What choices do individuals have when the medical community discharges them, and yet they are not satisfied with their health status, lingering pain, and dysfunction, i.e. things they still want fixed?

Who is equipped to support individuals who have complex medical issues where exercise can play an important role in managing their health?

Ongoing, sometimes heated, internal dialogues between exercise and fitness professionals and licensed clinical providers have identified the need for discussion regarding fitness professionals working with the “walking wounded”. Especially considering the explosion of “techniques” (myofascial release, neuromuscular activation, etc.) proffered to these professionals. These market forces push exercise and fitness professionals deeper into the realm of therapy and treatment thus blurring the lines of their scopes of practice.

Clearly certifying agencies like ACSM, ACE, and others, have recognized the issue and have developed certifications and continuing education for personal trainers to interact with this medically challenged population.

Is this enough?

We believe it's a good start, but more work needs to be done. We want to contribute to the progression. Exercise Professional Education, LLC aims to lead industry efforts to reconcile the controversy surrounding non-medical exercise providers interacting with individuals with disease and pain, with the reality that the exercise consumer is actively pursuing help in the face of their disease.

“The increase in the elderly population, with its concurrent elevation in chronic illness and pain and subsequent utilization of health services, will result in an exponential increase of health care expenditures. For example, falls are a foremost health care cost for the over 65 population, presumably due to balance deficits and weakness associated with either aging or secondary to a illness or disease state (e.g., stroke, Parkinson’s) [3]. The high incidence of injury from falls can be attributed in part to low bone mass in the elderly (higher occurrence of fractures) [4] and low muscle mass (since soft tissue can attenuate fall impact); furthermore, greater than 90% of hip fractures may result from falls [5]. Other rising costs include the increased need for hospitalizations, medications, and physician office visits. Therefore, it is important to find ways to counter the decline in health status with advancing age.

The answer to these health problems may lie in the investigation of comprehensive rehabilitation programs that utilize active-based physical therapy protocols involving therapeutic exercise. However, clinical programs, other than cardiac and pulmonary rehabilitation and preventative programs, have been slow to emerge as a standard treatment due to limitations in medical direction and supervision to handle the complex medical problems that those with chronic illnesses present. These patient populations need a carefully planned exercise prescription with regular assessments to monitor modes and intensities of work, medication interaction, disease interaction, and medical events [6]. Many older patients who have an orthopedic malady may have one or more diagnoses of chronic illness. Of all the treatment options, such as hospice care, medications, and surgical intervention, only active treatment options address recovery in terms of function, overall medical status, and future prevention.”

Smith, T.P., Kennedy, S.L., Smith, M., Orent, S., Fleshner, M., Physiological improvements and health benefits during an exercise-based comprehensive rehabilitation program in medically complex patients, Therapeutic exercise, aging, and chronic illness, p. 86.

“Musculoskeletal ailments have surpassed the common cold as the number one reason for physician visits in this country, due in part to our aging population as well as the “beat up” Baby Boomer generation. The result is that more and more individuals with vulnerable, aging frames are trying to stay active - or should be more active. This presents many challenges in the world of fitness.”

Nicholas A. DiNubile, M.D., Musculoskeletal Injuries: A Call to Action-and Opportunity-for Fitness Professionals, ACE Prosource 2013.