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The ACSM blog brings you up-to-date commentary from top ACSM experts around the world.

Opinions expressed in the Sports Performance Blog are the authors’. They do not necessarily reflect positions of ACSM.

  • Active Voice: Oral Citrulline to Circumvent Splanchnic Hypoperfusion and Gut Injury in Athletes

    by Active Voice | Mar 30, 2015
    By Karolina A.P. Wijnands, M.D., and Kaatje Lenaerts, Ph.D.

    Kaatje Lenaerts, Ph.D.

    Karolina A.P. Wijnands, M.D.

    In that work, we studied athletes on two occasions in which they performed a one-hour cycling protocol at 70 percent of their maximal workload capacity. In one of these cycling bouts, they ingested L-citrulline 30 minutes prior to exercise and, in the other, they ingested L-alanine as a placebo 30 minutes in advance. Oral citrulline intake significantly increased plasma citrulline and arginine in healthy athletes, resulting in prolonged increased arginine availability for NO synthesis?without causing GI discomfort, as has been reported for arginine. To assess the effect on splanchnic perfusion, we used gastric air tonometry and side-stream dark field sublingual imaging procedures (for more on gastric air tonometry, see van Wijck et al., 2012). Data revealed that citrulline intake prior to exercise resulted in preserved splanchnic perfusion and improved sublingual microcirculation. Importantly, these improvements were associated with significantly reduced enterocyte damage during exercise compared with placebo.

    These findings encourage further studies on the effects of citrulline in symptomatic athletes aimed at relieving ischemia-related abdominal complaints. Furthermore, our data may be of interest for asymptomatic athletes as well. Preserving enterocyte integrity during exercise by citrulline supplementation is expected to improve nutrient uptake during and after exercise, and in this way contribute to enhanced recovery. Furthermore, clinical studies are ongoing to determine whether citrulline supplementation exhibits similar beneficial effects in patients suffering from splanchnic-hypoperfusion, such as in sepsis.

    Viewpoints presented on the ACSM Blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Karolina A.P. Wijnands, M.D., is in the final phase of writing her Ph.D. thesis. Her research seeks to understand the effects of L-citrulline supplementation on arginine-NO metabolism and microcirculation, employing conditions that reduce splanchnic perfusion such as (experimental) sepsis and strenuous exercise in healthy athletes. Karolina currently is an orthopedic surgery resident with the Maastricht University Hospital in The Netherlands, where she will be continuing her research on arginine-NO metabolism in inflammatory conditions, bone healing and exercise.

    Kaatje Lenaerts, Ph.D., is an assistant professor in the Department of Surgery at Maastricht University, The Netherlands. Trained as a biomedical scientist, she studies several facets of gut wall integrity loss, from unraveling the molecular basis of intestinal ischemia to developing models and tools to assess the impact of stressors on the gastrointestinal tract. Her translational research focuses on the interplay between intestinal compromise, innate immunity and nutrition to enhance intestinal mucosal homeostasis.

    This commentary presents Drs. Wijnands’ and Lenaerts’ views on the topic related to a research article that they authored with colleagues. Their article appears in the November 2014 issue of Medicine & Science in Sports & Exercise® (MSSE).

    Up to 70 percent of endurance athletes suffer from abdominal complaints during or after performing strenuous exercise. Gastrointestinal (GI) symptoms include nausea, vomiting, flatulence, cramps, diarrhea and rectal bleeding. The incidence and type of GI symptoms depend on factors including exercise type, intensity, duration and food/fluid intake, and these symptoms can vary from mild to severe.

    Splanchnic blood flow reduction and concomitant intestinal ischemia are considered important factors in the development of exercise-induced GI discomfort. This decrease in intestinal perfusion is a result of blood flow redistribution, directing the blood toward the active muscles, heart and lungs, and away from the GI system. Formation of intestinal nitric oxide (NO), a potent vasodilator, is impaired during splanchnic hypoperfusion. NO is produced from amino acid L-arginine via NO synthase and has an important role in vasoregulation of the splanchnic bed. Hence, increasing the local availability of NO is a potential means to enhance the intestinal microcirculation.

    Logically, L-arginine was one of the first agents studied in this respect and, while its administration has been shown to increase plasma arginine availability, the results have not been unequivocally positive. In addition, arginine supplementation in man may induce adverse GI effects, such as nausea, vomiting and diarrhea, thus limiting its practical application. Another means to increase NO availability is by supplying L-citrulline, a precursor of L-arginine. Importantly, in a previous study we showed that, compared with arginine, citrulline is a more suitable substrate to enhance intestinal perfusion and microcirculation in endotoxemic mice. To translate these findings to humans, we applied our strenuous exercise model, which is characterized by splanchnic hypoperfusion, intestinal injury and intestinal barrier loss in healthy athletes, to study the protective effects of citrulline in our current study, recently reported in MSSE.

  • Active Voice: Can Exercise Capacity Predict Survival in Cystic Fibrosis?

    by Anne Spencer | Mar 16, 2015
    By Erik H. J. Hulzebos, P.T., M.Sc., Ph.D., and Tim Takken, M.Sc., Ph.D. 

    Life expectancy in patients with cystic fibrosis (CF) is increasing. However, since the predicted median survival is still around 50 years for individuals with CF who were born in 2000, life expectancy remains an important, clinically-relevant outcome. A number of modifiable and nonmodifiable variables, including gender, lung function decline, number of pulmonary exacerbations, nutritional status/lower muscle mass, diabetes mellitus, a positive culture for Burkholderia cepacia colonization and lower peak oxygen uptake (VO2peak), have all been associated with mortality in patients with CF. Among these variables, several studies have identified percentage of predicted forced expired volume in one second (FEV1%predicted) as being one of the best predictors of mortality in adults, children and adolescents with CF. Other common predictors of mortality in patients with CF are derived from cardiopulmonary exercise testing (CPET) including peak minute ventilation (VEpeak), peak ventilatory equivalent ratio for oxygen (VE/VO2), a marker of ventilatory efficiency and perhaps the best known predictor from CPET - the VO2peak.

    Nevertheless, exercise capacity in patients with CF is limited, which seems to have a multifactorial cause. If there is a possible relationship between CF genotype and some measures of exercise capacity, the mechanisms remain to be determined. It seems that there is an interrelationship between lung function, muscle mass, energy expenditure, respiratory and/or skeletal muscle function and exercise capacity in patients with CF. The pathophysiology of reduced lung function and reduced muscle mass are known to be the most important factors leading to exercise limitation in CF.

    Nixon et al. (1992) were the first to report a significant association between the aerobic exercise capacity of young patients with CF and survival over eight years. Patients with the highest levels of aerobic exercise capacity (VO2peak ≥ 82% of predicted) had a survival rate of 83% after eight years, as compared with rates of 51% and 28% for patients with middle (VO2peak, ranging between 59-81% of predicted) and lowest (VO2peak ≤ 58% of predicted) levels of aerobic exercise capacity respectively. Thus, higher levels of aerobic exercise capacity in patients with CF are associated with a significantly lower risk of dying. Although a better aerobic exercise capacity may simply be a marker for less severe illness, measurement of VO2peak appears to be clinical valuable for predicting prognosis.

    The debate with regards to the strongest predictor of mortality in CF is ongoing. To date, a strong focus has been on VO2peak as a biomarker for cardiorespiratory health status - for example, to assess how physical activity or exercise training might positively affect VO2peak. Yet, the question arises whether other parameters of exercise or a combination of both exercise and non-exercise parameters might yield even stronger biomarkers of health status.

    In our study, recently reported in MSSE, we found that a model consisting of BMI, FEV1%predicted and VE/VO2 is a strong predictor of mortality in adolescents with CF over a 7.5±2.7 year follow-up period. Further research is warranted to determine whether improving aerobic exercise capacity, through physical exercise programs or other interventions (e.g., nutritional supplementation) will result in a better prognosis.

    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Erik J. Hulzebos, P.T., M.Sc., Ph.D., is a clinical exercise physiologist, sports physical therapist, and assistant professor in clinical health sciences at the University Children’s Hospital of the University Medical Center Utrecht, the Netherlands. His main research and clinical interest is clinical pediatric exercise physiology. He has performed studies in many clinical populations including children with cardiorespiratory disease. Dr. Hulzebos published more than 35 peer-reviewed papers and authored five books. He is an ACSM Registered Clinical Exercise Physiologist, and member of the European Pediatric Work Physiology, European Cystic Fibrosis Society and ECFS working group “Exercise in patients with cystic fibrosis.

    Tim Takken, M.Sc., Ph.D., is a medical physiologist and associate professor in pediatrics at the Wilhemina Children’s Hospital of the University Medical Center Utrecht, the Netherlands. He has a special interest in clinical pediatric exercise physiology. He is currently director of the Clinical Exercise Testing Laboratory in Utrecht. Further, he is the chair of the Dutch chapter of CPX international. Dr. Takken has published more than 150 peer-reviewed papers and authored four books. This commentary presents Dr. Hulzebos’ and Takken’s views on the topic related to a research article that they authored with colleagues. Their article is published in the November 2014 issue of Medicine & Science in Sports & Exercise® (MSSE).

  • Active Voice: Lie, Sit, Stand or Ambulate? The Measurement of Body Postures

    by Active Voice | Mar 02, 2015
    By David R. Bassett, Jr., Ph.D., FACSM 

    There are many ways to group activities that people perform in everyday life in order to quantify and describe their physical activity so that it is easily reported and understood. For instance, activities are often grouped by intensity level (sedentary, light, moderate and vigorous). But another method is to group activities by the body postures people assume when performing them (lying down, sitting, standing and ambulating). “Postural allocation” refers to the amount of time people spend each day in different postures. Researchers are becoming convinced that the amount of time spent sitting may influence our health.

    The activPAL™ (PALtechnologies, Glasgow, Scotland) is a miniature device worn on the thigh. Roughly the size of a USB thumb drive, it has a miniature tri-axial accelerometer that senses dynamic accelerations produced by human movements, as well as static acceleration due to gravity. The accelerometer in this device can detect the angle of incline of the thigh, allowing it to distinguish between lying/sitting, standing and ambulating. However, since the thigh is horizontal when sitting and lying down, it cannot differentiate these two body postures.

    One could ask why it is important to distinguish lying down from sitting. One reason is that lying down usually represents sleep, and sleep has health-enhancing, restorative powers. Prolonged sitting, on the other hand, is viewed as deleterious to health - this applies more to individuals who do not perform leisure time physical activity than to those who perform aerobic activity for hours on end.

    In our study, recently reported in MSSE, we examined whether wearing two activPAL™ devices, one each on the thigh and torso, would allow four body postures (lying down, sitting, standing and ambulating) to be accurately classified. Fifteen healthy adults performed a routine consisting of lying down, sitting, standing, sweeping (floors), treadmill walking at 3 mph and treadmill running at 6 mph. We then used the data from both activPALs to predict a person’s body posture. When both activPALs were horizontal, that was taken to represent lying down. When the thigh device was horizontal and the activPAL™ on the torso was vertical, that was taken to represent sitting. When both activPAL™ devices were vertical, that was taken to indicate the upright position. This method of classifying body postures showed good agreement with direct observation.

