ASEPNewsletter
Vol 1 No 11
July, 1998
    ISSN 1097-9743
    The      ASEPNewsletter is devoted to informative articles and news items about exercise physiology. It is a monthly magazine of news, opinions, exercise physiology professionals, and events that shape exercise physiology. While it contains views and opinions of the Editor who oversees the ASEP Internet Websites, visitors can have a voice as well. We welcome interested practitioners, researchers, and academicians to e-mail the Publisher their thoughts and ideas or to respond directly via the ASEP Public Forum. 
    August, 1998


Exercise Physiology Professionalism: Myth or Reality
Tommy Boone, PhD, MPH
ASEP President
Professor and Chair
Department of Exercise Physiology
College of St. Scholastica
Duluth, MN 55811

Introduction
IN MAY 1975 I celebrated with my family the completion of the Ph.D. in exercise physiology from Florida State. I had been teaching exercise physiology for several years at Wake Forest University prior to finishing the dissertation. I have now taught exercise physiology 25 out of 28 years as a college teacher. At no time have I questioned what it means to be an exercise physiologist, until several years ago. As Chair of the Department of Exercise Physiology at The College of St. Scholastica and after considerable discussion with other exercise physiologists in the United States and around the world, it became apparent that exercise physiology (as an academic emphasis or major in our institutions) is not what it should be and, very likely, is moving in the wrong direction.

Physical Education's Influence on Exercise Physiology
But first allow me to reminisce a bit about myself and exercise physiology. Prior to entering Florida State, I was a health and physical education instructor at the University of Florida and at Northeast Louisiana State University. I was a college gymnast, and I had participated in a variety of other sports. I understood the value of athletics. I also knew the importance of such courses as "biomechanics, physiology of exercise, and kinesiology as part of the traditional physical education curriculum. Everyone knew that these courses helped to lay the foundation for understanding the science of movement (whether it was jogging, lifting weights, or playing tennis). Hence, while not often discussed, the physical educator, collectively speaking, is the father of exercise physiology. At first, only a few, then, more college physical education teachers offered several additonal courses in the sciences and, thus the academic "emphasis" in exercise physiology was created alongside the traditional degree in physical education.

Failure to Develop a Profession
We have come a long way in a short time. We have the courses, the faculty, and the academic programs. But, along the way exercise physiologists, who were interested in doing research and working with adult fitness and cardiac patients, failed to do several very important things. They failed to develop a professional code of ethics, a philosophy, an accrediting body, and an organization for exercise physiologists and, unfortunatelly, they failed to define "Who is an exercise physiologist?" In retrospect, these were major mistakes. The physical educator/exercise physiologist did not take the time to think about the "beginning" but rather the "doing." They were interested in exercise and how it might benefit society. Directly related, and almost as an afterthought, they embraced the American College of Sports Medicine as their professional organization. But sports medicine is not exercise physiology, and ACSM is not an organization of exercise physiologists. Instead, it is an organization of more than 60 different professions.

The fact that we did not start our own organization has caused us to be too dependent on ACSM and organizations like the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), which was born out of the idea that ACSM did not do enough to recognize the exercise physiologist who worked in the clinical setting (i.e., cardiac rehabilitation). This organization, however, has become primarily an organization for nurses, which should not come as a surprise since nurses are primarily responsible for the care of cardiac patients in the hospital setting.

Academic vs Technical Expertise
Since our credibility, in part, depends on the public's understanding that we know who we are and what we do in society, the idea that exercise physiologists work only in cardiac rehabilitation is highly problematic and a major disadvantage in that we have come to view what we do in a limited way. We must question the change in emphasis from academic scholarship to technical expertise. There are not enough jobs in cardiopulmonary rehabilitation (even if our students were 100% accepted by the medical community) and, moreover, most of what our students are taught is now being taught to physical therapy students, nursing students and others.

