Biokinetics: A South African Health Profession Evolving from Physical Education and Sport

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Chapter 2
Biokinetics: A South African Health Profession Evolving
from Physical Education and Sport
Terry Jeremy Ellapen, Gert Lukas Strydom,
Mariette Swanepoel, Henriette Hammill and
Yvonne Paul
Additional information is available at the end of the chapter
http://dx.doi.org/10.5772/intechopen.73126
Provisional chapter
© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly cited.
DOI: 10.5772/intechopen.73126
Biokinetics: A South African Health Profession Evolving
from Physical Education and Sport
Terry JeremyEllapen, Gert LukasStrydom,
MarietteSwanepoel, HenrietteHammill and
YvonnePaul
Additional information is available at the end of the chapter
Abstract
This chapter describes the South African profession of Biokinetics, which operates within
the pathogenic and fortogenic health paradigms. Biokinetics is an exercise therapy
profession that exclusively prescribes individulaised exercise and physical activity for
rehabilitation and promotion of health and quality of life. Biokinetics diers from phys-
iotherapy primarily due its management of injuries, illnesses and disabilities within the
nal-phase of rehabilitation. A brief history of the profession and its scope of profes-
sion and its alignment within the South African National Health statutory and profes-
sional bodies will be presented. The two pedagogic models adopted for the teaching
and training of Biokinetics will also be discussed. Interprofessional collaborative partner-
ships within the medical-rehabilitation fraternity, sport, health and tness industries and
educational employment opportunities will be reviewed. Finally, the idea of internation-
alisation of the profession of Biokinetics to similar exercise therapy professions such as
Clinical Exercise Physiology and Athletic Training will be presented.
Keywords: Biokinetics, exercise therapy, rehabilitation, health promotion
1. Introduction
The profession of Biokinetics is a specialised discipline of exercise therapy (ET), which
emerged from the South African Physical Education Programme. In the 1920s a medi-
cal and physical conditioning surveillance report surfaced, which identied South African
boys to be in poor health and physical condition [1, 2]. This prompted the South African
Defence Force (SADF) to establish the Physical Training Brigade in 1934 [1–3]. This specialised
© 2018 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.

interprofessional medical and rehabilitation collaborative unit addressed the poor medical
and physical condition of the boys joining the SADF, via the expertise of medical doctors,
dentists, nurses, physiotherapists, occupational therapists, social scientists and physical
education instructors. The focus of the South African Physical Education at that time was
ergogenic in nature and the research involved was to evaluate and subsequently prescribing
performance enhancing exercise or physical activity to improve the physical conditioning
of children. This research focused continued until, the late 1960s when a new additional
therapeutic focus emerged. The clinical rehabilitative research of Strydom (the salutogenic
eects of exercise therapy among coronary heart disease patients) and Buys (the salutogenic
eects of exercise therapy among diabetic patients) sowed the seed for the establishment of
the profession of Biokinetics [4, 5]. At the Potchefstroom (the PU for CHE, now North-West
University), a module on the salutogenic eects of exercise was taught, which was called
Kinetiotherapy. The philosophy behind this term reected the therapeutic benets of bodily
movement (kinesis) and the recognition should be sought from health professionals.
Concerted endeavours began in 1969, by the heads of the South African Human Movement
Science departments that produced a formal communiqué in 1973, to the then South African
Medical and Dental Council to include Kinetiotherapy on its register. However, the regis-
tration of this new exercise therapy profession (Kinetiotherapy) was not forthcoming due
to resistance from the professions of Physiotherapy, Occupational Therapy and Exercise
Science [6, 7]. The initial name of the new exercise therapy profession created considerable
tension among its distractors. Biokinetics comprises of two Greek words: “Bio” meaning life
and “Kinesis” meaning movement [8]. The literal interpretation of Biokinetics is “life through
movement”. Professor Gert Strydom’s persistent eorts with the South African Medical and
Dental Council (SAMDC), nally culminated with the ocial announcement of the registra-
tion of the profession of Biokinetics as a health discipline within the South African Government
Gazee on the 9th of September 1983, acknowledged as a profession on the professional board
of medical sciences of the South African Medical and Dental Council (SAMDC), which was
later renamed the Health Professions Council of South Africa (HPCSA) [7].
