Boundary Issues in Exercise Physiology
Larry Birnbaum, PhD, FASEP, EPC
Associate Professor
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN  55811

Exercise physiology is a relatively new addition to the health science professions.  It is so new that it is still largely unrecognized as such.  This is both a problem and an opportunity.  It is a problem because too many employers are not aware of the capabilities of certified (EPC) exercise physiologists.  It is an opportunity to the extent that exercise physiologists tap into the many markets available to them.  This requires initiative, confidence, and some degree of entrepreneurialship.  It also requires recognition of professional limitations or boundaries.  There are some tasks we cannot perform because other professions have claimed them as an exclusive part of their practice through licensure and/or because we lack the education and training to perform them.  Still the boundaries for exercise physiology are quite expansive at this time.  Unfortunately, these boundaries are likely to close in upon us if we do not take control of our own profession.  If we do nothing and wait for others to do the grunt work necessary to establish exercise physiology as a respected profession, we will lose the opportunity.  Other health science professions will claim the markets currently available to us. 

So, what can we do and what can’t we do?  We cannot give shots.  That’s an exclusive responsibility of physicians and nurses.  We cannot prescribe pharmaceuticals but we can prescribe exercise.  Indeed, we are the ultimate health science professionals for prescribing exercise to several different populations.  Those populations comprise some of our markets.  We can work with children (i.e., pediatrics) who are lethargic and/or obese to improve their well-being and reduce the risk of future diseases and disorders such as diabetes, heart disease, cancer, and musculoskeletal problems.  We can target adult populations who are also at risk for these chronic disorders.  Of course, a strong educational component is essential to help them understand why exercise is so important and to help motivate them appropriately.  Individuals who want to lose weight and maintain a target weight can benefit from the expertise of exercise physiologists.  Exercise physiologists can help keep elderly persons out of nursing homes or at least delay entry into such facilities with proper strength training, aerobic exercise, and stretching exercises.  Once in nursing homes, we can improve the quality of life for residents using similar protocols.  Care providers in nursing homes will also benefit as residents will be easier to transport.  In a nutshell, intervention by exercise physiologists at just about any stage in life will reduce future medical expenditures.

However, we do have limitations.  We cannot provide all the care the aforementioned populations require.  We must collaborate with physicians, nurses, physical and occupational therapists to best serve the client’s interests.  As part of the collaborative effort, we need to recognize when the client needs to see another health care professional (i.e., know thy limits).  For example, if the client injures her shoulder or knee, she needs to see a physician and possibly a physical therapist.  While we prescribe exercise for improving and maintaining health, physical therapists prescribe specific exercises for rehabilitation of an injured joint. 

If we are working in a home health care setting, more than likely a home health care nurse is working with the same clients.  It is essential that we communicate with that nurse to assure appropriate care for our clients without duplication of services.  Similarly, if any client is restricted in performance of daily activities due to chronic disease or a permanent injury (e.g., stroke), an occupational therapist (OT) may be working with that client.  It is imperative that we work with the OT to maximize benefit to that client.  We must have a clear and accurate perception of our role relative to other health care providers. 

It would certainly be easier for all exercise physiologists to know what they can and cannot do if the field had achieved the same professional status as other health care fields such as nursing.  That is, if all educational programs were accredited by one national accrediting agency and all exercise physiologists had to pass the same national certification exam, professional responsibilities would be standardized.  Employers and third party payers would know what services exercise physiologists can provide to a diverse population of clients.  This is precisely what we need to accomplish to attain professional status.  We cannot accomplish this by exercise physiologists working individually.  It has to be an organized and collective effort.  If you share this vision, ASEP is your professional organization [1].  But you cannot just join and watch the world pass by.  You have to contribute your time and talent to the effort. 

References

1.  http://asep.org