BooneThink

“A small mistake in the beginning makes for a large mistake at the end.”

Think about it as we move into 2006!

Have a great New Year.

With a smile….

The ASEPNewsletter is devoted to informative articles and news items about exercise physiology. It is a monthly magazine of news, opinions, exercise physiology professionals, and events that shape exercise physiology. While it contains views and opinions of the Editorial Staff who oversee the ASEP Internet Websites, visitors can have a voice as well. We welcome interested practitioners, researchers, and academicians to e-mail the Publisher their thoughts and ideas or to respond directly via the ASEP Public Forum.

Creating an Image by Tommy Boone

After one year of writing pieces for the ASEPNewsletter, just short of entering yet another academic year, it occurred to me that only a very few exercise physiologists contributed to it. I have tried to create an image of respect for exercise physiologists without being too terribly hard on sports medicine. At times, it has been difficult but generally okay.

What is the image of the ASEPNewsletter? Unfortunately, I don’t know. I’m guessing that a relatively few individuals seem interested in what it has to offer. The larger “potential” audience appears to remain unconvinced of its value. Yet, in the history of exercise physiology, how many newsletters have there been? The answer is too few to mention. Exercise physiologists, in actuality, have had and continue to have little to no means of communication (outside of the typical research format).

The ASEPNewsletter has tried to touch on ways to motivate the reader. The Society is interested in exercise physiologists feeling good about themselves, and it wants exercise physiologists everywhere to believe in their future. Hence, on one hand, the stories, articles, and motivational pieces tell the reader what the newsletter is and why it exists. But, an interesting question is, “Is the image valuable in the eyes of the exercise physiologist?” Perhaps, there is a need for a different set of lenses through which to view the concerns, ideas, and “whatever” of exercise physiologists?” If so, anyone can take the charge.

The problem may be my personal preconceived image of what might be helpful in launching a medium through which exercise physiologists can speak to each other. What is good or what is not so good in what they do can for the first time via the internet be examined and re-examined. This idea seems to be a legitmate one. Yet, after 12 months of overseeing the newsletter, I’m beginning to think I might be wrong. Everyone wants this and that to happen right now, but (at times) it seems to me that only a few exercise physiologists are truly willing and interested in working to achieve the possible. That is, while I understand that writing takes time, energy, and is hard work, it is nonetheless important. I can only guess that is part of the reason I’ve received so few submissions for publication in the newsletter.

All day, every day, I wait for help from those of you who have stated that exercise physiology must take charge of its future. The greatest challenge before me is no longer the continued editing of the countless web pages of ASEP, but the challenge to continue to write in your absence. Why does it seem that so few exercise physiologists pay so little time to the development of the profession through the ASEPNewsletter? I don’t know. It is a legitimate electronic document with an ISSN number for internet documentation. It is genuinely based on gaining support and control of exercise physiologists and the profession, respectively.

Well, I’ve tried to create a small “window into the world of exercise physiology” to increase national and international awareness of the negative subtleties that our students face at graduation. I promised myself that I would not give up, and that I would always communicate directly with simple phrases and leave, hopefully, favorable impressions. In short, though, it is time for exercise physiologists to create the image they want to communicate through the internet medium.

Small (2 to 3 paragraphs) pieces of interests to other exercise physiologists will do nicely. It doesn’t have to be a thousand-word document. Instead, think about what concerns you or what is going great in your professional work. What do you know that may be of some help to others. Exercise physiologists are interested in what you have to say. Don’t be afraid of your own creativity. If interesting new things are happening to you, mention them in the newsletter and ask how the reader feels about them.

It isn’t a suicide hotline. Your professional status will still be everything it was and very likely more! Why not submit your thoughts, hopes, and fears for the future of exercise physiology in the United States (if not worldwide)? Why not describe graphically what the future should be like, and how we can find more jobs for our students when they graduate? I know many of you have similar concerns as I do, and that you identify with many of the common problems we face. I believe it will be helpful, reasonable, and well-meaning to share your ideas and arguments with other exercise physiologists who are travelling the same road.

In short, I have pushed my points about as far as I can. There are a lot of important issues, and I believe there is an audience. Think about what is really important in your professional work, the knowledge of core issues, alternatives to jobs, mentors, and so forth and then share that information with other committed members. The potential benefits outweigh the probable costs.

