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Bringing Health and Fitness Professionals into the Healthcare System

Our Position

In recognition of physical activity’s value as a cornerstone of a more prevention-centered way of caring for the health and wellness of our nation’s people ( 1 ), ACE seeks public policies that position well-qualified health and fitness professionals as members of the patient-centered healthcare team, particularly for the prevention and treatment of obesity, diabetes, cardiovascular disease, and other lifestyle-related diseases.


There is increasing recognition that physicians simply instructing patients to “eat better” and “get more exercise” isn’t working ( 2 ). Patients lack the support and ability to turn that basic guidance into meaningful, long-term behavior change ( 2 ) ( 3 ) ( 4 ). The U.S. population lacks literacy in the quantity and types of physical activity recommended in the U.S. National Physical Activity Guidelines ( 2 ).

Our healthcare system has begun to evolve to reflect this reality. Preventive and wellness services are among “10 Essential Health Benefits” extended by the Affordable Care Act ( 5 ). Experts broadly recognize that effective prevention could facilitate vast cost savings ( 6 ), but the system has yet to establish how “prevention” occurs ( 7 ).

While physicians and nurses report that they want to help their patients adopt healthier lifestyles, most agree they are not ideally trained, properly situated, nor available in numbers needed to deliver preventive care and wellness interventions on the scale required ( 2 ) ( 3 ) ( 4 ) ( 7 ). What is needed is well-qualified health and fitness experts imbedded in the community—professionals who are culturally competent, affordable and highly accessible—to help individuals establish and maintain sustainable behavioral change long before they become at risk of disease.

Those health and fitness professionals are in communities today, but they remain marginal to the healthcare system. They are not regulated nor particularly recognized as health providers, so there is no construct in which their expertise may be systematically utilized ( 8 ). Their capacity to extend needed interventions into our nation’s neighborhoods and communities remains untapped.

Public Policy Priorities

ACE calls for public policies that recognize well-qualified health and fitness professionals as part of the healthcare continuum who are equipped to deliver programs and interventions for the treatment of lifestyle diseases. Specifically, ACE advocates for policies that:

  • Establish strict standards based on NCCA-accredited certification for well-qualified health and fitness professionals, up to and including registry and/or licensure, so the profession may be recognized and trusted as part of the healthcare continuum.
  • Recognize well-qualified health and fitness professionals as a suitable, optimal delivery model for the preventive and wellness services mandated as one of “10 Essential Health Benefits” in the Affordable Care Act.
  • Establish systems and processes by which physicians and other healthcare professionals may refer patients to well-qualified health and fitness professionals for health-related interventions that are affordable and readily accessible.

Behavior-Change Facilitation and Addressing the Obesity Epidemic Read More >
Professionally Led Physical Activity in Communities Read More >
Employee Wellness Programs that Support Sustainable Change Read More >

Reversing the Epidemic of Inactivity Reversing the Epidemic of Inactivity Read More >


1.   Institute of Medicine. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. May 2012. Retrieved from: ww.iom.edu

2.   U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National Action Plan to Improve Health Literacy. May 2010. Accessed January 2014. Accessed from: www.health.gov

3.   Pagoto, Sherry L. & Appelhans, Bradley M. A Call for an End to the Diet Debates. Journal of the American Medical Association. 2013; 310(7): 687-688.

4.   Prevention Institute. Community-Centered Health Homes: Bridging the Gap Between Health Services and Community Prevention. February 2011. Accessed January 2014. Accessed from: www.preventioninstitute.org

5.   U.S. Department of Health and Human Services. Building Healthier Communities by Investing in Prevention. February 2011. Accessed from: www.health.gov

6.   Brill, Alex. The Long-Term Returns of Obesity Prevention Policies. April 2013. Retrieved from: www.rwjf.org

7.   Partnership for Prevention. Preventive Care: A National Profile on Use, Disparities, and Health Benefits. 2007. Accessed February 2014. Accessed from: www.prevent.org

8.   U.S. Bureau of Labor and Statistics. Occupational Outlook Handbook: Fitness Trainers and Instructors. January 2014. Accessed from: www.bls.gov