    The notion that sedentary behavior is deleterious to health is not a new idea. Around 1700, Bernardino Ramazzini, the founder of occupational medicine, studied people in various jobs and noted that scurrying messengers were healthier than sedentary tailors and bookkeepers. He referred to the latter two classes of workers as “chair workers.”

    Ralph Paffenbarger, Jr., MD, DrPH, devised a questionnaire for the College Alumni Health Study, which began in 1960. His famous questionnaire is best known for its physical activity index (PAI), computed from distance walked, flights of stairs climbed, and sports and recreation. However, Paffenbarger also had the foresight to ask people how much time they spent during a usual 24-hour day, engaged in sleeping/reclining, sitting, light activity (e.g. office work, strolling, standing with little motion), moderate activity and vigorous activity. Some researchers are skeptical about people’s ability to accurately recall these behaviors, so they have turned to wearable activity monitors for more accurate answers.

    There is growing evidence that desk jockeys, long-distance commuters and television-viewing couch potatoes are at increased risk for metabolic syndrome and premature death. Interventions are needed to identify practical, low-cost and acceptable ways of reducing time spent in these sedentary pastimes, or converting them to more active ones. Measurement tools are needed to quantify the magnitude of behavior changes induced by these interventions.

    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Dr. David R. Bassett, Jr., is an exercise physiologist and researcher at the University of Tennessee in Knoxville, Tenn. His research focuses on the validity and reliability of objective measurements of physical activity, cross-sectional studies of the relationship between physical activity and health, and behavioral interventions.

    This commentary presents Dr. Bassett’s views on the topic related to a research article which he and colleagues authored. Their research article appears in the October 2014 issue of Medicine & Science in Sports & Exercise® (MSSE).

  • Active Voice: What Happens When an Active Couch Potato Ingests Added Sugar?

    by Active Voice | Feb 24, 2015
    By Amy Bidwell, Ph.D. 

    A diet high in added sugar has already been established to be correlated with increased weight and metabolic disturbances. However, what happens when a person is ingesting moderate amounts of added sugar, either in the form of sucrose or high fructose corn syrup (HFCS) while also being physically inactive? Moreover, in this context, what constitutes being physically active?

    Although previous research has shown that a diet high in fructose can cause deleterious metabolic effects to the body, these studies tend to use an excessive amount of added sugar, which often results in weight gain. Moreover, high fructose corn syrup is now being replaced with sucrose (table sugar) in many foods, giving the indication that they are “natural” and hence, healthier; although from a metabolic standpoint, HFCS and sucrose are essentially the same. This change in labeling has resulted in an even larger influx of added sugar in our diet.

    We have recently published a series of papers investigating the effects of a diet high in a more moderate amount of added fructose (~17 percent calories from added fructose). We found through this work that, in as little as two weeks, a healthy young adult’s metabolic profile begins to be negatively altered. The observed consequences included increased postprandial triglyceride, very-low density lipoproteins levels and low grade inflammation when subjects were physically inactive. These results were found without subsequent changes in weight.

    So now the question is this: What if a person who is ingesting only a moderate amount of added fructose, while maintaining their weight, is also physically inactive? According to the most recent ACSM Position Statement on exercise for apparently healthy adults, 30-60 minutes of moderate-intensity exercise is recommended, five days per week. The problem is that a person can go to the gym for 30-45 minutes, five days per week and still only be getting ~4000-5000 steps per day because they may be sitting at a desk at work or school all day then on the couch at night. This creates the active couch potato conundrum. The person thinks they are being active because they do their structured recommended exercise for 45 minutes per day. But, the fact is that they are inactive the remaining 23 hours per day! If you compound that circumstance with having just one bowl of sugary cereal for breakfast and a “natural” sweetened ice tea for lunch or dinner, you now have a person whose metabolic profile is being unfavorably altered, even though they were trying to be healthy.

    Even if someone is diligently going to the gym daily and maintaining a proper weight, they are still doing their body harm if they are not being active throughout the day and eating a diet composed of low sugar, unprocessed, whole foods. We have done such an immense job at promoting regular, daily exercise, we need to now take it one step further and begin to educate people on the harms of being physically inactive the remaining 23 hours per day. Additionally, there needs to be more focus on educating people on the metabolic disadvantages of a diet including even a moderate amount of added sugar, regardless of whether it is from sucrose or high fructose corn syrup.

    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Dr. Amy Bidwell is an assistant professor in the Department of Health Promotion and Wellness at the State University of New York at Oswego where she teaches exercise physiology and nutrition. Her research focuses on the adverse effects of physical inactivity and its interaction with diet, obesity and obesity-related diseases. Specifically, Dr. Bidwell researches the adverse effects of a diet high in fructose and low in physical activity. She is a member of ACSM.

    This commentary presents Dr. Bidwell’s views on the topic related to her research specialization. See the November 2014 issue of Medicine & Science in Sport & Exercise® (MSSE) for a report that she and her colleagues authored on findings from one of their recent investigations in this topic area.

  • Active Voice: Size Matters when Treating Victims of Exertional Heat Stroke

    by Active Voice | Feb 10, 2015
    By Glen P. Kenny, Ph.D. 

    The human body is quite inefficient at using the energy derived from metabolic processes to create external work, with approximately 70 to 95 percent of energy as heat— this does, of course, vary with the physical task. The human body has an amazing capacity to handle the large amount of heat released during physical activity. To offset the large increase in metabolic and environmental heat gain [high ambient air temperature, radiant heat sources (sun, fires, kiln, etc.), the human thermoregulatory system must adjust the rate of heat loss by increasing skin blood flow and sweating. Under circumstances where the body is unable to increase heat loss sufficiently to offset the increase in heat production/gain, core temperature continually rises. If left unchecked, core temperature can continue to increase to dangerously high levels— placing individuals at high risk of developing exertional heat stroke (EHS). The risk of EHS is always present when military personnel, laborers, athletes and others perform physical activity in the heat, especially when protective equipment is worn. Key to the survival of victims of EHS is the early recognition of the condition. Even if EHS is promptly recognized at the time of the incident, an individual can still succumb if extreme hyperthermia is not rapidly reduced. The severity and reversibility of multisystem organ failure associated with EHS is related to the duration of temperature elevation.

    Cold water immersion (2°C circulated ice-water bath, CWI) is the gold standard treatment for victims of EHS, as it has been shown to produce the highest core cooling rates to date (0.35°C/min). Recent work by DeMartini and colleagues showed that the use of CWI resulted in a 100 percent survival rate for all 274 recorded cases of EHS at the Falmouth Road Race over the last 18 years. Yet, despite the obvious clinical advantages of CWI in the treatment of EHS, some experts advocate the use of temperate water immersion (26°C) on the basis that CWI may negatively impact the health of the EHS patient as a result of the potentially undesirable side effects, such as cold shock response, excessive shivering, etc. – see the Casa et al. perspectives column in MSSE for an expanded discussion. However, as our recent research report published in MSSE showed, the benefits of CWI far outweigh the short lived discomfort that the patient may experience. More importantly, CWI provided core cooling rates 2.7 faster than temperate water immersion. A critical oversight in many discussions pertaining to the treatment of EHS patients relates to the physical characteristics of the patient. We showed that when it comes to treating victims of EHS size matters. Individuals with a low body surface area-to-lean body mass ratio (AD/LBM) experience longer cooling times irrespective of the choice of water temperature (i.e., temperature, 26°C versus cold water immersion, 2°C) compared to those individuals with high AD/LBM. However, immersion in cold water dramatically reduced the differences between groups such that the effects of the physical differences on core cooling rates were minimized.

    Exertional heat-related illness is a risk to individuals of all sizes and shapes irrespective of the nature of activity performed. While the pathway to hyperthermia may be different for each EHS patient, our study clearly demonstrates that the path to recovery must always be immediate CWI treatment for all individuals.

    Viewpoints presented on the ACSM Blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Dr. Glen P. Kenny is a professor of exercise physiology at the University of Ottawa, holds a university research chair in environmental physiology, and is a member of ACSM. His research has been directed at characterizing the physiological control mechanisms governing human temperature regulation during heat stress. An area of special focus in his work is investigation of the physiological effects of heat stress in subpopulations with conditions rendering them particularly vulnerable to heat injury, such as aging, obesity and diabetes.

    This commentary presents Dr. Kenny’s views on the topic related to a study which he and colleagues recently completed. Their research report appears in the September 2014 issue of Medicine & Science in Sports & Exercise® (MSSE).

  • Active Voice: Leg Pain in Athletes – Don’t Forget the Nerves

    by Active Voice | Feb 02, 2015
    By Jonathan T. Finnoff, D.O., FACSM 

    A 19-year-old soccer player goes to a physician’s office complaining of medial leg pain. The patient describes the pain as a deep, aching, burning pain with a severity of 0-8/10 that is exacerbated by running and relieved with rest. Occasionally, the pain radiates into the medial foot and can be associated with paresthesias (numbness or burning type sensations) in the same distribution. On physical examination, the athlete has no tenderness to palpation, benign findings on knee and ankle examinations and a normal lower extremity neurologic examination. Radiographs of the symptomatic region are normal. For the examining physician, what might be the differential diagnosis for this individual? What would the next step be in the physician’s evaluation process?

    This clinical scenario is not uncommon. Certainly the variety of entities that can produce these symptoms is broad, but one should keep in mind that peripheral nerve entrapments frequently present in this manner. In this particular case, the patient was diagnosed with a saphenous nerve entrapment at the level of the knee where the saphenous nerve passes between the sartorius and gracilis tendons. The patient responded to temporary avoidance of aggravating activities, stretching of the relevant musculotendinous structures, and an ultrasound-guided saphenous nerve block with a combination of local anesthetic and corticosteroid at the site of entrapment.

    In my opinion, there are a few key items that increase my suspicion that an athlete’s symptoms are being caused by a peripheral nerve entrapment.

    1. History
    2. a. Neuropathic symptoms (e.g., paresthesias, weakness) in the distribution of a peripheral nerve
      b. Symptoms exacerbated by activity that are improved with rest
    3. Physical examination
    4. a. Positive Tinel’s sign over the entrapment site (percussion elicits sensations of nerve irritation, e.g. ‘pins and needles’), which reproduces symptoms in the same distribution as the athlete’s pain

    While electrodiagnostic studies and standard imaging studies are frequently normal in athletes with peripheral nerve entrapments, I have found ultrasound to be very helpful when evaluating this patient population. First, diagnostic ultrasound can frequently identify the location of nerve entrapment, which presents as focal compression of the nerve at the site of entrapment and enlargement of the nerve proximal to the site of entrapment. Second, if the diagnostic ultrasound examination is unrevealing, but nerve entrapment is still suspected, an ultrasound-guided diagnostic nerve block at the probable site of entrapment can be performed. If the athlete’s symptoms are resolved by the nerve block for the duration of the local anesthetic, this is highly suggestive that nerve entrapment is the source of the athlete’s pain. If not, then an alternative pain generator should be sought.

