Professionalization of Exercise
Physiology: Images, Issues, and Trends
Tommy Boone
Professor and Chair
Director, Exercise Physiology Laboratories
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811
Introduction
It seems ironic that it has taken
so long to think of exercise physiology as a profession. Exercise
physiologists have been among the best thinkers about health and fitness
and, in particular, the benefits of exercise. Their work appears
in scholarly journals throughout the sciences. They encourage lifestyle
changes like other healthcare professionals [1]. University professors
teach their students about risk factors for heart disease and other lifestyle
disabilities. They have a professional identity with wellness and
muscular strength development programs, and they increasingly have become
more involved in a variety of healthcare initiatives.
The question why exercise physiology
is not a recognized profession with licensure deserves an answer.
Part of the problem is directly related to the lack of support from university
teachers. They are the gatekeepers to the new exercise physiology
paradigm [2]. Why they continue to be committed to sports medicine more
so than exercise physiology is as yet an unanswered question. Most
ASEP members believe it is just a matter of time. Eventually, all
exercise physiologists will come to think of exercise physiology from the
21st century perspective. They will recognize that self-regulation
and controlling one’s own practice are critical to professional development
and autonomy [3]. But, of course, what is the “practice” of exercise
physiology? How do exercise physiologists work in an integrated healthcare
environment? Answers to these questions are still pending.
More work is required of all exercise physiologists if we are to come to
a full and complete agreement about who we are and what we do as healthcare
professionals.
In short, a complete philosophy of
exercise physiology doesn’t exist. There is the understanding that
exercise physiologists aren’t going away. Their specialized knowledge
and understanding of the meaning of exercise as therapy in healthcare settings
have earned their place in scholarly journals. In fact, their research
is particularly relevant to matters pertaining to fitness, wellness, rehabilitation,
and athletics. The problem is that most students and still
a good number of university teachers know relatively little about what
constitutes a “profession,” or what is “professionalism,” and “professionalization”
(i.e., the continued work that goes into professional development).
A profession is generally defined
as an occupation of members who create and use their research and special
knowledge to solve problems at the individual level or at the public sector
level [4]. Mixed with this understanding that creates distinction
among different healthcare professionals is the special status of trustworthiness
and devotion to society’s needs [5]. When members act as professionals
and commit themselves to their work and the importance of self-regulation,
they practice the art and science of professionalism [6]. This dynamic
process sets the stage for advancing the ideology of professionalism; a
process that represents the constant continuation of work towards the goal
of professionalism (meaning, a process that defines professionalization)
[7].
To understand the extent to which
exercise physiology, like other occupations, has moved along the continuum
of professionalization to being a profession, all one has to do is compare
Flexner’s [8] six characteristics of a profession to what exercise physiology
is today. For example, is exercise physiology intellectual,
having an ethical and legal responsibility to clients? Is it based
on a body of knowledge? Is it practical? Is it taught in an
academic setting? Is it organized, and is it motivated by altruism?
The answer to each question is “yes”. Exercise physiology is a profession.
The question is: “What kind of profession is it?” The internal
structural within most academic programs of either kinesiology or exercise
science is generally an education and practice of what has evolved as the
profession of exercise physiology.
Exercise Physiology in the United
States
Before the founding of the American
Society of Exercise Physiology (ASEP) in the United States, the only recognized
exercise physiologists by title were individuals with a PhD degree.
In general, they taught exercise physiology in university academic departments
such as physical education, kinesiology, or sports science to mention a
few. The believed that research paved the way to scholarship and
recognition and, thus they were willing (and required) to carry out research
projects that involved exercise and almost every conceivable aspect of
sports training. About the same time period, others interested in
the psychology of sports developed their own in-roads into organizational
support and research. They became known as sports psychologists;
whereas, those who more inclined to apply physics to their athletic analysis
developed biomechanical societies, professional meetings, and published
their own scientific journals (hence, the sports biomechanist). Interestingly,
those who were more interested in the anatomical side of physical education,
athletics, and sports developed their own emphasis groups with kinesiologists.
While some members of each continued a strong relationship with the historical
elements of physical education, most embraced sports medicine as the primary
research outlet for expression.
At the end of several decades of
sports medicine leadership, a general nationwide view surfaced with the
understanding that exercise physiologists needed their own organization.
This was the view of some academic exercise physiologists and many non-PhD
clinically oriented exercise physiologists. Here again, though, the
use of the title “exercise physiologists” for most individuals who use
it do so incorrectly. This was the basis, among other important objectives,
to establish a new way to become an exercise physiologist. The doctorate
degree was believed to no longer be the deciding factor for who is and
is not an exercise physiologist. The time had arrived also that the
sports medicine interpretation of non-doctorate “exercise physiologists”
were something other than what they wanted to be, that is, an exercise
specialist. To be a “specialist” in the area of exercise was viewed
as similar to being an assistant, perhaps, like a dental assistant or a
physical therapy assistant.
