Licensure Update June 2003
Matt Wattles, MS
THE NEED FOR LICENSURE of the exercise physiologist again comes
to the forefront of the profession. I have stated it many times in
the past, the profession will not move forward until we obtain licensure!
Licensure of the exercise physiologist must come from ASEP affiliated state
associations as ASEP is the only governing body exclusive to the exercise
physiologist. Can exercise physiologists learn from there failures?
Many times in the past, exercise physiologists (not represented by ASEP)
have tried to obtain licensure from individual state legislatures and have
failed because they could not prove that they were governed by an association
exclusive to exercise physiologists. Again, we are seeing the profession
divided and not unified. I believe that exercise physiologists who are
trying to obtain licensure without the support and backing of the ASEP organization
are simply not aware of the issues. As history has demonstrated in
the past, these attempts will fail. At this time, I feel it is necessary
to revisit the need for an exercise physiology licensure bill and exactly
how we will eventually obtain state licensure.
The profession of Exercise Physiology has grown tremendously in
the last decade. Exercise physiology, in general, has moved from a research-oriented
profession to a profession that provides medically monitored exercise in
the management of diseases and maintenance of healthy populations. Exercise
is the major intervention component of this profession, but is certainly
not the only component emphasized in the training related to or application
used an Exercise Physiologist. Due to the development of the profession
into a diverse field of intervention in the management of all aspects of
health and wellness, it is necessary to specify and differentiate the qualifications
necessary to the profession of Exercise Physiology.
Due to the lack of legal and professional standards in the field
of Exercise Physiology, other professions (physical therapy, nursing, and
athletic training, and respiratory therapy) and individuals with little or
no educational preparation are practicing in public and healthcare settings.
Interest in developing some type of regulation is due to the expansion of
clinical practice related to populations serviced and the expanding medical
technology used in the medical profession today. The term “exercise
physiologist” has come to be applied as a universal term to numerous fragments
and tangent practices in the field.
The cost savings to society that exercise therapy provides is
immense. Compressed convalescence time decreases short-term disability
needs. Improved physical retraining returns people to work who would
otherwise have been permanently disabled. Reduced incidence of and
early detection of reoccurring or chronic disease lessens medical expenses
over the long term. The resources required to provide exercise therapy
are next to nothing when compared to the costs involved for interventions
like by-pass surgery, angioplasty and hospitalization. Exercise therapy
is cost effective and provides positive health outcomes for the nation’s
leading chronic diseases.
Today, the costs of medical treatment continue to skyrocket and
those who pay these expenses understandably try to limit these expenditures.
In an effort to control cost, some payers have gone as far as denying payment
for prescribed services. One such alarming trend is to deny payment
for exercise therapy on the grounds that “the 'therapy' was not provided by
a licensed therapist.” Should this happen with any kind of regularity,
cost effective programs would soon begin to disappear. The end result
would be poorer patient outcomes and dramatically increased medical costs
associated with more hospitalizations and surgeries. Licensure of exercise
physiologists will, therefore, provide for continued, quality, cost effective
care for appropriate patients (while at the same time protecting the medical
consumer from fraudulent or unqualified care givers who may provide injurious
or even potentially deadly treatment).
Today’s student of exercise physiology undertakes a challenging
curriculum of study, including courses such as anatomy, physiology, chemistry,
physics, statistics, and various medical classes. Yet, there are those
who would capitalize on the hard work of these professionals, claiming expertise
where they have none and valid credentials which, under closer inspection,
reflect at best a weekend seminar and an application fee. There are
currently over 200 organizations that certify exercise professionals.
This creates an issue of public safety because there is no guarantee that
the exercise professional is truly qualified. There are also those
who feel that because of their professional training, which may include some
overlap with the Exercise Physiologist, they are qualified to provide the
quality of medical care. Interestingly, at times, this may be true but
more often it is not true. Clearly, for the sake of quality patient
care, some form of regulation needs to be imposed.
It is stated that the profession of Exercise Physiology should
have uniform preparation to guarantee the quality and continuity of care.
The professional progression and emphasis of care should include a wide spectrum
of patient populations and guarantee the highest standards possible in educational
background and practical application. It is also noted that exercise
is the primary intervention technique employed in the profession of exercise
physiology. The field has developed to a point where the exercise physiologist
must be prepared through a multi-disciplinary educational curriculum.
Exercise therapy requires a strong emphasis in disease prevention and management
strategies as well as patient education.
There are specific steps necessary before ASEP state associations
may precede with licensure. A Federal report entitled “A Proposal for
Credentialing Health Manpower” (1977) recommends six criteria should be used
by state legislators to determine if a licensing bill is worthy of proceeding
through the legislative process. The six criteria are:
1. The unregulated practice of an occupation
will harm or endanger the health, safety, and welfare of the public and the
potential for harm is recognizable and not remote or dependent upon tenuous
committee will be working this summer on each of these steps. The immediate
goal of the committee is to create an in-depth licensure bill. Then,
with each area addressed, we will be ready to move forward with licensure.
I believe if we can learn from past then we can be triumphant in the future.
Exercise physiologists who can not learn from the past will continue to make
the same mistakes of the past and be doomed to fail.
2. The practice of an occupation requires a high degree of skill,
knowledge, and training, and the public requires assurances of initial skill
and continuing occupational competence.
3. The functions and responsibilities of the practitioner require
independent judgment and the members of the occupational group practice independently.
4. The scope of practice of an occupation is distinguishable from
other licensed and unlicensed occupations.
5. The economic impact on the public by regulating this group
6. There are no adequate alternatives to regulation (i.e., statutory
certification or registration) that will protect the public.