Chapter 63 Fundamentals of Exercise Physiology Professionalism  Tommy Boone, PhD, MPH, FASEP, EPC     “The American Society of Exercise Physiologists will be important if ASEP members challenge it to be; effective if the university teachers and students support its vision and professional functions; and successful if its leadership is held accountable.”  – William T. Boone Exercise physiology today is different from exercise physiology five or 10 years ago, and it takes the ASEP perspective and imagination to understand how exercise physiology will continue to change during the 21st century.  The ASEP view of exercise physiology is a healthcare profession, not a technical oriented discipline.  To comprehend the changes that have taken place under the leadership of the ASEP Board of Directors and to anticipate the need for professional credentials for all exercise physiologists, one must take the time to study the ASEP goals and purposes.  Recent Perspectives  Accreditation. Exercise physiology has undergone major changes in response to the anticipated needs of its members.  No longer is there no possibility for students to find an  institution with an academic degree in exercise physiology.  The number of accredited  university academic programs is still small, but changing under the influence of the ASEP leadership.  Students have put 2 + 2 together and realized that if they are to graduate asexercise physiologists, they need to graduate with an academic degree in exercise  physiology.  This is self-evident in nursing, physical therapy, occupational therapy, and all  liberal arts majors.  Only within the board field of kinesiology, human performance, and exercise science (among 30 or so related combinations of departmental and academic degrees) is it true that the students continue to struggle for professional acceptance and respect.  Board Certification The recurring theme with ASEP is that an exercise physiologist has either an exercise physiology academic degree or is presently certified by ASEP as a “Certified Exercise Physiologist” (EPC).  Either way, what is increasingly important is that the professional title is linked to the ASEP certification exam.  This factor is a significant influence on what exercise physiology is becoming in the United States.  The doctorate prepared ASEP exercise physiologists have also played a significant role in the development and identification of the 21st century exercise physiologists.  Although it takes time to build a profession, both are nonetheless significant influences on the future of exercise physiology.  Standards of Practice One only has to refer to the ASEP Standards of Professional Practice to understand the differences between the ASEP exercise physiologist and the personal trainer.  The Standards of Professional Practice document is the forerunner of change that defines the new exercise physiology.  It identifies the ethical and legal procedures by which exercise physiologists will provide healthcare information to the public.  Also, no longer is the exercise physiologist defined just by his or her training in cardiac rehabilitation.  In other words, to understand what exercise physiology is in the 21st century, one must get beyond the misrepresentation of exercise physiology as individuals who have knowledge only about graded exercise testing.  The idea is too narrow a view, and it is altogether wrong.  Exercise physiologists do have academic courses in cardiac rehabilitation and exercise test protocols, but their education is much more complex and integrated with preventive and health-promoting concerns and issues.  The act of supervising a stress test is important, but the more comprehensive cardiovascular assessment is critical to the unique interpretation of physical exercise and/or training by exercise physiologists.  The "Exercise Physiologist" Title No longer is the title, clinical exercise physiology, the only non-doctorate professional in the field.  For some time now, the ASEP certified exercise physiologist, either with or without the doctorate degree, is a recognized exercise physiologist with a certificate number.  This means that anyone who presents him- or herself as an exercise physiologist who is not ASEP certified will be recognized as something other than an exercise physiologist.  Exercise Physiologist is a person who has an academic degree in exercise physiology, or who is certified by ASEP to practice exercise physiology [via the Exercise Physiologist Certified exam (EPC)], or who has a doctorate degree with an academic degree or emphasis in exercise physiology from an accredited college or university [1]. This single factor is a major transformation from past decades.  With it, there is now the image of a professional with the education to make a difference.  His or her responsibilities are now designed to address the needs of society.  For lack of a better phrase, exercise  physiologists are now poised to confront career opportunities in public health, which is a precursor to current healthcare problems throughout society.  