Should college teachers allow the market to drive the academic program? Most college teachers think that the academic program has its own intrinsic values and, therefore, can not be replaced. Cardiopulmonary rehabilitation is one job opportunity among many, and while exercise physiologists may have been a major player in the development of cardiac rehabilitation, that alone does not authenticate the existence of the exercise physiologist.

Clinical Exercise Physiology vs Exercise Physiology
Another problem with the shift towards clinical exercise physiology versus exercise physiology is that it has resulted in a false certainty of some sort of logical emergence with the medical field. It is our responsibility to evaluate this rather subtle development because it has the potential for shaping our profession. The point being, while I have always considered exercise physiology more than aerobic dance, now I catch myself saying that exercise physiology is not cardiopulmonary rehabilitation. Obviously, this view should not be taken as an insult. It is simply the truth. Many exercise physiologists who have worked with heart patients years earlier have stopped to do other things because of the limitations in the medical field when one does not have an MD degree.

I also understand the importance of exercise rehabilitation and multiple risk factor intervention for heart patients and their families. I am not attacking the right of cardiopulmonary rehabilitation to exist or the right of various college teachers to prepare students to work in the medical field. But, do they understand (and do their parents understand) what they are getting for their college dollars? I do not think so and part of the blame must lie with the administrators of the academic programs that emphasize cardiopulmonary rehabilitation without having significant in-roads into changing the inertia of the medical community.

This inertia is proving to be a major impasse for our students. Moreover, since we do not control for how many students we graduate, in a short time, if not now, our students will have considerable difficulty landing a job in cardiac rehabilitation (i.e., unless they go back to college and get a physical therapy or nursing degree). There are too many graduates and too few positions, and there are too many other professions (e.g., nurses, physical therapists, respiratory therapists) who are not only ready to work in cardiac rehabilitation but are doing so with considerable ease and speed. They are in the system, and they are poised to work in the field although they may have relatively little understanding of the concepts taught in such as courses as exercise prescription, cardiopulmonary rehabilitation, electrocardiography, and exercise physiology.

What I have described is the future, and yet it is the present too. Exercise physiology students, upon graduation, believe (according to their professors) that they will be able to get that "great job" in cardiac rehabilitation! What may not be so obvious though is that we have a lot of opportunities as college teachers to teach students how to think critically and in a constructive discontent manner to empower and make better not only their lives but the lives of those they care about and those with whom they may be responsible (whether it is health promotion, teaching, fitness, or rehabilitation). We can help our students (and their parents) understand that the undergraduate program in exercise physiology may be exactly the grounding in the sciences needed to prepare the student for application to other academic programs. Just because a person gets an undergraduate degree in a particular major does not mean that person must stay in that field. In this way, the exercise physiology program can be viewed in much the same way as biology or chemistry.

My point is that the momentum of our brief history can not be lost thinking too narrowly even in the face of having to conclude we are not where we want to be. For certain, we are not well-oiled. We do have problems! Fortunately, however, most college administrators, students, and parents do not know about our problems. If we do not "get with the program" -- that is, if we do not unite as exercise physiologists, particularly the academic-types, we may (in the not too distant future) begin to have fewer students attending our academic programs. If that happens, getting rid of academic programs will not be far around the corner. Strangely though, as I talk about this with a few friends, I realize with astonishing clarity that the issue has not surfaced in the minds of most.

While I am not "anti-physical education," "anti-sport studies," "anti-human performance" or anti- one of the other 45 or so names for various departments where exercise science (physiology) is offered as an emphasis (not a degree), I believe that we should exist academically as a separate department (if possible). Yet, having said this, I also realize that the departmental configuration of most colleges does not allow (at present) the development of exercise physiology as a separate department. Change, however, is inevitable if maturation of the profession is to take place. We have the authority because we have the knowledge. This knowledge and the implied functions make it possible to actualize the essence of exercise physiology alongside the other scientific fields of study.