    In our article, “

    Lower Extremity Nerve Entrapments in Athletes

    ”, recently published in ACSM’s Current Sports Medicine Reports, the history, physical examination, diagnostic studies and treatment options for common lower extremity nerve entrapments in athletes are discussed. Hopefully, this information will add to the “tools in the physicians’ toolbox” and improve their ability to successfully identify and treat athletes with nerve entrapments.



    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Jonathan T. Finnoff, D.O., FACSM, is a senior associate consultant in the Department of Physical Medicine and Rehabilitation at Mayo Clinic School of Medicine, and a clinical professor in the Department of Physical Medicine and Rehabilitation at the University of California Davis School of Medicine. He is the medical director of the Mayo Clinic Sports Medicine Center in Minneapolis, Minn. and a faculty member for the University of California Davis School of Medicine and University of Nevada School of Medicine Sports Medicine fellowships. He specializes in non-operative sports medicine and diagnostic and interventional ultrasound.

    This commentary presents Dr. Finnoff’s views on the topic related to a clinical article which he authored with a colleague and which was published in the September/October 2014 issue of ACSM’s Current Sports Medicine Reports (CSMR).


  • Active Voice: What the New Congress May Mean for ACSM; Member Advocacy Will Be Crucial

    by Active Voice | Jan 20, 2015
    By Robert Oppliger, Ph.D., FACSM 

    The federal elections last fall seemed to indicate that the American voters wanted change. That change included Republicans taking control of the U.S. Senate while maintaining control of the U.S. House of Representatives. As the new 114th Congress convenes in January, it will be difficult to forecast what exactly will happen legislatively. World and national events— even the weather— can influence what transpires in Congress. The good news for ACSM is that there’s reason for optimism for our current key initiatives. Although their reasons for supporting physical activity (PA) may differ, members of Congress generally support legislation related to PA on a bipartisan basis. Like cities, states and businesses, Congress is catching on to the value PA provides for promoting health and the economic benefits for the individual, as well as for communities and the nation as a whole.

    In addition to its other policy priorities, ACSM supports three pieces of legislation. The requirement for periodic review of PA guidelines by the Secretary of Health & Human Services may come-up for vote in the lame duck session over the next month, and there’s good reason for optimism that it will pass. Likewise, legislation renewing the Carol M. White Physical Education Program (PEP) has received bipartisan support. The PEP bill asks for level funding for competitive grants to promote PA in schools. A third bill, the Personal Health Investment Today (P.H.I.T.) Act, expands the definitions of medical expenses to include PA as an element of preventive medicine. This allows individuals to deduct expenses for selected items relating to PA in their medical savings accounts. Although the bill has yet to be introduced in the Senate, it too has significant bipartisan support in the House.

    I would be remiss if I did not encourage ACSM members to engage in advocacy at the local, state and national level. National office staff offer resources for promoting the mission of ACSM. Becoming a Key Contact offers a simple, but significant, way to become engaged. Periodically, ACSM staff will contact Key Contacts regarding federal legislation and encourage us to contact Congressional delegates in support of specific issues, e.g. the three bills mentioned above. Becoming a Key Contact merely requires clicking the button on ACSM’s website and providing the needed information. On March 3-4 2015, ACSM will host its 3rd annual Capitol Hill Day. No experience is necessary to participate, and we do on-the-job training. It’s not difficult, but it is a great opportunity to see how public advocacy works. I hope you’ll join us. Contact Monte Ward ( for more details or to sign-up.

    In brief, there will be change. However ACSM’s mission to promote physical activity should continue to make progress.

    ACSM is planning a webinar in January that will provide more information about the new Congress and the implications for issues related to the promotion of physical activity. Look for more details in future issues of SMB.

    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Robert (Bob) A. Oppliger, Ph.D, is a Fellow in the American College of Sports Medicine and has served on a wide range of ACSM committees for more than 20 years. Currently, he is chair of ACSM’s Health Science Policy Committee and holds memberships on both the Strategic Planning Committee and ad-hoc ActivEarth committee. His academic vita includes more than 50 publications and well over a hundred presentation to scientific and lay audiences. He has chaired the authoring committee for an ACSM position statement and been a consultant to the NCAA, National Federation of High School Associations and several state high school sports associations. Bob is a League of American Bicyclist (LAB) Cycling Instructor and currently, a candidate for the LAB’s board of directors. When he’s not on a bike, he referees little league and high school soccer and tends his gardens

  • Active Voice: “Sarcopenic Obesity” – The Plague of Aging Baby Boomers?

    by Active Voice | Jan 12, 2015
    By David M. Gundermann, Ph.D, and Todd M. Manini, Ph.D., FACSM 

    David M. Gundermann, Ph.D

    Todd M. Manini, Ph.D., FACSM

    Over the next 20 years, the aging of the population and obesity epidemic will collide. These two aircraft carriers of health burden are expected to lead to the nation’s growing health issues. First, aging is associated with a dramatic and progressive loss of muscle mass and quality, which partly leads to a diminished functional ability, increased susceptibility to disease and a declining physical quality of life leading to the possibility of physical dependence. Individuals who lose significant muscle mass are considered to be sarcopenic and, as a result, they typically have low appendicular lean mass relative to body height. Second, advancing age leads to their increased susceptibility to weight gain that contributes to development of obesity, along with a host of cardiovascular, metabolic and functional consequences. Accordingly, there has been a rising concern that older adults who possess both low amounts of appendicular muscle and high levels of adipose tissue are particularly vulnerable to physical disability and health consequences. Low levels of muscle relative to the total fat mass clearly predisposes to metabolic dysregulation and biomechanical disadvantages in performing tasks of daily life against gravity (e.g., stair climbing, chair rising, etc…)

    Sarcopenic obesity (a phrase coined in 2000) is difficult to easily detect because many older adults maintain their body weight, but experience a body composition shift with losses in muscle mass and reciprocal gains in fat mass. Additionally, there are no clear criteria, nor are there well defined cutoffs for sarcopenic obesity. For example, there are at least five different published benchmarks, leading to different prevalence estimates ranging from 4 to 40 percent. More importantly, though, the debate about defining sarcopenic obesity is dwarfed by the debate about the actual health concerns it poses. One could assume that the combination of obesity and low muscle mass would lead to an additive effect on health risks, although that may be an unfair assessment. That is because those labeled with sarcopenic obesity still have significantly more muscle than those with frank sarcopenia (even by all the current definitions). Thus, in fact, they might not be expected to have the same health risks associated with sarcopenia. A more apt comparison tends to be between the obese and the sarcopenic obese. So far, there are mixed results in the research literature that the latter condition predicts higher health and disability risks.

    While it is a worthwhile endeavor to compartmentalize the older adult population into risk categories, sarcopenic obesity may simply be the natural progression from obesity, considering that high fatness, in fact, predicts accelerated loss of muscle. Therefore, even though sarcopenic obesity is a relatively new concept that is gaining traction, there remains much to be understood about whether additional risk is conferred by the condition, especially if you consider covariates such as changes in daily activity and diet. Regardless of the causes and consequences, sarcopenic obesity is a condition that can benefit from existing treatments of physical activity and appropriate dietary intake.

    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. 

    Drs. David Gundermann and Todd Manini are geriatric exercise scientists in the Department of Aging and Geriatric Research at the University of Florida. Their research focuses on enhancing skeletal muscle for preventing physical disability in late life. Both are members of ACSM and are actively involved with research to treat obesity and sarcopenia. Dr. Manini serves on ACSM’s Strategic Health Initiative on Aging Committee and has received an award from the ACSM’s Paffenbarger-Blair Fund for epidemiological research on physical activity.
  • Good Health Doesn’t Happen By Chance

    by Active Voice | Jan 07, 2015

    By: Stephen Cherniak

    Stephen is a Health Management Consultant with the Marsh & McLennan Agency. He is an ACSM member and serves on the Board of Directors of the International Association for Worksite Health Promotion (IAWHP).

    Good health doesn't happen by chance. It's the result of the choices we make on a daily basis. Good choices = good health. In fact, the right choices are so simple, people tend to not believe their effectiveness in not only improving health, but also: reducing the risk of heart disease, diabetes, stroke and cancer; lowering blood pressure; reducing weight, providing more energy and an improved outlook on life, lifting depression and managing stress; keeping focus and an improved capacity to learn and be more effective; and living longer.

    A study* involving researchers at the Johns Hopkins' Center for the Prevention of Heart Disease revealed that individuals who adopted four basic habits were 80% less likely to die from all causes over the study's 8-year span than those who had none of the four habits. The researchers added, "there are risk factors that people can't control, such as their family history and age, but these four habits are things that can change and consequently make a BIG difference in their health."

    So what are these choices that result in the best medicine for our bodies and lifestyle? They center on four lifestyle habits:

    1. Stop using tobacco - if you can only change one thing in your daily lifestyle this is it.
    2. Increase your daily physical activity
    3. Eat a diet high in fruits, vegetables, and LEAN meat
    4. Maintain a normal weight

    So, think “No Excuses” - the idea that while each of us can come up with a variety of excuses why we can't exercise, lose weight, and eat healthier - there really is not one good one.  Hundreds of times a day we're faced with moments that require choices regarding these four lifestyle habits. You can begin the change by making some of these choices the positive/good ones; and over time the right choices become good habits and lead to a healthier, longer and better quality of life.

    (*Multi-Ethnic Study of Atherosclerosis (MESA) reported in the American Journal of Epidemiology, June, 2013.)

  • Active Voice: Sedentary Behavior in Old Age is Rooted in Midlife — Intervene Early!

    by Active Voice | Dec 30, 2014

    By Julianne van der Berg, M.Sc., and Annemarie Koster, Ph.D. 

    Annemarie Koster, Ph.D.

    Julianne van der Berg, M.Sc

    In 2011, ACSM published an online brochure titled “Reducing Sedentary Behaviors: Sitting Less and Moving More” that reported on the harmful effects of too much sitting. Sitting or other sedentary behaviors such as lying down, watching TV and using the computer have been studied extensively during the last several years. Studies suggest that even when you exercise regularly, prolonged periods of sedentary time are a risk factor for cardiovascular disease, type 2 diabetes and even mortality. What is not well-understood yet is what factors influence the amount of sedentary time. 

    Our recent article in MSSE reports on an investigation where we examined factors present in midlife adulthood that were associated with subsequent sedentary behavior in old age. We used data of 565 adults participating in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study in Iceland. Measurements were obtained in all participants during midlife at the average age of 49 years and, again, in old age (average age of 80 years). During midlife, we measured factors in four domains:

    1. demographic factors (e.g., sex, age, marital status);
    2. socioeconomic factors (e.g., level of education, housing type, occupation);
    3. lifestyle (e.g., smoking status, physical activity, active commuting, occupation activity);
    4. biomedical factors (e.g., body mass index (BMI), weight status, blood cholesterol levels, heart disease, type 2 diabetes).
    Approximately 30 years later, we objectively measured the time people were sedentary over multiple days, using an accelerometer. We examined which of the factors measured during midlife were associated with sedentary time in old age, independent of the participants’ current health status and level of physical activity. Our results showed that lower educational level, poorer housing and not being married were associated with an average of 12, 13 and 15 more sedentary minutes per day. Also, being obese and having a heart disease during midlife resulted in considerably more sedentary time in old age. When these factors were present, subjects averaged 22 and 39 minutes more sedentary time per day, respectively! 

