for exercise physiologists
5 No 11 November 2002
Exercise Physiology Code of Ethics: A Dilemma or a Standard of Conduct?
PhD, MPH, MA, FASEP, EPC
Exercise Physiology Laboratories
of Exercise Physiology
of St. Scholastica
are individual faculty, whose lifetime work is dedicated to the advancement
of new thought, so apparently unwilling to take risks.” – Sharon A. Baiocco
and Jamie N. DeWaters 
DERIVED FROM THE
Greek term ethos, ethics refers to conduct and character that includes
the notion of approval or disapproval . Similarly,
the exercise physiology Code of Ethics deals with the important questions
of conduct that have relevance to us as professionals. Ethics raise
the question of what is right or wrong. The word implies a right
way to do something and a wrong way. Exercise physiologists are not
exempt from ethical dilemmas in their practice. Those who have wondered
if educated professionals can be stupid do not have to look too far, particularly
with reference to the following three dilemmas:
Ethical decisions regarding the use of grants for research from companies
that have an invested financial interest.
It is possible
of course that the three dilemmas can be viewed as ethical and acceptable,
unethical and unacceptable, ethical and unacceptable, and unethical and
acceptable. But, even so, what is the point? All four possibilities
exists when exercise physiologists fail to agree on the ethical answer
to “What is the dilemma? And, even seasoned researchers with a reputation
for some good research show ‘stupid’ behavior.” For that reason,
it is important that we come to terms with the seemingly inexplicable behavior.
Why do intelligent people think and behave in ways contrary to good common
sense? This article is devoted to addressing these questions, which
the vast majority of exercise physiologists seem to neglect. One
way to tackle this problem is implicit in the exercise physiology Code
of Ethics. This would allow the analysis of the following questions
to be treated as function of what is implied by the Code.
to make full, critical disclosure of academic and/or research information
that influences self-determination.
(or failure) to confront the public sector problems faced by students and
members of the emerging profession.
What is the right (ethical) behavior of an exercise physiologist who appears
to promote a product without scientific evidence to support it?
It’s time to stop
and take measure of these questions and to be mindful of the kind of behavior
arises when there isn’t a Code. We owe our students more thought
and analysis on this subject. If what we have been doing is ethical,
is it acceptable to continue doing so? If it is unethical (and therefore
unacceptable), then something must change. My point is this: Do non-ASEP
academic exercise physiologists have the right to simply dismiss the effort
of the American Society of Exercise Physiologists to professionalize the
field? Some feel that students have specific rights and, in particular,
the right to the support of their teachers on their behalf. To refuse
to support ASEP may therefore be interpreted as an ethical dilemma that
is seriously inconsistent with a professional education. Therefore,
it is inexcusable for the academic exercise physiologist to overlook obvious
evidence that the ASEP Code of Ethics is consistent with other ethical
procedures of recognized healthcare practitioners. The question of
why they appear to deny the existence and/or significance of the Code raises
a multitude of issues.
2. What should
the exercise physiologist say about the major difficulties with serious,
3. What responsibility
do exercise physiologists have in helping to professionalize exercise physiology?
or unethical business practices usually reflect the values, attitudes,
beliefs, and behavior patterns of the organizational culture; thus ethics
is as much an organizational as a personal issue.” -- Richard L.
Daft and Dorothy Marcic
Denial is complex,
ambiguous, and hard to understand. It is also a serious problem when
it comes to professional conduct. What is important to note here is that
if the exercise physiology Code of Ethics is not recognized, then distinction
as a profession is not possible. We must recognize the fundamental
changes underway in the delivery and practice of exercise physiology if
we are to provide a means of professional self-regulation. The Code
cannot be a fad or a fabric of the emerging profession that is seldom discussed
or embraced. There must be an enduring commitment to the Code and
to ethical research in exercise physiology. And yet it is obvious
from the lack of publications about exercise physiology ethics, quackery,
and fraud that few exercise physiologists appear ready to accept the change
in their reality. It is not a matter of ideas and behavior resulting
from inadequate information and resources. After all, the ASEP Code
of Ethics can be seen on the ASEP contact page. Ironically, perhaps,
one answer is as basic as colleagues becoming too smart or special in how
they think about themselves. Simply stated, they have become too
focused and too centered on being smart (i.e., what to think) rather than
on the constant challenge to learn how to think.
