Why EMD&T Is a Distinct Clinical Discipline
Exercise Medicine, Diagnostics, and Therapeutics (EMD&T) encompasses the full spectrum of clinical exercise science: from cardiopulmonary exercise testing (CPET) and performance assessments, to evidence-based exercise prescriptions for patients with complex chronic diseases, to laboratory quality assurance and data interoperability.
Unlike sports medicine — which focuses on musculoskeletal injuries in athletes — or rehabilitation medicine — which restores function after illness or injury — EMD&T focuses on the proactive use of exercise as a diagnostic and therapeutic tool across the full range of medical conditions. Its scope spans cardiology, pulmonology, oncology, pediatrics, psychiatry, metabolic disease, and beyond.
The clinical evidence supporting this discipline is both vast and rapidly growing. Below is a summary of the evidence across each major disease area, drawn from the Academy's ACGME submission.
Evidence Across 11 Disease Areas
Each area represents a body of clinical evidence demonstrating the role of exercise as a diagnostic and therapeutic tool.
Chronic Obstructive Pulmonary Disease
Level 1 evidence demonstrates improved exercise tolerance and enhanced quality of life after pulmonary rehabilitation, with rapid cost reduction from $18,569 to $11,472.
Cystic Fibrosis
CPET has been a valuable prognostic tool since the landmark 1992 NEJM study. The transformative CFTR modulator era creates exciting new opportunities for exercise therapeutics.
Heart Failure (HFrEF & HFpEF)
CPET is the gold standard for risk stratification and transplant candidacy. Exercise training consistently improves fitness, function, and quality of life in both HFrEF and HFpEF.
Congenital Heart Disease
CPET is critical for functional assessment, surgical planning, and the shift from lifespan to health span models. The AHA recommends exercise counseling as core CHD care.
Cancer Care & Survivorship
Preoperative CPET values predict postoperative outcomes. Exercise prescription is now widely recognized as part of contemporary cancer treatment and survivorship models.
Pediatric Pulmonary Disease
Exercise flow-volume loops, exercise laryngoscopy for EILO identification (7–28% prevalence), and exercise challenge testing for EIB are essential diagnostic tools.
Psychiatric & Behavioral Disorders
Growing evidence supports exercise interventions in anorexia nervosa, major depressive disorder, chronic pain, and PTSD. A critical tool in the mental health crisis.
Rehabilitation & Prehabilitation
Risk stratification and exercise programming across cardiac, pulmonary, neurological, and surgical rehabilitation. Prehabilitation evidence is growing exponentially.
Cardio-Metabolic Disease
Aerobic and strengthening exercises are foundational in obesity and diabetes management, with diverse modalities conferring different metabolic adaptations.
Sickle Cell Disease & Health Equity
Addressing research disparities — 100,000 US patients but only 12 exercise clinical trial publications. Safety evidence for exercise testing is accumulating.
Pulmonary Arterial Hypertension
Exercise testing is among the strongest prognostic predictors. Cardiopulmonary rehabilitation improves quality of life, exercise capacity, and vascular remodeling.
Cost-Effectiveness Evidence
For institutional leaders considering fellowship investments, the economic data is compelling.
| Condition / Intervention | Metric | Value | Source |
|---|---|---|---|
| COPD (Pulmonary Rehab) | Annual cost reduction | $18,569 → $11,472 | Zafari et al., AJRCCM 2020 |
| Breast Cancer (Exercise) | Cost per life year gained | AU $8,894 | Mewes et al., J Clin Oncol 2015 |
| Type 2 Diabetes (Combined) | Cost per QALY | $9,000 – $14,000 | Multiple RCTs |
| Heart Failure (Cardiac Rehab) | Hospitalization reduction | 25–30% reduction | AHA/ACC Guidelines |
| Physical Inactivity (Prevention) | Share of US health expenditure | 8.4% ($117B annually) | Carlson et al., Prog Cardiovasc Dis 2015 |
Addressing Disparities in Exercise Medicine
Health equity is central to the Academy's mission. Social determinants of health profoundly influence exercise prescriptions, monitoring, and access to rehabilitation services.
The case of sickle cell disease illustrates the gap: 100,000 US patients — predominantly from underrepresented communities — yet only 12 exercise clinical trial publications exist. Race-based normative data in pulmonary function testing raises additional concerns about equitable diagnostics.
EMD&T fellowship training addresses these disparities by equipping physicians to consider the full context of patient exercise behavior and access, and to advocate for equitable exercise medicine programs at institutional and community levels.