The Clinical Exercise Physiologists Interview Series: Steven J. Keteyian, PhD, FAACVPR

This is the second installment of a series of interviews with individuals who are clinical exercise physiologists (CEPs) and/or have greatly contributed to the field of clinical exercise physiology. I first met Dr Keteyian in June of 1985 when he interviewed me for a position in the Cardiac Rehabilitation Program at Henry Ford Hospital in Detroit, Michigan. And, for full disclosure, I have worked alongside him ever since and consider him a close friend. Throughout the past 4+ decades, Dr Keteyian has been among the leaders who have helped shape both the clinical exercise physiology profession and the breadth and strength of the clinical exercise physiology literature base. He has been a major force in multiple important studies, organizations, and initiatives, and has led the Cardiac Rehabilitation/Preventive Cardiology Unit (which is within the Division of Cardiovascular Medicine) at Henry Ford for more than 40 years. Thank you, Dr Keteyian, for your willingness to be interviewed.Q: I like to begin these interviews with some background about the interviewee's early life because I believe it can help early and precareer readers when planning their own path. Let me begin by asking you to briefly give us some of your personal history about where you grew up, went to school, and what might have influenced you during that time to move toward a focus in clinical exercise physiology? What was your route through college that led you to achieve a doctoral degree? And how did that shape your future career?I grew up in the Detroit, Michigan, area and my undergraduate degree is from Grand Valley State University (then called Grand Valley State Colleges). Immediately after graduating I continued my studies, completing a master's degree at the University of Northern Colorado. My doctoral studies were at Wayne State University in Detroit. Growing up I so enjoyed biology, chemistry, and astronomy, but I also enjoyed playing sports. In my junior year at Grand Valley I took an exercise physiology course taught by Jim Scott (an exemplary role model for myself and many others) and it was from that course that I first appreciated the connection between science and exercise.My decision to complete a doctoral degree was based mostly on my interest to seek answers to my own science questions, instead of just supporting or helping others with their research interests. I look back at those very early years of my career between 1981 and 1989 with partial disbelief… during that time I started my employment at Henry Ford Hospital, met and married my wife (Lynette), the first two of our four children were born, at the hospital we grew both our research platform and our clinical rehabilitation programs, and I started and completed my doctoral studies at Wayne State.Q: During your CEP formative years what was the most important decision you made? Was it an internship? A postdoc? A job? Someone who you met and was a mentor? Or maybe it was something else, or some of these, or all of these?It would be incorrect for me to identify a sentinel event. Instead, I would say that my career arch has been more of a focused evolution. After I completed my dissertation investigating the effects of exercise training in heart transplant patients, it was my division head at Henry Ford (Dr Sidney Goldstein) who helped drive both my clinical growth and the next step in my research agenda. Clinically, it was still a time when cardiac rehabilitation was not fully embraced by the cardiology community at large. Yet Dr Goldstein provided his full support of our programs, and as a result, they continued to grow in both depth and breadth. Regarding my clinical research, Dr Goldstein suggested that I work upstream from heart transplant and investigate exercise training in patients with heart failure. At that time this research line was very novel (maybe even frowned upon by some), which gave us the opportunity to secure external funding and conduct the first US-based randomized clinical exercise training trial that involved patients with heart failure. In 1998 a group of like-minded clinical scientists met in Atlanta to discuss a multisite RCT randomized controlled trial involving patients with heart failure… and the HF-ACTION trial was born.Q: Since I have known you, your career has been at Henry Ford in Detroit. How did you end up there? Were there any other steps along the way?After completing my master's degree at the University of Northern Colorado, I returned to the Detroit area and worked at Oakland University in Rochester, Michigan, for 2 years. I assisted with the phase 3 cardiac rehabilitation program that the university offered, and I was a lecturer in the health and physical education department. It was during this time that I realized that I needed to complete a doctoral degree. The position of coordinator of cardiac rehabilitation at Henry Ford was posted so I applied and was hired, a decision that served me doubly well because Henry