Professionalization of Exercise Physiologyonline
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Tommy Boone, PhD, MPH, MA, FASEP, EPC Professor and Chair Director, Exercise Physiology Laboratories The College of St. Scholastica Duluth, MN 55811
With the increase in personal trainers without an academic degree in exercise physiology, the science of exercise or training is not as important as the look. The public either doesn’t know the difference or cares to know. So, what is the big deal? It seems to me that exercise physiologists have continued to grow professionally despite the lack of a vision. They are experts in the scientific study of fitness and training. They have developed a highly specialized body of knowledge that embraces preventive medicine, the role of exercise in the treatment of disease, and the underlying science of function and performance. They deserve professional recognition for the decades of work on behalf of exercise physiology and the public’s health and the science of exercise. After earning the PhD degree from Florida State University in the mid-70s, I continued to think as a physical educator. It was a few years later that it occurred to me that I was not a physical educator. As an exercise physiologist, I taught kinesiology, functional anatomy (with cadavers), cardiac rehabilitation, and a variety of different kinds of health and physical education courses. My activity in those days was gymnastics. In fact, that is just about all I did for nearly 15 years. Doing handstand, swinging on the parallel bars, and doing flips were fun to do and physically and mentally beneficial. Only later did I learn to jog and teach the scientific literature on aerobic activities. Now, having come almost full circle and several universities later, it appears to me that either type of activity (i.e., anaerobic or aerobic) is good for the body and mind connection. And, I suppose that I finally got past the notion that exercise per se is the answer to society’s problems. Prevention is a good thing, but prevention is not an exact science by any means. I no longer believe that regular exercise will prevent me from having cancer or dying from some particular disease. Of course, it is logical (and, for the most part, scientifically demonstrated) that regular exercise can help decrease a person’s statistical risk of succumbing to a particular disease and/or dysfunction. This is not the reason I value regular exercise, however. Regular exercise is probably the most logical method to lose weight, keep the mind relaxed, have fun, and keep the body (both structure and function) from falling apart with age. There are numerous other reasons for engaging in regular exercise. Many of the reasons have been researched and published by exercise physiologists for at least five decades. The research has resulted in a specialized body of knowledge about exercise, health benefits, and the science of human performance. What is interesting is the credible image of exercise physiologists in the medical community. As a representative of the National Office of the American Society of Exercise Physiologists, I can contest to the increase in referrals from the medial community. Almost every other week, several individuals will call the ASEP office to locate an exercise physiologist in their part of the country to supervise an exercise program for them. This is a hard won image for exercise physiology. For the medical community to appreciate the value of exercise is a different perspective. Medical doctors have not always valued exercise. In addition to physical educators and a number of other professions with a side-interest in fitness, exercise physiologists have no doubt the record for most scientific research and knowledge on the subject. Hence, although the trend in the recent 10 years or so is still too new to thoroughly understand, it should not go unnoticed that there may be more to gain from investing in fitness and human development than previously considered by different professions. Interestingly, in May of 2003, Wilmore [1] published an article in The Physician and Sportsmedicine (PSM) journal. The article is informative for physicians. The content is consistent with what is taught in a typical undergraduate exercise physiology course. However, from an exercise physiologist’s point of view, the article raises the question, “What is gained from medical doctors prescribing exercise?” It seems to me that physicians should refer their clients to exercise physiologists who are academically prepared to deal with the prescription of exercise. What appears to be happening, however, is that physicians are being encouraged to practice exercise physiology. Wilmore [1] wrote the following: “Clinicians who understand how the body responds to exercise, how aerobic training improves cardiovascular fitness, and the benefits and principles of prescribing aerobic exercise can effectively encourage patients to become active and optimize programs for those already active.” While it appears that the point of the article is to educate physicians to the benefits of exercise for their patients, isn’t it better to refer patients to exercise physiology? This is exactly what medical doctors do when it comes to physical therapists and other healthcare professionals. If physicians become credible leaders in prescribing exercise, where does this leave exercise physiologists? Some would say that it is not good. Others would say that we need more credible professionals encouraging the public to exercise. Still further might say, “Don’t we already have credible professionals?” The answer to the latter question is “Yes, we do”. They are called exercise physiologists! With the emergence of exercise physiology as an evolving profession, exercise itself has taken on a new image. It seems to me that most of that image comes from the countless number of articles published by exercise physiologists about the health benefits of aerobic training [2]. There are also numerous consensus statements written at least in part by exercise physiologists [3, 4]. A major part of this expansion in the physiology of exercise is the increased understanding of exercise as medicine. Exercise physiologists have known for decades that exercise helps with controlling and/or modifying risk factors for different diseases, including but not limited to heart disease, diabetes, and osteoporosis. Apparently, the board members of PSM have come to the same conclusions [5]. I believe that there is a downside to this thinking, especially since it may have a direct impact on the practice of exercise physiology. It should be clear among healthcare
professionals that exercise physiologists advanced the concept of exercise
prescription. Pollock’s work in the late 1960s and early 1970s (and
even years thereafter) demonstrated the role of exercise physiologists
in prescribing exercise based on heart rate intensity, duration, and frequency
[6, 7]. His research helped to advance the concept of exercise
prescription to realize significant physiological benefits. In the
1970s several of my students and I published papers about the physiological
changes that associate with rehabilitation and the exercise prescription
of cardiac rehabilitation patients [8-10] We also researched the
importance of an accurate heart rate from carotid palpation [11].