In the last decade of the 20th century
exercise physiologists in the United States began to gain control of their
profession. By 1997 the first American organization for the professional
development of exercise physiology was founded. With the founding
of the American Society of Exercise Physiologists (ASEP), exercise physiologists
had at their disposal the first opportunity, as members of their own professional
organization, to begin the huge development of their profession.
As a result, exercise physiologists can now get involved in the accreditation
of the undergraduate university programs of study, and board certification
that produces the exercise physiologists’ professional title. In
a reasonable period of time, the ASEP Board of Directors expects that exercise
physiologists will be licensed like other healthcare professionals as the
legal case for licensure is developed. As leaders in health, fitness,
rehabilitation, and athletics, exercise physiologists will increasingly
be recognized for their scientific and hands-on “laboratory” knowledge.
Recognizing the significant strides
made by the American Society of Exercise Physiologists (ASEP) to professionalize
exercise physiology, “knowledge” is at the heart of the criteria of professions.
Knowledge sets the foundation for all professional associations with a
distinctive mission to demonstrate explicit or implicit codes of behavior.
Members have become convinced of their participation in the changing behaviors
that define the new evolving profession through improving its educational
programs. Collectively, they become concerned with credentialing
and, therefore, the opportunity to demonstrate before the public their
professional accountability [9] through accreditation, certification, and
licensure is important. This kind of thinking is significantly different
from the sports medicine model of fitness professionals. Another
outcome of the new exercise physiology paradigm is the board certification
for the exercise physiologist that is directly linked to the exercise physiology
professional title. ASEP is the driving force behind the evolution
of exercise physiology from its physical education beginning to its development
as a unique and dynamic healthcare profession. This is happening,
despite a myriad of obstacles, so that ASEP members can render care through
the application of their specialized body of knowledge to others.
Images of Exercise Physiology
When students are asked to imagine
an exercise physiologist in the public sector, most have difficulty describing
what they are and what they do. This is unfortunate, but it is the
result of evolutionary steps towards a clearer mental picture and, in particular,
the “new” image of the non-doctorate exercise physiologist. Most
indications are that students first think of “fitness” types of jobs.
Although important, the fitness professional image in itself is an out-dated
definition and expectation of exercise physiologists. The new image
of exercise physiologists has been shaped and suggested with new strategies
by ASEP and the professional documents that define it. An accredited,
professionally oriented academic program of study now defines the professional
image of exercise physiologists. No longer is the non-doctorate prepared
exercise physiologist defined by a technician-oriented program. Examples
from the ASEP web pages are illustrated in the “six” ASEP-accredited university
programs [10]. Added to this extremely important work on behalf of
the Board of Accreditation is the multifaceted collage of work and effort
across the spectrum of professional issues, concerns, and management of
exercise physiology.
Clearly, the new and involving image
of exercise physiology is critical to expanded career opportunities, professional
credibility, and financial stability. Exercise physiologists represent
multi-dimensional aspects of healthcare and, in time, they will be viewed
as critical healthcare professionals alongside physical therapy, occupational
therapy, and nursing. The king of exercise, as an important component
of healthcare, is the exercise physiologist. The professional title
is already recognized, but will increase dramatically as the gatekeepers
(i.e., university teachers) commit to the new architecture of the ASEP-accredited-based
schools of exercise physiology. It is simply a matter of time whereby
university teachers will understand the ASEP effort to establish its self-image
and public image as a profession with autonomy versus a discipline under
the mentoring of sports medicine.
Exercise Physiology as Academic
Departments
Can you imagine at some point in
the future that exercise physiologists will teach exercise physiology from
within their own academic departments? Can you imagine students going
to college because of their “calling” to be part of the new healthcare
profession, exercise physiology? Can you imagine 10 years from now
that exercise is so much recognized as a central value to healthcare that
exercise physiologists will be sought after professionals? Can you
imagine a “building” designed like nurses or physical therapists have for
their students? Can you imagine such a building? To place your
mental pictures in today’s context, there are a few (probably less than
5) Departments of Exercise Physiology. The exact number is
hard to know. One set of data and perspective was published in PEPonline.
After randomly selecting colleges and universities from the Internet, there
was only “one” college with a Department of Exercise Physiology [11].
This finding bears out the continued impact of the presence of physical
education (regardless of the various name changes). It also highlights
the overall lack of leadership within exercise physiology between 1960
and 1980. This doesn’t mean that the exercise physiologists for the
past 20 to 30 years have not engaged in many leadership roles, obviously
they have. The importance of their work primarily in the research
of exercise physiology, from health through athletics, has been dramatic.
Excellent research commands respect in the areas of research, but research
per se is not the central component of leadership matters.
