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Certified Exercise Physiologists

Educated Leaders in Fitness and Beyond

Cooper, Stephanie L. Ph.D., ACSM-EP; Ward-Ritacco, Christie L. Ph.D., FACSM, ACSM-EP, EIM-II; Maloney, Tony B.S., ACSM-EP; Collins, P. Blaise Ph.D., ACSM-EP

Author Information
ACSM's Health & Fitness Journal: 7/8 2022 - Volume 26 - Issue 4 - p 23-27
doi: 10.1249/FIT.0000000000000781
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An exercise physiologist (EP) is an individual who possesses a comprehensive understanding of how the body responds to acute and chronic bouts of exercise. EPs use this knowledge to assess fitness levels and health outcomes, and use exercise training to improve physical fitness, physical performance, and health. EPs are distinguished from other exercise professionals because of their formal education, as EPs are required to have at least a bachelor's degree in an exercise science–related field. In reality, the educational backgrounds of EPs vary in level — Bachelor of Science, Master of Science, or Doctor of Philosophy — and degree program titles vary in name, including but not limited to, exercise physiology, exercise science, movement sciences, kinesiology, and sports medicine. EPs typically complete coursework focused on exercise physiology, skeletal muscle physiology, exercise testing and prescription, biomechanics, and behavior modification within a diverse spectrum of healthy individuals and special populations, including those with metabolic disorders, cardiovascular disease, cancer, and pregnancy. The majority of university degree programs also provide opportunities for experiential learning and internship placement to enhance student classroom education.

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An exercise physiologist (EP) is an individual who possesses a comprehensive understanding of how the body responds to acute and chronic bouts of exercise. EPs use this knowledge to assess fitness levels and health outcomes, and use exercise training to improve physical fitness, physical performance, and health.

Degreed exercise professionals are often divided into two groups, EPs and clinical EPs (CEPs). Based on their education and training, EPs are skilled in developing exercise programs for healthy individuals looking to improve health-related and sport-related fitness, as well as applying exercise principles to reduce disease risk. Additionally, EPs may work with individuals with stable chronic conditions (e.g., hypertension, diabetes) and special populations, such as those experiencing pregnancy. Comparatively, CEPs specifically engage with special populations and those with higher risk medical conditions who require specialized programming in facilities that explicitly cater to those populations.

Professional organizations have created certifications to recognize individuals who have obtained sufficient competency in the knowledge, skills, and abilities required to be an impactful EP. Certifying organizations require specific qualifications and training for candidates to ensure highly qualified individuals are certified. The American College of Sports Medicine (ACSM) requires Certified Exercise Physiologist (ACSM-EP) candidates to possess a minimum of a baccalaureate degree in an exercise science–related field from a regionally accredited institution of higher learning, and the Certified Clinical Exercise Physiologist (ACSM-CEP) must have a minimum of a baccalaureate degree plus a specific amount of clinical experience (currently 1200 hours, or a master's degree and 600 hours of clinical experience) (1). Obtaining a certification is one way in which EPs can confirm their knowledge base is sufficient and demonstrate that they can perform the required job tasks for successful entry into the workforce since there is a lack of consistency in degree requirements for EPs and CEPs in higher education (2).

Obtaining a certification is one way in which EPs can confirm their knowledge base is sufficient and demonstrate that they can perform the required job tasks for successful entry into the workforce since there is a lack of consistency in degree requirements for EPs and CEPs in higher education.

To ensure that ACSM certification exams are valid and reliable tools to evaluate candidates' knowledge, skills, and abilities related to the profession (and passing the exam reflects that they are minimally competent to enter the workforce), ACSM conducts a Job Task Analysis (JTA) for its core certifications every 5 years. The JTA process engages subject matter experts, actively employed and certified professionals, in focus groups and survey format to revise and update exam content to reflect the current knowledge and skills of practicing ACSM-EPs and ACSM-CEPs. ACSM develops exam content outlines from the JTAs that are accessible to the public to provide transparency for both the candidates for certification as well as employers (3). It also should be noted that ACSM has begun to take steps to further unify the educational backgrounds of ACSM-EPs and ACSM-CEPs by requiring institutions to become programmatically accredited by an independent accrediting commission (i.e., Committee on Accreditation for the Exercise Sciences via the Commission on Accreditation of Allied Health Education Programs) in order for students to sit for certification exams. This change will occur in August 2027, with the goal of reducing variance in program requirements between college and university exercise science–based programs and ensuring that EPs have the in-depth knowledge, skills, and abilities required of advanced exercise professionals within the workforce.

