Two Nations, One Mission

Exercise is medicine. This is no longer a slogan — it is a statement backed by decades of rigorous evidence demonstrating that structured, individualised exercise interventions can prevent, treat, and manage many of the chronic diseases that place the greatest burden on modern healthcare systems. From type 2 diabetes and cardiovascular disease to cancer, mental health conditions, and neurological disorders, the evidence base for clinical exercise prescription is overwhelming.

Yet turning that evidence into a recognised, funded, and respected healthcare profession is an entirely different challenge. It requires professional bodies, university training pathways, government recognition, funding mechanisms, and — perhaps most importantly — a workforce of passionate practitioners who believe in the power of movement to change lives.

Australia has spent two decades building a mature, government-funded profession of more than 6,500 practitioners. The UK is at the beginning of that same journey, with formal registration opened only in 2022. The two countries are at very different stages — but they share the same destination. This article traces how each got to where it is, what each can learn from the other, and why the momentum behind clinical exercise physiology is unlikely to slow.

Australia's exercise physiology story begins with the founding of Exercise & Sports Science Australia (ESSA) in 1991, originally known as the Australian Association for Exercise and Sports Science (AAESS). At the time, exercise science graduates worked primarily in sports performance, fitness, and academic research. The idea that exercise could form the basis of a distinct clinical healthcare profession was still emerging.

The post-World War II era had planted important seeds, with physical fitness research expanding for both sporting performance and veteran rehabilitation. But the real transformation came when ESSA began the long campaign for government recognition of exercise physiologists as allied health professionals within the national healthcare system.

The single most transformative moment for the Australian profession came on 1 January 2006, when Accredited Exercise Physiologists (AEPs) were formally included in the Medicare Benefits Schedule — making Australia one of only a few countries in the world where university-qualified exercise professionals could provide services within a government-funded healthcare system. Following a long and arduous application process, then Health Minister Tony Abbott recognised AEPs as allied health professionals in 2005, with implementation the following year.

General practitioners could now refer patients with chronic conditions to AEPs under what was then the Enhanced Primary Care (EPC) program, with Medicare rebates covering part of the cost. The inclusion in Medicare was more than a funding mechanism — it was a statement of legitimacy that told the medical profession, policymakers, and the public that exercise physiology was a recognised allied health discipline, not a branch of personal training.

What followed was a period of significant growth. Universities expanded their exercise physiology degree programs, graduates entered the workforce at pace, and the profession established itself across multiple healthcare settings — public and private hospitals, community health centres, occupational rehabilitation, aged care, and private practice.

In the early 2010s, ESSA made the strategic decision to raise entry standards, moving toward a minimum four-year bachelor degree or a two-year graduate-entry master's with 500 hours of supervised clinical placement. This temporarily reduced graduate numbers — Victorian completions dropped 72% between 2010 and 2016 (Victorian Allied Health Workforce Report, 2016) — but it was a deliberate trade: slower growth for higher quality and clinical credibility.

By 2022, approximately 6,529 AEPs were practising across Australia (ESSA National Workforce Report 2021–22) — still a fraction of the physiotherapy or occupational therapy workforces, but an established and integrated part of the health system nonetheless.

The rollout of the National Disability Insurance Scheme (NDIS) from 2013, with full national implementation by 2020, opened a massive new market for exercise physiologists. Unlike Medicare's five-session annual cap for allied health, NDIS funding could support ongoing, intensive exercise programs for participants with disability.

NDIS participants could access exercise physiology under “Capacity Building” supports, specifically the “Improved Health and Wellbeing” and “Improved Daily Living” categories. Crucially, NDIS referrals didn't require a GP — participants could self-refer or be referred by support coordinators. Many EP practices pivoted significantly toward NDIS work, and entirely new NDIS-focused EP businesses emerged.

Today, Australian exercise physiologists benefit from one of the most diverse funding ecosystems of any allied health profession in the world. Revenue comes from multiple streams:

This diversity is critical. It means the profession is not dependent on any single funding source, and it provides multiple pathways for patients to access exercise physiology services.

