PEPonline Professionalization of Exercise Physiologyonline An international electronic journal for exercise physiologists ISSN 1099-5862 Vol 5 No 11 November 2002   The Exercise Physiology Code of Ethics: A Dilemma or a Standard of Conduct? Tommy Boone, PhD, MPH, MA, FASEP, EPC Professor and Chair Director, Exercise Physiology Laboratories Department of Exercise Physiology The College of St. Scholastica Duluth, MN 55811 “Why are individual faculty, whose lifetime work is dedicated to the advancement of new thought, so apparently unwilling to take risks.” – Sharon A. Baiocco and Jamie N. DeWaters [1] DERIVED FROM THE Greek term ethos, ethics refers to conduct and character that includes the notion of approval or disapproval [2].  Similarly, the exercise physiology Code of Ethics deals with the important questions of conduct that have relevance to us as professionals.  Ethics raise the question of what is right or wrong.  The word implies a right way to do something and a wrong way.  Exercise physiologists are not exempt from ethical dilemmas in their practice.  Those who have wondered if educated professionals can be stupid do not have to look too far, particularly with reference to the following three dilemmas: 1. Ethical decisions regarding the use of grants for research from companies that have an invested financial interest. 2. Failure to make full, critical disclosure of academic and/or research information that influences self-determination.  3. Refusal (or failure) to confront the public sector problems faced by students and members of the emerging profession.  It is possible of course that the three dilemmas can be viewed as ethical and acceptable, unethical and unacceptable, ethical and unacceptable, and unethical and acceptable.  But, even so, what is the point?  All four possibilities exists when exercise physiologists fail to agree on the ethical answer to “What is the dilemma?  And, even seasoned researchers with a reputation for some good research show ‘stupid’ behavior.”  For that reason, it is important that we come to terms with the seemingly inexplicable behavior.  Why do intelligent people think and behave in ways contrary to good common sense?  This article is devoted to addressing these questions, which the vast majority of exercise physiologists seem to neglect.  One way to tackle this problem is implicit in the exercise physiology Code of Ethics.  This would allow the analysis of the following questions to be treated as function of what is implied by the Code.  1. What is the right (ethical) behavior of an exercise physiologist who appears to promote a product without scientific evidence to support it?  2. What should the exercise physiologist say about the major difficulties with serious, scientific misconduct?  3. What responsibility do exercise physiologists have in helping to professionalize exercise physiology?  It’s time to stop and take measure of these questions and to be mindful of the kind of behavior that arises when there isn’t a Code.  We owe our students more thought and analysis on this subject.  If what we have been doing is ethical, is it acceptable to continue doing so?  If it is unethical (and therefore unacceptable), then something must change.  My point is this: Do non-ASEP academic exercise physiologists have the right to simply dismiss the effort of the American Society of Exercise Physiologists to professionalize the field?  Some feel that students have specific rights and, in particular, the right to the support of their teachers on their behalf.  To refuse to support ASEP may therefore be interpreted as an ethical dilemma that is seriously inconsistent with a professional education.  Therefore, it is inexcusable for the academic exercise physiologist to overlook obvious evidence that the ASEP Code of Ethics is consistent with other ethical procedures of recognized healthcare practitioners.  The question of why they appear to deny the existence and/or significance of the Code raises a multitude of issues. “Ethical or unethical business practices usually reflect the values, attitudes, beliefs, and behavior patterns of the organizational culture; thus ethics is as much an organizational as a personal issue.”  -- Richard L. Daft and Dorothy Marcic Denial is complex, ambiguous, and hard to understand.  It is also a serious problem when it comes to professional conduct. What is important to note here is that if the exercise physiology Code of Ethics is not recognized, then distinction as a profession is not possible.  We must recognize the fundamental changes underway in the delivery and practice of exercise physiology if we are to provide a means of professional self-regulation.  The Code cannot be a fad or a fabric of the emerging profession that is seldom discussed or embraced.  There must be an enduring commitment to the Code and to ethical research in exercise physiology.  And yet it is obvious from the lack of publications about exercise physiology ethics, quackery, and fraud that few exercise physiologists appear ready to accept the change in their reality.  It is not a matter of ideas and behavior resulting from inadequate information and resources.  After all, the ASEP Code of Ethics can be seen on the ASEP contact page.  Ironically, perhaps, one answer is as basic as colleagues becoming too smart or special in how they think about themselves.  