Where is Exercise Physiology Headed?
Lonnie Lowery, PhD
ASEPNewsletter Editor,
ASEP President -
2007-2008
Not a
single idea had been added to the speculative systems of antiquity, and a
succession of patient disciples became in their turn the dogmatic teachers of
the next servile generation.
-- Edward
Gibbon
[describing
Europe in the middle ages]
Introduction
During the years I have been
involved with ASEP, I have come to realize that we are in an era of change as
Exercise Physiologists (EPs). It is a dangerous time for a late comer
profession; there are very entrenched notions that we must overcome –
especially if we are to take the reigns in an “exercise as medicine” environment.
Evolving our strong research base into an evidence-based profession will be met
with obstacles and challenges both from outside and from within. From the outside,
other healthcare professions see not only the sheer effectiveness of exercise
but also strong growth in the exercise/wellness marketplace – growth that in
some cases surpasses their own. This makes exercise physiology a tempting
addition to their (existing) scopes of practice. From within, we must start
thinking beyond the laboratory, at least at times. That is, can we just
continue teaching EP students as we were taught, making ever more academics? I concur
with my ASEP colleagues that the unfortunate side effect of producing
under-valued bachelor’s students in the traditional, dogmatic system is a serious
flaw. Perhaps new ideas about a recognized undergraduate profession will even
become our lifeblood.
As I pass the baton of the ASEP
presidency, I would like to share a compilation of ASEPNewsletter ideas – and
add a few new ones - about which direction I would personally like ASEP to consider.
These are facts and my own opinions (not necessarily those of ASEP) regarding
challenges that I feel must be met. I sincerely hope that, in the larger
timeline of our developing organization, we can make progress toward these
necessities. It will take manpower (and womanpower). It will take time. It will
take thought and creativity and perhaps even a little luck. Some of these
challenges are common to other professional groups, some are unique to ASEP.
Here are the categories of focus:
- Membership
- Partnership
- Promulgation
- Finding a niche
- Justice
- Funding
Each category of need is
interrelated. Each category contains specific objectives to be further
clarified and passionately addressed. Drawing upon a number of years'
experience with the organization, I've seen a few issues that will continue to
affect my ASEP involvement and temper my enthusiasm with pragmatism.
Membership
As a "niche"
organization specific to the profession of exercise physiology, ASEP is not
large - at least not relative to multi-disciplinary or "umbrella"
groups. This has both positives and negatives. On the positive side, ASEP
remains nimble: able to coordinate key members quickly to address a given need.
Unfortunately, the down side of a membership residing in the hundreds rather
than in the thousands is that overall public awareness remains low. Recognition
from certain other professional groups remains low as well. There are economic
issues surrounding recognition from other groups who hope to expand their scope
of practice to include exercise physiology, but that is covered later in this
paper.
I don't have an answer regarding
the expansion of ASEP numbers but I do have some ideas. These ideas will need
to be discussed and acted upon, as deemed appropriate, by the Board of Directors.
As the specific voice for exercise physiologists, we will need to attract
enough members to make that voice heard. Discussions of meaningful incentives
have already begun; I hope some ideas will be feasible and appeal to both
graduated exercise science majors and developing faculty members as well.
We already have a revamped web
site and ASEPNewsletter, complete with job opportunities and other
advertisements. We already have a history of high-quality national meetings. We
already have a plan to form various committees among Board of Directors members
and strengthen key initiatives. I look for an influx of valuable man- and
woman-power as we move forward.
There are tens of thousands
former exercise science majors out there who are not working in their chosen
field. I've met many. Their investment of four to six years and tens of
thousands of dollars has not paid off. And yet they struggle day to day to make
ends meet. If we can reach them with a sincere message, I think they will be
eager to jump on board with ASEP. Similarly, there are dozens or even hundreds
of faculty out there who feel a slight twinge about advising and encouraging
students in exercise science - a major without a distinct profession. Aside
from discussions of learning for its own sake, there appears to be a real
ethical dilemma here - at least for students who expect a livable salary and
professional respect upon graduation. Exercise physiology is a challenging
major. It's on par with dietetics, nursing and other healthcare professions. We
must find a way to reach the graduates and professors who would like to see
commensurate rewards.
