We invited Isi Schneider to share her perspective on Sport and Exercise Medicine (SEM) in her home country, Germany.
Tell us more about yourself.
Short version: I’m a sports scientist.
Longer version: My pathway to becoming a sports scientist was not straightforward. I started with a row of coaching certificates from the BGKV (Bavarian Weightlifting Association) through all levels of fitness, strength, and health, and also a basic level in competitive weightlifting. At the same time, I attended university, aiming for a secondary school teaching degree in English and Geography. I worked for our local community sports club, enjoyed what I was doing, putting in hours, and ended up not being eligible to sit my state exam because I missed two crucial deadlines. But what felt catastrophic initially turned out to be one of the best things that ever happened. My professor convinced me to get some extra credits, one of which was creative teaching, and then graduate with a master’s degree. I wrote my thesis on intercultural learning.
Having blown my teaching career and convinced I would stay in sports, I knew I needed a better qualification. I obtained a diploma in sports massage and a sports physiotherapy (SPT) certificate that was temporarily offered at the Sport University in Cologne, financial security granted by the fact that I co-owned a little company for sports travel with my dad. I offered training therapy for private patients, started working with kids, coached ball-school classes, but I felt something was missing – solid and evidence-based scientific knowledge. So, I went back to university and eventually got a master’s degree as a sports scientist. I was offered to take over some classes as a freelance university lecturer a short while later. Still unsure about my own competencies, especially in sport and exercise medicine (SEM), I started reading more, tweeting, communicating on an international level, always curious, always eager to learn. I attended conferences and tried to suck in as much information and knowledge I could possibly deal with, which I would then try to put into practice. I still do. My work is still freelance and as versatile as my crazy career has been so far. I still evolve my teaching, help educate coaches for sports associations, and advise clubs and individuals. Still, I love most working with young athletes, making them stronger and more resilient. Strength and prevention always need to go hand in hand.
(I also love bickering about the German health system.)
…and perhaps one day I’ll have a chance to get a PhD!
What is the path to becoming a sports scientist in Germany, and what are the main hurdles on this path?
Anyone with a higher education entrance qualification (German “Abitur” or “Hochschulreife”) can study sports sciences, either at a State University or at a University of applied sciences. Some of these first require a physical aptitude test, some do not, and there can be huge differences in quality between schools. Also, there are different pathways within universities. Some start with a general undergraduate program and pre-specialisation in the final two semesters, and some offer specialisation right from the beginning. However, specialisation usually occurs during a master’s degree in health and prevention (although terminology differs between schools).
While it’s reasonably easy to become a sports scientist in Germany, the real challenge is being one.
Most sports scientists with an SEM focus will probably take up jobs in either academia, health and rehab centres, or sports clubs/federations. However, sports scientists who do not end up working in academia are usually very restricted in their decision making due to strict hierarchies in our health system. Proficiency in evidence-based practice is often not regarded as a quality feat. In Germany, physiotherapists (PT) rely on certificates and usually never undergo an academic education. An additional SPT qualification mainly consists of outdated contents such as massage or electrotherapy (1). Still, in the hierarchy of our health system, they are considered better qualified than postgraduate sports scientists. Similar issues apply to organised sports, which are mainly run by volunteers, be it in community clubs or national governing bodies. So, most sports scientists in Germany are subject to directives, whether these make much sense or not.
How developed is collaborative work in SEM in Germany?
Multidisciplinary work plays an essential role in our health system, but that does not necessarily mean it is interdisciplinary. As mentioned above, everybody plays their role in a very hierarchical system, and there appear to be rivalries even within each discipline. On the other hand, actual interdisciplinarity will often be found at a very basic level, such as self-funded health-based projects in community clubs, or unofficial cooperations with GPs, thus avoiding standard red-tape issues.
Are exercise physiologists/scientists integrated into your healthcare system, and does health insurance cover their services?
Many sports scientists work in health and rehab centres as part of multidisciplinary teams, but therapy is usually prescription bound, with a maximum of 4 weeks (20 treatment days).
On a more general basis, statutory health insurance can cover up to 80% of the participation costs in pre-registered prevention classes up to twice a year. There are also rehabilitation sports programs, fully covered by insurance when prescribed by a physician. However, what may sound like a great idea also has its caveats. All these courses take place as group fitness classes with up to 15 participants. Instructors of prevention classes need a professional qualification that meets basic standards, usually as a PT or sports scientist. On the other hand, rehabilitation sports can only be conducted by specialised coaches, which means that they are simply required to hold a German Olympic Sports Confederation (DOSB) -approved B-level qualification in that particular field. This can lead to the odd situation that sports scientists who teach qualification classes are not eligible to work as instructors in rehab sports if they have not attended a one-day seminar about red-tape in German rehabilitation sports (2).
What is done in Germany to promote SEM among students and young professionals regarding research and clinical opportunities?
I am unsure if there is a coherent strategy, as different universities offer and promote different SEM programs and opportunities. This applies to both medicine and sports sciences.
Finally, if you were Harry Potter, what would you change to SEM in Germany?
First of all, I would call up The Little Witch (3) to team up with me because, due to sheer magnitude, I would not be able to do it alone. We would then dump the complete system and build a new and better one from scratch. This would include (among other things):
- A proper SEM specialty for physicians
- Evidence-based, academic training for PTs according to international standards
- More and better clinical training for SEM-focussed sports scientists
- A digitised health system (no more fax machines) with Injury and illness registers for better communication and patient-based treatment
- Teamwork and interdisciplinarity at eye level (flat hierarchies!) with the patient being the most important member of the team
- Appropriate pay for sports scientists who do not work in academics or public service
- Focus on motor proficiency and enjoyment in elementary physical education
- Help everyone enjoy an active lifestyle
(1) DOSB (2020): Voraussetzungen zur Lizenzierung von Grundkursen in der Sportphysiotherapie durch den DOSB https://cdn.dosb.de/user_upload/Leistungssport/Dokumente/AllgemAusbildungsrichtlGruKu_2020_neu_09.04.2021.pdf
(2) BVS Bayern Sport und Reha (2021): Sonderausbildungen Übungsleiter*in B Sport in der Rehabilitation
(3) Preussler, O. (2015): The Little Witch; New York Review Books