Defining the
Exercise Physiologist
Tommy Boone, PhD, MPH, FASEP
Professor and Chair
Department of Exercise Physiology
College of St. Scholastica
Duluth, MN
Exercise physiology is a
profession much like physiology. The difference is that the study
of exercise physiology is specific to the body's response and adaptation
to exercise. However, it is more than running faster or longer.
Exercise testing, exercise prescription, exercise nutrition, and cardiac
rehabilitation are equally important subject areas. Heart patients,
for example, can benefit from exercise physiology just as athletes do.
Cardiovascular and metabolic effects and mechanisms are at the heart of
understanding exercise physiology.
Part of this understanding
and what we think exercise physiologists do depends upon the definition
of what is an exercise physiologist. Once the definition is understood,
then one goes about defining responsibilities. But, what if the definition
is too narrow, too board, or simply wrong? What then?
The definition of the exercise
physiologist must be as precise and definitive as a company's mission statement.
It is the distinguishing "light at the door" that guides and defines the
qualified from the unqualified. In short, the right definition points
the profession in the right direction.
U.S.
Department of Labor
The United States Department
of Labor's
Dictionary of Occupational Titles (U.S. Department of
Labor, 1991) defines an exercise physiologist as one who:
"Develops, implements,
and coordinates exercise programs and administers medical tests under a
physician's supervision to promote physical fitness."
Interpretation: To promote
physical fitness.
Population: The scope
of practice appears to speak primarily to cardiopulmonary patients.
Question: How does
the exercise physiologist promote physical fitness?
Answer: By developing,
implementing, and/or coordinating exercise programs. How?
-
Explaining the program to the
participants
-
Explaining the stress test procedures
-
Obtaining medical history
-
Recording heart rate via ECG
-
Measuring oxygen consumption
-
Measuring lung function
-
Measuring percent body fat
-
Performing blood samples for
cholesterol analysis
-
Performing glucose tolerance
test
-
Interpreting test results
-
Scheduling examinations and
tests, such as
-
Physical examination
-
Chest X-ray
-
Urinalysis
-
Recording test data in patient's
chart
-
Entering patient's data in computer
-
Writing initial/follow-up exercise
prescriptions
-
Conducting individual/group
exercises, including
-
Aerobic
-
Strength development
-
Flexibility training
-
Looking for exercise-related
signs of stress
-
Teaching behavior modification
classes, including
-
Stress management
-
Weight control
-
Related subjects
-
Ordering materials/supplies
-
Calibrating test and exercise
equipment
-
Supervising work activities
of other staff
Requirement: Physician
supervision.
Problem: From the
ASEP perspective, there are several concerns:
-
The U.S. Department of Labor's
definition is too restrictive. It reduces the definition of the exercise
physiologist to that the clinical exercise physiologist, as if cardiopulmonary
is the only career option available.
-
While physician supervision
is also commonplace with other medical professionals, nurses, physical
therapists, dietitians, and others are afforded significantly more freedom
to engage in their professional work. There are other issues that
deserve our attention as well (Carter
and Bentley, 1997).
-
The definition suggests that
the exercise physiologist is a technician. However, the most striking
point before us is that exercise physiology is not (and should not be)
clinically driven. Exercise physiology has to be an academically
driven profession.
Summary: The definition
is essentially the same as ACSM's definition of the clinical exercise physiologist
(ACSM, 1996).
ACSM
The American College of
Sports Medicine defines the clincial exercise physiologist as someone who:
"...works in
the application of exercise and physical activity for those clinical and
pathological situations where it has shown to provide therapeutic or functional
benefit."
Interpretation: To provide
therapeutic or functional benefit.
Population: Patients
for whom services are appropriate may include, but are not limited to the
following diseases and/or conditions:
-
Cardiovascular
-
Pulmonary
-
Metabolic
-
Immunologic
-
Inflammatory
-
Orthopedic
-
Neuromuscular
-
Populations
-
Geriatric
-
Pediatric
-
Obstetric
Question: How does the
clinical exercise physiologist provide therapeutic or functional benefit?
