The Preparation
of the Exercise Physiologist
How
To Conform To Today’s Health Care System
William F. Simpson, PhD,
FACSM
The College of St. Scholastica
Division Of Health Sciences
Department of Exercise Physiology
Duluth, MN
Introduction
Exercise physiology is both
a unique discipline and profession within itself. During my doctoral work,
one of my professors (a respiratory physiologist at the medical college)
remarked that she admired exercise physiology. She felt that it is
one of the only sub disciplines of physiology which is able to conduct
research and work directly with the human model. All of her research at
that time used the dog model. I found her comments interesting and somewhat
profound. As we debate the issues of accreditation, certification,
professionalism and other vital concerns to the exercise physiology profession,
we rarely address the issue of what species our graduates are going to
treat.
However, we must recognize
that our profession as opposed to many other health professions has two
major areas of emphasis which at times may be convoluted. We have research
exercise physiologists and then we have the "clinical" exercise physiologist.
The students who pursue both an undergraduate degree and graduate degree
at this college are typically planning to pursue clinical careers. The
majority of the graduate students from our most recent two classes was
interested in sports performance and training of elite athletes, athletic
training, corporate wellness and prevention programs, cardiac and pulmonary
rehabilitation. A few students have elected to further their education
in fields including medicine and physicians assistant programs. Only two
students selected the thesis option from the 1999-2000 class. Of those
two students one is currently pursuing a PhD. The other student defaulted
to doing a thesis secondary to his internship site withdrawing from the
contract at the last minute. Currently, he is a staff ATC/L at a local
hospital and is an adjunct instructor in the Department of Exercise Physiology
at St. Scholastica. No graduate students chose to complete a thesis project
from the 2000-2001 class. The variety of current internship placements
include cardiac and pulmonary rehabilitation, corporate wellness, performance
training and one student is completing her internship in California at
the Dean Ornish center.
Given the makeup of the students
in the graduate exercise physiology classes, one must begin to critically
examine the structure, content, and makeup of the professional exercise
physiology program. In this article I wish to highlight some observations
and make several suggestions which, perhaps, we need to recognize and begin
to deal with as professionals in an old yet new profession, particularly
as it relates to the health care professions.
Comparisons
My entry into the profession
was assisted by my activity in the American Corrective Therapy Association
[1946-1987] and the American Kinesiology Association [present name]. I
have purposely emphasized the name change as it illustrates a similar allied
health profession which found itself in a void and unable to become recognized.
Founded during World War II, corrective therapy [CT] essentially was an
outgrowth of adapted physical education and due to the lack of sufficient
numbers of registered physical therapists in the war effort. At the end
of the war the Veterans Administration added a new dimension to physical
rehabilitation by adding corrective therapy. The problem with corrective
therapy was that the majority of therapists stayed in the VA system and
never ventured out until the mid 1970s.
By the mid 1980s it was apparent
that a name change was needed to more accurately identify what a CT did
and how what the CT did was different from the practice of physical therapy.
The name “Kinesiotherapy” or “KT” was supported by a group from the
University of Toledo. It was actually the name that Dr. Robert Shelton
of the University of IL-Urbana proposed back in the early 50's. In 1987,
the name change was approved by the ACTA board and Corrective Therapy
or "CT" officially became Kinesiotherapy or "KT".
Even now, I still hear kinesiotherapy
referred to as corrective therapy. In 1995, CAHAEP recognized "KT" which
placed it along side athletic training, physical and occupational therapy,
and other professions as a valid allied health profession. Remember, kinesiotherapy
grew out of physical education. It took 50 years for the medical community
to accept and recognize kinesiotherapy. Interestingly, physical therapy
has ties to physical education as athletic training had its infancy based
in physical education. Now we see this "new" kid on the block, “clinical”
exercise physiology, moving away from the traditional physical education
model and beginning to stand on its own.
A similarity with all the
above professions was the slow but deliberate change in curriculum. For
example, I recall as an undergraduate in the 70s majoring in physical education
with an option to "concentrate" in athletic training. By the year 2003,
those days will be over and one will need to major in athletic training
just as one majors in physical therapy or nursing. In other words, athletic
training is a stand alone major and not connected to or with any other
major course of study. If one is to become a professional, clinical exercise
physiologist, one should major in clinical exercise physiology. That is
only a logical progression for the profession. Majoring in exercise science,
health promotion, human performance, and kinesiology may serve its function
today. However, to review the history of other allied health professions,
it is a logical step to move towards independence.
Further, with the curriculum
changes, it is important to identify the what competencies must be taught
to the pre-professionals. One way to define competencies is to examine
not only what the current exercise physiology professional does in the
field today, but what will it look like in five to ten years. In these
days of managed care and cross training, professionals must be proactive
and aggressive in what we define our profession to be. If we are to be
identified in terms of “clinical” or simply referred to as a clinician,
then we must not only be broad based but have the ability and training
to adapt to many different areas of clinical practice. If we continue to
emphasize only cardiac and pulmonary rehabilitation and call our courses
just that, we might as well order the hearse now. Those are only two areas
out of many that we should be preparing students to enter into the world
of professional exercise physiology. We must consider all other disabilities
including renal dysfunction, orthopedic injuries and disease, cancer, diabetes,
metabolic dysfunction, and mental health.
In addition to the rehabilitation
areas, we must also target our other strengths: preventive programs, fitness
evaluation programs, athletic conditioning, and community outreach programming.
