Transforming the Exercise Profession through Professionalization and Advocacy

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 in this special series , in conjunction with the American College of Sport Medicine , we're going to explore the September and October themed issue of the ACSM's Health and Fitness Journal on Professionalization and Advocacy . The ACSM asked me to be the guest editor for this special themed issue of the Health Fitness Journal .

I'm honored and humbled by the opportunity to tackle the professionalization effort in our field . In the process of doing so , over the past 12 months , I've collaborated with over 30 of the leading experts in our field on this professionalization effort .

After talking with so many experts in the field , the goals of this themed issue were twofold First , to raise awareness of the professionalization effort and secondly , and most importantly , to prepare exercise professionals for a future where they will be considered essential health care providers .

And that's really what the professionalization effort is all about is ensuring that qualified exercise professionals are able to function under the health care tent as qualified healthcare professionals . Over this series of episodes , we're going to talk to the lead authors from all of the articles in this themed issue .

In total , we'll bring you 11 podcasts with the lead authors from the articles in the themed issue , starting with an episode with myself where I'll talk about the issue introduction article , and then we'll dive into 10 other episodes with leading experts in the professionalization effort , and then we'll cap all of it off with a summary episode 12 weeks from now where

we'll summarize the most critical thoughts from every episode . These podcasts will drop every Monday for the next 12 weeks on your favorite podcast platform . And before we dive into this first episode , I'd like to give a special thanks to the American College of Sport Medicine , as well as the editorial staff from the Health Fitness Journal .

Lori Tisch , paul Gallo and Brad Roy were instrumental in bringing this issue to life . And , most importantly , I'd like to thank our authors for the different articles in the issue . We truly could not have put together this volume of work without their insight , expertise and dedication . I hope you enjoy this podcast series .

I hope you enjoy this podcast series and , most importantly , I hope it galvanizes our industry to elevate exercise professionals to the status of qualified healthcare professionals . Now let's get to today's episode . For this first episode in our series , we're going to run through my issue introduction article .

The title of this article is Professionalization in the Exercise Profession what it Means and why it Matters . This is very much going to be the level setting for the rest of our conversations in this podcast series .

I thought it was very important to set the table , to understand why we're professionalizing as an industry and what it means for both professionals in the industry as well as healthcare more broadly .

And I think the best starting point for this is the understanding of where the exercise profession is broadly at right now , which is essentially a hobbyist profession , maybe a novelty , maybe even an entertainment profession , as some people outside of the industry may consider it .

But unequivocally and broadly speaking , we are not an essential aspect of healthcare right now , and I don't think you have to look any further than the COVID-19 pandemic as an example of our industry not being considered an essential part of healthcare .

We were shut down in the midst of a public health crisis where our services could have actually benefited the population , and when we were reopened , we were reopened with restaurants , bars and other entertainment venues .

So it's very clear that policymakers and society more broadly does not view our industry as professional and as part of healthcare right now , and so , with that as kind of a bit of a pretext , let's dive a little bit deeper into why professionalization is needed . For some , they might say , well , look , the status quo is working .

We're going to be a $125 billion industry by 2030 . That's an annual compounded growth rate of 7.5% , which is a healthy growth rate for any industry . And they might say , hey , this is working , we are helping people , we are doing something that is healthcare related , even though we're not under the healthcare tech .

But I would choose to differ with that opinion , and I think many of the experts in this themed issue would also differ with that opinion . And I think many of the experts in this themed issue would also differ with that opinion that the status quo is working , because the objective reality is our market penetration is incredibly low .

We serve only about 20% of the American public and we've been hovering around 15 to 20% market penetration for the fitness industry nearly since its beginning .

We do a very good job , broadly speaking , in our industry of getting the fit , fitter and the healthy healthier , and you don't need to look much further than the CDC statistics around the percentage of Americans that achieve both the aerobic and muscular strengthening guidelines .

Only less than 25% of Americans achieve that guideline and beyond that , there's a true economic and public health cost to this .

The CDC and other federal agencies estimate that , on an annualized basis , lack of physical activity costs the American public $117 billion , and I would submit to all of you that one of the reasons there is such a significant physical inactivity crisis in our country is because there's no provider in health care that is responsible for physical activity and exercise .

If you think about it , there are providers in health care that are responsible for many things associated with lifestyle behaviors .