Simply stated, they have become too focused and too centered on being smart (i.e., what to think) rather than on the constant challenge to learn how to think. “He who cannot change the very fabric of his thought will never be able to change reality.”  -- Anwar El-Sadat A case in point is the adoption of an attitude against exercise physiologists having their own professional organization.  As we will come to understand, such thinking is driven by wrong ideas.  How we manage the ideas and how we grow over time determine the rate and quality of our commitment to the new exercise physiology driven by the ASEP leadership.  Yet, in face of this view, there is no reason to think that the significantly improved credibility of exercise physiology since the founding of ASEP will slow down.  And, still, we also know that unless something is done about the current trends in exercise science (or by other titles such as kinesiology, sports science, human performance), then the world will see more graduates without credible jobs.  This implies that the continued duplication of bad programs of study will only add to a poor futuristic view of exercise physiology.  Talk about a bad mind-set!  It is for this reason that the lack of respect for professional rules and standards tell others why we are culturally viewed as little more than fitness experts.  Some even think of us as physical educators while others, in contrast, view us with a highly valued commodity.  Which view is correct?  This does, in fact, define our problem.  It is also a function of traditional thinking that has been unchanged for some time, especially since exercise physiologists have not had a clearly-stated mission. “A clearly-stated mission provides more than a ‘common cause’.  It also can provide an ethic for the firm, or way of seeking to do what is right and avoiding what is wrong.”  -- C. William Pollard [3] It was not until “a suggested Code” was published in the January 1995 issue of The Exercise Standards and Malpractice Reporter [4] that it was determined that the medicolegal considerations for an ethical exercise physiology practice should reside in the Code.  With the founding of the ASEP organization in 1997, the Board of Directors accepted and approved the Code of Ethics as a professional guide for all members of the organization.  Finally, the profession had an official Code of Ethics.  Is it likely that it will change across time?  Codes are necessarily static.  At some point, it will be revised to keep in step with the members’ sense of professional freedom and the effort to establish exercise physiology as a legitimate “profession”.  The concern for ethics, if not the soul of exercise physiology, will no doubt be reflected when the members of the Board of Directions undertake a revision at some point in the future.  Perhaps, before confronting a change in the Code or whether a change is even appropriate at this time, it is appropriate to deal with the three ethical dilemmas mentioned earlier. Grants, Research, and Publishing  A number of academic exercise physiologists write research proposals for grants to help with the financial obligations of doing research.  This is not new or necessarily a problem, but it can be a problem depending on how the research conclusions are presented.  Indeed, in recent years, researchers from different fields of study believe that it has become an ethical problem and a moral conflict that needs immediate clarification and resolution.  The concern of ethics has to do with the accuracy and interpretation of the findings.  Otherwise, what is the point of statistical analysis and published research?  In short, the principal aim of published research in exercise physiology is to provide consistency to a more precise management of ideas.  Hence, the first question is always: Have the authors presented the data and the conclusions in the most ethical manner possible?  Well, what do you think?  Like most exercise physiologists, I figured that everyone was always publishing the truth.  It was not until some time into my teaching career that I realized that some research articles simply did not make sense.  Either the author(s) used the wrong statistics, interpreted the data wrong, or made conclusions that were not consistent with the findings.  Eventually I came to understand that some research articles are little more than a “product” market for a specific reason.  Now that I understand the “big picture” or the view that others may have always understood, it is no longer surprising to me when reading articles that some authors have failed as scholars.  Disagreement about the design, the statistical application(s), and the interpretation(s) is always a step away, but it should not constitute an obvious conflict in the integrity of practitioners and their work.  Indeed, the discerning eye that sees through the lack of professionalism is the striking picture of the 21st century exercise physiologist.  Why is this important?  Because professionalism is about honoring a Code of Ethics, especially during times when healthcare ideas are undergoing sweeping changes.  It is very likely that these changes are founded on the idea and financial consciousness that more is better.  Is more better even when it is wrong?  