Professionalization of Exercise Physiologyonline     


         ISSN 1099-5862   Vol 7 No 1  January 2004 
 



 
 

 

    Editor-in-Chief
    Tommy Boone, PhD, MPH, MA, FASEP, EPC
 
 
Exercise Physiologists as Educators and Healthcare Practitioners in the Multidisciplinary Exercise Physiology Healthcare (MEPH) Clinic
Tommy Boone, PhD, MPH, MA, FASEP, EPC
Professor and Chair
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811
 
“The greatest thing in this world is not so much where we are, but in what direction we are moving.”  -- Oliver Wendell Holmes
Health is important to everyone.  Every family is concerned with the health of individual family members.  Everyday life requires a high level of health.  The capacity to perform physically is linked to health.  Predisposition to different diseases is linked to health status.  Toward that end, health promotion is part of a huge collection of professionals who belong to established provider systems.  Historically, the providers are located in hospitals, clinics, and a variety of treatment centers with diverse interventions.  Linkages between these interventions and failed health are obvious, but at a high financial cost. 

This article presents an overview of how and why exercise physiologists must be figured into the challenges and opportunities for better healthcare in the United States.  Exercise physiologists can help reduce the overall costs of care by promoting healthy lifestyles.  The focus is on the use of exercise to improve the quality of life.  The relationship between exercise and health has been recognized for many decades.  Exercise physiologists are educated to initiate multilevel interventions to bring about healthcare changes.  Only by examining aggregates of lifestyle and behavior issues can individuals understand the combination of factors that associate with dysfunction and/or disease.  It is more than just exercise.  It is a high level of involvement with the expectation to improve day-to-day life.

The ASEP organization is central to the commitment of exercise physiologists as healthcare professionals in the community.  This shift from more traditional roles of work to the community with greater personal responsibility and involvement in helping individuals singly and collectively improve healthcare is important to the professional development of exercise physiology.  From this effort will come improved opportunities for improving the standards for healthcare by exercise physiologists.  The willingness to make this shift from the gym to the larger community is a daunting task.  It may not be easy for the established healthcare professions.  The old ways are comfortable even for exercise physiologists.  Yet thinking through the uncertainty is essential part of the new academic exercise physiology. 

The Challenge to Faculty

“We should become what we are.  We should release the image of exercise physiology that is within us.” -- William T. Boone
The challenge before academic exercise physiologists is to develop an integrated healthcare curriculum solidly grounded in the basics of exercise physiology knowledge and professional practice.  To achieve this objective, the faculty will need guidance in curriculum reform.  For example, faculty will need to spend less time teaching non-exercise physiology courses such as motor learning, “how to teach” different activities, and traditional physical education courses so that more time can be spent on exercise physiology courses, including but not limited to, exercise physiology, advanced exercise physiology, cardiovascular physiology, psychophysiology of health and exercise, physiological assessment, cardiopulmonary rehabilitation, exercise biomechanics, exercise nutrition, graded exercise testing, electrocardiography, exercise physiology research, and biochemistry of exercise.  Faculty will need to spend less time teaching the scientific strategies to increase athletic performance and more time teaching the application of exercise physiology content to improve healthcare issues and concerns.  Students will need courses on management, business, and computer skills.  They will need to understand private practice.  This will require the faculty to make significant changes in how exercise physiology is viewed.  Adherence to the ASEP definitions of what is exercise physiology and who is an exercise physiologist will place a primary focus on improving health through critical reflection and cognitive strategies.

Faculty Preparation for the Shift

“It is clear that many academic exercise physiologists are not prepared for the shift in thinking and interacting professionally with students that is needed in exercise physiology undergraduate or graduate education today.” – William T. Boone 
The shift in thinking occurs on the coat tails of decades of exercise physiology research success.  The recognition is solidly fixed to a specialized body of knowledge that is uniquely exercise physiology.  Like other healthcare professionals, there is increasingly less ambiguity with the question:  What is the exercise physiology scope of practice?  But, this doesn’t mean that the theory and practice that defines exercise physiology as a healthcare profession is completely defined or accepted.  Part of the difficulty lies with the faculty.  Some feel that the shift means they are doing something wrong, which makes them question the new thinking.  The reality is that the faculty has not failed unless they choose to define exercise physiology by past successes.  Clearly, most occupations are in transition from being a discipline to a profession.  Exercise physiology is no different.

While research has defined much of the success within the institution-based curriculum, the exercise physiology faculty must move to the healthcare-based, professional model.  Research is expected to continue as an important part of this model; it doesn’t get rid of research by any means.  The primary care model for health and wellness promotion isn’t in conflict with the research-publish model.  Both need to be fully integrated into the new exercise physiology institution-based curriculum.  In some context, the shift to healthcare promotion (and, therefore, disease prevention) from just the emphasis on research has always existed within the discipline.  The missing parts have been the failure of exercise physiologists to build their own professional organization and the philosophy that associates with professionalism and professional development.  Now, with increased emphasis on health promotion, fitness restoration, and disease prevention or postponement, it is the task of department heads and faculty to come to some understanding that the past is over.  Success today is defined by new expectations and hands-on skills.

