As a second-year medical student at New York Institute of Technology’s College of Osteopathic Medicine, Raja Mehta barely had time to breathe, much less exercise. Long hours led to poor eating choices, and he had gained weight during his training. Dr. Mehta knew he needed some help getting his exercise regimen back in gear to achieve all the profound benefits of physical activity that he understood could help him, just as much as it could help his patients.
“People think, ‘you’re a physician you should know what to do,’” Dr. Mehta chuckles. “While I could figure it out, I’d rather have someone else do that for me.”
Dr. Mehta found Matt Sulam, a veteran local personal trainer who had been recommended to him. Sulam’s first reaction was excitement that he would be working with a client who would know his biceps brachii from his biceps femoris. “It does make it easier when you’re training someone who really knows anatomy,” says Sulam.
But, he adds, whether he and Dr. Mehta are discussing physiology during his twice-weekly sessions, or their favorite Nicholas Cage movies, “from the very beginning of our training we hit the ground running.”
Three years later, they’re still moving forward together.
“I really enjoy my workouts with Matt,” says Dr. Mehta, now 26 years old. “I feel stronger, healthier.”
Alas, relationships between physicians and exercise professionals have rarely been that chummy or smooth.
How to Build Bridges With the Healthcare Community
There are signs that the medical and fitness industries may be gradually converging. How long and in what form such collaborations will develop is still a question, but there are things health and exercise professionals can do right now to build bridges to physicians and healthcare providers in your area.
Physical therapist Neil McKenna, DPT, CSCS, maintains strong relationships with certified personal trainers and strength coaches in his area. In fact, he says, “I get more of my referrals from non-physicians, including personal trainers.”
So, if you have a client who could use the help of a physical therapist (PT), help them by connecting with a PT in your area. “When you initiate a relationship based on referral, no one’s going to say no to that,” Dr. McKenna says. “They’re going to say, ‘Yeah, that’s great.’” And that’s the beginning of a network. “It’s a way that both professions can help each other,” he says.
To initiate such a relationship with a PT, approach it from the angle of calling upon their expertise to the benefit of your client. “Don’t come in with ‘I think it’s this, can you look at it?’” cautions Dr. McKenna. “It feels like you’re asking the PT to carry out an order. Better to approach them and say, ‘I’ve got someone with shoulder pain, can you check them out?’” And, he says, don’t be insulted if, as you establish this relationship, the PT asks you to execute a program they have designed for your mutual patient-client. “Don't be frustrated—it’s just the beginning of relationship,” he says. “The more they get to know you, the more likely they are to trust and refer to you.”
“Look for opportunities to make the medical professional aware of the type of services you offer,” suggests Dr. Bryant.
A good way, he says, is to get involved with healthcare initiatives in your community. Dr. Bryant specifically recommends the nationwide “Walk with a Doc” program, founded in 2005 by a cardiologist in Columbus, Ohio, to help get his patients moving. The program now encompasses 500 communities around the U.S.
“The astute, forward-thinking exercise pro could find the ‘Walk with a Doc’ chapter in their region and offer their services,” he says. You could participate in the walk, or perhaps offer to lead a warm-up or cool-down for those who are walking; or give a talk on the importance of resistance training. (Note: The “Walk with a Doc” program is still holding virtual events to help encourage people to walk. For more information: https://walkwithadoc.org.)
Identify the Right Docs
Matt Sulam, the personal trainer based in Commack, N.Y., networks with physicians in his area who put a premium on prevention and lifestyle factors. He suggests finding these types of physicians in your area, he says. “Present your credentials, and say, ‘I have clients…they’re on medication. I’d love to steer them to you.’”
As with PTs, you may find that the path you’re creating runs both ways. “I think you'll find reciprocity, as I have,” says Sulam.
“Many in healthcare and allied health fields view exercise and fitness as being important components to health and well-being,” says Cedric Bryant, PhD, ACE’s President and Chief Science Officer. “Where there’s been a guarded view is when they view the exercise profession through the lens of our poorest stereotypes. That's the unfortunate thing.”
A 2018 study in the journal BMJ Open Sport and Exercise found that, while more physicians are advising their patients to exercise, few are promoting the use of health clubs and personal trainers as a way to do so. The authors concluded that there was “a meaningful trust gap between physicians and exercise professionals who may be a partner to implement exercise and physical activity prescriptions.”
The fact that a new generation of physicians like Dr. Mehta recognizes the benefits of exercise, for both themselves and their patients, is encouraging.
Could this recognition be a harbinger of a new convergence between the medical and fitness industries?
