If you’ve got this “special sauce,” you’ll overcome any obstacles placed in your way to perform your best…anytime! Regardless of whether it’s sticking with lifestyle change to improve your health, a nutrition plan, cutting back on smoking or drinking, adhering to a medication regimen, following through with physical therapy appointments, or adhering to an exercise program, this essential ingredient will make all of the difference.
“An ounce of prevention is worth a pound of cure.”
This sentiment from Benjamin Franklin is as true today as ever. Especially when it comes to fitness and health. The past 50 years has seen a nearly triple increase in obesity rates for adults and youths. According to the website USAFACTS.ORG. this costs the American people $147 Billion annually. They also state that “roughly have of all medical cost associated with obesity are financed by Medicaid and Medicare”.
When I first entered the field of performance coaching, terms like building resilience, develop focused attention, manage sustainable energy levels and strengthen our emotional intelligence were sought after areas of development not only in elite athletic training; but also, executive development.
As the demands of life rise for our clients, the best way we can support them is by designing health and fitness routines that combine all the elements of health and performance. Our clients are seeking our expertise on how to “feel” better physically, mentally and emotionally. And the one tool that links the mind, body and brain is BREATH.
Musculoskeletal issues have become the number one reason for physician visits.(1) Doctors are starting to agree that many surgeries may have been unnecessary.(2) The opioid crisis is a symptom of a larger societal issue to be sure, but it appears that too many people are turning to pain medications to manage their various aches and pains. Certainly pain medication and surgery can help many diseases and symptoms. However, they can also have long-term detrimental effects on human health. Can supervised exercise contribute to helping the problems of too many surgeries and too many pain medications being prescribed?
The modern research on this subject continues to support the notion that properly dosed and executed exercise can have a long-term positive impact on pain and possibly reduce the need for surgery. Who in the health and wellness community conducts supervised exercise? The Personal Fitness Trainer and Exercise Professional.
Personal Trainers are sought out to create fun and challenging workouts, help people lose weight, or help athletes perform better for their sport. We feel that although important, this puts exercise professionals like personal trainers in too narrow of a box.
Can a Personal Trainer be more?
Can an Exercise Professional transcend these service niches and be considered part of one’s healthcare team?
We not only believe so, we think that we must.
Exercise has more power than we, and the exercise consumer, give it credit for. Exercise can stimulate powerful natural medicine to help individuals overcome chronic pain and possibly even avoid surgery.
Our goal is to trumpet this message to exercise professionals and consumers alike and work to support the development of the exercise professional to meet this demand. Our plan is to be one of the pioneers that move exercise to the forefront of healthcare as a powerful, and often overlooked, process to be integrated proactively within a healthcare team for supporting individual health where pain persists and surgery is being considered. Will you join us?
Article co-written by Greg Mack and Charlie Rowe of Physicians Fitness.
Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease.
Charlie Rowe has been in the fitness industry for almost 20 years, and currently a Muscle System Specialist at Physicians Fitness. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist. Charlie hold numerous certifications, including Cooper Clinic’s Certified Personal Trainer, NSCA Certified Strength and Conditioning Specialist, the ACSM Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and ACE Certified Orthopedic Exercise Specialist Certifications. Charlie’s experience and continued pursuit of education make him one of the best in his field.
(1) Musculoskeletal Injuries: A Call to Action and Opportunity for Fitness Professionals, ACE Prosource 2013 by Nicholas A. DiNubile, M.D.
(2) Doctors Perform Thousands of Unnecessary Surgeries. Peter Eisler and Barbara Hansen, USA Today. Published 3:25 p.m. ET June 19, 2013. Updated 1:34 a.m. ET June 20, 2013
Medical Fitness is a growing trend in health care. Medical Fitness helps extend basic healthcare from the classic and formal model of a person being a patient, receiving treatment and being discharged entirely, to after care professional services. Medical Fitness is the integration of ongoing fitness, wellness and preventive care under the supervision of health professionals such as, physical therapists, exercise physiologists, personal trainers, nutritionists, acupuncturists, chiropractors, massage therapists, mental health practitioners, health and wellness coaches, yoga professionals and more.