The areas of the physically challenged, pediatrics and gerontology are
also areas to concentrate our attention as exercise physiologists. As the
population ages and the baby boomers continue to climb towards retirement,
the need will be greater for qualified professionals. Unfortunately, if
we are not proactive and visible, someone else will be. Other professionals
such physical therapists, physical therapist assistants, personal trainers
[with and without academic degrees], nurses and others will step into the
preventative or “wellness” spotlight.
Currently I am teaching one
course in the college’s gerontology minor/certificate program. “Health
and Functioning In Later Life” is one of the two core courses which all
minors must complete. Professionally, I find it an honor to be included
in this course work. It brings attention to the Department of Exercise
Physiology, and it is obviously the next giant frontier in health care.
Our profession should be one of the leaders within the gerontology field,
both on the preventative and rehabilitative side.
Therefore, we need to train
our exercise physiology students who anticipate a position in the clinical
setting to work in multiple environments, and to have an adequate clinical
background to adapt to a variety of settings. For example, in our program
we do not teach the principles of echocardiography and in fact we do not
have access to an echocardiography machine. Should this be a mandate within
the exercise physiology curriculum? I would answer, yes, to the question
since exercise echocardiography GXTs have become a standard screening
tool within cardiovascular diagnostics. Exercise physiologists in
the clinical setting have had to adapt and learn the skills needed to complete
the echo procedures. We must adapt the professional preparation to assure
that our students can compete in the job market. Another area is basic
phlebotomy, including IVs. If many of the GXTs of today include echo's
and the administration of thallium, duputomine and other such medications,
shouldn't the exercise physiologist be involved?
Some may argue that this
is not the exercise physiologist’s job. They may conclude that it
should be left to other health care professionals. One must recall that
there was a day when an RN could only administer injections with the MD
present. Further, physical therapists were limited to performing only the
tasks that the MD prescribed and would need to gain permission to even
change the assistive device being used for gait training. Those professions
have progressed and entered into more clinical competencies. If we are
to be considered one of the allied health professions, we must also consider
changes in what the scope of practice may be and actually “push the envelope
at times”. I am aware of exercise physiologists in the clinical setting
who are doing echo's, administrating thalium with the supervising physician
extending this clinical privilege to them. The consequence may be that
if someone else can do the procedure with less education and certainly
a smaller paycheck, then why would the hospital administration keep a professionally
prepared exercise physiologist on staff at $35,000/year when the $23,000/
year technician can perform the same job skills. If we are not aggressive
and proactive, someone else WILL.
Future
The preparation of the exercise
physiologist requires an understanding of the two major tracts, research
and clinical. However, the preparation of an exercise physiologist in the
clinical setting needs to include similar preparation in course work that
other health professions require (such as medical terminology, the workings
of the US health care system). Further, since some exercise physiologists
choose not to work in a true clinical setting, proper training and emphasis
should also be placed upon basic business and marketing fundamentals in
the event they decide to open their own private practice or business.
After attending the 2001
ACSM meeting it has also become evident to me that the area of prevention
is certainly the wave of the future. Much of the major symposia that I
attended was based around exercise epidemiological models, dose response
of exercise, genetics, and the ultimate importance the role of physical
activity plays in the risk reduction of chronic diseases (such as coronary
heart disease and cancer). If we are professional exercise physiologists,
we must instill in our students the importance of the observational studies
along with the empirical and clinical trial studies. To be able to adapt
programming and curricular based on these data is imperative if we are
to remain current and viable.
Traditional research is certainly
important in a career of an exercise physiologist. However, one must
weigh the importance of research techniques and advanced clinical skills
which the clinical exercise physiologist will need on the job. The collection
of pulmonary values, telemetry, echocardiography, IVs, advanced cardiac
life support, diabetic control, renal function and other diagnostic and
monitoring information are extremely valuable. Also, the role of behavior
change and facilitation is of considerable importance if we are to remain
on the cutting edge of today’s health care setting. We must recognize that
if professional preparatory programs limit the student’s exposure to current
clinical aspects of the field by placing too much emphasis on non clinical
aspects, then the emphasis may limit and hurt the student who is interested
in clinical work. This is similar to the programs which continue to require
traditional physical education courses such as motor development, analysis
of motion and sports skills that indirectly impact the profession.
Exercise physiologists should
develop programs with a strong set of clinical competencies to help students
measure up to other allied health professionals. The road is a tough road,
but is possible (given the history of AKTA and NATA). Health care in the
United States is a competitive and confusing place to be. If we are to
enter it with credentials and a competitive edge, we must be prepared to
compete, adapt, change, and negotiate. There will most certainly be other
health professions who will be leading a charge to squelch anything that
the exercise physiologist profession and ASEP attempts to do to further
our profession. I would also add that will be the case in regards to whatever
ACSM attempts to do as well, whether at the state or national level. We
will be watched. We will be mentioned in legislative bulletins of
other professional organizations, and we will be the talk of the lobbyists
of those professions. I would speculate that as our profession becomes
more visible and makes an impression, we will need to begin the lobbying
effort at the state level in order to survive.
So, what is the bottom line?
It is a mean world out there but that is the nature and business of the
health care system. If we are going to step up to the plate, we are entering
the major leagues and in this league it is where they do not take prisoners,
the competition is simply eliminated. This is not acceptable for us and,
therefore, I reinforce that notion that we must continue to be proactive
and be prepared to encounter countless inquires and attacks. The final
outcome however should be worth the effort, and exercise physiology as
a profession should benefit.
Acknowledgement:
I would like to thank Ms. Rebecca C. Coady, MA for her comments and assistance
in the preparation of this manuscript.
Copyright
©1997-2001 American Society of Exercise Physiologists. All Rights
Reserved.
ASEP
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