Exercise is Medicine
“I think you’re seeing more movement in that direction,” says physical therapist Neil McKenna, DPT, CSCS, “but it depends on which population we're talking about.”
While Dr. McKenna says that exercise professionals are starting to play a more robust role in the rehabilitation of orthopedic injuries, it might not be the case for, say, oncological patients.
Edward Phillips, MD, a physiatrist at Harvard’s Spalding Rehabilitation Center—and a coauthor of the 2018 BMJ paper mentioned earlier—points to the American College of Sports Medicine's “Exercise is Medicine” initiative. EiM’s aim is to promote greater connections between mainstream medicine and fitness—in particular a program called Exercise is Medicine Solutions, which “aligns the medical community with the local YMCA.”
The idea, according to the EiM website, is that patients “are more likely to be referred for exercise guidance and to engage in recommended levels of physical activity when health care systems and community fitness enterprises work together.”
One pioneering EiM program, launched in 2016 at the YMCA in Greenville, S.C., seems to be doing just that. Indeed, it states its goals assertively: “From the heart of the stroke belt, comes a first-in-nation coalition that brings together medical school–based research with doctors, community resources and exercise professionals in an audacious partnership to slow the progression of chronic disease.”
“Audacious”—as in “bold”—is an appropriate word for the 12-week medically based program for adults with chronic health conditions such as hypertension and obesity.
However, there is a second definition of that word audacious—"showing a lack of respect”—that could describe the persistent view of personal trainers by some in the wider medical community. And here, says Dr. Bryant, the fault is not necessarily healthcare bureaucrats or physicians.
“In some respects, the industry has been its own worst enemy,” Dr. Bryant says. “A lot of the images that are popular on social media don’t speak well of the profession. And think about the headlines we often see in popular fitness magazine. You know, ‘Best butt in two weeks.’ That’s not the kind of thing that’s going to get physicians more likely to refer patients to the local gym or personal trainer.”
On the other side of the equation is a medical hierarchy that traditionally seems to dismiss anyone without similar credentials.
“If you don’t have the letters after your name, it can hurt you,” says best-selling author Joe Piscatella, who has been writing and speaking about living a healthy lifestyle since he had coronary bypass surgery back in 1977. But Piscatella, whose Institute for Fitness and Health is based in Gig Harbor, Wash., sees a shift. “I think it will change,” he says. “My observation is that from the cardiac rehab standpoint, there seems a tad more openness out here.”
Greater cooperation should stem from a focus on the ultimate goal. “The patient is who we should all be working for," says physical therapist McKenna, who routinely refers patients from his Solana Beach, Calif., practice to qualified health and exercise professionals in the San Diego area. “As long as we keep the patient’s goals as the top priority, it helps to get rid of the ego of that relationship, in terms of who should be doing what. I think everybody should be working together as a team for the benefit of the patient.”
A Vision of the Future
A vision of what might eventually be a better working relationship between medical and fitness professionals was spelled out by Dr. Bryant in a 2019 journal article about the Prescription for Activity (PfA) Task Force that he and other leading figures in the fitness and healthcare world have organized to help facilitate the process. The PfA Task Force, Dr. Bryant wrote in a 2019 article in the American Journal of Health Promotion, “imagines a new paradigm for physical activity where healthcare providers routinely assess physical activity levels, encourage physical activity among their patients, counsel on its necessity, and then refer patients to appropriate community partners based on each patient’s interests and readiness to change.”
It’s an ambitious goal—but it’s already a vision shared by at least one young medical practitioner: After about a year of training with Sulam, Dr. Mehta sketched out a vision of his future practice and share it with Sulam during a workout one morning. “He told me, ‘I’m going to have someone to do the billing, someone to do the appointments, I want a dietitian, and I want a personal trainer to refer patients to.’” And, Sulam adds with a chuckle, “he said, ‘Yes, Matt, you’re going to be the personal trainer.’”
While Dr. Mehta, now a graduate physician instructor at the medical college, is still a few years away from realizing such a vision—perhaps one that will become more commonplace in the future—Sulam believes the young doctor's idea of a preventive, wellness-oriented medical practice is rooted in his own lifestyle practices.
“Raja gets the value of exercise,” says Sulam, “because he’s actually doing it.”
Expand Your Knowledge
ACE’s Prescription for Activity Task Force
ACE’s Prescription for Activity systems-change map is a guiding light for ACE, informing our long-term plans for how we equip and situate ACE Certified Professionals and others who've been similarly armed with science-based behavior-change coaching skills to help far more people to get and stay moving.