2. The scope of profession of Biokinetics
The HPCSA describes Biokinetics as a nal-phase functional therapeutic health related pro-
fession concerned with enhancing the physical and physiological health status of patients
through personalised evaluation and subsequent exercise and human movement prescrip-
tion in the context of chronic clinical and orthopaedic pathologies and performance enhance-
ment (pathogenic health paradigm) [9]. Biokinetics is also dynamically involved with health
and wellness campaigns and the prevention of orthopaedic injury and hypokinetic diseases,
advocating salutogenic eects of exercise (fortogenic health paradigm) [10]. The health and
wellness campaigns promote the salutogenic eect of exercise to combat non-communicable
diseases (NCDs) and their predisposing risks. At this point the biokineticist is working within
the pathogenic health paradigm (illness and illness prevention healthcare dimensions).
Further biokineticists also promote an active lifestyle as a protective mechanism to prevent
the occurrence of NCDs among healthy individuals, working from the fortogenic paradigm.
Sport and Exercise Science16

The orthopaedic rehabilitation focuses primarily on nal-phase functional rehabilitation,
which entails enhancing muscle strength and endurance, cardiorespiratory tness, range of
motion of joints, neuromuscular proprioception, functional movement paerns and patient
education [9]. Muscle strength and endurance have a strong isokinetic and isotonic foci inter
alia on both global and local muscles. Range of motion includes enhanced muscle and liga-
ment extensibility, thereby dissipating contractures through passive, active and resisted
movements [9].
Clinical rehabilitation of NCDs entails structured rehabilitative programmes aimed to enhance
cardiorespiratory tness, cardio-metabolic prole, range of motion, neuromuscular proprio-
ception thereby improving the patient’s quality of life. The following section will describe the
interaction of biokineticists within the health dimensions and paradigms (Figure 1).
2.1. Health dimensions and health paradigms
The pathogenic paradigm is inclusive of both the ill care dimension (whereby the pathol-
ogy is present) and/or illness prevention dimension (the elevated intrinsic risk of prospec-
tive pathology) (Figure 2) [11]. Both health dimensions require clinical interventions by
the medical discipline, which include general medical practitioners, nurses, medical spe-
cialists (such as cardiologists, endocrinologists and orthopaedic surgeons) and physio-
therapists [12]. The fortogenic health paradigm involves the individual, who is apparently
healthy, having no elevated intrinsic risk of pathology, but is interested to adopt physical
activity regimes to prevent risk of illness and/or illness and increase quality of life. The
health dimensions actively intersect each other, and such the respective medical practitio-
ners. This dynamic trespassing between the health paradigms encourages interprofessional
collaborations. Figure 2 provides a graphic representation of the dynamic overlapping of
the dierent health dimensions and the respective healthcare practitioners. The following
scenarios describe the potential trespassing among health dimensions and paradigms and
practitioners.
i. Area A displays the intersection of the pathogenic and fortogenic health paradigms,
known as the nal-phase rehabilitation, or post medical phase (Figure 2). During this phase
rehabilitation consists exclusively of physical activity and condition as the primary thera-
peutic modality. A popular example would be a cardiac patient who is on prescribed
Figure 1. Scope of profession of biokinetics.
Biokinetics: A South African Health Profession Evolving from Physical Education and Sport
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17

medication, undergone physiotherapy and lastly is referred to biokineticist [11]. The
biokineticist aims to enhance the patient’s cardiorespiratory function, quality of life and
encourage independent living through structured exercise and physical activity.
ii. Area B is known as secondary prevention, where the patient has a pathology, who has un-
derwent medical treatment and/or surgical intervention and has since engaged in nal-
phase functional rehabilitation (Area A) to prevent the predisposing pathology from dete-
riorating and/or developing co-morbidities. Referring to the previous example of a cardiac
patient who has successfully undergone cardiac surgery, followed by physiotherapy and
then the subsequent referral to a biokineticist. The objective of the biokinetic rehabilitation
would be to encourage the patient to maintain a physically active lifestyle (within safe
guidelines) to avert the recurrence and/or development of co-morbidities. Many cardiac
patients are keen to live physically active lifestyles, through the pursuit of enjoyable physi-
cally active games and sport (recreational therapy) [11]. Biokineticists functioning as recrea-
tional therapists prescribe enjoyable games, sport and physical activity regimes to engage
Figure 2. Articulation of the health dimensions in the health paradigms [10].
