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Introduction
The American College of Sports Medicine (ACSM) was founded in 1954 as an umbrella organization for the diverse disciplines and professions that shared the common interest of how exercise influenced the human body. Based on the model provided by the European organization of the Federation Internationale Medico Sportive (FIMS), sports medicine was defined, not as a field of study in and of itself, but as a conglomerate of disciplines and professions. There was never a discipline of sports medicine, and this facts remains today.

Since the 1970s ACSM has framed objectives that have indirectly placed exercise physiologists and the discipline of exercise physiology as an integral component of the many functions of the college. Such a result is a clear reflection of the importance of exercise physiology to current ACSM functions. Nevertheless, the inclusion of a discipline within the operations and functions of ACSM are contrary to the original mission statements of the ACSM, and has and will continue to have negative consequences to the recognition of exercise physiology as an independent scientific discipline and professional vocation.

It is no surprise that because of the important involvement of exercise physiologists in ACSM functions, there has been a trend for exercise scientists, especially exercise physiologists, to view ACSM as their professional organization. No matter how extensive this belief is among exercise physiologists, the facts that will be presented in this article indicate that the belief is incorrect. Furthermore, the inability for many exercise physiologists to reconcile the differences between their professional needs and the functions of ACSM has and continues to be damaging to their very own discipline and future profession (exercise physiology is still not a true profession).

ACSM has and never will be a governing body to the field of exercise physiology. Exercise physiologists need to become responsible for their own academic and laboratory standards and certification, and receive recognition for their knowledge and contributions to society. They also need to strive to work with clinicians, ACSM, and the medical insurance industry to secure employment for exercise physiologists, as exercise physiologists, in the growing allied health and clinical medical fields. The best way for this to happen is if exercise physiologists pursue self autonomy so that they control their own certification standards, employment conditions, and future status in the allied health and medical communities. The presence and contributions of exercise physiologists in the ACSM should continue, as ACSM is unique it its abilities to combine exercise science, health, and medical fields into a collective body to further our understandings of the effects of exercise on the human body. It is for this reason that ACSM was founded, and should continue to exist.

The purpose of this article is to present evidence for why the ACSM is not an exercise science professional organization, let alone a professional organization for exercise physiologists. The facts that will be presented are not intended to downplay the importance or function of ACSM. The facts will simply reveal that exercise scientists and exercise physiologists need to be aware that no matter how successful ACSM has been in promoting the benefits of exercise to the public, there are professional needs that ACSM simply cannot meet. These professional needs are presently being addressed by the American Society of Exercise Physiologists (ASEP), which was formed to meet the needs for exercise physiologists.

The Historical Development of Exercise Physiology in the United States
A historical perspective on the interaction between ACSM and exercise physiology provides a developmental scheme that clearly justifies the professionalization of exercise physiology. History has also clearly documented the original mission of ACSM, and therefore provides an interesting comparison to present functions; a comparison that shows how and why disciplines who contribute to sports medicine must independently pursue steps towards professionalization.

The Origins of Exercise Physiology in the United States
There is no single widely accepted definition of exercise physiology. However, a satisfactory definition would be the study of how exercise influences the structure and function of the human body, both during exercise, as well as after long term exposure to repeated exercise participation. It is difficult to state a specific date where one can recognize the combining of the scientific knowledge of human physiological adaptation to exercise into the science of exercise physiology. However, thanks to excellent texts on the history of the ACSM (6), and the history of exercise science and exercise physiology (9,18), there are sources that provide answers to this query.

The study of exercise physiology has a long history (5-9,11,12,18). It is impressive that one of the first monographs written on exercise physiology occurred as early as 1855 in the American Journal of Medical Sciences (10). The first textbook on exercise physiology was published in 1888 (Table 1) (8,9). Many additional monographs followed, and during the 1890s George W. Fitz had established probably the first exercise physiology laboratory in the United States within Harvard University's Department of Anatomy, Physiology and Physical Training (6). By the 20th century, there was a solid framework in place for exercise physiology to be a branch of physiology focused on understanding the body's physiological responses to exercise stress (8,9).