Two landmark Deloitte Access Economics reports commissioned by ESSA quantified the extraordinary cost-effectiveness of exercise physiology interventions. A 2015 societal analysis found compelling benefit-to-cost ratios: 8.8 to 1 for type 2 diabetes, 6.2 to 1 for cardiovascular disease, 6.0 to 1 for pre-diabetes, and 2.7 to 1 for depression.

A follow-up 2016 report took a different lens — asking what AEP interventions are worth specifically to consumers, not just to the health system as a whole. The finding was striking: across five major chronic conditions (depression, type 2 diabetes, cardiovascular disease, COPD, and asthma), the average consumer benefit-cost ratio was AUD $10.50 (~£5.46) returned for every $1 spent.

The highest return was seen in COPD, with CVD close behind, and depression just above the consumer average. This consumer-centred framing matters enormously as healthcare systems worldwide move towards consumer-directed care models — it reframes exercise physiology not as a cost to the patient, but as one of the highest-return health investments available to them. Together, the two reports make the case from both directions — to policymakers through the lens of system savings, and to patients through the lens of personal return.

Despite its success, the Australian profession still faces significant challenges. Exercise physiology is not registered under AHPRA (the national health practitioner registration scheme), instead relying on ESSA's self-regulation model. GP referral rates remain low — a prospective study by Keating et al. (Journal of Science and Medicine in Sport, 2019) found rates of just 0.38 to 1.44 per 1,000 GP encounters between 2009 and 2016. The problem extends to medical training: a survey of all UK medical schools found that physical activity teaching averaged just 4.2 hours across the entire undergraduate degree (Weiler et al., Br J Sports Med, 2012) — a gap that is widely recognised across comparable healthcare systems. And the title “exercise physiologist” still causes confusion — a 2025 study by Beecroft et al. was literally titled “So many people don't understand what exercise physiology is.”

The UK's story begins from a very different starting point. While exercise professionals have been working in clinical settings — particularly cardiac and pulmonary rehabilitation — for over 25 years, they did so without a standardised title, unified qualification pathway, or formal professional regulation. An audit cited in the 2021 CEP-UK call to action found approximately 890 clinical exercise services operating across the UK, but the professionals delivering them held a variety of titles (exercise physiologist, exercise scientist, exercise specialist, advanced exercise instructor) and a mix of qualifications.

The British Association of Sport and Exercise Sciences (BASES) provided accreditation for sport and exercise scientists, but there was no equivalent of ESSA's AEP accreditation specifically for clinical exercise practitioners. The profession existed in practice but not in formal recognition.

The pivotal moment came in 2021, when Clinical Exercise Physiology UK (CEP-UK) published a call to action highlighting the urgent need for professional regulation. The group, led by academics and clinicians from institutions including Liverpool John Moores University, Loughborough University, and Manchester Metropolitan University, explicitly looked to Australia's model as evidence that formal recognition was both achievable and beneficial.

A crucial ally emerged in the Chartered Society of Physiotherapy (CSP), which publicly supported the development of a registered CEP role. The CSP acknowledged that while exercise is a cornerstone of physiotherapy practice, the growing demand for clinical exercise services could not be met by expanding the physiotherapy workforce alone. This endorsement removed a potential professional barrier and signalled to policymakers that the healthcare community itself recognised the need for this new role.

In January 2022, clinical exercise physiologists became eligible for professional registration with the Academy for Healthcare Science (AHCS) — which had absorbed the Registration Council for Clinical Physiologists (RCCP) in 2021, bringing the CEP register under the AHCS umbrella. This voluntary register, regulated by the Professional Standards Authority (accountable to UK Parliament), provides the formal regulatory framework the profession had lacked.

The numbers reflect just how new this is. By March 2023, there were just 57 registered clinical exercise physiologists in the UK. As of 2025, approximately 200 professionals have registered through the portfolio (equivalence) pathway. Compare this to Australia's more than 6,500 AEPs serving a population less than half the UK's size.

The UK has set its qualification standard at master's degree (MSc) level — higher than Australia's bachelor's degree entry point. Registrants must either graduate from an AHCS-accredited MSc in Clinical Exercise Physiology, or demonstrate equivalent knowledge and skills through a portfolio of evidence with at least six years of experience.

The portfolio pathway will close on 31 December 2026, after which registration will only be available through accredited MSc programmes. Universities are currently undergoing accreditation to offer these degrees, which will become the sole gateway to the profession.

