Table 3

Fellowship education curriculum

Domain	General learning areas	Specific learning areas
1.Exercise Physiology	1.1 Understand the body’s normal and abnormal responses to exercise and recovery	1.1.1 Examine the effects of exercise on the body, with special emphasis on the musculoskeletal, cardiovascular, respiratory, neuromuscular, and endocrine systems, as well as brain/mental health
2.Exercise Nutrition	2.1 Describe how energy is derived and used to fuel various types of exercise and physical activity	2.1.1 Explain the biological pathways involved in exercise metabolism 2.1.2 Explain energy absorption and release from macronutrient sources (carbohydrates, fats, proteins) 2.1.3 Explain the effects of low energy availability on the ability to exercise
	2.2. Understand sources of nutrition	2.2.1 Outline recommendations for the dietary intake of carbohydrates, fats, proteins, micronutrients and vitamins in the general and athletic populations 2.2.2 Define resting metabolic rate to estimate caloric use at rest, and active metabolic rate to estimate energy needs during exercise at different intensities 2.2.3 Differentiate the rationale for and the risks associated with nutritional supplements and ergogenic aids 2.2.4 Cite common equations and tools used to determine energy needs in adults and children18 2.2.5 Compare the elements and methods of a body composition analysis and how those values assist in developing a nutrition plan 2.2.6 Examine how social, economic, and cultural factors can impact nutrition and dietary choices of athletes and physically active patients
Practical elements Counsel 10 patients on hydration and fuelling plans for physical activity or exercise Design or participate in the design of nutrition plans (including daily metabolic/caloric needs, as well as social, economic or other cultural influences on dietary choices) for 10 individuals with chronic disease participating in physical activity. Design or participate in the design of nutrition plans (including daily metabolic/caloric needs) for 10 competitive athletes. Design or participate in the design of nutrition plans for 5 teams of differing energy demands. Examine a food recall diary for 10 physically active individuals (or patients). Perform resting metabolic rate assessments for 10 patients and determine the ratio of macronutrient energy utilisation at rest. Complete a body composition analysis on 10 physically active individuals (or patients). Counsel at least five athletes demonstrating low energy availability or poor nutritional intake.
3.Exercise Training	3.1 Describe training principles and types of exercise.	3.1.1 Distinguish the following types of exercise, their physiological effects, methods of fitness assessment and ways to optimise their health benefits Aerobic Anaerobic Strength and Power Flexibility Balance/Proprioception Mind-body
	3.2 Define how exercise capacity can be used to monitor physical fitness.	3.2.1 Demonstrate how to monitor exercise capacity via internal (eg, heart rate, blood lactate, oxygen consumption, and ratings of perceived exertion (RPE)) and external (power output, speed, acceleration, time–motion analysis, global positioning system (GPS) parameters, and accelerometer)training load measurements 3.2.2 Describe the signs and symptoms of overtraining and outline prevention and treatment strategies
Practical elements Participate in the design of 25 exercise training programmes for competitive athletes or physically active individuals (or patients).
4.Exercise and Behaviour Change	4.1 Define barriers to exercise and physical activity.	4.1.1 Describe the foundations of behaviour change (eg, Transtheoretical model of change) 4.1.2 Analyse how social, economic, and other factors can create barriers to exercise and physical activity 4.2.3 Outline general barriers (including social and economic) to physical activity that are specific to an individual 4.2.4 Identify general barriers (including the built environment, traffic, pollution, and climate) to physical activity that are specific to a community
	4.2 Describe how to motivate or work with patients to begin or maintain an exercise programme.	4.2.1. Develop cognitive and behavioural strategies for increasing physical activity behaviour (eg, enhancing self-efficacy, goal setting) 4.2.2 Outline collaborative strategies and approaches to increase exercise adoption and adherence (eg, motivational interviewing) 4.2.3 Produce ways to work with patients who disagree or cannot complete recommendations
Practical elements Utilise behavioural change and/or motivational interviewing techniques to increase physical activity behaviour during 25 patient encounters.
