The Medical and Fitness Communities: Working to Come Together

By Anthony Carey, MA, CSCS, CES About the Author: Mr. Carey, CEO of Function First, holds a master’s degree in biomechanics and athletic training and is a certified stretch and conditioning specialist and a certified clinical exercise specialist. He is the author of the new book The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder, and Joint Pain.

Not necessarily. If you hear the words “fitness professional” and the images of a steroid-enhanced muscle head, entertainer-turned-expert, or a cosmetically enhanced role model come to mind, I wouldn’t blame you. Why would you trust a patient’s health to someone like this? Because of these unfortunate stereotypes, the fitness industry is struggling to establish itself as part of the legitimate healthcare community.

As an exercise physiologist who takes my education, training, and my role with my clients as seriously as any physician does, let me clarify the role and qualifications of the serious exercise professional so that you can feel comfortable providing the appropriate direction for your patients’ long-term success.

Many people call themselves “personal trainers.” One may hold a graduate degree in biomechanics; another may have just finished his online course for $49.99 the night before. How do you know the difference?

The qualifications of the fitness professional continue to improve year after year. Several organizations that certify exercise professionals are now using third-party accreditation. These organizations use the National Commission for Certifying Agencies (NCCA), which is the accrediting body of the National Organization for Competency Assurance (NOCA).

These include the American Council on Exercise, the National Strength and Conditioning Association, the National Council of Strength and Fitness Professionals, the National Federation of Professional Trainers and the National Academy of Sports Medicine.

Within the realm of the fitness professional are advanced certifications that require supervised internships and advanced knowledge of special populations. These include the clinical exercise specialist through the American Council on Exercise; the medical exercise specialist through the American Academy of Health, Fitness, and Rehabilitation Professionals; and the ACSM exercise specialist® and the ACSM registered clinical exercise physiologist® through the American College of Sports Medicine.

Fitness professionals provide a service along a wide continuum of health needs. The entry-level trainer should have a certification from one of the organizations with NCCA accreditation. This individual is prepared to work with apparently healthy individuals seeking to improve their levels of fitness.

On the other end of this continuum is the fitness professional with advanced degrees in the fields of exercise science, multiple certifications, and clinical experience. Most of what we do looks nothing like a preconceived gym workout. Because of the health complexities of the types of clients these professionals see, they typically work with specific populations. For example, our clientele at Function First consists of individuals with musculoskeletal challenges. If we received a referral for a person with diabetes needing help controlling their insulin levels with exercise, we would recommend to their physician an exercise physiologist who excels with these types of clients.

We have worked successfully with physician referrals for exercise programs for more than ten years. During that time, we have observed characteristics in the physicians that refer their patients to exercise programs and have those patients follow through:

These physicians are active themselves and live the benefits of exercise. These physicians provide their patients with detailed instructions on the need to contact a professional to assist them in their exercise needs and provide their patients with contact information for exercise physiologists. These physicians take an active role in providing input on the patients’ needs and contraindications. These physicians have an expectation that they will receive timely documentation of the exercise physiologist’s initial assessment, plan, and reassessments.

We have also observed the type of physicians who are not successful getting their patients to get on a much-needed exercise program:

These physicians may not present a healthy lifestyle themselves. These physicians are not well-versed in the exercise vernacular or exercise prescription and are therefore vague in their instruction or recommendations. These physicians are unaware of the level of education and expertise many fitness professional possess today. These physicians do not fully appreciate that barriers to exercise from the past will continue to be barriers to exercise if not addressed.

As a physician, you are guided by an obligation to provide responsible direction to your patients for their health choices. This should include exercise. You wouldn’t recommend a diagnostic test as an afterthought at the end of a patient’s appointment and leave it to the patient to negotiate on his or her own. Instead, you would write the prescription, making a specific referral along with a follow-up visit to review the results. That same degree of influence and direction would have enormous impact on your patients’ initiating and adhering to an exercise program.

All of these challenges faced by physicians who find it difficult to convince patients to exercise can easily be resolved by developing relationships with qualified fitness professionals. It is our job to stay abreast of the current literature on exercise science. With knowledge of your goals for your patient, we can work to further your directives and assist in maintaining exercise compliance.

As managed care and sedentary lifestyles change the landscape and as baby boomers age, relationships between the primary medical providers and the supporting players in the fitness environment are inevitable. This is already evident in the growing number of wellness centers that place the medical team and the fitness team under the same roof.

If you are looking for fitness professionals with advanced degrees and certifications, seek out private studios or those working in conjunction with other medical practitioners. Typically, the big, commercial health clubs are not conducive to working with patients that may have special needs and risk factors.

Fitness specialists working cooperatively with the medical community know that exercise isn’t a substitute for expert medical care. And physicians working with the fitness community know that a safe, scientifically designed exercise program can produce tremendous health benefits for their patients. SDP