Article Text

Sports and exercise medicine in Europe and the advances in the last decade
  1. Daniel Neunhaeuserer1,2,
  2. Josef Niebauer3,4,
  3. Gino Degano1,2,
  4. Veronica Baioccato1,2,
  5. Mats Borjesson5,6,
  6. Maurizio Casasco7,8,
  7. Norbert Bachl8,9,10,
  8. Nicolas Christodoulou11,12,
  9. Juergen Michael Steinacker13,14,
  10. Theodora Papadopoulou8,10,15,
  11. Fabio Pigozzi10,16,
  12. Andrea Ermolao1,2
  1. 1 Sports and Exercise Medicine Division, University of Padova Department of Medicine, Padova, Veneto, Italy
  2. 2 Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Veneto, Italy
  3. 3 University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
  4. 4 Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
  5. 5 Department of Molecular and Clinical Medicine,Center for Health and Performance, Goteborgs Universitet Sahlgrenska Akademin, Goteborg, Sweden
  6. 6 Sahlgrenska University Hospital, Goteborg, Västra Götaland, Sweden
  7. 7 Italian Federation of Sports Medicine, Rome, Italy
  8. 8 European Federation of Sports Medicine Associations, Lausanne, Switzerland
  9. 9 Austrian Institute of Sports Medicine, Vienna, Austria
  10. 10 International Federation of Sports Medicine, Lausanne, Switzerland
  11. 11 School of Sciences, European University Cyprus, Nicosia, Nicosia, Cyprus
  12. 12 UEMS MJC on Sports Medicine, Lausanne, Switzerland
  13. 13 Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, Ulm University Hospital, Ulm, Germany
  14. 14 European Initiative for Exercise in Medicine, Ulm, Germany
  15. 15 Stanford Hall, Defence Medical Rehabilitation Centre, Loughborough, UK
  16. 16 Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Rome, Lazio, Italy
  1. Correspondence to Professor Josef Niebauer, University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg 5020, Austria; j.niebauer{at}

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Sports and exercise medicine (SEM) is a professional qualification for physicians responsible for the health and care of athletes, but also for the functional evaluation and exercise prescription in patients with chronic diseases. SEM clinicians are involved in health promotion, screening and illness prevention for public health purposes.1 These medical specialists provide preparticipation evaluations in sports as well as comprehensive support and counselling for all those who engage in physical activity and exercise training. Although the exact role may vary in different settings and countries, key competencies of SEM-specialists have been identified including2 3:

  • Exercise physiology.

  • Physical activity for public health.

  • Physical activity in extreme environments.

  • Sports and exercise for special/disabled populations.

  • Clinical/functional evaluation in athletes and patients.

  • Exercise prescription.

  • Musculoskeletal medicine, injuries and rehabilitation.

  • Nutrition.

  • Drugs and antidoping in sports.

  • Sports team care/management.

  • SEM-specific skills.

  • Medical emergencies.

  • Psychosocial and complementary competencies (ie, research, communication, management).

Scientific evidence clearly shows that physical exercise is one of the most important prevention strategies and cost-effective/cost-saving medical treatment options for multiple chronic diseases.4 5 Surprisingly, abilities regarding the prescription of this exercise ‘poly-pill’ is not adequately taught in medical schools or during postgraduate specialisations. Athletes from different sports and performance levels will also seek SEM specialists for medical care. We, here, report the current state of the SEM specialisation in Europe and reflect on both our advances over the last decade and contemporary challenges.

Current situation in Europe

Specialisation in SEM varies largely and a formal European Union (EU)-wide recognition as well as a defined role within healthcare settings have not yet been reached in many European countries. This is illustrated by the fact that a common curriculum has not yet been implemented, even though it has been recently proposed by the European Union of Medical Specialties (UEMS) and by a Delphi developed syllabus.2 3

To understand current training process of SEM-residents in Europe, national SEM-associations were contacted. Of the 27 EU countries and the UK, four representatives stated that there is no recognised specialisation (Cyprus, Denmark, Greece and Sweden). Sixteen countries have an independent and/or recognised specialisation with a training period that varies from 2 to 5 years (online supplemental table 1), while in the remaining eight countries professional training courses or medical subspecialisations are proposed and a specific diploma can be obtained through the responsible associations (figure 1). Compared with2009,6 SEM has been recognised as an independent specialisation in six more countries and various initiatives have engaged in drafting a standardised curriculum and in achieving EU-wide recognition.1–3