who cannot change the very fabric of his thought will never be able to
change reality.” -- Anwar El-Sadat
A case in point
is the adoption of an attitude against exercise physiologists having their
own professional organization. As we will come to understand, such
thinking is driven by wrong ideas. How we manage the ideas and how
we grow over time determine the rate and quality of our commitment to the
new exercise physiology driven by the ASEP leadership. Yet, in face
of this view, there is no reason to think that the significantly improved
credibility of exercise physiology since the founding of ASEP will slow
down. And, still, we also know that unless something is done about
the current trends in exercise science (or by other titles such as kinesiology,
sports science, human performance), then the world will see more graduates
without credible jobs. This implies that the continued duplication
of bad programs of study will only add to a poor futuristic view of exercise
physiology. Talk about a bad mind-set! It is for this reason
that the lack of respect for professional rules and standards tell others
why we are culturally viewed as little more than fitness experts.
Some even think of us as physical educators while others, in contrast,
view us with a highly valued commodity. Which view is correct?
This does, in fact, define our problem. It is also a function of
traditional thinking that has been unchanged for some time, especially
since exercise physiologists have not had a clearly-stated mission.
clearly-stated mission provides more than a ‘common cause’. It also
can provide an ethic for the firm, or way of seeking to do what is right
and avoiding what is wrong.” -- C. William Pollard 
It was not until
“a suggested Code” was published in the January 1995 issue of The Exercise
Standards and Malpractice Reporter  that it was
determined that the medicolegal considerations for an ethical exercise
physiology practice should reside in the Code. With the founding
of the ASEP organization in 1997, the Board of Directors accepted and approved
the Code of Ethics as a professional guide for all members of the organization.
Finally, the profession had an official Code of Ethics. Is it likely
that it will change across time? Codes are necessarily static.
At some point, it will be revised to keep in step with the members’ sense
of professional freedom and the effort to establish exercise physiology
as a legitimate “profession”. The concern for ethics, if not the
soul of exercise physiology, will no doubt be reflected when the members
of the Board of Directions undertake a revision at some point in the future.
Perhaps, before confronting a change in the Code or whether a change is
even appropriate at this time, it is appropriate to deal with the three
ethical dilemmas mentioned earlier.
Research, and Publishing
A number of
academic exercise physiologists write research proposals for grants to
help with the financial obligations of doing research. This is not
new or necessarily a problem, but it can be a problem depending on how
the research conclusions are presented. Indeed, in recent years,
researchers from different fields of study believe that it has become an
ethical problem and a moral conflict that needs immediate clarification
and resolution. The concern of ethics has to do with the accuracy
and interpretation of the findings. Otherwise, what is the point
of statistical analysis and published research? In short, the principal
aim of published research in exercise physiology is to provide consistency
to a more precise management of ideas. Hence, the first question
is always: Have the authors presented the data and the conclusions in the
most ethical manner possible?
do you think? Like most exercise physiologists, I figured that everyone
was always publishing the truth. It was not until some time into
my teaching career that I realized that some research articles simply did
not make sense. Either the author(s) used the wrong statistics, interpreted
the data wrong, or made conclusions that were not consistent with the findings.
Eventually I came to understand that some research articles are little
more than a “product” market for a specific reason. Now that I understand
the “big picture” or the view that others may have always understood, it
is no longer surprising to me when reading articles that some authors have
failed as scholars. Disagreement about the design, the statistical
application(s), and the interpretation(s) is always a step away, but it
should not constitute an obvious conflict in the integrity of practitioners
and their work.
discerning eye that sees through the lack of professionalism is the striking
picture of the 21st century exercise physiologist. Why is this important?
