The patient population
At the core of sport and exercise medicine (SEM) is the understanding of the physiological effects of exercise and its impact on health promotion and disease management, especially in chronic non-communicable diseases. There are very few chronic diseases in which physical activity does not have a beneficial effect. SEM therefore provides a major health promotion and disease management strategy.
There is good evidence that social inequality and poor health is partly mediated through physical inactivity. Encouraging an active lifestyle will improve health directly and may also have a beneficial effect on other unhealthy behaviours such as alcohol, smoking, substance misuse and nutrition (all of which are more common in socially-deprived communities). Involvement in sport may also lead to reduction in anti-social behaviour and crime. Therefore, regular physical activity may help to reduce social inequality.
The specialty should work with other specialties by offering exercise prescription clinics and/or by providing education and training to empower each specialty to incorporate exercise prescription into the holistic strategy for their patients. Socially deprived and ethnic minority populations should be targeted as they are likely to get the greatest benefit from increasing physical activity.
Prevention of disease
The health benefits of regular physical activity are indisputable. Exercise: The miracle cure, a recent report published by the Academy of Medical Royal Colleges, states that over 40% of adults do not reach the minimum recommended level of 30 minutes of moderately intense exercise five times per week. The percentage is even higher in people with chronic diseases, those over 65 years old and in some ethnic minority groups. There is therefore huge potential to improve the health of the population through regular physical activity.
It also gives clear evidence that regular physical activity leads to a 30–50% reduction in the incidence of a range of disorders including cardiovascular disease, type 2 diabetes, cancer, dementia and osteoporosis. There is equally good evidence for the benefit of regular physical activity in the management of many conditions (including cardiovascular disease, hypertension, diabetes, chronic obstructive pulmonary disease and chronic pain), which may lead to a reduction in medication requirements and an improved long-term outcome.
Planning effective services
The healthcare workforce needs to receive training in physical activity medicine. This should include an understanding of the physiological effects and health benefits of exercise, the principles of behaviour change with respect to physical activity and writing an exercise prescription. Each specialty, including primary care, can then decide where physical activity prescription fits within their patient population and whether it can be offered within their specialty. The sport and exercise medicine (SEM) specialty can support this development through education, by doing combined clinics or by offering regular exercise prescription clinics.
For most people, simple advice will be sufficient for them to increase their physical activity. For people with chronic diseases, supervision and monitoring of their physical activity with an exercise professional is valuable both in terms of safety and providing confidence for the patient and their doctor. Exercise professionals are currently not independently regulated in contrast to virtually all other healthcare professionals. There are several competing bodies offering training and qualification as an exercise professional. There are several levels of training with level 4 being the level advised to treat patients with chronic diseases. However, these bodies are self-regulated with vested interests. Therefore, independent regulation for exercise professionals dealing with patients with chronic diseases is necessary. This is a gap in service provision and a barrier to developing exercise prescription for patients with chronic diseases.
The SEM department should work closely with rheumatology, orthopaedic and physiotherapy departments so that the hospital trust provides an integrated musculoskeletal healthcare service. This should include an agreement on how patients who are referred to the service are triaged so that they receive the most clinically- and cost-effective service. This will vary between different secondary care trusts depending of the skillmix in each department.