PEPonline
Professionalization
of Exercise Physiologyonline

An international electronic
journal for exercise physiologists
ISSN 1099-5862

Vol 2 No 5 May 1999

 

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:

  • High performance human physiology, including
    • Business
    • Astronauts
    • Pilots
    • Underwater explorers
    • Athletes
  • Environmental extremes, including
    • Heat
    • High humidity
    • Cold
    • High altitude
  • Pediatric health, fitness, and screening
  • Community health, fitness, and wellness, including
    • Life-style modification
    • Risk factor screening
    • Disease prevention
  • Cardiopulmonary rehabilitation, including
    • Administering graded exercise tests
    • Measuring/interpreting cardiovascular variables
    • Measurement of hemodynamic variables
    • Exercise prescription specifics
    • Emergency protocols
  • Diabetic, obese, and other special populations
  • Athletes at all levels, including
    • 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
    • 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:

  • The Exercise Physiologist in Sports
    • Sports director
    • Strength coach
    • Director/manager of state and national teams
  • The Exercise Physiologist in College/University
    • Professor
    • Researcher
    • Administrator
  • The Exercise Physiologist in Community Practice
    • Manage health/wellness programs
    • Direct corporate fitness/wellness programs
    • 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
      • Hypertension
      • Children with heart disease
      • Low functional capacity
      • Pregnancy
    • Exercise technologies in cardiology suites
    • Work hardening
    • Occupation rehabilitation
  • The Exercise Physiologists in Government/Military Services
    • Fitness director/manager in military, including
      • Airforce
      • Army
    •  Careers in military services
  • The Exercise Physiologist in Business
    • Sports management
    • Consultant
    • Sport psychologist
  • The Exercise Physiologist in Private Practice
    • Personal health/fitness consultant
    • Sports psychology
    • Sports biomechanics
  • The Exercise Physiologist in Sports Nutrition Programs
    • Exercise nutritionist
    • Exercise counselor
  • The International Exercise Physiologists
    • Health/fitness promotion
    • Sports consultant
    • 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.


 

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