“Maybe you are here on Earth to learn that life is what you make it, and it’s to be enjoyed!”

--Dick Sutphen

The early tradition of exercise physiology placed its entire focus on aerobic endurance. The early exercise physiologists considered aerobic endurance as the only component of fitness. The International Fitness Professionals Association (IFPA) was the first to consider ten separate and distinct Components of Fitness, each of which is associated with underlying physiological systems.

The IFPA Ten Components of Fitness are:

1. Strength
2. Speed
3. Power
4. Anaerobic Endurance
5. Aerobic Endurance
6. Agility
7. Balance
8. Coordination
9. Flexibility
10. Body Composition

While early exercise physiologists focused on the exercise prescriptions for Aerobic Endurance and improving the cardiovascular and respiratory systems. IFPA Certified Personal Fitness Trainers, Group Fitness Instructors, Aerobic Instructors and other certified fitness professionals have learned to test and evaluate all the body’s physiological systems and develop the appropriate IFPA Component of Fitness to regenerate or rehabilitate the appropriate deconditioned physiological system. While a personal trainer or fitness professional may be appropriate for exercise prescriptions for health and fitness benefits, the physician must take charge of patients whose underlying physiological systems have degenerated to disease, disability and dysfunction. While the well-trained IFPA Certified Personal Trainer can easily manage any client who has no medical restrictions to exercise, it will require physician intervention to safely and effectively provide exercise and sports medicine prescriptions and exercise management for patients with one or more of the over 65 different diseases, disabilities and dysfunctions associated with physical inactivity.

The IFPA, working in conjunction with several medical associations, has developed the Fellowship in Preventative Medicine, Nutrition and Sports Medicine (FPMNSM) for doctors, medical and healthcare providers and elite level personal trainers and fitness professionals. The goal of the Fellowship is to provide the knowledge, skills and abilities for a new scope of practice. Fellows will learn to use exercise, nutrition and sports medicine prescriptions for the treatment, care and prevention of all the major afflictions in the worldwide community.

Fellows will write the appropriate prescription based on their evaluation and diagnosis of the degenerated underlying physiological system and use appropriate Component of Fitness to regenerate that system. The Fellow will then assign the appropriate healthcare provider, IFPA Certified Personal Trainer or Fitness Professional to execute and manage their prescriptions. All medical, health and fitness professionals involved in the process must follow the same scope of practice provided by the IFPA system.

This IFPA system is provided by 7 Phases:

1. Patient Consult & Evaluation
2. Medical-Fitness Testing and Diagnosis
3. Exercise-Sports Medicine Prescription
4. Program Design
5. Exercise-Sports Medicine Management
6. Exercise Physiology Management
7. Nutrition Prescription

Fellows will supervise the implementation of these IFPA System Phases and the FPMNSM Modalities to effect real cures in the patient by treating the underlying, degenerated physiological system with the appropriate exercise and sports medicine prescription by utilizing the appropriate IFPA Component of Fitness.

The exercise prescription has 4 primary components:

1. Frequency: Number of sessions per week
2. Intensity: Difficulty of the exercise session
3. Time: Total duration of the session
4. Type: Mode of exercise used in the session

The sports medicine prescription takes into account all of the above, but adds into the prescription all the medical restrictions to exercise. These include effects of medications/pharmacological agents, joint dysfunctions, muscle dysfunctions, nerve dysfunction, biochemical dysfunction and any and all other of the patients’ disease, disability, or dysfunction.

In order for you to gain a clear understanding of the appropriate use of the IFPA System and the incorporation of FPMNSM Modalities, let us illustrate the classic exercise prescription for a cardiovascular disease patient. You already know that with the rare exception of those unfortunate souls that are born with bad genetics, virtually all of the cardiovascular diseases are caused by lack of physical activity; specifically, aerobic activity. Endurance athletes rarely suffer from coronary heart disease, hypertension, atherosclerosis, hypercholesterolemia, cardiomyopathy, congestive heart failure or related diseases. The Patient Consult & Evaluation: Phase One and Phase Two: The Medical-Fitness Testing and Diagnosis will confirm the existence and severity of the disease.

The exercise prescription for a cardiovascular disease patient may be:

• Frequency: 4-7 times per week, 1-3 sessions per day
• Intensity: Very low to low
• Time: 5-10 minutes per session
• Type: Walking, stationary bike or recumbent bike, water aerobics

The sports medicine prescription will take into account all other medical restrictions to exercise. Unfortunately, many of the diseases, disabilities and dysfunctions caused by physical inactivity come in groups, not individually, so the doctor’s cardiovascular disease patient may also have metabolic disorders such as obesity and diabetes; musculoskeletal disorders such as low back pain and connective tissue tears and may have psychological disorders such as depression, anxiety or mood disorders. All of these add additional challenges and considerations to the sports medicine prescription.

Metabolic disorders place severe restrictions on the TIME factor due to the deconditioned endocrine system that affects aerobic endurance by the decrease in glucose and therefore the body’s ability to sustain the Krebs Cycle. Musculoskeletal disorders affect the TYPE factor since many activities may be too painful to sustain. The patient with low back pain may be restricted to non-weight bearing activities. Patients with psychological disorders may require counseling, nutrition prescriptions, and other interventions in order to develop the motivation to exercise.

Equally important is the implications medications play in sports medicine prescriptions. For example, a heart patient on beta-blockers will not see an increase in heart rate during exercise. The personal trainer who is unaware of this may cause devastating and potentially deadly consequence to a patient when the trainer is using heart rate to monitor training intensity. In these cases, the personal training session should be based on Rate of Perceived Exertion (RPE) to monitor training intensity.

Many personal trainers have avoided personal training sessions with any patient with disease, disability and dysfunction, fearing the risks of exercise activity for these special populations groups. Many doctors, while recommending exercise, have not provided sufficient information on precisely what their patient would do to perform safe and effective exercise without risk of harm to themselves. With healthcare costs continuing an inevitable rise and many doctors and patients alike questioning the efficacy of prescription drugs as a cure, the IFPA System and FPMNSM Modalities are long overdue as a solution to our current healthcare crisis.