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
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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