From the Swimming Pool to Precision Cardiovascular Physical Therapy: What a Journey!

Good afternoon. I would like to start by thanking the American Physical Therapy Association's Academy of Cardiovascular and Pulmonary Physical Therapy, its awards committee, and those who nominated me to receive this prestigious award. I did not have the chance to meet Dr. Linda Crane. According to previous awardees of this award, she was a trailblazer, a great clinician, and a very kind person.1-7 Receiving this award with her name and reading from other trailblazers, great clinicians, and kind persons is humbling to the core. For those who know me, I always say that I am not from this planet, especially when dealing with topics from the American culture. This lecture is a story on how I have found my tribe here in the United States, and how, I hope, the tribe will learn something from my planet. I always like to start my talks with this quote from Albert Einstein, “imagination is more important than knowledge” because I think that creativity and thinking outside the box is always something that we need to encourage our students and colleagues. As some of you know, I am originally from Chile and a former swimmer. Someone once said that Chileans are the British of South America. Not because of a kingdom or really good manners, but because of the sense of isolation. We are way down South, behind the Andes Mountains, beside the driest desert on earth, and bathing in the Pacific Ocean. Back in the old days, nobody wanted to visit because it was hard to get there. People from Europe always ended their journeys either in Brazil or in Argentina, and this is why Brazil and Argentina have much richer cultures and exchanges with the rest of the world. Swimming was my way to escape this sense of isolation. Not that I started swimming my way out in the ocean but by having the chance to travel and see other places. Competing for team Chile, I was able to see the world. I was lucky. I grew up in a stable middle-class family. My dad was an entrepreneur, I knew at least 6 different businesses that he tried and succeeded in and many others where he didn't succeed, and retired as a department store supervisor. He taught me that nothing comes easy and that hard work always pays off. My mom was a high school biology teacher. She taught me about the power of education and science. She was always grading papers and learning new things from different certificates, diplomas, and professional development courses. She still teaches. In fact, my students have learned from her as she has had several health conditions related to PT and cardiovascular pathophysiology that make her the perfect case study. Her last lesson was a perfect cardiopulmonary case when she survived Takotsubo syndrome 9 months ago. This culture of hard work and science ignited a need to learn how things worked. I lost count of how many wristwatches and portable transistor radios I took apart in the 80s. In high school, I thought that engineering was my path as I wanted to create stuff, until we had a biology laboratory where we dissected a rat. It blew my mind away. I wanted to know how the human body worked. It changed the way I would apply for college. As a high-performance swimmer, I always loved physical activity. Therefore, the natural path was … being a swimming coach. I did not want to be a surgeon, which was the second option. I did not know what physical therapy was, as I never got injured and I was never exposed to rehabilitation. But luck struck again. I got accepted to the only Kinesiology school in Chile at that time. Before I move on, I need to disclose some differences between the United States and the Chilean educational systems and show you that the same words can mean different things, especially in different worlds. First, there is not an undergraduate education in Chile. You go from high school to professional school; PT is a five-year degree. The first 2 years you take several general and foundational courses, what would be considered “prerequisite” here in the United States, but these courses are connected to your next 3 years: Two years of PT didactics and 1 years of clinical rotations. It is similar to the United States, but it is straight from high school, which has pros and cons. The pros are that you can get your degree in 5 years instead of 7. The downside is that most of the people are not ready to accomplish high-level learning when they are just 18 years old. There are multiple people who I know, in their third year of PT school are getting into the real PT school content, leave because they discover it is not for them. And when they move to another profession such as medicine, dentistry, law school, etc., they need to start from zero. Some people can think that this five-year model is better, but I think that the undergraduate education here in the United States allows for greater maturity for students to understand what they really want to be. Second, early PT in Chile was influenced by Europe, especially Belgium, where PT is called “Kinésitherapie”, or in Spanish “Kinesioterapia”. Translated that means Kinesiotherapy or therapy through movement. During the late 80s and early 90s, there was only 1 school of Kinesiology or “Kinesiología,” which in Chile means “clinical movement sciences”. This is the school that I went to. It has a focus in 3 applied sciences, critical thinking, and evidence-based practice (EBP). These 3 applied sciences were applied anatomy or biomechanics, applied physiology or exercise physiology, and applied neurology or neurorehabilitation. The other 3 schools that we had in Chile at the time were called “Kinesiterapia”. These schools were more technical schools with less EBP and applied sciences. The professional degree is “Kinesiólogo” or Kinesiologist. That is what PTs are called in Chile. In early 2000, all the schools became kinesiology schools. All the schools that