Exercise Physiology is the identification of physiological mechanisms underlying physical activity, the comprehensive delivery of treatment services concerned with the analysis, improvement, and maintenance of health and fitness, rehabilitation of heart disease and other chronic diseases and/or disabilities, and the professional guidance and counsel athletes and others interested in athletics, sports training, and human adaptability to acute and chronic exercise [1].  The Healthcare Perspective The essence of exercise physiology is “the delivery of treatment services” that involves three areas: analysis, improvement, and maintenance.  Each area is integral to promoting a healthy lifestyle through improved physical fitness and systematic exercise.  This may involve modifying a client’s health behaviors to helping the client during the rehabilitation period of disease or dysfunction.  Exercise physiology activities may include: (a) providing advice about exercise nutrition, the psychology of exercise, and specific training procedures that may involve the use of post-exercise recovery with massage, baths, and relaxation protocols; (b) performing cardiovascular assessment procedures, such as measuring oxygen consumption, cardiac output, blood pressure, and other physiological measurements before, during, and after the initiation of an exercise program; and (c) consulting with other exercise physiology professionals about guidance and counsel of athletes and their training.  Exercise physiology has direct care opportunities with helping and caring for clients of all ages.  It includes helping teenagers with overeating problems to helping older people design fitness problems in homes, community agencies, and throughout society.  The ASEP Standards of Professional Practice [2] outlines in detail the responsibilities for which exercise physiologists are accountable.  Aside from providing direction for professional exercise physiology practice, the standards are linked to the ASEP board certification for exercise physiologists.  The connection is a major step on behalf of ASEP to demonstrate to the public and other healthcare professionals that, as the professional organization of exercise physiologists, the “standards” represent the profession’s accountability and care to the public and the client outcomes.  Career Opportunities To ensure that the client’s outcomes are what they should be, exercise physiologists assume several different but related roles.  From communicating intellectual information that the client needs to know to reshaping his or her lifestyle to setting specific goals and objectives for clients, exercise physiologists provide emotional and psychological support while clients acquire new lifestyle attitudes and behaviors.  Regardless of the setting, exercise physiologists are professionals who are educated to ensure that clients are supported by board certified healthcare professionals.  The following is a brief list of expanded career roles for the ASEP board certified exercise physiologists:  General Health Practitioner  An exercise physiologist who has an undergraduate degree in exercise physiology or who is board certified by ASEP to practice exercise physiology across the spectrum of healthcare issues and concerns.  Gerontologist  An exercise physiologist who has advanced study in the physiology of aging or is considered an expert in gerontology provides client care, education, and directsupport (including research) of client issues that associate with aging.  Fitness Development  An exercise physiologist who investigates ways and means to increasing the strength,   flexibility, and endurance capacity of athletics is considered to be an expert in fitness.  Sport Nutritionist  An exercise physiologist who has an educational and/or research in nutrition and sports performance.  Cardiac Rehabilitation  An exercise physiologist who has expertise in the rehabilitation of patients in hospital and/or university based cardiopulmonary rehabilitation programs.  The exercise physiologist supervises stress testing procedures, develops exercise prescriptions, and oversees the patients’ rehabilitation.  Researcher Exercise physiologists who have special training in research design, data collection procedures, statistical analysis techniques, and writing scientific articles for publication are the backbone to the continued development of the exercise physiology body of knowledge.  They work primarily in academic institutions, research facilities, and other settings that encourage the investigation of exercise physiology to further improve the care of clients and to continue to refine and expand exercise physiology as a healthcare profession.  Administrator  The exercise physiology-administrator is primarily the director or chair of academic departments or a person who has a middle management position as a supervisor or director of a cardiac rehabilitation program, research center, or a cardiovascular consultant office.  Educator  Exercise physiology-educators are employed in exercise physiology programs, in   educational institutions where exercise physiology is taught as part of other programs, and other settings where education is part of the client’s recovery (as in cardiac rehabilitation, diabetic centers, obesity settings, neuromuscular rehab centers).  