Sport and Exercise Science18

the patient in enjoyable movement simultaneously gaining the health benets that they
would have received from a rigid clinical rehabilitation programme [10]. These patients
would need to have regular cardiorespiratory evaluations to determine the status of their
cardiorespiratory function and whether the exercise therapy is eective. This interaction
forces interprofessional collaboration between cardiologists and exercise therapists.
iii. Area C refers to instances when a person is healthy, illness free, neither having any pre-
disposition to risk of pathology and wants to use physical activity as a proactive protec-
tive mechanism against illness and risk of illness (primary prevention). Such individuals
seek the expertise of biokineticists to prescribe a physical activity programme to increase
their physical conditioning and quality of life.
iv. Area D known as complication prevention occurs, when a patient has no pathology, but is
at high risk of developing a pathology due to an unhealthy lifestyle (Figure 2). Such a
patient would require the prescription of physical activity to diminish the predisposing
risk prole. People are subjected to modiable (excessive alcohol consumption, smoking,
diet, physical inactivity and stress) and non-modiable (age, gender, genetic disposition)
risk factors which adversely inuence their cardiorespiratory status and cardiometabolic
proles. The salutogenic eect of exercise and movement helps to lower the modiable
risk factors, improves quality of life and prevents premature morbidity and mortality
[12]. The patient falls within the illness prevention dimension, which is an extension of
the ill care dimension of the pathogenic paradigm. This patient requires the interprofes-
sional collaborative expertise of medical discipline (general practitioners, nurses, medical
specialists (such as cardiologists, orthopaedic surgeons and endocrinologists) and physi-
otherapists) and the bio-psych-social discipline (biokineticists, dieticians and psycholo-
gists) [13, 14]. Diabetic patients are common examples of patients who adopt a therapeu-
tic exercise programme to prevent the further metabolic deterioration [15].
3. National statutory and professional bodies
In this section the HPCSA and Biokinetics Association of South Africa (BASA) aliations of
the profession will be reviewed.
3.1. Health Professions Council of South Africa (HPCSA)
The profession of Biokinetics is a health related discipline, which is aliated to the HPCSA
formerly known as the SAMDC. In the late 1990s, the then SAMDC underwent reorganisation,
resulting in the formation of 12 health professional boards that are intended to guide the vari-
ous health professions, as the moo of the HPCSA is to protect the public and guide the profession
[8, 16]. Health professions with a related scope of profession were congregated under a spe-
cic health professional board. In 1998, the Professional Board of Physiotherapy, Podiatry and
Biokinetics (PPB) was formulated to safeguard and serve the interest of the public and chap-
eron the aforementioned professions consequently [16]. Subsequently, in 1999 the SAMDC
changed its name to the Health Professions Council of South Africa (HPCSA) [7, 8, 16].
Biokinetics: A South African Health Profession Evolving from Physical Education and Sport
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3.2. Biokinetics Association of South Africa (BASA)
On 17th October 1987 in Potchefstroom, the South African Association of Biokinetics (SAAB)
was instituted, with its inaugural oce bearers being elected. These oce bearers were
Prof. G.L. Strydom (President) (Potchefstroom University for Christian Higher Education),
Prof. J.M. Loots (Vice-president) (University of Pretoria), Prof. M.F. Coeee (University
of Zululand), Dr. J.F. Cilliers (South African Defence Force), Dr. D. Malan (Potchefstroom
University for Christian Higher Education), Ms. M. Delport (Potchefstroom University for
Christian Higher Education) and Mr. H. Daehne (University of Pretoria) [7]. Subsequently,
the nomenclature of the SAAB was transformed to the present BASA [8]. The principal pur-
pose of BASA is to serve its constituent biokineticists, intern biokineticists and the student
biokineticists-in-training [16]. Annually HPCSA registration of biokineticists is compulsory
to gain eligibility to practice. Without HPCSA registration it is a criminal oence for bio-
kineticist to practice. However membership of BASA is optional and the professional can
practice, without annual registration but does not enjoy any benets of the professional
association (BASA).
4. Education and training
In this section the two pedagogic models, tertiary training institutions and academic curricu-
lum is presented. Presently, there are two pedagogic models adopted by the 12 South African
universities that provide biokinetic training.