With the appropriate education, training, and experience, certified ACSM-EPs can seek employment opportunities centered around assessing, prescribing, and implementing exercise programs for disease prevention and treatment, as well as optimizing health, fitness, and performance for a variety of populations, in a number of different settings. Employment opportunities can be found in corporate/worksite wellness programs, boutique fitness studios, large fitness centers, colleges and universities, and hospital systems (Table 1). The day-to-day tasks and roles of EPs strongly depend on the setting in which they work, their accumulated professional experiences and training, as well as the population(s) that they serve. Examples of the tasks that are often performed, such as conducting preparticipation screenings, risk assessments, measuring and evaluating health-related fitness, developing and implementing individualized exercise programs, and using behavior modification strategies, can be found in Table 2, and the populations with which those tasks are performed can be found in Table 3. Additionally, EPs often provide educational information to program participants on the benefits of regular exercise for physical and mental health.

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TABLE 1:
Common Workplaces for Certified EPs
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TABLE 2:
Common Tasks Performed by Certified EPs
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TABLE 3:
Populations Who Work with Certified EPs

Worksite-based wellness programs typically employ EPs to supervise onsite fitness centers for employees. In this role, EPs conduct fitness assessments, develop exercise prescriptions, provide individual and group-based exercise instruction, and monitor the onsite fitness offerings. The goal of worksite wellness-based programming is to improve and maintain the health and wellness of the employees and in turn improve work-related productivity. Commercial and community fitness centers exist in all sizes and cater to a number of interests and abilities for their clients — people seeking opportunities for general fitness improvement, those aiming to improve their sport-specific performance, individuals who prefer group fitness classes, and/or specialized class offerings reflecting current fitness trends. Lastly, institutions of higher education often have opportunities for employment for exercise professionals in several roles: research coordinators and assistants for physical activity/exercise-based research, and program directors and fitness instructors who staff university-based recreation and fitness centers. Professors who provide classroom and laboratory-based instruction for bachelor's and master's prepared students are often certified as well, ensuring that their students are properly prepared for certification exams and entry into the workforce.

Hospital-based exercise programs are unique in that certified exercise professionals (EPs and CEPs) often work with interdisciplinary teams of health care providers (HCPs) across the full spectrum, from those in metabolic disorder education to physicians. Physical activity is one of many strategies used by health care teams to manage and improve chronic disease conditions; creating and implementing effective exercise programming is the expertise of an EP and CEP. Employment opportunities are often available in cardiopulmonary rehabilitation programs due to the importance of having qualified exercise and health professionals to aid in the rehabilitation process. CEPs are most commonly employed in rehabilitation settings due to their specialization in clinical populations, whereas EPs can successfully engage in these environments with continued education and training, generally under the guidance and management of CEPs.

There are numerous other populations that would benefit from working directly with an EP to improve quality of life, mitigate disease risk, and enhance health, demonstrating that EPs are underutilized members of hospital-based health care teams. EPs at all levels of expertise (i.e., ACSM-EP and ACSM-CEP) should be part of a multifaceted health care team that works to enhance the lives of individuals experiencing: aging, physical function declines, diabetes, pregnancy, recovery from injury, cognitive declines, cancer, and a multitude of other disease states. Despite being qualified to work with such populations, there is a disconnect between EPs, CEPs, and the health care system. Kharmats et al. (4) recently suggested that medical professionals may hesitate to refer patients to qualified professionals for health-related behavior change, including exercise, due to the lack of insurance coverage for services provided by EPs and CEPs (4). Determining best practices for HCPs referring patients to EPs and CEPs must continue to be explored through initiatives such as Exercise is Medicine® (5).