Entrepreneur  An exercise physiologist with expertise in promoting exercise physiology via education, consultation, and/or research programs.  Anatomy Specialist  An exercise physiologist who has advanced training or expertise in functional anatomy provides direct client care (e.g., musculoskeletal dysfunctions), educates others about sound mechanics, flexibility, and muscular development, and consults with athletes to improve performance, and conducts research to better understand the role of the muscular system in promoting well-being. Professionalization of Exercise Physiology  Importance of ASEP. Exercise physiology is gaining recognition as a healthcare profession.  This doesn’t mean that exercise physiology is a profession equal to other healthcare professions at the present time.  It is still evolving as a profession.  There isn’t any question that exercise physiologists have increasingly expanded their career roles, such as those highlighted above that allow for greater independence and autonomy.  There is still a lot of work to be done. Aside from the specialized body of knowledge that is exercise physiology, the community of exercise physiologists has yet to fully embrace the need for change.  It is just a matter of time, however.  ASEP is believed to be the new exercise physiology of the 21st century.  It was born out of the perceived ineffectual relationship with other organizations that prevented exercise physiology from developing as a profession.  To continue without an organization designed exclusively for exercise physiologists would have been foolish.  Therefore, the general consensus is that other organizations should step aside from their interests in exercise physiology to allow ASEP to receive the attention it deserves and the support it needs to complete its vision.  In time, ASEP will be recognized as a “first-tier” professional organization whereby its members will respect and promote the inherent values of the ASEP vision, goals, and objectives.  The ability of the organizational leadership will be recognized in the support of the expanded career roles throughout government, nonprofit and private sectors.  Students will graduate into leadership positions with hands-on experiences and an educational reputation that is recognized as credible and accountable to the public.  ASEP members will demonstrate an unwavering commitment to quality, professionalism, and improvement in their practice of exercise physiology.  The different boards (e.g., accreditation, certification, and licensure) will establish a close working partnership with the ASEP Board of Directors to improve, monitor, educate, and oversee the professionalism of exercise physiologists.  Where appropriate and as funding permits, ASEP and its various administrative arms will represent a powerful opportunity to set educational initiatives and priorities, target special areas of the population with healthcare concerns, and maintain accountability.  ASEP  sponsored research should generate information to drive the path toward professionalism.  The anticipated changes represent the professionalism that associates with professional  character and spirit of the 21st century exercise physiologist.  Professionalism takes time along a specific course that ultimately drives the commitment and accountability of an emerging profession.  The process that ASEP is both experiencing and creating is the professionalization of exercise physiology.  This acquiring of a professional attitude and everything that goes into becoming a professional (and thus a profession) is time-consuming and hard work.  In some respects, it never stops since there are always reasons for modifying and/or updating facets of a profession at any point in time.  To do so, however, requires an understanding of the criteria of a profession: (a) professional organization; (b) code of ethics; (c) service oriented; (d) autonomy; (e) ongoing research; (f) body of knowledge; and (g) specialized education.  Professional Organization The most important fact is that a profession (such as exercise physiology) must operate from its own professional organization (like the American Society of Exercise Physiologists).  This is true for nursing, physical therapy, occupational therapy, and other professions.  Members of the professional organizations define and maintain standards and accountability of the profession.  Code of Ethics  Professional accountability is linked to a professional code that defines what is right behavior and conduct.  Service Oriented  Exercise physiology is a healthcare profession.  The members are driven to serve the public.  The profession is not a driven by profit.  This is an important distinction between professions.  Autonomy and Self-Regulation Professions are autonomous if the regulate what they do and set standards for the application of their knowledge.  Exercise physiology has made significant strides towards providing autonomy to its members, but certainly more must be done.  