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Sport and exercise medicine around the world: global challenges for a unique healthcare discipline
  1. Justin Carrard1,
  2. Ana Morais Azevedo2,3,
  3. Boris Gojanovic4,
  4. Pascal Edouard5,6,
  5. Tej Pandya7,
  6. Diana Gai Robinson8,9,
  7. Gürhan Dönmez10,11,
  8. Laila Ušacka12,
  9. Rodrigo A Martínez Stenger13,14,
  10. Luciana De Michelis Mendonça15,
  11. Jane Thornton16,
  12. Miguel Reis e Silva17,
  13. Isabel Schneider18,
  14. Johannes Zwerver19,20,
  15. Moa Jederström21,
  16. Kristina Fagher22,
  17. Omar AlSeyrafi23,
  18. Phathokuhle Zondi24,
  19. Fariz Ahamed25,26,
  20. Mandy Zhang27,
  21. Katja Van Oostveldt28,
  22. Norasak Suvachittanont29,
  23. Carole Akinyi Okoth30,31,
  24. Loïc Bel32,
  25. Eloise Matthews33,
  26. Luke Nelson34,
  27. Karen Kotila35,36,
  28. Karsten Hollander37,
  29. Patrick J Owen38,
  30. Evert Verhagen39
  1. 1Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
  2. 2La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
  3. 3The Australian Ballet, Melbourne, Victoria, Australia
  4. 4Swiss Olympic Medical Center, Hôpital de La Tour, Meyrin, Geneva, Switzerland
  5. 5Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology (EA 7424), Saint-Etienne, France
  6. 6Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
  7. 7Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
  8. 8Medical School, Notre Dame University, Sydney, New South Wales, Australia
  9. 9Sydney Sportsmed Specialists, Sydney, New South Wales, Australia
  10. 10Department of Sports Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
  11. 11Gençlerbirliği Sports Club, Ankara, Turkey
  12. 12Faculty of Medicine, University of Latvia, Riga, Latvia
  13. 13Dr A. Zubizarreta Hospital, Buenos Aires, Argentina
  14. 14Argentinian Sports Physicians Association, Buenos Aires, Argentina
  15. 15Physical Therapy Department, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  16. 16Western Centre for Public Health & Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  17. 17Health and Performance Department, Sport Lisboa e Benfica, Lisboa, Portugal
  18. 18Physio-Motion - Sport treiben gesund bleiben. Sports, Exercise, and Health Advisor and Service Provider, Groebenzell, Germany
  19. 19Sports & Exercise Medicine, SportsValley, Gelderse Vallei Hospital, Ede, Netherlands
  20. 20Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
  21. 21Athletics Research Center, Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
  22. 22Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
  23. 23Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  24. 24High-Performance Commission, Medical Advisory Committee, South African Sports Confederation and Olympic Committee, Houghton, Johannesburg, South Africa
  25. 25Sri Lanka Sports Medicine Association, National Hospital of Sri Lanka, Colombo, Sri Lanka
  26. 26Sports and Exercise Medicine Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka
  27. 27Singapore Sport and Exercise Medicine Centre, Changi General Hospital, SingHealth, Singapore
  28. 28Antwerp University Hospital, Antwerp, Belgium
  29. 29Heart Institute, Samitivej Sukhumvit Hospital, Bangkok, Thailand
  30. 30National Spinal Injury Referral Hospital, Ministry of Health, Nairobi, Kenya
  31. 31Medical Commission National Olympic Committee, Nairobi, Kenya
  32. 32School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
  33. 33Pinnacle Sports Physicians, Christchurch, New Zealand
  34. 34Health & High Performance, Melbourne, Victoria, Australia
  35. 35Danish Society of Sports Physical Therapy, Odense, Denmark
  36. 36Boarding School of Nyborg, Nyborg, Denmark
  37. 37Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
  38. 38Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
  39. 39Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  1. Correspondence to Dr Justin Carrard; justin.carrard{at}

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Since October 2021, BMJ Open Sport & Exercise Medicine has conducted a blog series entitled: ‘Sport and Exercise Medicine Around the World’.1 Sport and exercise medicine (SEM) professionals were invited to provide their perspectives on SEM in their countries by replying to the following questions:

  1. What is the path to becoming a sport and exercise physician/physiotherapist/scientist in your country, and what are the main hurdles on this path?

  2. How developed is collaborative work in SEM in your country?

  3. Are exercise physiologists/scientists integrated into your healthcare system, and does health insurance cover their services?

  4. What is done in your country to promote SEM among students and young professionals regarding research and clinical opportunities?

  5. Finally, what would you change to SEM in your country if you were Harry Potter?

Twenty-five blogs have been published, written by 26 SEM professionals (20 physicians, 4 physiotherapists, 1 chiropractor and 1 exercise scientist) representing 22 countries (Europe=11, Asia=4, America=3, Africa=2, Oceania=2; figure 1) and 2 genders (50% women, 50% men). This editorial highlights our collective takeaways from these blogs and outlines potential future developments for SEM globally.

Figure 1

Geographical locations of the contributors to the blog series ‘Sport and Exercise Medicine (SEM) Around the World’.