Can you imagine where exercise physiology
would be today if it had the kind of leadership physical therapists have
had for decades? Can you imagine a School of Exercise Physiology
if exercise physiologists created the opportunity 20 years ago to lead
themselves from a technical level of thinking to that of a strategically
important healthcare professional? Can you imagine if a think tank
of exercise physiologists had existed 30 years ago where the field would
be today? Against this backdrop of images, the professional image
of exercise physiology exists. The reason for the existence of the
image is to ensure the right thinking and beliefs in exercise physiology
and the values that associate with it. Another reason is proximity
of exercise physiologists to the fundamental lifestyle and aging issues
that have professional and economic factors of importance, and why not?
Exercise is medicine [1]. However, unlike most other healthcare professionals,
exercise physiologists are not licensed. Nurses work for a hospital,
like physical therapists, speech therapist, and others. Physicians
are independent contractors to a hospital. They generate revenue
for hospitals. Nurses and exercise physiologists do not, although
nurses are obviously more secure as employees than are exercise physiologists.
Imagine a point in the future where exercise physiologists will carry out
their duties in accordance with specific standards of professional practice.
Imagine that changes taking place today in exercise physiology are no different
from changes that were set in motion decades ago in other healthcare professionals.
Imagine a profession of exercise physiology with ongoing educational and
research opportunities in all facets that impact health and living.
The Future of Exercise Physiology
Little is know about the future
and most things are not a sure bet. Exercise physiology is different,
however. Its path towards professionalism is secure, its direction
is clear, and its motives are right. All are a result of thinking
right about exercise physiology and the benefits to the public sector.
Today, students are stepping up to the plate and taking charge of their
education and their membership. They are joining ASEP to become part
of its success. They want the “hot” seat at the head of table to
discuss the opportunities available to students. They want to share
the idea of professional autonomy among other healthcare professionals.
And, so it is a matter of time when gym shorts and jogging shoes will be
put aside for a professional look that conveys an impeccable understanding
and application of knowledge to better living. This initiative to
look for ways to bring our knowledge to the public sector is part of the
paradigm shift and future of exercise physiology. Academic exercise
physiologists can no longer stay in their offices and write research articles
that will be read by just a few hundred other exercise physiologists.
They need to get involved in the application of exercise physiology concepts
and ideas to the “real” world. In other words, it is about seizing
the moment. Once this connection with the public is made, increased
internship training and employment opportunities will enhance the image
of exercise physiology.
By thinking out of the box [12],
and looking at new and interesting ways to bring exercise physiology to
the public, individuals who look to exercise as medicine will seek treatment
from exercise physiologists. Hence, when the public is challenged
with questions and concerns about health, fitness, the role of exercise
in rehabilitation, and the application of mind-body science to athletics,
exercise physiologists are expecting that they will talk to someone who
has the answers. In view of this thinking, ASEP is the single national
forum to coordinate and facilitate interactions among exercise physiologists
and the public. But, most importantly, for the future to be realized
in accordance with what has been said so far, the professional title, exercise
physiologist, must be reserved for ASEP board certified exercise physiologists.
Referring to anyone else as an exercise physiologist who is not ASEP board
certified undermines the profession. In the future, exercise physiologists
will not encourage or allow anyone to use their professional title.
For example, a person with an academic degree in physical education with
a concentration in exercise physiology, who is not ASEP board certified,
but nonetheless is a certified exercise specialist, is not an exercise
physiologist and will not use the title. Similarly, individuals who
work in health and fitness centers who otherwise refer to themselves as
exercise physiologists will not be allowed to do so.
Another major change that will take
place in the future is that sports medicine will no longer have anything
to say about exercise physiology. The ASEP initiatives will be fully
operative with powerful benefits to its members. Accreditation of
exercise physiology programs will be a standard practice throughout the
United States. In time, graduate programs will be accredited along
with new and different doctorate programs of exercise physiology as well.
The Doctor of Exercise Physiology (DEP) degree will define exercise physiology
as having important clinical and research implications [13]. In this
new view of exercise physiology as a healthcare profession, exercise physiologists
will believe in each other and work to support each other. Job opportunities
for non-doctorate prepared exercise physiologists will increase in number
and complexity. Practicing exercise physiologists will be something
new throughout the public sector with literally hundreds of professional
businesses set up to counsel, consult, education, and test a broad variety
of clients. The proliferation of career opportunities will be explosive
with increased recognition in almost all matters that pertain to the mind
and body interconnectedness.
The future of exercise physiology
is bright. Within the next decades, employment of professional exercise
physiology is expected to grow. The growth is directly related to
the exponential-like problems that associate with individuals living longer.
The increased number of health-related problems will require the knowledge
of professionals to help keep the majority from hospitals settings.
