Professionalization of Exercise Physiologyonline   


         ISSN 1099-5862   Vol 7 No 4  April 2004 
 

 

 
 
Editor-in-Chief:   Tommy Boone, PhD, MPH, MA, FASEP, EPC
 
 
Exercise Physiologists in Denial
Tommy Boone, PhD, MPH, FASEP, EPC
Professor and Chair
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811
“For God’s sake tell me what to think.” – Ashleigh Brilliant [1]
We are so accustomed to thinking as we have always done that we are immune to the changes that must be made in exercise physiology.  It appears that many academic exercise physiologists go about doing their daily work without empathy for their students.  Entirely engrossed in our teaching positions (i.e., I am academic, too) and our next publication we seldom take time to reflect on what is wrong within exercise physiology. 

Remarkably, this kind of thinking is true for the majority of us who are insulated from undergraduate programs.  The only explanation is that the academic exercise physiologists are in denial.  They are aware of the problems at the undergraduate level, but they cannot accept their part in changing kinesiology (or one of a dozen other academic majors) with a concentration in exercise science to exercise physiology.  We are completely to blame, however.  There are many non-academic exercise physiologists who are sitting back and not doing anything to help with the change process.

There is some minor cause for optimism.  At least there are a few exercise physiology majors in the United States, thanks mostly to a handful of professors and their chairs and/or deans.  The number is so small that I think you get the picture.  A lot of work awaits us down the line.  The usual, run-of-the-mill academic majors is generally  a waste of time for students interested in exercise physiology as a healthcare profession. 

To begin, these programs do not provide adequate course work or hands-on laboratory experiences.  They are incredibly old for the 21st century way of thinking.  I have written about this many times during the past five or six years.  Where are we today?  I think the right answer is “several steps forward, but lacking in motivation”.  The appearance that everything is going as it should is exhausting.  Basically, many of us would like to see changes come about a bit faster, but patience is an important lesson to learn.

To compensate for the lack of academic accreditation at the undergraduate level, new certifications were created to take its place.  This has happened so often in recent years that it is almost funny, if it were not so serious.  Rather than do what is right to fix the decades of problems, our colleagues continue to make a mockery of the undergraduate programs by now adding personal trainer certifications to their list.  This giant sea of certifications is not benign. 

Each year, students get caught up in the certification game without realizing that a certification per se is meaningless without a solid academic degree.  This almost epic storm of certifications is savagely destroying any equal footing we have with physical therapists and other healthcare professions.  Every year students leave what could be a career in exercise physiology to go back to school to major in nursing, physical therapy, or physician assistants’ programs of study.  Carried by the notion that the alternative major must be better, they leave the field.

But, of course, from the students’ perspective, why shouldn’t they leave?  The final and, perhaps, greatest insult to them is that they believe their professors have their heads buried in the sand (or, at the very least, in their research papers).  Unhappily, there is little sign that the professors are willing to take charge of exercise physiology.  This has arisen primarily as a result of the continued belief in sports medicine.  On the positive side, at least since ASEP's conception, everyone should know that sports medicine is not exercise physiology. 

The bulk of the earlier belief that sports medicine gave birth to exercise physiology via exercise science is understood to be wrong.  Yet, the carry over from decades of emphasis on exercise physiology research that sports medicine supported by providing a forum at national meetings still confuses many students.  Just how long it will take for undergraduate students to see the real picture is anyone's guess.  I suspect that if the gatekeepers release some of their hold on the students, change will be very fast  indeed. 

Another major factor in slowing the transition in our thinking regarding exercise physiology is the idea that exercise physiologists are physiologists!  The picture that many professors have painted for themselves that they are academic physiologists is simply not true.  This will certainly be a topic for discussion for some time but, in the end, there is absolutely no question that physiologists require an academic degree in physiology.

Notwithstanding what appears to be a few doctorate prepared exercise physiologists, cardiac rehabilitation directors and employees, and others in diverse fields of work (e.g., athletics, lifestyle management, research, and sales to mention a few), the overwhelming consensus is that sports medicine supercedes exercise physiology.  Amazingly, this idea is still played out in the national meetings every year.  Hidden behind a veil of research by some and, most recently, by others who denigrate the efforts of a few who believe exercise physiologists have the right to their own professional organization, selective thinking prevails against the ASEP initiatives. 

This trend to ostracize exercise physiologists who do not support sports medicine is not a blip or hiccup in the politics of different organizations.  Rather, it is a consequence of two different philosophies, which is now creating a lot of stress with undergraduate students as well as some college faculty.  The big question of our time is – do academic exercise physiologists have what it takes to resolve the conflict?  Do they understand the difference between the two questions: "What exercise physiology can do for me?" versus "What can I do for exercise physiology?"

A further complication arises from the denial by exercise physiologists that ASEP is not their professional organization is the time that has been wasted.  The founding of ASEP has never been anything other than doing what is best for our students.  Now that it is apparent that the undergraduate programs of study are useless in terms of landing a professional career in the public sector, we have no choice but to correct the problems.  The undergraduate (and most academic programs) need serious revision of the number and type of courses (including degree titles that are senseless and meaningless).