Licensure is still a major hurdle.  And, yet it is imperative if the scope of the exercise physiology practice is to function in a responsible and autonomous manner.  Ongoing Research  Research is the backbone of exercise physiology.  It has always been at the forefront of what exercise physiologists do.  Research is carried out across many aspects of people’s lives, including sports performance, lifestyle risk factors, cardiac rehabilitation, and many other areas of interest and concern to the public.  Most research is done by doctorate prepared professions in university settings.  The research is presented at national meetings.  Subsequently, it is published in scientific journals (both print copy and electronic).  More non-doctorate prepared exercise physiologists need to do research in their areas of expertise.  If it is not considered part of their employment responsibility, it should be.  Body of Knowledge Exercise physiology has its own body of knowledge that is driven by research in a variety of areas.  Exercise physiologists are primarily responsible for the body of knowledge that defines exercise physiology.  The knowledge is acquired in academic settings.  Students study courses such as exercise physiology, sports nutrition, psychophysiology, kinesiology, cardiac rehabilitation, sports biomechanics, exercise physiology research design and statistical application, physiological assessment, cardiovascular physiology, and stress testing procedures.  Collectively, these courses make up the exercise physiology undergraduate degree.  With more advanced study of each of these courses and more (such as the physiology of aging, physiology of women training, exercise biochemistry, professional development of exercise physiology, functional (cadaver) anatomy and others), the student acquires an understanding of the body of knowledge that defines exercise physiology.  Specialized Education  The education that exercise physiologists get is highly specific to health, wellness, fitness, rehabilitation, and athletics.  Each is important to the total understanding of how stress influences the mind and body, how wellness is developed and maintained, the role of systematic exercise in keeping structures and functions of body strong, the use of rehabilitation procedures (including stress testing protocols) to prescribe exercise for heart patients and other medical conditions, and how athletics is enhanced through research by exercise physiologists.  Today baccalaureate exercise physiology programs are located in 4-year colleges and universities.  The ASEP Board of Accreditation has accredited six programs of study.  In addition to courses in liberal arts, basic sciences, and humanities, the curricula prepare students to sit for the ASEP board certification exam. Socialization to Exercise Physiology  The process by which exercise physiologists learn to become members of ASEP and understand the role of ASEP in developing standards is defined as socialization.  It is all about accepting who is an exercise physiologist, the value of a code of ethics, and learning to act as an exercise physiologist.  The fact that our history is linked to sports medicine doesn’t help a lot.  Those who still believe that sports medicine is future of exercise physiology do not behave or feel in a manner consistent with the ASEP perspective.  The goal is to have all exercise physiologists belong to ASEP as the professional society of exercise physiologists.  Increased participation will help to facilitate professional networking and interaction among exercise physiologists at different academic degree levels.  The gatekeepers, the university teachers, need to support the socialization process whereby students are encouraged to join ASEP and contribute to its different kinds of activities.  Summary Remarks  Clearly, the emergence of the profession of exercise physiology lies in the hearts and minds of the ASEP members.  The problem is that too many non-ASEP members are holding back with a “wait and see” attitude.  They need to join ASEP and help establish a profession of exercise physiology.   Similarly, the solution to our students’ problems is to get involved with ASEP and the path towards professionalism.  Those who have graduated (e.g., the master prepared professionals in the field) need to stop supporting non-exercise physiology organizations and get on board with ASEP.  Their help, support, and networking are critical to the socialization process.  Lastly, with working together, we will see the process of professionalization continue as expected to increase the internalization of our professional values.    References  1. American Society of Exercise Physiologist. (2003). ASEP home page. [Online]. http://www.asep.org/  2. American Society of Exercise Physiologists. (2003). ASEP Board of Certification  Standards of Professional Practice. [Online].  http://www.css.edu/ASEP/StandardsofProfessionalPractice.html   Note:  This chapter was originally published in the Journal of Professional Exercise Physiology, Vol 1 No 2 September 2003.  Permission has been granted to republished the article in The ASEP's Study Guide.