Chapter 01 1 Introduction Ehrman C H A P T E R

Past, Present, and Future of Clinical Exercise Physiology Breadth of CEP’s knowledge base: –Anatomy –Physiology (organ systems and exercise) –Chemistry (organic and biochemistry) –Biology (cellular and molecular) –Psychology (behavioral medicine, counseling) The CEP should also : –Have an undergraduate or graduate degree in related major –Have done a clinical internship (even if not required by the school) –Pass an accredited certification examination

The Past Roots lie in the late 1800s and into the 1900s –Physiology of Bodily Exercise by LaGrange –Harvard Fatigue Lab –Sid Robinson—studied the aging process –Influence of Europe in the 1950s and 1960s –Ken Cooper and the Aerobics Institute –Herman Hellerstein and bed rest –Cardiac rehabilitation

The Present 1996: U.S. Surgeon General’s Report on Physical Activity and Health 1995: CDC/ACSM physical activity guidelines Acceptance based on evidence that exercise and physical activity –Reduce risk of developing many chronic diseases –Play a role in treating and improving these conditions Development of exercise programs to treat obesity, diabetes, peripheral vascular disease, and pulmonary disease

The Present (continued) Diseases and conditions related to a lack of exercise –Cancer (breast, colon, prostate) –Cardiovascular disease (coronary artery, peripheral vascular, stroke) –Falling –Frailty –Health-related quality of life –Non-insulin-dependent diabetes –Mood and mental health (continued)

The Present (continued) Diseases and conditions related to a lack of exercise (continued) –Obesity –Osteoarthritis –Osteoporosis –Overall mortality –Premature mortality –Sarcopenia-related functional loss Adapted from the Surgeon General’s Report on Physical Activity and Health, (continued)

The Present (continued) Scope of practice varies –See U.S. Department of Labor, Bureau of Labor Statistics –Clinical Exercise Physiology Association (CEPA) –American College of Sports Medicine (ACSM) –American Council on Exercise (ACE) –Canadian Society of Exercise Physiology (CSEP)

The Future Future directions and goals might include: –Enhanced acceptance of the CEP as an allied health professional –Widening the types of patients the CEP might work with –Continued development of the Clinical Exercise Physiology Association (CEPA) as the professional organization for the CEP professional –Continued enhancement of the body of knowledge for treating chronic diseases with exercise and the role the CEP might play in this process

Important Biomedical Journals for the CEP ACSM’s Health and Fitness Journal American Journal of Cardiology American Journal of Clinical Nutrition American Journal of Physiology American Journal of Sports Medicine Annals of Internal Medicine Archives of Internal Medicine British Journal of Sports Medicine Canadian Journal of Applied Physiology Circulation (continued)

Important Biomedical Journals for the CEP (continued) Clinical Journal of Sport Medicine Diabetes Diabetes Care European Journal of Applied Physiology European Journal of Sport Science Exercise and Sport Science Reviews International Journal of Obesity Journal of Aging and Physical Activity Journal of Applied Physiology Journal of Cardiopulmonary Rehabilitation (continued)

Important Biomedical Journals for the CEP (continued) Journal of Clinical Exercise Physiology Journal of Obesity Journal of Sport Science and Medicine Journal of the American Medical Association (JAMA) Medicine and Science in Sports and Exercise New England Journal of Medicine Pediatric Exercise Science Pediatric Obesity The Physician and Sportsmedicine Research Quarterly for Exercise and Sport Sports Medicine

CEP Licensure Currently only Louisiana requires a state license for the practicing CEP Several other states are in various stages of the process of seeking CEP licensure (continued)

CEP Licensure (continued) Important legal questions that must be answered during the licensure process include: –What services may exercise physiologists lawfully provide given the absence or lack of licensure? –What practices performed by exercise physiologists may be prohibited as a matter of law because of state statutes regarding unauthorized practice of medicine? –What practices performed by exercise physiologists may be prohibited because they are in the scope of practice of other licensed health care professionals (e.g., physical therapy, nursing, dietetics) and thus prohibited by current law? –What potential liabilities may exercise physiologists face when their delivery of service results in harm, injury, or death attributable to alleged negligence or malpractice? –What recognition may be given to exercise physiologists and their opinions in a variety of legal settings (such as evaluating disability or working capacity in matters involving insurance, personal injury, or workers’ compensation)? Can they serve as reputable expert witnesses?

Professional Organizations See table 1.1 for comparison of qualifications for clinical exercise physiologists.

Professionalization of Clinical Exercise Physiology There is an effort to develop guidelines and standards for postsecondary academic institutions for exercise physiology academic programs: –Developed by CoAES There are other organizations important to the CEP: –American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) –Medical Fitness Association (MFA) –Exercise is Medicine (EIM) –American Heart Association (AHA) –American College of Cardiology (ACC)

CoAES Sponsors American Association of Cardiovascular and Pulmonary Rehabilitation ( American College of Sports Medicine ( American Council on Exercise ( American Kinesiotherapy Association ( Cooper Institute ( National Academy of Sports Medicine ( National Strength and Conditioning Association ( Reprinted from

Organizations Dedicated to Chronic Disease and Disability See table 1.2 for selected Internet sites of chronic disease and disability organizations and institutes.

Legal Case To appreciate what can be at stake for health professionals who become involved in courtroom litigation, consider this case of an exercise physiologist working in the clinical setting. –Refer to the legal case in practical application 1.3.

Conclusion Clinical exercise physiology is becoming an allied health profession recognized both by other practicing clinicians and by the general public. Given the growing evidence for and acceptance of the role of physical activity and exercise in the prevention and treatment of chronic disease, the timing has never been better for permanently solidifying the role of the clinical exercise physiology profession in the health care of the population.