As an example , nutrition is a lifestyle behavior , and there's a registered dietician that's involved in ensuring that lifestyle behavior is implemented properly , but there's nothing analogous to the exercise or physical activity health behavior , and this is where I think our industry has a great opportunity to fill a very important void that exists Now .

Beyond the public health and economic implications of this , there's also industry implications for this . The economic stability of our industry has always been questionable at best . If you look back historically , big chains opening , growing and then closing .

High labor turnover in our industry , and if you think about it hovering around the same market penetration rate for so many years , is an indictment of our industry's lack of ability to talk to and gain support from the larger mass of society .

And going a step further , our professionals in our industry , great people who want to help the public , who really want to make a difference , tend to cycle through our industry really quickly .

And if you've been in our industry for any period of time , you know the turnover rate for exercise professionals is incredibly , incredibly high and I would submit to you one of the reasons for that is the lack of compensation in our industry .

The Bureau of Labor Statistics tells us that the median wage for a fitness trainer in this country so we'll just broadly call that by BLS terms an exercise professional is around $45,000 . That only meets a livable wage in one of the 50 states , the state of Mississippi , and it just barely gets above that livable wage .

So not only do we have a public health crisis as it relates to inactivity that's brought about by the lack of professionalization in our industry , but we also have an economic crisis in our own industry , and I think that's the fundamental set of factors that are the impetus for the change that we need to professionalize .

And I don't think I'm the only one that holds this view , if nothing else by virtue of the fact that the ACSM decided to dedicate an entire issue of one of its prominent journals to the topic of professionalization . This no doubt speaks to the very important inflection point that we're at right now . So what is this really getting down to at its core ?

I realize the terms professionalization and advocacy can seem a little bit abstract and a little bit nebulous , but I'll put a very fine point on it to say our role in the professionalization effort is to achieve the status of qualified healthcare professional , and that is a definition , as I referenced in the article , that is very , very specific , but essentially it's

an individual who's qualified by education , training and regulation to perform professional services within their scope of practice and independently report that professional service .

So examples of qualified healthcare professionals are physicians , nurses , dietitians , physical therapists essentially all trusted providers underneath the healthcare umbrella are considered qualified healthcare professionals . And really at the root of what this qualified healthcare professional status means is it means trust . Ultimately , that's what a qualified healthcare professional is .

They're a trusted healthcare professional , they're trusted by policymakers , they're trusted by the public and they're trusted by other medical professionals , and in this themed issue , we tackle that topic head on in an article entitled Developing Trust and Collaborative Relationships Between Healthcare Providers and Exercise Professionals .

We cannot understate the importance of this distinction and its ability to help us garner trust in the medical profession . Now , part of gathering trust as you can surmise from that definition that we looked at is education and training , and I think this is an area where the exercise profession is evolving greatly .

If you think about how our professionals are educated , it's a bit of a patchwork of disconnected educational structures . All the different academic programs around the country are not uniformly accredited at this point .

There are multiple different types of certifications and other credentialing that exist and that can be confusing , not just for exercise professionals but also for healthcare providers and the general public .

And so because of that , in this issue , we tackled the topic of education in an article entitled the Role of Programmatic Accreditation , certification and Career Advancement , and that's such a critically important topic to understand because it provides the elemental aspects of the foundation of education that our professionals need to be successful .

Now , diving further in what it takes to professionalize our industry , we have to talk about collaboration , and certainly there is no shortage of people in this country who need to be assisted by qualified exercise professionals . As we've seen earlier , only about 15 to 20 percent of the American public engage with our industry .

Less than 25 percent of Americans meet the CDC's guidelines for muscle strengthening and aerobic exercise , so we need proper scale to be able to accommodate the demands that exist to improve the physical activity status of our country , and that topic will be tackled head on in an article that is going to examine the Coalition for the Registry of Exercise Professionals ,

and the article is entitled Harmonizing Health and Fitness with Healthcare for the US Registry of Exercise Professionals . The registry is a fascinating look at how we stratify what professionals can work with what populations through something that's referred to as the National Exercise Referral Framework .