Exercise physiology will, therefore, become a vital component of the “treatment
setting” outside of the formal hospital setting. With this transition,
there will be increased savings to individuals who automatically will benefit
from regular exercise. It will be recognized as not just meaningful,
but vital to the fundamental daily procedures to increasing longevity without
hospitalization. In short, the 21st century exercise physiologist
will be involved in (a) technologically advanced methods of fitness assessment
and fitness development, (b) cardiovascular and health promotion, (c) physical
and psychological wellness, (d) training and/or rehabilitation of clients
with neuromuscular, respiratory, and/or cardiovascular problems, (e) study
and application of alternative and complementary medicine to a variety
of emotional and stress induced issues, and (f) research to better understand
the human condition (including athletics and sports training). Exercise
physiologists will have multiple opportunities for different career options.
After reading the ASEP definition of exercise physiology, it is left to
one’s imagination to discover the almost limitless possibilities for the
profession.
The Doctorate of Exercise Physiology:
Becoming What We Think
In the not too distant future, exercise
physiologists will have the opportunity to get a Doctorate of Exercise
Physiology (DEP) degree [13]. The research, educational, and clinical
oriented degree will provide a vital connection to the public sector in
much the same way as physical therapy has evolved from master-prepared
professionals to doctorate-prepared (Doctor of Physical Therapy, the DPT).
With the DEP, exercise physiologists will be accepted as having an autonomous
practice. Without the degree, exercise physiologists, especially
in the clinical realm, will remain less recognized and/or accepted.
With the DEP degree, exercise physiologists will be elevated to the healthcare
position without issues or concerns. Without the degree, the healthcare
community will keep its basic feelings about “who know what” – unless exercise
physiologists without the DEP become licensed professionals. With
the degree, there are a variety of career and/or professional opportunities
worth realizing and reason, therefore, to expect that (in a short time
period) the degree will become reality.
“We become what we think,
what we talk about, and what we do. If we think our work is for the
right reason, if we think that our actions will bring forth positive results,
and if we start living as professionals, we will become our vision.”
-- William T. Boone, Jr.
References
1. Boone, T. (2002). Exercise is
Therapy, Prevention, and Treatment: An Exercise Physiologist’s Perspective.
Professionalization
of Exercise Physiologyonline. Vol 5 No
3 [Online]. http://www.css.edu/users/tboone2/asep/ExerciseIsTherapy.html
2. Boone, T. (2003). The ASEP Organization
is a Paradigm Shift. Professionalization of Exercise Physiologyonline.
Vol 6 No 2 [Online]. http://www.css.edu/users/tboone2/asep/TheASEPparadigmShift.html
3. Boone, T. (2001). Accreditation
is Necessary for Accountability. Professionalization of Exercise Physiologyonline.
Vol 4 No 6 [Online]. http://www.css.edu/users/tboone2/asep/AccreditationEQUALSaccountability.html
4. Moore, W.E. (1970). The Professions:
Roles and Rules. New York, NY: Russell Sage Foundation, pp. 53-54.
5. Freidson, E. (1970). Profession
of Medicine. New York, NY: Dodd, Mead and Company, pp. 71-72.
6. Olesen, V.L. and Whittaker, E.W.
(1968). The Silent Dialogue. San Francisco, CA: Jossey-Bass, p.
185.
7. Vollmer, H.M. and Mills, D.L.
(1966). Professionalization. Englewood Cliffs, NJ: Prentice-Hall,
p. 2.
8. Flexner, A. (1915). Is Social
Work a Profession? In Proceedings of the National Conference
of Charities and Corrections. Chicago, IL: Hildermann Printing Company,
pp. 578-581.
9. Hinsvark, I. (1982). Credentialing
in Nursing. In L. Aiken (ed.). Nursing in the 1980s: Crises, Opportunities,
Challenges. Philadelphia, PA: J.B. Lippincott, p. 316.
10. American Society of Exercise
Physiologists. (2003). Exercise Physiology “Accredited” Academic Programs
in the United States. [Online]. http://www.css.edu/users/tboone2/asep/accreditedINSTITUTIONS.html
11. Boone, T. (2000). Undergraduate
Programs in Exercise Science / Exercise Physiology: Issues and Concerns.
Professionalization
of Exercise Physiologyonline.
Vol 3 No
11 [Online]. http://www.css.edu/users/tboone2/asep/UndergraduateProgramsExerciseScience.doc
12. Boone, T. (2002). Exercise Physiology
of the Future: Thinking Out of the Box. Professionalization of Exercise
Physiologyonline. Vol 5 No 11 [Online].
http://www.css.edu/users/tboone2/asep/ThinkingOutsideTheBoxExercisePhysiology.html
13. Boone, T. (2003). Doctorate
of Exercise Physiology: An Excellent Idea or Is It? Professionalization
of Exercise Physiologyonline. Vol 6 No
3 [Online]. http://www.css.edu/users/tboone2/asep/DoctorOfExercisePhysiology.html