Building Trusted Collaborative Relationships between Healthcare Providers and Exercise Professionals w/ Dr. Amy Bantham

I'm your host , mike Stack , an exercise physiologist by training and a health educator , and a health entrepreneur by trade , and I'm fascinated by a phenomenon I call the wellness paradox . Entrepreneur by trade , and I'm fascinated by a phenomenon I call the wellness paradox .

This paradox , as I view it , is the trust , interaction and communication gap that exists between exercise professionals and our medical community . This podcast is all about closing off that gap by disseminating the latest , most evidence-based and most engaging information in the health sciences .

And today , today , we're joined by Dr Amy Bantham , who is coming on the podcast for her third episode .

She was the lead author of an article in the themed issue entitled Developing Trusted Collaborative Relationships Between Healthcare Providers and Exercise Professionals , and her co-authors are actually one exercise professional in Jeff Young , who's been in the medical fitness space for a very long time , and a physician provider , dr Matthew Kampert , who's at the Cleveland Clinic

, who also is an exercise physiologist by training . Trust is foundational to everything that we talked about in the themed issue .

None of the strategies , tactics , objectives and things we talked about in the theme issue matter if you don't have trust and this is really right in Amy's wheelhouse , and if you heard her on my podcast before , if you've heard her in other venues she often talks about how to build these collaborative relationships with healthcare providers and there's so many pearls of

wisdom in this podcast and in this article .

I really encourage you to listen to the podcast , read the article and do both of those again and again until you really imprint some of these lessons on your brain , because I think the combination of the author team here has such a diverse series of backgrounds that all coalesce around how we close off the gap between exercise and medical professionals that it's

really quite not only instructive but also inspiring . Any information we'd like to share with you from today's episode can be found on the show notes page , that's by going to wellnessparadoxpodcom . Forward slash , episode ACSM7 . That's forward slash , episode ACSM7 . Please enjoy this conversation with Dr Amy Bantham .

I'm delighted to welcome back to the podcast for the third time , actually our first three-peat guest on the podcast , dr Amy Bantham . Amy , thank you so much for joining us .

Today we're here to talk about an article in the themed issue , but before we launch into that , in case our audience hasn't caught either of those two episodes , can you give us a little bit of the idea of your background to provide some context ?

It was my entry into the health and fitness industry , I think 25 plus years ago , and I spent over 11 years working at the Health and Fitness Association formerly IHRSA working on advocacy and health policy and health promotion and helped start the now Health and Fitness Association Foundation , which was really focused on expanding access to physical activity and health

and fitness settings . And while I was doing that , I realized that I wanted to do more to connect the public health community and the medical community and the health and fitness community and community-led organizations .

And so I went back and got my doctor of public health and my physical activity research for my doctoral thesis was very much focused on the subject matter for the article that we're going to be discussing today . So it's something that I worked on on behalf of the Health and Fitness Association Foundation .

It's something that I researched and studied probably now for over 12 years , so I'm excited to be here to talk about that . I always neglect to mention , but it's first and foremost in our minds that I am the immediate past . President of the Physical Activity Alliance . You and I sit on the executive . President of the Physical Activity Alliance .

You and I sit on the executive committee of the Physical Activity Alliance together and that is the largest coalition of organizations in the United States which are really focused on promoting health and well-being through physical activity and focused on the policy and systems change .

So really top down and much of my work is top down , but much of my work is also bottom-up thinking about when we're connecting clinic and community . What does that look like in practice and how do we actually implement that ?

And , as you said , you were the lead author for an article in the Health Fitness Journal themed issue , and the title of that article was Developing Trusted Collaborative Relationships Between Healthcare Providers and Exercise Professionals , and your co-authors on the article were Jeff Young , who is a longtime medical fitness professional , and Dr Matthew Kampert , who is at

the Cleveland Clinic , who is an exercise physiologist as well as a physician , and I really loved a lot of what you talked about in the article , and you and I have been talking about this very topic for years , so it's not surprising that we included it in this issue on professionalization and advocacy .

But , just to get us started on this , what do you feel were the most important points that you and your author team covered in the article ?

We had the clinician perspective from Dr Kampert , and then we had the exercise professional perspective from Jeff Young , and then I am an exercise professional , someone who interviews and surveys healthcare providers , so as a researcher , I'm able to see both sides the person providing the referral and the person receiving the referral .

To have both those perspectives be able to come together as part of this writing team was really an excellent experience and hopefully one for the reader as well . From the title , building Trusted Collaborative Relationships it is a theme of all of our work I think I mentioned to you .