Because professionalism is about honoring a Code of Ethics, especially
during times when healthcare ideas are undergoing sweeping changes.
It is very likely that these changes are founded on the idea and financial
consciousness that more is better. Is more better even when it is
wrong? Are the “get rich” opportunities the best guide for character
development and, if so, what is the role of the standards of conduct that
define the essentials of honorable behavior for the exercise physiologist?
It is unfortunate that a fair piece of our research is little more than
advertisements for products that have limited if any benefit to the public
sector. For this reason, the current system for securing research
money should change because of the confluence of business conditions that
create serious questions regarding professional integrity. As an
example, consider the Principles 4, 6, and 10 adopted by the American
Society of Exercise Physiologists:
physiologists are expected to conduct health and fitness, preventive, rehabilitative,
educational, research, and other scholarly activities in accordance with
recognized legal, scientific, ethical, and professional standards.
is this standard important? I believe it was the American writer,
Ursula K. LeGuin, who said: “It is good to have an end to journey toward;
but it is the journey that matters, in the end.” The honoring of
what we do as professionals requires a commitment to excellence in the
science of our practice and a commitment to our set of ethical behaviors.
Every paper we publish along the way is a reflection upon our journey and,
in the end, it will be the papers that define us. If our work shows
that we have been traveling in the right direction with a commitment to
excellence in research and scholarly activities, then our progress can
be measured by what we have done.
physiologists are expected to call attention to unprofessional health and
fitness, preventive, rehabilitative, educational, and/or research services
that result from incompetent, unethical, or illegal professional behavior.
is this standard important? As professionals, even when we would
rather not disagree with our colleagues, it is important that we remain
credible in our actions. In short, there are actions resulting from
advances in technologies and personal self-interests that must not be tolerated
. Unethical uses of science and technology,
either personally or by association, harms the profession we serve as well
as our fellow exercise physiologists. It is therefore unthinkable
and unwise not to bring attention to unprofessional services. Remember,
in actuality, it is no different from the student who is looking on another
student’s paper for the answers. The behavior is not (or should not
be) tolerated. To allow it to take place without doing anything about
it is to argue that the educational process itself is meaningless and/or
has no integrity. What we do must have meaning and direction if we
are going to realize our goals.
physiologists should provide health and fitness, preventive, rehabilitative,
and/or educational interventions grounded in a theoretical framework supported
by research that enables a healthy lifestyle through choice.
is this standard important? The obligation to provide ethical
care grounded in good science is the obligation of every member of the
profession. It is both a privilege and a responsibility to regulate
the conduct of what we do, individually and collectively. This point
has two lessons: First, if we can accurately convey the real value
in exercise, more people will embrace it as part of their lifestyle.
Second, don’t be surprised when people turn away when frustrated by our
wishful thinking or the insistence that “our way” is the better way when
we have failed to ground our thinking with disciplined research.
Change is a challenge
and, most importantly, with it must come an understanding and sensitivity
to both integrity in research and the kind of service that is helpful in
meeting the needs of society. It is imperative therefore that we
look critically at what we are doing (especially within the framework of
research). The final chapter isn’t written for sure, but there is
considerable room for improvement. For example, let us imagine the
worst resulting from our research where we allow the communication of our
work in the form of a published article that the conclusions are false.
The impact may be profound on those who are willing to believe anything
they read. Naturally, the author(s) may understand why the conclusions
were written in a particular manner (especially if the research is related
to a grant). What is obvious (or should be) is that the reader will
not know about the admixture of research conclusions and grant funding!
What may be viewed as a scientific publication by the public may in actuality
be little more than an advertisement.