Exercise Physiology: A Work in Progress
It is rarely possible to switch completely from one model to another model over night.  This is why it is acceptable to think of exercise physiology as work in progress.  In fact, it is the only strategy that is sensible and realistic.  The ASEP leadership understands this point.  It is purposefully built into the ASEP guidelines for accreditation standards for academic departments.  Measures of accountability are consistent with measurable outcomes, but trying to be 100% specific about learning objectives and philosophical beliefs is a mistake.  Shaping a new profession of healthcare practitioners takes time.  Facets like course outcomes, innovative thinking, faculty development, curriculum planning, and handling anxiety and apprehension require time to be reframed in the new way of thinking.  The healthcare model is timely, but not every exercise physiologist will agree.  It is logical, but some will see it as illogical.  The unrest that is common with change clouds the thinking of others.  Still other faculty members thrive on the ambiguity and flux.  They enjoy the tinkering, disruption, and new ideas that are incremental, not dramatic [1].

Movement to the public sector to practice exercise physiology is “the” work in progress.  As mentioned, it is not easy for faculty to step from their comfort zone of laboratory setting to the community setting.  The required shift takes time to develop and to apply the exercise physiology concepts in a personalized care setting.  Course content must be reframed and laboratory experiences must be redesigned to address the community-based setting.  The new model as a career niche for exercise physiologists is defined by healthcare interventions that are personalized and continuous.  Goals are specific to helping individuals of all ages to promote better health and fitness.  The unique opportunity to assists with rehabilitation of diverse diseases and/or dysfunctions with a personalized care plan in a structured setting is new.  This approach allows for individual and/or family care, perhaps, over many years to maximize lifestyle potential for improving longevity and quality of life. 

Community-Based Curriculum Change in Exercise Physiology
The reason for the curriculum change is the commitment to exercise physiology practice in the hands of board certified exercise physiologists.  For decades, exercise physiology leadership and title were defined by the doctorate degree.  It is clear that exercise physiologists with the doctorate degree are not running to the community to practice.  They see themselves as college professors and/or researchers.  But, of course, they teach students who believe that at graduation they should be academically prepared to practice what they learned while in school.  They are becoming the exercise physiology force of the community.  Although the title has not been published before, it is appropriate to refer to these young professionals as “Community Exercise Physiologists”.  The focus on “community” versus “rehabilitation” sets the stage for the designation similar to “Clinical Exercise Physiologist”.  In actuality, however, the focus is really on the academic degree per se that yields, after board certification, the professional title, Exercise Physiologist. 
This thinking is new and contrary to the outdated thinking of exercise specialist or fitness professionals.

“The universe is change; our life is what our thoughts make it.”  -- Marcus Aurelius Antonius
Traditionally, there has been little integration of information from different disciplines.  Exercise physiologists need to focus less on the compartmentalization by discipline and more on the integrated application to community-based priorities.  This does present a problem, however.  The primary reason is that there are no plans in place to encourage students to increase their awareness of integrated knowledge.  With the almost unreal volumes of knowledge from different disciplines and the Internet knowledge explosion, exercise physiology professors need to rethink the traditional approach to education.  The curriculum needs to focus on a constant integration and mix of content from one discipline to the next.  Accessing information is important, but demonstrating the connectedness of all information is imperative.  This should be the primary purpose and approach to rethinking the exercise physiology curricula across baccalaureate and higher degree programs of study.  With increased knowledge and understanding of integrated lifestyle factors, clients increase their chances of staying out of the hospital and acute care settings.  The goal is to keep clients healthy by engaging them in positive lifestyle changes. 

The Multidisciplinary Exercise Physiology Healthcare (MEPH) Clinic
The primary vehicle for implementation is the development of “Multidisciplinary Exercise Physiology Healthcare Clinics”.  There are many community-based scenarios that can be played out during the students’ education in traditional laboratory experiences.  This shift from traditional exercise physiology and important educational and research developments carries with it change that does not come easily.  Change is always a challenge, especially when the emphasis is placed on the community setting.  This thinking is not completely new, but is now viewed as new.  In fact, students today may find that the original approach to cardiac rehabilitation was community-based [2, 3].  What used to be out-patient based Phase III university programs are now refashioned to Phase I and Phase II hospital-based cardiac rehabilitation programs.  This shift in orientation occurred with the founding of the American Association Cardiovascular Pulmonary Rehabilitation (AACVPR).  In effect, the organization set the stage for nurses to displace exercise physiologists.  What was once primarily a niche career opportunity for exercise physiologists no longer exists. From what was an excellent idea that had important educational and research opportunities for faculty and students, as well as the heart patients, is gone. 

