Physiotherapy and exercise: stop, collaborate and listen

Stop

This is about slowing down to understand, think and reflect. In May, our thought-provoking Frontline article Working it out explored the rich history of physiotherapy and exercise, highlighting the need to evolve. The response to the piece has been incredible. It’s clearly – but not surprisingly – a topic we really care about, resonating deeply throughout the profession. 

Two core themes emerged: we must support collaboration and ensure physiotherapy stands strong in this evolving exercise landscape. 

Collaborate

Collaboration is all about working together with a shared vision. Sounds simple, doesn’t it? But with different professions jostling over their proposed unique roles in the exercise space, the reality is far from it. Despite these challenges, collaboration is essential.

The need to collaborate also applies within our profession. By coming together to start conversations and encourage constructive debate we can enrich discussions and broaden perspectives, helping to collectively lead positive change for patients and practitioners alike. 

Listen

To listen well, we need to engage with a genuine desire to better understand and learn. We urge you to stay curious and open to differences of opinion. 

By doing so, we can all gain valuable insight, tap into a huge amount of knowledge and expertise within our membership and pave the way towards a more integrated, proactive, and considered approach to physiotherapy’s future with exercise.     

With this in mind, let’s sit back and appreciate the views of some thought-leaders from physiotherapy education. 

It is key to the role of an educator to be forward-thinking, actively planning curricula to ensure their graduates have the skills needed to excel in tomorrow’s professional landscape. This makes their valued and considered perspective the perfect place to start. 

Dr Roger Kerry, professor of physiotherapy education at the University of Nottingham, is a visionary advocate for the evolution of physiotherapy. Recently, he and his colleagues undertook a bold update of their well-established BSc (Hons) Physiotherapy curriculum to better prepare graduates for evolving demands of healthcare.

‘Collaboration is critical for the most effective patient care,’ states Roger. ‘With regards to exercise, there is a rich history of challenges and barriers to successful collaboration, a key one of these being individual professions’ assumptions of their “ownership” of exercise.    

‘There is a risk that this will worsen as professions fight for their identity to survive in the healthcare market. Strategic and meaningful collaboration is therefore more important than ever if we want to develop quality of care and the best delivery of exercise-based interventions.’

The University of Nottingham’s physiotherapy programme has led the way in collaborative education by integrating modules with its sport rehabilitation programme, which has proved mutually beneficial. 

‘Sport rehabilitation is a relatively young profession but has the principles and science of exercise at its core,’ Roger adds.

‘This partnership allows students to learn from each other’s skills and values. Building on this success, we are embarking on a collaborative initiative where all sport and exercise-related programmes will come together as an institute. This will expand collaboration opportunities for physiotherapy students, from sports medicine and exercise science to sports psychology and engineering. The opening of the National Rehabilitation Centre will further integrate our programmes with many other exercise professionals.’

Looking forward, Roger envisions physiotherapy’s evolving role in exercise. ‘Physiotherapy must accept that it is, perhaps not by default, the “expert in exercise” as traditionally thought.

Our evolution is dependent on working with others. I hope that we become much more engaged with exercise movement, but in a far more collaborative way.

‘Physiotherapists should exploit their critical thinking and leadership capacities to develop collaborations in the rehabilitation and exercise fields. Our excellent communication skills and holistic values can enhance the value of exercise in multi-modal approaches to managing complex health conditions.

‘Our education should really be focusing on leadership and communication, negotiating with others, supporting quality improvement, pushing evidence-based agendas, influencing policy, and motivating cultural change – both locally and globally. Our training should embrace exercise as a sustainable population health technology. Collaboration is key: we can’t do this alone.’  

Rob Tyer is a senior lecturer in physiotherapy at the University of Sunderland, where he designs and delivers modules within the three-year BSc (Hons) physiotherapy programme. 

Rob strongly believes that collaboration is essential for raising quality of care. He emphasises that: ‘There are core aspects to healthcare and siloed learning has more drawbacks than benefits. A rising tide raises all ships – transparency among exercise professionals has the potential to elevate standards across the board.’ 

At Sunderland, robust collaborations between physiotherapy and sports rehabilitation therapy programmes are routine. Integrated modules covering exercise prescription, anatomy, physiology and musculoskeletal studies support inter-professional learning. Additionally, Rob collaborates with exercise physiologists from the sports science team, jointly exploring the impacts of aerobic and anaerobic exercise. 

He sees physiotherapy’s future role with exercise evolving alongside societal needs. ‘Addressing needs in the social sector could alleviate significant healthcare pressures,’ he says.