This is an
unfortunate, if not, a sad view of what was once an ethical effort on behalf
of researchers. When asked, “What happened?” -- the only answer
it seems is that the researcher(s) priority changed. As a result,
neither exercise physiologists nor their students can assume that “scientifically”
published research is credible. Naturally, the problem with researchers
who make poor judgments is that the assumed rightness of their actions
in relation to the publication can no longer be preserved. This means
that the peer review process that has been used to judge research quality
needs reviewing. Often, there are conflicting if not confounding
variables with reviewers including, but certainly not limited to their
ability to think critically, their research and/or professional experiences,
and whether they are competitors or friends. These factors and others
have a direct bearing on whether an article is true or accurate when published
in an important journal and, unfortunately, most students assume that if
it is published it must therefore be accurate .
of exercise physiologists to each other as well as the dignity of the profession
is viewed as less than professional when fraud and misconduct are found
in their science. Exercise physiologists have the obligation to conduct
themselves in accord with the ideals of the profession. The Exercise
Physiology Code of Ethics should therefore mean something, especially since
it helps the practitioners to meet the exercise physiology service-needs
of the 21st century society. The Code serves as a guide to its members
in their day-to-day work activities. It helps them arrive at professional
conclusions and time-honored principles of professional thinking .
Ideally, exercise physiologists should observe the ethical principles because
they understand that the principles define who they are and what they do.
ultimate purpose of being a professional is not, or should not be, simply
to do research. Nor is it merely a system of promoting oneself, as
in tenure. The promise of professionalism is to associate with other
professionals who embrace the ethical philosophy and path of professionalism.”
– William T. Boone, Jr.
Think Straight Leads to Disclosure Problems
is that exercise physiologists are by and large good people. They
have spent time and money in pursuit of the right ideas to prevent and/or
promote physical and mental well being. But their decision making
and advice at the end of the day in regards to health, fitness, and rehabilitation
often times reflects a ready-made answer found in traditional thinking.
Few seem ready to question the founding principles or discern the diversity
of choices for action as a complex human being. That is, the content
of exercise physiology is at times simply over-bearing and too narrow in
its interpretation of many aspects of health and/or disease related matters.
Even at a gut-level feeling, the delivery of information is clear about
what not to do. But it seldom functions at a level to clarify the
physiologists should accurately communicate and provide health and fitness,
educational, preventive, rehabilitative, and/or research services equitably
to all individuals regardless of social or economic status, age, gender,
race, ethnicity, national origin, religion, disability, diverse values,
attitudes, or opinions.
is this standard important? An accurate communication of exercise
physiology concepts and ideas is critical to achieving professionalism.
physiologists should participate in and encourage critical discourse to
reflect the collective knowledge and practice within the exercise physiology
profession to protect the public from misinformation, incompetence, and
is this standard important? New, ASEP exercise physiologists
exist because the old-style academic-researcher-only is slowly but surely
changing. The idea that research will provide the student with the
paid-for-product (i.e., the academic degree) fails to demonstrate a responsible
understanding of the purpose of a college education. It is clear
to me that many academic exercise physiologists understand this point,
but appear inadequate when faced with the profound challenge to support
the infrastructure of the new exercise physiology. Students, in particular,
need an education to help them think critically with a collective understanding
that goes beyond what to think. College teachers should be paid for
how well they teach critical, multifaceted thinking of the complexity of
life and disease, not the results of continued memorization of the traditional
public health agenda and, therefore, the simple mandates of thinking that
A leads always to B. The sense of invulnerability, as a teacher,
may come from the presence of the illusion of protection .
After all, it is the teacher who passes along the knowledge that others
use in order to achieve success in life.
physiologists should be responsible and accountable for individual non-medical
judgments and decisions about health and fitness, preventive, rehabilitative,
educational, and/or research services.
is this standard important? A case can be made that exercise
physiology does not have a defined leadership in academia. We know
there is essentially no discussion about which courses should be taught,
how they should be taught, and what kinds of technology and hands-on experiences
are required to develop the best students. This is not the only problem.
