**2. Scope of profession of Biokinetics**

The scope of the profession of biokinetics focuses on enhancing the physical health status and quality of life of a person through a clinical exercise evaluation and subsequent prescription of personalised exercise rehabilitation in the dual context of pathology (pathogenic healthcare paradigm) and physical performance enhancement (fortogenic healthcare paradigm) [11, 12]. The profession of Biokinetics also aggressively campaigns for health and wellness promotion as well as for the prevention of neuro-musculoskeletal injury and NCDs (fortogenic healthcare paradigm), thereby inspiring a positive change in the health and wellness continuum towards optimal well-being [1, 13]. Biokineticists are clinically trained professionals who address *inter*-*alia* the chronic concerns of NCDs in South Africa and Namibia through structured exercise rehabilitative intervention [14]. In the fortogenic health paradigm a person who is otherwise considered healthy, having no predisposing risk of neuro-musculoskeletal injury and/or NCDs, but who seeks to adopt a physically active lifestyle in order to avoid the onset and/or risk of illness, while simultaneously increasing their quality of life, consults a biokineticist [1, 14].

### **3. Health dimensions and health paradigms**

Strydom *et al.* described the pathogenic healthcare paradigm as being inclusive of both the illness-care dimension and illness prevention dimension (**Figure 1**) [15]. The illness-care dimension involves the presence of disease and/or injury, while the illness prevention dimension involves the predisposing intrinsic risk of prospective disease and/or injury [15]. The illness-care and illness prevention health *The Profession of Biokinetics in South Africa: The Need for Access to the Public Healthcare System DOI: http://dx.doi.org/10.5772/intechopen.97756*

**Figure 1.** *Articulation of the health dimensions in the health paradigms [15].*

dimensions necessitate clinical management by the medical discipline that involves the expertise of the following medical specialists: oncologists, cardiologists, cardiothoracic surgeons, endocrinologists, neurologists, neuro-surgeons and orthopaedic surgeons, general medical practitioners, physiotherapists and nurses [16]. The fortogenic healthcare paradigm is the active attempt to prevent the onset of predisposing risk of neuro-musculoskeletal injury and/or NCDs. The aforementioned three healthcare dimensions actively intersect each other, thereby necessitating the expertise of the aforementioned medical and psycho-social disciplines (biokineticists, dieticians, and psychologists). This dynamic interweaving of the health paradigms encourages interprofessional collaboration [14, 17]. **Figure 1** provides a graphic representation of the dynamic overlap of the different health dimensions and of the interventions of the respective healthcare practitioners [12, 15]. **Table 1** describes the interaction of medical specialists in the rehabilitation of NCDs. The focus of this chapter is to illustrate the value of the profession of Biokinetics to the South African public healthcare sector. As such the chapter will exclusively describe the rehabilitation of NCDs. It must be stressed that Biokinetic rehabilitation also has a strong emphasis on neuro-musculoskeletal rehabilitation.

The aforementioned examples of NCD management provided by a biokineticist illustrate the value of their expertise that can serve both the private and public healthcare sectors. Many patients in the public healthcare sector who experience NCDs receive standardised treatment and do not receive individualised management. The medical and paramedical staff in the public healthcare sector are overworked and therefore prescribe general healthcare management strategies whose


**Table 1.**

*The Profession of Biokinetics in South Africa: The Need for Access to the Public Healthcare System DOI: http://dx.doi.org/10.5772/intechopen.97756*

efficacy may not be applicable to all patients suffering from NCDs. The inclusion of skilled practitioners (such as biokineticists) in the public healthcare sector will provide the necessary medical assistance to patients and alleviate the stress placed upon already overworked public healthcare sector staff. The incidence of NCDs and the upsurge in their mortality is of international concern, therefore countries that have skilled professions that are able to assist the present medical workforce in order to better combat NCDs should embrace the aid offered by these healthcare practitioners and include them in the public healthcare management team. The paper encourages the South African Department of Health to include the profession of Biokinetics in the public healthcare registry.

### **4. Non-communicable diseases**

Non-communicable diseases (NCDs) are a group of non-infectious diseases which include chronic diseases of slow progression over a prolonged period of time. These diseases can, however, progress rapidly should they remain untreated and have the potential to lead to premature death. Epidemiological statistics attribute approximately 41 million premature deaths per year globally to NCDs [19], with 85% of the aforementioned mortalities occurring in low to middle income countries such as South Africa [19]. The World Health Organisation has identified four primary non-communicable diseases, which include cardiovascular diseases, respiratory diseases, cancer, and diabetes mellitus as being of particular concern. Collectively, these primary NCDs account for 80% of all deaths attributable to NCDs per year [19]. The individual morality rates of the primary NCDs are: 17.9 million deaths (43.6%) due to cardiovascular diseases, followed by cancer (nine million deaths, 21.9%), respiratory diseases (approximately four million deaths, 9.7%), and diabetes mellitus (approximately one and a half million deaths, 3.6%) [19].

Unhealthy nutritional choices, physical inactivity, alcohol, and tobacco use have been identified as modifiable predisposing risks for mortality related to NCDs. These aforementioned risk factors have been classified as modifiable risk factors, suggesting that if a patient changes their behaviour, this would favourably improve their health status. Regular physical activity of moderate intensity (150 minutes/ week) and/or high intensity (75 minutes/week) as recommended by the American College of Sports Medicine has proven successful in improving the risk factors associated with NCDs, thereby improving not only the longevity of patients, but also their quality of life [16, 18, 20].

#### **5. How exercise combats non-communicable diseases**

This section will describe the manner in which habitual exercise, through exercise-induced physiological mechanisms, favourably influences the primary mortality agents of NCDs: cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, and cancer.

#### **5.1 Exercise-induced mechanisms for combatting cardiovascular diseases**

Empirical exercise physiology literature has shown that habitual physical activity and exercise reduces heart rate and blood pressure, favourable alters high density lipoprotein (HDL) levels, low density lipoprotein (LDL) ratios, total serum cholesterol, excess body mass and body fat [20, 21]. The following exercise-induced physiological mechanisms assist compromised cardiovascular function:

	- Habitual physical activity and exercise produces laminar shear stress on the coronary endothelium, which changes the shape of the endothelial cells in the direction of blood flow which in turn stimulates the release of nitric oxide. Nitric oxide diffuses into the endothelium and surrounding smooth muscles producing vasodilation [20].
	- Habitual exercise produces better calcium handling in coronary muscles, which decreases coronary vasoconstriction and conversely increases coronary vasodilation. Coronary vasodilation reduces resistance to blood flow thus lowering blood pressure [20].
