Download Words - American Society of Exercise Physiologists

1
Journal of Exercise Medicine online
June 2016
Volume 1 Number 3
JEMonline
Official Research Journal
of the American Society of
Exercise Physiologists
ISSN 2378-4083
Physicians Should Refer Patients with NonCommunicable Chronic Diseases to Exercise
Physiologists
Tommy Boone, PhD, MPH, MAM, MBA
Board Certified Exercise Physiologist
ABSTRACT
Boone T. Physicians Should Refer Patients with Non-Communicable Chronic
Diseases to Exercise Physiologists. JEMonline 2016;1(3):1-12. Unfit and sedentary
individuals develop chronic diseases prematurely and die at a younger age than the
physically fit and active individuals. Regular exercise is a medication that decreases
the sedentary risk factor for increased mortality. Yet, the medical community is not
interested in prescribing exercise as therapy, especially when compared to the
prescription of pharmaceutical medications. Physicians do not assess the exercise
habits of patients, and they do not refer their patients to exercise physiologists.
Perhaps, that is part of the reasons why exercise physiologists are not identified as
part of the healthcare team. The beneficial effects of exercise medicine are
diminished when physicians fail to promote regular exercise as a chronic disease
prevention and management strategy to improve the health of their patients and,
frankly, it is equally true when they fail to make referrals to Board Certified Exercise
Physiologists. Physicians need to acknowledge that exercise physiologists are trained
to deliver safe and effective advice for their patients. By working together, physicians
and exercise physiologists can help treat the burden of cardiovascular diseases,
diabetes, some cancers, and chronic respiratory conditions. The development of an
exercise prescription as preventive therapy should not be viewed as a subject area
that can be taught to medical students during a 5-hr or even 10-hr period. But,
unfortunately, that is the case and therefore the majority of the physicians are not
educated in medical school to even the basic science behind regular exercise, the
mind and body benefits, the risks involved, and the ways to evaluate and prescribe
exercise programs. They are also not educated in areas of modifying risk and
promoting health, particularly after an injury and/or surgery. The American Society of
Exercise Physiologists (ASEP) defines exercise physiology as “The comprehensive
delivery of treatment services concerned with the analysis, improvement, and
maintenance of the physiological mechanisms underlying physical and mental health
and fitness through regular exercise, the rehabilitation of heart disease and other
chronic diseases and/or disabilities with exercise medicine, and the professional
guidance of athletes and others interested in athletics and sports training.” The ASEP
exercise physiologists are graduates of a 4-yr ASEP accredited academic degree
with specific course work that addresses risk stratification, behavioral change, and
the impact of exercise medicine. The ASEP Accreditation Manual provides insight
into what is academically expected from classroom and hands-on laboratory training
of the students who attend an ASEP accredited academic program.
Key Words: Interdisciplinary Team, Non-Communicable Diseases, Board Certified
Exercise Physiologists, ASEP Academic Accreditation, Healthcare Professionals
2
INTRODUCTION
The health literature is clear in the analysis that the unfit and sedentary individuals develop chronic
diseases prematurely and die at a younger age than the physically fit and active individuals (1). This
point has been expressed many times during the past several decades, regardless of whether it is
men or women, different ethnic groups, or children and teenagers (2). Regular exercise contributes
to the prevention and treatment of several diseases (e.g., coronary heart disease, type 2 diabetes,
hypertension, obesity, and some cancers) and medical conditions, including neurological diseases
(such as dementia and Parkinson’s diseases),and psychiatric diseases (e.g., depression) (3).
Exercise Is Medicine, But…!
A patient with an “exercise habit” is someone who is engaged in his or her own prescription of
medicine. Exercise is a medication that decreases the sedentary risk factor for increased mortality.
Yet, despite the scientific evidence that exercise is important in the promotion of a healthier lifestyle
for patients of all ages (4), exercise referral schemes by the medical community in the United States
does not exist. Less than 10% of the total outpatient visits have included exercise counseling or
education (5). It is apparent that the medical community is not interested in prescribing exercise as
therapy. After all, physical activity as therapy seems to be too simple to be taken seriously,
regardless of what some physicians (6) advocate and what the scientific literature says.
