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If exercise is such a powerful medicine, then what does this mean for health reform?

Introduction by Croakey: As Australians head towards the polls on 21 May, Exercise and Sports Science Australia will hold a conference that provides a timely opportunity to highlight its election priorities.

Research to Practice 2022 will be held virtually from 19-21 May, with presentations about the role of exercise in aged care, maintaining health and wellbeing, and in managing a range of health conditions.

Sports performance is also on the program, including a keynote presentation by Ian Roberts, who will talk about his time as a professional footballer and actor, and his experiences with trauma-related memory loss.

The Croakey Conference News Service will be live-tweeting #RTP22. Below, freelance writer H. Clare Callow previews the conference and ESSA’s election priorities.


H. Clare Callow writes:

Management of chronic conditions requires treatment well beyond doctor visits. Dieticians, exercise physiologists and many more allied health practitioners provide complementary treatments that enhance the efficacy of medications and help with preventing and managing conditions.

Despite their usefulness, access to these services is restricted in terms of Medicare funding. Addressing the need for expanded access to allied health services is one of the priorities of Exercise and Sports Science Australia (ESSA) in the run-up to the election.

The organisation’s five election priorities, titled ‘Exercise for good health and a strong economy’, cover access for people with mental health conditions, chronic disease and using aged care.

To make exercise physiology services more accessible, ESSA is asking the next Federal Government to remove the imposition of GST on exercise physiology private appointments, and provide more Medicare-funded sessions for all allied health services.

At present, people wanting to access exercise physiology appointments can get only five appointments funded by Medicare per year – and those five visits have to cover all allied health services. If people wish to access exercise physiologists in a private appointment, their fee is subject to GST, adding to the financial burden.

Photo of Dr Shelley Keating
Dr Shelley Keating

“The challenge here is that all of the allied health services are very important,” says Dr Shelley Keating, accredited exercise physiologist and NHMRC Early Career Fellow at the University of Queensland. She will speak at the ESSA conference on exercise and metabolism in management of chronic disease.

“The health benefits of exercise are only going to be sustained if the exercise is sustained long term. And exercise adherence in the long-term is a challenge. Without the appropriate support, people will likely be unable to sustain any behaviour change they make.”

Professor Steve Selig, who is one of the keynote presenters, puts it succinctly. “We get to the end of those sessions and we know in our heart it’s not going to benefit their long-term health.”

Selig, the retired Chair in Clinical Exercise Science at Deakin University, will deliver the Tony Parker lecturer, covering his personal journey from being a teacher of physical education in the 1970s to a career as a researcher, teacher and mentor in cardiac exercise physiology.

He will also share his perspective of the “Medicare Moment” in 2005, the “once in a generation breakthrough” when the Federal Government announced that Accredited Exercise Physiologists (AEP) were approved to provide services using new Medicare items.

This signalled the entry of the AEP into allied health in Australia and was a world first, leading to AEPs gaining access to private health insurance schemes, and compensable schemes covering veterans, individuals injured at work or in traffic accidents, and more recently people with disabilities.

“It is safe to say that the breadth and depth of access to compensable schemes enjoyed by the AEP today is without parallel anywhere in the world,” according to the RTP22 program.

ESSA members include:

Accredited Exercise Scientists (AES), who use exercise to improve health, well-being and fitness
Accredited Exercise Physiologists (AEP), who use exercise to help manage chronic conditions, disability and injuries
Accredited Sports Scientists (ASpS), who use exercise to improve sporting performance
Accredited High Performance Managers (AHPM), who manage a range of performance services for elite sport.

A ‘first-level intervention’ for mental health

Exercise physiologist Peter Woollett has extensive experience in the use of exercise for treatment of mental health conditions. Having worked in inpatient mental health settings and more recently in managing the mental health of people in COVID quarantine, he sees exercise as a first-level intervention for mental health conditions.

“There’s good evidence for exercise to help with depression and anxiety, psychotic disorders, things like that, directly treating the illnesses themselves,” he says. “So much so that looking at recommendations at the Royal Australian and New Zealand College of Psychiatrists would recommend lifestyle therapies – so exercise – as the first level of intervention when treating people with anxiety and depression.

“So even before talk therapies and even before medications which are traditionally viewed as the treatment, the recommendation from the experts is that lifestyle intervention and exercise should be implemented first.”

Implementing an exercise program can not only help in mental health management, it can improve life expectancy, he says.

“If we go down the severe end of the spectrum – people living with enduring mental illness – they have a life expectancy of about anywhere between 15 and 25 years less than the general population,” he says, “and the primary driver of that is cardiovascular disease and metabolic disease. And exercise physiology is one of the best tools we have to help people improve their cardiovascular health and their metabolic health.”

Dr Shelley Keating agrees. “Exercise is a multi-pill,” she says.

The lack of recognition of the value of this ‘multi-pill’, Woollett says, is preventing people from getting much-needed, effective treatment.

“Even though exercise is recognised as such a powerful treatment for people through the whole spectrum of people with mental illness, that stage-zero, ground-floor intervention for people with mood disorders, people can’t access exercise physiology through a mental health care plan.”

Chronic disease management and Long COVID

Improving access to exercise physiology could benefit people with a whole spectrum of chronic conditions, says Keating.

