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Exercise is Medicine™: Your Role as a Health/Fitness Professional

Paternostro-Bayles, Madeline Ph.D., FACSM

doi: 10.1249/FIT.0b013e3181bcd785
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Exercise is Medicine™: Your Role as a Health/Fitness Professional.

Madeline Paternostro-Bayles, Ph.D., FACSM, is an associate professor of Health and Physical Education at Indiana University of Pennsylvania (IUP), where she serves as the undergraduate exercise science program coordinator and the graduate coordinator for exercise physiology. The IUP is the largest of 14 schools in the Pennsylvania State System of Higher Education. Before joining IUP, Dr. Bayles worked for several years as a clinical exercise program director for both the University of Pittsburgh Medical Center and Allegheny General Hospital. Dr. Bayles received her graduate degrees from Adelphi University and the University of Pittsburgh. She is a fellow of ACSM and the American Association of Cardiovascular and Pulmonary Rehabilitation. She has served on ACSM's Committee on Certification and Registry Boards (CCRB) in several capacities, including ACSM Certified Health/Fitness Specialist® and ACSM Certified Clinical Exercise Specialist®subcommittees, and she currently serves on CCRB's executive committee. She has been an ACSM Health/Fitness Instructor® workshop director for the last 8 years.

Exercise is medicine. Everyone knows it, but still not enough people do it! We have all seen the grim figures that only one third of people in this country exercise regularly. Obesity also is increasing at an alarming rate, particularly in the adolescent and young-adult populations (1). Even more disturbing is the recently published information on the independent and profound effect of time spent being sedentary. According to the study, "The association between sitting time and mortality was independent of the amount of leisure time physical activity and BMI," (2) the message is clear: people need to get off the couch, out of their cars, and off the elevators.

The Exercise is Medicine™ (EIM) initiative was launched in November 2007 by the American College of Sports Medicine (ACSM) and the American Medical Association. It is a broad-based campaign maintained by ACSM, which seeks to impact health and well-being on a public health basis. The initiative is far-reaching and ambitious. The basic premise of EIM is the education and participation of all physicians to make "physical activity assessment and revision a routine part of every visit to a physician's office." (3) It expands the sphere of influence of physical activity beyond health and fitness professionals and extends to the public, media and its supporting partners, and most important, to policy makers and legislative advocates.

As a health/fitness professional, your role in EIM should be clear, or is it? Get people moving; get them off the couch and to a fitness/wellness facility. That should be the easy part for most professionals. Well, maybe not. EIM provides an opportunity for the health/fitness professionals to develop important relationships by working with primary care physicians and other medical specialists to refer appropriate patients for physical activity. How can the health/fitness professional be most effective in the EIM initiative? The answer may require a systematic approach to working with the public and supporting partners such as physicians, policy makers, and legislative advocates.

For the health/fitness professional, working with the public is what the business is all about. How can EIM influence that relationship? Not only are fitness professionals valuable resources to the public regarding the delivery of reliable information on exercise and fitness, but they may assist their clients in becoming their own health advocates when dealing with their primary care physicians. For example, health/fitness professionals can encourage clients to talk to their physicians regarding guidelines and benefits of exercise and assist clients to develop questions about exercise when visiting their physician's office. Health/fitness professionals can also assist clients and the general public with decisions regarding appropriate exercise facilities, fitness clubs, and the risks and benefits of the services offered. Finally, health/fitness professionals can provide valuable strategies to clients designed to make physical activity a permanent behavior change.

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Working with physicians is something the health/fitness professional may or may not be familiar with. Many health/fitness professionals may assume they know how to work with physicians, but how can we improve and facilitate this relationship? Connecting with physicians may be as simple as visiting local doctors' offices to remind physicians of your location, services, and credentials. Are you familiar with key office personnel for your primary care physicians? These are often the staff who make contacts for the patients regarding referral for exercise services. Try providing fitness fact tip sheets or business cards to your local primary care physicians. Health/fitness professionals can serve as valuable resources to the medical community specifically to physicians. Try providing statistics on the benefits of exercise for a variety of medical conditions in the form of professional handouts for their patients. Do you know how to contact the physician's office should you have questions regarding your client's care? Do not hesitate to serve as a surveillance system for the physician. Make sure you know when to refer the client back to their physician or when to refer them to another program that might be more appropriate.

Finally, one critical component of the EIM initiative involves advocating for health policy and legislative activity to make exercise counseling a permanent and reimbursable component of every visit to a physician's office. Other activities involve promoting the benefits of physical activity especially to businesses and employers. What is the role here for the health/fitness professional? At a local level, it may involve connecting with community leaders to introduce them to the EIM initiative and proclaim an EIM month. The EIM Web site has many valuable tools including an EIM Action and Promotion tool kit. The tool kit could be used to assist health/fitness professionals in approaching legislators to educate them about the value of physical activity. In addition, the tool kit might be a valuable resource when approaching legislators and hospital/corporate leaders regarding the initiation of physical activity/wellness programming at the community or corporate level. Initiatives such as the development of community walking trails and incorporating wellness programming into the local corporate community may all result from advocacy efforts by health/fitness professionals. On a national level, efforts to add reimbursement for office-based exercise counseling to the pending health care reform legislation are continuing. If these efforts are successful, health/fitness professionals must possess the necessary knowledge and skills related to communication with primary care physicians. These skills also include the ability to work within various health care networks to understand and establish relationships between allied health professionals, insurance providers, and the local and corporate community. The ACSM certified personal trainers and health fitness specialists currently are undergoing periodic assessments of their job tasks, knowledge, and skill statements. Part of that assessment will include the addition of specific knowledge and skill statements regarding physician referral, the ability to access health care providers, and work within the health care system to ensure that we maximize participation in physical activity programs. Exercise may in fact be the best medicine; it is easy to take, and frequent use causes little or no side effects! Additional information regarding this initiative can be found at www.exerciseismedicine.org.

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References

1. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. Appropriate physical activity intervention strategies for weight loss and the prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459-71.
2. Exercise is Medicine Web site, Indianapolis, (IN): Available from http://www.exerciseismedicine.org.
    3. Hamilton MT, Healy GN, Dunstan DW, Zedevic TW, Owen N. Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behaviors. Curr Cardiovasc Risk Rep. 2008;2:292-98.
      © 2009 American College of Sports Medicine