There is another reason why physicians have resisted using exercise as a medication. They are not
educated to the patient’s physiologic responses to different evaluation protocols, especially when
compared to the prescription of pharmaceutical medications (7). If exercise is actually a medication
for living a longer and healthier life, wouldn’t the subject area be taught in medical school? Of
course it would be. Not doing so is an ethical problem for medical providers. It is the responsibility of
the physician to determine the physical activity levels or exercise habits of his or her patients. The
association between physical inactivity and health status is clear, just as it is regarding the other risk
factors (such as smoking, high blood pressure, and/or obesity) that contribute to a shorter and
unhealthy life.
It is medically and scientifically appropriate that physicians should address their patients’ exercise
habits. They need to know if their patients are engaged in 150 min·wk-1 (i.e., 30 min·d-1, 5 d·wk-1) of
walking or brisk walking? If not, their patients should be told to start a walking exercise program
immediately. They also should know if the children patients are engaged in 420 min·wk-1, which is
~80 min·d-1, 5 d·wk-1 (2). Although physicians should refer their sedentary patients and those living
with chronic diseases to exercise physiologists for guidance in the management and treatment of
chronic diseases, the current medical system does very little to promote preventive healthcare.
While the reasons are myriad and complex, physicians have a duty of care to promote exercise
since physical inactivity is a known risk factor for chronic diseases.
Medical Referrals and Exercise Physiologists
The reality of medical care is that physicians do not assess the exercise habits of patients and they
do not refer their patients to exercise physiologists. Perhaps, that is part of the reasons why
exercise physiologists are not identified as part of the healthcare team. It does not make sense that
the Board Certified Exercise Physiologists are not recognized by physicians and other healthcare
providers as credible healthcare professionals. They are professionals whose scope of practice
3
includes working with cardiovascular, pulmonary, metabolic, and neuromuscular diseases. They are
trained in developing exercise programs to strengthen the musculoskeletal system and prescribing
exercise prescriptions to optimize the cardiovascular system.
It is clear that regular exercise, regardless of whether it is light, moderate, or vigorous exercise,
improves the patient’s mood, confidence and sex life while decreasing the risk of high blood
pressure, obesity, elevated cholesterol, and diabetes. Yet, the beneficial effects of exercise
medicine are diminished when physicians fail to promote regular exercise as a chronic disease
prevention and management strategy to improve the health of their patients and, frankly, it is equally
true when they fail to make referrals to Board Certified Exercise Physiologists. Physicians need to
acknowledge that exercise physiologists are trained to deliver safe and effective advice for their
patients. Then, by working together, both the physicians and the exercise physiologists can help
treat the mental and physical burden of cardiovascular diseases, diabetes, cancer, and chronic
respiratory conditions. Board Certified Exercise Physiologists can also prescribe exercise medicine
to the physicians’ patients who presently do not have a chronic disease to avoid ill health.
Minimal Medical Commitment to Exercise Medicine
Unfortunately, even among the few medical schools that provide some education about the patient’s
assessment, recommendation, and promotion of physical activity, the commitment is very small.
Most physicians are not interested. Some even think of exercise medicine as a “soft” science. Those
who may be interested feel that they are not prepared to provide physical activity advice and support
of their patients. Equally disturbing is the idea that a one-time brief physical activity counseling
intervention by a nurse practitioner is sufficient to produce positive and sustaining results. It is an illconceived approach to promoting physical activity and lifestyle changes in patients who need
support and counseling. The benefits of regular exercise (e.g., lowered body fat, improved muscle
tone and strength, increased energy and libido, normalized blood glucose, insulin, and leptin levels)
are too important to avoid referring patients to a trained healthcare professional who understands
exercise physiology and exercise medicine.
The bottom line is this. It will be a long time and a major uphill battle before physicians change the
way they practice medicine. Hence, while many different well-educated healthcare professionals
from several disciplines of study understand that the lack of regular exercise is comparable to the
negative health effects of smoking and obesity (8), the per cent of physicians providing exercise
counseling to their patients in the United States will remain very low for years if not decades (9).
This is problematic because physicians are ethically responsible for helping their patients adopt
healthy behaviors, and everyone knows that healthcare costs are spiraling out of control. Think
about it. Diabetes costs the healthcare system $245 billion per year (10), stroke increases the costs
by another $34 billion (11), and sarcopenia adds $19 billion (12). A major contribution to the solution
of these diseases and the huge costs is exercise medicine.