Active participation is necessary in order to achieve ASEP goals and to make the Society a success.

“The crisis of a young man’s life may be reached exactly when he half-realizes that he is fatally overcommitted to what he is not.” — Erik Erikson [Young Man Luther: A Study in Psychoanalysis and History, p. 43]

The neglected theme in exercise physiology is the culture of professionalism. Indeed, one could conclude that essentially no one in the field is writing about the professional development of exercise physiologists. Outside the context of the American Society of Exercise Physiologists, professionalism per se remains undefined. Unfortunately, too many colleagues believe that doing things that support the fitness professional is sufficient work that defines professionalism. It’s not. The professionalization of exercise physiology got its start in 1997, although academic exercise physiologists have been doing their thing for some 50 years. However, regardless of the work of the academics, just as the first “World” Series was played in 1884, the first “board certified” professional exercise physiologist was not defined until 2000. In other words, professional recognition as an educator and/or researcher by itself it not enough to define a profession. A higher standard of education, graduation, and expectation, among other criteria, are important to creating the culture of professionalism. There are more elaborate rituals that define and support a theoretical body of knowledge from which the practitioners are recognized as having the authority and respect to practice throughout society. The ASEP leaders recognize that exercise physiology is no longer a discipline or an occupation. Rather, exercise physiology has become a profession with a “code of ethics.” Now, the opportunity exists to properly merge one’s education with a defined healthcare career. In fact, the first really important step at the professionalization of exercise physiology waited until the development of the ASEP “board certification” and career-driven “standards of practice.” Fortunately, exercise physiologists are no longer muddling along. The professionalization process is in full swing; it is establishing the direction and the culture of the future of exercise physiologists as healthcare professionals.

“The person who is waiting for something to turn up might start with their shirt sleeves.” — Garth Henrichs

It’s a fact: Students won’t see the differences between certifications if they can’t see them in action. You know this from your own experience as an ASEP faculty member. It is self-evident in the few official sites that offer the examination. So how do the ASEP leaders create a clear and simple connection between the ASEP Board Certification (the EPC exam) and exercise physiology?

Picture this: It’s Monday afternoon and you’re headed for the classroom to talk about the EPC exam. As you walk towards the front of the class, you’re thinking, “Hmmm. Where do I begin?” As soon as you have come to a stop in front of the class, you start looking at the students and begin saying, “The EPC exam is a board certification that earns the candidate the professional title, Exercise Physiologist.” It holds the EPC accountable to the ASEP code of ethics and standards of practice. The exercise physiologist is therefore held accountable in the practice of exercise physiology. Held to a higher standard, the EPC exercise physiologist is recognized for his/her credibility and integrity as a healthcare professional.”

“Hmmm,” you think, “Accountability and credibility!” Both are important to professional development. Now that you sense being on the right track, you’re excited about the upcoming EPC exam, and you start to ask questions, “How many are you planning on sitting for the exam this Friday?” Slowly the hands pop up. In back of the classroom, you hear Greg say, “I am.” And others do the same. By the time a few minutes pass, 80% of the class has committed to taking the test. You think that’s good, but wonder a bit: “Why isn’t Tara, Erin, and Beth taking the test?” It’s a decision on their part that doesn’t make sense to you.

In many ways, in the “real” world of exercise physiology, there are very few EPCs. The differences between a fitness certification and a professional certification have not been discussed beyond the walls of the classroom. However unsettling, the reality sets in and forces you to push even harder. “Hello students, wake up. It is important to sit for this test while you are academically prepared. Typically, people wait until they forget much of what they learned in school and, of course, life becomes filled with all kinds of others issues and concerns. With any luck, taking the test now is your best shot for success.

Yes, the painful truth is that most people in the public sector do not yet know about the value and importance of the EPC certification. And, yes, there are exercise physiologists who argue that the certification is meaningless. It’s obvious they are not ASEP members. Worst of all, they are entirely out of touch with the reality of the 21st century view of exercise physiology. In fact, they are so lost in the inertia of traditional sports medicine thinking, it is essentially correct to believe they will remain that way the rest of their lives.

