1 No 11
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
Physiology Professionalism: Myth or Reality
Boone, PhD, MPH
of Exercise Physiology
of St. Scholastica
MAY 1975 I celebrated with my family the completion of the Ph.D. in exercise
physiology from Florida State. I had been teaching exercise physiology
for several years at Wake Forest University prior to finishing the dissertation.
I have now taught exercise physiology 25 out of 28 years as a college teacher.
At no time have I questioned what it means to be an exercise physiologist,
until several years ago. As Chair of the Department of Exercise Physiology
at The College of St. Scholastica and after considerable discussion with
other exercise physiologists in the United States and around the world,
it became apparent that exercise physiology (as an academic emphasis or
major in our institutions) is not what it should be and, very likely, is
moving in the wrong direction.
Education's Influence on Exercise Physiology
first allow me to reminisce a bit about myself and exercise physiology.
Prior to entering Florida State, I was a health and physical education
instructor at the University of Florida and at Northeast Louisiana State
University. I was a college gymnast, and I had participated in a variety
of other sports. I understood the value of athletics. I also knew the importance
of such courses as "biomechanics, physiology of exercise, and kinesiology
as part of the traditional physical education curriculum. Everyone knew
that these courses helped to lay the foundation for understanding the science
of movement (whether it was jogging, lifting weights, or playing tennis).
Hence, while not often discussed, the physical educator, collectively speaking,
is the father of exercise physiology. At first, only a few, then, more
college physical education teachers offered several additonal courses in
the sciences and, thus the academic "emphasis" in exercise physiology was
created alongside the traditional degree in physical education.
to Develop a Profession
have come a long way in a short time. We have the courses, the faculty,
and the academic programs. But, along the way exercise physiologists, who
were interested in doing research and working with adult fitness and cardiac
patients, failed to do several very important things. They failed to develop
a professional code of ethics, a philosophy, an accrediting body, and an
organization for exercise physiologists and, unfortunatelly, they failed
to define "Who is an exercise physiologist?" In retrospect, these were
major mistakes. The physical educator/exercise physiologist did not take
the time to think about the "beginning" but rather the "doing." They were
interested in exercise and how it might benefit society. Directly related,
and almost as an afterthought, they embraced the American College of Sports
Medicine as their professional organization. But sports medicine is not
exercise physiology, and ACSM is not an organization of exercise physiologists.
Instead, it is an organization of more than 60 different professions.
fact that we did not start our own organization has caused us to be too
dependent on ACSM and organizations like the American Association of Cardiovascular
and Pulmonary Rehabilitation (AACVPR), which was born out of the idea that
ACSM did not do enough to recognize the exercise physiologist who worked
in the clinical setting (i.e., cardiac rehabilitation). This organization,
however, has become primarily an organization for nurses, which should
not come as a surprise since nurses are primarily responsible for the care
of cardiac patients in the hospital setting.
vs Technical Expertise
our credibility, in part, depends on the public's understanding that we
know who we are and what we do in society, the idea that exercise physiologists
work only in cardiac rehabilitation is highly problematic and a major disadvantage
in that we have come to view what we do in a limited way. We must question
the change in emphasis from academic scholarship to technical expertise.
There are not enough jobs in cardiopulmonary rehabilitation (even if our
students were 100% accepted by the medical community) and, moreover, most
of what our students are taught is now being taught to physical therapy
students, nursing students and others.
college teachers allow the market to drive the academic program? Most college
teachers think that the academic program has its own intrinsic values and,
therefore, can not be replaced. Cardiopulmonary rehabilitation is one job
opportunity among many, and while exercise physiologists may have been
a major player in the development of cardiac rehabilitation, that alone
does not authenticate the existence of the exercise physiologist.
Exercise Physiology vs Exercise Physiology
problem with the shift towards clinical exercise physiology versus exercise
physiology is that it has resulted in a false certainty of some sort of
logical emergence with the medical field. It is our responsibility to evaluate
this rather subtle development because it has the potential for shaping
our profession. The point being, while I have always considered exercise
physiology more than aerobic dance, now I catch myself saying that exercise
physiology is not cardiopulmonary rehabilitation. Obviously, this view
should not be taken as an insult. It is simply the truth. Many exercise
physiologists who have worked with heart patients years earlier have stopped
to do other things because of the limitations in the medical field when
one does not have an MD degree.
understand the importance of exercise rehabilitation and multiple risk
factor intervention for heart patients and their families. I am not attacking
the right of cardiopulmonary rehabilitation to exist or the right of various
college teachers to prepare students to work in the medical field. But,
do they understand (and do their parents understand) what they are getting
for their college dollars? I do not think so and part of the blame must
lie with the administrators of the academic programs that emphasize cardiopulmonary
rehabilitation without having significant in-roads into changing the inertia
of the medical community.
inertia is proving to be a major impasse for our students. Moreover, since
we do not control for how many students we graduate, in a short time, if
not now, our students will have considerable difficulty landing a job in
cardiac rehabilitation (i.e., unless they go back to college and get a
physical therapy or nursing degree). There are too many graduates and too
few positions, and there are too many other professions (e.g., nurses,
physical therapists, respiratory therapists) who are not only ready to
work in cardiac rehabilitation but are doing so with considerable ease
and speed. They are in the system, and they are poised to work in the field
although they may have relatively little understanding of the concepts
taught in such as courses as exercise prescription, cardiopulmonary rehabilitation,
electrocardiography, and exercise physiology.