Essential Healthcare Professionals: Exercise Physiologists
The physician’s corrective measure is to refer their patients to an exercise physiologist who is
academically prepared to deal with common barriers to starting and maintaining an exercise routine
or an active lifestyle. Exercise physiologists are also prepared to provide each patient with his or her
own individualized exercise prescription. They understand the evidence-based exercise medicine
research, and they have the hands-on laboratory training and skills to provide a safe and effective
assessment of the patient’s physiological health. Exercise physiologists are educated to do these
things and more even though they are not presently health professionals with licensure. Their work
4
with patients is not paid through the typical healthcare insurance reimbursement model. Their pay is
typically the fee-for-service for preventive exercise care, which demonstrates that the healthcare
marketplace undervalues exercise medicine as preventive care. This point speaks volumes about
the medical insurance coverage, and yet the American people spend more than $350 billion every
year on prescription drugs and $2.7 trillion on a healthcare system that is financially driven to treat
disease.
The development of an exercise prescription as preventive therapy should not be viewed as a
subject area that can be taught to medical students during a ~5-hr period as reported in the UK
medical schools (compared to 109 hrs spent teaching pharmacology) (13) or even a 10-hr period of
lecture or a slide set series, regardless of the good intentions (14). Also, while the responsibility for
promoting exercise medicine is historically shared by numerous specialized professionals with
degrees in physical education, kinesiology, exercise science, physical therapy, rehabilitation
therapy, occupational therapy, nutrition, and others, it seems reasonable to conclude that academic
exercise physiologists (as members of the American College of Sports Medicine, ACSM) during the
past several decades are probably the key health professionals in developing guidelines for
exercises testing and prescription (15). Many members of the different disciplines and professions
have reached the understanding that it is logically indefensible for healthcare professionals, doctors
in particular, not to promote physical activity for patients with non-communicable chronic diseases.
Unfortunately, the majority of the physicians are not educated in medical school to even the basic
science behind regular exercise, the mind and body benefits, the risks involved, and the ways to
evaluate and prescribe exercise programs. They are also not educated in other areas of modifying
risk and promoting health, particularly after an injury or surgery. So, in a nutshell, just as physicians
refer their patients to physical therapists to teach patients how to prevent or manage their condition
so that they will achieve long-term health benefits and to dietitians for nutrition counseling and
problematic eating habits, the medical doctors should refer their patients to exercise physiologists to
promote cardiovascular health, restore musculoskeletal function, and prevent disability from physical
inactivity. Exercise physiologists are educated to deliver exercise medicine for the prevention and
treatment of chronic diseases and disabilities.
ASEP Board Certification
The American Society of Exercise Physiologists (ASEP) defines exercise physiology as: “The
comprehensive delivery of treatment services concerned with the analysis, improvement, and
maintenance of the physiological mechanisms underlying physical and mental health and fitness
through regular exercise, the rehabilitation of heart disease and other chronic diseases and/or
disabilities with exercise medicine, and the professional guidance of athletes and others interested
in athletics and sports training” (16). And, with respect to the specifics of exercise medicine: The
ASEP leaders state that: “The bulk of the epidemiological evidence and the scientific papers by
exercise physiologists support the health benefits of regular exercise (i.e., exercise medicine).
Moreover, it is clear that an active lifestyle protects from many chronic diseases and disabilities.
Now, with the ASEP Board Certification as the gold standard for exercise physiologists, the
supervision, safety, and care of clients and patients are increasingly evident throughout the public
sector” (16).
In closing, it has been know for many years that chronic diseases such as cardiovascular disease,
cancer, type 2 diabetes, different respiratory diseases, and osteoarthritis represent the number one
cause of death in the United States and the world (18). The burden is not only heavily correlated
with economic issues, but also emotional with social implications that speak to lifestyle factors such
5
as physical inactivity and a loss of functional capacity. Board Certified Exercise Physiologists are
well-prepared to develop a patient-specific exercise prescription to improve physical functioning,
health, and well-being, which is consistent with the goals and objectives of ASEP (19). The ASEP
exercise physiologists are graduates of a 4-yr ASEP accredited academic degree with specific
course work that addresses risk stratification, behavioral change, and the impact of exercise
medicine. The course load is typically 3 to 4 courses per fall and spring semester during the last 2
yrs of college or, depending on the institution, the exercise physiology courses may be taken
throughout the 4 yrs of college. The following material taken from the ASEP Accreditation Manual
(17) provides insight into what is academically expected from classroom and hands-on laboratory
training of the students who attend an ASEP accredited academic program:
“SECTION 2 – Required Content in the Exercise Physiology: Academic programs seeking
ASEP accreditation must teach the broad content areas listed below.