Those of us who are willing to look to the future, on the other hand, tend to think students like change. The belief that everything will remain as it always has been is a myth. Change is good. Change is inevitable. Change is expected of professionals, as well as growth. There’s no substitute for it. In fact, if you observe other healthcare professionals, you know that change is a good thing. Maybe we better do some serious thinking in this regards. “Hello, students, try to resist the temptation to side with non-ASEP members. Try to resist the temptation to jump to any conclusions until you’ve talked to an ASEP member.” In short, think…think about your future and what it means to be a professional.

Imagine it is 1996, and you are an exercise physiologist somewhere in the United States. You no longer believe, as your colleagues do, that your work and who you are can be defined by the American College of Sports Medicine. But you still have respect for your friends even thought they believe in their divine right to rule over you. You can’t imagine why you still respect them, but you do. After all, some of them contributed significantly to the exercise physiology body of knowledge (even though it frequently goes by the name of sports medicine).

You have heard how sports medicine authorities tried their best to work with the ASEP leadership! Yet, you know the truth, and you know that they continue to discount the work of the ASEP leaders. It just doesn’t make sense, but nonetheless it is still true today. ACSM officials have not acknowledged the right of ASEP to exist. Who is responsible for the contradictions and the untruths should be obvious, but it isn’t. And that leads to one of the main messages of this posting: For the first time in the history of exercise physiology, members of the profession can belong to their own professional organization. This is a revolution that got its start in 1997. It’s all about having the choices the revolution offers — and all of us — now have the opportunity to shape a new exercise physiology. Frequently, I refer to it as “the” 21st century exercise physiology.

Many factors influenced the founding of ASEP. Overall, though, it was done on behalf of something better for students of exercise physiology (or, in actuality, those who think they are majoring in a degree program that earns the title, exercise physiologist). There is, however, a critical difference between exercise science and exercise physiology or other related degree programs and exercise physiology. Even more remarkably, while members of the ASEP organization get it, the sports medicine “fitness professionals” do not get it. And herein lies another key message of this posting: The sports medicine organization is not what it was in the 70s and 80s. In other words, you can see all too easily that the leaders have simply failed to lead on behalf of exercise physiologists. Frankly, this came as a shock to me just a few years before closing the intellectual door to sports medicine. As I think about it, in a sense, it was already closed for years before my mind was open by the possibilities of belonging to one’s own professional organization. There are big differences between an umbrella organization and a profession-specific organization. It hardly needs saying what the differences are but, frankly, I try every month in the PEPonline electronic journal. In fact, the journal is full of examples about exercise physiology, code of ethics, board certification, accreditation, standards of practice, and much more to help move the reader to move forward in professional development, credibility, and accountability.

What we need is a new model of exercise physiology, and that is the ASEP organization. It doesn’t just mean getting big or “big is better” kind of thinking. It is all about quality and integrity. ASEP is “the” leader in exercise physiology. The leaders are inspired to do the right things for the right reasons. By communicating a vision that speaks to hope and opportunity for all exercise physiologists, others see the value in ASEP, others see the realistic views the leaders write about, and still others focus on the message of professionalism. None of this evolved from “sheer good luck.” Rather, it has evolved from “sheer hard work.” And, the work is not finished. Exercise physiology will be evolving for decades to come. Members are especially challenged to find their own authentic voice as healthcare professionals.

It is now up to you to make the choice between sports medicine and exercise physiology. This new awakening is the springboard for solutions to problems. It is all about networking and communicating and, yes, coming together and breathing life into exercise physiology. Remember, as the German philosopher Schopenhauer said in so many words: All truth [or a new idea, like ASEP] passes through three stages. First, it is ridiculed. Second, it is opposed. Third, it is accepted. The process is well underway. This is a “time of choosing.” It is a way for you to create the future of exercise physiology rather than turning it over to others who don’t know what to do. Personal commitment is powerful. Why not choose today? Do you want to be a fitness professional? Do you want to be an exercise physiologist?