    Given the large number of highly sedentary adults and the related risks for health, it is important to develop prevention programs that aim to reduce sedentary time. The results of our study indicate that risk factors for a sedentary lifestyle in old age can be identified years before this behavior manifests. This information can be used to identify groups in an early stage that are at risk of becoming highly sedentary. Our findings, therefore, provide essential information for developing effective prevention strategies to reduce sedentary time and its related adverse health effects.

    Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. 

    Julianne D. van der Berg, M.Sc., studied health sciences at VU University Amsterdam, The Netherlands. After graduation, she joined the Exercise, Nutrition and Health Sciences department at the University of Bristol (UK), where she worked on projects focusing on physical activity, physical environment and health. Since 2012, she has been working at the Maastricht University as a Ph.D. candidate, investigating effects of leading a sedentary lifestyle on type 2 diabetes and its complications. 

    Annemarie Koster, Ph.D., is an assistant professor in the Department of Social Medicine at Maastricht University in the Netherlands. As an epidemiologist, her research focus centers on understanding the causes and consequences of physical (in)activity and obesity in old age. She has a strong background in physical activity assessment by accelerometry, with a particular interest in the health effects of sedentary behavior. 

    This commentary presents Ms. van der Berg’s and Dr. Koster’s views on the topic of a research article which they and their colleagues had published in the July 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). 

  • Active Voice: Overcoming Fear of Movement due to Back Pain in the Obese Older Adult

    by Active Voice | Dec 19, 2014
    By Heather K. Vincent, Ph.D., FACSM 

    Physical activity is recommended to obese individuals by their doctors for weight loss and overall joint heath. Activities that increase caloric expenditure are helpful for reducing weight and offloading the joints of the body. However, obese individuals commonly experience low back or knee pain during exercise, leading them to avoid exercise. Avoidance behavior initiates a cycle of continued weight gain, worsened joint pain, pain catastrophizing, fear of movement (termed kinesiophobia) and disability.

    The published literature has shown that people with chronic low back pain demonstrate fear avoidance behaviors and kinesiophobia. Separate research teams have identified different pain-related issues that contribute to exercise avoidance. First, pain catastrophizing triggers the negative pathway leading to physical disability. Second, obese and older populations have high prevalence of joint pain complaints that contribute to avoidance of physical activity. Third, obese individuals are more likely to catastrophize and ruminate about their pain issues than non-obese individuals. We are in the infancy of understanding the relationships between different exercise programs and the effectiveness on reducing fear behaviors, kinesiophobia and catastrophizing in the obese, older population with back pain. This is problematic, because clinicians do not yet have the information necessary to prescribe the appropriate exercise type or dosage needed to combat pain catastrophizing and kinesiophobia in this growing demographic. Evidence of exercise methods that can help clinicians empower patients to reduce pain, improve exercise tolerance, and achieve better musculoskeletal health is becoming increasingly important.

    We recently published a series of papers showing that lower lumbar muscle strength was related to higher pain scores during activities such as walking and stair climbing in obese older adults with chronic low back pain. Kinesiophobia predicted perceived disability. We also identified a direct positive relationship between muscle strength and walking endurance. Our most recent study, published in MSSE, was a randomized, controlled single blind trial. The goal was to determine the efficacy of two different types of resistance exercise programs (total body exercise vs. lumbar extension only) compared to a non-exercise control condition on measures of pain symptoms, kinesiophobia, fear avoidance beliefs and catastrophizing and mobility. Walking endurance improved, especially when the lumbar strength gain was greater than 20 percent from baseline. We showed that even with no weight loss, total body resistance exercise reduces pain catastrophizing by as much as 64 percent. Total body exercise also reduced perception of disability due to pain and pain during physical activities more than lumbar extension.

    In our view, these results indicate that resistance exercise with a lumbar strengthening component can be used to counteract the psychological steps that initiate avoidance behaviors and physical disability in this population. Reducing pain catastrophizing is an appropriate treatment target because the measure is related to reductions in ambulatory pain severity and perceived disability. Decreasing pain catastrophizing levels may help obese older adults with back pain re-assess the harmfulness of the pain and develop confidence in performing physical activities. We believe that regular participation in resistance exercise should be encouraged to help these patients positively change their personal experience with exercise to achieve high quality mobility (low pain or pain-free movement).



    Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Dr. Heather Vincent is a research faculty member in the Department of Orthopaedics and Rehabilitation at the University of Florida (UF) College of Medicine in Gainesville, Fla. She is the director of the Human Dynamics Research Laboratories and UF Sports Performance Center. Her research is focused on developing appropriate exercise-based interventions for obesity to improve the physiological, mechanical and psychological disease risk factors and attenuate musculoskeletal disease progression. She is currently serving on the ACSM Consumer Information Committee.

    This commentary presents Dr. Vincent’s views related to a research article she and her colleagues had published in the September 2014 issue of Medicine & Science in Sports & Exercise® (MSSE).


  • Active Voice: Finding a Cure for the Plague of the 21st Century

    by Active Voice | Dec 15, 2014
    By Robert Sallis, M.D., FACSM 

    I recently represented Exercise is Medicine® and the Every Body Walk! Collaborative at Walk21, the 15th Annual Conference on Walking and Walkable Communities. The meeting was held on October 21-23 at the Luna Park Conference Facility located alongside the beautiful harbor in Sydney, Australia. Walk21 2014 was a remarkable meeting that brought together a wide variety of stakeholders interested in the development of healthy and sustainable communities where people choose to walk. In addition to those from the fields of medicine and public health, the bulk of the attendees were involved in city planning, transportation, education, urban design and architecture. All of the attendees were passionate about the importance of walking for health and quality of life. In addition, the premier of New South Wales and the lord mayor of Sydney also attended and spoke, underscoring the importance of this meeting at the highest levels of government in Sydney and beyond.

    I came away from this meeting with an enhanced appreciation for the importance of walking and how we might best get citizens of the world to do it. My focus has primarily been from a medical perspective and on assessing and prescribing walking to patients, using physical activity as I would a medication. However, I came to realize that it does little good for me to prescribe exercise to my patients if they have nowhere to do it. On the contrary, if patients have inviting walking trails and green space nearby where they live and work, they are much more inclined to walk. Furthermore, if they live in a city that places an emphasis on public transportation, with safe sidewalks and crosswalks that make getting around easier, they are much more likely to walk than take a car. So it became clear to me that we, as health care providers, need to partner with urban planners to improve the health of our urban populations.

    I also realized there is a long history of city planners coming together with public health professionals to prevent and cure disease. The bubonic plague of 14th century Europe was cured when urban planners developed effective means of collecting and disposing of garbage in order to eliminate rats carrying fleas that transmitted the disease to humans. Cholera was also essentially eliminated when urban planners figured out how to keep sewage separated from water, food and the environment. These simple measures to improve sanitation in our cities, brought about by astute urban planners, saved more lives than any medicine or vaccine could.

    Today the major causes of death around the world are no longer infectious diseases, but non-communicable diseases (NCD’s) which are mainly related to inactivity and poor diet. Lately, the news has been filled with hysteria over Ebola, but almost nothing on the biggest global threat, which is a sedentary lifestyle. The plague, cholera and TB have been replaced by diseases closely linked to a sedentary lifestyle such as heart disease, diabetes and cancer. What we now understand is that this has occurred because we have engineered physical activity out of our daily lives. The consequences have been catastrophic, but really quite predictable. And, once again, we need to call on our urban planners to rescue us from the epidemic of NCD’s by making our communities more walkable so people are able to walk every day.

    Stamping out disease is a role that our urban planners have played before and must play again. We must design cities built for walking and physical activity so that everybody can gain the health benefits achieved through an active and fit way of life. While NCD’s are the plague of today, our response has been much more indolent than was the case for the bubonic plague of centuries past. Yet, these NCD’s are just as deadly and must be taken just as seriously. We all need to work together to ensure this happens.

    Editorial Note: Dr. Sallis spoke at this conference, representing ACSM, Exercise is Medicine®, and the Every Body Walk! Collaborative. His participation in Sydney was supported, in part, by a grant ACSM received from Kaiser Permanente -Improving health through clinician-to-patient conversation on benefits of walking.

    Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Robert E. Sallis, M.D., FACSM, is a past president of ACSM and currently is chair of the Exercise is Medicine® Task Force. He originated the EIM concept and has been its leading advocate from the beginning. Dr. Sallis earned an M.D. from Texas A&M University and completed his residency in family medicine at Kaiser Permanente Medical Center in Fontana, Calif. He has continued his medical career with Kaiser and now codirects their sports medicine fellowship training program. Dr. Sallis is the founding editor-in-chief of ACSM's Current Sports Medicine Reports journal.

  • Rethinking the Role of the Human Heel Pad during Barefoot Locomotion

    by Active Voice | Dec 08, 2014

    By Albrecht Dietze, M.D., and Scott C. Wearing, Ph.D.

    Textbooks on sports medicine typically report that the heel pad is a thick elastic-adipose tissue which plays a critical shock-absorbing role during human locomotion. The concept of the heel pad as a shock absorber owes much to the work of McNeil-Alexander, Radin, Aerts and colleagues who, in the 1970s and 80s, used mechanically-simulated impacts to hypothesize that deformation of the heel pad attenuated peak force at impact, dissipated mechanical energy during heel strike and, ultimately, protected the calcaneus by lowering local stress.

    In one of the few studies to investigate deformation of heel pad during locomotion, DeClercq, Aerts and co-workers demonstrated in the 90s that the heel pad actually offered minimal resistance to deformation at initial impact and ‘bottomed out’ during barefoot running. They hypothesised that deformation of the heel pad during barefoot running, therefore, mainly served to minimize local stress at the calcaneus. Given that shock absorption is related to energy dissipation over the entire load-deformation cycle, their study was unable to assess the shock absorbing capacity of the heel pad. So we decided to further examine the hypothesized function of the heel pad by undertaking an observational study which detailed the force-deformation behavior of the healthy human heel pad over the entire load-deformation cycle and at a lower gait speed.

    Our most recent report, published in MSSE, is the first to assess the force-deformation properties of the heel pad in healthy subjects while walking barefoot at preferred speed using a dynamic radiographic imaging technique coupled with a pressure measuring platform. We confirmed previous observations and showed the heel pad had a distinct nonlinear behavior during walking, in which increasing force was associated with progressively less deformation. Initial stiffness of the heel pad was a tenth of its final stiffness and only about one joule of energy was dissipated by the heel pad with each walking step. The energy dissipated by the heel pad in our carefully controlled laboratory–based experiment was 5 to 10 times less than that reportedly dissipated by other structures such as the Achilles tendon and the ligaments of the medial longitudinal arch. In our view, this finding warrants a critical reappraisal of the relative shock reduction and energy dissipating role of the heel pad during locomotion.