2.1 First Aid CPR: Basic first aid and cardiopulmonary resuscitation skills (following the procedures
approved by certifying agencies such as the American Red Cross or the American Heart
Association). It is recommended that those seeking a specialization in cardiac rehabilitation
pursue advanced cardiac life support (ACLS). Note: Verification of current certification waives
this requirement for students.
2.2 Human Anatomy and Physiology: Basic but comprehensive overview of the structure and
function of the systems of the human body to include all the systems of the body: circulatory,
immune, respiratory, digestive, urinary, reproductive, skeletal, muscular, nervous, and endocrine
systems.
2.3 Anatomy / Kinesiology: A detailed study of the skeletal and muscular systems to include
identification of the origin, insertion, action, and nerve distribution (i.e., innervations) of the major
muscles (particularly, the upper and lower limbs). Students should become proficient in the use
of directional and movement terminology and be able to classify movement levers and identify
the plane / axis as well as the agonists and antagonists in a movement.
2.4 Biomechanics: Advanced application of muscle mechanics and physiology to sport and human
movement patterns to include the analysis of kinematics and kinetics, linear and angular
kinematics and kinetics, loads and injuries of joints, and movement in a fluid medium.
2.5 Exercise Prescription: A study of wellness topics and physical fitness concepts to include the
health-related components of fitness, fitness assessment, and basic exercise program design.
2.6 Introductory Exercise Physiology: A study of the energy systems (metabolic pathways,
conversion of food to energy, and measurement of this energy), the cardiorespiratory system,
and the neuromuscular system, and how these systems respond and adapt to exercise.
2.7 Advanced Exercise Physiology: A study of advanced exercise physiology topics to include
body composition, endocrine / hormonal responses to exercise, environmental physiology (e.g.,
heat, cold, hyperbaric, and hypobaric), aerobic and anaerobic power, exercise and aging, and
gender differences.
2.8 Exercise Physiology Laboratory: Practice using commonly used field and laboratory testing
devices for the purpose of fitness assessment, clinical analysis, collection of research data, and
the improvement of sport performance.
6
2.9 Exercise Biochemistry: A study of chemistry and molecular biology as it relates to exercise to
include basic genetics, bioenergetics, enzyme regulation, catabolism and synthesis of different
fuels during exercise, and the interactions between liver, skeletal muscle, and adipose tissue
metabolism during exercise.
2.10 Sports Nutrition: A study of the six fundamental nutrients carbohydrates, fats, proteins,
vitamins, minerals, water and their role and importance in exercise, as well as ergogenic aids
and supplementation, weight gain, loss, and maintenance, eating disorders, nutritional fads,
and consumer nutrition and food labeling.
2.11 Electrocardiography: A detailed study of the anatomy of the heart and electrical conduction
system to include preparing a subject for a 12-lead ECG and reading a 12-lead ECG to include
rate, rhythm, heart blocks, axis, hypertrophy, and injury.
2.12 Exercise Testing: Practical study of submaximal and maximal exercise tests using a variety of
testing apparatus to include contraindications for testing, testing procedures, guidelines for
stopping a test, interpretation of the test data, and exercise recommendations.
2.13 Statistics: Introduction to organizing, analyzing, and presenting data with basic descriptive
(measures of central tendency and variance or dispersion) and inferential (t-tests, ANOVA, and
simple prediction/regression) statistics; the use of computer applications (SPSS, SAS, etc.)
should be encouraged.
2.14 Research Design: Students should be introduced to the basics of conducting research to
include the formulation of an idea, planning of a study, collection of data, analysis of data, and
presentation of the results, quantitative versus qualitative research, hypothesis testing, and
controlling for extraneous variables.
2.15 Internship: Provide supervised practical experience(s) in the specialization area in which the
student anticipates a career. A diary/log should be recorded with comments relative to what
was good and bad about the experience.
SECTION 3 – Cognitive Learning Objectives: The objectives are grouped with suggested
courses. Although the course titles may vary between institutions, the objectives are required.