Are the “get rich” opportunities the best guide for character development and, if so, what is the role of the standards of conduct that define the essentials of honorable behavior for the exercise physiologist?  It is unfortunate that a fair piece of our research is little more than advertisements for products that have limited if any benefit to the public sector.  For this reason, the current system for securing research money should change because of the confluence of business conditions that create serious questions regarding professional integrity.  As an example, consider the Principles 4, 6, and 10 adopted by the American Society of Exercise Physiologists: 4. Exercise physiologists are expected to conduct health and fitness, preventive, rehabilitative, educational, research, and other scholarly activities in accordance with recognized legal, scientific, ethical, and professional standards.  Why is this standard important?  I believe it was the American writer, Ursula K. LeGuin, who said: “It is good to have an end to journey toward; but it is the journey that matters, in the end.”  The honoring of what we do as professionals requires a commitment to excellence in the science of our practice and a commitment to our set of ethical behaviors.  Every paper we publish along the way is a reflection upon our journey and, in the end, it will be the papers that define us.  If our work shows that we have been traveling in the right direction with a commitment to excellence in research and scholarly activities, then our progress can be measured by what we have done.  6. Exercise physiologists are expected to call attention to unprofessional health and fitness, preventive, rehabilitative, educational, and/or research services that result from incompetent, unethical, or illegal professional behavior.  Why is this standard important?  As professionals, even when we would rather not disagree with our colleagues, it is important that we remain credible in our actions.  In short, there are actions resulting from advances in technologies and personal self-interests that must not be tolerated [5].  Unethical uses of science and technology, either personally or by association, harms the profession we serve as well as our fellow exercise physiologists.  It is therefore unthinkable and unwise not to bring attention to unprofessional services.  Remember, in actuality, it is no different from the student who is looking on another student’s paper for the answers.  The behavior is not (or should not be) tolerated.  To allow it to take place without doing anything about it is to argue that the educational process itself is meaningless and/or has no integrity.  What we do must have meaning and direction if we are going to realize our goals.  10. Exercise physiologists should provide health and fitness, preventive, rehabilitative, and/or educational interventions grounded in a theoretical framework supported by research that enables a healthy lifestyle through choice.  Why is this standard important?  The obligation to provide ethical care grounded in good science is the obligation of every member of the profession.  It is both a privilege and a responsibility to regulate the conduct of what we do, individually and collectively.  This point has two lessons:  First, if we can accurately convey the real value in exercise, more people will embrace it as part of their lifestyle.  Second, don’t be surprised when people turn away when frustrated by our wishful thinking or the insistence that “our way” is the better way when we have failed to ground our thinking with disciplined research.  Change is a challenge and, most importantly, with it must come an understanding and sensitivity to both integrity in research and the kind of service that is helpful in meeting the needs of society.  It is imperative therefore that we look critically at what we are doing (especially within the framework of research).  The final chapter isn’t written for sure, but there is considerable room for improvement.  For example, let us imagine the worst resulting from our research where we allow the communication of our work in the form of a published article that the conclusions are false.  The impact may be profound on those who are willing to believe anything they read.  Naturally, the author(s) may understand why the conclusions were written in a particular manner (especially if the research is related to a grant).  What is obvious (or should be) is that the reader will not know about the admixture of research conclusions and grant funding!  What may be viewed as a scientific publication by the public may in actuality be little more than an advertisement.  This is an unfortunate, if not, a sad view of what was once an ethical effort on behalf of researchers.  When asked, “What happened?”  -- the only answer it seems is that the researcher(s) priority changed.  As a result, neither exercise physiologists nor their students can assume that “scientifically” published research is credible.  Naturally, the problem with researchers who make poor judgments is that the assumed rightness of their actions in relation to the publication can no longer be preserved.  This means that the peer review process that has been used to judge research quality needs reviewing.  