The emerging role of the Exercise for Health Professional

This post aims to shed some light on the relatively new role of Exercise for Health professionals (AKA "EH specialists", as defined by EREPS), in the context of risk stratification and referral in the Maltese fitness sector. For sake of disambiguation, the terms EH professional and EH specialist are interchangeable, however the former is used throughout this post to avoid connotation or confusion with respect to medical specialists. Below is a JPEG version of a document distributed as a resource among students enrolled in the Health and Fitness Assessment module, which forms part of the Level 5/6 Exercise for Health (EH) courses at the Malta College of Arts, Science and Technology (MCAST) for aspiring EH professionals.

The document is organised according to client groups by risk, pegged to associated strategies and relevant competent professionals. The first four columns are of international scope, based on the sources referenced in the document itself, specifically of American, Canadian, and British origin. The final two columns on the right are included to establish some local context. The final column, specifically, indicates European Qualifications Framework (EQF) levels at which professionals are expected to be minimally qualified. Formal qualifications, in this sense, serve to establish trust among professionals, by constituting evidence of basic competence in lieu of a formal unifying referral framework.

Currently, apparently healthy members of the public interested in increasing their physical activity levels with a view to improving general health, and more specifically, those interested in seeking the services of professionals to assist them in doing so, are categorised in the first row (from the bottom). A widely available option for such individuals, is joining a gym, fitness centre, or fitness club, where they will typically encounter fitness professionals qualified at, as a minimum, EQF level 3. Fitness/gym instructors or group fitness instructors are expected to, according to general EQF level descriptors, apply basic fitness methods and techniques, and take responsibility for safely and effectively leading fitness sessions with clients either individually or in groups.

Individuals with minor and stable conditions (low risk, second row from the bottom), or with more specialised health and fitness goals, will typically seek the services of a personal trainer, qualified at EQF level 4. Personal trainers are expected to, according to general EQF level descriptors, have broader knowledge of training methods and techniques than fitness instructors, evaluate and generate solutions to specific health/fitness-related problems, operate with a degree of self-management in circumstances that, while predictable, are subject to change, and ultimately assume greater responsibility in safely and effectively leading fitness sessions with clients individually or in small groups.

It is worth noting that fitness instructors and personal trainers may very well hold qualifications at higher levels than those mentioned, and often do, thereby bringing unique knowledge, skills, and experience to these roles. Indeed, in a competitive sector, professionals are encouraged to pursue additional qualifications and learning opportunities both higher and broader in level and scope. Formal learning courses and qualifications levels are cited here when they are pegged to, or otherwise most closely approximate, the specific scope of practice surrounding a given role.

At this stage, a gap emerges with respect to apparently healthy individuals with more highly specialised fitness goals, as well as those with health challenges stratified as medium risk (categorised in the third row from the bottom). One would expect that, in accordance with general EQF level descriptors, such individuals be able to access professionals with more advanced knowledge and a critical understanding of the field of exercise science and training methodology. Such professionals should be able to undertake complex and technical professional activities, generate creative solutions to abstract problems, and work in unpredictable circumstances. They should demonstrate the kind of critical thinking skills characteristic of higher education, to be able to identify pseudo-scientific approaches or products, and pursue courses of action based on the evaluation of evidence-based guidelines and literature.

It is precisely this gap that the role of the EH specialist, as defined by the standards first published by the European Health and Fitness Association (EHFA – now EuropeActive) back in 2012, is intended to address. Training providers have since responded by developing formal courses based on these standards, to prepare professionals for a role that, locally, until now, has been filled only incidentally and informally. Like many other nations, Malta faces the danger of a widening skills gap in response to the challenges incurred by an ageing population, and increasing incidence of overweight and obesity. In the local context, the gap has so far been addressed by a handful of professionals who, in response to market needs, have adapted, or otherwise operated in addition to, the primary role for which they were formally trained. The diagram below shows a number of interesting routes by which this has occurred, as indicated by the directional arrows in yellow.

A number of personal trainers already operating in the fitness sector, initially qualified at EQF level 4, have taken it upon themselves to pursue foreign short courses based on exercise referral, and exercise for pre- and post-natal, older clients, as well as other special populations. Others have pursued degree courses at EQF level 6 in sports or exercise science either locally or abroad. Some have instead begun their journey into the EH role from higher EQF levels, including physical education teachers (level 6), or those possessing Master’s degrees in sport science, exercise physiology, or strength and conditioning (level 7).

With local training providers already formally engaged in the preparation of suitably trained EH professionals, further understanding of how the changing nature of the sector will play out in practice, is needed. Future posts will explore the role of EH professionals within wider  referral networks, and how symbiotic relationships with other medical and health care professionals including general practitioners, physiotherapists, psychotherapists and nutritionists are mutually beneficial, serve the best interests of clients, and ultimately help promote a culture for healthier living across the board.