Academic program must demonstrate that 90% (50 of the 56) of the objectives are being taught for
ASEP accreditation.
Lifetime/Personal Fitness:
3.1 Recognize the extent to which physical inactivity is a public health problem and a major
contributing factor to certain chronic diseases, and know the minimal physical activity and
energy expenditure recommendations for the primary and secondary prevention of
cardiovascular disease and other conditions associated with a decreased risk of premature
death.
3.2 Identify the health-related components of fitness (cardiorespiratory fitness, muscular strength
and endurance, flexibility, and body composition), demonstrate knowledge of how they are
assessed, and recognize personal strengths and weaknesses relative to these components
following a fitness appraisal.
7
3.3 Demonstrate knowledge of basic fitness, assessments, and exercise training principles as well
as the benefits of “aerobic” and “anaerobic” exercise.
First Aid CPR:
3.4 Perform artificial respiration and cardiopulmonary resuscitation.
3.5 Recognize various emergency situations and demonstrate the skills to help sustain life and to
minimize pain and the consequence of an injury or sudden illness until professional medical help
arrives.
Anatomy:
3.6 Use proper anatomical terminology associated with body structures, directional location, and
limb movement.
3.7 Be able to identify skeletal and joint structures and demonstrate knowledge of their function in
human movement.
3.8 Be able to identify and explain the movement function of the major muscles of the upper and
lower extremities, chest (front and back), abdomen, and the low back, including their origin,
insertion, and action.
3.9 In addition to the skeletal and muscular systems, demonstrate a basic knowledge of other
structures that are vital to human movement such as the nervous system (including reflex
pathways and proprioceptors).
3.10 Identify joint movements and recognize which muscles are involved and what their specific
roles are in complex human movements.
3.11 Demonstrate an elementary knowledge of basic biomechanical concepts to include anatomical
lever systems, stability, and laws of motion.
Biomechanics:
3.12 Demonstrate knowledge of kinetics and kinematics and explain the ways in which they are
related.
3.13 Be able to solve quantitative problems involving vector quantities.
3.14 Demonstrate knowledge of the biomechanics of bone growth and development as well as joint
articulations.
3.15 Demonstrate knowledge of the biomechanics of the upper extremity, lower extremity, spine and
pelvis as related to internal and external forces.
3.16 Explain the purpose of a variety of biomechanical research equipment including force plates,
electromyography, 3-D cinematography, computerized vector analysis and high speed film
analysis.
8
3.17 Recognize risks associated with biomechanical stress, extrinsic forces, and physical demands
inherent in the performance of motor skills common to various sports.
3.18 Be able to apply biomechanical principles to a broad range of movement activities.
Exercise Physiology:
3.19 Demonstrate knowledge of physical fitness tests and proficiency in using field and commercial
fitness testing equipment and the testing protocols for the measurement of aerobic and
anaerobic cardiorespiratory fitness, power, muscular strength and endurance, flexibility, and
body composition through laboratory experiences.
3.20 Gain an understanding of the relationship of exercise physiology to the sports medicine field
and identify professional societies in which to participate.
3.21 Demonstrate an understanding of bioenergetics, recognizing the different metabolic systems,
their interaction, regulation, and how they apply to exercise.
3.22 Demonstrate an understanding of the physiological and metabolic processes that facilitate
exercise recovery.
3.23 Understand the concepts involved in measuring energy, work, and power and describe the
means by which the energy cost of exercise can be estimated and measured (including
metabolic calculations).
3.24 Demonstrate an understanding of the structure, function, mechanics, and control of the
cardiorespiratory system to include ventilation, gas transport and exchange, hemodynamics,
and cardiac output at rest and during steady-state and progressive exercise.
3.25 Demonstrate an understanding of the structure, function, mechanics, and control of the
neuromuscular system to include synaptic transmission, proprioception, muscle contraction,
and fiber typing.
3.26 Describe what a hormone is and demonstrate an understanding of the significance of specific
hormones with respect to exercise.
3.27 Expound upon why and how flexibility is related to health and athletic performance.
3.28 Demonstrate an understanding of the methods of assessing body composition, recognizing
healthy values for body fat, and what effects body composition has on athletic performance.
3.29 Recognize the differences in the physiological responses to exercise to maximum aerobic
power (VO2 max) throughout the life span.