Medical Fitness is appropriate for many types of conditions such as arthritis, diabetes, orthopedic conditions, pre and post natal, heart disease, fibromyalgia, stroke, cancer, mental disorders, and others. When properly implemented, Medical Fitness is a win-win for both patient and health professional.
Medical Fitness Advantages for the Patient
First, after discharge from the formal healthcare world, the patient can be referred to a variety of health professionals educated in the patient’s condition, providing both a continuum of care and a multi-discipline approach. For example, a person discharged from physical therapy after a total knee replacement might be referred to a certified personal trainer facility educated in post-rehabilitation of a total knee to continue to make further functional gains and improvements. If that person needed help with weight loss, perhaps a referral to a nutritionist would be included. If they also had issues with coping with their diminished function, a consult with a specialist in mental health might be provided as well.
Second, many times the medical facility in which care was provided will have a Medical Fitness component associated with it. Direct referral to this type of facility can provide the patient with security and confidence, being familiar with the facility and with the knowledge that the new health professional is familiar with their condition and diagnosis.
Medical Fitness Advantages for the Health Professional
First, by being part of a Medical Fitness community the health professional can refer a discharged patient for follow up care, secure in the knowledge that their patient will be cared for by an ancillary care professional who is trained and certified to provide a proper continuity of care plan along with the appropriate goals and treatments.
Second, by referring to a Medical Fitness multi-discipline team, the health professional receives security that if their patient has any other issues, those concerns will be addressed. For instance with the example of the total knee replacement patient needing assistance with weight loss or nutrition consults, (treatments that don’t fall under the umbrella of physical therapy), the physical therapist is assured their patient will be helped to achieve a better transition back into their “non patient” status.
Third, when the health professional refers their patient into a Medical Fitness wellness and preventative care environment, the chance for overall improved outcomes is increased. Patients learn better self-confidence in caring for themselves, taking charge of their own health and lifestyle. If a patient’s condition begins to backslide, the wellness program professionals can help make sure the patient gets referred back to the health professional in a timely manner.
In conclusion, Medical Fitness benefits all involved. Quality of care is improved. Patients receive access to multi- discipline care and can learn to take charge of their life. Health professionals receive security of proper continuity of care and gain improved patient outcomes.
Douglas Feick, PT is a licensed physical therapist in Texas, with emphasis in orthopedics for over 15 years. He is President of BioEx Systems Inc, a software company providing software solutions for physical therapists, athletic trainers, chiropractors, dietitians and personal trainers. His hobbies include scuba diving, raising bees and he is an avid skydiver.
The need for medical and fitness services/products continues to grow. In the United States, and around the world. The corporate and industrialized delivery of medical and fitness products/ services continues to grow to meet increasing demand. Innovations in medical diagnostic technologies, surgical procedures, biomaterials, and medicines help individuals live longer, and with a higher quality of life. Technology and scientific research are propelling fitness product/service innovation with digital activity monitoring apps . . .
Your passion is to help people maintain or regain optimal health and fitness. Under current law and standards, you are only permitted to work with clients who are already fit and healthy or have been released for independent exercise and have passed your health screening questionnaire. But those are not the people you yearn to work with. The clients you seek must have authorization or approval from a medical provider before you can proceed.
How often have you met with a potential new client, asked them to get clearance from their doctor and then never seen them again? Or, a client develops a new pain or problem and you refer them for consultation and that ends the relationship. Another frequent scenario: Your client has followed through with your request only to be referred by their primary care provider for a cardiac treadmill test, but your concern about their low back pain or shoulder dysfunction was not addressed. Success as a medical fitness professional is dependent upon working relationships with medical professionals. In order to establish those relationships, the aspiring medical fitness trainer needs better understanding of the medical system. What follows are a few insights into the medical system that medical fitness professionals need to understand.
Recognize how busy the medical practitioner might be
“Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients.”1[i]. Today, the average primary care provider is responsible for roughly 2,300 patients, so not quite 21.7 hours of work/day, but more than any individual can possibly provide.