Supplemental material

Figure 1

Current situation in Europe. This map shows the current situation of sports and exercise medicine (SEM) in Europe and the UK. Green highlights the countries with a recognised/independent medical specialisation, while orange shows those with other professional training courses leading to secondary/subspecialisations. However, in four countries, SEM is not yet organised and recognised in any form of specific specialisation (red). The training periods for recognised medical specialisations and secondary subspecialisations range from 2 to 5 years and 1 to 3 years, respectively (for details see online supplemental table 1). Six new independent and/or recognised SEM specialisations have been developed in the last decade (Croatia, Estonia, Ireland, Lithuania, Malta and Poland)

The body responsible for promoting the recognition of SEM in Europe is the UEMS Multidisciplinary Joint Committee on Sports Medicine, which is trying to include SEM as full specialty in Annex-V of the European Directive to enable free movement of professionals in EU. Each EU-country having SEM as a full specialty with a training period of at least 4 years, must upload the relevant documents to the internal market information system. To date this, procedure has been completed by nine countries while two more are needed to reach the required two fifths within the EU. Thus, the remaining countries with an independent SEM-specialty should join this initiative, while others could engage in becoming a full specialty, in order to realise an EU-recognised SEM

The role of SEM specialists

The SEM concept has been emphasised by concrete initiatives. Indeed, in Italy, a mandatory SEM preparticipation screening has been shown to be associated with a reduced incidence of sudden cardiac death in competitive athletes.7 European initiatives on exercise prescription also have been launched. In the UK, the faculty SEM has developed Moving Medicine and in Sweden SEM is driving the Physical Activity on Prescription model, recently acknowledged as ‘best practice’ to increase patients’ physical activity levels. Global and European projects like Exercise-is-Medicine or Exercise-Prescription-for-Health are also important SEM-supported initiatives in this continued endeavour. Numerous international studies have been published in the past decade by SEM specialists, emphasising the scientific foundation and evidence-based approach. Thus, SEM ensures safety in sports, promotes exercise in health and disease, and combats sedentarism.8 Knowledge, abilities and research activity of SEM specialists must cover a wide spectrum of medicine. Indeed, the expertise in pathophysiology of physical exercise and training prescription must be integrated with competencies in internal medicine, sports cardiology and pulmonology. Cardiopulmonary exercise testing is, therefore, one of the main competencies of SEM specialists. Emergency medicine, nutrition and musculoskeletal medicine are also included in the training curriculum as well as additional competencies to manage multidisciplinary teams for different diseases and optimise patient recovery. Specifically, SEM specialists offer a holistic view with regard to the effects and potential side effects of physical exercise, which links care provided to patients, healthy subjects and athletes. SEM-specialists can provide comprehensive medical assistance for athletes because of competencies in general medicine, prevention/rehabilitation of injuries and expertise in performance diagnostics and training science. These issues are frequently influenced by athletes’ environment, antidoping measures and sports-eligibility evaluations. Their medical management of a sports team must consider the close cooperation with administration directors, physiotherapists, exercise professionals and mental health providers.

Future perspectives

As a fully recognised and endorsed medical specialisation throughout Europe, SEM will be of benefit for public health, illness prevention, improved disease management, cost savings in healthcare and performance and rehabilitation enhancements for athletes. SEM specialists would also aid specific education in the curriculum of medical students and the specialisation of other physicians and healthcare professionals involved in the therapeutic application of exercise in medicine. The existing socioeconomic challenges, the ageing population and the associated increase in the prevalence of chronic diseases, strongly support a high demand for the skills of SEM specialists.8 The recently proposed syllabus for SEM should help promote a standardised medical specialty and enable its implementation across Europe.2 3 Many European countries (and the USA) still refer to the specialty as sports medicine. Due to the importance of physical activity promotion and exercise prescription, we propose it is time to uniformly become SEM specialists. The positive impact of existing SEM initiatives, its role in public healthcare and the increasing professionalisation of athletes, underline the importance of SEM as an EU-wide specialisation.

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This editorial has been endorsed by the International Federation of Sports Medicine (FIMS), the European Federation of Sports Medicine Associations (EFSMA), the European Union of Medical Specialists (UEMS) MJC on Sports Medicine, the European Initiative for Exercise in Medicine (EIEIM), the European Initiative Exercise Prescription for Health and the Clinical Network of Sports and Exercise Medicine of the Veneto Region-Italy.


Supplementary materials

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  • Contributors All listed authors have made substantial contributions to the conception or design of the work, or the acquisition/analysis of data or interpretation of the current situation of Sports and Exercise Medicine in Europe. Additionally, they have been involved in the drafting or critical review and have approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.