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An Internet
Electronic Journal Dedicated to
Exercise Physiology
as a Healthcare Profession
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Fundamentals of Exercise Physiology
Professionalism
Tommy Boone
Professor and Chair
Director, Exercise Physiology Laboratories
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811
“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, Jr.
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 as exercise
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:
Exercise Physiology-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.
Exercise Physiology-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 direct support (including
research) of client issues that associate with aging.
Exercise Physiology-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.
Exercise Physiology-Sport Nutrition
An exercise physiologist who has
an educational and/or research in nutrition and sports performance.
Exercise Physiology-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.
Exercise Physiology-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.
Exercise Physiology-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.
Exercise Physiology-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).
Exercise Physiology-Entrepreneur
An exercise physiologist with expertise
in promoting exercise physiology via education, consultation, and/or research
programs.
Exercise Physiology-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
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