The 21st century practice of
exercise physiology is challenged both by issues internal regarding agreement
on what constitutes the practice and by changes in the external aspects of what
presently constitutes healthcare in the United States. Perhaps at no other time in the history of
exercise physiology has it been so critical to face up to the concerns that
define competent exercise physiologists.
After all, they need the acceptance of the healthcare community as well
as society’s acknowledgment of their value as key professionals in the use of
exercise as medicine. The areas of
vulnerability are many:
- More exercise physiologists are attracted to
athletics and research than health, wellness, fitness, and rehabilitation.
- The amount of time devoted to the practice of
exercise physiology at workshops and professional meetings is essentially
nonexistent.
- Graduate programs in exercise physiology seldom teach
courses in professionalism and the importance of supporting their own
professional organization.
- Most doctorate prepared exercise physiologists work in
academia and those without the doctorate are increasingly inclined towards
personal training and fitness programs.
- Exercise physiologists do a very bad job of
describing the role of “exercise as medicine” in healthcare.
- Not having licensure doesn’t help when board
certified exercise physiologists work in traditional healthcare settings.
- Other than fee-for-service, exercise physiologists
fail to understand how they can generate a viable income for the services
they provide.
- Professional role differentiation for exercise
physiologists versus exercise science graduates is based on the failed
support of the academic exercise physiologists.
These issues must be addressed if
Board Certified Exercise Physiologists are to gain a footing in healthcare. The
problem is that the historical connection to something other than exercise
physiology continues today unabated.
ASEP should represent the emergence of the new exercise physiologist,
yet it does so only at the expense of other colleagues who contribute to this identity
formation. Here, “expense” is used to
argue that changing from yesterday’s thinking to today’s view of exercise
physiology comes with a price! In other
words, the challenges to identify with and describe the ASEP role in the
practice of exercise physiology may associate with a failed tenure process or a
loss of opportunities that otherwise were very common.
The point of this direct message
is that exercise physiology today is very different from what it was in the 80s
and 90s when no one thought a moment about their own professional
organization. An idea such as that
simply didn’t enter their minds. Rather,
they felt successful simply having the opportunity to present their research
papers at national meetings. No one
thought differently. Life was simple and
very professional-like. Of course the
problem is that the academic exercise physiologist was living in a dream world
full of fanciful notions, such as “I’m a physiologist.” Indeed, the challenges are many and it no
doubt takes exercise physiologists longer than most to get their business in
order.
Even now they have little idea
how close they are to giving away their very own “pot of gold.” And, what is that: Simply stated, it is the power of
exercise to heal. As “exercise”
physiologists, they are still more excited about doing another research paper
as if one more paper will define them separate of what they really are. Yes, the challenges and issues faced by
exercise physiologists are multifaceted.
They are no longer just poorly academic but now emotional and painful
issues as well. The latter in particular
is somewhat different from other professions.
That is, at least they recognize and understand the need to come
together to evolve successfully. In a
real sense, the pain of knowing that exercise physiologists have embraced a
failed rhetoric actually keeps them addicted to the same false rewards. It is this understanding that is also painful
to those who know the benefits of the recent developments by the American
Society of Exercise Physiologists.
The ASEP leaders are faced with a
new kind of challenge – fear of failure!
They aren’t afraid of failure, but they sense it in their
colleagues. Even those who become part
of ASEP for several years drop out, much like a student who doesn’t get the
importance of an education. In a very
real sense, they stop supporting ASEP because they don’t want to fail. And so they realign themselves with the
status quo. This reminds me of the quote
I read several years ago in a colleague’s office: “Dare to make a difference in
the face of indifference.” Change
requires standing up to indifference.
The task of exercise physiologists today and in the years ahead is to
evolve beyond the formative years in sports medicine and define their own professional
roles and functions based on current realities.
For example, the fact that “exercise is medicine” needs to be
reconceptualized in a healthcare perspective.
Exercise physiologists need a broader context of who they are and what
they do in society.
Unfortunately, the mindset
of the academic exercise physiologist hasn’t changed from what it was decades
ago. This is a huge problem, especially
with the emerging emphasis on exercise and the roles and functions for the
exercise physiologist of the 21st century.
Failing to recognize that exercise physiology is now more of a
healthcare profession than a sports training discipline does not speak well for
the profession. They must start planning
how to enact professional partnerships with clients (and patients), and they
must anticipate doing so in their own business settings within their
community. They must come to understand
that they are ultimately responsible for their fiscal growth and stability,
that they have significant social and legal obligations to society as
healthcare professionals, and that it is critical they develop
interdisciplinary collaboration to promote and grow their own healthcare
clinics.
No longer should Board Certified
Exercise Physiologists focus exclusively on working for the other person. Rather, they must broaden the context of
their care. The must act as healthcare
professionals responsible to their own Code of Ethics and Standards of Practice. Thus, the current practice of exercise
physiology requires greater sensitivity to society’s healthcare needs,
particularly the use of exercise as medicine.
It also mandates thoughtful consideration of legal, ethical, and
spiritual dimensions that arise within the healthcare system. Therefore, it is also important that the educational
process addresses the scope of competent care, whether it is with athletes,
clients interested in health and wellness, or patients referred for
cardiovascular conditioning.
There are three areas of
contemporary concerns that are essentially educational needs to ensure the
correct training of students in exercise physiology programs. These needs should be incorporated
immediately in programs of exercise physiology that are presently accredited by
the American Society of Exercise Physiologists via The Center for Exercise
Physiology-online. These concerns
represent an overlap in professionalism, curriculum, and practice of exercise
physiology. It is critically important
that each of the three is addressed with equal dedication of classroom time and
hands-on experiences. The integration of
the concerns is expected to be time-consuming, but extremely valuable to the
future of exercise physiology in the 21st century healthcare system.
It is important that academic
exercise physiologists recognize the differences between non-exercise
physiology degree programs and exercise physiology. This point has been explained in many different
articles in PEPonline. While these other
academic degrees have existed for many decades, they do not reflect the current
nature or scope of competent caring or thinking by exercise physiologists. In addition, exercise physiologists are
acknowledge by the following:
- Make scientifically sensitive health assessments.
- Design and implement exercise training plans for
clients and patients with health problems and medical conditions.
- Engage in the planning and care of other dimensions
of healthcare, including but not limited to depression and stress
management.
- Provide complete sports training resources for
athletes of all ages.
- Promote and maintain through analysis and testing the
mind-body interconnectedness.
These activities and others will
be further articulated both by non-doctorate and doctorate prepared exercise
physiologists on behalf of the individual client, family, and/or sports
entity. In particular, as a result of
the rising healthcare costs and reimbursement issues and problems,
increasingly, members of the public sector will look to ASEP Board Certified
Exercise Physiologists for healthcare.
Not surprisingly, the majority of the exercise physiologists in the United States
are not ASEP certified. This will need
to change in the foreseeable future.
This is presently the greatest area of challenge for those interested in
exercise physiology. After all,
credibility and effectiveness are both linked to a profession’s organization
and members who support the evolving nature and outcomes of exercise physiology
care.