“As a physician, I need something more than just telling my patients to get active-I need to refer them to someone to help them.” Bob Sallis, MD
These words spoke to me as I sat in the large meeting room packed to near capacity at the ACSM Health and Fitness Summit in San Diego. The presenter was Dr. Bob Sallis, Co-Director of the Sports Medicine Fellowship at Kaiser Permanente, Family Practice Physician for Kaiser Permanente and Chairman of the Exercise is Medicine Advisory Board.
The keynote talk, entitled, “The Importance of Connecting Fitness with Healthcare,” was a compilation of startling facts highlighting the dismal state of our healthcare system combined with the overwhelming evidence for exercise in the prevention of degenerative conditions including, diabetes, cancer, hypertension, depression, osteoporosis, dementia and heart disease.
As healthcare spending has risen over 800% in the last 50 years, Dr. Sallis spoke to the importance for the integration between the healthcare system and the fitness industry to tackle what has been called a pandemic of physical inactivity leading to the staggering costs of healthcare delivery in this country.
As I sat in the audience, I couldn’t help but remember a time working in the clinical setting when exercise was not considered vital to a patient’s success and getting patients to exercise regularly was not part of the treatment plan. Yet, years later, here is evidenced-based data suggesting the opposite. Having worked in both the healthcare field and fitness industry for 30 years, I admit feeling a sense of vindication. Yet I can speak for many fitness professionals, we are frustrated at the lack of momentum for recognition within the healthcare system.
There is a chasm between the fitness industry and the healthcare system; the burgeoning question is how can a more cohesive relationship exist between the two? I recently had a conversation with Dr. Sallis on this topic. The cost of fitness services is the barrier most mentioned in discussing exercise with his patients. As such, he strongly advocates for health insurance companies to begin reimbursing the cost of fitness professional services.
This would require a cohesive effort amongst the wide and varied healthcare and fitness industry stakeholders. The primary barrier to address the issue of reimbursement is the lack of cohesiveness amongst the copious number of fitness organizations. The fitness industry remains a fragmented lot. With the staggering number of certifying agencies, it is confusing for the consumer and the physician. “I am confused by all the certifications,” stated Dr. Sallis. He went on to say this issue of certification is less important to him than the ability for the professional to communicate, motivate and get results for his patients.
There is no governing body to oversee standards of practice for fitness professionals. Certifying agencies compete with each other for membership and certification offerings. They are closed off from each other thereby leaving their members to fight for respect in the healthcare system on their own.
Insurance reimbursement will help the patient get a leg up on physical activity. Oftentimes this leg up is the first step for a patient to see possibility in a life of activity. Reimbursement would also directly address the demonstrated value of physical activity on health status. However, personal trainers tend to develop a sense of dependence on the part of the client. A trainer tells the client what to do, which, in my opinion, disempowers the client for lasting change. For lasting change, the patient needs to understand from within the bigger vision of why exercise can be important for them. The issue at hand is behavior change-a lifelong endeavor.
This is where the health coach comes in.
According to the CDC, health behaviors (smoking, diet and exercise) contribute more to overall health status than genetics, environmental factors or access to medical care. And although there is much discussion and disagreement among health professionals regarding the best foods to eat, as Dr. Sallis succinctly states, “We may not all agree on the “right” diet, but we can all agree that physical activity is crucial for health.”
The International Consortium for Health and Wellness Coaching was formed with the input from over 70 representatives from coaching schools and organizations. The ICHWC believes health and wellness coaching is “the change agent that shifts the culture and delivery of healthcare from dependency to empowerment.” As stated on their website, “Our most fruitful accomplishment was to navigate a winding path toward consensus among many individuals and organizations representing widely divergent viewpoints.”
According to Margaret Moore, founder of the Wellcoaches School of Coaching, it took seven years and numerous collaborative efforts and vigorous discussion to agree on what constitutes a qualified health coach. Issues including education and credentials, job tasks and scope of practice had to be agreed upon for a cohesive statement to ensue. This is what organizations can accomplish by overcoming their bias and self-interests for the betterment and advancement of their industry.
To further push for recognition, the ICHWC formed a partnership with the National Board of Medical Examiners to launch a National Board Certification for Health and Wellness Coaches. According to the NBME website, this credential, “allows healthcare professionals, patients, employers and educators to identify practitioners who have demonstrated knowledge, skills and abilities essential to health and wellness coaching.”
The time has come for change. As with the collaborators in the ICHWC, the fitness industry needs to form a consortium of leaders from the industry, from organizations, educational institutions and the medical field to bring to the table the desire for recognition and professionalism in the field. Using the ICHWC model, this mobilization of like-minded individuals with varied backgrounds can strengthen not only these organizations but the future of the fitness industry as a whole.
The fitness industry stakeholders remain resistant to unite for the advancement of the profession in the healthcare setting. With the staggering amount of evidenced-based data supporting exercise and health status, fitness professionals can no longer play small in what ultimately is a disservice to insurance policy holders and the public at large. As a certified fitness professional and certified health coach with a master’s degree in exercise physiology, I no longer look to the fitness industry for direction and support. I look forward to sitting for the National Board Certification for Health and Wellness Coaching exam later this year.
MELISSA WOGAHN is the author of Off the Couch: How to Find Joy in Physical Activity Even if You Hate to Exercise.