EPs at all levels of expertise should be part of a multifaceted health care team that works to enhance the lives of individuals experiencing: aging, physical function declines, diabetes, pregnancy, recovery from injury, cognitive declines, cancer, and a multitude of other disease states.

Establishing a systematic way to conduct EP referrals for patients with medically controlled chronic conditions or those seeking assistance with preventative health strategies must be prioritized to minimize patient burden (e.g., insurance coverage, HCP relationships). This would potentially reduce barriers to EP referral and reduce the strain on the health care system. The opportunity for EPs to have a positive effect on an individual's health is potentially a result of the higher frequency of engagement with clients (2 to 3 times per week) compared with the lower frequency by which physicians engage with their patients (1 to 2 times per year). EPs should be considered key contributors to enhancing individuals' health as qualified professionals who are included in a multifaceted health care network.

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Although strides have been made in establishing EPs as educated fitness leaders who are able to serve individuals with diverse physical abilities and fitness levels, their position within suitable health care–related settings is still underrepresented. This is of particular importance when acknowledging a limitation of most HCPs is that they are not expected to be experts in exercise science. Thus, qualified experts (e.g., EPs) should be referred to and relied upon to engage the general population in preventative health measures as well as to provide exercise guidance for those with controlled chronic diseases. One way to strengthen the relationship between HCPs and EPs would be to ensure that EPs are earning ACSM certifications, which has its certification process accredited by an outside organization (National Commission of Certifying Agencies [NCCA]). NCCA accreditation ensures that the development, implementation, maintenance, and governance of the certification program is fair, valid, and reliable for candidates and that the program meets the standards expected by the field. As a result of having proper oversight on certification, HCPs and facilities that hire or refer out to certified EPs should be confident in their ability to provide science-based exercise programming and apply behavior modification techniques to individuals with various levels of well-being as defined by the knowledge, skills, and abilities that they possess, as determined by their ACSM certification.

BRIDGING THE GAP

Exercise physiologists are educated professionals who use science-based exercise principles to enhance the physical and mental well-being of healthy individuals, individuals with stable chronic conditions, and special populations. Obtaining an ACSM Exercise Physiologist (EP) certification allows employers, HCPs, and patients/clients to have confidence in the certified professional's ability to provide proper exercise programming and behavior change techniques for the general population, including individuals with medically controlled chronic conditions, such as hypertension and diabetes. Those who obtain an ACSM Clinical Exercise Physiologist (CEP) certification have additional experiences through clinical observation and/or graduate-level training at the time of certification and often work with clinical populations with greater health risks rather than the general population with stable chronic conditions. Continued progress must be made in strengthening the relationship between HCPs and EPs/CEPs in order for patients to receive accurate information about the health benefits of exercise and help facilitate exercise behavior change.

References

1. American College of Sports Medicine [Internet]. Indianapolis (IN): American College of Sports Medicine; 2021. Become an ACSM Certified Clinical Exercise Physiologist. [cited 15 June 2021]. Available from: https://www.acsm.org/get-stay-certified/get-certified/cep.
2. American College of Sports Medicine [Internet]. Indianapolis (IN): American College of Sports Medicine; 2020. ACSM Certified Exercise Physiologist Exam Content Outline. [cited 15 June 2021]. Available from: https://www.acsm.org/docs/default-source/certification-documents/ep/acsm-certified-exercise-physiologist-exam-content-outline.pdf.
3. American College of Sports Medicine [Internet]. Indianapolis (IN): American College of Sports Medicine; 2020. Exam Content Outlines. [cited 13 September 2021]. Available from: https://www.acsm.org/get-stay-certified/get-certified/prepare-for-exams/exam-content-outlines.
4. Kharmats AY, Pilla SJ, Sevick MA. USPSTF recommendations for behavioral counseling in adults with cardiovascular disease risk factors. JAMA Netw Open. 2020;3(11):e2029682.
5. American College of Sports Medicine [Internet]. Indianapolis (IN): American College of Sports Medicine; 2021. Exercise is Medicine. [cited 15 June 2021]. Available from: https://www.exerciseismedicine.org/.
Keywords:

Exercise Physiologist; Certification; Exercise is Medicine

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