When reading of the history of exercise physiology, the work and life of R. Tait McKenzie stand out as pivotal features. McKenzie was trained as a physical educator (1891) and physician (1892), and became the Chair of the Department of Physical Education at the University of Pennsylvania, Philadelphia in 1904. McKenzie was influenced by the anthropometry work of Dudley Sargent, and applied his interests in exercise by implementing physical examinations before and after exercise training to quantify the beneficial effects of regular physical activity on the human body (5,6). McKenzie recognized very early the important connection between medicine and physital education. Therefore, it is fitting that the founders of ACSM stated in many of their initial speeches that they owe credit to McKenzie for cementing a strong belief in their lives for the role of exercise in disease prevention and health promotion (6).

Apart from the life of McKenzie, another landmark event in the recognition and future development of exercise physiology was the appointment of Archibald V. Hill as the Joddrell Professor of Physiology at University College, London in 1923. Hill chose to express the importance of exercise physiology on normal, healthy individuals in his inaugural address. Hill's support of the discipline of exercise physiology impressed Ernest Jokl, a physical educator and one of the founding members of ACSM, who noted in 1925 that because of Hill, exercise physiology was now an academic topic in its own right (6,8). Note that these events occurred prior to 1930, over 75 years ago, and despite this time as a recognized academic topic exercise physiology is still not a profession.

Pioneering research in exercise physiology occurred at the Carnegie Nutrition Laboratory during the period between 1910 - 1945. The formation of the Harvard Fatigue Laboratory in 1927 was also instrumental in adding to exercise physiology research, and continued until 1947 (6,12). However, the legacy of the Harvard Fatigue Laboratory continued in the lives of the researchers who gained experience under its founder Lawrence J. Henderson and director D. Bruce Dill. Due to the researchers of the Harvard Fatigue Laboratory, exercise physiology laboratories were developed at the University of Minnesota (Ancel Keys and Henry L. Taylor), at navy and army military bases (D. Bruce Dill, Steven Horvath), the University of Southern California (Laurence Morehouse), and Indiana University (Sid Robinson). By 1950, of the 16 United States universities who had physical education programs with a laboratory, 15 used the laboratory for exercise physiology teaching and research (6,12).

In these early years, the discipline of exercise physiology was a component of the field of physical education, and as such was represented by the American Physical Education Association (APE), formed in 1919. The APE eventually combined with what is now recognized as the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) (Table 2).

This historical summary clearly reveals that exercise physiology was a growing and important discipline prior to the formation of the ACSM in 1954. It existed prior to many currently recognized and self regulating scientific/ professional organizations. For example, the founding date of the American Dietetics Association was 1917, the American College of Cardiology was 1949, and the National Athletic Trainers Association was 1950 (Table 2). Many of the organizations listed in Table 2 contribute to the functions of ACSM, have their own research journal, and are responsible for maintaining their own educational, vocational and research standards. This is even true of exercise science disciplines, such as biomechanics, sports psychology, motor learning, kinesiology, and so forth. Why has the field of exercise physiology remained unstructured, and unorganized in the 142 years since the first publication in 1855? Why has it been necessary for numerous organizations to form, such as the National Strength and Conditioning Association, and the International Association of Fitness Professionals, which represent examples of applied aspects within the academic discipline of exercise physiology? Why has their been no journal specific to exercise physiology prior to ASEP's Journal of Exercise Physiologyonline? Why has ACSM overseen the professionalization of other sport science disciplines, yet remains unsympathetic to the professional needs of exercise physiology?

The answers to the latter questions are easily answered after an understanding is developed of the origins, and developments of the ACSM.

