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An international resource fueled by the science of sports medicine

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: Running Biomechanics from Ages 20 to 60: What’s Going On at the Ankle?

    by Guest Blogger | May 16, 2016
    By Paul DeVita, Ph.D., FACSM

    The Runners Injury and Longitudinal Study, or TRAILS, is a multi-organization study investigating the hypothesis that a discrete set of biomechanical, behavioral and physiological risk factors distinguish runners who sustain an overuse running injury from those who remain injury-free. Wake Forest University, the U.S. Army and East Carolina University are collaborating to define factors that differentiate injury-free from injured runners over one year.

    The long-term goal of this research is to reduce the number of injuries sustained by military recruits during their training. As described in our January 2016 MSSE paper, we used the baseline data from 110 male and female runners to address this issue and produce relevant data on the changes in running biomechanics for subjects aged 20 to 60 years. The primary results of this cross-sectional study were: 1) stride length and running velocity decreased 15 percent over the 40 years, but stride rate did not change; 2) hip and knee muscle function also were unchanged over the four decades, but ankle calf muscle function decreased precipitously. I need to mention that non-biomechanical factors possibly may have contributed to these observed changes with age. For example, reduced overall fitness may have led the older runners to decide to run slower and they did so by reducing calf muscle function to take shorter steps and run slower. The focused decline in ankle muscle function is still a unique observation, no matter the causal factors, and suggests either strength or power training focusing on the calf muscles may be a viable mechanism for attenuating the reduction in running biomechanics with age.

    Training these muscles is typically performed less frequently by runners. Instead, runners tend to train with squats, the leg press and knee extension exercises - with the result being improved strength or power in the quadriceps. Certainly, fewer people perform ankle squats, ankle presses and ankle extension exercises — but, we now are suggesting that they should try to incorporate ankle training into their overall regimen. Reduced ankle power also may be related to the observed increase in Achilles and calf muscle injuries that occur in older vs. younger runners. This may be due to the fact that these tissues may not be able to handle the stresses of running as we reach our 40s and 50s. We also find it interesting that the focused decline in ankle muscle function agrees with data showing that older adults (i.e. 70 years and older) lose a relatively greater degree of muscle function at the ankle than at the hip. Perhaps we have identified a functional decline prompted by the aging process, as far as locomotion is concerned — loss of calf muscle function. This idea suggests that training our calf muscles also may benefit older adults during more routine activities of daily living.

    Beyond what I have just described, we also were able to calculate a yearly rate of decline for these variables. This calculation was a novel contribution of the study and may serve to help other investigators by providing reference values for these measures. The regression equations may be used to accurately estimate stride length and running velocity at various adult ages. Furthermore, these predictions can be used to assess an individual’s current performance level and provide target goals for coaches, medical personnel or runners themselves. Finally, these data support the idea that long-term running behavior ameliorates the increase in body weight and BMI evident in sedentary, middle aged adults. In support of this impression is the fact that the 30 to 59 year olds in our study had nearly identical body mass and BMI values, and their values were only slightly higher than those in the 20 to 29 year olds.

    Hey - wherever you are on this age continuum, keep running!

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

    Paul DeVita, Ph.D., is the director of the Biomechanics Laboratory in the Department of Kinesiology at East Carolina University in Greenville, North Carolina. He currently is president of the American Society of Biomechanics and an ACSM Fellow. Dr. DeVita is a locomotion biomechanist and has investigated walking and running gaits in healthy, young and old adults, obese individuals and people with knee osteoarthritis. The work he discusses in this commentary is part of a larger research project on running injuries that has been funded by the U.S. Army, with Stephen P. Messier, Ph.D., FACSM, as the principal investigator.

    This commentary presents Dr. DeVita’s views on the topic of a research article that he and his colleagues had published in the January 2016 issue of
    Medicine & Science in Sports & Exercise® (MSSE).
  • May 4 is Project ACES Day — All Children Exercise Simultaneously!

    by Guest Blogger | May 03, 2016
    In conjunction with May's Exercise is Medicine® Month, tomorrow is the day that "The World's Largest Exercise Class" will come to children and schools around the world. Millions of participants across the globe will be celebrating the annual Project ACES® Day beginning at 10 a.m. This Youth Fitness Coalition (YFC) signature program, in partnership with the American College of Sports Medicine’s Exercise is Medicine® initiative, promotes physical activity to children in order to decrease the prevalence of childhood obesity. Project ACES, an acronym for All Children Exercise Simultaneously, also coincides with National Physical Fitness and Sports Month and National Physical Education Week. To learn more, please visit
  • Active Voice: Increasing Motor Skill Performance, Not Physical Activity, In Preschool Children is Possible with Joyful Activities

    by Guest Blogger | May 02, 2016
    By Kristina Roth, Ph.D.

