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.