not investigate alone.
- Share information only as the safeguarding procedure allows.
POL-DATA · Data protection and confidentiality
Purpose: Keep patient and staff information private, secure and used only for care and legal purposes.
Scope: All staff who access records or systems.
Key rules:
Scope: All staff who access records or systems.
Key rules:
- Access only the records needed for your work.
- Keep records secure; do not leave screens or paper unattended.
- Do not share information without a lawful basis.
- Report any breach to the data protection officer within 24 hours.
Linked trainings: T-10 · Review every 12 months · Template 0.1 (draft)
POL-WHISTLE · Speaking up (whistleblowing)
Purpose: Let staff raise patient safety or conduct concerns without fear of reprisal.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Raise a concern with your line manager or the named speaking-up officer.
- If that route fails, escalate to the board or the national regulator.
- Retaliation against anyone who speaks up is a disciplinary offence.
- Concerns are recorded, investigated and the outcome given to the person raising them.
Linked trainings: T-01 · Review every 12 months · Template 0.1 (draft)
POL-EQUAL · Equality, diversity and inclusion
Purpose: Give every patient and colleague fair access, respectful treatment and reasonable adjustments.
Scope: All staff and patients.
Key rules:
Scope: All staff and patients.
Key rules:
- Treat every person with dignity regardless of background.
- Make reasonable adjustments, including interpreters, for language and disability.
- Report discrimination through the speaking-up route.
- Monitor access and outcomes by group.
Linked trainings: T-01 · Review every 24 months · Template 0.1 (draft)
POL-INC · Incident reporting and open disclosure
Purpose: Report and learn from incidents and near misses, and tell patients honestly when things go wrong.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Report every incident and near miss the same shift.
- Give the patient and family an honest account and an apology where appropriate (open disclosure).
- Take immediate action to protect others.
- Learn: contribute to the review and follow the agreed actions.
13. Standards that name this role
14. Record history
| Date | Change | Approved by |
|---|---|---|
| 2026-10-27 | Draft record, batch 1 of the position build | Awaiting approval |