4.1. The twin pedagogic models of training
There is the former model (3 + 1 year model) and the new 4 year professional degree. The
former Biokinetics degree entailed a three-year undergraduate degree in Human Movement
Science or an equivalent (such as Human Kinetics and Ergonomics) followed by a post
graduate honours degree specialisation in Biokinetics (3 + 1 year model). During the post
graduate year of study, being the student’s 4th year, the incumbent begins their 2 years of
professional clinical internship [8, 16]. During the post graduate honours year, students are
obligated to aliate with the HPCSA and BASA as a student biokineticist-in-training, provid-
ing admissibility to commence their professional clinical internship. A student biokineticist-
in-training is in the process of completing a Biokinetics degree. During the fth year, the
student biokineticist-in-training must then aliate himself/herself with BASA and the HPCSA
as an intern biokineticist [10]. An intern biokineticist is a post graduate student biokineticist
who has successfully completed his/her academic university requirement of the Biokinetic
degree, but is presently concluding the ultimate year of professional clinical internship. An
intern-biokineticist must secure professional clinical internship at either private Biokinetics
practices or biokinetics training institutions (universities and SADF), which are endorsed
by HPCSA and BASA. Presently, professional clinical biokinetic internship is not accessible
in the South African public healthcare sector. During this year, the intern biokineticist may
receive a salary as per the incumbent’s negotiation with the biokineticist providing the
clinical internship opportunity.
Sport and Exercise Science20

4.2. Tertiary training institutions
There are many South African Biokinetics tertiary training institutions viz.: the North-West
University, University of Venda, University of Johannesburg, University of Free State, University
of Pretoria, Tshwane University of Technology, University of Zululand, University of Kwa-Zulu
Natal, Nelson Mandela Metropolitan University, University of Stellenbosch, University of Western
Cape and the University of Cape Town. The Nelson Mandela Metropolitan University, University
of Venda, University of Johannesburg, North-West University and University of Free State have
already instituted the new professional 4 year degree, while the other seven tertiary institutions
are preparing to follow suit [8].
5. Academic curriculum
Figure 3 illustrates academic curriculum of the 3 + 1 year model.
Figure 3. An illustration of the academic curriculum of the Biokinetics: 3 + 1 year model [17].
Biokinetics: A South African Health Profession Evolving from Physical Education and Sport
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6. Occupational career opportunities
In the discussion of biokinetic career opportunities national and international prospects will
be reviewed.
6.1. National career opportunities
Presently biokineticists are only eligibility to practice in the South African private health-
care sector. There are on-going negotiations for biokineticists to be allowed entrance into the
public healthcare sector. Despite this challenge, Moss and Lubbe have reported that there is
a viable private healthcare biokinetic patient market [18]. South African biokineticists pre-
dominantly operate in private biokinetic practices, corporate wellness programmes, private
school and the SADF. Private biokinetic practices and biokineticists employed by SADF gen-
erally mange the orthopaedic and sport injuries, clinical rehabilitation of NCDs and disabled
patients and feverously campaign the salutogenic eects of exercise. Many private schools
employ biokineticists to rehabilitate and guide their sport teams, physical educators and
sport co-ordinators.
Prominent South African corporate companies have engaged the expertise of biokineti-
cists to manage the health status of their employees, as part of a multidisciplinary medi-
cal rehabilitation team [19]. The multidisciplinary team includes medical doctors, nurses,
dieticians, occupational therapists, speech and hearing therapists and biokineticists. Large
South African companies and their medical insurers have developed medical schemes such
as the Med Benet and Discovery Vitality assessments, aimed towards health and wellness
campaigns, which mutually benet the employers (company), employees (patient) and the
medical insurer. Employees receive expert nutritional, exercise and health advice to empower
them to adopt a healthier life. The company benets healthier employees, who are absent less
thereby increasing productivity [19, 20]. The medical insurers lessen their nancial numera-
tion to employees/patients who receive biokinetic and occupational rehabilitation to manage
NCDs and occupational musculoskeletal related injuries due to the enhanced health of their
patients. Large South African companies such as inter alia BMW, ABSA Bank, First National
Bank, SASOL, Mondi Unlimited, have established multidisciplinary health and wellness cen-
tres at work residence to inspire employees to live healthier lifestyles. These corporations
have embraced the salutogenic eect of exercise.