Continuing into the 21st century with the old way of doing things will not help students.  Denying that there is a problem just will not cut it anymore.  Continuing to disagree among ourselves is not good for our students when they graduate.  It is therefore inevitable that we must stop denying what we know is true.  We must face the need for dramatic changes to our curriculums.  We need laboratories for our students as well as for our professors.  Our academic programs must have focus.  They must be accredited, and our students must rise to the competency level to pass the ASEP board certification to practice exercise physiology. 

In other words, we have come face to face with the enemy and it is our very own inertia and denial.  Increasingly, therefore, rather than working together, we have worked against each other.  It also looks like we have facilitated others to work against us.  There is every reason to expect that as we continue to deny what must be done in our own field, members of other healthcare professions will change their licensure bills to incorporate our public sector career niche into their own thinking and practice. 

In fact, this is being done as I write this piece.  It is not a prediction.  It is a reality that is leading us down a very bad road.  Our failure to unite as professionals is likely to result in terrible consequences for what we wish to do in the very near future as healthcare practitioners.  We must get beyond the fashionable notion that ASEP and its leadership are easy targets.  Blaming the leadership and making ASEP out as a useless organization cannot enhance the image of exercise physiology.

Clearly then, it will be far more beneficial for our students if we stop denying the extent to which exercise physiology must adapt to its problems with significant changes.  It is too late to stay in accordance with our history as technicians or fitness experts.  Others are seriously thinking about how they can incorporate health, fitness, rehabilitation, and athletics into their practice.  They want this because it makes life that much easier, and it gives them increased revenue. 

If you are concerned about your career as I am, you do not want to see physical therapists doing cardiovascular assessments or even using exercise physiology laboratory equipment.  Only recently, I received the following email from the President of the ASEP organization.
 
 
March 8, 2004

Dear ASEP Board of Directors:

Please consider writing to the Indiana state legislators regarding SB 360. I have sent the following letter to each senator and will send it to representatives.  You can find names and email them at:  http://www.in.gov/legislative/legislators/ and
http://www.in.gov/legislative/legislators/ 

Please forward to other interested parties, today!

Dear Senator:

The American Society of Exercise Physiologists (ASEP) is strongly opposed to Indiana SB 360. This bill is also strongly opposed by our affiliate, the Indiana Association of Exercise Physiologists (IAEP) and the Indiana State Medical Association (ISMA). 

While the bill primarily addresses direct access to physical therapy without a physician referral, a hidden provision would allow the physical therapist to provide fitness and wellness services to asymptomatic individuals in a non-medical setting without a physician referral.

Since the fitness industry is currently unregulated, this bill essentially provides regulation by default. Upon passage of this provision, there is concern that the American Physical Therapy Association would conclude that, by Indiana law, ONLY physical therapists could provide these services. Furthermore, exercise prescription and wellness services are not within the physical therapist's scope of practice. This provision is unwarranted and unnecessary and would cause economic harm to the Exercise Physiologist and increase the cost to a taxpayer seeking fitness and wellness services.

The American Society of Exercise Physiologists is the professional organization of Exercise Physiologists. Exercise Physiologists graduate from accredited universities and demonstrate competence in fitness assessment, exercise prescription, and wellness services through board certification. Exercise Physiologists are uniquely trained and provide fitness and wellness services in a variety of work environments including medical and non-medical settings.

Sincerely,
Steve Jungbauer
President ASEP 
Past President - IAEP

Before this gets too involved let me try and pull a few things together.  Medical care in the United States is increasingly a problem.  Traditional healthcare professionals, like physical therapists, are aware of this fact.  They also know that to maintain the income they want for their professional services, they must extend their services.  This means identifying new services even if they are not academically prepared to deliver the services to the public.  The scene is not a very professional one, but that will not stop them from moving to incorporate the exercise physiology body of knowledge into their own scope of practice.  Of course, in the meantime, we sit by arguing with each other or giving each other the silent treatment!  It makes no sense whatsoever, as I have noted in numerous articles published in PEPonline [2].

If for no other reason than to stop physical therapy from keeping our students in the "gym rat" business for decades to come, academic exercise physiologists must stop denying the challenges before them.  The more they get engaged in the change process, the more hope there is for our students and our profession.  One of the ways to do this is to get involved with the ASEP organization, support the vision, and short-circuit the strategies that are going to turn us in the wrong direction.  It now looks as though we must get moving on this initiative if we are to put forth a serious effort to maintain the momentum that ASEP has generated. 

Bearing in mind that ASEP has accomplished a lot in six years, there remains a lot to be done at this stage in our development as healthcare professionals.  Surely, the only thing holding us back is our failure or slowness in coming together.  It may be extraordinarily difficult for yet a number of years, but it is immensely important that we do. 

By now I hope to have convinced you that many of us are in denial.  We are not thinking straight, for if we were, we would understand that our field of study is under attack.  If we are to survive, as I’m confident we can as healthcare professionals, we must embrace a sustaining belief in our ability to effectively deal with the issues and concerns that face us.  I’m optimistic that we can, and the fact is that we are now well into the cycle of change that is certain to lead to increased professionalism. 

References
1.  Banner, D.K. and Gagne, T.E. (1995). Designing Effective Organizations: Traditional and Transformational Views. Thousand Oaks, CA: SAGE Publications, Inc., p. 169.
2.  Professionalization of Exercise Physiology. (2004). PEPonline Archive. [Online]. http://www.asep.org/asep/asep/FLDR/pro1a.html
 

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