Emerging Health Technologies: Opportunities and Practical Applications for the Exercise Professional w/Dr. Lou Atkinson

As always , I'm your host , Michael Stack , an exercise physiologist by training and a health educator and a health entrepreneur by trade , and I'm fascinated by a phenomena 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 to do that , in this 10th episode of our series with ACSM , we're joined by Dr Lou Atkinson .

Lou's a behavioral scientist who works for a company called ETSI , and she was one of the authors of the article in the themed issue entitled Emerging Health Technologies Opportunities and Practical Applications for the Exercise Professional .

And , as you could imagine from this title , there's a lot to talk about with this particular topic and we get into some of the more important points during this conversation .

And I think the most important point that Lou talks about is how exercise professionals should think about approaching technology in a manner that causes them to embrace it , not push it away for fear that it's going to take our jobs .

As Lou so eloquently puts it at the end of the podcast , our perfect role is connecting with people , and technology can help us do it better if we leverage it in the right way . 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 ACSM 10 .

That's forward slash , episode ACSM 10 . Please enjoy this conversation with Dr Lou Atkinson Today . We're delighted to be joined by Dr Lou Atkinson . Lou , thank you so much for joining us .

But before we get to that , why don't you just give our audience a little bit of a better idea of your background and provide some context for the discussion ?

So I've worked as a personal trainer , group exercise instructor , also still work as a master trainer , delivering education for instructors , and during all that time I've been involved in developing standards for exercise professionals with Europe Active .

I've also been through the process of having my own education courses accredited , so professionalisation of standards within the industry is really important to me Also . Then , while working as a fitness professional , I got really interested in the sort of psychosocial determinants of people's physical activity , so I studied health psychology .

So I now have a master's and a PhD in health psychology . And since 2008 , I've worked as an applied health researcher and I'm currently the head of research for ETSI . So ETSI is the global medtech partner for ACSM's Exercises Medicine programme .

We are a digital platform that delivers personalised exercise prescription for people with long term health conditions , as well as remote monitoring for clinical and other professional teams who are working with those individuals . So I was delighted to be asked to co-write this article .

Looking at these emerging health technologies and on a personal level , I'm also a hugely passionate advocate for physical activity during and after pregnancy , and also for diversity , equality and inclusion in the fitness industry , and I work with a couple of nonprofit organizations where we're looking to push that agenda forward as well , so I keep myself busy , mike .

I actually sat in on your presentation at the ACSM National Conference this year where you talked about some of the work that you and Brad did with XE . Brad is the editor of the Health and Fitness Journal . So certainly a lot of great work that you've done .

And you've made mention of your article and the title of the article was Emerging Health Technologies Opportunities and Practical Applications for the Exercise Professional , and you wrote that with your author team of Paul Chase , lori Witzel and Wesley Smith .

And this is such a big topic and I think we should level set for our listeners to say you know , in one podcast or even in one article , we're not ever going to cover everything that's happening from a tech standpoint , but what I do want you to do is to really hit on some of the most important topics covered in the article and then we'll take the

conversation from there there .

So if we think about that bigger picture that the whole special edition that you've put together is looking at , we have got some really great progress towards having exercise professionals recognized for those really important skills that we know can make a huge impact in public health and in health care .

But also we know there's still work to be done on recognition and integration into health care systems .

And then , since the pandemic , we've had this huge increase in digital and technological solutions to support physical activity and now both the exercise professional and perhaps some of their potential clients in the health care space particularly having to try and figure out how those technologies can be used safely , how those technologies can be used effectively to achieve

more impact . So I think what this article hopefully does is give some insight into how this range of technologies from wearables to smart equipment , to digital therapeutics and even AI how they can be integrated into an exercise professional's services . So that's really what we were trying to achieve , I think , with this article .

As I said , it's hard in an article to get into the depth of any one thing , but I do want to kind of go a layer or two deeper on some of those topics that you talked about , because I think it's important for our audience to get an understanding of what really is emerging .

And you mentioned wearables and you also mentioned digital therapeutics , and so I'm really curious when you mention those things . I mean , I think , look , I'm wearing a Fitbit right now , you're wearing an Apple Watch .