The Origins of the ACSM
Founding Years
The events leading to the formation of ACSM have been detailed by Berryman (6). Many events transpired together, but an overwhelming influence to the development of the ACSM was the European movement towards the development of sports medicine. For example, Germany had institutionalized sports medicine as a component of clinical training during the early 1900s, and the Federation Internationale Medico Sportive (FIMS) was founded in 1928 (Table 3). By 1952, FIMS had received official recognition by the International Olympic Committee and the World Health Organization (6). The impact that FIMS would have within the US was further reinforced by the participation of several United States physical educators and clinicians in FIMS conferences. Three such participants were involved in the founding of ACSM - Joseph Wolfe, Ernst Jokl and Grover Mueller. Events were therefore in place for the formation of a US organization concerned with the medical and scientific aspects of exercise and sport, and for this organization to have in its name the term "Sports Medicine".

A prominent event leading to the formation of the American College of Sports Medicine (ACSM) was a conversation in 1939 between two of the three founding clinicians, Joseph Wolfe and Albert Hyman, and other cardiologists named Allen Sussman, Aaron Parsonnet, and John Cudmore (6). Ironically, it was a conversation between physicians that indicated that physicians were not adequately trained to understand and research the potential effects of exercise on all human physiological systems. Berryman (6) published a quote from Sussman: It is obvious that no one of us has the information necessary to evaluate these (cardiac) patients. Many types of interest are involved and I would like to suggest a multidiscipline group made up not of cardiologists exclusively but of physiologists, physical educators, (and) physicians who cope with major disabilities in normal healthy people.

"What we need then is a group or organization dedicated to the study and understanding of the basic physiology of both normal and abnormal individuals."

The ensuing 15 years were disrupted by World War II. However, time was also needed to organize a coherent and consistent professional attitude towards the need for an organization that tapped the knowlddge of physicians, physiologists and physical educators. Eventually, the hard work of all the founding members led to the support of ACSM by the medical community within the USA and from FIMS in Europe. The founding members of ACSM consisted of three cardiologists (Joseph Wolfe, Albert Hyman and Louis Bishop), and eight physical educators (Grover Mueller, Peter Karpovich, Neils Neilson, Clifford Brownell, Leonard Larson, Josephine Rathbone, Ernst Jokl and Arthur Steinhaus).

On January 23, 1954, FIMS approved of the formation of an American chapter. This chapter was founded on April 22,1954 and named the American Federation of Sports Medicine. In 1955, the American Federation of Sports Medicine was renamed the American College of Sports Medicine.

It was interesting that the founders of ACSM chose a name of "Sports Medicine".
After all, even today there is no university degree in the United States in sports medicine. Sports medicine is also a name biased towards recognizing medicine in the application of exercise knowledge to society, and it is misleading as it does not express what its members do. Given all these characteristics, it is also ironical that the majority of founding members were not clinicians, but physical educators with a clear interest in exercise physiology. Berryman (6) explained the choice of this name by first identifying that the United States was relatively late in responding to the growing interest and importance of exercise in society. For example, FIMS was a reflection of the European dominance in sports medicine, and FIMS was therefore a prime example for a United States organization to follow.

The name "Sports Medicine" was also suitable due to its lack of specificity. The clinical and scientific disciplines that contributed to the body of knowledge concerning exercise and the human body during the founding years were physiology, physical education and cardiology (Figures 1A & 1B). In fact, the organization of ACSM during the initial decades of function was organized into these three divisions. Furthermore, at that time, and even today, the connection between exercise and heart disease was the focal clinical interest (5,6). Today, additional clinical interests and even new fields of inquiry are interested and add to our knowledge of exercise and the human body, and therefore contribute to the function of the ACSM.

Evolution to Present Day Functions
An excellent thorough explanation of the changing function of ACSM since its foundation is presented in the text by Jack Berryman (6). Based on this publication, prominent features of the development of ACSM that pertained to the field of exercise physiology can be found (Table 3), and many of these have already been discussed.

When reading the text by Berryman (6) it becomes obvious that despite the adoption of a sports medicine name by ACSM, there was no definition of sports medicine, and no clear statement of a mission or list of objectives until 1968. In a report from the Interdisciplinary Coordination and Advisory Committee of the ACSM, the following was stated:

"Sports medicine draws from the various professions but does not absorb them. A mutual understanding and respect among these professions, therefore, is necessary for the promotion of the ideals of sports medicine. Mile physicians, educators, athletic trainers, biological scientists, and behavioral scientists comprise most of sports medicine's professional reservoir, conceivably any professional person could apply his competencies to some component of sports medicine. The meaning of sports medicine is its responsibility to share, respect, and synthesize the interprofessional implications of these components."

