The Stormy Winds of Change: My Future in Exercise Physiology
Mel Sando
Board Certified Exercise Physiologists
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811

"Exercise Physiology is the identification of physiological mechanisms underlying physical activity, the comprehensive delivery of treatment services concerned with the analysis, improvement, and maintenance of health and fitness, rehabilitation of heart disease and other chronic diseases and/or disabilities, and the professional guidance and counsel of athletes and others interested in athletics, sports training, and human adaptability to acute and chronic exercise." [1] 

Since the inception of the American College of Sports Medicine in 1954, exercise physiologists have researched and created a highly specific body of knowledge that researchers and the medical community have come to know as "exercise physiology".  Through decades of creative thinking and exploration these individuals have brought the study or exercise physiology from the now cliché "acute and chronic adaptations to exercise" to the forefront of research in cellular microbiology and biochemistry.  And, yet despite the impressive volumes of research and years of work, it seems that the individuals that make up this group of exercise physiologists have failed to recognize the specificity of this body of knowledge and it's application to the public sector. 

"No one at Florida State University ever planned on using Gatorade to do anything but give their football team an advantage. How could they have known that Coca-Cola corporation would turn their side line cocktail into a huge for-profit soft drink."  -- J. Rob 

What seems even more confusing is that exercise physiologists have failed to recognize themselves.  This is a big mistake.  It seems that, in particular, the group with doctoral distinction across a great span of specialties such as, kinesiology, biochemistry, biomechanics, and sports medicine in general, failed to define their work in the area of exercise physiology, although they worked and published in the field. They failed to recognize exercise physiology as a specific body of knowledge or academic study with important healthcare implications like physical therapy and nursing.

In 1978, several exercise physiologist tried to give direction to the emerging field of exercise physiology [2].  These individuals believed that the ACSM would be interested in an exercise physiology document that addressed the definition of an Exercise Physiologist, program prerequisites, academic program requirements, in depth training, post doctoral experiences, promising areas of research, and matters of certification.

Interestingly, when the report was presented to the ACSM Board of Trustees, it was met with a hostile response because many Board members viewed the group as unauthorized, and the material inappropriate for discussion. The result was that the report was tabled, "for eternity".  Until recently the ACSM had continued to ignore issues concerned with exercise physiology as a profession until the clinical practice of exercise physiology has all but been handed over to physical therapists and registered nurses.

It is a Question of Education
Exercise physiology is a specific body of knowledge that covers, but is not limited to, cardiopulmonary disorders and rehabilitation, human hemodynamic responses to stress and exercise, kinesiology, biochemistry, and microbiology.  Until the appearance of a new organization, the American Society of Exercise Physiologists, the ACSM has had complete control over this specific body of knowledge, and, unfortunately, has done little to protect it, or to help it prosper beyond the realm of doctoral environments.  ASEP on the other hand has recognized the specificity of this body of knowledge.  It is dedicated to creating, in addition to PhD prepared exercise physiologists, a new group of bachelors and masters educated exercise physiologists who are prepared to practice exercise physiology in clinical and private health and rehabilitation facilities as Board Certified Exercise Physiologist, as EPCs.

In response to this new organization, the ACSM has had to back pedal and reorganize their certification guidelines. The fundamental difference between the two organizations is in the educational requirements.  The ACSM allows anyone with a bachelors degree in exercise science to sit for their certifications. This means that anyone with a degree from an exercise science program regardless if the subfield is "Fitness Center or Recreational Center Management", can sit for their exams. This means that someone with no previous experience reading ECGs can enter into a career in cardiac rehabilitation. The ACSM has failed to accredit undergraduate programs because it is, quite frankly, bad business to do so. They have instead created a partnership program in an effort to solidify curriculum across sports medicine scope of practice.  The differences between exercise science and exercise physiology are real, and they are important, too:

Exercise Science is a diverse field of study that may include sport psychologists, exercise physiologists, biomechanists, physical educators, and kinesiologists.