3.30 Demonstrate knowledge of the physiological adaptations that occur with exercise training.
3.31 Identify differences in physiology between men and women that impact exercise performance
and recognize the effect of the menstrual cycle and pregnancy on fitness and athletic
performance.
9
3.32 Recognize the methods of heat transfer in the body and the physiological adjustments that
occur during exercise in extreme temperatures, and identify strategies to reduce thermal injury.
3.33 Demonstrate an understanding of the gas laws, acclimatization, and how performance is
affected by exercise at extreme altitudes.
Exercise Biochemistry:
3.34 Apply thermodynamic principles and demonstrate an understanding of the basic concepts of
metabolism.
3.35 Explain the basic concepts and kinetics of enzymes.
3.36 Explain the mobilization, utilization, and regulation of substrates at rest and exercise and the
corresponding role of skeletal muscle, the liver, and adipose tissue.
3.37 Explain the pathways of biosynthesis and their role in metabolism.
Sports Nutrition:
3.38 Demonstrate an understanding of basic nutrition concepts by differentiating between essential
and nonessential nutrients, duplicating the food guide pyramid, and having a working
knowledge of the RDA.
3.39 Recognize dietary misconceptions and fads and the impact that these can have on health and
physical performance.
3.40 Demonstrate knowledge of human bioenergetics and metabolism and how this relates to the
dietary needs of the athlete prior to, during, and after competition.
3.41 Explain the function of carbohydrates, fat, protein (amino acids), vitamins, minerals, and water
and electrolytes and their role in athletic performance.
3.42 Recognize the factors affecting body composition and the methods of determining body fat, as
well as the principles of weight control and the signs and symptoms of common eating
disorders.
3.43 Explain the effect of a variety of ergogenic aids, dietary supplements, and nontraditional dietary
practices on human physical performance.
3.44 Evaluate the nutritional profile of an athlete and make appropriate recommendations.
ECG Interpretation & Exercise Testing:
3.45 Demonstrate an understanding of the electrophysiology of the heart.
3.46 Demonstrate strategies for health screening and risk stratification and identify contraindications
to exercise testing.
10
3.47 Identify various stress test protocols and be able to select a protocol appropriate for the client
and the testing situation.
3.48 Interpret the results of an exercise test and design an exercise prescription appropriate for the
client’s capacity and goals.
Statistics & Research Design:
3.49 Demonstrate knowledge of the scientific process to include the formulation of a hypothesis,
experimental design, data collection, data analysis, and the reporting of results.
3.50 Read, synthesize, and critique exercise science and sports medicine literature, and be able to
distinguish between lay publications and peer-reviewed journals.
3.51 Develop and demonstrate competence in research, library, and computer skills by using library
resources, including computer databases, to search for literature and using statistical computer
software to analyze data.
3.52 Conduct a mini-research project and write a data based report about the project.
3.53 Present research in an oral and poster format.
3.54 Demonstrate knowledge of statistical analysis to include the organization and display of data
and basic descriptive and inferential statistical procedures.
Internship:
3.55 Integrate the knowledge obtained through classroom and laboratory experiences into an
independent (supervised) work setting.
3.56 Synthesize the pros and cons of the internship experience and develop strategies to improve
the operation of the facility where the internship took place.
SECTION 4 – Laboratory Skill Objectives: An academic program must demonstrate that 90% (13
of the 15) of the objectives are being taught for ASEP accreditation. The student should be able to:
4.1 Calibrate commonly used testing apparatus (bicycle ergometer, treadmill, and scale).
4.2 Prepare a laboratory for testing and take basic pre-test measurements (temperature, barometric
pressure, and humidity).
4.3 Identify contraindications to exercise testing and make appropriate risk stratification based on
health screening information.
4.4 Determine resting and exercise heart rate, oxygen consumption, and related hemodynamic
values (e.g., stroke volume, cardiac output, arteriovenous oxygen difference, etc.) using
metabolic analyzers and/or regression equations.
4.5 Assess resting and exercise blood pressure using manual sphygmomanometry.
11
4.6 Conduct a variety of submaximal tests that estimate aerobic capacity, using tests and exercise
modes appropriate for the client (examples include Astrand or YMCA bicycle ergometer test,
YMCA or NYU step test, Cooper 12-min run or Rockport One Mile Walk Test).
