PEPonline Professionalization of Exercise Physiologyonline An international electronic journal for exercise physiologists ISSN 1099-5862 Vol 2 No 6 June 1999   Exercise physiology and art of perception Eric Durak, MSc Santa Barbara, CA "In order to attain power, you associate with the people who have money".  -Scott Wenz, MA - Exercise Physiologist   I Love Magic As a boy I was a tremendous fan of Harry Houdini.  It is said by today's magicians that Houdini broke all of the rules of magic in his day.  He transformed magic both into a world-wide phenomenon, and legitimized many aspects of magic from the bar rooms and street venues into a true element of show business.  One of the primary rules of magic is to transcend the rules of nature.  Maybe there is something I CAN do, thus is the transformation of exercise physiology.  It is the latter part of the 1990s.  Ideas and opinions have been flowing from sports medicine meetings for the better part of a decade.  But where have we gone in our quest for recognition?   In my opinion, not too far.  Consider the following items that have happened within the past six years that need to be noted by exercise physiologists. 1993 - Licensure bill to regulate fitness professionals introduced  in the California state legislature.  It is not accepted by fitness organizations, and does not pass committee. 1994 - Medical Exercise Specialist certification course introduced by the American Academy of Fitness Professionals - a course designed by a Physical Therapist to teach physical therapy and post rehab concepts to fitness instructors. 1995 - Fitness Practitioner certification course introduced by the Aerobics and Fitness Association of America. 1995 - Licensure status attained by exercise physiologists in the state of Louisiana.  Although it is perceived as a step forward for the profession, it is not recognized by many insurance companies or Medicare, and it has restricted the practice of many to solely cardiac rehab. 1996 - Fitness Therapist™ continuing education course is introduced through the International Sports Sciences Association. 1998 - Physiotechnologist licensure bill introduced into the California state legislature.  The bill is a two-part licensure process for clinical exercise and fitness consulting.  The bill is killed in through a lobbying effort  by the California  Physical Therapy Association before it reachef the business and professions committee. 1998 - The Clinical Exercise Practitioner certification course is introduced by the American Council on Exercise. 1998 - Nova Care, the nation's second largest rehabilitation provider lays off thousands of physical therapists and PT assistants as part of their response to the Medicare Reform Act of the Fall of 1998.  This is seen by many industry insiders as an opportunity to expand post rehab programs within the health club setting.  As can be seen, there has been a tremendous movement surrounding clinical exercise - however, it has not been with exercise physiologists.  Most of the movement has been with outside agencies wishing to capitalize on the concept of post rehab exercise programming.   It seems as though the profession of exercise physiology is destined to repeat the same procedures of previous health care entities.  From Physical Therapy to Marriage and Family Counseling, the first item on the agenda is to create a state-mandated licensure process.  They have had a head start. What will happen with clinical exercise and health promotion?  There have been three publications of recent that will point to the inevitable.  First was an article in OT Weekly in 1996 about the use of OTs in wellness counseling and prevention services for work-related situations.  The second appeared in the American Journal of Managed Care in the summer of 1997.  This article stated that pharmacists will take the lead in delivering wellness services to patients because they supply wellness products in their stores (vitamins, massage products, diabetes supplies, etc., in addition to prescription drugs).  The third article is in the January 1998 issue of Rehab Management, whereby PTs are told to take the lead in delivering prevention services for work-related situations.  Since most Americans work, it is essentially promoting health and exercise services to many people who would use them in the workplace.  Also, it is marketing health and wellness services away from exercise physiologists and health educators. What is Needed? Historically, exercise professionals never thought of having to market themselves against any other health profession.  Partly because they assumed that their type of work spoke for itself, or was dramatically different from other professions.  It is not.  If exercise professionals at any level (from personal trainer to university-based PhD exercise physiologist) wish to compete in the ever-hostile world of healthcare, they need to understand their place in the market, and promote their services within their community. One prime example of this is the Train to Attain fitness studio in Syracuse, NY.  Under the direction of owner and trainer Eric Prager, Train to Attain has successfully marketed itself to the medical community through attainment of accreditation of its facilities, and using a specific campaign to reach to doctors for their post rehab exercise program.  Since its inception in the beginning of 1998, physicians now refer directly to their practice.   