I have described is the future, and yet it is the present too. Exercise
physiology students, upon graduation, believe (according to their professors)
that they will be able to get that "great job" in cardiac rehabilitation!
What may not be so obvious though is that we have a lot of opportunities
as college teachers to teach students how to think critically and in a
constructive discontent manner to empower and make better not only their
lives but the lives of those they care about and those with whom they may
be responsible (whether it is health promotion, teaching, fitness, or rehabilitation).
We can help our students (and their parents) understand that the undergraduate
program in exercise physiology may be exactly the grounding in the sciences
needed to prepare the student for application to other academic programs.
Just because a person gets an undergraduate degree in a particular major
does not mean that person must stay in that field. In this way, the exercise
physiology program can be viewed in much the same way as biology or chemistry.
point is that the momentum of our brief history can not be lost thinking
too narrowly even in the face of having to conclude we are not where we
want to be. For certain, we are not well-oiled. We do have problems! Fortunately,
however, most college administrators, students, and parents do not know
about our problems. If we do not "get with the program" -- that is, if
we do not unite as exercise physiologists, particularly the academic-types,
we may (in the not too distant future) begin to have fewer students attending
our academic programs. If that happens, getting rid of academic programs
will not be far around the corner. Strangely though, as I talk about this
with a few friends, I realize with astonishing clarity that the issue has
not surfaced in the minds of most.
I am not "anti-physical education," "anti-sport studies," "anti-human performance"
or anti- one of the other 45 or so names for various departments where
exercise science (physiology) is offered as an emphasis (not a degree),
I believe that we should exist academically as a separate department (if
possible). Yet, having said this, I also realize that the departmental
configuration of most colleges does not allow (at present) the development
of exercise physiology as a separate department. Change, however, is inevitable
if maturation of the profession is to take place. We have the authority
because we have the knowledge. This knowledge and the implied functions
make it possible to actualize the essence of exercise physiology alongside
the other scientific fields of study.
Turning Point in Exercise Physiology
are at a turning point in exercise physiology. Those of us who teach at
the college level must ask the question, "Are we in control of our profession?"
or "Have we given up control of our academic programs to ACSM and AACVPR?"
If the authority of a profession lies in its knowledge, and that knowledge
is generated for the most part from within the profession, then a direct
relationship should exist between the faculty of college-directed exercise
physiology programs and the opportunity to actualize the professionalization
of exercise physiology.
brings me to the point of asking, "How do we decide which courses our students
should take?" It seems to me that the emphasis should first be on the education
of the student as a critical, reflective thinker with the intuition, knowledge,
and qualities of a professional. The students' education can not be limited
to technical skills or technology that delegates the graduate to an inferior
work position. Something must change. Either the medical community (doctors,
nurses, therapists, educators, administrators) must recognize the academic
preparation for the exercise physiologist or, admittedly, the academic
programs at the college level must prepare students for different job careers.
The identification of new jobs with opportunities for independent, critical
thinkers should be put into action. We can not wait any longer if the degree,
the curriculum, and the faculty are to be respected. This problem has gone
on too long and has now moved to the question of ethics and fraud.
particular point should not come as a surprise to the college faculty upon
realizing their students may be spending in the range of $40,000 to $70,000
just in tuition fees for the undergraduate degree! What is the answer?
We need to pull together. As exercise physiologists, we need a vision for
our future. A vision that will not do away with our students working in
cardiac rehabilitation, fitness, and athletics, but will help to overcome
the dependent subordinate role that many feel at the expense of their self-esteem.
The image of exercise physiology must be better configured, and it must
be developed within the context of the academic community. It is futile
to think we can exist outside the academic setting. We are more than trainers
and technicians. I know that we are more in the eyes of many, and that
we have moved from opinion thinking to scientific thinking, from subordinance
to the medical community to authority in exercise physiology research,
and from no academic position to a respectable position in higher education.
So with just a little restraint from giving in too easily to those who
may wish otherwise, we may still have a chance to keep exercise physiology
an academic major with integrity. Then, and only then will we, as exercise
physiologists, move from dependence on other disciplines to the specifics
of what constitutes the knowledge of exercise physiology.
We a Profession or a Discipline?
extent to which we control our destiny is important, and now is is a crucial
time for organizational focus. Are we a profession or a discipline? Do
we have the right to discern the appropriateness of what we call ourselves,
what we teach, the kind of research we do, the health, fitness, and rehabilitative
services we provide? Are we, as exercise physiologists, educated professionals
or highly skilled ECG and/or exercise technicians? The implication of this
analysis is that the exercise physiology profession can not exist without
its own professional organization. The intoxicating challenge is whether
exercise physiologists can agree that nothing is exempt from re-examination.
