Thoughts on Achieving Professionalism in Exercise Physiology
Danita Saunders
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811

 
AS A REGISTERED dietitian for 20 years, my perspective on exercise physiology may be different than that of a more traditional student who recently completed undergraduate work.  My journey from a clinical / inpatient dietitian to a more wellness-based entrepreneurial practitioner has mirrored the advancement in employment options for RDs.  It was only within the last decade or so that dietitians gained state licensure status and only within the last five years did they become eligible for Medicare reimbursement [2].  Following those gains, other insurance companies followed suit and began paying for nutrition therapy provided by a registered dietitian.  These gains have provided more recognition for dietitians as healthcare professionals.  In order to provide jobs, employers (such as clinics or hospitals) are certainly more likely to hire individuals whose services are reimbursable through insurance companies.  Although it can be argued that insurance reimbursement is not the answer to success for a healthcare profession, it certainly does provide an avenue into the healthcare arena, especially for professionals just starting out.  More and more dietitians are starting their own businesses, but if you look at their resumes, you will often find that their early experiences included a substantial amount of time in clinical dietetics.  Perhaps exercise physiology as a profession will follow a similar course over the next decade or two.

The Value of Clinical and Community Experience
As an undergraduate in dietetics, we participated in clinical and community rotations every semester. This provided a sense of belonging, and helped us in identifying the work we most enjoyed, and where our personal skills might best be utiliized.  To become recognized as healthcare professionals, college experiences for exercise physiology students could include community and clinical rotations.  Although the internship might be seen as the vehicle to meet this need, well-planned undergraduate experiences could serve several purposes. Hospitals, clinics and other participating agencies would meet timely, well-dressed, energetic students who would serve as ambassadors to the profession of exercise physiology.  A clinical/community program administered by the college or university also serves as outreach between the educational institution and the world.  The instructors in the program would maintain a sense of awareness about what is being provided in the community, and would come to know who is involved in providing these services.  At this time there is an explosion of cardiac-related programming aimed at many different populations.  Although exercise physiology is not only about cardiovascular physiology, most of these programs would by nature be multi-faceted since cardiac disease treatment and prevention must deal with the whole person.  If the programs do not do this, perhaps this feedback from student to instructor could lead to internships or projects for the students which would enhance these programs, furthering respect and recognition for the exercise physiologist.

The ASEP Accreditation Guidelines for Undergraduate Programs provides a list of required competencies for students [1].  When reviewing the competencies, with the exception of ECG techniques, most student experience relates to exercise laboratory techniques.  As preparation for a career as a healthcare professional, exercise physiology students undoubtedly would benefit from a wide range of clinical experiences.  These experiences could include some of the following areas of expertise:

• Cardiac Rehabilitation
• Non-invasive and Invasive Cardiology
• Pulmonary Rehabilitation
• Corporate Wellness and Employee Assistance Programs
• Orthopedics
• Pulmonary Rehabilitation
• Sleep Studies
• Pain Management programs
• Stress Management programs
• Clinical and Public Health Dietetics
• Bariatric Surgery Programs
• Physical Rehabilitation

A Clear Message
Although we will all go into sub-specialties of our own interest, finding the underlying message that applies to all of us, no matter what area of exercise physiology we chose to practice, could be helpful for us as professionals, and for the world in trying to understand who we are.   For example, exercise physiologists understand how the large skeletal muscles, especially those in the legs, act as a “second heart” in supporting blood flow [3].  We understand how different situations impact enzymatic and hormonal responses.  Hopefully, we also understand that expensive supplements and equipment are not required for good health. Perhaps by pulling these ideas into simple clear messages, we can define ourselves as broadly trained individuals who can be trusted to treat clients / patients wisely, ethically, and effectively.

Willingness to Refer
If we want to have respect as healthcare professionals, we must show the same respect to other healthcare professional, and recognize them for the services they perform.  To act as members of the healthcare team, we must refer patients appropriately.   This does not show weakness, it shows strength in that we understand our role and where our limitations lie.  In private practice I frequently referred my clients back to their physicians, sometimes for treatment of pain or specific injuries, sometimes for further testing related to blood lipids or better control of blood pressure.  Some have gone on to see orthopedic physicians for diagnoses of injuries that limit exercise.  Some have received physical therapy, which later led to greater mobility, allowing for the initiation of an exercise plan.  The healthcare system is not easy to maneuver, and often patients will pay out of pocket to have their healthcare managed.  If the system is overloaded and other healthcare professionals are rushed and pressed for time, our clients will still come back to us if we are willing and able to look at the big picture as we guide them toward improved health.  Also, in making referrals, we are getting our names out there.  Physicians, physical therapists, dietitians and nurses and other members of the healthcare team will more readily embrace us as healthcare professionals if we act in the manner.

