in Medical Education*
Lajos Ángyán, M.D., D.Sc.,
University of Pécs, Faculty of Medicine,
Institute of Kinesiology, Pécs, Hungary
Abstract - The
purpose of this article is to describe a program to incorporate
kinesiology into medical education. An institute of kinesiology
was established in our Faculty of Medicine, its mission being to
develop, teach and apply knowledge about the nature and consequences
of regular physical activity. Kinesiology, the science of human
motion, was initially offered in the medical curriculum as an optional
credit course. Three main points were considered when preparing
the subject matter: 1. the fundamentals of kinesiology, 2. its connection
with the other subjects in the curriculum, and 3. suggestions from
family physicians. At the end of the course the students take a
written exam and are asked to evaluate the course.
Nowadays the harmful
consequences of a sedentary lifestyle are widely recognized by both
physicians and the general population.1 Because of this,
medical practitioners should have a positive attitude about the role
of physical exercise in medical practice. In order to assume a positive
attitude, practitioners should first understand the physiological consequences
of regular physical exercise and of no physical exercise. 2
Physicians are often asked to give appropriate exercise prescriptions
both to healthy people to improve their physical condition and to patients
to prevent or treat particular diseases. However, physicians are not
prepared for this task during their university years. The traditional
medical curriculum does not contain a well-defined subject of the science
of human motion. Consequently, the use of physical exercise in prevention,
therapy and rehabilitation is left to kinesiologists, physiotherapists
and other experts. However, medical evaluation, exercise prescription,
and control of the effects of regular physical exercise should not be
passed to other specialists. The responsibilities of physicians and
other experts must be strictly delimited. Therefore, it is important
to adapt the medical curriculum to the contemporary requirements of
medical practice. For this reason our Institute of Kinesiology was established.
The Institute of Kinesiology
Our Faculty of Medicine
is the first in Hungary to establish an Institute of Kinesiology. Because
of various implications, there is a certain aversion to use of the term
kinesiology among the faculty members. However, the necessity to teach
the science of human motion is accepted. This acceptance is strengthened
by the Hungarian name of the institute, the Institute of Human Motion.
The Institute of Kinesiology
has two main divisions: theoretical and applied kinesiology. The theoretical
division organizes the teaching of kinesiology and scientific research.
The applied kinesiology division coordinates recreational and sport
activities, as well as special movement therapies for patients. We are
currently preparing postgraduate programs for medical practitioners.
Credit Course in Kinesiology
for medical students have been held at our institution since 1997. The
program provides the essentials of the science of human motion as shown
in Table 1below. Our multidisciplinary approach prepares medical students
to evaluate the benefits of and limitations to physical performance,
and to select physical activities compatible with the needs, abilities,
and interests of patients. The course also acquaints students with potential
adverse effects of sports activities such as injury, overtraining syndrome,
osteoarthritis, female athlete triad, and sudden death.
A group of family
physicians was asked to complete a questionnaire concerning their recommendation
of physical exercise to their patients. We received 25 completed questionnaires
from the 33 we had sent out. The group as a whole had practiced for
an average of 16±3
(mean+S.D.) years. All 25 physicians recommended regular physical
activity to their patients when it was reasonable, but only two prescribed
specific exercise training. Not surprisingly, 92% of the group felt
incompetent to give exercise prescriptions. All of the physicians who
completed the questionnaire recommended that we incorporate kinesiology
into the medical curriculum.
In order to be admitted
to the course, students must pass examinations in anatomy and physiology.
Approximately 20 to 30 students per year or around 10% of a class participate
in the course. The grade point average of these students was 3.5 ± 0.5
after the second academic year, which is in the middle of the distribution
of grades for the medical school class. At the end of the course the
students must pass a written exam to receive credit. It is important
to note that most of the participants (around 80%) regularly do some
form of physical exercise.
Evaluation of the Credit Course
Considering the traditional
attitude to medical education and the packed medical curriculum, it
is promising that around 10% of each class participated in the optional
kinesiology course. After passing the exam, the participants evaluated
the program in a group discussion. All of them were generally satisfied
with the subject matter, but they suggested more practice, e.g. special
measurements. Their motives for participation in the course were variable:
to accumulate credit points, to prepare for clinical studies, to use
this knowledge in practice, and for athletes, to improve personal sport
physical exercise has been involved in medical practice in one way or
another since the ancient Greek physicians, there is still a great
gulf between medical education and medical practice. All the family
physicians responding to our questionnaire and the data in the literature3
stated that they felt inadequately trained to practice exercise medicine.
While it is true that some subjects of the traditional medical curriculum
(medical physiology, orthopedics, cardiology, etc.) mention the preventive
benefits of regular physical activity, but this is far from being systematized
and sufficient. Despite the insufficiency of the medical curriculum,
general practitioners are compelled to prescribe exercise programs for
their patients just as they would drugs. 4, 5, 6, 7 Although
there are various useful guidelines to help general practitioners8,9,10,
they cannot provide the theoretical basis of the science of human motion.
Medical education can and should provide this theory in order to prepare
physicians to give appropriate medical counseling and exercise prescription.
The necessity of including
kinesiology in medical education is understood by our faculty members,
students and the family physicians who completed our questionnaire.
However, there are questions outstanding on the place of kinesiology
in the curriculum as a preclinical subject, whether kinesiology should
be a compulsory or optional subject, and what form the exams should
take: theoretical, practical or both. Some answers to these questions
may be uncovered in the next academic year.
1. Fentem PH: Exercise in prevention
of disease. Br. Med. Bulletin, 48:630-650, 1992.
2. Ángyán L: Is it reasonable to involve
kinesiology in medical education? Acta Physiol. Hung. 86(3-4):199-203,
3. Buckler DG: General practitioners
training for, interest in, and knowledge of sports medicine and its
organizations. Br. J. Sports Med. 33(5):360-363, 1999.
4. Browne D: Exercise by prescription.
J. R. Soc. Health, 117(1):52-55, 1997.
5. Petrie D, Matthews LOS, Howard WH:
Prescribing exercise for your patient. Md. Med. J. 45(8):632-637,
6. Will PM, Demko TM, George DL: Prescribing
exercise for health: a simple framework for primary care. Am. Fam.
Physician, 53(2):579-585, 1996.
7. Wing RR: Physical activity in the
treatment of the adulthood overweight and obesity: current evidence
and research issues. Med. Sci. Exerc. 31(11 Suppl):S547-552,
8. American College of Sports Medicine:
Guidelines for exercise testing and prescription (4th ed.). Lea and
Febiger, Philadelphia, 1991.
9. King CN, Senn MD: Exercise testing
and prescription. Practical recommendations for the sedentary. Sports
Med. 21(5):326-336, 1996.
10. Lear SA, Brozic A, Myers JN, Ignaszewski
A: Exercise stress testing. An overview of current guidelines. Sports
Med. 27(5):285-312, 1999.
Ángyán L. Launching
kinesiology in medical education. Med Educ Online [serial online] 2000;5:8.
Available from URL http://www.med-ed-online.org
Address Correspondence to:
Prof. Dr. Lajos Ángyán
University of Pécs, Faculty of Medicine,
Institute of Kinesiology,
P.O. Box 99,