Marcus Bach, the author of The Power of Perception [4] said, “I am disposed by nature to great expectations. I believe in them, anticipate them, invite them, and therefore usually find them verified in the experiences of others who, as I, bring to them life by first feeling them in life.”  The power of expectation is great.  Essential to understanding the MEPH Clinic is to know about the power that comes from being disposed to great expectations.  Exercise physiologists have done great things in recent decades.  But, only recently, beyond the scientific method of exercise physiology practice, have exercise physiologists undergone such rapid change in concepts of professionalism and the need for regulation.  A new philosophy has emerged with the founding of the American Society of Exercise Physiologists (ASEP) that recognizes the big difference in exercise physiology as a technician-driven discipline and exercise physiology as a healthcare profession.  The ASEP vision is the incentive for conceptual thinking behind the MEPH clinic-style of providing healthcare.  The ASEP vision statement [5] is also the difference between ASEP and other organizations that have not organized their philosophic framework of healthcare around academic accreditation, accountability, and the profession’s scope of practice. 

In many ways, the ASEP concept of healthcare should be recognize as important steps toward controlling costs.  Obviously, this is all new to exercise physiologists.  The founding of MEPH clinics throughout the United States is right for the economy and market conditions.  The trend in alternative therapies also favors the competitive opportunities of exercise physiologists.  Still, other factors have changed today’s views about healthcare, particularly prevention of diseases and health promotion.  The increased interest in fitness and athletics is another important reason to build MEPH clinics staffed with competent, board certified professionals.  The focus on keeping clients well is balanced against today’s needs to continue defining the exercise physiology body of knowledge through research.  The process that drives the MEPH clinics is integrative and based on multidisciplinary data that allows for a new, personal, and alternative method of healthcare.  The primary purpose is to provide high-quality, effective healthcare services to promote health and wellness.  The MEPH clinics will emphasize clients first by providing cardiovascular physiology profiles using advanced technology in a scientific- based environment.  It will enable exercise physiologists and other members of the MEPH team to meet needs of the community.

Implications for Exercise Physiologists
The implications of the above growth of MEPH clinics in the future management of health, fitness, rehabilitation, and athletics is a clear mandate for ASEP to accredit more academic programs and certify more exercise physiologist.  The aging “baby boomers” will have significant age-related changes in vital organs that will need functional analysis and rehabilitation.  They will also have the “…unprecedented wealth to spend on health services, wellness and prevention, and the rehabilitation…” [5].   The American public wants more involvement in their healthcare.  With the money to pay fee-for-service, they stand to regain control over healthcare decisions with increased involvement in their care.  Exercise physiologists have the opportunity to organize smoking cessation programs, exercise for building athletic skills, for decreasing fat, and for increasing lean muscle tissue, nutritionally sound programs for athletics and a positive lifestyle, and stress management programs to decrease stress related conditions.  The result will be an increase in the client’s control over healthcare matters with a decrease in chronic disease by 50% [5]. 

Exercise physiology should therefore be considered along with other types of alternative medicine in the handling of lifestyle issues and concerns.  The future looks bright for exercise physiology because its specialized body of knowledge is scientifically based.  Hence, if $3 billion can be spent each year on alternative (or complementary) medicine such as massage, aroma therapy, guided imagery, acupuncture, and so, Americans have the money to spend on exercise physiologists as healthcare professionals.  The success of the MEPH clinics will to a large degree be due to first-ever comprehensive cardiovascular profiles.  The data will be generated from a variety of exercise physiology metabolic equipment and comparison-histories.  With decades of exercise-specific education tempered with a highly significant understanding of integrated systems and disease-prevention, MEPH clinics will play increasing roles in the future philosophy of healthcare.  This will cause college administrators and exercise physiology faculty to think about academic accreditation, board certification, and ASEP licensure.  In the end, exercise physiologists will become recognized as healthcare educators with a scientific specialty niche marketed directly to the community. 
 

References
1. Tagliareni, M. E. (1997). Teaching in the Community: Preparing Nurses for the 21st Century. New York, NY: National League for Nursing Press. Pub. No. 14-7262. 
2. Cardiac Rehabilitation Program. (1975). Out-Patient Based Organizational Guidelines for Cardiac Rehabilitation.  North Carolina Heart Association, Inc., Wake Forest University, Bowman Gray School of Medicine, and North Carolina Department of Human Resources, Division of Vocational Rehabilitation Services. 
3. Pollock, M.L. and Schmidt, D.H. (1995). Heart Disease and Rehabilitation. (Third Edition). Champaign, IL: Human Kinetics. 
4. Bach, M. (1965). The Power of Perception. Garden City, NY: Doubleday & Company, Inc., p.137.
5. Goe, S. (2001). Healthcare Delivery in the Future.  In Creating Responsive Solutions to Healthcare Change. McCullough, C.S. (Editor). Indianapolis, IN: Center Nursing Press.
 
 

Return to top of page