Using Our Imaginations
In seeking jobs that require our expertise as professionals, we will have to be creative.  If you are an RN and want to find a job as an RN, the job search proceeds fairly smoothly.  In the newspaper, you would turn to healthcare employment, then look for nursing positions.  A similar method can be followed for physical therapists, occupational therapists, dietitians, respiratory therapist, etc., etc.  For the exercise physiologist, we need to look more deeply, paying attention to corporate wellness, positions within biomedical research and medical device companies, opportunities within school and other non-profits seeking to enhance health within the populations they serve.  We might start out in a part-time position at a fitness center, yet look for every opportunity to reach out to the community through this position to prove ourselves as a valued community resource.  We might join a school board, become involved in community walks and runs. We may need to do more to get the word out on who we are and what we do, but the rewards can be great.  We have the opportunity to be creative at a time when we are less constrained by the types of rules governing other healthcare professions, so we can create our destiny.  Along with this freedom we may have greater responsibility in presenting ourselves in an ethical manner.  An RN who doesn’t happen to be a good nurse will initially be given the benefit of the doubt because of the recognizable credential. An EP will need to work harder since we still have a reputation to build. 

Seek Role Models
Without a lengthy history as a profession, looking to established professionals for guidance might be very important.  If we enjoy working with obese youth and admire the determination and sense of fair play modeled by the local high school coach, that individual can be one of our role models.  Our work may be related more to physiology and health, but we will need to work well with children to make a go of it, and most likely we will need to deal well with parents.  We might also look to the skills of an admired instructor, or the demeanor of a physician who has taken the time to listen and assess our situations thoroughly.  We can pick and chose the characteristics we need for our chosen specialty.  However, being a new, emerging profession, we may need to turn to a number of different professionals to guide us in our development.
 
Tell How We Are Different
There might be larger organizations which seem to dominate many areas of exercise physiology.  Rather than wasting energy trying to prove that ASEP is the better route to take to student pursuing exercise physiology, perhaps the organization can be defined in a way that allows students to decide for themselves what route better serves them.  As a dietitian working to specialize in weight management, I saw the need for some further education in movement and exercise.  Although I was able to attract clients, I was not often unable to convince them to pursue an exercise professional to help them safely pursue exercise.   I needed a baseline understanding of fitness to proceed so initially I pursued a certification with ACSM, and even attended a conference out-of-town to prepare for the test.  I could see that this was not the route for me.  It felt as though the word “sports” in ACSM had permeated the training.  It has always been hard for me to put to words, but I don’t want to be associated with sports.  I can understand how physical education and athletics became the ground-swell behind exercise physiology, but we have to realize that there is a lot of physical movement individuals can participate in for good health that cannot and should not be called sport.  For some individuals, initial steps toward better health may simply involve leaving the house more, or perhaps over-coming the challenging obstacle of getting into and out of the car.  Maybe initiating a more active lifestyle will start with us helping obese clients in becoming comfortable sitting in a booth with friends for coffee and conversation. Perhaps a client will finally be able to walk around the block, or overcome their fear of being seen in public. Maybe we will help a client return to worship, something that they gave up due to discomfort sitting or standing for too long.  Movement goes way beyond sports and fitness.  There are already enough personal trainers out there to help those who want six-pack abdominals.  Give me the challenging clients who simply want to regain some joy in living.  In conclusion, aligning myself with the ASEP approach better supports my goals as a professional.  Most likely there are many others who share the same feelings, and would see ASEP as an organization more inline with their point of view on health and wellness.
 
Build Bridges with the Community
When reviewing information related to cardiac rehabilitation at a local medical center (St. Mary’s Medical Center in Duluth), it states that all cardiac rehabilitation staff members are ACSM certified [4]. Although this could be viewed as an obstacle for those choosing the ASEP route, perhaps we need to see it as an opportunity.  It seems quite unreasonable that students at St. Scholastica are not gaining experience at St. Mary’s. Both institutions are part of the Benedictine tradition, and for years St. Scholastica has trained many of the healthcare professionals working at St. Mary’s.  It is naïve to believe both institutions would see eye to eye at all times, but with the passage of time, perhaps new options develop that increase the possibility of cooperation.  If we consider what strategies were used in the past to develop a relationship, are there other “outside the box” strategies we did not envision?  If individuals have become worn out by this struggle, perhaps other individuals can be engaged to try building this relationship again.  Maybe it’s possible that the students themselves can be engaged to help in developing a relationship.  This is not something that can be forced, but with the passage of time, it should be revisited.  St. Mary’s has grown in size and stature as a provider of quality regional cardiac services.  It is important that this local resource not be overlooked.  Hopefully in time, St. Mary’s Cardiac Services will also look to the exercise physiology program at St. Scholastica as a vital local resource, one that provides professionals for its ever-expanding programming.  If we can be successful at building this bridge, an example can be set for others across the country facing the same challenge.
 
 
 
References

1. American Society of Exercise Physiologists.. ASEP Website. Abstract retrieved February 18, 2005, from http://www.asep.org/accreditation/
2. NHIC - National Heritage Insurance Company.. Medicare Coverage for Medical Nutrition Therapy (MNT) Services (chap.) Retrieved February 18, 2005, from Medicare: http://www.medicarenhic.com/whats_new/archive2001/med-nutrition-therapy.htm
3. Rowell, L. B. (1993). Human Cardiovascular Control. Page 29, paragraph 2. New York, NY: Oxford University Press.
4. St. Mary's / Duluth Clinic.. SMDC Online - Cardiac Rehabilitation Page (chap.) Retrieved February 18, 2005, from http://www.smdc.org/hospitals_clinics_centers_excellence_page.cfm?oid=104472&page=106484