4.7 Estimate energy expenditure, workload, and oxygen consumption by mathematical calculation of
metabolic prediction equations.
4.8 Prepare a client for a 12-lead ECG and record a resting and exercise 12-lead ECG.
4.9 Read and systematically interpret an ECG to identify rate, rhythm, axis, blocks, and injury.
4.10 Conduct a maximal graded exercise test using a protocol and exercise mode appropriate for
the client.
4.11 Detect the ventilation threshold and use established criteria to determine if maximal oxygen
consumption was achieved.
4.12 Conduct commonly used tests of static (hand grip dynamometry) and dynamic (1RM) muscular
strength.
4.13 Assess flexibility using a variety of commonly used tools, such as a goniometer and a sit-andreach box.
4.14 Assess body composition by means of skinfold measurements or hydrostatic weighing.
4.15 Conduct commonly used tests of anaerobic and explosive power, such as the Wingate test and
the vertical jump test.”
Address for correspondence: Tommy Boone, PhD, MPH, MAM, MBA, American Society of
Exercise Physiologists, USA, Email: [email protected]
REFERENCES
1. Blair SN. Physical inactivity: The biggest public health problem of the 21st century. Br J
Sports Med. 2009;43:1-2.
2. Sallis R. Developing healthcare systems to support exercise: Exercise as the fifth vital sign.
Br J Sports Med. 2011;45(6):473-474.
3. Warburton DER, Nicol CW, Bredin SSD. Prescribing exercise as preventive therapy. CMAJ.
2006;174(7):961-974. DOI:10.1503/cmaj.1040750
4. Pavey TG, Taylor AH, Fox KR, et al. Effect of exercise referral schemes in primary care on
physical activity and improving health outcomes: Systematic review and meta-analysis. BMJ.
2011;343(d6462):1-14. DOI:10.1136/bmj.d6462
5. Tulloch H, Fortier M, Hogg W. Physical activity counseling in primary care: Who has and who
should be counseling? Patient Educ Couns. 2006; DOI:10.1016/j.pec.2005.10.010
12
6. Sallis RE. Exercise is medicine and physicians need to prescribe it. Br J Sports Med. 2009;
43:3-4.
7. Church TS, Blair SN. The benefits of exercise in a pill? A tough one to swallow. JSEP.
2009;31:409-417.
8. Lee IM, Shiroma EJ, Lobelo F, et al. Physical Activity Series Working Group. Effect of
physical inactivity on major non-communicable diseases worldwide: An analysis of burden of
disease and life expectancy. Lancet. 2012;380:219-229.
9. Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students
influence their counseling practices. Br J Sports Med. 2009;43:89-92.
10. American Diabetes Association. The Cost of Diabetes. June 22, 2015. http://www.diabetes.
org/ advocacy/news-events/cost-of-diabetes.html
11. Centers for Disease Control and Prevention. Stroke Facts. March 24, 2015. http://
www.cdc.gov/stroke/facts.htm
12. Janssen I, Shepard DS, Katzmarzyk P, Roubenoff R. The healthcare costs of sarcopenia in
the United States. J Am Geriatrics Soc. 2004;52:80-85.
13. O’Shaughnessy L, Haq I, Maxwell S, et al. Teaching of clinical pharmacology and
therapeutics in UK medical schools: Current status in 2009. Br J Clin Pharmacol. 2010;
70:143-148.
14. Gates AB. Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients. Br J
Sports Med. 2015;49(4):207.
15. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. (Fifth
Edition; Senior Editor: Leonard A. Kaminsky. New York, NY: Lippincott Williams & Wilkins.
16. American Society of Exercise Physiologists (ASEP). Definitions. Accessed. 5/31/2016,
www.asep.org/index.php?cID=229
17. American Society of Exercise Physiologists (ASEP). Board of Accreditation Manual.
Accessed. 5/31/2016, www.asep.org/files/5014/6482/7729/ASEP_ Accreditation_Manual.pdf
18. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from
the Centers for Disease Control and Prevention and the American College of Sports
Medicine. JAMA. 1995;273:402-407.
19. American Society of Exercise Physiologists (ASEP). Goals and Objectives. Accessed.
5/31/2016, www.asep.org/index.php/about-asep/goals-objectives/
Disclaimer
The opinions expressed in JEMonline are those of the authors and are not attributable to
JEMonline, the editorial staff or the ASEP organization.