Dr Dane Vishnubala, MBBS PGCME PGDipSEM MRCGPDipSEM (UK&I) MFSEM FHEA, is the Chief Medical Advisor for Active IQ, the UK’s leading Ofqual-recognised Awarding Organisation for the Active Leisure, Learning and Wellbeing Sector which specialises in designing and delivering sector-leading vocational qualifications. He has over 14 years’ experience in the health and fitness industry as an exercise professional and has worked in numerous health clubs across the UK.
Dane is a GP at Haxby Group in York, an NHS Sport and Exercise Medicine Doctor and Public Health England GP Clinical Champion for Physical Activity. Dane is also the Great Britain (GB) Basketball Senior Men’s Team Doctor and the York City Football Club Doctor. He is the Royal College of GPs’ (RCGP) Lead Clinical Advisor for Physical Activity and Lifestyle and a British Association of Sport and Exercise Medicine (BASEM) Executive Member.
We spoke to Dane about:
- The barriers people with chronic diseases face when they are prescribed exercise by their GP
- What leisure operators and PTs can do to reduce these barriers
- Advice for PTs on how to better address the physical inactivity problem
When people with chronic diseases are prescribed exercise by their GP, what sort of barriers are they encountering?
It is common for patients with high blood pressure, hypertension, mental health problems, obesity or diabetes to be advised to exercise by their GP. However, when people with these conditions arrive at a gym, often for the first time, they are asked to fill out a standard PARQ form. While these forms are designed to identify prospective members where exercise may pose a risk, many of those with low risk health problems are being turned away at this stage. In some cases, it is due to the facility not having a fitness professional with the appropriate training. In other cases, people are asked to go back to their GP for a referral letter. These letters cost money. While it varies from GP to GP, every practice will charge a different fee. With both the inconvenience and financial barrier, many people never return to the gym.
What can leisure operators do to help alleviate these barriers?
First and foremost, operators need to invest in better-qualified staff. Every operator should have at least one PT with an Exercise Referral qualification. If they have at least one PT with this form of advanced training, more patients with chronic disease will likely be accepted then turned away. However, this is still dependant on the club’s policies. Not only does this stop operators from turning people away, it helps improve member acquisition.
What sort of training is required to address these barriers?
The need for education and upskilling in the industry is growing increasingly important. I would argue that chronic diseases that people frequently present at gyms should be included in all Level 3 PT Training qualifications, not just as part of exercise referral qualifications. Ultimately, with chronic diseases and inactivity on the rise, PTs need to place more value on qualifications and skills which equip them to work with these types of clients. Those already qualified should seek to maintain their knowledge and keep up-to-date in a rapidly changing field.
In your opinion, is there a gap between the fitness world and the medical world?
Yes. But the medical industry, and particularly, awarding organisations like Active IQ are actively working to close it. We recognise that the average PT does not keep up-to-date with the latest evidence. This is not surprising considering they are written for the academic/science community. Training providers and/or awarding organisations should step-up to the plate and act as the conduit between these two worlds. Active IQ is already doing this, and we have added common chronic diseases into Active IQ’s recently updated Personal Training qualification. I have also provided a range of webinars, blogs and other resources to support the transition to the new improved qualification.
Is there anything else being done to address this issue?
Yes. In fact, this is so topical right now that Public Health England has a clinical champions programme to up-skill health care workers in providing physical activity advice. The Royal College of GPs has a clinical priority group looking at how it can influence physical activity and lifestyle-based issues in general practice. Many other organisations in the medical world are pushing this agenda too, including the British Association of Sport and Exercise Medicine and the Faculty of Sport and Exercise Medicine. For all the negativity about what GPs don’t know, once a gap in knowledge is found, you can be rest assured, it will be plugged. This is already evident from all the good work that has started over the last few years in this area.
What’s your single biggest piece of advice for fitness professionals?
Qualifying as a fitness professional is a fantastic achievement, but if you don’t stay up-to-date with the latest evidence then very soon your knowledge will be out of date in a rapidly changing field. Staying current and continuing to learn is a key skill and there are a range of different ways to do this.
We need to push our education industry to engage with other allied sectors and raise standards, not just in qualifications, but also in maintaining knowledge and staying up-to-date to ensure the credibility of our profession.
I really do feel the fitness industry has a key role to play in addressing a range of chronic diseases arising from our country’s physical inactivity. There are strengths and weaknesses of all professionals. What the medical sector does well is ensuring its staff stay up to date, documenting learning and continual professional development. We must find a way to learn from other sectors to improve our own profession and raise our standards higher.