Professionalization of Exercise Physiologyonline    


         ISSN 1099-5862   Vol 7 No 1  January 2004 
 



 
 

 

    Editor-in-Chief
    Tommy Boone, PhD, MPH, MA, FASEP, EPC
 
 
The Struggle to Serve the Profession
Tommy Boone, PhD, MPH, MA, FASEP, EPC
Professor and Chair
Director, Exercise Physiology Laboratories
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811
 
“Expectation is a servant of the will, the will is the result of a wish, and a wish is spun from the power of spirit.”  -- Marcus Bach
This work began many years ago, and has just recently taken the form of an academic inquiry into the role of academic exercise physiologists in the struggle to serve the profession.  As a college teacher for nearly four decades, I began revising my thinking about exercise physiology about 10 years ago.  At that time, my thoughts changed from just teaching to chairing a department and teaching.  Although I'm responsible for numerous administrative decisions, my primary motivation and what I think about most of time is teaching.  To be a teacher is uniquely special to me.  It takes a lot of work and time to organize the right content for the right reasons.  Not everyone is a teacher.  In fact, many teachers aren't very good at teaching.  Teaching allows for an expression of feelings and thoughts that few other jobs allow for or encourage.  The unfolding of ideas in class could not be more exciting to the teacher who is still learning.  It is therefore important that I teach despite my age or other considerations.  I am eternally thankful that I am a teacher.  After all, it is a special opportunity to share one's thinking with young people, to enjoy everything about it, and get paid for doing so. Therein lies the understanding behind my desire to do what is right on behalf of my students and exercise physiology.  However, "the power of spirit" to teach is always a mixed blessing.  Not all the students are equally motivated to learn.  Some have no idea what college is about.  And, there are students who choose an academic major without even knowing why!  In short, when students and faculty are not on the same page, there is little hope of a quick understanding of the challenges within the profession.  This lack of focus creates circumstances that take from a unified purpose.  As a result, teachers who must teach within the transition period of change will struggle to serve.  This brief article is about the "struggle to serve". 

The concept “to serve” is part of what college teachers understand.  They are expected to perform a “service” to the students, the college, and the community.  Service is an important part of the academic model for promotion and tenure.  It is a mutually understood concept among the faculty and between the faculty and administrators.  Therefore, when there is a struggle to serve or to demonstrate one's service to the institution, there is a problem that must be solved.  Although it may not have an immediate, direct influence on promotion or tenure, faculty members are often predisposed to “serving” their students as part of the service requirement.  The typical backdrop to service is in the classroom and laboratories.  In other words, teaching is a service and a duty, although traditionally "service" is something that is done beyond teaching and research.  When teaching is viewed as a form or type of service, then the service in the form of teaching becomes problematic when students fail to understand the purpose of the content.  The failure, then, sets the stage for the “struggle” per se.  In terms of content, most students understand what is expected (i.e., if its a kinesiology course, then the content is about muscles).  Yet, from discussions with other teachers, when they bring up ideas relevant to students after graduation than before graduation, they fail to grasp the importance.  For example, I’ve observed that some students aren't interested in legal issues, negligence, and supervision of exercise programs before graduation.   These same students appear disinterested in the obvious benefits of having a scope of practice. 

A part of the problem stems from the overall lack of professionalism and what it means to be a professional in the field.  Another part is the lingering effects of traditional thinking that exercise physiology is little more than counting heart beats.  Still further, there is the lack of an agreement among academic exercise physiologists as to what is exercise physiology and who is an exercise physiologists.  Hence, why should students know what is important, right, or wrong?  Until teachers take time to teach about the issues and concerns that impact exercise physiology, serving students within the "professional frame of thinking" will be a struggle.  This point is concretely linked to the fact that students have no knowledge of what constitutes professionalism or why a professional organization is important.  Few, if any, students in exercise physiology or related programs talk about professionalism and, if that isn’t bad enough, few faculty speak of professionalism.  Further, the conflict may be directly related to the students’ emphasis on athletics and the faculty’s emphasis on research.  Both kinds of thinking are traditional and comfortable.  Neither the students nor the faculty across many campuses seem to understand the need for exercise physiology to evolve.  It can therefore be concluded that the history of exercise physiology is in contrast with the contemporary thinking of the ASEP leadership [1].  Yet, the latter must be understood and embraced if exercise physiology is to survive beyond a "fitness professional" status.  Surely, the board certified exercise physiologist is more than a fitness professional or a personal trainer?  The question is, "Do students understand the difference?"  If they don't, which is very likely, it is a problem, especially when teaching about professionalism, accountability, and licensure rather than about running faster, jumping higher, and getting stronger.  Consider the factors that have contributed this dilemma:

