Q&A: Where is Exercise Physiology in Medical Education?
A recent graduate's viewpoint on what physicians need
Lee Pierson, M.D., is an ACSM member who completed medical school at the University of North Carolina at Chapel Hill in 2008. He has undergraduate and M.S. background in exercise physiology, as well as very recent experience in medical school training. Given his recent exposure to both areas, Pierson shares his thoughts on the status and needs for exercise physiology within medical education.
Throughout his training, Dr. Pierson has been actively involved in research on exercise applications in the prevention and management of cardiovascular disease. Certainly, training in exercise physiology is fundamental to preparing physicians to consistently and effectively address physical activity needs of their patients Ė the fundamental basis for the Exercise is Medicine? program.
Q: How do you see your knowledge and special training in exercise physiology relating to your medical career and care for patients?
I am interested in a career in cardiology, with emphasis on secondary prevention of cardiac events and disease progression in patients with coronary disease. I believe that exercise, as part of comprehensive cardiac rehabilitation, is very important to help reduce disease progression and prevent cardiovascular events.
I am interested in research to define the type, intensity and duration of exercise that is optimal to achieve health outcomes such as blood pressure reduction, weight loss, changes in lipid profile, and glycemic control. Research in these areas will add to the current knowledge base to help further refine the exercise prescription for patients with specific risk factors for the disease progression. My goal is to have a positive influence on the use of exercise as an adjunct to optimal medical therapy in treating patients with coronary disease or risk factors for its development.
Q: What was your academic background before medical school and how did you learn exercise physiology and its healthcare applications?
I studied exercise physiology at Virginia Tech, and received both a bachelorís and masterís degree in the exercise science program there. I learned the clinical applications of exercise in the cardiac rehabilitation program that was associated with the exercise science program at Tech. After graduation, I worked at Carolinas Medical Center in Charlotte, N.C., on research in the area of physical fitness in patients undergoing coronary artery bypass surgery and how this influenced outcomes of surgery. I was also involved in a research project studying the effects of resistance training in a traditional cardiac rehab program. After completion of these studies, I worked at Duke University Medical Center on research involving the influence of exercise and mental stress reduction training on stress-induced myocardial ischemia. .
Q: What are the essential topics/learning activities that should be covered in medical school so that physicians can more effectively use exercise and physical activity intervention as a fundamental part of patient care?
The basic principles of exercise prescription and health outcomes that can be achieved through exercise should be emphasized in medical school. Information regarding how to best counsel patients to achieve lifestyle modification is helpful as well. The role of allied healthcare providers and services such as cardiac rehab, physical and occupational therapy, nutrition services, etc., should be discussed so that these services can be mobilized in an efficient manner to optimally meet the needs of the patient.
Q: Given the ever-increasing demand on medical schools and students to cover more and more requirements in the curriculum, how do you propose these exercise topics/learning activities be integrated into the program?
In the first or second year of medical school, information should be provided in lecture format regarding basic exercise prescription principles and health outcomes that can be achieved through exercise training. This information can easily be integrated into a teaching block covering physiology or cardiovascular physiology and disease. The information provided should include acute and chronic changes in cardiopulmonary response with exercise training, as well as changes in endocrine and metabolic systems. The clinical application of this information should be reinforced by adding therapeutic lifestyle change modules to case studies throughout the years in medical school when discussing patients with disease states that may be influenced in a positive way by exercise therapy.