    Reduced physical activity and motor skills in children remain a major public health concern, as these issues are associated with several cardiovascular risk factors and overweight status. However, we also know that motor skill acquisition and physical activity play key roles in child development and promotion of health. In particular, the preschool period seems to be a key phase for prevention and numerous intervention studies have been implemented and evaluated all over the world. Some intervention strategies focusing on preschool settings show great promise for prevention. However, the answers to some questions are still lacking: can a child-appropriate preschool intervention program with individualized components led by the preschool teachers be effective, especially in the long run? Also, are there some persisting positive effects? A randomized controlled trial with an intervention phase lasting one academic preschool year gave us the opportunity to provide answers to these questions.

    Our research report on this study, the Prevention through Activity in Kindergarten Trial (PAKT) was published in the December 2015 issue of MSSE. We investigated how a multi-component, child-appropriate preschool intervention program lasting 11 months with a daily 30 minute physical activity intervention can enhance physical activity, motor skill performance and other health-related outcomes in four- and five-year-old children. We consider motor development and physical activity motivation of children to be individualized and complex. Thus, we developed an intervention program based on a holistic pedagogic approach. This offered a huge scope for individualizing components and focusing the joy and fun that could be incorporated into motor tasks in children. Furthermore, our intention was that intervention lessons can be led easily by the preschool teachers ? irrespective of the equipment, personnel and space of the preschool.

    Our results showed that children in the intervention group gained significant benefits in motor skill performance compared to children in the control group. Much to our pleasant surprise, this positive effect still persisted three months after the end of intervention. Regarding physical activity behavior, we found a slight increase in the children who participated in the intervention group. But, this effect was at borderline significance and was not sustained after the intervention ended. Furthermore, we could not detect any positive intervention effects on body mass index, skinfold thickness, blood pressure, rates of accidents in everyday life, or infections for the entire intervention group over the controls. But, what seemed more important, our findings in a subsample of overweight children suggested that the intervention may clearly reduce increases in subcutaneous fat.

    The findings from our study are relevant to the many institutions and personnel involved in providing care to preschool children. We demonstrated that a child-appropriate physical activity intervention can be easily implemented in preschools by the preschool teachers. Successful implementation is feasible, regardless of whether personnel and special resources are available or not. This type of intervention can have positive implications on motor skill performance and, at least among overweight preschool children, may counter tendencies to increase body fat. Finally, regular and obligatory physical activity in preschool settings could be a key factor in public health strategies in young children. However, a change of health-related behavior such as physical activity seems to be a greater challenge. Further research is needed to gain knowledge about the possibility to change children’s physical activity habits in the long-term.

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

    Kristina Roth, Ph.D., is a physical education scientist, physical education teacher and a researcher at the University Children’s Hospital Würzburg, Germany. Her research focuses on the cross-sectional association and the longitudinal effects of physical activity intervention on motor skill performance, physical activity and health in children.

    This commentary presents Dr. Roth’s views on the topic of a research article which she and her colleagues published in the December 2015 issue of
    Medicine & Science in Sports & Exercise® (MSSE).
  • May is Exercise is Medicine® Month; Toolkit Available

    by Guest Blogger | Apr 20, 2016
    Exercise is Medicine® (EIM) Month begins in less than two weeks! During May, communities throughout the U.S. will hold activities that recognize the positive impact of physical activity and exercise in helping to prevent and treat more than 40 chronic diseases. Individuals and organizations of all kinds, from youth groups to universities, churches, fitness centers, corporations and hospitals, will hold events aimed at keeping people active and healthy, and encourage them to make exercise a part of everyone’s health care plan.. To learn more about EIM Month 2016 and how to get your local college or university campus involved, visit the EIM website or download the EIM Month toolkit.
  • April 24 Marks the First National Park Rx Day

    by Guest Blogger | Apr 13, 2016
    By Thomas P. Martin, Ph.D., FACSM 

    Sunday, April 24, 2016 will be the first-ever National Park Rx Day, and it’s an opportunity for members to spread the Exercise is Medicine® message. This day will be celebrated across the United States to promote the growing movement of prescribing parks and nature to patients as a means for improving human health. VADM Vivek H. Murthy, US Surgeon General, will present a keynote address at this event when it is celebrated in Washington, DC. 