In 1948, Morehouse and Miller [2] published Physiology of Exercise text.  The pioneering work of researchers at that time was directed at the physiology of sport, work, and war.  The Intoduction of the text was written by David B. Dill, who wrote "It is not enought to make neat studies of frogs' nerve-muscle preparations, of swimming rats and of pating dogs.  Man himself must be the subject; many of the advances in exercise physiology have come from self-experimentation."  [2, p. 9]  Dill's use of the words "exercise physiology" is impressive.  Certainly, at that time, there was little to serious thinking about exercise physiology as a healthcare profession.  It was then as it still is today primarily about research on the physiology of sport.  In 1965, Karpovich [3] published the sixth edition of Physiology of Muscular Activity.  Although easily interpreted as an exercise physiology text, it was written for the physical educator.  Similarly, the 1970 Textbook of Work Physiology, by Astrand and Rodahl, was written for the physiologist, the physical educator, and the clinican.  It was not written to meet the needs of the student of exercise physiology [4].  It wasn't until 1986 [5] that a text was written that placed considerable emphasis on the use of exercise physiology to "...understand the role that exercise plays in the development of a healthy life-style based on legitimate research (i.e., Physiology of Exercise and Sport by Noble).  Still, Nobe did not define exercise physiology.  In 1993, the problem continues with the text by Fox, Bowers, and Foss, The Physiological Basis for Exercise and Sport [6].  Instead of a definition that would allow for a profession to be built from underneath it, the authors wrote, "Exercise physiology is an aspect of kinesiology and sports medicine that involves the study of how the body, from a functional standpoint, responds, adjusts, and adapts to exercise." [6, p. 3]  Unfortunately, this definition is still believed by many exercise physiologists today.

In 1994, Wilmore and Costill [7] published Physiology of Sport and Exercise.  They wrote that "Exercise physiology is the study of how our bodies' structures and functions are altered when we are exposed to acute and chronic bouts of exercise.  Here again, the definition is somewhat in agreement with Fox, Bowers, and Foss.  This is yet another example of not having the right definition from which to build a profession.  These researchers were primarily physical educators who were interested in "...how the body adapts physiologically to the acute stress of exercise, or physical activity, and the chronic stress of physical activity." [7, p. 5]  Brooks and colleagues [8] published Exercise Physiology, second edition, in 1996.  The defined exercise physiology as "...a branch of physiology that deals with the functioning of the body during exercise."  [8, p. 3]  In 1997, Plowman and Smith [9] published Exercise Physiology for Health, Fitness, and Performance.  They wrote that "Exercise physiology can be defined as both a basic and an applied science that describes, explains, and uses the body's response to exercise and adaptation to exercise training to maximize human physical potential." [9, p. 3]  Note that the definition is similar to the previous definitions plus it supports Dill's earlier 1948 comment.  In other words, little progress was made across essentially 50 years in the definition of exercise physiology.  In fact, the authors of the fourth edition, 2001 Exercise Physiology text [10], did not even try to define exercise physiology!

Prior to the founding of ASEP, it should be clear that Exercise Physiology was defined as the acute and chronic adaptations to exercise.  No one had a problem with the definition or the lack of a proper defintion for 50 years.  Frankly, the academic exercise physiologists apparently paid very little attention to the definition.  Had they done so, faculty in particular, the definition of "what is exercise physiology" would have changed long ago.  The historical and, yes, sports medicine/physical education definition is not just inadequate but totally incorrect.  It is not possible to build a profession around the definition(s).  Perhaps that was always the point; the doctorate prepared exercise physiologists are primarily researchers.  They teach when they have to and, where possible, assign their classes to doctorate students.  No one (until the past 10 years) actually expected exercise physiologists to emerge from an undergraduate program.  Maybe the mix of physical education with kinesiology and exercise science courses is sufficient to create a “health and fitness” certification, and maybe the master prepared graduates could call themselves “fitness professionals”.  But, neither the kinesiologist, exercise scientist (if there is such a thing), or the fitness professional is an exercise physiologist.  Now, it is clear that the struggle to serve is partly due to lack of leadership by exercise physiologists at the college level for many decades (perhaps, as long as 50 plus years). 