Partnership
There are challenges beyond a
serious need to expand membership. Recognition does certainly require a certain
"critical mass." But this is not just true of individual members.
Creating awareness and recognition among other professional groups should be
one of ASEP's priorities. The strength of ASEP-accredited preparation creates
competence within a scope of practice that is unique and complimentary to other
professions.
Here is a list, in no particular
order, which I personally think we should reach out to:
- American Counseling Association (ACA)
- American Psychological Association (APA)
- American Medical Association (AMA)
- American
Hospital Association
(AHA)
- American Nurses Association (ANA) ...and relevant
subgroups
- National Athletic Trainers Association (NATA)
- American Chiropractic Association (ACA)
- Sports Cardiovascular and Wellness Nutritionists
(SCAN)
- International Society of Sports Nutrition (ISSN)
- American
College of Nutrition
(ACN)
- National Strength and Conditioning Association (NSCA)
- American
College of Sports
Medicine (ACSM)
- Various Coaching Associations
- Various personal trainers' organizations
As we flesh out committees related
to partnerships in the ASEP, we can explore ways in which we might work
together with groups like those listed above. Examples may include specialty
subgroups, taskforces, reciprocal representation on governing bodies (boards of
directors), and some level of cross-certification and/or reciprocated presence
at national meetings. The important thing in today's capitalistic, competitive
healthcare and wellness environment is that we educate others on the necessity
of including exercise physiology beyond a self-endowed ("in-house")
certificate. Professional organizations must find respect for one another's
rigorous preparation. That is, without developments like referral guidelines,
interdisciplinary co-certifications and structured communication, we risk a
society where four-hour workshops or certificates weakly replace four years of
accredited university preparation in the "crossover" discipline.
All of this is meant in the most positive of
ways. As ASEP educates - and learns from
- other health-related associations through our partnership efforts, exercise
physiology gains awareness and respect. I think that our challenge, then, is to
any EPs or like-minded professionals reading this paper: Step up and volunteer
to sit on an ASEP committee that reaches out to other organizations.
Promulgation
Here I will discuss the efforts
that I believe ASEP could pursue to increase awareness of our existence and
purpose. Each of these suggestions is just that: a suggestion; each idea will
require deliberation by a Board of Directors-led committee. Here is a (by no
means comprehensive) list of 15 efforts that could reach other professionals
and the lay public regarding ASEP's wealth of information, strong ethics and
exercise-physiology-specific perspective:
- Appearances (perhaps reciprocal) at conferences,
manning expo hall booths
- Appearances (perhaps reciprocal) at conferences,
presenting EP-specific professional information*
- Publication of EP-specific textbooks and book
chapters*
- Publication of EP-specific scholarly articles in
various journals*
- Participation in targeted, relevant Internet forums*
- Appearance on television and in newspapers and
magazines as exercise experts*
- Student group activities at Universities and via
online social networking sites
- Mailings to academic departments in Exercise Science/
- Exercise Physiology announcing the ASEP Annual
Conference and Meeting*
- Mailings to academic departments in other, related
fields announcing the ASEP Annual Conference and Meeting
- Mailings or faxes to academic departments with
EP-related employment opportunities
- Mailings or faxes to academic Exercise Science
departments as a campaign to highlight the ethics of accepting large
amounts of tuition in the face of a questionable job market (livability of
the profession)
- A mailing campaign to gymnasiums, community centers,
natatoriums and fitness centers sharing benefits of ASEP membership and
use of its knowledge base
- Professional, individual behaviors and display of
knowledge as EPs*
- Maintenance of JEPonline and PEPonline*
- On-schedule electronic mailing of the
ASEPNewsletter*
Notice the asterisks. These are
accomplishments and efforts that I have personally seen ASEP's members perform.
Sometimes this takes a heroic amount of work. Nonetheless, the work is done and
has been done for about a decade. If one thing has been shown, it's that ASEP
is staying the course.
Yet we have a long way to go. Not
only do the bulleted points without asterisks need attention and discussion,
but the ones that currently are labeled need expanded. Further, new ideas need
explored as to how our knowledge, skills, and professional networking
opportunities for graduates can reach the public. I, like the other members of
the Board of Directors, welcome ideas and a willingness to share in the gratifying
work ahead.