SEM: a key label for a broader recognition

Most countries (Australia, Brazil, Canada, France, the Netherlands, New Zealand, Singapore, South Africa, Sri Lanka, Sweden, Switzerland and the UK) now use SEM to designate our discipline. In contrast, some countries (Argentina, Belgium, Germany, Latvia, Portugal, Qatar, Thailand and Turkey) still use the term sport medicine. In our opinion, adopting the term SEM globally is an essential step towards unifying a field that encompasses both the management of health issues related to physical activity (ie, sport medicine) and the prescription of exercise to prevent and treat diseases (ie, exercise medicine).2 This appellation better positions SEM professionals towards policy makers as specialists uniquely equipped to manage musculoskeletal disorders, sport-related conditions and chronic diseases. In fact, in a number of countries, a key factor influencing the recognition of SEM as a stand-alone medical specialty was the impact of SEM on disease management, quality of life and healthcare costs.3

SEM education: heterogeneous journeys to the grail

Following the pioneer countries of Australia, New Zealand and the UK, several countries introduced a stand-alone SEM specialty for physicians (Argentina, Brazil, Latvia, Portugal, the Netherlands, Turkey, South Africa, Sri Lanka and Singapore). Interestingly, western countries traditionally recognised for having high-quality healthcare systems, such as Belgium, Canada, France, Germany, Sweden and Switzerland, have not yet adopted the stand-alone SEM specialty model. Consequently, young physicians desiring to pursue a career in SEM must combine full clinical training in another specialty before additional training in SEM. However, such additional training is often insufficient to reach the level of expertise encountered in other medical specialties.4

Training paths to sport physiotherapy are equally sinuous. Following undergraduate physiotherapy training, it is often possible to enrol in a Master’s degree or postgraduate diploma in sport physiotherapy. Unfortunately, sport physiotherapy is not a protected title in every country, often due to a lack of recognition by local health or sport authorities. Thus, a sport physiotherapy title may not increase professional responsibility or earnings. Regardless of the profession, pursuing a career in SEM requires a lot of enthusiasm and sacrifice, while interspecialty recognition might be lacking.

Interdisciplinarity: a central feature of SEM

While physicians have traditionally dominated healthcare systems,5 SEM represents a markedly interdisciplinary culture with different professions often complementing one another.6 In countries such as Australia, New Zealand and South Africa, this is supported by multidisciplinary sport medicine societies that actively promote this interdisciplinary culture. In many countries, however, collaboration remains in its infancy and is often limited to private practice, high-performance or university settings.

The limited inclusion of SEM in the public healthcare system, restricted funding, and a lack of professional recognition were commonly noted as rate-limiting factors for collaboration. For example, reimbursement is often lacking for services delivered by sports psychologists, nutritionists and exercise physiologists. In Australia, New Zealand and the UK, however, clinical exercise physiologists are uniquely recognised as healthcare providers and embedded into the public healthcare system. Given the effectiveness of the services clinical exercise physiologists provide,7 policy makers from other countries should consider how a similar recognition could curb the burden of chronic diseases.

Suggestions for advancing SEM

Figure 2 summarises challenges in the SEM field and suggests solutions. As said by American civil rights activist Marian Wright Edelman, ‘You can’t be what you can’t see’. Consequently, SEM should be more visible in the health-based undergraduate curricula.8 9 This exposure would contribute to raising awareness and unveiling vocation among students. SEM teaching should ideally be delivered interdisciplinary where lecturers and students of different backgrounds copresent.10

Figure 2

Challenges currently faced by sport and exercise medicine (SEM) and suggested solutions.

Additionally, it is necessary to involve SEM specialists in health-related governing bodies to better translate research findings into clinical practice, healthcare policies and insurance coverage. Establishing medical specialties for SEM and integrating sport physiotherapists and exercise scientists/physiologists more comprehensively into healthcare systems are also essential. Improving accessibility to SEM providers for patients of all conditions and athletes of all levels is another important step to ensure adequate knowledge implementation and care delivery.

To improve SEM-related knowledge, further efforts to create research opportunities for interested students and professionals are required. The combination of medical residency with doctoral/postdoctoral time and access to higher academic education (Master’s degree or PhD) for allied health students should be facilitated. In addition, professor positions should be established to ensure high-quality SEM research and teaching. Ultimately, we firmly believe that patients, communities and economies would benefit from stronger SEM integration and more proactive healthcare systems.

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Figures 1 and 2 were created with the online platform (accessed on February 16, 2023).



  • JC and AMA are joint first authors.

  • PJO and EV are joint senior authors.

  • Twitter @CarrardJustin, @Morais__Azevedo, @DrSportSante, @PascalEdouard42, @PandyaTej, @dianarobdoc, @gurhandonmez, @kailalailap, @luludemichelis, @JaneSThornton, @miguelreisesilv, @isi69schneider, @HansZwerver, @MJederstrom, @KristinaFagher, @phatho_z, @farizahamed, @mandy_zjj, @DrNorasak, @bel_loic, @sportschiroluke, @KarenKotila, @K_Hollander_, @PatrickOwenPhD, @evertverhagen

  • JC and AMA contributed equally.

  • PJO and EV contributed equally.

  • Contributors JC and AMA wrote the original draft. All the coauthors reviewed and edited subsequent drafts. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

  • Competing interests JC, AMA, PE, TP, LU, MJ, KF, NS, CAO, KH and PJO are associate editors at BMJ Open Sport and Exercise Medicine. DR is senior editor at BMJ Open Sport & Exercise Medicine, and EV is the editor-in-chief of BMJ Open Sport & Exercise Medicine. JT is editor, while PE, PZ, KK and EV are associate editors at the British Journal of Sports Medicine.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.