Vol 2 No 1
January, 1998
ISSN 1097-9743
ASEPNewsletter is devoted to informative articles and news items about exercise physiology. It is a monthly magazine of news, opinions, exercise physiology professionals, and events that shape exercise physiology. While it contains views and opinions of the Editor who oversees the ASEP Internet Websites, visitors can have a voice as well. We welcome interested practitioners, researchers, and academicians to e-mail the Publisher their thoughts and ideas or to respond directly via the ASEP Public Forum. 
February, 1998
Questions Exercise Physiologists Should Ask Themselves
Tommy Boone, PhD, MPH
ASEP President, Professor and Chair, 
Department of Exercise Physiology, College 
of St. Scholastica, Duluth, MN 55811

Non-PhD exercise physiologists are interested in licensure. They think that a licensed exercise physiologist would not have the problems they are facing, especially in the clinical field. At this time, though, only the state of Louisiana has licensure for clinical exercise physiologists. Several other states are considering it, given the interests of the clinical professionals in those states, and even one fitness organization outside of the sports medicine field has asked its members to consider the pro and con of licensure.

Why do exercise physiologists think that licensure is the answer? In theory, licensure at the state level validates the assumption that the exercise physiologist has acquired the knowledge required for safe performance. Not passing the examination, for example, would eliminate the unqualified and, therefore, protect the consumer from harm (the client specifically, and the public in general). The reality, however, is that exercise physiologists probably want licensure because they think will put them on the same level (or status) with, for example, physical therapists or nurses, which leads to the next question.

Will licensure afford the similar status as is given to the physical therapist? The answer is no. First, exercise physiologists need support from a professional organization to think through the process and ensure that it is done right. By this, I mean, the profession is not served well when good intentioned professionals initiate licensure procedures in this state and that state when the profession itself is not in on the process. It is simply too unorganized to control the body without the head!

It seems, first, that exercise physiologists should come together and unify their efforts and work through logical debates about what is best for the profession. Individuals frustrated with where they are in their practice may achieve their goals faster when joining forces with other professionals who have similar beliefs. Second, interested exercise physiologists should agree to meet to define the specifics of what consititutes a college or university (hereafter, college) academic program of course work in exercise physiology (science) that will stand the test of national certification (or licensure). Aside from the exercise physiologist's desire to be on equal footing with other health professions, the perceived lack of respect they receive, the obvious salary differences, and the lack of reimbursement opportunities for services rendered, "Is there a problem of protecting the consumer from harm and thus the need for licensure?

Are all exercise physiologists equal?" The answer is no to both questions. Again, many students graduate from college programs that are significantly if not seriously flawed with academic weaknesses in exercise physiology course work (both depth and number). Too many of these programs are designed around the notion that two or three courses in exercise physiology is sufficient to warrant an academically engaging concentration in exercise science (not physiology). These programs are in the majority not the minority, yet the students graduate thinking that they are exercise physiologists (and they would be if the academic programs were better configured).

Because there are academic programs that offer a degree (major) in exercise physiology, and because there is so much emphasis on health, fitness, wellness, rehabilitation, and athletics, all academic programs that offer a concentration in exercise science should be moving towards a major in exercise physiology. It isn't that hard to do if we had the support of the exercise physiologists who teach throughout these programs. Until then, it does seem logical and correct to conclude that the only BS exercise physiologist is the one who graduated from a college that has an academic degree in exercise physiology. There are a few in the United States. Logically, the number will increase as more PhD-academic-exercise physiologists become more aware of the problems of not having the degree presents to the graduate.

Hence, there should be an agreed upon set of course work, hands-on experiences (in anatomy, kinesiology, biomechanics, and exercise physiology laboratories), and internship hours if exercise physiology is to continue to move effectively towards professionalization. The consumer intuitively understands this vital point as does the medical community. Some exercise physiologists, however, at the BS and MS levels would concur that it is apparent that too many academic PhDs in exercise physiology do not understand this point. Perhaps, it is no longer possible to just do a good job of teaching classes, publishing research articles, and attending national meetings to be considered a complete professional. Professors must begin to think about their students beyond the required courses and lab experiments. Not everyone is happy, especially the students, regardless of the hard work to make the good grades and then graduate, particularly if there are only a few good jobs to get, while most jobs make it terribly difficult to survive financially. No, many of the exercise science (physiology) students are hard pressed to find that job their professors spoke of when in the kinesiology or exercise physiology courses. Some have even asked the question, "What are the PhD professors doing to help us?" It seems that the students are saying, we, the professors, need to gain control of where we are, professionally speaking, and regulate the profession of exercise physiology as other health care professions have done, and that they believe it is realistic to do so with certification than licensure.

