Something Has to Change
Tommy Boone, PhD, MPH, MAM, MBA Board Certified Exercise Physiologist
Professor, Department of Exercise Physiologist The College of St. Scholastica
Duluth, MN 55811
hile research has occupied the minds of many doctorate prepared exercise physiologists, that is not the case with non-doctorate college graduates who often refer to themselves as exercise physiologists. More often than not, they majored in exercise science. Given that this degree is frequently a track for pre-professional careers, they students are challenged to find meaningful employment if they are not accepted in, for example, physical therapy. Those who do find employment struggle with the pay and benefits that associate with fitness jobs. Even working in cardiac rehabilitation isn’t everything it has been made out to be.
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Given that the exercise science curriculum isn’t much different from the physical education, inadequate academic preparation throughout the kinesiology departments has limited career opportunities in healthcare. Another problem is that the exercise science student thinks he/she is actually engaged in an exercise physiology curriculum. This often results in the students referring to themselves as exercise physiologists. In fact, probably 90% of the time they aren’t what they say they are! So, in some ways, it is all too obvious to the employers that they can pay whatever they want to pay to the non-exercise physiology employee. After all, such a person isn’t a board certified exercise physiologists, and isn’t aware of even the importance of a code of ethics, professionalism, and a standards
Journal of Professional Exercise Physiology
ISSN 1550-963X
of practice. Not that these factors are complex, rather they aren’t taught to exercise science and/or kinesiology students.
For Ives and Knudson [1] to present the exercise science “need for greater disciplinary balance” as a problem driven (in part) by the American Society of Exercise Physiologists (ASEP) makes very little sense. The problem exists 100% within the failed philosophy of what is known as kinesiology and related degree programs. The ASEP leaders require one course in biomechanics because they believe the exercise physiology “major” should consist primarily of the physiological sciences. This has been made clear in the ASEP accreditation [2] and scope of practice guidelines [3], none of which was written to embellish the exercise science curriculum.
The coming together of exercise physiology faculty members, an integral part of the change process, would provide not only the opportunity to deliver a better education for the students, but also to rise above the 20th century narrow focus and limited career perspective of the American College of Sports Medicine (ACSM). Such thinking has kept exercise science faculty (including academic exercise physiologists) decades behind other college degrees. Appreciate that the discussion throughout this article is about exercise science, but at its core is the discussion of an academic and faculty partnership to build exercise physiology as a healthcare profession. It is not about more sports medicine certifications. Honestly, does anyone believe that the majority of the students have been helped by the decades of exercise science certifications? If they were important, why aren’t administered by an exercise science professional organization? The fact is they are administered by ACSM, which is a generic sports medicine and exercise science organization. The ACSM organization does not represent the scope or depth of the exercise physiology course content or hands-on laboratory skills that exercise physiology majors need. The required knowledge base for exercise physiology is defined by the ASEP organization [4].
best interests of the exercise science major. The ASEP leaders are doing the same for what they believe is exercise physiology. What’s more, from the ASEP perspective, exercise science and related degree programs should be updated to exercise physiology [5-7]. There is simply too much confusion with the several dozen or so undergraduate degree titles, and it is simply unrealistic to think that the curriculum of each degree program is that of an exercise physiology major [8] (e.g., exercise physiology (with a lab), kinesiology (with a lab), sports nutrition, psychophysiology of health and exercise (with a lab), physiological assessment (with a lab), cardiopulmonary rehabilitation/graded exercise tests, biomechanics, exercise electrocardiography (with a lab), advanced exercise physiology (with a lab), exercise physiology research (with a lab), and exercise physiology statistics.
One challenge for academics, as they dust off their decades of research and failure to think about professionalism, professional development, and credibility of the exercise physiology major is that exercise physiology isn’t just about teaching the exercise physiology course. It is about the undergraduate students and their challenges to navigate the uncharted waters of finding a career after college. College teachers, chairs, deans, and other administrators are responsible for informing the students of the true reality of the academic product of which they are purchasing (and earning) as a direct result of studying and passing tests. It is simply unethical if not illegal to continue with the suggestion that the curriculum for exercise science is identical to exercise physiology. While exercise physiology courses provide a scientific foundation for the exercise science major, the converse is not true for exercise physiology.
that the problem is directly a result of a limited curricular focus that moves the exercise scientists away from the semiprofessional status of education and allied health [1], the problem is there are no “exercise scientists.” That is simply an illusion. There are no exercise science career opportunities of any significance for 99% of the college graduates.
Does anyone believe that attending law school or medical school would be as popular as they are if in fact upon graduation there were no jobs, no career opportunities to grow, and no successful as a person or as a professional? Of course not, so why is it accepted in exercise science? Why is there the absolute failure of trust between the faculty and the students? Why isn’t there a clear communication of what is what? Why aren’t the administrators doing something about delineating the issues and concerns that face the degree and the students? The need for assessment of where things with wrong, why it is continuing, and how to identify a better future is great in exercise science. A mutual awareness of “what is” versus “what should be” when it comes the department’s mission and goals is likely to help create a successful future for students.