    In our experiment, we also found that the energy required to deform the heel pad during walking was only marginally less than that reported during barefoot running at moderate speed. Furthermore, we found that the peak deformation of the heel pad during walking was close to that predicted for the limit for pain tolerance. This finding has important clinical implications. For instance, to avoid potential pain and injury at higher barefoot gait speeds, movement of the rearfoot and soft tissues of the shank must increasingly contribute to energy dissipation during heel contact or gait adjustments must occur to ensure the contact energy during heel strike is comparable during barefoot walking. These findings also provide indirect support to the so–called ‘Robbins and Hanna’ hypothesis in which plantar foot sensation is proposed to moderate impact loading of the foot during gait. These findings also may, in part, account for the more plantar–grade foot strike pattern that occurs with barefoot gait at speeds faster than walking.

    With the advent of treadmills containing inbuilt pressure sensor technology, our next step is to address some limitations associated with use of a one-dimensional analysis and fluoroscopic imaging of the heel pad to evaluate heel pad mechanics over a wider range of gait speeds— and the potentially mitigating effects of footwear. 

    Albrecht Dietze, M.D., is an orthopedic trauma surgeon with a special interest in foot and ankle surgery. His research focuses on clinical application of foot and ankle biomechanics. In particular, imaging techniques and pedobarographic analysis are the main methods applied to improve strategies and clinical outcome in the treatment of foot and ankle pathology.

    Scott C. Wearing, Ph.D., is an experimental soft tissue bioengineer and researcher at the Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia. His research focuses on the measurement of human soft tissue adaptation to exercise, pathology and disease and is targeted toward prevention, recovery and expedited rehabilitation of musculoskeletal injury.

    This commentary presents Drs. Dietze’s and Wearing’s views on the topic of their research article which they and their colleagues published in the August 2014 issue of Medicine & Science in Sports & Exercise® (MSSE).

    Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

  • Active Voice: Strengthening Muscle for Your Health

    by Active Voice | Dec 02, 2014
    By: Martin Sénéchal, Ph.D., CEP 

    Exercise is a cornerstone in the management and the prevention of obesity-related chronic conditions. National and international agencies are recommending a minimum of 150 minutes per week of endurance exercise at moderate intensity in conjunction with at least two days of strengthening activity. However, the public generally only remembers the endurance part of this recommendation. 

    Based on some changes that occur through the lifespan, there is a rationale for emphasizing strength training in individuals. For example, between 20 to 70 years of age, a natural loss in about 40 percent of muscle mass, called “sarcopenia” occurs. In adults, strength training is a rational strategy to attenuate the effect of muscle mass loss. However, it is unknown if older adults can actually increase muscle mass with resistance exercise training. Nevertheless, besides “sarcopenia,” aging is also associated with a decline in muscle strength commonly called “dynapenia.” Interestingly, the rate of loss of muscle strength with aging is much steeper compared to that for muscle mass decline. In other words, individuals lose more muscle strength than muscle mass for a given time period. Therefore, strength exercises should be emphasized to prevent decreases in muscle strength rather than targeting the muscle mass. 

    The good news is that when sedentary people begin strength training, they obtain fast improvements in muscle strength— within six weeks! In addition, gain in muscle strength can be as high as more than 100 percent, and this occurs in all age groups. Fast improvement in muscle strength is more likely to help people maintaining adherence to exercise training, which is a real challenge in the field of clinical exercise. Specifically with older adults, increasing overall muscle strength will help to achieve activities of daily living such as climbing stairs, and carrying objects (e.g., grocery bags), thereby helping them to be more independent. Finally, being stronger has been associated with a better quality of life and health outcomes. 

    In this paper recently published in MSSE, we investigated 7,226 men from the Aerobics Center Longitudinal Study first to determine whether low muscle strength was associated with an increased risk of having the metabolic syndrome (cluster of risk factors) and second, to quantify the level (threshold) of muscle strength associated with the metabolic syndrome. In our study, we found that low muscle strength, defined as < 20 percentile of combined 1RM (from bench and leg press) scaled to body weight (per kg body weight), was associated with having metabolic syndrome, especially in young men. 

    Our result confirms previous work on the topic. However, limitations of previous research were the presence of confounding effects of fitness or adiposity, which were controlled in our study. In addition, our study adds to the literature by proposing thresholds of muscle strength associated with the metabolic syndrome. This point is a stepping-stone for professionals working in the field of exercise. First, the study gave thresholds of relative muscle strength based on two widely used exercises (bench and leg press). Second, these thresholds help them design exercise programs that aim to improve health outcomes. Third, as muscle strength is a modifiable risk factor, our result reinforces the message that people should perform strength training as a part of their exercise regimen to help enhancing metabolic risk factors. Therefore, this study provides evidence for exercise professionals in their day-to-day practice. The next steps are to investigate these thresholds with a prospective study and look at potential mechanisms (biological markers) that could explain why muscle strength is associated with metabolic syndrome.

    Martin Sénéchal, Ph.D., CEP, is associate postdoctoral fellow at The Manitoba Institute of Child Health, University of Manitoba, faculty of medicine, department of pediatrics and child health in Winnipeg, Manitoba, Canada. His research focuses on cardiometabolic risk factors, chronic disease and exercise. More specifically, he is interested in the metabolic response to resistance training and the predictors associated with exercise-responders. 

    This commentary presents Dr. Sénéchal’s views on the topic of a research article which he and his colleagues had published in the August 2014 issue of Medicine Science in Sports & Exercise® (MSSE). 

    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.
  • High-Intensity Interval Training, It's a HIIT!

    by Lauren Johnson | Oct 09, 2014
    The popularity of high-intensity interval training is on the rise. High-intensity interval training sessions are commonly called HIIT workouts. This type of training involves repeated bouts of high intensity effort followed by varied recovery times.

    What are the benefits of HIIT workouts? How often can you do them? How do you develop a HIIT program? The ACSM Consumer Information Committee has created a brochure to answer all of these questions and more: ACSM Information on High-Intensity Interval Training

  • Two athletes from different backgrounds both diagnosed with progressive conditions that have no cure. How can these athletes pursue their athletic endeavors?

    by Lauren Johnson | Feb 21, 2014

    Written by Kristin Duquette, US Paralympic Swimmer

    For athletes like myself and Gary Hall, Jr. being physically active proved to be an important part of our lives. Not only are we both swimmers, but both of us learned how to manage and deal with our conditions through physical activity. As Hall was faced with Type 1 Diabetes and I was diagnosed with Muscular Dystrophy, we both learned how to properly train and ultimately succeed in our sport.

    Much of our training came with lots of trial and error: mentally focusing and refocusing on what is possible. With Type 1 Diabetes, practices for Hall consisted of glucose monitoring and insulin treatments during his workout sets and competitions. During this process, Hall learned how to maintain a steady insulin level by matching carbohydrates consumed with the amount and level of physical activity. Training with Muscular Dystrophy brought its own challenges. With a body having the potential to constantly change, much of my training was finding what strokes should be modified for best water dynamics in addition to avoid fatiguing. Another challenge included how to isolate and engage a muscle without compensating from other parts of my body. And with an unconventional body, training and physical activity requires innovative thinking from the athlete, parents, coaches, trainers, and doctors.

    Having a progressive condition is not only manageable, but one can benefit from physically activity. I realized this epiphany a few months after I did not make the 2012 US London Paralympic Team. Different doctors told me that training helped maintain my strength and mobility. Swimming was, and will always be one of the best things I can do for my condition. Even before I was diagnosed at age 9, swimming established the neural pathways and mental memory in my brain which became evident when I retaught a different body how to swim after a 6 year break. Regardless of competition, sport and physical activity provide more benefits than we may know. Physical activity can truly shatter our limitations on one’s potential and how far the human body can truly go. 

  • Coping with Sports Injuries & Rehab – Reframing Attitudes & Goals Pays Dividends

    by Lauren Johnson | Feb 18, 2014

    Written by Matt Cuccaro, Ed.M., and Greg Chertok, M.Ed., CC-AASP

    Under the illumination of the Olympic torch, many human stories are emerging in Sochi - from some extraordinary athletes. The unfortunate reality of training, competing and pushing human limits is that injury is a potential result. Lindsay Vonn’s recent departure from the US Ski Team is just one example of the many difficult decisions athletes are facing regarding injuries throughout the Olympic Games.

    Overcoming an injury is something most athletes will face at least once throughout a career. Here are a few brief ideas to assist any athlete who is managing the difficulty and uncertainty of injury recovery.


    Much the same as an athlete cannot choose his or her opponent or win/loss record, an athlete cannot control the time, place or severity of an injury. One of the most important mental factors in effectively overcoming injury comes in the form of acceptance. It is natural to have an emotional reaction to injury, yet helplessness, anger, and denial are not emotions which will assist the individual to progress or adhere to a rehabilitation program. Once an athlete accepts the presence of an injury, he or she tends to become more recovery-focused and action-oriented (“How can I get better?”). Accepting something that may impede participation in an event for which one has trained for so many years is remarkably difficult. Yet, athletes who become more emotionally charged with embracing the challenge of recovery tend to adhere to medical advice and achieve better results in the end.


    Medical staff becomes the coach

    Because many athletes are accustomed to being healthy and functioning at a high level, spending time with a medical team – which, to most athletes, is synonymous with dysfunction and poor health – may be uncomfortable. Rightfully so, athletes have a closer and more trusting relationship with their athletic team than with their medical team. A coach is meant to assist an athlete in reaching his or her goals, while a doctor or physical therapist is often indication that a barrier has arisen that might hinder achievement of those goals. However, effective injury recovery revolves around the close work of the athlete and their medical staff. Those who recognize and embrace their new team will build stronger relationships, gain deeper trust and likely to increase adherence to expert advice along the road to recovery.

    Injury recovery becomes new sport

    Much the same as the medical staff becomes a new coach, injury recovery becomes the new sport. As much as an athlete yearns to resume play, physical and mental investment into the rehabilitation process will prove to create better use of time and energy. Some days may be filled with stretching and strengthening, while others might include ice and repeated rest. An athlete who stays committed and active with their rehab process, the same as they would their sport training, will find greater purpose and feel more fulfilled along the path back to the playing field.


    Beware of “ticking clock”…deadlines become distractions

    Having a specific date or game in mind to come back to the field may prove to be more of a distraction than a motivator throughout the recovery process, especially as that day approaches. Game time doesn’t make an athlete ready, recovery makes an athlete ready. Those who stay focused and committed to recovery will make a stronger and healthier return to the playing field, while those who allow certain games or dates to dictate their return might find themselves right back at the beginning of the injury recovery process.

    How an athlete views an injury is ultimately the choice of the athlete. Observe the behaviors of the athletes at the highest level and you will see a reaction to injury not unlike the one described above. From the beginning to end stages of an injury, an athlete has complete control over his or her physical and emotional response. Olympic athletes understand and adhere to a more facilitative response, one that will quicken the recovery process and leave them fully ready to return to their sport.