Who regulates exercise physiologists? That is, do we attempt regulation of our profession by an organization with exercise physiology membership or by an organization with many different and diverse members? The answer is (or least should be) obvious. Exercise physiologists need to step forward and voluntarily take the lead and the control to protect and to develop the exercise physiology profession. They need to do this not just for themselves, personally, but for their students who look up to them and who depend on them to guide, mentor, and help beyond the college days. The professors need to help the students understand that while certification, licensure, and accreditation are important issues, they are not the immediate answers to the problems faced by students. Exercise physiologists must first organize themselves! For example, when the American Society of Exercise Physiologists passes an agreed upon statement by its members (or by a committee of designated members of ASEP) that defines required course work, exercise physiologists everywhere may infer from the national certification examination that will follow that the graduate is a qualified professional. Not only will the graduate benefit, but the public (and the medical community) as well will know what an exercise physiologist does as part of the exercise physiology profession.

Why is ASEP concerned with the title, "Exercise Physiologist"? Because the professional title informs the public who we are and what we do. It is that simple. It may not restrict other health care professionals from engaging in what exercise physiologists do, but nonetheless it should establish ownership that what they do is fully within their right to do it. Therefore, given our credibility, credentials, and title that establishes our relationship with the consumer (and I might add with the college administrators), those who infringe, misuse, or dilute what we do can be held accountable.

Credibility is defined and demonstrated by the exercise physiologist as having confronted, developed, and carried out the requisite features of the ASEP National Certification Examination for all graduates of approved (and at some point, accredited) college exercise physiology (or science) programs. Again, the integrity of the exercise physiology academic programs must be established first, and then the national examination becomes like the icing on the cake. Then, at some point down the road, ASEP members should consider the need and inherent value in select members of the profession becoming licensed given their areas of specialty. At this time, however, licensure should not be a priority because of the specifics of regulation at the state level, the costs and time involved in the process, and the fact that some states are working to abolish licensing boards.

Equally important, if we believe licensure is designed to protect the consumer and, at some point in the relatively near future, the exercise physiology (science) programs are academically superior to what we have today, then exercise physiologists who think licensure is necessary (to balance the health care professions playing field) may want to rethink their position. Until then, we do have a problem. That problem is one of not being able to document the quality of the exercise physiology (science) programs throughout the colleges in the United States. As a result, without accreditation, it is reasonably easy to understand why the outsider such as the medical doctor, the nurse, the psychologist, or the physical therapist (who is familiar with both the meaning and significance of accreditation in their professional work) to hold the exercise physiology graduate in suspect of knowing and/or fulfilling his/her professional responsibilities.

Will professional licensure correct the problem of lack of excellent academic preparation? The answer is no. Licensure is not necessary and may do more harm if used to distinguish the academically and hands-on qualified from the less qualified, particularly if it divides the profession into two primary areas of study (exercise physiology and clinical exercise physiology). In fact, adopting the legislation that Louisiana has done will not correct the professionalization problem. Licensure without a serious academic program that leads to a major in the field is a waste of time in the long run and may, in fact, result in equally unprecedented restrictions in the field. It is not the right step in the direction exercise physiologists should go at this time. It is too restrictive (at this time) and may, as stated earlier, be important only for a subset of professionals in exercise physiology that ultimately may distract from the larger development of the profession.

Is exercise physiology and clinical exercise physiology the same? The obvious answer is no, but some students (and maybe more than a few PhD professors) have forgotten that exercise physiologists are educated (or least should be) to work in multiple work settings. Exercise physiology is neither clinical exercise physiology nor is it just about exercise, aerobics, or even the prevention (if possible) of certain diseases faced by the aging population. Hence, the undergraduate student in exercise physiology should be exposed to a comprehensive and engaging set of core courses. There should be sufficient depth to warrant a comprehensive and holistic understanding. Then, at graduation, the graduate of the program should be honored with the title "exercise physiology" in the same way the nurses are acknowledged in their academic field of study when they graduate. They don't have to wait until they get another degree (such as a master's or a PhD) to refer to themselves as a nurse, so why should the exercise physiologist wait? The problem, of course, stems from the general understanding that the undergraduate exercise science (physiology) programs are too inconsistent to know what the students are getting from them. The larger problem is there appears to be no one working on the first problem, yet students graduate in full faith that they will have a job with respect. It will be important for the members of ASEP to work towards accreditation no matter how big a hill they must climb. Time is on their side, at least to a point. With accreditation, both the student and the consumer can be assured of academic uniformity, respectability, and integrity.