Exercise physiologists as college faculty and everyone else who is part of exercise physiology in the public sector must take on the challenge of creating and sustaining the profession of exercise physiology. Building professionalism into the learning environment is critical to career opportunities and partnerships with other health professions. But, first, understand that exercise physiologists are at the crossroads of becoming either a personal trainer or an exercise physiology healthcare professional. They are not the same, but neither the public nor those in academia seem to realize this distinction. Second, the world’s transition from the industrial age to the information age cannot be safely helped by personal trainers. Healthcare is complex and engaging, calling for changes in academia. The skills, knowledge, and experiences of the exercise physiologist are significantly more advanced than the qualifications (i.e., if there are any) for a personal trainer.
bottom line is that parents are not going to allow their children to continue to attend college at the cost of tuition today, much less in the future, to major in a degree that does not set the stage for a credible career, financial stability, or respect. Indeed, if exercise physiologists don’t step up to the plate, their meat and potatoes, “exercise is medicine” in particular will be incorporated into other professional areas (such as physical therapy, medicine, and nursing). This, too, will create problems for the profession of exercise physiology.
More than ever before, college teachers – and the public – must learn that exercise physiology is a distinct, unique body of knowledge that is a scientifically founded profession with its own code of conduct/ethics and scope of practice. Ethical underpinnings and the actions that ought to accompany college teaching have too often been tossed aside. The cynical twist of this failure to do the right thing has often been directly linked to the decades of contact and support of the American College of Sports Medicine (ACSM). College teachers find themselves caught in the crossfire of abiding by decisions that are consistent with behavior more of a lobbyist for ACSM than for the right education of their students. Hence, without control over the academic resources, those who could (and should) drive the change process are often in the difficult position of having to stay the course. Year after year they tell their seniors, “You can get a job in cardiac rehab, fitness centers, and research.” The problem is that the job opportunities are made worse by the obvious willingness of employers to hire individuals with little to no education but otherwise look the part with a weekend-warrior certification.
prescription. This distinction is a professional one, driven by necessity and the purpose of professionalism to benefit society and to do so safely.
The role of the board certified exercise physiologist belongs to the general class of healthcare professionals, including health educators, physical therapists, nurses, physician assistants, and physicians. As healthcare professionals, isn’t it inevitable that the exercise physiology educator is responsible for the context of professionalism in exercise physiology as well as its goal to make exercise physiologists the professionals of choice for prescribing exercise as medicine? Because of the scientific complexity and subtlety of the health-oriented application to mind-body medicine, it is difficult to see how the college teachers can continue doing the same thing year-after-year (i.e., research and more research without regard to other concerns and/or objectives). And yet, for decades they have done just that – research, more research, publish, more publishing, and attend meetings after meetings while their students end up as losers! Exercise as medicine and the high technical competence that it implies argues strongly for credible professionals, such as the ASEP board certified exercise physiologists. Under no circumstances does one expect the personal trainer or fitness instructor to have better knowledge about exercise physiology than the exercise physiologist. What about the physical therapist? The American Physical Therapy Association’s “Vision 2020” states that one goal is to make physical therapists the professionals of choice for wellness interventions [14].
The point here is this: There a moral context and connotation to teaching? It should go without saying that teaching is almost always about the students or at least it should be. It is noteworthy that today’s exercise science teachers continue to commit to keeping things as they have been. Understandably, they are getting the message that their college graduates are being replaced in the job market by graduates from the established healthcare professions. While this is unsettling, they also understand the decades-old certifications are essentially meaningless in the public sector. Even the graduates who refer to themselves incorrectly as exercise physiologists fail to secure position and/or salary that nurses and/or physical therapists get. The low salaries and lack of person and professional recognition are a problem, but who is listening? The short answer is “no one.”
As originally conceived, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) is a complete failure. It is a nursing organization. There is some indication that this will always be the case with any organization (such as the Clinical Exercise Physiology Association, CEPA) that tries to address the specificity of exercise physiologists as so-called “clinical exercise physiologists.” Why, because it is intuitive that exercise physiology is more than just clinical, as the sports medicine thinking has argued for decades. In fact, the ASEP leadership [15] believes that, “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 of athletes and others interested in athletics, sports training, and human adaptability to acute and chronic exercise.”
ideas and possibilities aren’t good for students or the profession, especially since it encourages academic and technical incompetence. It is here that the failed role of the academic community of exercise physiology faculty continues to articulate an imbalance between the academic degree and the students’ career opportunities. Once again, new thinking is needed. That is exactly what the ASEP leadership has done. Their sense of duty has led them to new patterns of thought and caring for students and exercise physiology. However challenging it is and despite the ongoing efforts by sports medicine and exercise science organizations and educational programs, they continue to resist the temptation to listen to evidence or opinion that confirms traditional thinking.
