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Regular physical activity confers important health benefits, reduces all-cause mortality and can prolong life.1 Physical activity and exercise as preventative measures, through enhancing health and well-being, managing multimorbidity, and guiding rehabilitation from illness and injury or postoperatively, as well as promoting social inclusion and addressing aspects of health inequalities, form one of the cornerstones of the specialty of sports and exercise medicine (SEM).2 Approximately one-third of the world’s population suffer from musculoskeletal (MSK) injuries that negatively impact their health, cause disability and constitute a major economic burden on the health system and society.2 SEM physicians are trained in assessing, diagnosing and managing MSK injuries, therefore, avoiding unnecessary investigations and procedures and reducing costs.2 SEM physicians are also key in prescribing exercise, especially for chronic medical conditions, therefore, decreasing the consumption of medications and reducing costs to healthcare systems.2
SEM as a professional medical specialty or subspecialty exists in most European countries.3 However entry requirements, training pathways and curricula differ considerably between countries.3 Although the European Union allows free travel and recognition of professional qualifications, this is not the case for SEM physicians, as there is currently no general recognition of the specialty within Europe.3
Early SEM was more focused on athletes and teams’ care. They also fulfilled further specific tasks such as prevention and promotion of exercise and health, and conservative treatment of MSK injuries although possibly in a less structured way than current SEM.4 5 The addition of exercise medicine is a more recent field extension4 5 and was recognised in the UK, for example, only in 2005.6 The specialty now encompasses a wide range of activities with increasing emphasis on prevention and health promotion for the population in general, and not just for elite athletes.2 Providing preventative measure and health promotion of course is not exclusive to SEM specialty. It requires a multifactorial and multidisciplinary approach, however, SEM physicians have a unique skill set in giving guidance in this area.7 Integrating the information as provided by different specialties (eg, general practice, cardiology, sport science or dentistry) enables the SEM physician to deliver an individualised treatment strategy to an athlete or exercising person and to steer the further development of medical policy in general. But it is not only the terminology that is important. Indeed, what happens to healthcare systems that currently do not have SEM specialists providing the described services?
Some of the main challenges of SEM as a specialty2–7:
Adopting SEM as a specialty name for better reflection of skill set.
Defining recognised curricula and training pathways for clinical specialists and university academics in SEM.
Mutual recognition of the specialty across countries.
Inclusion of SEM training in undergraduate curriculum.
Provision of adequate and equal employment opportunities (including portfolio careers and adequate reimbursement for services).
Establishing the role of SEM specialists within public health medicine (including at individual, community and governmental policy-making level).
Financial support, undertaking and disseminating appropriate and innovative research.
Recognition and promotion of both multidisciplinary, transdisciplinary and interdisciplinary teams.
Promote the message of exercise and preventative medicine.
And finally, along with many other aspects of medical practice, are the challenges or maybe opportunities, represented by the inevitable advances that artificial intelligence (AI), robotics and other technologies can bring to the specialty.
We believe that specialised pan-national medical associations/societies can play a pivotal role in raising awareness, working with governments and societies, initiating a constructive conversation about addressing these challenges through effective collaboration and bringing SEM together. Such pan-national associations include, for example:
The European Federation of Sports Medicine Associations (EFSMA), which aims to promote, develop and harmonise Sports Medicine training and recognition as a primary medical specialty and inclusion in the basic curricula of medical schools within Europe.8
Fédération Internationale de Médecine du Sport (FIMS) or International Federation of Sports Medicine, as an international association, committed to the promotion and development of Sports Medicine throughout the world, aiming to protect the physical and mental health and ensuring the well-being of all who are engaged in sports and exercise, assisting athletes in achieving optimal performance. FIMS also engages in education, research and collaboration and discussions with other organisations and stakeholders.9
The European College of Sports and Exercise Physicians (ECOSEP), a non-profit, scientific medical society dedicated to SEM and SEM physicians.4
With the example of ECOSEP, we want to highlight what the aims and roles of a pan-national association should be in advancing SEM in the 21st century.