If the technique is not accurate, then the prescription will not be correct
either. Naturally this would be a problem of considerable magnitude.
This is why exercise physiologists have carried out volumes of research
in this area. This kind of thinking has somehow been missed or overlooked
by other professionals. This tells me that something is wrong.
Also, why has the PSM definition of sports medicine changed four times
since 1986?
“Sports medicine is practiced in a number of venues by clinicians with overlapping but distinct areas of expertise. What ties the field together is its focus on a health model of medicine. As such, in addition to the care of athletes – their injuries, safety, and general health – sports medicine embraces preventive medicine, the role of exercise in the treatment of disease, and the underlying science of function and performance.” -- Gordon O. Matheson, MD, PhD, 1999 [5] The addition of “…the underlying science of function and performance” to the 1992 and 1998 definitions is a distinct difference to the most recent 1999 PSM definition of sports medicine. Why is this important? Perhaps, part of the reason lies in the following statement: “Being a sports medicine physician means having diverse practice skills, and we at PSM want to help you expand your professional skills by helping boost your financial as well as your clinical acumen” [5].
The use of exercise as exercise physiology healthcare professionals is an evolving field. It is not medicine, and it is not sports medicine. The goal is to zero in on academically accredited university exercise physiology programs that link directly to the ASEP Board Certification and the professional title, Exercise Physiologist. The use of exercise in the healthcare setting ought to be recognized from the standpoint of the exercise physiology, not sports medicine. This, I believe, is critical to the professional development of exercise physiology. Hence, the take home message is that exercise physiologists ought to be consulted when discussing and/or promoting cardiovascular or aerobic fitness programs. Similarly, when prescribing exercise, when using exercise in health enhancement, maintenance, and rehabilitation, and when describing exercise programs for athletics, exercise physiologists should be consulted. I am dumb-founded to realize that this is not the case with many practitioners. In other words, the defining, measuring, and quantification of exercise (with various ergometers and exercise machines) should employ the academic training of exercise physiologists. Further, when describing the different sources of energy for different kinds of exercise, exercise physiologists should be consulted. Still further, when requesting an understanding of how exercise is prescribed (particularly, strength vs. aerobic exercise), the qualified professional ought to be the exercise physiologist. And, yet not once did Knuttgen [13] identify or associate an exercise physiologist with the previous content information. The online article, What Is Exercise? A Primer for Practitioners fails to identify the “practitioners”. Worst yet, the author does not use the “Exercise Physiologist” title at all in the 11-page article. Since the author is the Exercise Physiology Series Editor of PSM, one can only conclude that the article is written for sports medicine professionals. By not connecting the exercise physiology content with the exercise physiology title, there is no reason for anyone to look to the exercise physiologist as the healthcare professional with specific academic training in those areas. This is a problem that needs correction. Some people might say that I am making too much of this point. Many different professionals have the capacity to express their unique academic skills and hands-on talent in their own unique way. Those individuals who experience the greatest joy in sports are likely to recognize the seed that it nurtures in creating a distinctive lifestyle. At least this is how I would like to think. Each of us however understands the unfolding of the healthcare dimension to shaping a financial base. To reach out to serve the public is an extraordinary gift to help. The reality is that healthcare costs are rising. It does not take a scientist to figure out that different forms of medicine, even if un-researched, may be allowed and encouraged without proven benefits. The challenge is to make sure that the healthcare professionals have credible, critical thinking skills based on proven scientific method and academic course work. Steve “Mississippi” Brock, the Ph.D. exercise physiologist who is a successful entrepreneur, put it this way: “There are many kinds of healthcare professionals. There are physical therapists, occupational therapists, nurses, dietitians, physician assistants, and others. The recognized healthcare professionals are those who understand the importance of their own professional organization. They understand risk taking with the American Society of Exercise Physiologists. To be a member is to risk being defined as an ASEP exercise physiologist. To speak positive about ASEP is to risk a startling difference from the sports medicine sentiment. To reach out for others to join the ASEP organization is to risk not being asked to join sports medicine. To place the ASEP ideas and dreams before other exercise physiologists is to risk losing friends. To share the ASEP vision is to risk not being embraced by sports medicine colleagues. To hope for something better is to risk losing everything. But risk is exactly what we must do if we are to realize the unlimited creative career opportunities in exercise physiology.” Without exception, if we really believe in the ASEP reality, it will guide us to a better future than we might have otherwise experienced. Put another way, the possibilities we imagine as experts in the workings of exercise and the ever-emerging reality that exercise is medicine are endless. We must therefore see the practical necessity of the connectedness between exercise prescription, human performance, and exercise physiology. This brings me back to the theme of this article. That is, exercise physiologists have developed concrete scientific evidence of the connection between exercise and lifestyles. This connection should be our reason for thinking we are experts in the powerful reality of our profession as exercise medicine. Any person who wants to immerse him- or herself in the exercise-medicine connection should abandon the 20th century notion of exercise physiology and sports medicine and start reconstructing the foundations of a personal and professional organizational commitment of exercise physiology as healthcare professionals under the responsibility of the American Society of Exercise Physiologists.
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