Although Mr. Prager is an excellent trainer and business owner, he is not a clinical exercise physiologist (nor does he purport to be).  I use his example as one of using good business sense to improve referrals and increase revenue, independent of clinical exercise status. Thinking in Terms of the Future! Where would you like to be? Yogi Berra is credited with stating the phrase:  “Making predictions is difficult, especially when it’s about the future!”   His statement rings true for many exercise professionals who take on a job and don’t know where they would like to see themselves professionally in the coming years. Like many businesspersons, I too am in the process of re-invention.  This year I have launched the Cancer Well-fit Program to promote wellness and exercise programming for cancer patients.  Not only is this program being marketed to healthclubs, but to clinics, hospital-based wellness centers, and oncology professionals (who may make up a large percentage of sales).  This will be part of my business plan for the next two-to-three years.  During this time I hope to branch off component programs to Cancer Well-fit (patient resource books, kits, nutritional supplements, etc.) all in an effort to keep this aspect of my business going strong.  Since I do not work with cancer patients on a daily basis, I hope to help their status through the promotion of exercise and health products internationally. Understanding the Changes in Healthcare Where there is termoil there is also opportunity! For those who wish to work full time in clinical exercise, the overt signs of the time may be a bit discouraging seeing thousands of physical therapists laid off from major rehab providers, but if we look closer we will see some underlying positive happenings.  This year Health South signed a contract with Cybex equipment to put aerobic and strength products in each of their facilities.  This may see a shifting of traditional acute phase programming in favor of lifestyle management and wellness programming. Of course, there are many signs in the healthclub world that doing business with managed care is the business of the future.  Companies such as Health Care Dimensions (Phoenix, AZ), and International Fitness Club Network (Providence, RI) are all doing business with regional managed care organizations, and this trend will continue in the coming years.  It is very exciting news for persons who wish to run post-rehab (clinical exercise) programs in the health club environment. Marketing Your Services Marketing has been the buzzword since the 1980s when we saw a turn in business in the United States.  Now in the late 1990s we are seeing companies grow to unprecedented proportions in the stock market, and in the fitness world we are seeing online companies and new start-ups that are doing very well financially in short periods of time. Clinical exercise physiologists need to understand that when all is said and done, they will become a more powerful player in the healthcare environment by understanding trends in healthcare, and looking for companies to do business with.  This may include health clubs that in the past have been seen as the lowest common denominator in terms of working as a clinical exercise physiologist.  However, when one sees where the large chains are going (health care contracts), it is easy to see the liaison between exercise physiologists and health club programs.   The growth in hospital wellness centers each year is also a testament to the emphasis placed on prevention and wellness in business traditionally thought of as sick-care providers. Conclusions As written in the title, the art of perception is not fooling the public about your services or professional status.  It is simply letting them in on your talents.  It is also working with businesses that would appreciate your skills if they only knew you existed.  By using your resources (the Surgeon General’s Report, your writing and communication skills), you can make an impact locally in clinical exercise in ways you may have never imagined.   It is now time for organizations such as ASEP to promote themselves and create a membership that is willing and able to transform clinical exercise from cardiac rehab to “wellness provider”.  It will not be too hard to accomplish with some creativity and vision.  And instead of “slight of hand” -- CEPs can use their knowledge and clinical abilities to show local physicians, therapists, and businesses that they are part of the healthcare community, and that they can provide top level services for persons in need of rehab, or who may need an ounce of prevention.  The result may be magic! References Bryan, JM, Bursch, G. et al. The Future of Physical Therapy. Rehab Management J. 11:48-55, 1998. Srnka, L, Porter, AM. Exploring Self-Care and Wellness: A Model for Phamacist Compensation by Managed Care Organizations. Am J Managed Care. 3(6)943-955, 1997. Eric Durak is the Director of Medical Health and Fitness in Santa Barbara, CA.  His business is consists of consulting, lecturing, and fitness instruction.  He is also co-director of the Cancer Well-fit Program, which was awarded the “best practice” as the 1999 IHRSA International Conference in San Diego, CA. Copyright ©1997-2000 American Society of Exercise Physiologists. All Rights Reserved. ASEP Table of Contents Questions/comments