For those of you who've never heard of the registry , or CREP , which is the acronym for the Coalition for the Registry of Exercise Professionals , I think you're going to find this article very enlightening , because it specifically stratifies how we work with different populations , and I think one of the big take-homes from this article is that it indeed takes the

village of our entire industry , at different levels of credentialing and different levels of academic ability , to be able to meet the needs of the population as a whole . I'd like to take a quick break from today's episode to tell you about a special discount available from the American College of Sport Medicine .

If you're listening to this episode prior to November 1st , you could take advantage of a $30 discount on the ACSM's Alliance membership . This discount and this membership will give you access to the themed issue of the Health Fitness Journal that we're talking about in this podcast series , as well as a whole host of other member benefits from the ACSM .

Go to the show notes page and click on the link that allows you to sign up for the Alliance membership . When you get to that page , enter the code ALLIANCESAVE30 . Again , that's ALLIANCESAVE30 . That will save you $30 on the ACSM's Alliance membership , bringing it from $110 down to $80 .

That will give you access to all of the articles from this theme issue , as well as a host of other member benefits from the ACSM . I want to thank the ACSM for extending this offer to our listeners and I hope all of you take advantage of it . Now back to today's episode .

Now , when we dive further into the professionalization effort , as you heard in the title of the themed issue , it's professionalization and advocacy and those are two sides of the same coin .

Because the reality is advocacy results in policy and systems changed and health care is a very bureaucratically intensive system that has a lot of policy , system and structure wrapped around it . To protect the public as well it should .

And if that's an arena that we are going to play in as an industry , we need great advocacy to ensure we shift the policy and systems environment in the direction that's favorable to our professionals getting underneath the healthcare tent . And we're going to address that in two different articles in this issue .

One article , entitled Emerging Health Technologies Opportunities for Practical Applications for the Exercise Professional , is going to look at the Physical Activity Alliance's it's Time to Move initiative . It's Time to Move has a goal of making physical activity assessment , prescription and referral the standard of care in medicine .

This represents a multi-year , multi-pronged effort to shift the policy environment in a direction that allows for qualified exercise professionals to be underneath the healthcare tech . Now advocacy happens in lots of different ways .

Certainly it happens at the macro or the federal level from organizations like the Physical Activity Alliance and the ACSM , but it also happens at the micro level , at the local level . In fact , you've probably heard people say all politics is local , all health is local and that means all of us can be an advocate for our industry .

And we're going to tackle the topic of advocacy head on in an article from Mike Kaczynski , who's the head of government affairs for the Health and Fitness Association , and that article is entitled Advocating for Industry Representation and Policy Influence and Mike lays out some very specific steps in this article for all of us to be industry advocates to start to shift

the policy and systems environment in the right direction . Now , ultimately , at the end of the day , I think some of the most important insights in this issue have to do with the programs we're developing , particularly evidence-based , outcome-oriented programs that produce clinically meaningful outcomes .

I think one of the challenges we face as an industry is that no one needs to be told that exercise works anymore . Everyone is unequivocally clear that exercise works and it is effective .

The challenge and the thing that we need to show policymakers , healthcare providers and the public more broadly is we can get the people that need to do the exercise to do it for long enough to have a substantive improvement on their health .

And we're going to really dive into this topic in an article entitled Making Exercises Medicine a Clinical Reality Program Development and Implementation . And this talks about how we develop evidence-based , outcome-oriented programs that are reproducible and scalable . And this is where the rubber meets the road For you exercise professionals that are out there .

Everything we're talking about is important , but at the end of the day , if we cannot produce clinically meaningful outcomes consistently for the people that need it the most , then the professionalization effort falls flat very quickly .

Now , in order for us to be able to properly quantify and communicate those clinically meaningful outcomes that we're making in our programs , we need technology , and this is where we go back to the article on emerging health technologies to talk about how we can capture data inside of these technologies , analyze that data and , most importantly , feed that data back to

healthcare providers through electronic health records . So , again , I cannot emphasize enough the role that the individual exercise professional plays in this professionalization effort by developing , implementing and then measuring the impact of evidence-based , outcome-oriented programs .

Now , broadly speaking , the last topic we'll tackle in this issue is the most thorny topic , which is the topic of who pays , and we're going to talk about reimbursement for exercise professional services in an article entitled Compensation for Exercise Professional Services in an article entitled Compensation for Exercise Professional Services .

