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2 Specialties Sport and exercise medicineThe levels of physical activity and chronic disease ofpeople from different ethnic, cultural and religiousgroups vary significantly. Equality, diversity and equityof access are integral considerations to SEM services,regardless of ethnic, religious or socioeconomic factors.Patients with chronic conditions are a priority for SEMservices, and consultants are involved in the preventionof chronic disease through health promotion, as well asin establishing chronic disease rehabilitation services.They are trained in evidence-based behaviour changetechniques, such as motivational interviewing,self-determination theory and social–cognitive theory.All these techniques improve efficacy for changingphysical activity behaviour and improve compliancewith exercise prescription.4 Interspecialty and interdisciplinary liaisonSEM consultants are effective working at the centre ofthe care of those with musculoskeletal pathology. Theymay treat or sign-post the patient to appropriate otherclinicians or services. They can also work side by sidewith many different healthcare professionals in effectivemultidisciplinary teams. These teams often includeorthopaedic surgeons, physiotherapists, podiatrists,occupational therapists, nurses, dietitians andpsychologists. In this way, SEM consultants work closelywith other clinicians to reduce unnecessary burden ontheir services. This also ensures that patients are seeingthe most appropriate clinician based on the SEMconsultant understanding the pathology and the healthsystem.5 Delivering a high-quality service – howSEM contributesSEM involvement in services will contribute to deliveryof improved and innovative patient care, contribute toefficiency in pathways and reduce the financial burdenon the NHS, both short and long term. Outside theirdirect patient contact role, SEM consultants can providecomprehensive and ongoing education onevidence-based and effective exercise prescription forapplication in primary care, as well as for teamsworking in specific chronic disease areas. They canintroduce a formal system of CPD, mentoring andappraisal for medical and other professional staffworking within musculoskeletal interface services.Clinical governance will be a key feature of all existingand new SEM services, with active involvement in audit,critical event analysis and appraisal. Most SEM serviceshave an active programme of research, and this will beencouraged in new services as they are set up. Theestablishment and endorsement of the National Centrefor Sports and Exercise Medicine provides a foundationfor continued development in quality and standards.The National Centre will be tasked with beingexemplars in clinical and research excellence in sportand exercise medicine. The National Centre will forgetranslation of biomedical and behavioural research intoclinical practice, facilitating breakthroughs andinnovation to drive improvements in patient care. Thisincludes the establishment of protocols for processevaluation of clinical pathways and development oflean, sustainable organisational structures.6 Clinical work of consultantsThe work of SEM consultants includes (but is notlimited to): musculoskeletal and soft-tissue diagnosis, treatmentand rehabilitation musculoskeletal pain management musculoskeletal injury prevention diagnostic musculoskeletal ultrasound andimage-guided soft-tissue and joint injections physical activity health promotion management of exercise and physical activityinterventions assessment of chronic disease patients for theexercise referral service exercise prescription clinical exercise testing and risk stratification beforeexercise clinical exercise testing and risk stratification beforeanaesthesia advising on, and leading, workplace wellnessschemes.7 Workforce requirements for the specialtyCurrent workforce numbersSince 2006 79 trainees have entered SEM training.Currently there are 49 trainees across the UK onspecialist training schemes and 61 SEM physicians onthe specialist register helping to further thedevelopment of the speciality.Number of consultants requiredEmployment in the SEM field is still evolving so thesefigures are estimates only. Currently, there are 12 NHSC○ Royal College of Physicians 2013 253
Consultant physicians working with patientsSEM services already in existence in secondary care,with many more community settings. The requirementfor SEM consultants will evolve according to specificlocal needs, but it is expected that a minimum of 2consultants will be required for a population of 330,000.This equates to 300 consultants across the UK. As theservices develop within SEM, the number of consultantsrequired is likely to grow further, given the enormousnumber of patients with a chronic disease or at high riskof developing one, all of whom would benefit fromexercise prescription to help ease the burden of ill healthin an ageing population.8 Key points for commissioners1 Globally physical inactivity causes 9% of prematuredeaths, 5.3 million of the 57 million deaths thatoccurred in 2008. 22 Maintaining physical activity at recommend levelscan equate to 3–4 years in additional life expectancywith risk reductions of the order of 20–40% for over22 non-communicable diseases. 43 The NHS could make substantial savings bytargeting promotion of physical activity as part ofchronic disease models. 54 Current costs of providing healthcare cover for aphysically inactive ageing population are notsustainable. 6,75 The NHS needs to invest proportionately to theburden of physical inactivity to develop sustainableprevention and treatment models for chronicdisease. 5–76 SEM consultants are trained in providingevidence-based and effective physical activityinterventions for primary and secondary preventionof chronic disease. 8–107 SEM consultants offer unique and specificskills in the diagnosis, treatment and rehabilitationof musculoskeletal, soft-tissue and sportinjuries.8 SEM services may be situated in both communityand secondary care settings, and tailored to meetlocal pressures and needs.References1 SportEngland’sActivePeople’sSurvey6.SportEngland,2012. www.sportengland.org/research/active peoplesurvey/active people survey 6.aspx [Accessed January2013].2 LeeI-M, ShiromaEJ, LobeloF, et al.Effectofphysicalinactivity on major non-communicable diseasesworldwide: an analysis of burden of disease and lifeexpectancy. Lancet 2012; 380: 219–29.3 Townsend N, Bhatnagar P, Wickramasinghe K, et al.Physical activity statistics 2012. London: British HeartFoundation, 2012.4 Wen CP, Pui Man Wai J, Tsai MK, et al. Minimumamount of physical activity for reduced mortality andextended life expectancy: a prospective cohort study.Lancet 2011;378:1244–53.5 Jarret J, Woodcock J, Griffiths UK, et al. Effect ofincreasing active travel in urban England and Wales oncosts to the National Health Service. Lancet2012;379:2198–205.6 AndersonLH,MartinsonBC,CrainAL, et al. Healthcarecharges associated with physical inactivity, overweightand obesity. Prev Chronic Dis 2005;2(4):A09.7 Nazmi S. Physical inactivity and its impact on healthcareutilisation. Health Economics 2009;18:885–901.8 Moore G. The role of exercise prescription in chronicdisease. Br J Sports Med 2004;38:6–7.9 WeilerR, JonesN. Sports and exercise medicine: A freshapproach. NHS North West. www.northwest.nhs.uk/document uploads/2012/Sport-andExercise-Medicine-A-Fresh-Approach.pdf [Accessed January 2012].10 Pedersen BK, Saltin B. Evidence for prescribing exerciseas a therapy in chronic disease. ScandJMedSciSports2006;16(suppl 1):3–63.254 C○ Royal College of Physicians 2013
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