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The primary aim of the accreditation process is to achieve comparability of athlete testing results between different laboratories. Secondary aims are to give coaches and athletes greater confidence in exercise physiology services, encourage sports scientists to exchange information, develop a national database of accredited laboratories and encourage national sporting organisations and coaches to use it, develop a database of appropriate measurement error tolerances for commonly conducted tests, and develop a database of test results on elite athletes by pooling results from all accredited laboratories.

Quality assurance in laboratories is well established in areas such as pathology and haematology, materials testing and metrology. For example, if you receive a cholesterol result from your doctor, the result is likely to be from a calibrated analyser, using documented procedures with the result printed on the report actually pertaining to the sample that was submitted for analysis. Many government laboratories must, by law, have quality assurance certification. ISO Guide 25 (1990) is specifically concerned with quality assurance in laboratories. This guide is based on ISO 9001 and all 20 clauses of this standard must be addressed by the applicant laboratory. ISO Guide 25 is the standard against which a hospital pathology laboratory would be assessed for certification.

The ISO 9001 standard and evaluation by National Association of Testing Authorities assessors are considered to be too excessive for exercise physiology laboratories because they may often have fewer than six staff and generally cannot afford to have a full-time quality assurance officer. Despite such limitations, a certification scheme has been developed that is appropriate and functional within the constraints of the time and resources of exercise physiology laboratories that test athletes.

The process continues to be refined over time because quality assurance is, by definition, one of ongoing improvement. It should also be pointed out that quality assurance in Australian exercise physiology laboratories has been implemented gradually after being initiated by sports scientists themselves. Laboratory accreditation is not merely an examination of a laboratory, but a collaborative effort to improve standards of athlete exercise testing. NSSQA advises applicant laboratories on how to rectify any perceived deficiencies observed during an assessment.

The rationale and mechanisms of the NSSQA accreditation program are summarised below.

Accreditation and competence

Laboratories can receive accreditation for demonstrated competence in five streams that group the most common physiology tests conducted on athletes. The streams, with examples of tests within each, are listed below. Laboratories can apply for accreditation in all five streams or in selected streams. A laboratory that is accredited in all five streams offers a greater range, not necessarily higher quality, than a laboratory that is accredited in only one or two streams. The quality of measurements from any certified laboratory meets similar criteria based on calibration records and the reliability/precision of measurements.

The physiology accreditation streams are:

• anthropometry (such as skinfolds, height and mass)
• field testing (such as 20-metre shuttle run, sprint tests, vertical jump and agility runs)
• oxygen consumption (such as VO_2max and maximum accumulated oxygen deficit)
• ergometry (such as performance tests on calibrated cycle ergometers, rowing ergometers and treadmills)
• blood analysis (such as measurement of blood lactate and blood gases).

How laboratories are accredited

Accreditation is based on an on-site assessment by three expert peers to 'critically evaluate all aspects of the laboratory management, staff, facilities and operations likely to affect the reliability and accuracy of its test results'. A report of the visit and the typical error data for each laboratory are evaluated by the National Accreditation Committee, which is the body that grants accreditation. The committee is convened by the Australia Sports Commission and NSSQA.

Two phases of accreditation have been implemented.

Phase 1 - Precision

The first phase of Exercise Physiology accreditation, implemented between 1995 and 1997, required laboratories to demonstrate the precision (or reliability) of athlete test results and to establish the technical error of measurement (TEM) associated with these test results. Equipment limitations, combined with biological, day-to-day changes in the performance of athletes, mean that all measures have an uncertainty or error associated with them. Thus, instead of reporting a sum of skinfolds as 65 mm, it is reported to an athlete and coach as 65±3 mm. The expression '±3 mm' indicates the level of uncertainty or typical measurement error associated with the measure. Similarly, a VO_2max result would be reported as 70±2 ml.kg^-1 .min^-1, rather than 70.2 ml.kg^-1 .min^-1. Note that this is exactly the same kind of measurement error that is associated with any scientific measurement; for instance, cholesterol results are usually reported as a value with a measurement error range of ±0.1 mmol.L^-1.

Phase 2 - Accuracy

In the second and current phase of the accreditation scheme, laboratories are required to demonstrate both reliability and the accuracy of measures. This means laboratories must show that the measures have not only a small level of uncertainty, but also that they are accurate when compared with a criterion (or first principles) measure. For example, an athlete in a maintenance period of training might have their VO_2max measured as 73±2 ml.kg^-1 .min^-1, but two weeks later is tested at another laboratory as part of a training camp and is measured as 68±2 ml.kg^-1 .min^-1.

Establishing the accuracy of measures will help us to interpret differences in measurements between laboratories. To this end, the LSAS has collaborated with others to develop devices such as a dynamic calibration rig for skinfold calipers (Carlyon et al., 1998; Gore et al., 2000), a gas analysis calibrator that can simulate the ventilation pattern and expired gas fractions of an elite athlete (Gore et al., 1997) and a torque meter for calibration of cycle ergometers (Stanef, 1988; Woods et al., 1994).

Accreditation is granted for a period of four years, and reviewed every four years thereafter. Re-accreditation requires a laboratory to collect new reliability data to demonstrate competence in all techniques of athlete testing, as well as an on-site assessment of the laboratory quality systems by three expert peers.

An annual report process is implemented to further facilitate quality control procedures in laboratories, and encourage annual data collection so that the quadrennial accreditation visit becomes a summary of the preceding four years, combined with a thorough check that the documented quality procedures are being utilised effectively. This is an attempt to reduce (or spread) the workload of both the applicant laboratory and NSSQA.

Accreditation requirements

Requirements for accreditation can be divided into the following areas:

• staffing
• documentation
• measurement and calibration
• test methods
• reports
• reliability data

Requirements are applicable to all five streams of accreditation (anthropometry, field testing, oxygen consumption, ergometry and blood analysis). Specific details pertaining to calibration and maintenance requirements (that is, frequency and tolerances), targets for reliability data and other relevant information are provided to laboratories on application for NSSQA accreditation.

Accreditation costs

Whilst there is no application fee or membership fee associated with NSSQA accreditation, there are a number of costs that can be attributed to achieving and maintaining NSSQA accreditation requirements. It is difficult to be precise because the needs of different laboratories will vary.   Furthermore, the fundamental aim of any quality assurance program is continued improvement, so costs of accreditation should not be viewed as simple 'one-off' costs, rather as an ongoing commitment of resources.

Overall, "direct costs" of accreditation have been estimated at ~ $10,000 per year. However, some "indirect costs" (such as employment of QA officer / laboratory manager etc.) may also be associated with accreditation in some laboratories. Examples of costs associated with achieving and maintaining requirements for NSSQA accreditation are detailed below (does not include purchase of relevant equipment).

* These costings do not include costs for purchase of equipment in establishing laboratory.

Accredited laboratories

Current NSSQA-accredited exercise physiology laboratories, their accreditation streams and their re-accreditation dates are:

More information

For more information on the NSSQA exercise physiology laboratory accreditation program or to receive 'intention to seek NSSQA accreditation' documentation contact:

Email: NSSQA@ausport.gov.au