AMERICAN SOCIETY
OF EXERCISE PHYSIOLOGISTS
Founded, 1997

Professionalization
of Exercise Physiologyonline
An international electronic
journal for exercise physiologists
ISSN 1099-5862
Vol 2 No 9 September 1999



Exercise Physiology: A Perspective

Tommy Boone, PhD, MPH, FASEP

Professor and Chair, Department of Exercise Physiology, College of St. Scholastica, Duluth, MN


"Destiny is not a matter of chance, it is a matter of choice; it is not a thing to be waited for, it is a thing to be achieved." William Jennings Bryan

Questions of exercise physiology professionalism grow ever more complex with increased awareness of ethical issues.  Yet, by comparsion to other professions, exercise physiology is just beginning its struggle to professionalize its work.  Even the use of the word practice seems somewhat inappropriate when defining the professional work of exercise physiologists.  Instead, most exercise physiologists use such words as work and career.

It is frustrating that exercise physiology is a profession without a history.  Learning about the profession is exciting and, yet oftentimes frustrating.  Exercise physiologists have for the most part been educators more than practitioners.  The latter is defined as a career in something other than college teaching (e.g., directing a cardiopulmonary rehabilitation program or managing a fitness center).

The practitioner is generally the non-PhD exercise physiologist who has important roles in assisting individuas who need professional guidance in building muscles, running better, or losing fat.  The college teacher is the educator who teaches the students to become good practitioners.  Sounds simple, and I suppose it is.  But, while exciting, it is also confusing.

I rarely go a week, as an educator, without a student asking several questions: "What is exercise physiology?"  "Where do exercise physiologists work?"  "Is there a demand for exercise physiologists?"  "How much money does an exercise physiologist make a year?"  The questions are excellent and the preexercise physiology student needs answers to make an informed decision about career options.

Concise, accurate, and organized information should be available to young people when making career and educational decisions.  Exercise physiology is no exception.  Unfortunately, however, it is more of a "work in progress" than a well-oiled machine.  From its beginning, the specifics of organizational development were not addressed nor were the professional instructions and curriculum guidelines for both the students and the teachers.  Without these "how to" in developing a profession and the commitment to a high standard of work, it has become difficult to maximize a student's experience in exploring and learning more about the profession of exercise physiology.

What About Other Professions?

Medicine

Growing pains may not be all that unusual.  For example, at its first official meeting in 1847, the American Medical Association established a code of ethics.  In 1858, the association created a Committee on Ethics, now called the Council on Ethical and Judical Affairs to ensure implementation of the code.  In 1997, given the dynamic medical environment confronting physicians, the AMA created the Institute for Ethics.(1)  My point is, that the AMA continues to address questions of ethics and professionalism across its rich history of 150+ years!

Occupational Therapy

Again, by comparison, the Occupational Therapy profession began as the Society for the Preservation of Occupational Therapy in 1917. (2)  The professional association is now known as the American Occupational Therapy Association (AOTA).  The profession has directed its attention from specialization within the profession in the 1960s to community-based programs in the 1970s to both specialization and expansion of services into a variety of area in the 1990s.  As a profession, they have been developing and defining their work for nearly 83 years.

Dietetics

Dietitians have been recognized as food and nutrition experts since 1917, the year that the American Dietetic Association (ADA) was formed.  By 1924, dietetic education included a four-year course of academic study plus an internship. (3)  The profession demonstrated its credibility to the public sector and others because the ADA established educational standards.  The dietitians supported the association and its activities.  They also supported the progression of educational standards up to and including the 1987 standards that continue to be the requirements today.

Before the formation of the ADA, anyone who worked in food and nutrition joined the American Home Economics Association (AHEA).  Why?  There was no professional organization for dietetians to associate with and communicate with others of like interests.  But, there was no common way to identify who was professionally qualified as a dietetian (hence the need for their own professional organization).  From an exercise physiologist's point of view, sounds like history repeating itself (i.e., ASEP vs ACSM)!

Nursing

A 100 years ago the nursing profession argued a lot about nursing education and licensure.  Today, both are still major concerns.(4)  The first school for training practical nurses was in 1897.  By 1930 there were 11 schools, and in 1947, there were 36.  Today, the number very high indeed.  There are more nursing programs and nursing organizations than probably needed for one occupation.

Physical Therapy

Many elements of the history of the organizational efforts of physical therapy and its professional association have been summarized in books and journal articles. (5)  Imagine, a history of the American Physiotherapy Association was published in 1946, the 25th anniversary year of the founding of the organization.  Members of the Association adopted their first set of ethical principles in 1935 with amendments in 1952, 1969, 1977, 1981, 1982, and so forth.  The first minimum course of study was published in 1928.  The American Physiotherapy Association was responsible for enforcing the standards until 1934 when the APA requested that the responsibilities of establishing minimum standards be assumed by the AMA.  This decision proved to be good and bad for physical therapy.  By 1983, the APTA became the only accrediting agency for physical therapist.  The point is, physical therapy has been around for a long time and has a rich history of professionalism.