I go back and I look at my publications and my presentations at conferences over the last I don't know five , 10 years , and they all have some iteration of bridging the gap , connecting the dots , building bridges between healthcare and fitness , and so key to that is collaboration and communication and building trust , and trust takes time to build , and so I based

that a lot on the research that I did , really looking at an exercise referral network that had been in place for almost 10 years in a healthcare system and trust really bubbled up as something that was .

It takes a long time to build , it takes a short time to break and it is absolutely critical to helping facilitate the referral from the clinician , helping to facilitate patient follow through , patient report back .

And so that is one thing , that , to get to your question , one thing that I really hope readers take away the importance of that feedback loop , that two way bilateral communication and collaboration based on a trusting relationship .

So the healthcare provider knows who they can trust to send their patients to and the exercise professional can receive the patient with all of the information they need to help them follow through on the referral and then they can work with the patient to report back outcomes to the healthcare provider .

So it sets up this open loop that really the goal of which is to help that referred patient but also to set up a referral pathway . So it's not a one-off , it is a relationship that can benefit lots and lots of patients and help them achieve their best health .

All the topics covered in the theme issue kind of help to provide that scaffolding for trust that we're not just trying to build on the local level between clinic and community , but also on the larger systemic level with some of the policy and systems change .

But I guess for starters , as a follow-up , what are some of the biggest barriers that you and your authors talk about when you're talking about developing trust ? We'll talk about the trust and collaborative partnership part first and then we'll talk about that bi-directional communication , because I think that's a separate set of challenges and barriers .

So let's start with some of the initial barriers to developing trust .

So time where the clinician doesn't have the time , the tools , the training , the technology , the trust , or they have concerns about cost , and so what I liked about this article is that we were able to have Dr Kampert use the BRIDGE project as a case study essentially , which in many ways addresses the barriers of tools and technology , because it's very technology

focused and by leveraging that technology and those tools starts to address the time issue and really seeing having a healthcare provider say that it is a two-way street . Dr Kampert had generated a visual which is it is the bridge project .

It is literally a bridge between healthcare provider and exercise professional , and so having a healthcare provider who understands exercise , understands exercise referrals and understands the importance that it's not just waiting passively to have an exercise professional come to them and make the case for why they should be trusted , but working together to really , instead of

snapping their fingers and say , trust me , you need to trust me and this is why actually putting the mechanisms in place that start out with pilot projects , that start off small and then start to build and think much bigger .

And then having Jeff Young , who really does this in practice and is out there receiving but is also very proactive about going out and visiting healthcare providers and knowing that he needs to be talking about credibility and credentialing .

And we have a section in the paper that really talks about knowing the science , knowing the evidence base and educating ourselves as exercise professionals . So we're going and having these conversations with health care providers . They are confident in our skills and abilities and are able to work with patients and help them achieve their best health outcomes .

That we have the knowledge , the expertise , the experience and not experience just general experience , but specific experience working on those disease conditions and working with those specific populations so that they know their patients are in good hands .

I've known Jeff for years and the one thing I really admire about him , as well as all professionals that work with providers in this exercise referral framework , is that they do understand the science , they understand the clinical conditions and they don't just rely on what they learned in their undergraduate or their graduate programs , because those programs are

insufficient to teach you on a granular level how to deal with those chronic conditions .

I do want to go back to something you said earlier which I think is really important as a starting place , because it's not lost on me that a lot of people that are reading the themed issue or maybe listening to this podcast , they haven't been talking about this for a decade or more like we have .

I mean , the goal of this whole themed issue was to bring awareness to the professionalization effort and to get exercise professionals ready for this future where we are a part of healthcare . And trust does take time to build and it builds slowly .

You talked about the idea of a pilot program and I think that's such a great point because it's very easy to get excited about what Dr Kampert talked about but then really quickly become a little demotivated because you realize well , he's at the Cleveland Clinic and the Cleveland Clinic probably has more resources than I don't know anywhere else on this planet to

implement health care . But the idea of a pilot program , I think , is a great way to think of it , to slowly build trust . So can you talk about your experiences just in some of the things you've seen with regard to maybe , how a pilot could work ?

So when Dr Kampert is talking about what needs to be part of the exercise referral and Jeff Young is talking about what needs to be part of the progress report back to the healthcare provider , I was actually I had previously generated resources where the healthcare provider could make the referral and refer out to a community-based fitness studio referral and refer out

to a community-based fitness studio and then the fitness studio could empower the member , the client , to take the progress report and report back to the healthcare provider . And we were testing it in the field as we were going through this process .