Answer: By applying
exercise principles and concepts. How?
By performing exercise:
-
Evaluations
-
Prescriptions
-
Supervision
-
Education
-
Outcome evaluations
Requirement: Physician
supervision.
Problem: The ACSM
Scope of Practice (ACSM, 1999) is written to identify and register the
clinical exercise physiologist, not the exercise physiologist. It
is restricted primarily to cardiopulmonary rehabilitation whereby the clients
must be referred by or under the continued care of a licensed physician.
The document defines the exercise physiologist by clinical procedures and
rehabilitation principles. It is the path of least resistance, which
can not sustain the transition to being an academically driven profession.
Summary: The definition
of the clinical exercise physiologist by ACSM and the definition of an
exercise physiologist by the U.S. Department of Labor are essentially the
same. Why? Because the items listed in the "Answer" section by the
U.S. Department of Labor are the same laboratory and hands-on exercise
skills required to perform items listed in the "Answer" section by ACSM.
The Missing Ingredient
What could possibly be missing
from these two definitions? The answer is obvious or, at least, it
is to the professionals who graduate from other fields of study.
Because they graduate from professional programs, there is the understanding
that academic undergraduate and/or graduate courses are linked to professional
outcomes. Otherwise, the emphasis is upon applied or technicial aspects
of one's job. Education per se is underplayed.
ASEP
The American Society of
Exercise Physiologists defines an exercise physiologist as:
"...a person
who has completed at least an undergraduate degree (or emphasis) in exercise
physiology (science)."
Interpretation:
Once an individual is defined as having graduated from an exercise physiology
(science) academic program of study, then the next question isn't all that
necessary. That is, "What does an exercise physiologist do?
It is important that the sequence is correct and, for the most part, once
the academic preparation for a profession is understood then the second
question is a moot point. For example, you wouldn't ask "What does
a nurse do?" Instead, if an individual were to refer to him- or herself
as a nurse, in general, it would be understood what he/she does.
The historical lack of emphasis on the exercise physiology students' education
has unfortunately resulted in the emphasis on services. Had emphasis
been properly placed from the beginning, exercise physiologists would be
in the same grouping as other professionals, that is, by title not by service.
Population: The word
"client" takes the place of "patient." The work environment defined by
the word "patient" is too restrictive. This is true even though most
exercise physiologists who work in the clinical realm are non-PhDs.
There are other career opportunities. Exercise physiology is not
just about clinical issues, however important and appropriate as a desired
career option. The exercise physiology scope of practice is much
larger and defined no differently as, for example, a psychologist who treats
the population at large, although specialization is always a possibility.
Question: How does
the exercise physiologist provide professional services?
Answer: By acknowledging
that the exercise physiologist's primary objective is to serve the public
by optimizing human performance. How? By sharing, guiding,
counseling, and educating clients with an interest in:
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High performance human physiology,
including
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Business
-
Astronauts
-
Pilots
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Underwater explorers
-
Athletes
-
Environmental extremes, including
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Heat
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High humidity
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Cold
-
High altitude
-
Pediatric health, fitness, and
screening
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Community health, fitness, and
wellness, including
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Life-style modification
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Risk factor screening
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Disease prevention
-
Cardiopulmonary rehabilitation,
including
-
Administering graded exercise
tests
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Measuring/interpreting cardiovascular
variables
-
Measurement of hemodynamic variables
-
Exercise prescription specifics
-
Emergency protocols
-
Diabetic, obese, and other special
populations
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Athletes at all levels, including
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Strength and flexibility development
-
Anaerobic and aerobic training
-
VO2 max, metabolic threholds,
and competition
-
Promoting wellness in industrial
settings
-
Motivating and managing athletes
-
Human physiological research,
including
-
Research design
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Statistical analysis
-
Publishing
-
Developing and marketing fitness
products
-
Behavior and/or mind-body changes,
including
-
Progressive relaxation protocols
-
Stress reduction techniques
-
Mental and exercise strategies
-
Exercise nutrition
Requirements: Academic
degree in exercise physiology (science) or a concentration in exercise
science. Exercise Physiologist Certified (EPC) by the ASEP Board
of Certification.