I think we all have our wearables , but orient us to where those are going and maybe even how they're used in conjunction with a digital therapeutic , like what you guys have at XE ?

Uh , you know , when I was sitting on the bike and looking at my watch to see what my heart rate was . But I would have been the anomaly in the in the indoor cycle studio to have that wearable technology on me .

Now we see a huge number of people who are not particularly involved in sport or training are wearing those technologies or they're using an app to either track or monitor something or in order to try and change their mindset or their habits .

So there's this huge uptake in these technologies and I think that is why it's important that exercise professionals do start to really get on top of those and , as I said , I think I think , yes , integrate them into their services , because what we don't want to be seen as doing is competing , because while technology can do some fantastic things and I'll go through

some examples in a moment um , it can't substitute for that human touch , and I think since working in this digital space myself , I've really become a big advocate for letting the humans do what they do really well and letting the technology do what I often refer to as the boring parts right , so actually writing a program for someone you know is part of what we

do as exercise professionals , but often we're writing similar things for similar clients . You know , we we have a tick box of oh , this person needs and Z , and the programs are being churned out the same . So you know , that's the first example . Let's let technology do that .

So what XE does , for example , is takes all of the guidance from the Exercises Medicine Program , from the World Health Organization , from other really important recognized health bodies , from the world health organization , from other really important recognized health bodies around the world american heart association , etc .

Takes all of that , that guidance , and is able to automate that process of saying , okay , what are these in ? What is this individual's risk factors ? What do we need to take into account ? How does that affect what type of exercise they should be doing in terms of intensity , frequency , duration , and produces that personalized program .

And then where we see the exercise professional fitting into that mix is to provide those really important check-ins , that coaching . A lot of it for me and stop me if I'm going into behavioural scientist speak but it's things like identifying barriers and helping someone to overcome those barriers .

You know we talk a lot in the behavioural science world around the intention behaviour gap .

We have a bunch of people who have a pretty good level of motivation to be physically active , especially when they have a long-term health condition and they've been advised by their doctor or their physician that they should be doing physical activity because it will either alleviate their symptoms or reduce the impact of their illness or even , in some cases , of

course , reverse that condition . So the motivation is there and what's difficult is how do we actually get them to a place where they can act on that motivation ? And that's where the exercise professional can really add value .

So we get the technology to do the exercise prescription part and then the monitoring part and we get the exercise professional to do the coaching . The support help someone to make plans , the exercise professional to do the coaching . The support help someone to make plans . And also , what our users talk to us about is about some level of accountability .

So you use the example of the work that we did with Brad Logan , where we had Exit but also we had some health coaching , and it's those two things combined that the users told us were really , really important to them . So with digital therapeutics , it's really important that they are regulated . You know that . We know that they're safe .

You know safety is going to always be the exercise professionals' number one concern for their client and also to reduce the risk for themselves . So these regulated therapeutics are really important , but we shouldn't underestimate where the human touch is also really important .

And then , if you look at some of the other technologies so , as you say , wearables , I think wearables are fascinating . So , as you say , wearables , I think wearables are fascinating . You know your wearable will always come with some kind of app , and what that app tells you can vary greatly . A lot of it is based around more is better .

So , for example , it might have a scoring system . You might earn some kind of points . You might be in a community where everyone's comparing how they've done that week . All of this can be really positive , but it can also have risks and it can have some negativity . Overlays , these generic apps and this sort of generic feedback , to say .

Actually , if you're experiencing , perhaps , a flare-up of your condition or you're having some symptoms this week that you weren't having last week , that's probably your body's way of saying there's something going on . You might need to have a more restful week and you shouldn't worry if that means you're not top of the leaderboard in your workplace's .

You know weekly competition this week , so I think wearables are hugely beneficial in terms of raising an individual's awareness of their activity levels and their overall health , because the sensors now can give you a huge amount of insight , of course , into your heart rate , your heart rate variability , your sleep patterns .