Often, there are conflicting if not confounding variables with reviewers including, but certainly not limited to their ability to think critically, their research and/or professional experiences, and whether they are competitors or friends.  These factors and others have a direct bearing on whether an article is true or accurate when published in an important journal and, unfortunately, most students assume that if it is published it must therefore be accurate [6].  The relationship of exercise physiologists to each other as well as the dignity of the profession is viewed as less than professional when fraud and misconduct are found in their science.  Exercise physiologists have the obligation to conduct themselves in accord with the ideals of the profession.  The Exercise Physiology Code of Ethics should therefore mean something, especially since it helps the practitioners to meet the exercise physiology service-needs of the 21st century society.  The Code serves as a guide to its members in their day-to-day work activities.  It helps them arrive at professional conclusions and time-honored principles of professional thinking [7].  Ideally, exercise physiologists should observe the ethical principles because they understand that the principles define who they are and what they do.  “The ultimate purpose of being a professional is not, or should not be, simply to do research.  Nor is it merely a system of promoting oneself, as in tenure.  The promise of professionalism is to associate with other professionals who embrace the ethical philosophy and path of professionalism.” – William T. Boone, Jr.  Failure to Think Straight Leads to Disclosure Problems The reality is that exercise physiologists are by and large good people.  They have spent time and money in pursuit of the right ideas to prevent and/or promote physical and mental well being.  But their decision making and advice at the end of the day in regards to health, fitness, and rehabilitation often times reflects a ready-made answer found in traditional thinking.  Few seem ready to question the founding principles or discern the diversity of choices for action as a complex human being.  That is, the content of exercise physiology is at times simply over-bearing and too narrow in its interpretation of many aspects of health and/or disease related matters.  Even at a gut-level feeling, the delivery of information is clear about what not to do.  But it seldom functions at a level to clarify the unclear.  1. Exercise physiologists should accurately communicate and provide health and fitness, educational, preventive, rehabilitative, and/or research services equitably to all individuals regardless of social or economic status, age, gender, race, ethnicity, national origin, religion, disability, diverse values, attitudes, or opinions.  Why is this standard important?  An accurate communication of exercise physiology concepts and ideas is critical to achieving professionalism.  9. Exercise physiologists should participate in and encourage critical discourse to reflect the collective knowledge and practice within the exercise physiology profession to protect the public from misinformation, incompetence, and unethical acts.  Why is this standard important?  New, ASEP exercise physiologists exist because the old-style academic-researcher-only is slowly but surely changing.  The idea that research will provide the student with the paid-for-product (i.e., the academic degree) fails to demonstrate a responsible understanding of the purpose of a college education.  It is clear to me that many academic exercise physiologists understand this point, but appear inadequate when faced with the profound challenge to support the infrastructure of the new exercise physiology.  Students, in particular, need an education to help them think critically with a collective understanding that goes beyond what to think.  College teachers should be paid for how well they teach critical, multifaceted thinking of the complexity of life and disease, not the results of continued memorization of the traditional public health agenda and, therefore, the simple mandates of thinking that A leads always to B.  The sense of invulnerability, as a teacher, may come from the presence of the illusion of protection [8].  After all, it is the teacher who passes along the knowledge that others use in order to achieve success in life.  2. Exercise physiologists should be responsible and accountable for individual non-medical judgments and decisions about health and fitness, preventive, rehabilitative, educational, and/or research services. Why is this standard important?  A case can be made that exercise physiology does not have a defined leadership in academia.  We know there is essentially no discussion about which courses should be taught, how they should be taught, and what kinds of technology and hands-on experiences are required to develop the best students.  This is not the only problem.  There simply is not enough guidance by college teachers or the communication between the administrators of university programs or among exercise physiologists in general to argue for an ethical rightness and/or proper overview of the enormous assumed benefits of the vast array of different academic degrees.  Here is the problem: Students should get what they pay for.  