The committee then delineated the following objectives of ACSM:

1. Advancement of research and education concerning the effects of sports and other physical activities on the health and well being of individuals.
2. Cooperation with organizations in this country and abroad having allied interests.
3. Promotion of meetings of interdisciplinary nature and interprofessional composition.
4. Furtherance of postgraduate educational offerings in the various sciences related to sports medicine.
5. Correlation, integration, and dissemination of information ftom the allied sciences with sports medicine application, and
6. Publication of a scientific journal pertaining to the various aspects of sports medicine.

These objectives were important as they were natural extensions of the aforementioned definition of sports medicine, and thereby provided a template from which ACSM could strive to function. A notable feature of the definition and objectives was the cooperative manner by which ACSM should function. ACSM was to be an organization that respected all disciplines influential to the study of how exercise influences the human body, and in fact was to function to support and serve these disciplines to improve research findings and the dissemination of this information.

In 1967, Bruno Balke led a committee to create ACSM's journal. Ironically, at the same time a group in England led by Roy Shephard had made plans for the development of a journal specific to exercise physiology, tentatively titled, International Journal of Exercise Physiology. However, upon notification to Shephard of the plans of a journal by ACSM, the idea for an exercise physiology journal was abandoned. Balke's committee proceeded knowing that their journal would be supported internationally, and have no clear competition. In 1968 legal controversy existed over the originally accepted name of the ACSM journal, Science and Medicine in Sports. Apparently there were other organizations who were recognized by the words "Medicine in Sports". The solution was to rearrange the originally accepted name, and by March 1969 ACSM published the first issue of its journal, titled Medicine and Science in Sports. In 1979 Charles Tipton, the then newly elected editor of the journal, was successful in changing the name of the journal to Medicine and Science in Sports and Exercise, with the first newly titled issue published in the spring of 1980.

Little did the members and officials of ACSM know that the blocking of an exercise physiology journal was the first blow to retarding the development of exercise physiology as an independent discipline recognized around the world. Furthermore, such a move unintentionally directed exercise physiologists to develop the notion that they had to rely on ACSM for an administrative function and purpose.

The decade of the 1970s witnessed the reign of exercise physiologists over the ACSM (Table 4). For example, between the years 1971 and 1982 the elected presidents of the ACSM consisted of 7 exercise physiologists, 3 physiologists, one medical physiologist and one cardiologist More importantly, for two separate three year spans, exercise physiologists presided over ACSM. These individuals strongly influenced the expansion of the ACSM's objectives and functions, as well as the future development of ACSM. Nevertheless, it is obvious that these exercise physiologists, and the exercise physiology members of ACSM were not aware of their present and future needs to progress towards professionalism.

One can only wonder what the status of exercise science and exercise physiology would be today if during the decades since 1970 the efforts of exercise physiologists, or exercise scientists in general, were directed at improving the status of their own disciplines rather than solely supporting ACSM. Would there be more and better undergraduate and graduate programs offering exercise science degrees? Would all exercise scientists be better recognized for their knowledge and skills? Would exercise physiology already be established as a vital profession in the allied health sciences and fitness industry?

In 1972 several ACSM members conferred over the need for guidelines for exercise testing and cardiac rehabilitation programs. This meeting led to the first Annual Exercise Testing and Prescription Workshop in Aspen Colorado in December of the same year. By 1975, the first published guidelines were available, titled, Guidelines for Graded Exercise Testing and Exercise Prescription. In December of 1974, participants of the 1974 Invitational International Conference on Implementation of ACSM Exercise Testing and Exercise Prescription Guidelines discussed a certification process for individuals involved in exercise testing and prescription. These moves clearly indicated the new vision of ACSM in implementing directives, largely focused on or dependent upon exercise physiology, rather than being a forum for the combining of multidisciplinary research to better understand the effects of exercise on the human body.