Exercise Physiology

The American Society of Exercise Physiologists (ASEP) was founded in 1997 not in 1917.  As part of its Charter, and as a principle item of business was the establishment of a code of ethics.  It is the first emphasis placed on professional conduct by exercise physiologists for exercise physiologists via their own organization.

Does it matter whether or not we know anything about exercise physiology history?  Yes, it does matter.  Exercise physiology today is a result of its history or the lack of it, which is also true with the relationships between exercise physiology and other healthcare professions.  Knowledge of the past history of occupational therapy, dietitics, physical therapy, nursing, and other disciplines is important.  Exercise physiology does not exist by itself in the healthcare market.

Most exercise physiologists have no idea how complex and prolonged the arguments of professional development have become for other professions.  It is a very sophisticated and constantly changing process.  It is also undeniably necessary.  Not all the answers or even all of the questions can be developed at one point in time.  Time changes the questions and the answers may be different for the same question from one decade to the next.  However complex though, it is important for exercise physiologists to come to terms with their history (or the lack of it) and to take control of their future.  Anyone who has a problem with this idea is either unresponsive to the needs of exercise physiologists or simply doesn't understand the present-day reality.

The ASEP Reality

The ASEP strategy is to get these exercise physiologists involved with the professionalization of exercise physiology.  It is not a new idea, and is imperative if exercise physiologists are going to move alongside the other healthcare professions.  The role of ASEP, its objectives, and its influence is to overcome the lack of 100 years of organizational development.  ASEP is about helping exercise physiologists, understanding their complex relationships with the healthcare market, and expanding educational opportunities, developing credentials, and addressing issues of employment.

ASEP is about helping the public sector, college teachers, and healthcare employers understand what exercise physiologists do.  Take for example, if asked what an exercise physiologist does, probably most people entering exercise physiology, like the general public, say, "personal trainer."  That is a common response.  Almost every non-PhD exercise physiologist would understand the comment.  It is part of their history, however brief, missing, and broken.

Does the public understand this historical reality?  No, it doesn't but it is forgiving.  Society will come to accept that there are many employment opportunities for exercise physiologists.  Why? Because there are many similarities between the other professions and exercise physiology.  What happened with the members of other professions and the responsibilities they share with the healthcare community will happen (is happening) with exercise physiology.  It is just that exercise physiologists are decades behind.  Early on, they looked to sports medicine as the way, and lost their own direction and initiative.  Sharing their power with sports medicine is a loss of power.  However, sharing power and working on behalf of exercise physiologists enhances the power of all exercise physiologists.

ASEP is an organization of exercise physiologists.  It is a network of unified strength on issues that support the practitioner as well as the educator.  It is an organization of new leaders at all levels that encourages sharing, trusting, and depending on one another.  It is about demonstrating accountability and professional pride.  It is moving forward under their own power, whereby they collectively take control of their profession so that they can respond to their needs as well as the needs of the consumer and the marketplace.

ASEP is about doing what has not been done before.  It is not about "more of the same".  The ASEP Internet pages are setting the stage for a revolution where all exercise physiologists, regardless of rank, will emerge as important players in the future of the profession.  The website expands and connects exercise physiology professionals worldwide.  No longer are they limited by local or regional influences.  The future belongs to the exercise physiology professional who can face up to the professional challenges, who can dream, and who is willing to work to make the dream into reality.

Fait accompli ("Now it's up to you")

If "Minds are like parachutes, they only work when they are open" (6), then, given the dynamic forces and trends our graduates are expected to encounter, the profession needs more open minded, flexible, and receptive exercise physiology teachers.  We simply do not have the choice of ignoring the ASEP reality.  Exercise physiologists need to make plans and decisions about the future of the profession.  What "you" do today or fail to do will influence exercise physiology tomorrow.


References
1. American Medical Association. (1999). Ethics.  [Available online] http://www.ama-assn.org/ethic/ethics.htm

2. Anderson, L.L.S. & Malaski, C.K. (1999). Occupational Therapy as a Career. Philadelphia: F.A. Davis Company.

3. Winterfeldt, E. A., Bogle, M.L., & Ebro, L.L. (1998). Dietetics: Practice and Future Needs. Gaithersburg, Maryland: Aspen Publishers, Inc.

4. Kelly, L.Y. (1992). The Nursing Experience: Trends, Challenges, and Transitions. New York: McGraw-Hill, Inc.

5. Pinkston, D. (1989). Evolution of the Practice of Physical Therapy in the United States.  In Physical Therapy by Rosemary M. Scully and Marylou R. Barnes (Editors). Philadelphia: J.B. Lippincott Company, pp. 2-30.

6. Cetron, M. & O'Toole, T. (1983). Encounters with the Future: A Forecast of Life into the 21st Centry. New York: McGraw-Hill.


Copyright ©1999 American Society of Exercise Physiologists. All Rights Reserved.


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