And, if students fail to get what they assume they are getting, both in an education to think critically and in an academic degree to secure a credible and financially rewarding job, then it comes down to a terrible performance by the teachers.  This point of view is especially significant if the teachers are failing in an important modification of curriculum for better learning and integrated understanding of disease prevention and risk factor assessments.  5. Exercise physiologists should respect and protect the privacy, rights, and dignity of all individuals by not disclosing health and fitness, rehabilitative, and/or research information unless required by law or when confidentiality jeopardizes the health and safety of others.  Why is this standard important?  Respecting and protecting the privacy, rights, and dignity of others defines the professional.  Our relationship with others is what our thoughts make of it.  If we think positive thoughts and have the conviction to be professional in our work, then we will certainly be on the right road to ethical behavior.  It may sound a bit too easy, but respecting the rights of all individuals is a power we hold in our heads [9].  It is a mental attitude: We either think as professionals or we don’t.  The reality is if we do, then we are and, if we don’t, we aren’t. An Ethical Dilemma The concerns of ethics also have to do with personal conflict between two paths.  One is obvious because it has always been the way.  The other (or alternative) is either de-emphasized or made fun of because it conflicts with perceived responsibility and/or duty.  The first problem is in believing in the notion that the historical way is always the right way.  What is the meaning in doing something wrong, especially when it is hurtful just because it is safe and non-threatening?  The second problem is characteristic of one form of behavior that failed to mature; behavior that denies responsibility and action that has significant implications for students.  The stakes are very high, especially with the spotlight on the students’ huge financial sacrifice and the motivation to “get a better job” and “make money”.  Today, professors are teaching students who are paying customers and they paying for a product [1,10]. 3. Exercise physiologists should maintain high quality professional competence through continued study of the latest laboratory techniques and research in preventive and rehabilitative services. Why is this standard important?  Frankly, if there is an evaluation of an academic program, it is consistently geared to the number and type of course offerings, not the number and type of laboratory offerings.  Yet, the quality of professional competence is directly a function of the latest laboratory equipment that is used by the students, not just by the faculty.  Students must have the opportunity to calibrate metabolic analyzers (and, similarly, use and become accustomed to other laboratory equipment that measures strength, flexibility, and muscular endurance), ask research questions, create data collection protocols, statistically analyze data, and write up research reports with clarity and precision of a professional.  If the students cannot pass the ASEP Board of Certification exam, either the teachers’ motivation and/or teaching techniques should be evaluated and/or improved.  7. Exercise physiologists should contribute to the ongoing development and integrity of the profession by being responsive to, mutually supportive, and accurately communicating academic and other qualifications to colleagues and associates in the health and fitness, preventive, rehabilitative, educational and/or research services and programs.  Why is this standard important?  As a reality check, we should support the professoriate (faculty) on the basis of the professional performance of their students.  If the students’ ongoing development and integrity are consistent with the body of knowledge of exercise physiology professionals, the faculty should be congratulated.  If the results are less than impressive, then the faculty should consider either a different job or what is necessary to improve the students’ chances of securing a professional job in the public sector.  This should not come as a surprise or as a threat to the faculty working to improve exercise physiology; a process that begins with small but significant incremental steps with students.  8. Exercise physiologists should participate in the profession's efforts to establish high quality services by avoiding conflicts of interest and endorsement of products in the health and fitness, preventive, and/or rehabilitative services and programs.  Why is this standard important?  Without a shared sense of purpose and a unified vision, it is next to impossible to work together and/or create something special.  This is an important reason people tend to devote less time and attention to the objectives of an organization.  It is also a reason why exercise physiologists fail to avoid conflicts of interest and endorsement of products that threaten credibility.  The final test of ASEP and its membership (including the leadership) is that they must have a positive impact on the entire spectrum of professionalism.  In other words, ASEP exercise physiologists must endorse products that are supported by sound research.  It is astonishing that so few academic exercise physiologists understand the negative consequences of continuing the same unwarranted and unwanted (and even outdated) thinking.  