In order to cope with the workload, doctors must rely on their support staff to help whenever possible. Do not be alarmed or offended if your inquiries are met by a nurse or medical assistant. Most providers simply do not have the time to meet with you for introduction or discussion. On the flip side, most doctors would love to have effective, safe and reliable resources for their patients who need to lose weight, get fit, manage diabetes, recover from surgery or cancer treatment etc. They need you.
Understand the current reimbursement rules
In most cases providers cannot bill for services unless the patient is in the room with them. Therefore, time spent talking on the telephone, responding to emails, or filling-out forms is usually unreimbursed time. This means that your client will probably need to actually make an appointment to be assessed and cleared for exercising with you. To streamline the process, send a letter with your client introducing yourself and what you do. Include a form stating your concerns and your proposed training plan. Design the form to be easy to read, with a simple agree or disagree that can be checked or circled and space for the provider’s signature. You might also want to leave room for comments and questions. If you have received a response from a provider, you should consider sending intermittent progress reports updating the provider about your mutual client/patient.
Be familiar with HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to protect an individual’s medical confidentiality, particularly when changing jobs which at that time meant changing health insurance providers. Unfortunately, the law is complicated and places multiple restrictions on who members of a medical team can talk to about a patient’s medical condition.
As an unlicensed party, the fitness professional is not privy to “protected health information” (PHI) without direct written consent from the patient (your client). Due to these restrictions, the medical providers cannot fill-out or respond to your request for information or clearance without your client’s “written” consent. If the client takes the form and returns it to you, this action implies they have agreed to share the information. If you send the form directly to the provider, that permission has not been granted unless the client has signed a HIPAA release form allowing the doctor to share personal health information with you personally.
The aforementioned are a few reasons why you may have perceived a wall or barrier between you and medical providers. One solution is to ask your client if you might accompany him or her to the appointment to obtain medical clearance or guidance. That way the medical provider would have a specified time and be reimbursed for addressing your concerns. You would be communicating directly with the medical provider and not support staff, and it would be easiest for the client/patient. It is also a way to introduce yourself to the medical provider and initiate a working relationship. Although you will probably not be compensated, it may be well worth your time in the long run.
Once you have made it into the office with your client, now what?
Know your details
Because there are so many different avenues to becoming certified as a personal trainer, there can be large differences in the knowledge base and competence of one trainer compared to another. The aspiring medical fitness professional must have a thorough understanding of the pathophysiology of the conditions they will be working with in order to communicate effectively with medical providers. In addition, you need skill and experience in the programs you design and utilize with your clients. Be able to back up your training plans with published research.
Recognize that a medical fitness professional has a fund of knowledge that the medical provider does not have
Exercise science is not covered in medical school curricula. Medical school is about illness and disease not health and fitness. Generally speaking, the average MD knows very little about exercise science. Most do not know about the effects of eccentric versus concentric loading, how to train for endurance versus strength, what to do to improve stability, balance and core strength. Fitness professionals are not inferior to medical professionals; you have a different knowledge base. Recognize and believe that you have something to offer. You may not know all of the anatomy and biochemistry that the doctor does, but you have a basic understanding of your client’s condition and you know the potential benefits of your interventions. Share this information with the medical providers.
Stay within your scope of practice
Because personal trainers and medical fitness professionals are not licensed by any governmental or legal agency, and because laws vary from state to state, there is no clear definition of the skills and competencies of a medical fitness professional. Working outside of your scope of practice can lead to civil and even criminal penalties[ii]. Therefore, for the time being, if you want to work with clients struggling to manage chronic illnesses, recover fully from injuries or surgeries, etc., you need to work under the wing of medical professionals who have prescriptive authority – those professionals in the medical field licensed to diagnose problems and prescribe treatment.
Dr Robert Butler MD, founder of the National Institute on Aging once said: “If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” There are pockets here and there in the US where medical providers and fitness professionals work together. In many cases there is a visionary medical provider at the helm of an interdisciplinary team. In other cases, fitness professionals have worked hard to become part of a medical delivery model.[iii] The more medical fitness professionals that can take the leap and align themselves with medical providers, the more people will be helped.
This article was featured in MedFit Professional Magazine Winter 2020 issue. Subscribe to MedFit Professional Magazine to read more great content like this!