    About Matt Cuccaro, Ed.M.: Matt Cuccaro is the Director of Mental Training at Ivan Lendl International Junior Tennis Academy in Hilton Head Island, SC. He has a Masters of Education in Counseling/Sport Psychology from Boston University and is an active member of the Association for Applied Sport Psychology. Matt has worked with athletes, coaches, and administrators in a number of sports from the junior to world-class professional level.

    About Greg Chertok, Ed.M.: Greg Chertok is the Director of Mental Training at CourtSense, a high performance junior tennis academy in Bergen County, NJ. He has a Masters of Education in Counseling/Sport Psychology from Boston University and is a certified consultant with the Association for Applied Sport Psychology. Greg has worked with athletes from the junior to Olympic level.

    Note: The views expressed in ACSM Olympics Hot Topics are those of the contributors only, and should not be construed as official statements of the American College of Sports Medicine. 

  • Active Voice: Equipment & Technology Issues in the Paralympics

    by User Not Found | Feb 17, 2014

    Written By Peter Van de Vliet, Ph.D.

    Dr. Peter Van de Vliet is the Medical & Scientific Director, International Paralympic Committee (IPC). He holds a PhD in Physiotherapy and Motor Rehabilitation from Leuven University (Belgium) and held a post-doctoral research position in Adapted Physical Activity at that university prior to moving to Bonn, Germany, for the actual position as IPC Medical & Scientific Director. The portfolio includes the coordination of anti-doping and medical services, classification, and sports science developments in the Paralympic Movement. Dr. Van de Vliet has (co-)authored several scientific publications and book chapters on the subject, and coordinates the relationships with internationally leading research bodies in the respective areas.

    Equipment rules are becoming more prominent in the Paralympic Movement. As a result, the International Paralympic Committee’s (IPC) Sports Science Committee recently held a scientific forum to exchange current information, research, and expertise that focused entirely on equipment and technology in Paralympic Sports. This conference, “VISTA 2013”, was held May 1-4 last year at the Gustav-Stresemann Institute in Bonn, Germany. The conference program describes the complex issues that the IPC must address in determining what equipment may or may not be approved for use by competing Paralympic athletes. What are the implications of a technology for competitive fairness? Is the device a necessity that enables the individual to participate or might it enhance performance in some manner? Does it represent a ‘grass roots’ approach that could be broadly applied by low-income countries or is it a high-tech, individualized application that only athletes from selected countries might be able to access?

    Equipment rules are a sport-specific subject. To effectively address those details in this brief commentary would require that experts from each sport present specific and detailed responses. Rather, it is better here to avoid such a case-by-case discussion, and instead draw your attention to the IPC Equipment Policy. This policy is part of the IPC Handbook (see Section 2, Chapter 3.10), to which all members of the Paralympic Movement (sports and athletes) must to adhere.

    In brief, this policy states that all adaptive equipment used in a Paralympic sport must be in compliance with four main principles:

    1. Safety: all equipment must be safe for the athlete, any opponent, and may not cause irreversible damage to the field of play;
    2. Fairness: sport rules must detail the provisions of all equipment in terms of dimensions, weight, and use of material;
    3. Universality: prototype equipment is not allowed, and costs must be 'under control' to avoid that access to equipment becomes a matter of exclusivity. For this reason, the IPC also actively engages in the development of low cost equipment (for examples, see the website;
    4. Physical Prowess: equipment may not be steered by machine, computer or robot.
    For further information on this topic, I highly recommend the following journal article by Brendan Burkett, PhD, from the University of the Sunshine Coast (Australia): Paralympic Sports Medicine—Current Evidence in Winter Sport: Considerations in the Development of Equipment Standards for Paralympic Athletes. Professor Burkett is a member of the IPC Sports Science Committee.    

  • Performing at High Altitudes

    by User Not Found | Feb 13, 2014

    Written By Jordan Guillot, ACSM Health Fitness Specialist

    Varying altitudes may propose a new challenge for athletes competing in the Winter Olympic Games. As the elevation above sea level increases, not only does the barometric pressure of the air decrease, but the pressure of oxygen in that air also decreases (Exercise Physiology, McArdle, Katch, and Katch, 6th ed., 2007).

    This decrease in pressure of oxygen becomes that new challenge. The diffusion of oxygen from inspired air in the lungs across a membrane and into the blood stream depends on a pressure gradient (from area of higher pressure to area of lower pressure). As blood flows through the body, muscles and other tissues utilize the oxygen, which decreases the pressure of oxygen in the blood stream before returning to the heart. Once this blood reaches the lungs from the heart, its pressure of oxygen is much less than that of the inspired air.

    This difference in pressure allows diffusion of oxygen from the greater pressure inside the lungs and into the area of lower pressure – the blood stream – to be delivered throughout the body. The blood leaving the lungs is what is commonly known as the oxygenated blood, and is vital to muscle and tissue function. At higher altitudes, as mentioned before, the pressure of oxygen is lower than at sea level, and that pressure continues to decrease with every increase in elevation. If the pressure of oxygen lowers in inspired air, the difference in pressures between the inspired air and the blood stream would decrease, also. This decrease in difference lowers the rate at which diffusion takes place. Thus, a decrease in oxygen saturation of the blood can be expected. Now the muscles have an inadequate supply of oxygen, which inevitably affects and decreases performance than what can be expected at sea level or at lower altitudes.

    Olympic Winter Games rules state that a downhill skiing course must have a vertical drop of 800-1100 meters (2600-3280 ft.) (FIS Ski Rules 2008, 79). This is more than enough vertical distance for the start and finish to differentiate in their pressures of oxygen. However, there is a question of how much oxygen pressure change effects might come into play. Given these events are relatively brief and as a consequence, is a substantial part of the needed energy generated by anaerobic pathways?

  • Bioenergetics and the Olympic Athlete

    by User Not Found | Feb 11, 2014

    By Mark Deaton, Ph.D., CSCS, EIM

    We all desire to be bigger, faster, stronger – but how do we get there?

    Some people look to the $400 billion supplement industry, while others take a more natural approach. Bioenergetics is the term used for the interactive energy systems within the human body and how energy is expended through exercise. It is defined as the conversion of protein, carbohydrates and fats into biologically usable energy that can be used for muscular activity (Powers, S.K, Howley, E.T. 2009, p 23). Fueling a working body is as vital to training and performance as gasoline or electricity is for an automobile. Some may think understanding the biochemical components of each food isn’t necessary, as long as you “just eat it!” But we know food comes in various nutrient levels; therefore, it would be best to understand proper nutrition. It is critical for an athlete to have a better understanding of bioenergetics to increase the efficiency of their personal performance (Powers, S.K., Howley, E.T. 2009, p. 23-24).

    The three energy systems are: 1) Phosphagen (ATP-PC) – responsible for producing energy for the first few seconds of any athletic event; 2) Glycolysis – continues energy production from 30 seconds to three minutes into the athletic event via the breakdown of carbohydrates from blood glucose or muscle glycogen stores; and 3) Oxidative (aerobic) – produces energy after three minutes until the event ends or fatigue limits the performance. The primary source of energy produced by these three systems is adenosine triphosphate (ATP). Depending on the intensity and duration of the athletic event, these energy systems will interact with one another and even revert back and forth on a continuum of ATP production. An example would be a sprint at the end of an endurance event where a crossover effect to fast glycolysis will occur (Baechle, T.R., Earle, R.W., 2008, p. 22-36). Educating yourself on the effects of certain nutrients and their combinations will provide a potential natural advantage that your energy systems will utilize.

    So, what do you need to know? Educate yourself as an athlete and as a health professional who works with athletes regarding bioenergetics and proper nutrition for performance. Before recommending or taking supplements, reevaluate training principles (overload, progression, etc.), and supplement safety. Analyze current calorie-to-protein intake from natural sources (Hoffman, J. 2010, SSTC). Chances are you may find an area to manipulate slightly that could result in a more productive performance.


    How does your food intake affect your performance?

    Knowing the sport-specific demands of your sport, how have you manipulated your training and nutrition?

    What are your thoughts on nutrient timing (pre-event, post-event) and what foods are ingested?


    Baechle, T.R., Earle, R.W. (2008). Essentials of strength training and conditioning. National Strength and Conditioning Association. 3rd edition.

    Hoffman, J. (2010). Sport-specific training conference. National Strength and Conditioning Association.

    Powers, S.K., Howley, E.T. (2009). Exercise physiology: Theory and application to fitness and performance. 7th edition. McGraw-Hill, New York, NY.    

  • Olympic Figure Skating: What It Takes

    by User Not Found | Feb 09, 2014

    Written By Gemmie S. Devera, MD, MS, MP

    Olympic Figure Skating consists of women’s singles, men’s singles, pairs, and ice dancing. Elite competitors skate at the senior level. To reach this level, skaters must pass 16 rigorous tests in Moves in the Field and Free Skating. Moves in the Field showcase skating skills and transition elements such as spirals, a move that involves balancing on the skating leg and extending the free leg, or non-skating leg, into the air. Free Skating moves highlight jumps, spins, and transition elements in a choreographed program. Ice dancers complete a separate series of dance tests.

    Each Olympic year, the U.S. Figure Skating National Championships double as the Olympic Trials. The number of athletes a country can send to the Games depends on the country’s placements at the previous year’s World Figure Skating Championships. Winners from the last U.S. National Championships or World Championships automatically qualify for the U.S. Nationals. Other athletes qualify for the Nationals from a top placement at another major event or by advancing through both Regional and Sectional Championships.  U.S. Figure Skating (USFS) then chooses the Olympic Team based on placements at Nationals and the skaters’ previous body of work through the years.

    At the Olympics, the women, men, and pairs have six minutes to complete short and long programs. The top men will attempt quadruple jumps that rotate four times before landing. The top women will attempt triple – triple combinations. Pairs will attempt dangerous twists, throws and lifts. Ice dancers will display their unison with intricate footwork sequences in three dance performances.   A new team skating event will debut in Sochi, featuring top skaters in each discipline to determine which country reigns supreme.

    Reaching the Olympic podium takes strength, flexibility, endurance, musicality, charisma and strong mindsets. Skaters typically train at least 15 hours on the ice, five days per week, and also do off-ice training. Skaters need strong core muscles to pull the body in tightly and rotate. A triple axel, for example, uses a forward take-off from a quarter-of-an-inch skate blade and completes three-and-one-half revolutions in 0.7 seconds. Skaters acquire strength from skating, Pilates, or weight training. Yoga and ballet increase flexibility and awareness of body position in space. Run-throughs of skating programs build endurance. Music and the arts develop musicality and a point of view. Periodization of training helps skaters avoid injury. Elite skaters have achieved a certain level of athletic performance, and a positive mindset allows skaters to express figure skating’s unique blend of artistry and athleticism on the Olympic stage.

    Discussion question: What training aspects in the days before the Olympics, mental or physical, are most important for a peak performance?

  • Diabetes and Physical Activity

    by Lauren Johnson | Feb 08, 2014

    Written by Barbara Bushman, Ph.D., FACSM

    Diabetes is a disease characterized by high blood glucose (high sugar in the blood). Diabetes affects 346 million people worldwide.