The Turning Point in Exercise Physiology
We are at a turning point in exercise physiology. Those of us who teach at the college level must ask the question, "Are we in control of our profession?" or "Have we given up control of our academic programs to ACSM and AACVPR?" If the authority of a profession lies in its knowledge, and that knowledge is generated for the most part from within the profession, then a direct relationship should exist between the faculty of college-directed exercise physiology programs and the opportunity to actualize the professionalization of exercise physiology.

This brings me to the point of asking, "How do we decide which courses our students should take?" It seems to me that the emphasis should first be on the education of the student as a critical, reflective thinker with the intuition, knowledge, and qualities of a professional. The students' education can not be limited to technical skills or technology that delegates the graduate to an inferior work position. Something must change. Either the medical community (doctors, nurses, therapists, educators, administrators) must recognize the academic preparation for the exercise physiologist or, admittedly, the academic programs at the college level must prepare students for different job careers. The identification of new jobs with opportunities for independent, critical thinkers should be put into action. We can not wait any longer if the degree, the curriculum, and the faculty are to be respected. This problem has gone on too long and has now moved to the question of ethics and fraud.

This particular point should not come as a surprise to the college faculty upon realizing their students may be spending in the range of $40,000 to $70,000 just in tuition fees for the undergraduate degree! What is the answer? We need to pull together. As exercise physiologists, we need a vision for our future. A vision that will not do away with our students working in cardiac rehabilitation, fitness, and athletics, but will help to overcome the dependent subordinate role that many feel at the expense of their self-esteem. The image of exercise physiology must be better configured, and it must be developed within the context of the academic community. It is futile to think we can exist outside the academic setting. We are more than trainers and technicians. I know that we are more in the eyes of many, and that we have moved from opinion thinking to scientific thinking, from subordinance to the medical community to authority in exercise physiology research, and from no academic position to a respectable position in higher education. So with just a little restraint from giving in too easily to those who may wish otherwise, we may still have a chance to keep exercise physiology an academic major with integrity. Then, and only then will we, as exercise physiologists, move from dependence on other disciplines to the specifics of what constitutes the knowledge of exercise physiology.

Are We a Profession or a Discipline?
The extent to which we control our destiny is important, and now is is a crucial time for organizational focus. Are we a profession or a discipline? Do we have the right to discern the appropriateness of what we call ourselves, what we teach, the kind of research we do, the health, fitness, and rehabilitative services we provide? Are we, as exercise physiologists, educated professionals or highly skilled ECG and/or exercise technicians? The implication of this analysis is that the exercise physiology profession can not exist without its own professional organization. The intoxicating challenge is whether exercise physiologists can agree that nothing is exempt from re-examination. The freedom to evaluate the feeling of inescapability from sports medicine organizations is the right if not the responsibility of every exercise physiologist.

What makes this thought particularly striking is that it has never been fully understood during our brief history. The point being, we did exist before the advent of ACSM, and we not only have the right but the responsibility to identify "who we are" and "why we exist." It is our responsibility to write out our professional philosophy and to live by a certain agreed upon ethical standard of practice. I propose that we can do these things and more through the collective participation of all exercise physiologists in the American Society of Exercise Physiologists (ASEP). Those who belong to it will need to address the concerns I have identified and, then, the problems that stem from an increasingly specialized academic program (such as clinical EP). In this way, we will clarify who we are, for what purpose(s) we exist, and how best to exercise our options.

All it takes is a willingness to see that it happens. The reward for transforming the profession will be felt by the graduates, although creating the conditions that will allow for new jobs and professonal opportunities will take time. The struggle is worth the investment, both in our students and in our profession. It will require us to be attentive to all concerns that appear to diminish the longevity, integrity, and professional capacities of the exercise physiologist. To do this task well, we need to commit to ASEP and its goals and objectives to advance and improve the exercise physiology profession. It will provide exercise physiologists in the United States and worldwide the forum for leadership and exchange of information to stimulate discussion and collaboration among exercise physiologists active in all aspects of the profession. We also need ASEP to work on behalf of exercise physiologists everywhere to set the standards via ASEP-approved curricular throughout the universities and colleges in the United States.