All sorts of biometric data can be gathered . We're getting into a place now where we're going to be able to easily monitor blood pressure and blood glucose at a really reliable level , but that needs to be overlaid with the exercise professionals expertise . Something else , I think that taps into that area is what we talk about when we talk about the worried .

Well , so , people who actually don't have any significant health conditions , which we know is now rapidly becoming a minority , of course , but we do still have a chunk of the population who want to work with an exercise professional , want to be proactive about their health , and , of course , we would support that and advocate for that .

But the increasing amounts of data that individuals have access to about themselves and their body can lead to some health anxiety . No-transcript .

Is it going to take my job as a writer , as an actor ? And I think that can get people to not only not embrace the emerging technology that's out there , but that can get people to actually fight against it to a certain degree .

So I love how what you said earlier the technology does the boring stuff , the rote stuff , the stuff that we'd rather not spend our time doing . So it allows us to spend time with people and I believe this , at least in our lifetime .

I think technology is not going to be able to replace that one-on-one kind of therapeutic interaction that happens between an exercise professional and a wellness coach and the patient or client they're working with . So I'm so happy to hear you say that , but I am curious as a behavioral scientist .

Obviously you think a lot about okay , I got technology over here and I got people over here . What are some of the pieces of advice you have for the exercise professionals that are listening to be able to not be afraid of technology , embrace it and actually like work with it ?

Like , how are you advising the coaches at Logan , when you were working with Brad , to leverage the technology ?

Is you know , realistically , if we want exercise prescription , physical activity prescription , physical activity provision to become the standard of care , we will need to have technology to be able to achieve that .

There just are not , and will never be enough highly qualified , highly knowledgeable exercise professionals to be able to support the numbers of people out there who would benefit from being more physically active . So technology is absolutely necessary . I think there's a couple of different ways to think about it .

I think if you're an exercise professional , you're thinking about what services am I offering , where can I add value , and then looking at what technology could enhance those services . So I think there's a couple of key things . One is is access to data . So we all know we work with a client . We give them advice , guidance , a plan , whatever it is .

They go away at some point and they're on their own . They come back to you and you say , hey , how did it go ? And that conversation is going to go one of two ways . They're either going to be 100% honest with you and that happens a lot , right , people say I've had a terrible time .

You know I work was stressful , the kids were sick , whatever it is , and and I haven't been able to do any of the things you asked me to do or they're going to be quite vague oh , I tried my best , uh , you know . Oh , I I managed to do some of it , but not all of it .

And , and you know , we'll have those conversations where they don't want to turn around to a human being and say I messed up or I didn't get it done . So having access to the data means you don't have to have those awkward conversations .

You can remotely monitor how that individual is getting on and , as I said , users themselves are the ones that say they want the accountability , but they certainly , we know , don't want to be told off . You know they don't want to be reprimanded . What they want is a supportive person who can say hey , I can see you've had a really tough week .

What's been going on with you , and look forward to , well , what's likely to happen in the next few days or weeks and how can we work together to make sure you can still get the best out of yourself in terms of your activity and in terms of your health .

So having access to data , it's not um , big brother , it's actually users saying I like the fact that my exercise professional , my doctor , can see how I'm doing . Because on the flip side of that , of course , there's a huge amount of positive reinforcement that can be given for the people who are doing great , you know , making great efforts .

So I think that's one thing is just having much more visibility and much more interaction when you've got access to that information . The other thing as well , as we said , we've already covered taking out the boring parts .

Right , if we could take away a lot of the or fast track , a lot of the admin , then it means we've got more time to spend doing those human things . And that means , again , you can reach more people just because you're more effective , you're more efficient , can reach more people just because you're more effective , you're more efficient .

And then the third thing I think is we all know that the key to helping someone develop that long term physical activity habit is we've got to find a way to make physical activity fun and engaging .

Absolutely no one sticks with physical activity in the long term if they haven't found something that brings them some internal motivation , whether they get joy from it , whether they enjoy the , the competition , whether it's a social aspect where they're part of a tribe , it doesn't matter . There has to be some intrinsic motivation .

So technology potentially can engage people who wouldn't get that any other way .