This was probably the most challenging topic to tackle in this issue because there's so much confusion and complexity around compensation and reimbursement Right now . Broadly speaking , the vast majority of this reimbursement is cash pay and all of you are well aware of that . Vast majority of this reimbursement is cash pay and all of you are well aware of that .

However , all of you are also probably aware of the movement to allow for HSA and FSA dollars these are health savings account dollars , that's pre-tax money to be used towards certain qualified healthcare services . Right now , there's a lot of ambiguity around how exercise services can be utilized in the HSA FSA landscape , so we'll tackle that in that article .

We'll also talk much unknown right now around reimbursement , as there is things that are known and factual , but it is a topic that we do need to tackle . So , overall , that looks at some of the broad topical areas for this themed issue and we're going to dive much deeper into each one of those topics with the lead authors for all of the articles .

We're also going to look at a couple other pieces from the themed issue . We'll summarize all of this with the top 10 actionable items that fitness professionals can be focusing on right now as we integrate with healthcare . We'll look at lessons learned from the wellness coaching profession as they've undergone their professionalization effort .

Learned from the wellness coaching profession as they've undergone their professionalization effort . We'll even look at risk management strategies that we need to be thinking about as we transition into healthcare and as we work with a more chronically diseased population . So we really hope to cover the full spectrum of the different elements of the professionalization effort .

Again to make sure you're informed , but , most importantly , to make sure you're prepared for the inevitable future where qualified exercise professionals are considered qualified healthcare professionals . This is an incredibly exciting time for our profession . This is a true inflection point that is a long time in coming .

We have many groups and individuals have come together to make this a reality , and one of the things I will urge everyone listening to this podcast to ensure they do as we move forward in this professionalization effort is we stay unified . We stay unified as a profession . We try to avoid tribalism . We try to avoid different groups saying different things .

What will short circuit this professionalization effort faster than anything else is us having cracks in our unified front .

Coming together as a unified profession to have conversations with policymakers , with healthcare providers and with the public more broadly has gotten us to this point , and it will be what gets us across the finish line , as long as we can maintain that single-minded focus on collaboration as we go down our professionalization path .

The last thing I'd like to leave you with in this episode is something we'll end every episode in this podcast series on , which is a single piece of advice from the guest as to what you can do to ensure we elevate and advance our profession , and I can give many pieces of advice that would build on the advice you're likely going to get from the other podcast

guests in this series . So the piece of advice that I want to focus on is where I started this entire endeavor with the ACSM around this theme issue with it is being informed so often .

So many of us are heads down in our gyms and in our clinics working on the front line helping people every day get healthier , that we often don't pick our head up to realize some of the broader conditions and the broader environment that is shifting in our industry , and that was the primary goal of this issue .

Yes , we want to prepare you , but first we have to inform you on what's coming , so I would encourage you to stay informed . There are many different individuals and groups that are going to come up time and time again as we go through this podcast series and as you read the themed issue that you're going to find it might be beneficial to connect with .

Connect with those groups , see what they're doing , subscribe to their newsletters , be informed .

The only way you can be an active part of the professionalization effort and the only way , broadly , we can ensure we get there through collaboration is for all of the professionals in our industry , every stakeholder from every level , to be as informed as possible to allow us to maintain that unified front as we travel down this path .

I've never been more excited for the opportunities that are in front of us in our industry . We've come so far and we've done so much work , but there's so much further that we have to go , and it takes all of us , every single one of us , being informed and acting in a unified way , to make that a reality .

I have all the faith , trust and belief in the world that the amazing professionals in our industry can make this professionalization effort a reality and get us underneath the healthcare tent consistently .

My challenge to all of you is to stay informed , listen to this podcast series , read the themed issue , connect , collaborate and be an active advocate in our professionalization effort . Well , I hope you enjoyed that discussion that introduces the themed issue as well as this podcast series .

In the upcoming 10 weeks , we will talk with the 10 lead authors from the articles mentioned in this podcast . We'll dive deep into topics that are critically important to our professionalization effort . I encourage you to listen , to share and to engage actively in this movement for movement we are creating in our industry .

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 ACSM1 . Again , that's forward slash episode ACSM1 .

Please be on the lookout for the next episode in this series when it drops next Monday , and don't forget to subscribe through your favorite podcast platforms . Until we chat again next week , please be well .