Fitness Research update: The forgotten weapon in the war on obesity

A partnership between Australian Fitness Network, the University of the Sunshine Coast and the Australian Institute of Fitness, Fitness Research studies the populations, communities and environments related to the fitness industry, with the mission of improving the health of Australians through an improved body of fitness knowledge.

Research paper: Exercise professionals – could they be the forgotten public health resource in the war against obesity?
Authorship: Dr Mark McKean; Professor Brendan Burkett; Dr Florin Oprescu
Published: Journal of Sports Medicine & Doping Studies, Volume 2 Issue 5 2012
Read more: www.researchgate.net/profile/Mark_McKean

Obesity continues to develop worldwide, creating a burden on individuals, communities and health care systems. There is a general push to promote the idea that ‘exercise is medicine’, encouraging more of the population to develop exercise habits that will help to prevent obesity and fight lifestyle disease. However, questions remain regarding the means by which this message will be disseminated, as well as about who is responsible for delivering this message.

Exercise professionals as a public health and health promotion resource

Health promotion is the science and art of enabling people and communities to have more control over their health and lives. The potential of exercise professionals to be a key health promotion resource, as a bridge between sport and health, is still to be fully recognised. Thus, greater understanding of the potential role, impact and influence that exercise professionals can have in the war against obesity and chronic disease needs to be pursued through research, consultations and professional collaborations. The purpose of this paper was to outline some findings and recommendations regarding this unacknowledged potential.

Scientific literature indicates that obesity and associated chronic diseases are a major burden on the populations and health systems of many countries. There are many complex issues around obesity and chronic diseases such as:

• increased morbidity and mortality due to preventable chronic diseases
• failure of health care systems, including public health, to address the growing obesity epidemic and its associated morbidity
• nutritional risk factors and reduced physical activity contributing to a high proportion of the aforementioned burdens across gender, age and socio economic status.

Strategies

The real challenge lies not in documenting problems, but in finding solutions to reduce the burden of obesity and chronic diseases, preferably sustainable solutions for which resources are already available. Various inter-professional strategies have been identified that include exercise professionals as key players in the health promotion team. These strategies can be used to enhance physical activity and nutrition for general populations, as well as for elite athletes. Examples include:

1. Providing incentives to physicians to prescribe exercise and refer patients to exercise professionals, while lowering the cost of such interventions.
2. Development and use of shared evidence-based guidelines between exercise professionals, nutritionists and public health professionals.
3. Enhancing communication and trust between exercise professionals and their clients through education and availability of evidence-based guidelines.
4. Providing financial incentives to reduce barriers and encourage increased participation in supervised physical activity, especially in at-risk populations.
5. Enabling community health workers and other health promotion professionals to encourage and sustain community-based physical activity supervised by exercise professionals.

Impacts

The paper proceeds to summarise the potential impacts of exercise professionals as a health promotion and disease prevention resource:

1. Play an active role in the development of social norms and role models that encourage regular physical activity.
2. Early identification of at-risk populations and their risk factors (injury, weight, medical conditions, nutritional and hydration risk factors).
3. Expand primary care scope of practice roles for exercise professionals (health promotion and disease prevention, plus non-traditional medical services referral).
4. Enhance the functionality and capacity of primary care and community networks through engagement with multidisciplinary health teams in order to provide solutions to the growing problem of chronic diseases.
5. Reduce the overall burden on hospital admissions due to preventable conditions.\
6. A healthier population in the long term.

Documentation

To ensure that impacts can be documented, they need to be tracked. As such, better data collection may be necessary. Three strategies related to data collection and impact evaluation are available:

1. Collect and report data on access to, and use of, exercise professional services, including variables such as age, ethnicity, socio-economic status and language.
2. Include measures of referral sources, client longevity and attrition rates in assessing provider performance.
3. Monitor progress using individual and population level measures.

Concerns

There are several concerns with respect to the role of exercise professionals and their skills. Research suggests that even though giving nutritional and health advice may not be in the contractual domain of the exercise professional, advice was still often provided. Such behaviour may influence some exercise professionals to assume a wider definition of their expertise. It has been reported that financial incentives offered to fitness professionals for referring products to their clients can create a bias away from accepted recommendations. Concerns have also been raised that the title ‘personal trainer’ can be assumed by anyone, regardless of qualifications, making it difficult for the general public to determine quality. Furthermore, there is little evidence that exercise professional training courses include health promotion components, raising the question of whether exercise professionals have the skills to adopt the role.

Considering these concerns, as a first step towards exercise professionals becoming health promoters, it may be warranted to determine the current relationship that exists between them and the population with respect to nutrition advice and guidance.

Take home message

Existing evidence suggests that exercise professionals could play a much more significant role from a health promotion perspective. With proper education, exercise professionals could be a key resource for health promotion and disease prevention.