    • Type 1 diabetes is an autoimmune disease which causes the destruction of insulin-producing cells in the pancreas.
    • Type 2 diabetes occurs when the body no longer uses the insulin produced, resulting in insulin resistance.

    In both types of diabetes blood glucose levels become elevated without the assistance of insulin to help move glucose into the body's cells.

    Athletes must have glucose (carbohydrate) available in the muscle cells for high intensity activity and so it would seem diabetes and athletic competition would be a poor match. On the contrary, former successful Olympians (swimmer Gary Hall Jr., volleyball player Kevin Hansen, cross country skier Kris Freeman) as well as many others (marathoner Missy Foy, football quarterback Jay Cutler) have been very successful athletes while managing their diabetes.

    Physical activity and a focus on diet are two important lifestyle factors for everyone, and are especially important for individuals with type 1 or type 2 diabetes. Monitoring blood glucose levels to ensure adequate glucose levels are maintained is an added challenge, but one worth the effort, not just for those pursuing Olympic glory, but for everyone.

    Read more from the ACSM Sports Performance Center

    Recommended Resources

    Barbara Bushman, Ph.D., FACSM, is a professor at Missouri State University. Dr. Bushman has authored papers related to menopause, factors influencing exercise participation, and deep water run training. She authored ACSM’s Action Plan for Menopause (Human Kinetics, 2005), edited ACSM’s Complete Guide to Fitness & Health (Human Kinetics, 2011), and serves as an associate editor for ACSM’s Health & Fitness Journal

    Note: The views expressed in ACSM Olympics Hot Topics are those of the contributors only, and should not be construed as official statements of the American College of Sports Medicine.

  • Sport-Related Concussion & the Olympics

    by User Not Found | Feb 07, 2014

    Written By Michael J. O’Brien, MD and William P. Meehan III, M.D.

    Sport-related concussion, sometimes referred to as mild traumatic brain injury, is a temporary, trauma-induced interruption of normal brain function. Concussions occur due to a rapid, rotational acceleration of the brain, often as a result of a blow to the head or face. It is a functional injury, as opposed to a structural injury. There is no detectable bleeding, swelling or bruising of the brain.    

    Concussions occur in all sports. Although much of the medical literature on sport-related concussions focuses on American football players, higher incidence rates have been reported in one of the sports featured in the winter Olympics: ice hockey.1,2  Concussion has also been reported in skiing, snowboarding, luge, and speed skating.3-7 8,

    Concussion is suspected if, after a rapid acceleration of the head, an athlete shows any of the signs of concussion or experiences any of the symptoms of concussion. Signs of concussion include vomiting, amnesia, imbalance, confusion, and less commonly loss of consciousness, among others. Symptoms of concussion include headaches, dizziness, nausea, sensitivity to light, and changes in sleep patterns, among others.

    On-site management of brain injury during the Olympics will start with assessment of the airway, breathing, and circulation of the injured athlete and proceed along established protocols. Once all other injuries are addressed, focus will turn to managing the athletes’ concussions.

    The mainstays of concussion management are physical and cognitive rest.10-12 The athlete will avoid strenuous activity and rigorous training during the recovery period. In order to achieve cognitive rest, intellectually challenging tasks, such as studying, reading, playing video games, and working online, will be minimized. Once the injured athlete’s symptoms subside, they will be started on a return-to-play regimen, beginning with some light aerobic activity, and advancing as tolerated by symptoms to more rigorous activities. Stages for the return-to-play progression have been outlined by the international conferences on concussion in sport. The stages from the 4th conference are shown below (table).11


    Level of Activity


     No activity  (symptom limited physical and cognitive rest)


    Light aerobic exercise e.g., walking, swimming, stationary cycling; <70% maximum permitted heart rate)


    Sport-specific exercise, (e.g., skating drills in hockey, running drills in soccer)


    Noncontact training drills (progression to more complex training drills (e.g. passing drills in football and ice hockey) may start progressive resistance training


    Full-contact training, following medical clearance


    Return-to-play, normal game play

    Table.  Return-to-play stages as adapted from the 4th international conference on concussion in sport.11.  Athletes should proceed to a given level, only if asymptomatic at the previous level.  Each level should take, at a minimum, 24 hours to complete.11

    According to recent consensus statements, same-day return-to-play should no longer be allowed.11

    Readers are encouraged to post their comments on the following question: Does the opportunity to win an Olympic medal outweigh the potential risks associated with an earlier return to play after a sport-related concussion



    1.         Koh JO, Cassidy JD, Watkinson EJ. Incidence of concussion in contact sports: a systematic review of the evidence. Brain Inj 2003;17:901-17.

    2.         Tommasone BA, Valovich McLeod TC. Contact sport concussion incidence. Journal of athletic training 2006;41:470-2.

    3.         Chaze B, McDonald P. Head injuries in winter sports: downhill skiing, snowboarding, sledding, snowmobiling, ice skating and ice hockey. Neurologic clinics 2008;26:325-32; xii-xiii.

    4.         Cummings RS, Jr., Shurland AT, Prodoehl JA, Moody K, Sherk HH. Injuries in the sport of luge. Epidemiology and analysis. The American journal of sports medicine 1997;25:508-13.

    5.         Florenes TW, Bere T, Nordsletten L, Heir S, Bahr R. Injuries among male and female World Cup alpine skiers. British journal of sports medicine 2009;43:973-8.

    6.         Quinn A, Lun V, McCall J, Overend T. Injuries in short track speed skating. The American journal of sports medicine 2003;31:507-10.

    7.         Wasden CC, McIntosh SE, Keith DS, McCowan C. An analysis of skiing and snowboarding injuries on Utah slopes. The Journal of trauma 2009;67:1022-6.

    8.         Steenstrup SE, Bere T, Bahr R. Head injuries among FIS World Cup alpine and freestyle skiers and snowboarders: a 7-year cohort study. British journal of sports medicine 2014;48:41-5.

    9.         Graves JM, Whitehill JM, Stream JO, Vavilala MS, Rivara FP. Emergency department reported head injuries from skiing and snowboarding among children and adolescents, 1996-2010. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention 2013;19:399-404.

    10.       Cantu RC. Consensus statement on concussion in sport--the 3rd International Conference on Concussion, Zurich, November 2008. Neurosurgery 2009;64:786-7.

    11.       McCrory P, Meeuwisse W, Aubry M, et al. Consensus statement on concussion in sport--the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Clin J Sport Med 2013;23:89-117.

    12.       Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP, 3rd. Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms. Pediatrics 2014.

  • Vitamin D and Athletics

    by User Not Found | Feb 07, 2014

    Written By Alan Remde, M.D., FAAFP

    Vitamin D (actually a hormone), is an essential fat-soluble hormone required for the health of the bones, muscles, heart and blood vessels, nervous, immune and other systems of the body. Given that many of these systems are critical for athletic performance, the adequacy of vitamin D status is relevant for Olympic athletes.

    Sources & requirements: The majority (~ 90%) of vitamin D is derived from direct sunlight (cannot be through windows, sunscreens or clothes) when the sun is at least 40 degrees above the horizon. Thus at latitudes above 35 degrees, there is a “vitamin D winter” when none of us can make enough vitamin D from the sun, and we rely on stored vitamin D banked during the warmer months. The amount of sunlight needed is modest – in the range of 10 to 45 minutes per day, and thus should not pose a significant risk of skin cancer in most people. This range varies due to factors such as darkness of the skin, older age, air pollution and many other factors that reduce the ability to make Vitamin D from sunlight. For example, for people with medium-light skin who gradually tan but sometimes burn (Skin Type 3), 15-30 minutes of sunlight most days is probably adequate. Only a small proportion comes from dietary sources such as oily fish and fortified dairy products, and these should not solely be relied on to satisfy the body’s total requirement.

    Vitamin D deficiency is common in athletes. Deficiency is associated with osteoporosis (thinning of bones), stress fractures, muscle weakness, falls, poor coordination, depression and fatigue, as well as many other problems. More research is required to confirm that optimizing Vitamin D levels improves performance. (Cannell, J. J., et. al.  Athletic Performance and Vitamin D. Med. Sci. Sports Exerc., Vol. 41, No. 5, pp. 1102–1110, 2009).

    Vitamin D status can be assessed with a blood test for 25 (OH) Vitamin D level. Normal is considered by many to be ~ 30 – 60 ng/ml. The range of normal 25 (OH) Vitamin D level is controversial, however. The IOM in a major recent review states that the lower limit of normal level is 20 ng/mL. There is also preliminary evidence suggesting that Afro-Americans can have even lower level than this and be healthy. This finding awaits confirmation.

    Prevention: Taking 1000 to 2000 units daily of Vitamin D3 in the colder months will help maintain stores.

    Deficiency is treated with higher doses, e.g. 50,000 units oral vitamin D3 weekly for 8–16 weeks. (Modern nutrition in health and disease/senior editor, Maurice E. Shils; associate editors, Moshe Shike…[et al.].—10th ed. Chapter on Vitamin D)

    Discussion question: What other vitamins may be necessary for athletic success in the Olympic Games?

  • Who am I after a shattered Olympic dream?

    by User Not Found | Feb 06, 2014

    Written By Sharon A. Chirban, Ph.D.

    That is the question often haunting an athlete following an unexpected loss during high-level competition. For many athletes, it was achieving Olympic-level competition that drove years and years of training and preparation. For some sports (figure skating, ski racing, skeleton, etc.), the Olympics are the largest venue for competition and the Games only come around every four years.

    Reorganizing one's identity following athletic loss can be one of the most challenging experiences an athlete faces after the rigors of training and mental preparation for the Olympic stage. Depending on the reasons for the loss (and they have ranged, in Olympic years, from family tragedies to catastrophic injury to burnout, to just not “having it” on the day of competition), the athlete can have a range of feelings from shame for self or for one’s country to anger and extreme feelings of disappointment and/or disorientation.

    Some pick themselves back up and commit immediately to their next four years of training. This is a quick resolution to restore the identity and pursue their life path – as many athletes do, over and over. For others, the disillusionment, the pain, the shame can last for months, even years. For these athletes, it’s often the end of a long road and without glory. It can be devastating to try to make sense of the years of commitment to training and a disciplined lifestyle with an unintended outcome.

    Many high-level athletes talk about not knowing who they are outside of their performance domain. Researchers (Palmer, 1981) explain that who athletes feel they are is heavily dependent on what roles they have carried out. For some, it’s the only role they know, and adjustment to post-athletic life can be very difficult. Those who identify more with their athletic role (Brewer, Van Raalte, and Linder, 1993) often have traded other life roles in order to pursue training and competition at the highest levels. Recovering from this kind of identity disorganization often follows similar stages as recovering from loss. Some athletes who do not move through the phases with ease may need professional assistance to negotiate a reorganized identity to make a healthy transition to post-athletic career adjustment.

    Post your comments: What cases of emotional distress and disappointment from competitive loss have you seen in athletes you’ve worked with?