were called “kinesiterapia” saw the value of centering more on applied sciences and EBP than just the technical aspect. Finally, and because of the aforementioned factors, PT practice in Chile looks different than that in the United States. There is no exercise science because we do not have an undergraduate education and people do not have the option to have a bachelor's degree in exercise science, so they go into physical education. It is a professional school because we need teachers in the schools or coaches in the athletic environment. In addition, we do not have athletic trainers. Moreover, we do not have respiratory therapy or chiropractors as professional paths. Chilean PTs do all the above: athletic rehabilitation, respiratory therapy, and spinal manipulation. I like to think about my Chilean colleagues as Swiss Army knives. However, we do not have direct access, except for respiratory therapy during wintertime, where Chilean PTs can diagnose and treat upper respiratory illnesses to prevent hospitalizations and deaths in children and the elderly. My early professional years were full of several interesting activities. First, and as soon as I finished PT school, I did a post-professional diploma in exercise science. I went to Argentina to the Biosystem Institute to work with Dr. Juan Carlos Mazza, who was trained by Dr. David Costill at Ball State University in Indiana, where I learned about the use of lactate metabolism as a marker for exercise intensity. In addition, I got introduced to the American College of Sport Medicine and its annual meeting, which I attended for the first time in 1998. Then I worked as a clinician for 15 years in cardiovascular rehabilitation, sports rehabilitation, and sports performance. My background gave me the tools to be able to combine these 3 things and most of my patients in cardiovascular rehabilitation were training using the same principles as high-performance athletes.8 In 1998, I got an adjunct position in the School of Kinesiology (i.e. Physical therapy) at the Pontificia Universidad Católica de Valparaíso, where I moved up the ladder from a young adjunct professor to tenured faculty. So, what do you do after 15 years in the profession, you have your own clinic with many patients, and athletes that follow you? In fact, I had 2 clinics. I was tenured in a PT school. I was doing research. I was teaching. I was doing service. I was living in a nice place by the beach. So, what would you do? Well, you go back to school. I moved thousands of miles north to the University of Florida to pursue my PhD. I wanted to have a PhD in exercise physiology, something that is not very common right now. During my gator years, I first went to the College of Health and Human Performance in the Department of Applied Physiology and Kinesiology. Dr. Randy Braith accepted me in his laboratory as a research assistant. It was an amazing experience where I learned many noninvasive cardiovascular assessment tools, as well as some invasive techniques such as endothelial cell biopsies. I'll be forever grateful to Randy for taking me into his laboratory. Then, when I finished my PhD, I went to the School of Medicine at the University of Florida Department of Physiology and Functional Genomics to do my postdoc. Instead of having 1 mentor, I had 3 mentors: Dr. Judy Delp who taught me a lot of in situ techniques in vascular biology, Dr. Chris Baylis who was the director of the Hypertension Center at the University of Florida and taught me about vascular regulation in the kidney, and Dr. Debbie Scheuer who taught me about cardiovascular control in the central nervous system. In 2011, it was time to make a decision: to stay or not to stay in the United States? On the one hand, I had my job in Chile, my whole family in Chile except for my wife who was with me, and I found things a little complicated here in the United States. Why are there so many different people working in the same field but do not work together? For example, a clinical exercise physiologist, who has a bachelor's or a master's degree in kinesiology (kinesiologist) with an ACSM certification and working with patients. Well, is not that a PT? Why do we need clinical exercise physiologists if we have PTs? Or a biomechanist with the same bachelor's or master's degree in kinesiology working in biomechanics? I was educated like a PT. We deal with biomechanics every time you treat a patient. Why are they so siloed here? Why things are so different? On the other hand, and even though I was in a kinesiology department, I learned more about the PT world in the United States. I had a spy at the Department of Physical Therapy at University of Florida: My wife Carolina. My wife was pursuing her PhD in Rehabilitation Sciences at the same time as me, under the mentorship of Dr. Steve George who most of you know and is the new editor-in-chief of the PT Journal. So, Carolina introduced me to this PT environment with Steve, Krista Vandenborne, Carolyn Pattern, Mark Bishop, and others, and I was able to understand the differences in clinical practice a little better. However, I really was at the edge of a neuropsychiatric disorder wondering “Who am I”? What can I do with everything I've learned? I was like Jean Valjean from Les Misérables asking “Who am I”?9 I had 3 options: (1) I have to a Kinesiology department as I had a really good and I was in one of the of the I have to a physiology department like many of my and I had another great in physiology through or I go to a PT school where my was very but I knew that they were for PT with As Jean I was not able to my a physical Therefore, I applied to in the United States. 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And that is Physical the exercise that will and to the health of our patients. you very much to the Academy of Cardiovascular and Pulmonary PT for this amazing of the Linda I I have Dr. and in the way in which she would have