The National Exercise Referral Framework aims to connect healthcare and fitness, guiding physicians in prescribing physical activity safely and effectively
In a step toward bringing physical activity assessment, prescription and referral into mainstream healthcare as a standard of care, the Coalition for the Registration of Exercise Professionals (CREP) and the United States Registry of Exercise Professionals (USREPS) have unveiled the National Exercise Referral Framework (NERF) — a new framework designed to connect physicians with appropriately credentialed exercise professionals based on patient health status and clinical need.
The release supports the mission of the Physical Activity Alliance to make physical activity assessment, prescription, and referral a standard part of U.S. healthcare. A core challenge has long been helping physicians determine which exercise professionals are qualified to work with specific patient needs.
“There’s been a persistent gap in how the healthcare and fitness industries communicate, especially around credentials, safety, and scope of practice,” says Dr. Brian Biagioli, President of the Board at CREP. “NERF is designed to close that gap.”
Building a Standardized Pathway
The NERF document outlines a scalable referral model that aligns job classifications from the U.S. Department of Labor with education, certification and licensure standards. It relies on recognized accrediting bodies, including the National Commission for Certifying Agencies (NCCA) and the International Organization for Standardization (ISO), to ensure consistency and trust.
By establishing clear referral pathways, NERF enables physicians to make informed decisions about which professionals to engage, depending on factors like comorbidities, exercise intensity and the need for medical oversight. For example, a patient with mild hypertension may be referred to a certified personal trainer, while someone recovering from cardiac surgery would require a clinical exercise physiologist.
Connecting Healthcare to Wellness
The framework not only clarifies roles and responsibilities but also supports broader shifts toward preventive care and healthcare cost reduction. Structured physical activity is already gaining traction as a reimbursable intervention in some CMS-approved programs. NERF builds on these models, to advocate for nationwide adoption.
“We view exercise as more than just prevention — it’s a cornerstone of long-term care,” adds Danielle Vitogiannes, Executive Officer at CREP. “NERF empowers providers and professionals to work together with confidence.”
What Comes Next?
With the technical paper now publicly available, CREP and USREPS are calling on healthcare systems, professional registries, insurers and fitness organizations to explore NERF’s implementation strategies. They emphasize that adoption will require cross-sector collaboration — while promising gains in patient engagement, health outcomes, and system-wide efficiency.
Download the full technical paper at https://usreps.org/who-we-help/healthcare/