5.Exercise Prescription	5.1 Define when and how to screen prior to the initiation of a physical activity or exercise programme.	5.1.1 Identify the populations for which a screening health assessment is recommended prior to beginning a new exercise programme 5.1.2 Demonstrate the major components of a screening evaluation with special emphasis on the general medical, cardiovascular, musculoskeletal, and neurologic elements 5.1.3 Define ancillary testing and prevention in patients at higher risk for adverse events with exercise (eg, cardiovascular disease, diabetes) 5.1.4 Understand contraindications to beginning an exercise programme
	5.2 Define how to write exercise prescriptions for healthy individuals and those with chronic disease.	5.2.1 Describe the Frequency, Intensity, Time, Type, Volume, and Progression model for writing an exercise prescription 5.2.2 Write an exercise prescription for healthy/low-risk patients 5.2.3 Appreciate modifications of an exercise prescription for commonly encountered medical (eg, coronary artery disease, obesity, asthma, diabetes, pregnancy) and musculoskeletal (eg, osteoarthritis) conditions 5.2.4 Write exercise prescription modifications for special circumstances (eg, advanced age, children, physical disability, learning disability, beginners, post-surgery)18 5.2.5 Explain the effect of commonly used medications in children (eg, stimulants) and adults that might influence exercise capacity (eg, beta blockers, diuretics) or create risk with exercise (eg, insulin, fluoroquinolones, QT prolonging medications, impaired thermoregulation with anti-cholinergic medication)18
Practical elements Examine a physical activity log for 25 patients Write a physical activity prescription for 25 patients, including individuals with chronic disease or mobility impairment
6.Exercise Testing	6.1 Use exercise testing for screening, diagnosis or development of exercise programming	6.1.1 Demonstrate the appropriate use and indications for the following tests for screening, diagnosis, or development of an exercise programme In-office assessment of physical fitness Exercise treadmill testing -Cardiopulmonary exercise testing Pulmonary function testing
Practical elements Perform and interpret 50 exercise treadmill tests19 20 Perform and interpret 50 cardiopulmonary exercise tests Perform and interpret 10 active metabolic assessments and use the information to design exercise programmes and target intensity training zones Perform and interpret 10 pulmonary function tests
7.Exercise in Clinical Practice	7.1 Define sustainable clinical practice models to promote exercise and physical activity in the sports medicine physician’s office	7.1.1 Enact models for physical activity assessment, counselling, and referral to community programmes 7.1.2 Investigate options for billing and coding in a sports and exercise medicine physician’s practice that will help sustain clinical practice models that support EM-PAP 7.1.3 Determine the multi-disciplinary partners who can facilitate exercise promotion inside and outside of the clinical practice setting 7.1.4 Define EM-PAP resources for children/youth, particularly in under-resourced settings 7.1.5 Describe how physical activity for youth requires counselling for the entire family 7.1.6 Examine the bias (implicit or explicit) that can affect one’s ability to counsel patients
Practical elements Find at least one community partnership that may assist patients who wish to begin an exercise programme Conduct 10 billing/coding audits for notes you completed where a patient was counselled on exercise or nutrition Assess physical activity levels of 25 patients in the office
8.Exercise and Population Health	8.1 Learn how exercise and physical activity can help prevent or treat chronic disease	8.1.1 Assess how physical activity can modify both individual and population health 8.1.2 Explain the health benefits of meeting physical activity guidelines and the health risks of not achieving minimum physical activity levels 8.1.3 Describe how social determinants and community infrastructure can affect physical activity in different populations 8.1.4 Determine effective physical activity interventions that can improve population health
	8.2 Understand strategies for community engagement	8.2.1 Organise local community resources that are available to promote exercise and physical activity 8.2.2 Examine social and economic barriers to exercise for individuals and communities
Practical elements For a defined population of patients within a clinic/hospital-based setting, determine whether physical activity improved a chronic disease marker (eg, hypertension, hyperlipidaemia, diabetes, obesity) over a 3- month period Design an exercise programme for individuals (>10 people) from an underserved community, disadvantaged background, or disabled group Locate at least five different types of accessible resources (eg, community partners, online videos) that can be used to assist physical activity promotion for patients or a community Identify at least one funding source to assist patients in need of financial assistance to conduct a physical activity programme Identify barriers, including social and economic, to exercise for individuals within your community or society as a whole and consider how advocacy can be part of the solution