While research is important to exercise physiology, it must have a purpose beyond jumping higher, running faster, and getting stronger.  Athletics is all about athletics.  Exercise physiology cannot be just about athletics.  It must also be about health, fitness, wellness, and rehabilitation [11].  In other words, exercise physiology has always been rooted in the tradition of healthcare.  Unfortunately, it is only since 1997 that the ASEP leadership has re-defined exercise physiology apart from the obvious link to athletics.  Here again, exercise physiology is not exercise (or sports) nutrition.  Although part of the subject matter of exercise physiology, no one should be driven to push dietary or sports supplements onto athletes.  Athletics is not just about winning.  It is much more than that, and exercise physiologists are much more than technicians.  But, here again, this is part of the struggle.  It seems that some students are down right happy to stand by a treadmill and monitor heart rate day after day.  The struggle is in trying to help them think of what they could be doing.  With the right education and professional credentials, they could be leaders in health, wellness, and rehabilitation.  The problem is that they don’t seem to get the big picture and, of course, it all comes back to the faculty who are responsible for sharing the picture and time for it to sink in. 

Exercise Physiology is the identification of physiological mechanisms underlying physical activity, thecomprehensive 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.” 

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.” [12]

It is noteworthy that physical therapists in academic settings are entrusted to share professionalism with their students.  This aspect of their academic position largely represents the value placed on professional development.  They understand the importance of having a professional code of ethics and scope of practice.  Nurses in the academic setting teach professionalism.  It is not a struggle because physical therapy students and nursing students appear to understand from the beginning that professionalism, professional development, accountability, and standards of professional practice are as important as other subject matter.  This is not true in exercise physiology.  Of course, there are only a few colleges and universities with an undergraduate (or graduate) academic degree in exercise physiology [13].  Knowing this, living with it, and sharing it with students, faculty, and friends are also part of the struggle to serve.  The problem can only be fixed by upgrading programs through ASEP accreditation [14] to exercise physiology programs of study.  It cannot be fixed by calling the problem, which presently exists with 30 plus different names, by a similar name (i.e., fitness professionals).  Fixing the problem requires a completely new way of thinking.  Part of this problem is that exercise physiologists have not embraced professionalism [15]. 

One can safely say that the role of an exercise specialist or fitness profession in the public sector is a contradiction to the ASEP definition of an exercise physiologist [12].  Therefore, one wonders how the sports medicine declaration that has supposedly justified its powers and influence over exercise physiology has been maintained even into the 21st century.  It is interesting to note that the declaration is far from complete, however.  In this sense, the exercise physiology heritage with sports medicine is appreciated, and therefore, is valued and will always be remembered.  That is, in brief, exercise physiologists helped create a forum whereby their research could be presented, talked about, and published.  That process is still important because it is fundamental to continuing the scientific base that is largely the specialized body of knowledge exercise physiologists have created.  Yet, in an age of change, in order to fully realize the potential invested in the knowledge base of exercise physiology, regardless of feelings otherwise, exercise physiologists must capture it within a scope of practice that is tied to licensure.  But, the struggle to serve is part of this issue of exercise physiologists failing to move exercise physiology from a research discipline to a profession and, therefore, failing to discover the implications for service in the public sector.  It is not enough for exercise physiologists to understand the value of exercise and to encourage the public to exercise.  Several established professions do that all the time. 

To effectively undertake a study of the role of exercise physiology in the public sector, exercise physiologists must consider the integrated disciplinary body of knowledge that defines exercise physiology.  To do this, however, they must look beyond their immediate interest in research.  This should not come as a surprise, although it will be a surprise to many exercise physiologists.  They, in particular, will need to rethink what they are teaching and why it is important [16].  Every profession must have a reason for its existence if the public is to acknowledge it.  There must be something about what the members of the profession do that is unique to their education and “service” to the public as healthcare professionals.  The irony of course is that the ASEP organization was founded to help with the rethinking process, to move students from an inferior education to a respectable field of study, and to embrace professionalism just as other healthcare professionals have done. 