So if we think about gamification , if we think about virtual augmented reality , you know , if we think about the community aspect , and particularly if people are remote , they're not able to get to a physical facility to be able to connect people digitally to others who are similar to them is one of the biggest success factors we know in terms of long term behavior

change for physical activity . So I think for the exercise professional it's thinking about what's my value and then what value can technology bring ?

And and I think it's usually one of those three things it's effectiveness , it's that interchange of data and information between the two parts of this equation , or it's about making physical activity more fun and interesting for individuals .

And I do want to make one point here and since you're over in the UK and not a part of our crazy healthcare system here in America although I feel like you would probably say there's equally craziness in the Erica , although I feel like you would probably say there's equally craziness in the NHS over there it's a different kind of crazy .

It's a different kind of crazy .

So two of your co-authors , lori Witzel and Paul Chase they were on the article because they work with the Physical Activity Alliance and on its Time to Move , which is the initiative here in the States to make physical activity assessment , prescription and referral the standard of care and medicine , and I'll refer everyone to the article and the PAA's website to read

more about that . But you mentioned the power of having that data not only get back to exercise professionals but also to the health care providers , and that's a lot of what it's Time to Move seeks to do . I know with the work you're doing at XE , you ultimately want the providers to get the information .

Talk about the importance of that just in terms of putting on their radar what's happening with their patients' physical activity levels .

So every healthcare professional you speak to knows on a on a sort of intellectual , scientific level , that physical activity is going to be beneficial . But we know there's great papers out there that that detail this in great depth . You know there's a lack of confidence . There's a in prescribing , there's a lack of confidence in who do I send these people to ?

How do I know that those people are going to look after them and be suitably qualified ? Um , you know , and I think because they're often , then the patient is often sent to someone else , uh , to receive some physical activity support , whether it's prescription or provision , whatever it is .

Um , there isn't often a feedback loop and certainly over here in the UK , having worked with a lot of providers of public health interventions , that's a big issue for healthcare professionals . I send them away . I don't get any feedback to say how did that individual get on . Did it work for them , you know ? Has it been beneficial ?

So yeah , having visibility of those patient data has a huge impact , and the clinicians that we work with talk about that a lot . Saying you know are some good examples . Some great examples that we have of how that data can help is , for example , in the obesity space .

So if a clinician is looking at an individual to say , are they a good candidate for surgery , for example , or are they a good candidate for GLP-1 agonist medications , we know that neither of those interventions will be successful in the long term without behavior change .

And so what we can do as a first step is say , ok , I'm going to give you this physical activity program for maybe three months , six months . I want you to follow it because that will help you prepare for whatever intervention you're going for next .

But also it gives that health care professional the reassurance this individual is in the is the right time for them to make that change , they are able to make the changes necessary .

That's going to mean that intervention has the long-term success that it's going to have , and that's what a lot of clinicians talk to us about , saying I need to know that that individual is going to stick to the plan once they've been through surgery or once they come off their medication .

So I think those are really great examples of where that exchange of data can be really impactful .

But one thing I want to ask you really quickly before we move on to the last couple of questions and this is going to be a hard question , but I think it's an important one , particularly given something you said earlier about your interest in equity .

The digital divide is certainly a concern and I realize that this is not a policy level discussion on how to address the digital divide internationally . But how do you think of that , as somebody who's in the behavioral sciences but also working for a technology company , that it does require a smartphone and an internet connection and a wearable ?

How should we be thinking about the equity element of this as technology comes into the conversation ?

You know what we're talking about in the article is thinking through how that digital divide might impact on your clients and how technology actually can help you reach people who otherwise wouldn't have access to your services .

So , for example , smartphone ownership now is very , very high , even in people who are on the lowest incomes , where we often see the limiting factor is actually access to data .

So the device itself is often a one-off purchase , um , but those individuals may not have ready access to mobile data , for example , might be relying on public wi-fi or or , you know , only able to use it . Use the smart capabilities in the home , for example . Might be relying on public Wi-Fi or only able to use it .