Finding a Niche
This topic addresses a reality in
today's health and wellness market. Exercise Physiologists are not alone. As
the organization exclusive to Exercise Physiologists, ASEP needs to adhere to
its definition of what exercise physiology is while working cooperatively with
larger groups that overlap with our scope of practice. We are uniquely
qualified and skilled, yes, but as late comers to the cluster of healthcare
professions, I believe this is the responsible course of action.
I feel that a critical feature of
working cooperatively with larger groups will be to hold business meetings,
perhaps during existing conferences. These meetings could simply result in
reciprocal letters of recognition. Or perhaps these meetings could have agendas
that help iron-out when referrals could be invoked. I realize that it may sound
naïve to think that "competing" organizations would "send their
business elsewhere" regarding referral guidelines but such cooperation could
lead to generation of reciprocal business - and a safer public.
Another topic regarding finding
our niche involves licensure and other means of legally defining who the
legitimate EPs really are. In a "diluted" climate of literally
hundreds of fitness certificates, opinions differ as to how to best approach
recognition. In my own experience, this would be different in each state. For
example, in states where exclusive licensure is currently unlikely, efforts
could focus upon title protection of the EPC credential or even trade marking
the presentation of a term such as "Exercise Physiologist Certified"
(EPC).
Or perhaps we could explore
existing registries of fitness professionals. Voluntary registration has been
undertaken in other countries and may be an interesting, if secondary choice
for ASEP to investigate. Efforts being undertaken in Great Britain and the European
Union are an example (online see exerciseregister.org). One feature that I
personally find interesting here is the set criteria for physician referrals.
All of the examples in this
manuscript are ways to help us "find a niche" in a large, growing and
confusing exercise marketplace. My hope as a past ASEP President is to stay
open-minded and continue to explore all options to safeguard the public and raise
the quality of exercise as both prevention and treatment. No other professional
group can do this specific task as well as ASEP can. So, as our Board of
Directors grows, I will continue to expect the chairperson who spearheads
licensure-related activities to investigate these - and other - possibilities.
Unless we remain reasonable in carving out an agreeable niche for ourselves, we
will risk being ignored by larger, more recognizable organizations that have a
decades-long jump on us in the healthcare environment.
This month we finish exploring
points on which I believe ASEP should focus. The last of the categories is:
Justice
My last point of discussion
regarding what I would personally like to see in ASEP's future surrounds a
theme of justice. With regards to this manuscript, definitions of the word
might be "getting what one deserves (but not more)" or "being
rewarded based on hard work and merit." Unfortunately, I cannot help but
see certain injustices in today's health and wellness marketplace. For example,
in my state, a person needs a license to cut hair but not to put a middle-aged,
obese, hypertensive, arrhythmic client on a treadmill. I wonder if anyone else
finds this kind of thing odd.
Too, there are health-related
organizations aggressively policing and expanding their scopes of practice,
which already reach into the realm of exercise physiology. In my state any
weight management program must involve a registered dietitian to be
"legal". Yet diet alone (e.g., kcal restriction) is well known to be
largely ineffectual, in itself, for long term weight loss. Not to say this
involvement isn't hugely important; it is a necessary component! What else has
to be included to achieve more lasting client/patient success? You guessed it:
exercise. But there is no licensure for Exercise Physiologists (EPs) in my
state or 48 others. Nowhere can one find governmental insistence that an
exercise professional, similarly qualified in education and experience to a
dietitian, be part of weight loss. This essential component is left to those
with much less specific training (if any). With about 65% of Americans
overweight and obese - and with so much at stake - I wonder if anyone else
finds this to be odd.
Note: You may be interested in reading Dr.