It seems obvious that the unfolding of the ASEP effort has by no means been overlooked or underestimated except in the service department.  To serve students and the profession is important.  To always do so under stress and general unrest is not healthy.  Students of exercise physiology should expect discussions of professionalism, the importance of ethical thinking, and the politics of professional development.  Yet it is more than curious to find students not necessarily contrary in their thinking about professionalism, but overall less engaged in the symbolic significance of the ASEP effort.  In this sense, I’ve observed students who seem to look at their instructors during class with little appreciation of the work that they do on the students’ behalf.  It is obviously disconcerting and disappointing.  This isn’t true with physical therapy, nursing, or other recognized healthcare professions.  Part of the reason is that the students have worked hard to get into those programs.  For the most part, this is not true when it comes to majoring in programs that are traditionally linked to physical education, kinesiology, or exercise science.   Whether anyone wants to admit it or not, these programs accept just about any student who attends college.  So, I suppose these students are not thinking about their major in the same context as students who apply to get in nursing or physical therapy.  I argue that this kind of system (i.e., one or two courses that separate a physical education degree from an exercise science degree) is not just less than desirable, but contrary to the 21st century thinking that defines exercise physiology as a healthcare profession.  Taken literally, why don’t the academic exercise physiologists do something about the problem? 

Perhaps, the criteria for triggering change are set out in the authentic, passionate support of ASEP.  In short, to influence others is to live the vision.  To serve students and the profession is to live the vision [17].  To not live the vision is to say, in effect, “I don’t really care about it.”  This kind of thinking can run a person in circles, which brings to mind the statement everyone has heard at some point:  “You can lead a horse to water, but you can’t make him drink.”  The imagery that readily comes to mind here is that of students who don’t understand the need for professional development, and they don’t see any reason for talking about it.  Trying to force them to do so is futile.  They have no idea about the importance of regulation, professionalism, and accountability.  They don’t understand why the teacher has undertaken an official declaration to discuss professional issues and concerns that face exercise physiologists.  They have no idea as to the nature of exercise physiology as an evolving profession [18].  This dilemma presents itself as a serious obstacle to serving the students.  And, yet simply by a twist of mind students can embrace change.  An inner vision gives them the justification to joins hands in the same effort.  This isn’t a struggle, and it is fun to be part of.  But, when it doesn’t happen, it is a struggle and the question is, “How can the struggle be eliminated?”  What can teachers do to help students reconsider deceptive practices by other organizations?  These are just a couple of the questions that relate to service.

Just recently, I was asked to speak to a class of exercise physiology students.  Several times during my carefully chosen words with the potential to influence or launch a new idea or hope for increased career opportunities, I realized that the secret of my presentation regarding “licensure” was not having the impact that I thought it would.  This really surprised me.  Instantly, I wanted to take an inventory of what was going on but it was not possible or appropriate at the time.  Since then, I’ve thought a lot about the students’ failure to assimilate the thoughts that associate with professionalism.  I suppose the art of awareness reminds us that we grow by many different ways, and we do so at our own pace.  Meaning simply this:  I had hoped that every student would be on the same page with me.  I had hoped that my presentation would be a “motivational piece”.  Instead, it was met with altogether something different.  The students were not ready to think differently.  Also, they were not prepared by the teacher to think outside of the box.  It isn’t easy to serve.  Let me tell you that the 40-minute presentation was a challenge.  The spirit of the past pressed heavily upon the students.  Every feeling of hope was put aside with the willingness to stay in the 20th century with the outdated sports medicine commitment.  My attention to this point was less than it should have been.  I should have been better prepared to address the concept of groupthink [19].  No matter what I said or how I said it, the impact of what I said was of little consequence.  Whatever I thought I was going to say with ease met permission only with considerable difficulty. 

To serve is a struggle, but so is life.  At least this seems to be the right expression that awaits those who have a similar passion.  As I look at the world of healthcare professionals today, I’m convinced that the struggle is a time dependent factor that few exercise physiologists understand.  By “time dependent” I mean that the longer the idea is discussed (i.e., month after month, year after year) the less difficult it is to talk about it.  Gradually, time itself gives permission to everyone to discuss the idea.  This, it seems to me, is important to understand.  After all, to transcend the grip of one’s past thinking, the breakthrough thinking must be a kind of transformation that registers a significant effort.  For one thing, nobody said that it would be easy to turn exercise physiology from sports medicine to something no one had even considered (such as their own professional organization).  What I’ve learned is that it is a matter of keeping the topic of professionalism before the camera’s eye so to speak.  Even the phenomenal changes that associate with a “first-ever” code of ethics and standards of practice must be discussed, written about, and woven into exercise physiology classes.  In writing this piece, I am disposed by nature to believe in possibilities. 

