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Before You Go - October 2014

Changing Behavior

Exercise Pros Deemed Fit for Special Programming

By Deborah L. Vence


For the very first time, properly trained exercise professionals now are considered to be among those qualified to deliver behavior change programming.

This, according to the American Council on Exercise (ACE), which responded to recommendations on behavior-change counseling—particularly for those at risk for cardiovascular disease—published by the U.S. Preventive Service Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine established by the U.S. Congress.

"This is just the first step toward recognition as an exercise professional as a provider of healthcare services," said Graham Melstrand, vice president of corporate affairs for ACE, in a recent interview. He also noted that Triple Aim—a framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance—is cutting costs, increasing access and improving health outcomes on a general population scale.

The USPSTF released in August a recommendation that overweight or obese adults with at least one additional risk factor for cardiovascular disease be offered or referred for behavior-change counseling interventions that promote healthy diet and exercise for cardiovascular disease prevention. This particular recommendation is for adults who have a BMI of 25 (those who are overweight) or 30 and above (those who are obese), and are, therefore, at increased risk for diabetes and hypertension. And, this further sets the stage for the healthcare system to extend the clinic into the community with preventive lifestyle interventions.

"For a very long time everyone has been aware that if you maintain or achieve good healthcare status, it lowers healthcare costs. If we can provide leadership and support for individuals who are more at-risk, the potential for savings is significant," Melstrand said.

The USPSTF recommendations that are assigned get one of five letter grades (A, B, C, D or I) based on research findings. Because of the outcomes of the analysis, the recommendation in this case was given a Grade B rating. Both grades A and B ratings have a moderate to high level of certainty regarding strength of evidence and magnitude of net benefit of implementation outcomes. In addition, they bring with them a suggestion to clinicians to discuss, offer and/or recommend the service.

"The Task Force recommendations represent a significant milestone for the professionals who ACE educates, certifies and supports," stated ACE Healthcare Solutions Director Natalie Digate Muth, M.D., MPH, RD, FAAP, in a press release. "For the first time, an independent national recommending authority has named properly trained exercise professionals among the professions qualified to deliver behavior-change programming, which includes structured, supervised physical activity, as part of the healthcare system.

"The recommendations further set the stage for certified, well-trained exercise professionals and health coaches to become part of a diverse new network of professionals who, operating as part of the healthcare system, extends the clinic into the community," she said. "That network would help at-risk patients adopt healthy lifestyles and thus require fewer costly and more involved interventions later, advancing the system toward the triple aim of cutting costs, increasing access to care and improving health outcomes on a population scale."

And, ideally, you want interventions to be delivered with the primary care practitioner, with a referring professional, so they understand what patients are experiencing in those programs, Melstrand noted.

What's the next step?

"The next logical step … for ACE and others through the coalition … is that it's now incumbent on us to reach out and work with the other professions that are named in this to establish what roles and services that each can provide. I think the next step is informing and educating not only the other healthcare professions, but continuing to inform the federal government on what to look for in an exercise professional," he said.

Opportunities exist, too, in various categories for exercise professionals to be a part of behavior change counseling, including membership-based and university recreation settings—a significant opportunity for young adults.

"Our recommendation is the first piece of track toward realizing that other things have to happen … building the infrastructure, and how it's interpreted," Melstrand said.

According to information from ACE, cardiovascular disease is the leading causes of death in the United States, with close to 50 percent of all adults having at least one risk factor for cardiovascular disease—such as high blood pressure, high cholesterol, overweight or obese, or smoking. Furthermore, nearly 70 percent of all U.S. adults classify as overweight or obese, meaning they are at increased risk.



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