Whilst some specialties of medicine have been in existence since the Ancient Egyptians, new fields must arise due to a change in disease burden. The field of Sport and Exercise medicine (SEM) is a prime example of how the Health service provided to the public had to adapt to meet a change in patient demand.
Since the early 2000s, it’s been observed that an inactive person spends 38% more days in Hospital than an active person, needing more GP visits, nurse visits and more specialist services . Indeed, research showed that regular physical activity decreases the risk of heart disease, strokes, cancer (Breast and Colon), Type 2 Diabetes, hypertension and even depression . It was therefore important that patients recognize the benefits of exercise.
However, there are barriers that prevent patients from exercising. These include musculoskeletal disorders (such as back pain) and obesity. Musculoskeletal (MSK) disorders are painful, which would discourage physical activity. Obesity can make exercising mechanically difficult, as well as giving patients confidence issues, which can deter individuals from an exercise setting (such as a gym).
Given the complexity of these barriers, it was clear a multidisciplinary approach involving physicians, physiotherapists, dieticians and physiologists was necessary. Collectively, this multidisciplinary team could diagnose and treat the patient, overseeing the management of their chronic illnesses, with a goal to encourage exercise. Not only will the exercise decrease the risk of several illnesses, but it can also tackle the barriers that prevent them from exercising in the first place (e.g. exercising will help them lose weight).
At the time, it was clear this service was not possible and the demand was not being met . For example, patients with MSK disorders were often referred to an orthopedic surgeon to be assessed in an outpatient setting. However, most patients with MSK disorders do not require surgery, with 80% of total cases seen by the surgeon not requiring an operation. These patients then had to re-present to their GPs, who originally referred the patient to the surgeon. This was deemed to be inefficient in both time and money.
Patients with obesity were also not receiving the best possible service. Prescribing physical activity for preventing and treating diseases was regarded as a primary care service. However, there was no routine education or support for GPs on prescribing exercise.
So, it was clear patients with certain disorders were not given the best possible interventions that would improve their quality of life and prevent the risk of further chronic diseases. New infrastructures within the NHS had to be built, with new specialists needed to provide the service.
Sport and Exercise medicine (SEM) was accredited as a specialty in 2005, with the Faculty of Sport and Exercise medicine being launched the year after with the aim to be one of the main bodies leading the discipline. A training scheme for a doctor to become a SEM specialist was constructed, combining pathways in public health, general practice and musculoskeletal medicine . As a result, a SEM specialist is trained not only in diagnosing and treating musculoskeletal injuries, but also in developing and delivering exercise plans to patients who would benefit from physical activity. This means barriers that prevent certain patients from exercising can now be managed appropriately.
To conclude, the inception of the SEM specialty is a great example of how the NHS improves its services. It’s worth noting the whole process was research driven. A new way of treating patients (prescribing physical activity) was discovered to have multiple benefits (managing MSK disorders, treating obesity, decreasing the risk of several chronic illnesses). The infrastructure of the NHS was assessed and deemed not to be suitable to provide this new treatment. Proposals were put forward for a new specialty, which was eventually set up. A new way of treating patients is now possible under the NHS.
It’s worth noting many SEM specialists would have started their general medical training before their discipline existed. It’s likely in the future new disciplines will have to be set up to provide new treatments to patients with different demands. So, when considering what field of medicine to go into, keep an open mind, it may not even exist yet!