Aims of ECOSEP in promoting SEM specialty
The general aims of ECOSEP are advancing the competencies of SEM physicians, highlighting the most current evidence-based, best practice advice for the care of athletes and the general population through continued professional education, publishing and distributing research, collaboration with other sports medical organisations, the public, governing bodies and stakeholders. While ECOSEP recognises that different countries have different healthcare systems, standards, demands and resources for SEM physicians, ECOSEP aims to promote the specialty and proposes facilitation across countries, always being mindful and respectful of national arrangements. To that end, ECOSEP creates support and discussions between national partners and stakeholders, promoting the highest standards for SEM practice, facilitating communication between SEM physicians and all sports medicine organisations both in Europe and internationally. ECOSEP also provides a platfrom for other specialties associated with SEM, and for authorities to provide the appropriate sport medicine specific advice and guidance. ECOSEP strongly believes that various organisations directly or indirectly associated with sports, physical activity and public health, should be encouraged to employ appropriately trained SEM specialists. Examples of these organisations include but are not limited to sports teams/clubs, sports federations, governing bodies, state run or national health systems, private establishments providing MSK/sport injury clinics, universities and academic institutions, public health, and sports and physical activity policy-making boards and committees. ECOSEP acknowledges and promotes SEM practitioners’ role in prevention as well as treatment and rehabilitation and through its Europe-wide network of specialists, supports various enquiries from the general public, officials and athletes by providing information and signposting to local SEM specialists for in-person assessment, advice and treatment.
ECOSEP has established several committees, chaired and supported by experienced SEM physicians, that thrive through interaction and consultation with its members (see table 1). The committees provide more specific guidance and consultations in bringing a more harmonised and evidence-based approach to SEM. ECOSEP further provides training courses (such as on the field trauma emergency courses), workshops and biannual congresses. Indeed, the eighth ECOSEP Congress is due to be held in Saudi Arabia in 2024 and we encourage all health professionals to attend this exciting event. ECOSEP also aims to bring together SEM and allied health professionals internationally and facilitate communications, exchange of views and a better understanding of the needs of the SEM specialty in the 21st century, advancing research, teaching and educational opportunities and promoting exercise on a public health level.
Why is it important that pan-national associations such as ECOSEP promote the SEM specialty?
ECOSEP addresses some of the challenges facing the SEM specialty in the 21st century as its members and stakeholders come from different countries, with their unique insights into local and national healthcare systems and training structures. Through dialogue and communication strategies, ECOSEP aims to promote further global advances of the SEM specialty, not just across Europe, but globally. The members of ECOSEP believe that recognition and better appreciation of the pivotal role that SEM specialists can bring to healthcare systems, can be achieved through providing research, teaching and educational opportunities alongside public health awareness and population, health-based programmes. National governing bodies or colleges are important in tackling these challenges on a national level, but ECOSEP can act as a wider reaching professional society, combining the views of various national institutions from across Europe.
SEM encompasses a wide range of aims and objectives, and it is hoped that a collaborative approach can help further define the specific aims of the specialty and provide international recognition. To achieve this goal an open and active participation in this process is necessary and collaborations between different pan-national societies, such as ECOSEP, FIMS and EFSMA would be welcomed. Only through growing international networks, providing unique opportunities for exchange of views, a better collective understanding of the needs, and a greater input for SEM as a specialty in providing a more efficient and more effective health service to the public.
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Collaborators The following authors are members of the European College of Sports and Exercise Physicians (ECOSEP): VS, HL, NM, AP, KT, NM, XV, MG, JMBP and NH.
Contributors VS drafted the inital manuscript and all coauthors edited and worked on subsequent versions. All authors approved the final version.
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.
Competing interests The following authors are members of the European College of Sports and Exercise Physicians (ECOSEP): VS, HL, NM, AP, KT, NM, XV, MG, JMBP and NH.
Provenance and peer review Commissioned; externally peer reviewed.