Problem: ASEP is still
in the development phase of the EPC Examination.
Summary: Once the
EPC Examination is implemented, and once exercise physiologists are certified
based on academic outcomes and competencies plus a required academic degree/concentration
in exercise physiology (science), the career restrictions placed upon exercise
physiologists and the profession will decrease.
The Transition
The transition from a discipline
to a profession is not an easy process. It will have to be spearheaded
by those who understand the necessity for change. Success will depend
to a great degree upon the correct definition of exercise physiology.
If exercise physiologists,
regardless of whether they have a bachelor's degree or a PhD degree, locate
and engage in a job doing one or more of the following, then it is logical
that exercise physiologists do not work just in cardiac rehabilitation
or engage in just research. They are nonetheless exercise physiologists.
Consider, for example:
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The Exercise Physiologist
in Sports
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Sports director
-
Strength coach
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Director/manager of state and
national teams
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The Exercise Physiologist
in College/University
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Professor
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Researcher
-
Administrator
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The Exercise Physiologist
in Community Practice
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Manage health/wellness programs
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Direct corporate fitness/wellness
programs
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Health/fitness club instructor
-
Health/fitness director in correctional
services and in police organizations
-
The Exercise Physiologist
in Clinical Practice
-
Test/supervise cardiopulmonary
patients
-
Evaluate/supervise special populations
-
Diabetics
-
Obesity
-
Rheumatoid arthritis
-
Dyslipoproteinemia
-
Cystic fibrosis
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Hypertension
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Children with heart disease
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Low functional capacity
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Pregnancy
-
Exercise technologies in cardiology
suites
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Work hardening
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Occupation rehabilitation
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The Exercise Physiologists
in Government/Military Services
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Fitness director/manager in
military, including
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Careers in military services
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The Exercise Physiologist
in Business
-
Sports management
-
Consultant
-
Sport psychologist
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The Exercise Physiologist
in Private Practice
-
Personal health/fitness consultant
-
Sports psychology
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Sports biomechanics
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The Exercise Physiologist
in Sports Nutrition Programs
-
Exercise nutritionist
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Exercise counselor
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The International Exercise
Physiologists
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Health/fitness promotion
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Sports consultant
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Affliation with international
organizations
Clearly, the work that many
exercise physiologists do is much more than clinical. Exercise physiologists
work in health promotion, fitness development, strength development programs,
colleges and universities, state and national positions in health and wellness
programs, military services, and in sports and athlete programs.
The Future in Exercise
Physiology
As the profession enters
into the next century, it will be more important than ever to have the
right definition of what is an exercise physiologist. It is an issue
of specificity and control, including professional and economic autonomy.
In time, there is no reason why exercise physiologists must continue to
work under the supervision of the medical community. Instead, exercise
physiologists will have the professional right to bill for services separate
from supervision.
The picture for exercise
physiology is good. Exercise physiologists are more involved and
more influential today than a few years ago. Exercise physiology
research is alive and diverse. It is respected, and it prepares the
way for leadership and a scientific foundation for academic preparedness.
There is still much to be done, however. There is the need to support
the emerging profession through the ASEP organization. ASEP is about
empowerment and possibilities. It is also about realism and the need
to deal with barriers to change. To be successful, exercise physiologists
need to hold both these perspectives in mind. In so doing, as a combined
force of professionals, exercise
physiologists will be in an excellent
position to compete for the diversity of job opportunities in the public
sector.
References
Carter, L & Bentley,
C (1997). The licensing of exercise physiologists. Fitness Management
Magazine, 13;2:36-38.
American College of
Sports Medicine (1999). ACSM Registered Clinical Exercise Physiologist:
Knowledge, Skills, and Abilities. pp 1-27. ACSM: Indianapolis, IN.
American Society of
Exercise Physiologists (1999). Scope of Practice: ASEP Certified
Exercise Physiologists. pp 1-3. ASEP:Duluth, MN.
Copyright
©1999 American Society of Exercise Physiologists. All Rights
Reserved.
ASEP
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