Ford Hospital is literally 10 minutes from the Wayne State University campus … where I had just started my doctoral coursework.Q: You have certainly worked with many CEPs whom you have hired or taught as a student intern or in a classroom setting. What is the most common career advice you provide to them? Have you ever had one who wanted to go to a different health-related route (or another field) that you inspired to remain in the CEP setting? What are your thoughts on why someone who is thinking about being a CEP as a career should pursue the field?Over the past 40+ years I have had the wonderful opportunity to work with and help train literally hundreds of clinical exercise physiology interns and medical residents/­fellows. This experience alone has helped nurture and satisfy my interest to teach others. That said, I'm not sure I imparted career advice that was all that meaningful. When speaking to young physician senior staff at the hospital I do often suggest that they be sure to keep their own research and clinical interests in focus. New senior staff so often get pulled into enormous clinical duties, as well as helping others with their research projects. Whereas this collegial approach is favorable, it can also be detrimental to growing one's own interests. So, learning to graciously "pass" on some opportunities as means to preserve the time needed for one's own clinical and research passions is a skill worth developing.For CEPs just entering the field, seek out clinicians, professors, and scientists with similar interests and work with them to further your knowledge and sharpen your skills. My take is that today's CEPs are wicked smart and well trained … able to help solve difficult problems to improve patient care outcomes and advance science. I encourage CEPs to become great clinicians. Observe others as they work, then put yourself in positions that develop your interviewing and assessment skills and clinical decision-making. More so than ever before, other health care providers now view CEPs as an integral part of the health care team, which includes evaluating and treating their patients and effectively communicating back our findings and plan.Q: What do you think your most important accomp­­lishment(s) and/or contribution(s) is/are to the field of CEP?Our initial research study (published in 1996) on exercise training in patients with heart failure contributed to the conceptualization and conduct of the HF-ACTION trial, the results from which led to a change in Medicare policy in favor of covering cardiac rehab for patients with heart failure. As such, that work represents an important milestone for me and many others. Also, I'd like to think that our unit has been a persistent, innovative force in the clinical exercise community… having been involved in advancing the use of higher intensity interval training; reducing the reliance on ECG electrocardiogram telemetry in Phase II cardiac rehab; incorporating virtual cardiac rehab into routine patient care; and expanding rehab services to include patients with cancer, those living with mechanical circulatory support, and those with peripheral artery disease.Q: Where do you see the field in the future with respect to continuing to solidify itself among the various allied health professions?Great strides have been made for clinical exercise physiology as a profession over the past 15 years. CEPA the Clinical Exercise Physiology Association, ACSM the American College of Sports Medicine, and other organizations are doing much to standardize the curriculum and certification exam needed to practice as a CEP. This work must continue. That said, I challenge my senior colleagues to reach out and engage our junior colleagues that are working in the field. The onus is on us to continue to teach, mentor, and encourage others as they help us solve the many clinical, programmatic, and research challenges we confront. Unlike 40 years ago, we (CEPs) now have the broad-based support of our colleagues in medicine. I believe we need to leverage such to form learning communities and working partnerships that advance society and contribute to our chosen profession.Addendum: I would be terribly remiss if I did not take this opportunity to acknowledge and thank several people. First, to my past and present coworkers in the preventive cardiology/cardiac rehabilitation unit at Henry Ford, I remain thankful for the wonderful care you provide to our patients, as well as your willingness to explore the boundaries of knowledge through clinical research. And, most important, I remain forever grateful for my wife and my now four adult children and their families… you are my world.Thank you, Dr Keteyian, for this informative interview. Goals of these interviews are to provide younger professionals with insight to the careers of senior CEPs, and to also provide them with an understanding of successful career paths in the field. Your story, in my opinion, certainly demonstrates the opportunities that exist for those willing to put in the time and effort.