So I was wonderfully able to interview studio operators about their experience on the receiving end and then I was able to go back and check in with health care providers who had helped to inform what the exercise referral templates needed to look like and say , okay , this is our experience , they're in the field . What do you think ?

Is this what you were talking about when you said they needed to be simple and easy to use and they needed to demonstrate uptake of the referral and they needed to demonstrate adherence to the referral and some type of progression and really some type of capturing of the patient , client , member engagement .

Because what has been so surprising to me and I certainly appreciate Dr Camper and the BRIDGE project and their use of technology and their ability to capture data , and I do think that's very important but what has been surprising to me in doing the pilot project is hearing from healthcare providers .

I went in in my mind my hypothesis was that they just wanted to receive just a ton of data on their patients and what I learned is they really ? What they really want to know is if their patients are following through and if they're moving from inactive to meeting the physical activity guidelines or even if they're moving from inactive to insufficiently active .

But they're moving the dial and they're engaged and they're doing it consistently .

And so the ability to see where the referral and the progress report are capturing what the provider and the fitness professional think need to be captured and really having that patient , member , client be that conduit between the two , they are helping to build the trust because they are helping to keep that line of communication open .

Well , here's your pushing strength and your pulling strength and here's your VO2 max , and here's this . And to your point earlier , physicians are busy and they want it sounds like to hear high-level data , but they want to hear data .

And so let's stay on that for a second Because , although it doesn't come up at great depth and detail in your article , as it came up in some of the other articles in the issue the example is the article on disease management program design and development by Karen Wonders and her team Outcomes are a big part of this and regardless of what outcome you're

reporting back , a physician is only going to feel comfortable with trusting you and referring to you if you're actually producing outcomes . Have that be a certain volume of physical activity every week or maybe certain fitness outcomes ?

So I'm just curious for you to touch on that kind of , both from the perspective of the article , but also just from your perspective , working in the space for so long about the importance of consistently generating outcomes with the populations we work with .

We move the sector from being a very anecdata-driven , testimonial-driven industry to be much more focused on outcomes and really working with healthcare providers to understand what they want to receive back via the patient .

And I think it was Dr Kampert who talked about what he is able to capture in the healthcare setting and he doesn't need a duplication of that but does need what the exercise professional is able to capture consistency , progression over time Because my research from years ago showed that almost a third of healthcare providers have no idea if their patient follows

through on their exercise referral A third . So if we do better than that , right , that's a very low bar , it just goes out into the void .

And so really identifying what the outcomes that the provider wants to see , what the exercise professional is able to share via the patient , and that the exercise professional is and we have sections on this really educating themselves on the importance of capturing outcomes and the mechanisms by which outcomes need to be captured , so just a general awareness about their

importance and the influence they have on that trust building . Because when I have talked with healthcare providers over the years , there is a lot of just lack of awareness , understanding of what a fitness credential qualifies a fitness professional to do .

And so they say I want to know that my patient will progress , I want to know that they'll be well taken care of . I don't really understand your system , but I'm trying to find proxies for trust and so let's make it easy for them , let's get to know them , let's leverage our patients and members as ambassadors for what we do .

Let's invite them in to use our facilities . I've had healthcare providers say I wouldn't refer to anything that I haven't done myself . Great , let's get them in the doors . Let's bring them in so they understand , so they can refer their patients based on personal familiarity and knowledge and personal confidence in what they're referring them to .

It's you know , dr So-and-so , here it is , or here's how we're going to do it . It's Dr So-and-so , dr Kampert , tell me what's important for you . What are you hearing ?

So I think fitness professionals , broadly speaking , I think do a really good job of wearing the expert hat and we're used to prescribing and sticking to guidelines and kind of all these things we're taught in an academic setting . Sticking to guidelines , kind of all these things were taught in an academic setting .

But it sounds like this trust-building process for collaboration really starts with a little bit of humility and curiosity in conversations with the medical professionals that you have access to .

If we've added a behavior change component to the work that we do and so we are trained in it we have the skills . So having that curiosity and one thing I appreciate so much about Jeff Young is his curiosity . The reason I met him is because he reached out to me and he said hey , I read your doctoral thesis on exercise referrals and I wanted to .

I have a number of questions for you . And I thought he read a hundred page doctoral thesis . So I said , oh great , you , my mom , my dad , my family , the rest of my family , maybe my doctoral committee and you and he and I spoke for an hour where he just said what's your experience based on this ? What were you getting at here ?