Unlike Australia, where AEPs work across a diverse mix of public, private, and insurance-funded settings, UK clinical exercise physiologists work primarily within the National Health Service (NHS) and the third (charity) sector. Registered CEPs are typically employed at NHS Band 6, with trainee positions at Bands 4 and 5. Their work is concentrated in disease-specific rehabilitation — cardiac rehab, pulmonary rehab, cancer prehabilitation and rehabilitation, and similar services.

The NHS Long Term Plan (2019) provided important policy backing, advocating exercise programmes for patients with cardiovascular disease to prevent 14,000 premature deaths. The Office for Healthcare Improvement and Disparities has also acknowledged the need to embed physical activity into clinical care pathways. The demand is there — the challenge is building the workforce and infrastructure to meet it.

Despite being at different stages of development, the two countries share remarkably similar challenges.

In both countries, the title “exercise physiologist” remains poorly understood by the public, by other health professionals, and even by policymakers. Patients confuse EPs with physiotherapists, personal trainers, or sports scientists. GPs may not know what services EPs provide or when to refer. Building awareness and understanding is a shared, ongoing task that requires persistent advocacy, education, and — most importantly — demonstrating outcomes.

Australian data shows that even after a decade of Medicare inclusion, GP referral rates to exercise physiologists remained strikingly low — just 0.38 to 1.44 per 1,000 encounters (Keating et al., 2019). Medical education devotes minimal time to exercise prescription. The UK faces an even steeper hill, with the profession only just entering formal recognition. Both countries need strategies to embed exercise physiology awareness into medical training and routine clinical practice.

The economic evidence is compelling. Two Deloitte Access Economics reports commissioned by ESSA quantified the value of AEP interventions across a range of chronic conditions. From the consumer's perspective, the numbers are striking: for every AUD $1 a patient personally spends on AEP sessions, they receive an estimated $10.50 in return across five major chronic conditions — rising to $26.50 for COPD and $12.10 for cardiovascular disease. The UK's NHS Long Term Plan recognised exercise's role in preventing thousands of premature deaths. Yet translating evidence into funding, referrals, and workforce growth requires relentless advocacy. The numbers are there — the challenge is ensuring decision-makers act on them.

Australia provides a proven roadmap. The journey from ESSA's founding in 1991 to a profession of more than 6,500 practitioners shows that sustained advocacy, strategic professionalisation, and progressive expansion of funding pathways works. Key lessons include the power of diversifying funding sources beyond a single government payer, the importance of establishing a strong professional identity through accreditation, and the transformative impact that disability and rehabilitation funding (like the NDIS) can have on workforce growth.

The UK's approach offers insights too. Setting the qualification bar at master's level positions clinical exercise physiologists alongside other healthcare science professions from the outset. The integration within the NHS's structured healthcare system, while slower, may create a more systematic pathway to embedding exercise into clinical care pathways. The explicit support from the Chartered Society of Physiotherapy — a profession that could have been a competitor — demonstrates the value of building interprofessional alliances rather than working in isolation.

The conditions that drive demand for exercise physiology are not going away. The global burden of chronic disease is growing. Physical inactivity remains one of the leading risk factors for premature death worldwide. Healthcare systems everywhere are searching for cost-effective, evidence-based interventions that reduce the demand on hospitals, GPs, and acute services. Exercise physiology is precisely that intervention.

Australia has shown what is possible when a profession commits to the long game — building evidence, securing government recognition, diversifying funding, and raising standards. The UK is now beginning that same journey, with the advantage of being able to learn from Australia's experience and the tailwind of growing policy recognition.

The trajectory is clear — and the evidence for it is now quantified, peer-reviewed, and growing. Every patient who moves better, manages their condition more effectively, or avoids a hospital admission because of an exercise physiologist's intervention strengthens the case for both professions. For practitioners in Australia and the UK alike, the task is the same: keep doing the work, keep publishing the outcomes, and keep making the case to the people who hold the keys to funding and referral.

The mission is the same on both sides of the world: to ensure that exercise — the most powerful medicine we have — is prescribed by qualified professionals and accessible to everyone who needs it.