The growing influence of exercise physiology within ACSM was not met without criticism. Roy Shephard published a "Viewpoint in the January 1974 issue of ACSM News in which he stated that the College was "in danger of becoming an association, albeit a distinguished association, of exercise physiologists." Roy Shephard was voted the next president elect for 1975-76. Nevertheless, between 1975 and 1979 another three exercise physiologists were elected as president

"The American College of Sports Medicine is a multi-disciplinary professional and scientific society dedicated to the generation and dissemination of knowledge concerning the motivation, responses, adaptations, and health aspects of persons engaged in exercise."

Specifically, the College is concerned with:

1. Basic physiological, biochemical, biomechanical and behavioral mechanisms.
2. Improvement and maintenance offunctional capacitiesfor daily living.
3. Prevention and rehabilitation of chronic and degenerative diseases.
4. Evaluation and conditioning of athletes.
5. Prevention and treatment of injuries related to sport and exercise.

These objectives were more specific than the previous list from 1968. It was also clear that there was a definite bias towards incorporating exercise physiology content into the function of ACSM. For example, objectives 2 and 4 are of primary interest to and within the realm of exercise physiology. However, their inclusion is not surprising given the preponderance of ACSM presidents between 1971 and 1979 who were exercise physiologists or "pure physiologists" (Table 4). It seems that the 1970s marked a period where exercise physiology became incorporated into the functions of ACSM, rather than becoming a separate discipline that contributed to a multidisciplinary sports medicine conglomerate as per the 1968 objectives. In hindsight, perhaps Roy Shephar's fears became reality!

In 1982, ACSM once again published a statement of purpose, with only minor wording changes to the 1979 version. The 1980s witnessed growing support within ACSM for expansions to certification, better connections to political and media organizations for improving the dissemination of information on exercise and health, and an expanding number of position stands and opinion statements. In 1992, ACSM developed a strategic plan that included 12 goals for the period from 1992 to 1996. While too lengthy to be included in this article, the goals expressed the need to further support clinical and exercise science research, pursue efforts to improve the safety of exercise participation by the public, and ensure a future for ACSM in leading the world in issues of sports medicine.

The brief history of ACSM indicates the overwhelming influence of exercise physiologists to the development and success of ACSM. Today, and since the 1960s, membership statistics have also revealed this support (Figure 2). In 1995 4,435 non-student members (33.6%) were traditional or clinical exercise physiologists, 3,869 (29.3%) were medically trained, 340 (2.6%) were physical educators, 328 (2.5%) were athletic trainers, and 425 (3.2%) were physical therapists (1). Student membership by training is not categorized by ACSM membership records. However, if it was it is reasonable to expect that exercise physiology numbers would be further inflated relative to other membership categories. Based on membership, exercise physiologists represent the largest sector within ACSM.

The contribution of exercise physiologists to ACSM is also evident in the overwhelming number of exercise physiology papers presented at the annual scientific meeting (Figure 3) (4). For example, in 1996, 729 (58%) of the 1256 published abstracts concerned exercise physiology and clinical exercise physiology. Given the overwhelming importance of exercise physiology to the ACSM, the obvious question is once again:

Why does exercise physiology remain a discipline that lacks self autonomy? Also, Why has the ACSM not taken the initiative to recognize the need and importance for exercise physiology to attain self autonomy?

The Exercise Physiology Identity Crisis
Exercise physiologists around the world have an identity crisis. They can define what exercise physiology is, but when they compare themselves to a medical doctor, a physical therapist, or athletic trainer it is clear that they have no official support to protect their existence in society. For example, unlike medical doctors, physical therapists, or athletic trainers, until the foundation of ASEP in 1997 there was no governing body of exercise physiology. There currently remains no national certification that maintains education and work standards, or promotes and maintains employment conditions. Consequently, there is no formal direction for how exercise physiology functions in the growing field of the allied health sciences involved in the prevention, diagnosis, and rehabilitation from disease. In addition, exercise physiologists have minimal employment recognition based on their university education, and despite the growing importance of their knowledge and skills they witness the continual domination of their field by clinicians, and the threat of dwindling university programs supporting the study of exercise science.