Tommy Boone's article in
PEPonline regarding respect among other healthcare
professions in "21st Century Changes....," found at:
http://www.asep.org/asep/asep/21stCENTURYChangesEXERCISEphysiology.htmlIt wasn't until I was in graduate
school that it started to sink in that some of my fellow Master's degree peers
were graduating to take near-minimum wage positions as personal trainers. Six
to seven years of university training, countless hours in the lab and at
scientific meetings, often a huge personal and financial investment, and they
were rewarded with $6.25 per hour. That is, when they were hired. Reality was
prone to setting-in. To many club managers, expertise in high-pressure sales
tactics is just as attractive as years of training and competence in exercise
physiology. At times uneducated personal trainers or those with a six-hour
investment and subsequent certificate were given the jobs over my peers who
sported six years of effort. I once went to an interview in which I was told
that I must have a university degree or a certificate of some kind. Doesn't
anyone else think this to be odd or unjust?
As I was about to graduate with
my PhD, I started to contemplate my experiences and wonder how to address my
upcoming role as a faculty advisor. Would I encourage my students to enter the
discipline of exercise science (physiology), offering nebulous advice like
"the world is what you make of it"? After all, there was injustice
out there. Licensure and related pay/ recognition just weren't to be found. How
would I balance my experiences in the "real world" with comments from
my Dean addressing Departmental viability and the necessity of accepting
tuition from hopeful students? "Bums on seats, Lonnie - bums on
seats!"
Although I know such comments
were tempered with a degree of responsibility and possibility, the reality is
still difficult. I would argue that most exercise science students are not
looking for a "personal enrichment degree," nor do they have an
awareness such as one might find among certain humanities (e.g., philosophy,
psychology, history, anthropology, etc.) that a Bachelor's is more of a
stepping stone to further schooling. There is an unformed, back-burnered notion
that something commensurate with their training awaits. Many are simply too
busy getting good grades and fulfilling their curriculum requirements as they
move toward the finish line of graduation. What lies beyond that finish line
may take months to set in, at a time when former advisors have responsibilities
to new and current students. Do others see injustice in this?
I wish I had a specific detailed
plan to pass on so future ASEP presidents could address such injustices. As the
ASEP Board of Directors expands, hopefully we will find an individual up to the
challenge of becoming a Justice Chair of sorts. This person could have the
flexibility to form a committee that might do such things as start a mail
campaign increasing awareness of our difficult academic cycle. That is, of
churning out thousands of new students who end up working outside of their
field in order to pay rent or have a reliable car. The advocacy could reach out
to existing exercise science professors / advisors or to committees in other
healthcare groups or to state legislatures. Perhaps a quarterly advocacy
newsletter/flyer would suffice. I for one would like to offer some real world
cases of bright exercise science grads who, despite the ability to discuss
glycogen synthase at the drop of a hat, are landscapers or house painters.
Funding
Rob Robergs, a founding father of
ASEP, suggests a need for grantsmanship in addition to membership-driven
funding to support the organization. Why is this necessary? For starters, it
could enable a full time staff and a new brick-and-mortar national office for
ASEP. And it is not unrealistic. Clearly there are public health groups,
government institutes and private foundations that would see the benefits of
creating a new, independent national office for a group as established and
potentially impactful as ASEP. From the prevention and treatment of obesity to
diabetes to cardiovascular disease to select mental disorders, much could be
gained. Yet growth has its demands. There is so much work to be done in
maintaining and growing the organization that it will not be possible for a
select few individuals to complete it all in their limited personal time. Thus,
it is my hope that this funding challenge can be met by experienced members or even
by ASEP-employed grant writing specialists.
Conclusion
In summary, the six topics
presented here, offering both fact and opinion, could potentially serve as a
guiding influence on ASEP in the future. I do not pretend to know all we must
do to grant Exercise Physiology the recognition it deserves. I can only ask for
comments, for ongoing efforts and for a willingness to volunteer. For years I have
seen hundreds of ASEPNewsletter subscribers and conference attendees keep a
watchful eye on ASEP, that "slightly radical group who stays its course
and insists on change." They know that breaking from dogma always requires
new ideas - ideas that some consider radical. Yet they keep tabs on ASEP
because the future is worth it. But such things don't happen without manpower
and womanpower. We can make a difference and we can do so by acting on issues
such as membership, partnership, promulgation, finding a niche, justice and
funding. With the right ideals and an evolving plan we can indeed prevent
ourselves from becoming the dogmatic teachers of the next servile generation.