Use the smart capabilities in the home , for example . So , thinking about recommending or using apps or technologies that don't require a constant data connection , so something that stores data and then syncs up , so Exy , for example , you only have to open the app really once a week , as a as an absolute minimum , and connect to the Internet .

So , thinking about how we can recommend things that are going to be cost effective and don't require that constant connection , and also the fact that the investment for the individual in that wearable technology is going to bring all of that benefit in terms of that remote access for people who are perhaps in rural areas , who or who don't have transportation , for

example , to go and physically see a trainer or an exercise professional . So I think there are ways in which actually , we can think about how technology increases access . But , but we do have to think through very carefully , I think , on a higher level . Um , there's a big conversation that needs to be had around the economic case .

So , um , you know and like you might , you know , we've been around for a while now and we've seen these sorts of arguments come up , I think , time and time again where there's a perception that , uh , you know , individuals shouldn't be rewarded for their poor health by being given things .

Um , you know , and this is a real sort of bugbear again for someone who works in in my field around behavioral science is , uh , yeah , you know well , why should somebody who , uh , you know , hasn't been active for 20 years and has perhaps eaten , you know , a poor diet , etc . Etc .

Why should they be given a fancy wearable device when other people who have been doing all the right things don't get that ? I think we really need to flip that script around completely .

You know , first of all , we need to understand and we do , you know , again , on a scientific and evidence based level , we understand why there are so many individuals out there who aren't active , who aren't eating a healthy diet , and it's never to do with a lack of motivation or poor willpower .

It's all to do with their social circumstances , you know , and all of those really complex things that build into somebody's lifestyle .

But also looking at the purely economic case of actually investing up front in a bit of technology and it doesn't have to be , of course , a 300 apple watch , yeah , wearable devices with good quality sensors now can be purchased for under a hundred dollars uh , and investing in that up front , with the technology that goes with that , that supports that .

So so the app , the monitoring , and then the important human part of that .

And then looking at the really , really hard evidence that says that that investment of a few hundred dollars now over the next five to 10 years is going to save thousands and thousands of dollars in terms of reduced healthcare utilization , reduced medication , enhanced productivity and overall , of course , quality of life for that individual .

So yeah , we really need to start flipping that script and saying giving someone a piece of technology or giving someone access to technology should be seen as a way to save money , not as an expense that we can't afford .

I think many of us that are younger and in urban areas don't always think about that .

But then , on the more macro level and this is one of the levels the Physical Activity Alliance works on is advocating for that prevention first approach or risk mitigation approach of investing upfront , because we're all well aware that healthcare costs are only increasing and we're not saying we're going to get them to decrease .

But if we can bend that curve , it makes a substantial difference to society as a whole and we probably should put a period on that , because if we go any further in that discussion , we're going to have a three-hour podcast and this is not Joe Rogan here .

So , Lou , before we get to the final question , where can people go if they want to find out more about you and the great work you're doing ?

Um , if you want to know more about xc , then it's nice and simple . Our website is xclife , so you can can find us there . Yeah , and you know , in terms of the other work I do , the Active Pregnancy Foundation is a charity that I work with around the , you know , maternal physical activity space and they do some really fantastic stuff .

And , yeah , I think , just find me , follow me and get in touch .

In a 30-minute conversation it's hard for us to get everything in and the authors of this article do such a great job . So we'll link up to that on the show notes page . But the last question that I'm asking all of our guests on this podcast series is to give our listeners one piece of advice .

They feel that exercise professionals should be focusing on to elevate and advance the profession .

You know there is so much out there that could help you , support you to do the great work that you do , to help you to reach more people . We know that AI isn't advanced enough yet to be able to give really great , reliable , consistent advice on physical activity that's tailored to individuals , so don't be worried about that .

Instead , look at how can I combine the value technology brings with the value I bring , to be able to differentiate what my personal service can offer or what my business can offer and then articulate that really well . So I think , the blending of technology .

You know so many more people out there are using technology , but you can make that technology even more beneficial for them by layering over what it is you do and you are currently irreplaceable .

Forward slash episode ACSM10 . That's forward slash episode ACSM10 . Please be on the lookout for our next episode in this 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 .