There simply is not enough guidance by college teachers or the communication
between the administrators of university programs or among exercise physiologists
in general to argue for an ethical rightness and/or proper overview of
the enormous assumed benefits of the vast array of different academic degrees.
Here is the problem: Students should get what they pay for. And,
if students fail to get what they assume they are getting, both in an education
to think critically and in an academic degree to secure a credible and
financially rewarding job, then it comes down to a terrible performance
by the teachers. This point of view is especially significant if
the teachers are failing in an important modification of curriculum for
better learning and integrated understanding of disease prevention and
risk factor assessments.
physiologists should respect and protect the privacy, rights, and dignity
of all individuals by not disclosing health and fitness, rehabilitative,
and/or research information unless required by law or when confidentiality
jeopardizes the health and safety of others.
is this standard important? Respecting and protecting the privacy,
rights, and dignity of others defines the professional. Our relationship
with others is what our thoughts make of it. If we think positive
thoughts and have the conviction to be professional in our work, then we
will certainly be on the right road to ethical behavior. It may sound
a bit too easy, but respecting the rights of all individuals is a power
we hold in our heads . It is a mental attitude:
We either think as professionals or we don’t. The reality is if we
do, then we are and, if we don’t, we aren’t.
of ethics also have to do with personal conflict between two paths.
One is obvious because it has always been the way. The other (or
alternative) is either de-emphasized or made fun of because it conflicts
with perceived responsibility and/or duty. The first problem is in
believing in the notion that the historical way is always the right way.
What is the meaning in doing something wrong, especially when it is hurtful
just because it is safe and non-threatening? The second problem is
characteristic of one form of behavior that failed to mature; behavior
that denies responsibility and action that has significant implications
for students. The stakes are very high, especially with the spotlight
on the students’ huge financial sacrifice and the motivation to “get a
better job” and “make money”. Today, professors are teaching students
who are paying customers and they paying for a product [1,10].
physiologists should maintain high quality professional competence through
continued study of the latest laboratory techniques and research in preventive
and rehabilitative services.
is this standard important? Frankly, if there is an evaluation
of an academic program, it is consistently geared to the number and type
of course offerings, not the number and type of laboratory offerings.
Yet, the quality of professional competence is directly a function of the
latest laboratory equipment that is used by the students, not just by the
faculty. Students must have the opportunity to calibrate metabolic
analyzers (and, similarly, use and become accustomed to other laboratory
equipment that measures strength, flexibility, and muscular endurance),
ask research questions, create data collection protocols, statistically
analyze data, and write up research reports with clarity and precision
of a professional. If the students cannot pass the ASEP Board of
Certification exam, either the teachers’ motivation and/or teaching techniques
should be evaluated and/or improved.
physiologists should contribute to the ongoing development and integrity
of the profession by being responsive to, mutually supportive, and accurately
communicating academic and other qualifications to colleagues and associates
in the health and fitness, preventive, rehabilitative, educational and/or
research services and programs.
is this standard important? As a reality check, we should support
the professoriate (faculty) on the basis of the professional performance
of their students. If the students’ ongoing development and integrity
are consistent with the body of knowledge of exercise physiology professionals,
the faculty should be congratulated. If the results are less than
impressive, then the faculty should consider either a different job or
what is necessary to improve the students’ chances of securing a professional
job in the public sector. This should not come as a surprise or as
a threat to the faculty working to improve exercise physiology; a process
that begins with small but significant incremental steps with students.
physiologists should participate in the profession's efforts to establish
high quality services by avoiding conflicts of interest and endorsement
of products in the health and fitness, preventive, and/or rehabilitative
services and programs.
is this standard important? Without a shared sense of purpose
and a unified vision, it is next to impossible to work together and/or
create something special. This is an important reason people tend
to devote less time and attention to the objectives of an organization.
It is also a reason why exercise physiologists fail to avoid conflicts
of interest and endorsement of products that threaten credibility.