“There may be a price to pay in terms of ridicule by those who can’t match your courage, but that is the price of leadership.” — Terry Pearce, author of Leading Out Loud

It seems that everytime I turn my head, somebody is trying to point out the obvious weaknesses of the ASEP leadership. And, yet these same individuals are followers — not leaders. Take, for example, the fact that the American Society of Exercise Physiologists was founded in 1997. Hello, get real people. There isn’t any reason that the leadership has to break its back to be perfect with every idea, plan, strategy, or program. Why not talk about the good things the leadership has done in just seven years! Just think, the national organization for occupational therapy was created in March 1917. I believe it was 1968 before an official definition of occupational therapy was adopted for the first time. The ASEP leadership agreed on an official definition of exercise physiology within the first two years of operation. All a person has to do is check into the history of nursing, physical therapy, and other healthcare professions to find the same thing. Each of these professions has decades, if not, nearly a 100 years of time to get it perfect, and they haven’t done so yet. So, why not give the ASEP leadership a break. After all, they have accomplish many good things since 1997. Even if parts of the package remain less than perfect, time is on their side. In fact, if you are an exercise physiologist, why not get involved with ASEP? No one is asking you to be perfect. Anyway, it isn’t a good idea to wait until every little thing is worked out, even if possible. Ideas should be implemented and, when necessary, evaluated and implemented again. The truth is, no one really has all the answers. The ASEP leadership knows that it makes mistakes, but they are trying to make exercise physiology better for all exercise physiologists. Oh, by the way, I should point out that the Board of Accreditation does not exist within the ASEP organization. It is located in The Center for Exercise Physiologists-online. The Center is a sister organization that deals with accreditation, certification, and licensure. The URL is different from the ASEP organization, and it is on a completely different server. Yes, seveal members of the Board of Accreditation are members of ASEP, but that is where less than perfect will be corrected when friends and colleagues stop being negative and join in to help.

POSITION PAPER

The American Society of Exercise Physiologists (ASEP) representing its membership and affiliate state associations strongly opposes the creation of the American College of Sports Medicines (ACSM) and Commission of the Accreditation of Allied Health Education Programs (CAAHEP) Committee on Accreditation for the Exercise Sciences (CoAES). ASEP believes that CoAES is not in the best interests of Exercise Physiologists and does nothing to help unify the profession or to protect the public safety.

The main reasons for ASEPs opposition to CoAES are listed below:

1. The public does not need more sports medicine certifications along with the 400 other fitness certifications (some not requiring a college or university degree). Accreditation and certification lead to credibility only within the established context of a profession. Less is more when it comes to the quality of the certification. ASEP believes that the creation of CoAES will create a situation that continues to dilute the exercise field by further opening the exercise profession to other disciplines at the expense of the professional Exercise Physiologist.

2. ACSM is a multi-disciplinary sports medicine organization. The purpose of the organization is to advance and integrate scientific research to provide educational and practical applications of exercise science and sports medicine. The membership of ACSM is made up of individuals from many professions who come together because of their interest in exercise, science, and sports medicine. ACSM has 46 distinct membership categories under its membership umbrella. Furthermore, Exercise Physiologists comprise only about 2,100 members (11%) of the entire ACSM membership (http://www.acsm.org/membership/mailinglist.htm). The question must be raised, how can a multidisciplinary organization accredit academic programs and attempt to regulate one small membership category within its vast, diverse organization? As a multi-disciplinary organization, ACSM cannot attend to the legal and legislative issues of any current or proposed profession. ACSM should not act to compromise the professions of its membership. Imagine the conflict created if ACSM or another multidisciplinary organization proposed a new allied health profession, physical medicine specialist, using the educational requirements, training, and scope of practice of the Physical Therapist, but allowed other professionals to enter this profession. Even further, currently there is a nursing shortage in the United States; why not develop a sport medicine nursing specialist profession to help minimize the effects of an insufficient number of trained nurses? By design, professions are exclusionary to assure quality through consistent educational, training, and certification standards.

3. ACSM is working with The Commission on Accreditation of Allied Health Education Programs (CAAHEP) to develop four tracks for the exercise professional: the bachelor prepared Exercise Specialist, both the clinical and practical Exercise Physiologist, and the Personal Trainer. They have focused their effort towards the clinical exercise physiologists. This in itself creates several issues. By focusing on the masters prepared exercise physiologist, they have devalued the significance in a bachelors degree. Meanwhile, many of our peers in healthcare require only a bachelors degree, or associates degree in the case of nursing. The ACSMs view is at the expense of well-prepared bachelors degreed exercise physiologists. After all, ASEP accredits undergraduate programs in exercise physiology. Additionally, by identifying the clinical role of exercise physiology as if it is separate from what exercise physiologists do, it tends to restrict the options of those in the field. Certainly the exercise physiologist is educated to work in the clinical realm, too. No other healthcare profession separates the clinical professionals from the rest of their field, so why would exercise physiologists?