‘By identifying overlaps in this Venn diagram, we can expand the role of physiotherapists in shaping public health policies. 

We still need people for the “doing” aspect of physiotherapy, but the future largely depends on the systems we work within.’

Rob cautions against physiotherapy losing sight of its foundations. ‘I hope we learn from the mistakes of the recent past and recognise that the core values of a movement-based profession should not be left behind in the pursuit of perceived medical specialism.’

Whilst recognising these skills are not unique to physiotherapists, Rob states: ‘We combine knowledge of exercise science with social determinants of health, readiness to change and the impacts of co-morbidities to address these factors with a person-centred approach.’

To strengthen our identity in the future, he stresses the need for comprehensive education.   

‘Our focus should blend exercise science with problem-solving skills, the body as a system, and effective communication. Integrating these elements will help differentiate us in practice.’

Rob acknowledges the challenges that exist and that being proactive comes with ‘discomfort’.

‘There’s some resistance to collaboration from fear of diluting physiotherapy’s value,’ he adds.

But isolation breeds tribalism, and tribalism shuts down dialogue, creating more problems than it solves. 

‘We are not going to run out of people who require exercise and we presently do not work in a system that helps many in a timely manner. To be truly patient centred, we each need to consider our bias on this topic.’   

Dr Rachel Chan, associate professor and head of physiotherapy at the University of Roehampton, recently led the development of a new two-year MSc Physiotherapy programme that launched in January.  With a focus on health promotion, wellbeing and exercise, Rachel emphasises the importance of collaboration in modern healthcare. 

‘Collaboration is essential in everything that we do as contemporary healthcare professionals,’ she says.

‘Not only does it bring diversity and different perspectives, but it is fundamental to the provision of high-quality, person-centred care.’ 

Rachel identifies the need to prepare graduates for current healthcare needs in an evolving landscape. ‘As educators, we have a responsibility to the profession and to our learners, to ensure graduates understand and embrace current and ever-changing healthcare needs. Students need strong teamwork skills, advanced communication skills, flexibility, resilience and innovation.’

In designing the new curriculum, Rachel integrated modules exploring physiotherapy’s role in health promotion and wellbeing, with a core focus on exercise prescription and physiology. 

‘This sparked interest at our stakeholder events, with modules designed alongside practice experts to ensure alignment with essential physical activity competencies for all health professionals,’ she explains.

‘The curriculum includes health promotion, modelling behaviour and supporting behavioural change. It also addresses wider determinants of health, acknowledging the impact of social, economic, and environmental factors on health and wellbeing. Importantly, it cultivates an understanding of the role that other health professionals play in this space and encourages interprofessional respect.’

Looking ahead, Rachel advocates for physiotherapy’s expanded role in public health. ‘We are well-positioned to expand our role beyond rehabilitation, to be more active in terms of health promotion and wellbeing and strengthen the impact we have on public health,’ she says. ‘There is opportunity to engage more with local communities, helping address unmet needs.’

Rachel says the physiotherapy profession is uniquely positioned to bridge gaps between exercise professionals and other health professionals, encouraging co-production and empowering teams to promote physical activity across healthcare sectors.

Rachel also stresses that every physiotherapy programme should provide learners with a solid foundation in exercise physiology and exercise prescription. 

‘We also need to develop students’ understanding of scope of practice, encourage creativity and build confidence. Our education and training should strive to meet the recommendations in a recent consensus statement ¹.’  

¹. Alsop T et al. What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement. Br J Sports Med, 2023; 57:1419-27.  

Vanilla Ice’s lyrics ‘alright stop, colloborate and listen’ capture the essence of this professional project: stop to understand, collaborate to innovate, and listen to evolve.

This journey through physiotherapy and exercise has ignited a crucial conversation, re-affirmed by the views from leaders in education. 

What themes have emerged?

Firstly, collaboration is crucial. All three experts emphasise the need for physiotherapists to work with other exercise professionals to provide effective patient-centred care.

Secondly, there is a consensus that physiotherapy should extend beyond traditional rehabilitation to broader health promotion roles.

Thirdly, a strong emphasis on exercise prescription and physiology is essential in physiotherapy education, alongside developing skills in teamwork, communication, leadership, and health policy.

Finally, the profession must be adaptive to change, responding to population needs and societal trends. Physiotherapy has a long tradition of doing this. A unified vision across professions is crucial for growth and relevance.

What next?

Stay tuned for our next article where we delve into the thoughts of members in clinical practice. Let’s stay curious and open to learn as we progress on this journey. 

Read our resources titled 'Collaborate, Don't Compete: useful resources' which provides the reader with a list of useful resources.