Exercise Physiology means the identification of physiological mechanisms underlying physical activity, the comprehensive delivery of treatment services concerned with the analysis, improvement, and maintenance of health and fitness, rehabilitation of heart disease and other chronic diseases and/or disabilities, and the professional guidance and counsel of athletes and others interested in athletics, sports training, and human adaptability to acute and chronic exercise. [1]

The ACSM leadership has attempted to make up for the differences in the undergraduate and graduate academics by requiring protracted internships as a way to guarantee that the candidates have a sufficient body of knowledge.  Currently there are no ACSM accredited bachelor or master programs of study.  ASEP on the other hand, has accredited several college and university academic programs.  The programs accredited by the organization all cover a specified body of knowledge specific to the research and application of exercise physiology, not a generic title of exercise science.The following are ASEP accredited academic programs (and the accreditation effort was carried out in less than six years of the founding of ASEP):

• Slippery Rock University m 
• Wright State University 
• University of New Mexico - Abuquerque
• Marquette University 
• Bloomsburg University
• The College of St. Scholastica 

The failure of the ACSM to control the exercise physiology body of knowledge has left it open as fair game to other health and clinical professions such as physical therapy and nursing as these organizations seek alternative areas to employ there growing numbers and to retain control over there clinical domain.  For this reason, from a student's perspective, it is clear that the ACSM organization failed the educational requirements of exercise physiology below the doctorate level.

The 21st Century Exercise Physiologist
As the practice of exercise physiology becomes increasingly left to the master and bachelor-prepared exercise physiologist, the face of the profession must also change.  The image of the lab-coated researcher will go away and be replaced by the clinical practitioner in health and rehabilitation facilities.  In fact, in the Professionalism of Exercise Physiologyonline journal, Boone [3] proposed several "megatrends" for the future of exercise physiology.  Here are some from that passage: 

• We are moving from a technology thinking to an integrated healthcare thinking.
• We are moving from sports medicine to a future as exercise physiologists.
• We are moving from and exclusive emphasis on research to a broader analysis of our specialized knowledge, to an integrative application for the prevention and rehabilitation of disease or dysfunction.
• We are moving from the exercise physiologist identified by the doctorate degree to exercise physiologists defined by the ASEP Board of Certification.

Who is an exercise physiologist?  Clearly, an exercise physiologist is a person who has an academic degree in exercise physiology, or who is certified by ASEP to practice exercise physiology [via the Exercise Physiologist Certified exam (EPC)], or who has a doctorate degree with an academic degree or emphasis in exercise physiology from an accredited college or university. [1] 

I understand this more today than just months ago.  Now, just as I'm about to finish the course requirements of the graduate degree in exercise physiology, I have entered into the "real world".  It isn't going to be easy, but I feel confident knowing that ASEP is on my side.  The future will be challenging, but not impossible.  There are jobs beyond the realm of cardiac rehab and submission to the nursing profession.  I look to the world of a changing health and fitness center industry as rehab facilities begin to privatize and look to academia for people educated far beyond the role of "personal trainer".  I feel certain that they will be looking for someone who understands cardiovascular profiling, metabolic assessments, ECG, cardiac rehabilitation and, in general, someone who understands that "exercise is medicine".  The public will demand that the exercise physiologist knows more than generalized knowledge of kinesiology, functional anatomy, and ergometer assessments.  That's okay with me because I'm Board Certified Exercise Physiologist with an academic degree in Exercise Physiology.

References

1.  American Society of Exercise Physiologists. (2004). ASEP Contact Page. [Online]. http://www.asep.org/
2.  Tipton, C.M. (1998). Contemporary Exercise Physiology: Fifty Years After the Closure of Harvard Fatigue Laboratory. In Exercise and Sport Sciences Reviews.  Edited by John O. Holloszy. Vol 26:315-339. Baltimore, MD: Williams & Wilkins.
3. Boone, T.  (2003). The Struggle for Meaning in Academic Exercise Physiology.  Professionalism of Exercise Physiologyonline. Vol. 6 No. 12
[Online]. http://www.asep.org/asep/asep/THEacademicEXERCISEphysiologySTRUGGLE.html