There are nurses and physical therapists, not clinical nurses or clinical physical therapists. By creating separate tracks, not only is the confusion increased, but professional opportunities are restricted. Exercise physiologists should have as many choices (e.g., health, fitness, wellness, clinical, and athletics) as possible with the option to select a specialty that best suites their interest, skills, and desire.

4. ACSM has been in existence for 50 years, and according to their own website documenting their 40 most significant events (http://www.acsm.org/membership/top40.htm), they have done nothing to directly promote the profession of exercise physiology. ACSM is a great multi-disciplinary sports medicine organization. The leadership of ASEP has stated repeatedly that exercise physiologists should join ACSM since it is a good venue for research. But, for the profession to move forward, exercise physiologists must unite under an organization devoted exclusively to exercise physiologists.

5. ACSM does not have a history of protecting the rights and careers of exercise physiologists. For example, in 2004, ACSM did not oppose the Centers for Medicare and Medicaid Services (CMS) rule changes regarding “incident to physician.” The changes mandate that any “physical therapy” services provided incident to physician care be delivered by or under the direct supervision of a physical therapist.

This rule change has directly undermined exercise physiologists as healthcare providers. This is exactly why ASEP has rallied to fight for exercise physiologists across the country. The ASEP leadership worked with a dozen organizations to form the Coalition to Preserve Patient Access to Physical Medicine and Rehabilitation Services. Presently, ASEP is working with the American Kinesiotherapy Association (AKTA), National Athletic Trainers’ Association (NATA), and other organizations to support a coalition statement that opposes the CMS rule change. ACSM was not part of this coalition.

In 2004, SB360 was introduced in Indiana primarily to address direct access to physical therapy without a physician referral. But, there was a hidden provision that would have allowed physical therapists to provide fitness and wellness services to asymptomatic individuals in a non-medical setting without a physician referral. Since the fitness industry is unregulated, the bill essentially would have provided regulation by default. Upon passage of the provision, there is the concern that the American Physical Therapy Association would conclude that, by Indiana law, ONLY physical therapists could provide these services.

The Indiana Association of Exercise Physiologists, with help from ASEP, opposed the bill. SB 360 was defeated, but not because of the hidden provision. ACSM did not oppose the bill. If ACSM would not support exercise physiologists in these two very important professional issues, do you really believe that ACSM is interested in supporting the professional development of exercise physiology?

Would the APTA allow NATA to intervene in the development of their profession? Absolutely not, as that would be disastrous for APTA. Do you believe Jon M. VonderHaar, President of the AKTA, would ask ASEP for assistance on accrediting AKTA programs? Would Eve Becker, Executive Director, of the NATA, ask ASEP for assistance with the regulation of athletic trainers? Again, the answer is no. This is why ASEP opposes CoAES, and why it is not in the best interests of the exercise physiology profession.

Green and Eleffers wrote in their book: The 48 Laws of Power, “Rely too much on other people’s ideas and you end up taking a form not of your own making.” I’ve read the sentence many times. It should be a reminder to every exercise physiologist to stop relying so much on sports medicine. Too many colleagues have taken a form not of their own. For this reason it makes sense to rethink what is necessary to create our own form as exercise physiologists. After all, everyone is said to admire boldness. Exercise physiologists must think of themselves destined for great things in healthcare. This is why they must do their own thing. This is why the ASEP leaders have the power to produce changes in exercise physiology. They refuse to conform to the inertia of sports medicine. They understand that the downfall of the sports medicine leaders is traced to their losing contact with the roots and identifiability of exercise physiologists. There is plenty of evidence that exercise physiologists are constantly bombarded by attempts to influence the way they think, feel, and act. Our senses are assaulted through flyers and web sites designed to promote the thinking of fitness professionals over exercise physiologists. Academic gatekeepers try to influence their students to earn fitness and personal trainer certifications. Some have come to believe such information is factual. They do not understand the many faces of persausion. Many ASEP exercise physiologists believe that students need to know that there are options. They believe students must have the freedom to choose and the freedom to adapt to their own form. This is why ASEP educators believe that it is important to teach students “how” to think” and not “what” to think, to encourage students to learn more about the profession of exercise physiology, and to learn how to evaluate what they hear and read rather than accept someone’s definition of exercise physiology.