Dr. Mary Hoagland-Scher,MD is a board-certified family physician who practiced medicine for 30 years. When she entered medical school, her goal was to help people stay healthy. As the focus of western medicine shifted away from health to disease management with a strong emphasis on pharmaceutical and or surgical intervention, she became uneasy with her role and decided to discard her prescription pad and learn new tools. Now as a NASM Certified Personal Trainer she is working to shrink the gap between fitness and medicine.
- [i] Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation Justin Altschuler, MD, David Margolius, MD, Thomas Bodenheimer, MD⇓ and Kevin Grumbach, MD Ann Fam Med September/October 2012 vol. 10 no. 5 39
- [ii] For an excellent discussion of this issue, see: Abbott, Anthony Ed.D, FACSM, FNSCA. Scope of Practice, ASCM Health and Fitness Journal ,Sept/Oct 2018, Vol 22 Issue 5 pp 51-55
- [iii] Watch MedFit TV webinar by David Rachal III, “Exercise Prescription: Integrating Services with Medical Professionals and Insurance Providers”
A discussion of medical fitness is rooted in an understanding of the health benefits of fitness and exercise. The documented benefits are endless and include management of chronic disease, management and prevention of osteoporosis, improved mood and sleep disorders, stress relief, management and prevention of obesity.
Health agencies across the spectrum of public health and disease-specific organizations recognize and promote exercise and fitness as an integral part of the management of chronic disease; diseases that include diabetes, cardiovascular disease, Parkinson’s, depression, multiple sclerosis, and arthritis, among others.
If fitness and exercise are well accepted as part of the management strategy for multiple diseases, why is it that access to organized exercise plans, and fitness professionals who can help implement those plans, are not a standard part of the medical treatment paradigm? Why is it not a standard benefit covered by common medical insurance policies?
The reasons are multifactorial and a reflection of the overall healthcare conundrum in our country today. Let’s focus, however, on how to make a change. We need to focus on how to integrate fitness professionals into the medical paradigm. A perfect model for this is an integrative medical fitness center.
What is a medical fitness center? It is a fitness facility with a multidisciplinary staffing approach and has the following characteristics:
- Regular medical oversight by a medical director
- Practitioners with nationally-recognized certifications and training in the care of chronic disease
- Comprehensive health assessments and exercise prescription
- Exercise classes geared toward specific medical conditions
These centers bring together credentialed staff in a collaborative way to provide exercise prescription plans specific to the needs of an individual with chronic disease.
The concept of the medical fitness center is not new; many currently exist in communities throughout the United States. However, an understanding of their importance in the context of the current healthcare environment has grown. The idea of creating “medical homes” that are collaborative across disciplines and provide a comprehensive healthcare approach is now being recognized to provide a high standard of care while simultaneously decreasing overall healthcare costs. This is true specifically for high-risk individuals who suffer from chronic disease.
Further integration of medical fitness centers, and broad access to exercise and fitness resources, will hopefully become standard of care and widely accessible to all individuals, especially those with chronic disease. This integration will inherently bring fitness professionals into the paradigm of healthcare and promote healthcare through fitness.
This article was featured in MedFit Professional Magazine fall 2019 issue.
Subscribe to MedFit Professional Magazine to read more great content like this!
Dr. David Kruse attended medical school at UC San Diego, after graduating from UC Berkeley. He holds board certifications in family and sports medicine. He practices sports medicine with the Orthopaedic Specialty Institute, in Orange, CA. Dr. Kruse is the Chief Medical Officer for the MedFit Network and on the Medical Advisory Board for the MedFit Education Foundation. He is currently a Team Physician for USA Gymnastics, Orange County Soccer Club, and Biola University. Visit his website, krusesportsmd.com
Let’s start with four statements I’m willing to call facts:
1. Chronic disease afflicts the majority of American adults over the age of 45.
2. People with chronic disease choose a visit with an allopathic physician (conventional medicine) as their first course of action.
3. A pharmaceutical prescription is the first course of action after linking symptoms and biomarkers to a commonly diagnosed disease (type 2 diabetes, hypothyroidism, hypertension, hypercholesterolemia, etc.).