Sports and exercise medicine clinic in public hospital settings: A real-life concept and experiences of the treatment of the first 1151 patients
Authors: Alanko Lauri , Laukkanen Jari A. , Rottensteiner Mirva , Rasmus Salla , Kuha Tero , Valtonen Maarit , Kujala Urho M. 
Published: June 2022

AbstractExercise has been shown to have a multitude of health-promoting effects, including improvements in cardiorespiratory and muscular fitness, function, symptoms and risk factors. Furthermore, exercise may slow down, stop or even reverse the progression of various non-communicable diseases (NCDs). Despite the overwhelming evidence, exercise is still not comprehensively used as a treatment component either in primary care or in hospital settings. The outpatient Sports and Exercise Medicine Clinic (SEMC) is the first specialized clinic in Finland to use exercise as part of patient protocols in the public health care system. Patients needing specialist attention due to NCDs, usually combined with sedentary lifestyles, are referred to this central hospital clinic. The prerequisites for patient referral are the known efficacy of exercise intervention in the treatment of disease and the need for sports and exercise medicine expertise. The focus of the clinic is to implement regular physical activity into daily life and give guidance on other health-promoting habits such as diet, rest and the reduction of substance use. In addition, SEMC promotes the inclusion of exercise in several local treatment guidelines in the hospital district, such as the treatment paths of non-insulin-dependent diabetes, sleep apnoea, severe obesity indicating bariatric operation, and breast cancer. The advisory treatment protocol of SEMC consists of a primary evaluation, face-to-face controls with a physician and/or physiotherapist at 3, 6 and 9–12 months, and contacts via phone between hospital visits. Laboratory tests, body composition, walking tests, and measurements of muscle strength and balance are performed at the beginning of the treatment. Body composition and physical tests are repeated after 6 and 9–12 months. In addition, questionnaires on lifestyle and quality of life are completed prior to the first visit and at 6 months of control. At the core of the treatment is individualization, using motivational interviewing, considering the patients’ personal interests and possibilities, and encouraging the patient to be an active member of our multi-professional team. In this article, our protocol is described and some preliminary data and experiences on the treatment of first 1151 patients are reported. Furthermore, strengths, challenges and future steps in the development of our protocol and outpatient clinic are discussed.Key messages boxRandomized controlled trials show that exercise therapy improves function, the cardiometabolic risk factor profile, mood, some indicators of disease progression, and health-related quality of life in patients with a variety of chronic diseases.However, exercise therapy has only occasionally been incorporated into the treatment of chronic diseases in public healthcare organizations.We summarize experiences of the clinic development and treatment of patients at the Sports and Exercise Medicine Clinic at the Central Hospital of Central Finland.Our protocol consists of a primary evaluation, face-to-face controls with a physician and/or physiotherapist at 3, 6 and 9–12 months, contacts via phone between hospital visits, as well as the use of questionnaires, body composition, and fitness tests during the contacts.At the core of the treatment are personalized exercise recommendations that are tailored using motivational interviewing and taking the patient’s personal interests, possibilities and limitations into consideration.Collaboration with primary care and exercise-sector professionals in the hospital district makes it possible to tailor exercise therapy to many patients for both prevention measures and the treatment of the patients.