The final test of ASEP and its membership (including the leadership) is
that they must have a positive impact on the entire spectrum of professionalism.
In other words, ASEP exercise physiologists must endorse products that
are supported by sound research.
It is astonishing
that so few academic exercise physiologists understand the negative consequences
of continuing the same unwarranted and unwanted (and even outdated) thinking.
Talk about a moral dilemma! Talk about an ethical concern!
Ethics appear to be the last thing on the minds of some exercise physiologists,
and yet one of the essential features of a profession is that it is self-regulating
. Their commitment to traditionalized thinking
continues to raise many of the same research questions. The question
that should be researched is whether the academic exercise physiologists
are in touch with the reality of their students? With all due respect
(and personal pride as a college professor), there is also the question
of whether we can justify our existence if the very foundation upon which
we evolved is not reinforced with new thinking. Even one person can
make a difference; think about it. To continue to ignore the power
of past thinking on higher education is patently foolish. To continue
to ignore the importance of our code of professional conduct and the work
that other healthcare practitioners have put into their codes is a major
problem. A code of ethics is essential to establishing professional
standards that define a profession .
is from numberless diverse acts of courage and beliefs that human history
is shaped. Each time a man stands up for an ideal, or acts to improve
the lot of others, or strikes out injustice, he sends forth a tiny ripple
of hope.” -- Senator Robert F. Kennedy (1925-1968)
What is Our Professional Responsibility?
As far as
I am concerned, seldom is the opportunity for change so desperately needed.
Members of the emerging profession must ask themselves, “Who are we, and
what is our purpose?” And, in fact, seldom have so many good college
teachers failed to acknowledge the cultural change before them. This
fact alone is a significant loss in confidence in those who profess to
nurse and/or build the curricula of job opportunities through their teaching.
Yet despite the hardships of our students when they graduate, those who
enjoy tenure continue to do so while their students have a hard time in
finding a job to secure finances. Today’s professors are faced with
the challenge of not just shared values and education but the question
of careers, too. Whether we like it or not, the current system is
not working. The caveat here is critical: College teachers must come
to understand that professional programs of study are grounded in ethical
reasoning, moral concerns, and values that reflect upon the students and
the profession. Why? “A code of ethics is a formal statement
of the company’s ( organization’s) values concerning ethics and social
issues; it communicates to employees (members) what the company (organization)
stands for” . As a member of the ASEP organization,
members will almost surely face ethical dilemmas. The answers to
the following questions [12-14] will help you to think
about the professional, social, and ethical consequences of your actions,
relationships, and/or research proposals:
Is the dilemma really what it appears to be? If you are not sure,
it is your responsibility to find out.
“It is a professional
obligation to uphold and abide by the exercise physiology Code of Ethics
and ensure that exercise physiology colleagues do likewise.”
2. Is the action,
relationship, and/or proposal you are considering legal and/or ethical?
If you are not sure, it is your responsibility to find out.
3. Do you understand
the thinking and/or rationale of those who oppose the action you are considering
or you are presently engaged in doing? If you are not sure that you can
justify your actions, it is your responsibility to speak with a person
who does and come to terms with the dilemma.
4. Does your
action, relationship, and/or proposal benefit you, yet may harm others
(if nothing else by mis-information)? If you are not sure, it is
possible that your involvement may be a mistake.
5. Are you
convinced of the benefit of the action, relationship, and/or proposal that
you would encourage everyone to purchase and/or consume or use the product?
If you are not sure, it is your responsibility to determine the scientific
merit of the product.
6. Have you
considered speaking with a person who has scientific knowledge about the
product? If you have not done so, why not? Knowing what to
think is not always easy. Speaking with someone who would be objective
may be very helpful.
7. Would your
action, relationship, and/or proposal be embarrassing to you if others
knew what you were doing? If you are not sure, it is your responsibility
to find out. Ask a friend from a related area of work or, perhaps,
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American Society of Exercise Physiologists All Rights