I believe in them, invite them, and expect them.  I believe in service to ASEP, students, and the public.  I anticipate that more exercise physiologists will enthusiastically embrace the ASEP vision.  Even since the founding of ASEP, I just never expected anything else.  I expected students to become members of ASEP.  I expected members of ASEP to become board certified.  I expected non-ASEP exercise physiologists to join ASEP.  I expected a new way to think about exercise physiology would happen.  What I’ve learned is that expectation does make things happen.  I just didn’t expect the struggle to serve!


References
1.  Boone, T. and Robergs, R. (2003). Original Thinking by the ASEP Founders. Professionalization of Exercise Physiologyonline. Vol 6, No. 11 [Online]. http://www.asep.org/asep/asep/originalTHINKINGbyASEPfounders.html
2.  Morehouse, L.E. and Miller, A.T. (1948). Physiology of Exercise. St. Louis, MO: The C.V. Mosby Company.
3.  Karpovich, P.V. (1965). Physiology of Muscular Activity. Philadelphia, PA: W.B. Saunders Company.
4.  Astrand, P-O. and Rodahl, K. (1970). Textbook of Work Physiology. New York, NY: McGraw-Hill Book Company.
5.  Noble, B.J. (1986). Physiology of Exercise and Sport. St. Louis, MO: Times Mirror/Mosby College Publishing.
6.  Fox, E.L., Bowers, R.W., and Foss, M.L. (1993). The Physiological Basis for Exercise and Sport. Madison, WI: Brown & Benchmark.
7.  Wilmore, J.H. and Costill, D.L. (1994). Physiology of Sport and Exercise. Champaign, IL: Human Kinetics.
8.  Brooks, G.A., Fahey, T.D., and White, T.P. (1996). Exercise Physiology. Mountain View, CA: Mayfield Publishing Company.
8.  Plowman, S. A. and Smith, D.L. (1997). Exercise Physiology for Health, Fitness, and Performance. Boston, MA: Ally and Bacon.
10.Powers, S.K. and Howley, E.T. (2001), Exercise Physiology: Theory and Application to Fitness and Performance.  Madison, WI: McGraw-Hill.
11.Boone, T. (2003). You Are Not a Healthcare Professional.  Professionalization of Exercise Physiologyonline. Vol 6, No. 12  [Online]. http://www.asep.org/asep/asep/ExercisePHYSIOLOGISTasHEALTHCAREprofessional.html
12.American Society of Exercise Physiologists. (2003). ASEP. [Online]. http://www.asep.org/ 
13.The College of St. Scholastica. (2004). Undergraduate Degree in Exercise Physiology. [Online]. http://admissions.css.edu/factsheets/exercphys.shtml and http://www.asep.org/asep/ASEP/ExercisePhysiologyGraduateProgram.html
14.American Society of Exercise Physiologists. (2004). Guidelines for the Accreditation of Undergraduate Programs in Exercise Physiology. [Online]. http://www.asep.org/accreditation/
15.Boone, T. (2001). Cultivating the Values of Professionalism: A Professor's Point of View.  Professionalization of Exercise Physiologyonline. Vol 4, No. 1  [Online].  http://www.asep.org/asep/asep/DefiningProfessionalism.html
16.Boone, T. (2002). A New Academic Paradigm for Exercise Physiology Teachers.  Professionalization of Exercise Physiologyonline. Vol 5, No. 9  [Online]. http://www.asep.org/asep/asep/TeachingWithINTEGRITY.html
17.Boone, T. (2003). A Shared Vision Precedes Reality: A Personal Perspective.  Professionalization of Exercise Physiologyonline. Vol 6, No. 6  [Online]. http://www.asep.org/asep/asep/SharedVisionPrecedesReality.html
18.Boone, T. (2003). Overcoming Institutional Inertia with Leadership.  Professionalization of Exercise Physiologyonline. Vol 6, No. 2  [Online].  http://www.asep.org/asep/asep/OvercomingInstitutionalInertiaWithLeadership.html
19.Boone, T. (2002). Exercise Physiology of the Future: Thinking Out of the Box.  Professionalization of Exercise Physiologyonline. Vol 5, No. 11  [Online]. http://www.asep.org/asep/asep/ThinkingOutsideTheBoxExercisePhysiology.html
 

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