Overqualified and overlooked? The interventions of accredited exercise physiologists are largely underutilised in the prevention and management of chronic disease.

A report by Deloitte Access Economics showed that almost 50% of Australians are living with some form of chronic disease and as many as 13 millions people are at risk of chronic disease. However, it was estimated that less than 1% of those at risk were referred to an accredited exercise physiologist.

Exercise & Sports Science Australia (ESSA) commissioned Deloitte Access Economics to identify the benefits of employing accredited exercise physiologists in chronic disease management, particularly economic benefits of exercise interventions relating to avoided health system costs, avoided productivity costs and years of life saved. The result showed a high return on investment for accredited exercise physiology services in treating people with chronic conditions. Following is an outline of the evidence.

Diabetes

• Exercise interventions delivered by accredited exercise physiologists are estimated to reduce the incidence of type 2 diabetes in high risk populations by 31%, on average
• The cost savings due to a reduction in complications of diabetes are estimated to be $477 per person annually
• The expected annual saving in health system expenditure is $5,107 per person annually for type 2 diabetes, and $1,977 per person annually for pre-diabetes
• Avoided productivity impacts of type 2 diabetes for people with pre-diabetes are estimated to be $1,520 per person annually, and as high as $760 per person annually for people with type 2 diabetes
• With the burden of disease avoided annually, the total annual wellbeing gains are estimated to be $6,115 per person with pre-diabetes, and $7,967 per person with type 2 diabetes.
• The benefit to cost ratio (BCR) per person with pre-diabetes is 6.0 to 1, when the burden of disease is accounted for, the indicated BCR becomes 10.5 to 1. For people with type 2 diabetes, the BCRs are 8.8 to 1 and 13.7 to 1, respectively.

Mental Health

• Exercise interventions, as delivered by accredited exercise physiologists, which avert each case of depression saves society $10,062 per year.
• Assuming that patients still be in recovery at one year follow up and allowing for translational effects, the total annual savings are estimated to be $2,239 per person with a mental health condition
• The implied cost per Quality Adjusted Life Years (QALYs) gained is $6,485
• The incremental BCR of exercise interventions for people with depression is 2.7.

Cardiovascular Disease

• The total annual lifetime burden of disease savings resulting from in people with Chronic Heart Failure is estimated to be $11,487 per person.
• The estimated BCR is 6.2 in community settings.

Other Chronic Diseases

• Against the Value of a Statistical Life Year (VSLY) of $187,495, interventions cost on people with chronic back pain is $12,830/QALY, osteoarthritis is $46,595/QALY, and rheumatologic disorders $44,944/QALY. All considered cost effective.
• BCR of exercise interventions for people with chronic back pain is 14.6, osteoarthritis 4.0, and rheumatologic disorders 4.2

ESSA Chief Executive Officer, Anita Hobson-Powell encouraged general practitioners to refer patients to an accredited exercise physiologist where medically appropriate. She said that it is essential that patients are made aware of the exercise intervention services available to them through Medicare.

More articles on My Health Career:

• The health industry responds to “Wasted” – the 4 Corners report on overdiagnosis and treatment in medicine
• Too few exercise physiologists in Australian hospitals
• Upskilling online made possible by Monash University

Image: Seth Linn – flickr