What is required for accreditation? Professors from the different colleges that offer academic concentrations in exercise science (physiology) should consider the importance of coming together to discuss the complexity and difficulties of beginning the process of re-configuring their academic offerings (programs). Programs that simply cannot be re-configured must be identified and addressed accordingly. Those that can should consider the importance of moving towards a major in exercise physiology (not exercise science) and eventually moving awaying from the emphasis track altogether.

Why haven't exercise physiologists made these changes before now? The answer is multi-dimensional. One, the reality is that many, if not most, simply haven't thought about it. They have worked hard towards developing research interests and application to the athletics and sports, rehabilitation, and lifestyle matters. They haven't been caused to stop and think about the philosophy of exercise physiology, the ethics of exercise physiology, or the professionalization of exercise physiology. To my knowledge, there are no workshops that deal with these kinds of issues. Course work is identified much in the same way they were taught earlier somewhere else. They perform their work in much the same way as earlier exercise physiologists, and probably, many lost their way working too hard to develop sports medicine. There are a lot of reasons. What is important now is that more exercise physiologists at all levels are thinking about the profession and how it can move ahead in its development.

Change is inevitable, particularly in exercise physiology. We must consider it imperative that we are at the beginning of significant programmatic revisions. These changes must come from within the academic ranks, and especially from the academic PhD exercise physiologists who, by their earlier work, set the stage for why we are today. However, they need to now learn from the students they taught just a few years earlier. They need to listen to the BS and MS graduates and learn from their first-hand experiences outside of the college environment. They need to know about the difficulties the students are faced with. If they don't listen, the college administrators will eventually come to understand the problems, and just around the corner will come downsizing! Departments will get new names to continue afloat. Cut-backs in programs, equipment, and ideas will eventually bring the big engine to a stop. All of this will happen if the exercise physiology student does not have a job with respect and enough money to surive.

Why aren't the academic PhD exercise physiologists working to correct the problem?
Given our infancy as a developing (semi-) profession, the short answer is that the academic exercise physiologist may not have realized his/her responsibility in this area. The students' emotional health and welfare is the business of the college professors just as it is to ensure excellent academic preparation. Members of ASEP hope to leave a legacy of concern for every graduate who finishes an exercise physiology program. At the national level, bridges must be built between colleges with exercise physiology programs, the faculty who teach in these programs, and a better analysis and understanding of the exercise physiology job opportunities throughout the United States and worldwide must be initiated by the professors. ASEP is designed to be a big part of these changes because it is an organization by and for exercise physiologists at all academic levels (BS through PhD). ASEP, in particular, is designed to help facilitate the development of certification for the academically prepared exercise physiologist.

Why is there so much discussion about licensure and so little about certification? The answer lies in the views of a few exercise physiologists in the clinical realm who understandably felt they had to do something to get the ball rolling. Unfortunately, it appears that no one ever thought about exercise physiology certification per se. To certify the exercise physiologist would mean that he/she had to be exposed to a rather engaging academic program of study. Maybe, no one (strangely enough) thought that the exercise science programs warranted a good enough product to move towards certification. Hence, why not do it then within the context of a sports medicine organization? Unfortunately, this particular direction moved away from the emphasis that should have been placed on academic programs and set the profession of exercise physiology back a few decades!

The bottom line is, exercise physiologists have the right to their own certification via their own professional organization. The certification should represent the years of academic study at the college level. Hence, while academically prepared exercise physiologists may be certified as an exercise specialist (should they decide to do so), the person who decides to become a certified exercise specialist (without the college-level exercise physiology academic preparation) is not an exercise physiologist. In that the certification should testify to the academic status and professional competence achieved by the college graduated exercise physiologist, ASEP is dedicated to developing, supporting, and supervising the certification of the academic exercise physiologists (whether at the BS, MS, or PhD level). The problem of lack of interest in the professionalization of exercise physiology has been ignored too long as well as the downstream difficulties it has caused. 

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