And just a real curiosity about informing himself and comparing it with his own experience as a practitioner . And I think that we were able to really leverage that in the article to really talk about process and pathways . This is what this is Dr Camper's perspective , this is what we've done with the Bridge Project , so it's a case study .

But to your point about we're not all the Cleveland Clinic , we tried to make it more generalizable for the population and and for Jeff thinking about okay , maybe you don't have an exercise referral network and maybe you're on the outside looking in .

So we added some language and we added a process by okay , if you're outside the tent , if you're outside the healthcare system , how do you get in and what's the process by which you do that ?

So I think we try to , just as the whole issue is intended to be , a really actionable roadmap for fitness professionals to really professionalize themselves and the industry as a whole , we really try to make our article as well very actionable .

These are the three steps that you need to take in order to build the trust , build the collaboration , set up an exercise referral network , tap into an exercise referral network and , recognizing that all fitness professionals don't sit in the same place , they may be very much embedded in a commercial health and fitness setting , or they may straddle the commercial and

medical fitness worlds , or they may be squarely inside the tent in the healthcare system , in a medical fitness setting . So we try to make make it actionable for all types of fitness professionals , wherever they work or sit .

I think that all of the articles are very , very relevant . This is foundationally relevant , because if you don't have the trust , it's difficult to get to anything else . Before we bring this to a close and I get to a couple of final questions , I'd be remiss if I didn't ask you what you're most excited about right now in the professionalization effort .

You are someone who has such a unique perspective on this and you and I do so much work together . As you said , you're an exercise professional . In fact , you just taught an exercise class before we did this episode . You work at the very highest level of policy and systems change .

You're working with some of these big commercial organizations and I feel like this issue is a great example . We've got momentum like we haven't had before . What excites you the most right now ? In the years to come ?

But for years it almost felt like we were pulling the sector along with us , and now it really feels like there are a lot of exercise professionals who really see they see themselves as being squarely part of healthcare .

They see the value of what they do as exercise is medicine and I like to amend it as exercise movement is better than medicine because it means that you don't have to take as much medicine and so really seeing ourselves as having this really critical role to play and then looking for the tools to help move us along and play that role .

And as we raise our own visibility and credibility , we are seen in a different light and we are seen as partners rather than simply than simply receivers of referrals . I always ask when I'm interviewing providers I ask about do you have a collaborative care team ? Where does the exercise professional sit on your collaborative care team ?

And I've had those descriptions of well , that's really the holy grail for us to be working together collaboratively to have the tools and mechanisms that we need to share the information that we need to best help our patients achieve their best health outcomes .

And we have a seat at the table and we belong at the table and we are seen as belonging , we are seen as having an absolutely critical role to play .

You know you and you know three or four other people in the room , and now I mean I was at one of your panels last year and it was a full room and there were some very prominent players in that room from big organizations and I do feel like we've reached kind of that critical mass of belief in exactly what you said , that not only do we need a seat at

the table and we deserve a seat at the table and we deserve a seat at the table , but now we're starting to get that seat at the table and we need to maintain the momentum which I hope this themed issue and all the work of all the great authors that wrote in the themed issue will help .

It can happen very quickly through an incident or a case , and so we need to be ready .

I have a podcast , movetolivemorecom slash podcast , where I interview thought leaders in the physical activity , healthcare , youth , sports space , very much thinking about all the topics that you and I talked about . In addition to really focused on healthy aging , focused on getting kids active , I also have a book , movetolivemorecom book , which is not unlike this issue .

It's a very practical guide for fitness professionals , coaches , teachers , parents , grandparents , caregivers for how to get kids moving , based on 20 interviews with 20 thought leaders in the space .

The last question for this podcast series is different than the question for the normal podcast , although there are a lot of similarities . So at least this gives you a different swing at it for the third time .

For the third time , taking everything you said today , you know , from the perspective of your article , what is one piece of advice that you can give the listeners of this podcast series that they should be focusing on to advance and elevate our profession .

Well , we start with what we know and who we know , and elevating what and who we know so we can really build . To me , a lot of the goal and the end game is building a collaborative referral network and so we can rely on them , they can rely on us and we can best meet the needs of patients , clients and members .

So , really taking stock of what we know , adding to what we know and then going out and building that network . And we do have very actual tips on how to build a network in the article .

Any information we like to share with you from today's episode can be found on the show notes page , that's by going to wellnessparadoxpodcom forward slash episode ACSM7 . That's episode ACSM7 . In this podcast series , when it drops next week on Monday . And don't forget to subscribe through your favorite podcast platforms Until we chat again next week , please be well .