Exercise referral networks

Primarily, the main function of Exercise for Health (EH) professionals is to plan and supervise exercise prescriptions, where circumstances are complex, possibly unpredictable, and involve an element of risk beyond the reasonable purview of exercise professionals who essentially operate within the parameters of European Qualifications Framework (EQF) general descriptors at level four or lower. In the case of referral by general medical practitioners, the scope of EH professionals essentially exemplifies the notion of exercise [as] medicine (as espoused by the American College of Sports Medicine (ACSM) - see http://www.exerciseismedicine.org/).

EH professionals are expected to demonstrate the critical thinking skills characteristic of higher education, to recognise misinformation and pseudo-scientific approaches and products, as well as plan and evaluate courses of action informed by evidence-based guidelines and peer-reviewed literature. They are expected to have a multifaceted perspective on exercise for health, showing sensitivity to the physiological, psychological and sociological aspects of physical activity and exercise with respect to their clients, and the community as a whole. Secondarily, EH professionals will also encourage, motivate and advise clients to adopt a holistic approach to fitness, that incorporates strategies and habits based on healthier eating and the maintenance of good general and mental health.

EH professionals are particularly suited to the promotion and supervision of physical activity and exercise among individuals representative of various special populations, including those who are older, pre- and post-natal, with disabilities, or afflicted by health challenges including injuries, conditions, and diseases constituting an element of risk. It is essential to immediately qualify these statements as contingent on referral, and subject to the professional judgments of relevant competent and qualified health care or medical professionals taking point when required. 

Effective screening is key, and sound referral processes will ensure that clients are acquainted with the appropriate fitness, health care or medical professional, regardless of who within a given referral network represented the first point of contact. The diagram below indicates various complementary professionals constituting a referral network. Referral is defined here as the mobility of clients possible between professionals via the central practice of effective screening, where one or more professionals may become involved in a given case over time, as required and always in the best interests of the client and their unique circumstances.

Suppose, for matter of argument, a client with a minor, stable health challenge approaches the EH professional as a first point of contact. In exercising their professional judgement and acting in the best interests of the client according to the unique circumstances at play, the EH professional may choose to prescribe an exercise programme and maintain close contact and direct supervision of the client. Alternatively, they may provide a set of recommendations and/or guidelines, and refer the client to a personal trainer, or a fitness instructor to exercise with minimal supervision in a fitness club setting. They may even decide, depending on the circumstances or at the request of the client, not to refer, but to “return to the community”, and provide a set of recommendations and/or guidelines for the client to follow on their own, where appropriate.

Now suppose a client with a higher-risk mobility-related health challenge approaches an EH professional as a first point of contact. Upon effectively screening the client, the EH professional decides to refer the client to a physiotherapist. The physiotherapist then proceeds in diagnosing and treating the injury or condition using a range of therapies, including exercise. In the same way as the EH professional may decide to refer a client to a personal trainer, fitness instructor, or “return to the community”, the physiotherapist may similarly choose, at the appropriate time, to refer according to the interests of the client and the unique circumstances at play. Circumstances influencing judgments on the side of both professionals and clients may, of course, comprise numerous factors, including availability, convenience, access, or financial considerations, rendering a sound needs analysis an essential part of effective screening.

Consider, for instance, an example of a wider network in which a fitness instructor refers a fitness club member with an injury to a physiotherapist. Upon diagnosis and successful treatment of the injury, the physiotherapist may refer the client to an EH professional to supervise the final stages of their rehabilitation exercise programme before they return to exercising with minimal supervision at the fitness club. The client may later express an interest in learning more advanced training methods, and request a personalised eating plan. At this stage the fitness instructor may refer the client to a personal trainer, and a nutritionist. At any given time throughout this process, circumstances may also dictate that any professional within the network refer the client to a general practitioner should the need arise.  

In mutually beneficial arrangements such as this, privately operating professionals stand to benefit by expanding their client bases, while clients avail themselves of expertise most suited to their specific needs and circumstances at any given time. Satisfied clients are also more likely to recommend any professional within the network to other prospective clients. Future posts will explore how tighter regulation and accreditation might be achieved among fitness professionals in Malta, particularly those operating in roles pegged to EQF levels three to five.