The Professionalization of Exercise Physiology
ASEP will be the change agent in the professionalization of exercise physiology by demonstrating through its membership an increased connectedness (cohesion), a commitment to ethical norms of service to the public, a higher percentage of members remaining in the profession throughout their lifetime, a homogeneity of membership, and a control over professional matters that we have never had before.

Naturally, the "vision" for ASEP is to be recognized as the leading professional organization of American scholars and practitioners in the study and application of exercise physiology research to fitness, health, rehabilitation, sports, and athletic training. ASEP is dedicated to unifying exercise physiologists to promote and support the study, practice, teaching, research, and development of jobs as an exercise physiologist. In time, it is reasonable to expect (if not require) a prospective member of ASEP to be a graduate of a qualified college/university exercise physiology major with academic consistency acrosss programs of study. The public will, therefore, come to understand the answer to "Who is an exercise physiologist?" just as they have come to terms with who is a physical therapist, a nurse as well as other recognized professional programs.

An exercise physiologist will, in time, be recognized as a university/college educated professional who has at minimum an undergraduate degree in exercise physiology. But, first, we must come to terms with developing a curriculum (or at least an agreed upon list of core courses) that is expected of the exercise physiology faculty and departments. The bottom line, there are too many programs that offer three (maybe four) courses in exercise physiology versus other programs (few in number) that require 12 to 14 undergraduate courses in exercise physiology that are taught by exercise physiologists. There is a need to get control over what constitutes professional membership in the field. Also, why not (after academic and hands-on outcomes have been identified) develop just ONE national certification test for all graduates of the approved exercise physiology curriculum. After passing the exam, the exercise physiologist would be identified as a Certified Exercise Physiologist (EPC))? To take the examination, one would have to have an academic degree (or emphasis) in exercise physiology (science)!

Exercise Physiology as a Profession
With ASEP certification, everyone will know who we are and what we stand for and, equally important, the EPC will belong to a profession that meets the six basic characteristics of a profession, which are:

  • It is intellectual, carrying with its standards of education and practice with high personal responsibility.
  • It is based on systematic, theoretical views and ideas that are readily researched and published.
  • It has a relationship with professional colleagues regulated by a Code of Ethics.
  • It has a formal professional association supporting a professional philosophy and culture.
  • It is well organized internally to promote exercise physiologists.
  • It is recognized legally by a certification board staffed by professional members.
    • These basic characteristics of a profession are being met through the organizational structure of the American Society of Exercise Physiologists. ASEP exists to serve its members, and to set the stage for a new beginning.

    New Beginning
    The members of the Society have come to an understanding of the need for the professionalization of exercise physiology. They recognize and understand the importance of exchange of ideas, advancement of academic programs, and career opportunities. They (with their BS to PhD degrees) are in the process of working towards the implemention of a national academic accreditation of exercise (science) physiology programs, a national exercise physiology certification (based on an assessment of outcomes), and the advantages (and how to) of licensure in exercise physiology. They understand the reasons for setting the ASEP agenda, direction, and decision making process to increase visibility and enhance the image of the profession. They recognize the importance of defining the impact and concerns of exercise physiologists who work as clinicans, and the steps needed to support the quality and integrity of their work.

    Hence, ASEP members are important to the clarification of the role and importance of exercise physiology research in health promotion, disease prevention, rehabilitation, fitness, and athletics. They understand the academic and practical aspects of what it takes to be a successful exercise physiologist in today's market. And, yes, they realize the importance of identifing ways to respond to the ethical and professional challenges presented to exercise physiologists in health, fitness, rehabilitation, and related professions.

    Exercise physiology professionalism is a reality!

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