There is also talk of state licensure for exercise physiologists, based on definitions of exercise physiology (3,11) that are totally unacceptable for who an exercise is, how an exercise physiologist is trained, and what an exercise physiologist is competent to do (11). State licensure for clinical exercise physiologists currently exists in Louisiana, is being discussed in Georgia, and may spread to other states. Certification is also provided for individuals trained in exercise related content by ACSM. However, it is also difficult to understand how ACSM certifications fit into the realm of who an exercise physiologist is, and how these certifications actually accredit all knowledge and skills of an exercise physiologist In reality, ACSM certification enables individuals with less training than those who successfully complete exercise science undergraduate and graduate programs to gain equal recognition as a "fitness instructor" or an "exercise specialist" (Table 5). What does this say about how ACSM views the quality of exercise science undergraduate and graduate programs in the US and around the world?

Why Exercise Physiology Does Not Have Self Autonomy
In the historical details that have been provided it is clear that the development and success of ACSM is as much dependent on exercise physiologists as it is clinicians, and far more so that any other division of exercise science. However, evaluation of history also reveals that inclusion of exercise physiology into the inner workings of ACSM has possibly been of detriment to exercise physiology, and all exercise physiologists. Given the focus to develop ACSM, exercise physiologists have forgotten themselves, and their own discipline. Exercise physiologists have assisted in the development ACSM certifications that detract from the recognition of the quality of their own undergraduate and graduate programs in exercise science. Exercise physiologists have contributed research to the journal of ACSM, and in the process prevented the formation of a journal specific to exercise physiology. Exercise physiologists have contributed enormously to ACSM being recognized in the clinical world, yet despite their knowledge being pivotal to many of ACSM's achievements, their own field has not been recognized or promoted by ACSM.

Based on the lessons of history, exercise physiologists must first blame themselves for how they are not recognized for who they are, what they do, and what they are capable of doing. However, the issue is not to lay blame on any one organization or historical event, but to recognize what is needed to cement our field in the applied and clinical communities. Exercise physiologists need to act in a manner that will foster the continued existence of exercise physiologists, trained in exercise science graduate programs, and guaranteed employment opportunities in a diverse number of applied and clinical environments. Exercise physiologists owe this to those who came before them and developed their discipline, to themselves, and to the future exercise physiologists.

Recommendations For The Future of Exercise Physiology
Exercise physiologists need to:

1. Recognize that they deserve and need to represent themselves in the professional development of their discipline.

2. Support the only organization that exists to foster the professional development of their organization; the American Society of Exercise Physiologists (ASEP).

(1) Develop and enforce licensure standards for exercise physiologists, with additional emphasis options for fitness, sports physiology, and clinical exercise physiology.
(2) Develop education and hands-on laboratory skills standards for licensing exercise physiologists.
(3) Politic the American Medical Association, the American College of Cardiology, and the ACSM for recognition of the essential role exercise physiologists have in disease prevention, diagnosis, and rehabilitation.
(4) Politic universities to ensure the continued support of exercise science undergraduate and graduate programs.
(5) Develop standards and competencies for universities offering academic programs and degrees in exercise science, leading to accreditation of exercise science programs providing a major tract in exercise physiology.
(6) Develop an international exercise physiology journal.
(7) Continue involvement in the ACSM, and
(8) seek official recognition and support by the ACSM as an integral, independent component of sports medicine.

The professionalization of exercise physiology will not detract from the functions of ACSM. Rather, as with the professional advancement of all disciplines that contribute to sports medicine, the professionalization of exercise physiology will strengthen the sports medicine field (Figure 4). An organized, self governing body of exercise physiologists, who secure the future development and functions of exercise physiologists in society, will bring a powerful and strong voice to sports medicine. Surely this is a development that is positive for all.

References

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