Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the late 20th century that sports medicine has emerged as a distinct field of health care. Medicine doctors are specialist physicians who have completed medical school, appropriate residency training and then specialize further in sports medicine or 'sports and exercise medicine' (the preferred term). Specialization in sports medicine may be a doctor's first specialty (as in Australia, Netherlands, Norway, and Italy). It may also be a sub-specialty or second specialisation following a specialisation such as physiatry, family medicine, paediatrics or orthopaedic surgery. The various approaches reflect the medical culture in different countries. Specializing in the treatment of athletes and other physically active individuals, sports and exercise medicine physicians have extensive education in musculoskeletal medicine. SEM doctors treat injuries such as muscle, ligament, tendon and bone problems, but may also treat chronic illnesses that can affect physical performance, such as asthma and diabetes. SEM doctors also advise on managing and preventing injuries. SEM consultants also deliver clinical physical activity interventions, negating the burden of disease directly attributable to physical inactivity and the compelling evidence for the effectiveness of exercise in the primary, secondary and tertiary prevention of disease.