Talk about a moral dilemma!  Talk about an ethical concern!  Ethics appear to be the last thing on the minds of some exercise physiologists, and yet one of the essential features of a profession is that it is self-regulating [5].  Their commitment to traditionalized thinking continues to raise many of the same research questions.  The question that should be researched is whether the academic exercise physiologists are in touch with the reality of their students?  With all due respect (and personal pride as a college professor), there is also the question of whether we can justify our existence if the very foundation upon which we evolved is not reinforced with new thinking.  Even one person can make a difference; think about it.  To continue to ignore the power of past thinking on higher education is patently foolish.  To continue to ignore the importance of our code of professional conduct and the work that other healthcare practitioners have put into their codes is a major problem.  A code of ethics is essential to establishing professional standards that define a profession [11]. “It is from numberless diverse acts of courage and beliefs that human history is shaped.  Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out injustice, he sends forth a tiny ripple of hope.”  -- Senator Robert F. Kennedy (1925-1968) Final Thoughts: What is Our Professional Responsibility? As far as I am concerned, seldom is the opportunity for change so desperately needed.  Members of the emerging profession must ask themselves, “Who are we, and what is our purpose?”  And, in fact, seldom have so many good college teachers failed to acknowledge the cultural change before them.  This fact alone is a significant loss in confidence in those who profess to nurse and/or build the curricula of job opportunities through their teaching.  Yet despite the hardships of our students when they graduate, those who enjoy tenure continue to do so while their students have a hard time in finding a job to secure finances.  Today’s professors are faced with the challenge of not just shared values and education but the question of careers, too.  Whether we like it or not, the current system is not working.  The caveat here is critical: College teachers must come to understand that professional programs of study are grounded in ethical reasoning, moral concerns, and values that reflect upon the students and the profession.  Why?  “A code of ethics is a formal statement of the company’s ( organization’s) values concerning ethics and social issues; it communicates to employees (members) what the company (organization) stands for” [12].  As a member of the ASEP organization, members will almost surely face ethical dilemmas.  The answers to the following questions [12-14] will help you to think about the professional, social, and ethical consequences of your actions, relationships, and/or research proposals: 1. Is the dilemma really what it appears to be?  If you are not sure, it is your responsibility to find out. 2. Is the action, relationship, and/or proposal you are considering legal and/or ethical?  If you are not sure, it is your responsibility to find out.  3. Do you understand the thinking and/or rationale of those who oppose the action you are considering or you are presently engaged in doing? If you are not sure that you can justify your actions, it is your responsibility to speak with a person who does and come to terms with the dilemma.  4. Does your action, relationship, and/or proposal benefit you, yet may harm others (if nothing else by mis-information)?  If you are not sure, it is possible that your involvement may be a mistake. 5. Are you convinced of the benefit of the action, relationship, and/or proposal that you would encourage everyone to purchase and/or consume or use the product?  If you are not sure, it is your responsibility to determine the scientific merit of the product.  6. Have you considered speaking with a person who has scientific knowledge about the product?  If you have not done so, why not?  Knowing what to think is not always easy.  Speaking with someone who would be objective may be very helpful. 7. Would your action, relationship, and/or proposal be embarrassing to you if others knew what you were doing?  If you are not sure, it is your responsibility to find out.  Ask a friend from a related area of work or, perhaps, a coworker. “It is a professional obligation to uphold and abide by the exercise physiology Code of Ethics and ensure that exercise physiology colleagues do likewise.”    References 1. Baiocco, S.A. and DeWaters, J.N. (1998). Successful College Teaching. 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Academe, 80(5), September/October, 38,41. 11. Kelly, L.Y. (1992). The Nursing Experience: Trends, Challenges, and Transitions. New York, NY: McGraw-Hill, Inc. 12. Daft, R.L. & Marcic, D. (1998). Understanding Management. 2nd edition. New York, NY: The Dryden Press. 13. Pagano, A.M. & Verdin, J.A. (1988). The External Environment of Business. New York, NY: Wiley. 14. Badaracco, J.L. & Webb, A.P. (1995). Business Ethics: A View from the Trenches. California Management Review. 37(2), 8-28. Copyright ©1997-2007 American Society of Exercise Physiologists   All Rights Reserved.