  • Embracing Challenges for Performance Excellence

    by User Not Found | Feb 05, 2014

    Written By Greg Chertok, M.Ed., CC-AASP

    In pursuit of long-term goals, rarely does the elite athlete enjoy the luxury of a smooth ride.  Very few athletes achieve international greatness in sports with ease, and without obstacles. And especially at the Olympic Games, the presence of obstacles is inevitable, that is, the opportunity to experience “choppy waters” exists at every turn. For instance, the athlete whose life is dedicated to excellence in his or her sport is highly routinized – if not by choice then by necessity – and likely follows a strict daily regimen of sleep, meals, and training. Even down time, or rest, is deliberately structured into the schedule.  Imagine how an ultra-competitive, obsessively disciplined athlete may respond, emotionally and in performance, to a significantly overhauled schedule and new environment upon arriving at the Olympic Village in Sochi.   Combine this with the frequent media distractions, unfamiliar playing conditions, and the presence of family and friends, and it becomes inevitable for an athlete to place a greater value on the Games, causing performance anxiety to heighten and the managing of that anxiety to become more difficult.  Since challenges are guaranteed for every athlete as he or she strives for individual sporting goals, it is necessary to embrace challenges in order to enhance performance.

    While the challenges of participating in the Games may be unique and at times unpleasant, mentally tough athletes will know that obstacles also provide opportunities for learning, growth and development. When embraced, challenges, such as having to adjust to a new schedule and competition environment, are seen as exciting tasks to be overcome rather than situations to be avoided. Confronting and embracing challenge allows athletes to develop skills for focusing and relaxing during potentially stressful endeavors on and off the playing field. Athletes who avoid challenges, or choose not to embrace them, will often remain problem-focused and not solution-focused, and therefore have a more difficult time coping with the adjustments.

    Consider a fitness-related example. Curling a five-lb. weight for several repetitions is not a remarkably challenging task - for most, it's rather simple. As a result, very little muscular growth will occur, and the biceps will remain as it was. Curling a 25-lb. weight for several repetitions is a far more difficult task, and while the feeling in the moment may be uncomfortable, unfamiliar, or distressing, the muscle is sure to grow when put under that kind of stress. The mind, too, needs to be put under stress in order to learn and grow. A player who adopts this approach will not only accept challenges, but begin to actively seek them out as a means of growth. What a wonderful difference between this and the athlete who actively avoids challenging or uncomfortable situations, and subsequently performs poorly due to the heightened cognitive tension (“I don’t want to be here!  I don’t think I can do this!”) as well as somatic tension (muscular tightness, stiff and overly mechanical movements).

    Elite athletes also know that embracing challenge means maintaining a healthy performance intensity. That is, they understand the importance, and appreciate the inherent difficulty, of not allowing anxiety to cause them to play over-aroused (“too intense”) or under-aroused (“too relaxed”), both of which can hinder performance. A recent Harvard Business School study reiterates a similar point. Contrary to the belief of many coaches and athletes, whose automatic reaction to anxiety is to relax, there are benefits of getting excited in the face of performance anxiety rather than using mental energy to attempt to calm down. While trying to calm down to manage stress is preferred to simply suppressing or hiding anxiety, the study revealed that reappraising anxiety as excitement is easier and far more effective than trying to calm down. Whereas anxiety is a negative, aversive emotion that harms performance, excitement is a positive, pleasant emotion that can improve performance.

    Any performer who is able to reframe the physiological response from “I’m feeling nervous, I better calm down now to “I’m feeling excited” is taking advantage of the natural surge of sympathetic nervous system energy being experienced. Repurposing anxiety as excitement can help an athlete feel in control, which will improve self-efficacy and focus. A noted difference between professional and amateur athletes, then, is not necessarily the amount of anxiety experienced, but rather their interpretation of it.

  • New Year, New Fitness Habits

    by Lauren Johnson | Feb 04, 2014

    Along with an abundance of family get-togethers, pitch-in meals, and throwing normal rules about dessert out the window-the Holiday season is also one for reflection and goal-setting. And after a month surrounded by "sugar and spice, and everything nice", fitness is often top of mind when the New Year rolls around.

    Despite all the good intentions that energize thoughts of another year, an estimated 60-percent of gym memberships never get used. While we can chalk that fitness gap up to a lack of priority, winter weather, or other responsibilities-fitness professionals can help motivate, inform, and hold accountable those individuals who aren't just looking to set a goal, but reaching, excelling, and exceeding.

    Here are a few helpful strategies for the flurry of New Year's fitness plans. Share your favorites in the comments below!

    Schedule Time

    It's quick and easy to say you'll workout 3 days a week, but as the calendar moves on and fills up, you can find yourself short on time. Establish regular days of the week and book them in your calendar, planner, or online schedule. Block out time for your workout, and you'll have one less excuse for missing one!

    Set Specific Goals

    Specific goals can help take away some of the fuzziness associated with individual workouts, which can easily vary in frequency or quality. Instead, set specific and reasonable goals attached to a date or achievement. Enter a 5K race, or identify a pace or weight-training goal that pushes you to excel but also recognizes your starting point.

    Find a Friend or Class

    Part of any goal-setting regimen is accountability, and fitness goals are no different. If you struggle with working out by yourself, find a workout partner who shares your schedule. Or, find a fitness class, pick-up game, or other activity to attend on a regular basis. And if none of those work; share your plans and goals with your friends and family-the more people you tell about it, the more accountable you'll feel.

    Incentivize Your Training

    Sometimes, you need a little motivational help to reach your end goals. Whether it's a favorite food, a trip someplace special, or even a new piece of workout gear-rewarding yourself after reaching a goal can help give you that extra push towards the next step. Many gyms and fitness facilities offer incentives for participation as well, in case you're not one for rewarding yourself.

    Use an App

    Are you a phone person? If you just can't put down your smartphone, consider all the different types of fitness and healthy living applications. From calorie counters, to run distance trackers, and more-you're sure to find a visually appealing app that keeps you invested in your goals. Taking it another step, there are even social networks you can join to follow and even compete against yourself and others.

    How do you help your clients set and achieve their New Year's fitness goals? 

  • Snacking Tips for Olympic Viewing

    by Lauren Johnson | Feb 04, 2014

    Written by Felicia D. Stoler, DCN, MS, RD, FACSM
    Nutritionist & Exercise Physiologist

    I have always found the Olympics fascinating since I was a little girl- I could watch for hours uninterrupted. My guess is plenty of adults will be doing that as well this summer. However, unlike the mass food consumption of Super Bowl Sunday, the Olympics last for two weeks. In order to prevent increasing your waistline while watching the competitions, it’s important to be mindful of what you are eating. In addition to food selection, it’s also important to measure out your food or snacks onto a plate or in a bowl. Be aware of the calories you may be drinking as well, unless water is your beverage of choice. I suggest that you use the commercial breaks as an opportunity to stretch and even exercise.

    Fresh fruits and vegetables always make great choices for snacks, and if you must dip, try to make a dip using fat-free Greek yogurt as the base. Salsas can be low in calories and packed with flavor. Consider hummus or other bean dips in lieu of the more calorie-laden varieties. Baked chips are a great alternative to the regular variety, unless you can exert some self-control and not eat an entire ten ounce bag of chips (one serving is one ounce!). Pretzel flats and pita chips are a favorite dipping food in our home, and try to choose low-fat cheeses.    

    If you happen to be consuming alcoholic beverages, I highly recommend a full glass of water or club soda between beverages. It helps you to stay hydrated and will decrease the calories you consume from alcohol (which is 7 kcal/g – making it closer in calories to fat).

    Enjoy being a spectator and while the summer Olympics only happen every four years, we have plenty of opportunities to over eat this summer. Don’t end up with Olympic rings around your waist!

    What do you think? Join the conversation on our Facebook Page and on Twitter.

     Felicia D. Stoler, DCN, MS, RD, FACSM, is a registered dietitian, exercise physiologist and expert consultant in disease prevention, wellness and healthful living. She is the current president of ACSM’s Greater New York Regional Chapter, and she is a member of the American Dietetic Association’s House of Delegates. She maintains a private practice, is a consultant and has been on many national television and radio programs. She is the former host of the popular television series “Honey, We’re Killing the Kids,” which focused on issues of parenting, nutrition and physical activity in families.

    Note: The views expressed in ACSM Olympics Hot Topics are those of the contributors only, and should not be construed as official statements of the American College of Sports Medicine.

    More on this topic:

  • Sports Nutrition Unplugged

    by User Not Found | Jan 28, 2014

    Written by Felicia D. Stoler, DCN, MS, RD, FACSM
    Nutritionist & Exercise Physiologist

    When one works in a lab setting doing research and has access to equipment and testing, sports nutrition is really a precise science. However, for most athletes, even those bound for the Olympics, until they are part of the official Olympic team they hopefully use the same principles we have espoused for many years.

    The factors that are important for Olympic athletes include fueling and hydration (rest, too). The nutrients recommendations, per the joint position of the ACSM and Academy of Dietetics and Nutrition remain the same: 

    • Protein – 15-20%
      • 1.2 – 1.4 g/kg/bw/day for endurance athletes
      • 1.6 – 1.7 g/kg/bw/day for strength athletes
      • RDA 0.8 - 1.0 g/kg/bw/day
    • Carbohydrate 50-60%
      • 6-10 g/kg/bw/day
    • Fat <30% total kcal/day
      • Less than 10% from saturated fat

    Fluid needs are an important aspect of sports performance – for maintaining body temperature, blood pressure, circulation of oxygen, glucose, etc. Replenishment of fluids/water is 16-24 fl oz for each pound of body weight lost during exercise. Electrolyte replenishment is based upon the extent of sweat loss. Some people know they are super salty sweaters because they are sometimes covered in salt after long durations of exercise (or see salt residue on clothing).

    For endurance events – maintaining carbohydrate levels is important: 1.5g of carbs/kg body weight during first 30 min and again every 2 hours for 4 to 6 hours. Regardless of the particular sport, protein replenishment is important for recovery, but it should be combined with carbohydrates. The carbohydrate to protein replenishment ratio is 3:1 or 4:1.

    When athletes compete internationally, sleep and usual foods may be a challenge. The mantra of all sports nutritionists to athletes: don’t do anything new the day of a race. Practice is a great opportunity to tweak fueling, hydration and replenishing strategies, even though the surge of adrenaline is never the same. We usually suggest that athletes get as much of their nutrient needs from real food versus supplements. There are strict rules with regard to supplementation and potential performance enhancement products – intentionally or unintentionally being ingested. It is a great disgrace to be disqualified or have to return a medal due to testing positive for a banned substance.

    What do you think? Join the conversation on our Facebook Page and on Twitter.

    Felicia D. Stoler, DCN, MS, RD, FACSM, is a registered dietitian, exercise physiologist and expert consultant in disease prevention, wellness and healthful living. She is the current president of ACSM’s Greater New York Regional Chapter, and she is a member of the American Dietetic Association’s House of Delegates. She maintains a private practice, is a consultant and has been on many national television and radio programs. She is the former host of the popular television series “Honey, We’re Killing the Kids,” which focused on issues of parenting, nutrition and physical activity in families. 

    Note: The views expressed in ACSM Olympics Hot Topics are those of the contributors only, and should not be construed as official statements of the American College of Sports Medicine.

    More on this topic:

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