“There’s not really an evidence gap,” she says, “there’s an implementation gap. There’s an abundance of evidence.”

The main difficulty, Selig feels, is that unlike medication, exercise physiology requires an ongoing series of sessions to be implemented properly and effectively.

“The limited number of sessions funded by Medicare are simply not enough,” says Selig. “Because it is exercise and not a pill in a box… that behaviour change can’t satisfactorily come with the limited services provided by Medicare,” he says. “The assumption is that we can achieve behaviour change in up to five sessions. Five sessions a year is inadequate.”

With more people expected to develop Long COVID, Woollett points out the lack of funding for exercise physiology will have an ongoing impact on the population’s health.

“In terms of Long COVID and chronic disease management plans, the reason it’s so important is that the presentation of Long COVID can be multi-system,” he says. “So people may experience fatigue symptoms, unusual hormone readings, cardiovascular symptoms, neurological, cognitive mental health and it’s a really complex picture that people are presenting with.

“Given the complexity that people are presenting with the five sessions people may be able to access through their chronic disease management plans may not be enough.”

Woollett points out that exercise is recognised as an effective COVID treatment. “The [Royal Australian] College of General Practitioners’ guide to GPs for COVID management is referral to exercise physiologists,” he says.

Writing about his personal experience with Long COVID in Croakey earlier this year, Scott Willis, National President of the Australian Physiotherapy Association, argued that there is an urgent need for integrated, multidisciplinary care for people with Long COVID.

“We need MBS and Pharmaceutical Benefits Scheme benefits that adequately support patients living with Long COVID, to reduce out-of-pocket costs,” he said.

Conference participants will also hear a keynote presentation from ABC broadcaster Dr Norman Swan, ‘Exercise in the Time of COVID’. Swan recently announced he has a new book on the way and no doubt it will include a focus on the importance of physical activity.

Prevention as a focus

Central to all of ESSA’s election priorities is the understanding that exercise physiology is as much about prevention as cure.

Professor Itamar Levinger

One area this can be observed most clearly is when exercise physiology is used in an aged care setting. This is something Professor Itamar Levinger, who will be presenting at the ESSA conference alongside Keating, knows well.

Levinger, Professor of Clinical Exercise Physiology at Victoria University, highlighted that research has established that exercise used effectively in an aged care setting can prevent frequency of falls, improve mental health and benefit health more generally.

“We know that exercise is medicine,” he says. “And we know that it’s the most powerful drug that exists.”

Funding for exercise physiology in aged care settings would see savings elsewhere in healthcare, says Selig.

“If you can keep an elderly person out of hospital because of preventative measures, you’re saving roughly $3000 a night,” he says as an estimate. “With symptom vigilance, we can take early intervention with most of our clients to prevent them going to hospital.”

This cost benefit sets aside the mental and emotional benefits of keeping an older person out of hospital, he adds. “People deserve to live with dignity with optimal function as long as they can.”

Although prevention of serious illness is of undoubted benefit to the Australian economy, asking any government to make prevention a priority is a big request, Prof Selig admits.

“It’s so difficult for governments of all persuasions to strategically fund primary prevention,” he says. “It’s hard to see results. It’s hard to prove that something hasn’t happened because of what you’ve done.”

Like the Public Health Association of Australia, ESSA is advocating for five percent of total annual health expenditure to be invested in preventive health. The PHAA’s election scorecard shows, however, that the LNP Coalition and Labor have not supported this policy, though The Greens have.

Other highlights

Other speakers and presentations at the Research Into Practice 2022 conference are listed below.

Oongi Barb Flick, Elder of the Yawallyi/Gamillaaray/Bigambul Nations, and Dr Tuguy Esgin, a Noongar/Yamatji and researcher at UNSW, will speak in a session: Talking Together, Walking Together: Working with Indigenous Australians to Embrace Exercise as Medicine.

Ray Kelly, a Kamilaroi man, Accredited Exercise Physiologist and PhD candidate, will discuss the Too Deadly for Diabetes program designed by Indigenous people for Indigenous people.

‘The Athlete’s Heart: Friend or Foe’ is the title for a keynote presentation by renowned sports cardiologist Dr Benjamin D Levine, the founder and Director of the Institute for Exercise and Environmental Medicine (IEEM) at Texas Health Presbyterian Hospital Dallas where he also holds the S. Finley Ewing Chair for Wellness and the Harry S. Moss Heart Chair for Cardiovascular Research. He is Professor of Internal Medicine/Cardiology and Distinguished Professor of Exercise Sciences at the University of Texas Southwestern Medical Center. He has also advised NASA’s flight surgeons on cardiovascular medical issues. His work with astronauts has translated into one of his other areas of clinical expertise, namely patients with syncope (fainting) and orthostatic intolerance (the inability to stand up and withstand the effects of gravity on Earth).

The Canadian experience in championing physical activity for health is the topic for Dr Jane Thornton, physician with the Canadian Academy of Sport and Exercise Medicine and Rowing Canada.


More news

On Twitter check out the discussions: #RTP22.

Also follow this Twitter list of participants.

Croakey columnist Associate Professor Lesley Russell and H. Clare Callow, a freelance writer, will live-tweet #RTP22 for the Croakey Conference News Service.

 

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