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Your Question Appear Online!
Dr. Don Diboll
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ASEP Board of Directors
"There is a need and
the need is great!"
Aliisa Criffield, MA, EPC, ATC
I was glad to see in PEPonline the article entitled Entrepreneuring
as an Exercise Physiologist by Steve Daugherty. I thought it gave
some good ideas to get a person thinking about starting your own
business. One thing that stuck out to me was the list of jobs that an
exercise physiologist might do.
The ASEP leadership 
states that, exercise physiologists work in health promotion, fitness
development, colleges and universities, clinical rehabilitation, and
sport and athletic programs. The website also lists some of the
specific positions that are filled by exercise physiologists:
sports and wellness program instructors
strength coaches for college, university and professional sports
teachers at institutions of higher learning (i.e., if they have a PhD)
researchers in sports medicine and adult fitness programs
managers and exercise leaders in corporate wellness programs
instructors in health and fitness clubs
supervisors of specialized health, fitness, wellness, or lifestyle
programs in correctional services, police, fire, and emergency response
fitness instructors in YMCAs, spa and resort centers
exercise specialists in cardiopulmonary rehabilitation programs
fitness directors and managers in the military (such as the air force
exercise technologists in cardiology suites
exercise program designers for special need children
fitness instructors and supervisors at the state, regional, and
national levels in sports and athletic programs including
Nowhere on that list did it mention working as an exercise
physiologist. The question that I would pose is, What about working as
an exercise physiologist? What might that specifically look like? I
know there are professionals out there with their actual job title
being exercise physiologist. I am one of them.
I think about the dietitian profession. Everyone knows exactly what a
dietitian would do. Dietitians counsel individuals on nutrition. They
may also teach and do other things, but that is what you primarily
I work along side a
dietitian in my department. I saw referral after referral from
doctors for her to see patients with diabetes. It got me thinking
that all those patients she is seeing should be seeing me, also, to get
started on an exercise program. Not only is nutrition important for
diabetes, but exercise is equally important in managing the disease.
Then I got to thinking about all the other diseases/health conditions
out there that exercise has been shown to have a positive effect on:
osteopenia /osteoporosis, cancer, high blood pressure, high
cholesterol, obesity, fibromyalgia, multiple sclerosis, etc There could
be a huge market here for my services. I know some, if not most,
physicians are telling people they need to exercise but they do not
have the time or know how to show the specifics of what that means.
So my question is, Why
not have a practice set up like a dietitian where one would receive
referrals from doctors to work with patients who are in need of an
exercise program that will positively affect their disease or health
condition? Theoretically there should not be a shortage of
referrals because of the numerous conditions that exercise benefits.
The roadblock comes with reimbursement. Because exercise physiologists
are not licensed we dont stand a chance of getting reimbursement. That
is one of the first things physicians askis this service covered by
insurance? It is not that they dont support my initiative. It is just
that many people are not willing or cant afford to pay out of pocket
for their health.
We have a hugely
untapped resource in a large area of need. Many people need to learn
how to exercise to benefit their health. Just think about the people
you know that have diabetes. Are they exercising? Most likely they know
they should exercise but do they know how to exercise to most
affectively benefit their specific disease and what things to watch out
for? If you open your eyes you will see the need and the need is great.
But our hands are significantly tied without reimbursement to
tap into this need.
Ask the Professor: Your Inside Scoop on
Note: Ask the Professor is intended for informational
purposes only. It is not to be taken as healthcare advice. Please do
not submit questions of a personal nature (e.g. fitness programs,
nutrition advice solicitation, etc.) Thanks.
Q.) I have been trying
to figure out if there is a real difference between my heart rate and
whether I am loosing weight or burning fat and loosing weight. I
understand "calories in - calories out", but can the exertion level
actually determine what my body uses for fuel?
A.) Dear George,
The exertion level (exercise intensity), which heart rate is a good
indicator of, can influence whether you are using a greater percentage
of fat or carbohydrate to fuel your exercise. In general, the higher
the exercise intensity, the more carbohydrate compared to fat used for
fuel. Lower exercise intensities tend to use a greater percentage
of fat compared to carbohydrate. At best, we use approximately 70% fat
to fuel our metabolism, but that is during the resting state. For these
reasons, some individuals incorrectly advocate low-intensity aerobic
exercise to burn more fat, even if a person is capable of maintaining a
higher-intensity exercise for a reasonable period of time (e.g., 20 30
The question to ask is how many total calories of fat are
being used during exercise, not the percentage of fat calories. The
reason is simple. Although a greater percentage of fat calories is used
during each minute of low-intensity exercise, the total number of
calories used is small; therefore the total number of fat calories used
is also small. However, for exercise that is moderate or higher in
intensity, the total number of calories used each minute is greater.
Even with a lower percentage of fat being used, since the total number
of calories is greater, then the total number of fat calories used each
minute is potentially greater. Additionally, as a person improves
cardiovascular (i.e., aerobic) fitness, they can exercise at a
higher intensity for a longer period of time, thus expending even more
total calories and fat calories. So as people improve their fitness,
their bodies become better at using fat for fuel.
ASEP offers a downloadable PowerPoint presentation you
should see: "Why Join ASEP?" (just click the link!)
Please use this web page (click above) and new email address: firstname.lastname@example.org
ASEP is a member of
the Health Profession Network
Check out the HPN Links!
And keep in mind: For
more information on professional scope of practice, professional
standards and code of ethics for exercise physiologists, accreditation
of academic programs, board certification examination, and other
important tasks already completed by ASEP in establishing a profession,
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