In a nutshell, it is more than reasonable to argue that the ASEP leaders have done only what should have been done decades ago. For example, they developed an inspiring vision and aligned it with the professionally strategic steps (e.g., code of ethics, accreditation, and certification) to launch the first-ever professional organization of exercise physiologists. They took time to envision the future of exercise physiology from the board certified exercise physiologist’s perspective. All they have ever asked of colleagues is to “have a little faith in them.” Collective, we can make a difference in the quality of career opportunities for students… [17].
Leaders in the profession must embrace the thinking that change is possible, and that they can become what they want to simply by doing whatever it takes to get there. By thinking positive, and by believing that they have the right to their own thinking and their own ASEP profession, they will succeed and improve their ability to make things happen. What is needed therefore is a new way of thinking and feeling about exercise physiology, if not an emotional rebirth to separate from the inertia of yesterday’s thinking.
the future.” Why not give change a try and embrace the ASEP organization? Why not reward those who are passionate about exercise physiology? Why not update exercise science to an ASEP accredited exercise physiology major? Why not become an ASEP transformational leader and role model for change? Why not use your imagination and generate images of the future exercise physiologist as a healthcare professional versus a specialist or trainer? Why not believe that exercise physiologists can create their own destiny?
There are more questions, but consider for now a vision of the future. Every vision, whether it is an organization or a business helps the members and employees, respectively, to get excited about and to act on behalf of the future. Courage is everything, but not everyone is courageous. A good vision helps with the passion to succeed, to make things better, and to believe that things can be better. Part of every vision is a new way to think about change. That is why the ASEP leaders put in place a new and credible infrastructure; one design to support the professionalism of exercise physiology. It will take a lot of work and imagination to rethink exercise physiology, to get past the politics of exercise science and sports medicine, and to view the profession in healthcare terms and not in specialist or technician terms.
first-choice professionals for designing individualized exercise prescriptions for a diverse population.
In fact, if you look at the healthcare profession from the perspective of the exercise physiologist, there is a demand for credible professionals, a cry for better faculty involvement in the professional development of students, a wish and expectation for greater depth and career possibilities in the public sector, and finally, a coming to terms with the significance of a profession organization. It is simply incomprehensible to think of exercise physiologists as not having the academic training and laboratory skills to help clients and patients with wellness and fitness issues, to rehabilitation them from acute and chronic diseases and disabilities, to incorporate musculoskeletal training and development in the prevention of injuries, to deal with mind-body and spirituality concerns (including depression, anxiety, and other psychophysiology issues).
There is no credible evidence that the emphasis on exercise physiology knowledge is the problem with exercise science as a failed or failing academic degree. The exercise science curriculum or the lack of one is the problem along with the failure to build a professional infrastructure to drive career-specific jobs. That is also why exercise science is not a profession. Professionalism is critical to the success of all healthcare professionals. Integrity is everything. It is critical to credibility. Without professional integrity, society will not grant credibility to its services. University teachers, in particular, must share the truth about exercise science. They must share insight into ethical thinking not their research agenda for fame and recognition. It is time to draw the line in the sand.
performing cardiovascular assessment procedures, such as measuring oxygen consumption, cardiac output, tissue extraction, 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.
References
1. Ives, J. and Knudson, D. (2007). Professional Practice in Exercise Science: The Need for Greater Disciplinary Balance. Sports Medicine. 37:2:103-115.
2. American Society of Exercise Physiologists. (2010). ASEP Accreditation. [Online]. http://www.asep.org/services/accreditation
3. American Society of Exercise Physiologists. (2010). ASEP Standards of Professional Practice. [Online]. http://www.asep.org/services/standards 4. Boone, T. (2009). The Professionalization of Exercise Physiology:
Certification, Accreditation, and Standards of Practice of the American Society of Exercise Physiologists (ASEP). Lewiston, NY: The Edwin Mellen Press.
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8. The College of St. Scholastica. (2010). The Exercise Physiology Curriculum. [Online].
http://www2.css.edu/publications/advisor/ExercisePhysiology.html 9. Boone, T. (2010). Exercise Science Is a Meaningless Degree.
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11. Boone, T. (2007). The Tragic Illusion of Exercise Science.
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13. Boone, T. (2008). Exercise As Medicine. Professionalization of Exercise Physiologyonline. 11:2 [Online].
http://faculty.css.edu/tboone2/asep/ExerciseASmedicine.html
14. American Physical Therapy Association. (2004). Autonomous Practice: A Roadmap to Our Future. Physical Therapy. Suppl. Vision 2020:4-6. 15.American Society of Exercise Physiologists. (2010). ASEP Definition of
Exercise Physiology. [Online]. http://www.asep.org/
16. Boone, T. (2010). Integrating Spirituality and Exercise Physiology: Toward A New Understanding of Health. Lewiston, NY: The Edwin Mellen Press.
17. Boone, T. (2009). The Coming of Age of the Professional Organization. Journal of Professional Exercise Physiology. 7:5 [Online].