The freedom to evaluate the feeling of inescapability from sports medicine
organizations is the right if not the responsibility of every exercise
makes this thought particularly striking is that it has never been fully
understood during our brief history. The point being, we did exist before
the advent of ACSM, and we not only have the right but the responsibility
to identify "who we are" and "why we exist." It is our responsibility to
write out our professional philosophy and to live by a certain agreed upon
ethical standard of practice. I propose that we can do these things and
more through the collective participation of all exercise physiologists
in the American Society of Exercise Physiologists (ASEP). Those who belong
to it will need to address the concerns I have identified and, then, the
problems that stem from an increasingly specialized academic program (such
as clinical EP). In this way, we will clarify who we are, for what purpose(s)
we exist, and how best to exercise our options.
it takes is a willingness to see that it happens. The reward for transforming
the profession will be felt by the graduates, although creating the conditions
that will allow for new jobs and professonal opportunities will take time.
The struggle is worth the investment, both in our students and in our profession.
It will require us to be attentive to all concerns that appear to diminish
the longevity, integrity, and professional capacities of the exercise physiologist.
To do this task well, we need to commit to ASEP and its goals and objectives
to advance and improve the exercise physiology profession. It will provide
exercise physiologists in the United States and worldwide the forum for
leadership and exchange of information to stimulate discussion and collaboration
among exercise physiologists active in all aspects of the profession. We
also need ASEP to work on behalf of exercise physiologists everywhere to
set the standards via ASEP-approved curricular throughout the universities
and colleges in the United States.
Professionalization of Exercise Physiology
will be the change agent in the professionalization of exercise physiology
by demonstrating through its membership an increased connectedness (cohesion),
a commitment to ethical norms of service to the public, a higher percentage
of members remaining in the profession throughout their lifetime, a homogeneity
of membership, and a control over professional matters that we have never
the "vision" for ASEP is to be recognized as the leading professional organization
of American scholars and practitioners in the study and application of
exercise physiology research to fitness, health, rehabilitation, sports,
and athletic training. ASEP is dedicated to unifying exercise physiologists
to promote and support the study, practice, teaching, research, and development
of jobs as an exercise physiologist. In time, it is reasonable to expect
(if not require) a prospective member of ASEP to be a graduate of a qualified
college/university exercise physiology major with academic consistency
acrosss programs of study. The public will, therefore, come to understand
the answer to "Who is an exercise physiologist?" just as they have come
to terms with who is a physical therapist, a nurse as well as other recognized
exercise physiologist will, in time, be recognized as a university/college
educated professional who has at minimum an undergraduate degree in exercise
physiology. But, first, we must come to terms with developing a curriculum
(or at least an agreed upon list of core courses) that is expected of the
exercise physiology faculty and departments. The bottom line, there are
too many programs that offer three (maybe four) courses in exercise physiology
versus other programs (few in number) that require 12 to 14 undergraduate
courses in exercise physiology that are taught by exercise physiologists.
There is a need to get control over what constitutes professional membership
in the field. Also, why not (after academic and hands-on outcomes have
been identified) develop just ONE national certification test for all graduates
of the approved exercise physiology curriculum. After passing the exam,
the exercise physiologist would be identified as a Certified Exercise Physiologist
(EPC))? To take the examination, one would have to have an academic degree
(or emphasis) in exercise physiology (science)!
Physiology as a Profession
ASEP certification, everyone will know who we are and what we stand for
and, equally important, the EPC will belong to a profession that meets
the six basic characteristics of a profession, which are:
intellectual, carrying with its standards of education and practice with
high personal responsibility.
based on systematic, theoretical views and ideas that are readily researched
a relationship with professional colleagues regulated by a Code of Ethics.
a formal professional association supporting a professional philosophy
well organized internally to promote exercise physiologists.
recognized legally by a certification board staffed by professional members.
basic characteristics of a profession are being met through the organizational
structure of the American Society of Exercise Physiologists. ASEP exists
to serve its members, and to set the stage for a new beginning.
members of the Society have come to an understanding of the need for the
professionalization of exercise physiology. They recognize and understand
the importance of exchange of ideas, advancement of academic programs,
and career opportunities. They (with their BS to PhD degrees) are in the
process of working towards the implemention of a national academic accreditation
of exercise (science) physiology programs, a national exercise physiology
certification (based on an assessment of outcomes), and the advantages
(and how to) of licensure in exercise physiology. They understand the reasons
for setting the ASEP agenda, direction, and decision making process to
increase visibility and enhance the image of the profession. They recognize
the importance of defining the impact and concerns of exercise physiologists
who work as clinicans, and the steps needed to support the quality and
integrity of their work.
ASEP members are important to the clarification of the role and importance
of exercise physiology research in health promotion, disease prevention,
rehabilitation, fitness, and athletics. They understand the academic and
practical aspects of what it takes to be a successful exercise physiologist
in today's market. And, yes, they realize the importance of identifing
ways to respond to the ethical and professional challenges presented to
exercise physiologists in health, fitness, rehabilitation, and related
physiology professionalism is a reality!
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