6.2. Present international collaborative relationships between biokinetics and other
exercise therapy professions
The following section demonstrate the capability of biokineticists to practice as exercise
therapists in other countries, adding value to the health and well-being of society [20, 21].
International career opportunities for biokineticists currently exist in Namibia, Australia,
New Zealand, and the United Kingdom as clinical exercise physiologists. Further many bio-
kineticists practice as personal trainers in South Africa, United States of America, Namibia,
United Kingdom, Australia and New Zealand.
Sport and Exercise Science22

6.2.1. Namibia
At this time Namibia is the only other country that allows biokineticists to practice as bio-
kineticists. The biokineticist requires a work permit and registration with the Allied Health
Professions Council of Namibia (AHPCN) and Biokinetic Association of Namibia (BAN)
(AHPCN, 2017, Act 55 of 2004: RN 105 & 106) and completing a compulsory Council examina-
tion [22]. These Namibian biokineticists practise in the private sector, among corporate busi-
nesses, private practices, health and tness centres, and schools. Their eligibility to practice in
the public healthcare sector is also not yet forthcoming [23].
6.3. Clinical exercise physiology (CEP)
International biokinetic career opportunities exist for biokineticists to practice as clinical
exercise physiologists in Australia, New Zealand and the United Kingdom. Biokineticists
need to aain recognition of prior learning and then complete the respective national
entrance board examination. However a clinical exercise physiologist’s scope of profes-
sion includes the following health care services: (i) chronic disease rehabilitation, (ii) the
management of predisposing chronic disease risk factors, (iii) the propagation of an active
and healthy lifestyle, (iv) enhancing the ease of elementary daily activities, and (v) foster-
ing continued physical, social, and economic independence [24, 25]. There is no profes-
sional biokinetic association in the USA, United Kingdom, Australia or New Zealand, nor
is the profession of Biokinetics registered with the respective national health and medi-
cal statutory bodies. Ellapen et al. reported that although CEP and Biokinetics share simi-
lar educational curricula and management strategies, CEP focuses on the management of
NCDs while Biokinetics rehabilitates both clinical pathologies and orthopaedic injuries in
the pathogenic paradigm and enhances the quality of life in the fortogenic paradigm [25].
While the scope of profession of CEP is more limited than that of biokineticists, the ability
to practice as a CEP nevertheless presents a lucrative opportunity, allowing biokineticists
to practice internationally.
6.3.1. Botswana and India
While biokineticists practice in Botswanan private hospitals and corporate businesses, there
is however no professional body governing the profession of Biokinetics nor registration
with the Botswana Ministry of Health [26]. Marias reported that there is a need for biokinetic
rehabilitation in Botswana in order to improve the country’s quality of life [27]. Anecdotal
reports of Indian and Botswanan universities expressing interest in the profession of
Biokinetics have circulated, but no rm steps have been initiated. Collaboration between
BASA and the interested universities need to be undertaken so as to create an undergradu-
ate degree in Biokinetics, which, it is hypothesised, will pave the way for the establishment
of Indian and Botswanan Biokinetic professional bodies. The registration of these bodies
with the respective national health and medical statutory bodies coupled with the formali-
sation of a national Biokinetic undergraduate programme will in turn create beer career
opportunities for biokineticists in Botswana and India.
Biokinetics: A South African Health Profession Evolving from Physical Education and Sport
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7. Conclusion
Table 1 provides a synopsis of the profession of biokinetics, adopted from Paul et al. [28].
Table 1. Synopsis of the profession of Biokinetics.
Sport and Exercise Science24

Acknowledgements
The authors would like to acknowledge the support, encouragement and funding from the
North-West University, South Africa.
The authors would like to thank Pro. Awie Koe (Dean of the Faculty of Health Science,
North-West University) and Hans De Ridder (Director of the School of Human Movement
Science, North-West University) for their tremendous support and encouragement.
Conict of interest
There is no conict of interest.
Author details
Terry Jeremy Ellapen1*, Gert Lukas Strydom1, Mariee Swanepoel1, Henriee Hammill1 and
Yvonne Paul2
*Address all correspondence to: tellapen1@yahoo.com
1 North-West University, PhASRec, Potchefstroom, South Africa
2 Department of Sport, Rehabilitation and Dental Science, Tshwane University of
Technology, Tshwane, South Africa
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