    National Park Rx Day encourages everyone to see recreational visits to parks and public lands as very important parts of their health. According to the National Parks Service, there are eight reasons to get outdoors and enjoy a walk in the park on Park Rx Day!
    1. Being in nature can improve your mood.
    2. Having access to parks can increase physical activity and combat obesity.
    3. Parks and their health benefits can be enjoyed by anyone, regardless of who you are or from where you come.
    4. Contact with nature through parks improves all people's physical, mental and spiritual health.
    5. Parks foster social connections which are vital to community cohesion and contribute to social well-being.
    6. For children, parks foster active play, which is associated with physical, cognitive and social benefits.
    7. For adolescents, parks improve mental and social health during what is often a challenging time of life.
    8. Park use is linked to physical and mental health benefits among adults, especially older adults.
    National Park Rx Day is a promotion of the National Park’s “Healthy Parks Healthy People” initiative. It is a global movement that harnesses the power of parks and public lands in contributing to a healthy civil society. The idea originated with Parks Victoria, Australia, and was brought to global prominence at the 1st Healthy Parks Healthy People Congress in April, 2010. The National Park Service’s Healthy Parks Healthy People US program was established in 2011 to reframe the role of parks and public lands as an emerging, powerful health promotion strategy. See the NPS Healthy Parks Healthy People website for further information. 

    Moving, in all its forms, is advantageous to healthy body function. Outdoor physical activity/play can and should be interesting, enjoyable and satisfying. In that way, it will provide both reinforcement and motivation for continued participation. This is the goal of National Park Rx Day. Participation also may confirm and/or instill the realization that a reasonable level of physical fitness is beneficial for both outdoor activities and everyday life! 

    For those with higher goals, preparation (e.g., training) for challenging outdoor “adventures” becomes an additional reason to maintain or improve physical fitness. 

    So, get out there and wheel chair, walk, run, hike, backpack, climb, swim, canoe, kayak, raft, snorkel, cycle, etc. And, encourage others to do the same — not only on April 24 but every day!

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

    Thomas P. Martin, Ph.D., FACSM, is professor emeritus in the Health, Fitness, and Sport Department at Wittenberg University in Springfield, Ohio. He is an ACSM Registered Clinical Exercise Physiologist and Exercise is Medicine® credential holder (Level 3). He is a member of the National Park Foundation and has been promoting healthy “physical activity” on our protected land/water for several years. His avocation is “Outdoor Pursuits.” He has been physically active in all 59 of the U.S. National Parks and continues to pursue a goal of experiencing all National Park Areas (>400). In addition, he has completed 49.8 of the 
    U.S. State Highpoints and created the “Martin Classification of Difficulty for U.S. State Highpoints.” The Martin scale is based, in large part, on the total energy expenditure to reach each highpoint – click here to access the Martin scale. 
  • Active Voice: Sedentary Behavior and Regional Fat Distribution: Are You Sitting Too Comfortably?

    by Guest Blogger | Apr 11, 2016
    By Joseph Henson, Ph.D.

    Our modern day society now encompasses an ecological niche in which sedentary behavior (best conceptualized as sitting during waking hours with low energy expenditure) and labor-saving devices have become the new reference of living. Despite this shift being considered by many as an improvement in living conditions, the insidious nature of sedentary behavior has undoubtedly created a mismatch between our evolutionary history and the environment for which humans adapted. Within modern society, many adults now spend the majority of their waking hours sedentary (up to 70 percent), a figure that far surpasses the hunting, gathering and migratory patterns of our ancestors.

    Recently, multiple observational studies have demonstrated a positive association between objectively measured sedentary time and markers of diabetes risk, independent of the amount of moderate-to-vigorous physical activity (MVPA) undertaken. These findings, alongside its ubiquitous nature, suggest that sedentary behavior is likely to be a distinct risk factor for type 2 diabetes mellitus (T2DM) and, thus, a potential target for lifestyle intervention.

    In this observational study, published in the August issue of MSSE, we examined the association between objectively measured sedentary time and heart, liver, visceral and total body fat, independent of MVPA and whole body fat in a population at high risk of T2DM. These are important markers of health, particularly as regional fat deposits have been postulated to be of greater importance than overall adiposity in provoking metabolic disturbance.

    We examined magnetic resonance images (MRI) and accelerometer data from 66 participants, who were recruited from diabetes prevention programs. Each 30 minutes of sedentary time was associated with a 15.7cm3 increase in heart fat (p=0.008), 1.2 percent increase in liver fat (p=0.026) and a 183.7cm3 increase in visceral fat (p=0.039) after adjustment for several covariates, including glycemia, whole body fat and MVPA.

    The findings from this study suggest that objectively measured sedentary behavior has a deleterious impact upon heart, liver and visceral fat in individuals at a high risk of T2DM. Interestingly, since the associations remained after adjustment for whole body fat and MVPA, it may suggest that sedentary behavior is linked to selective depositions of fat which cannot be fully explained by an increase in overall adiposity and may act via an independent mechanism. These observations need further examination in carefully controlled experimental research studies.

    The results from this study, coupled with the mounting evidence promulgating the importance of reducing sedentary behavior as a therapeutic target (particularly in the promotion of metabolic health), mean there is an ongoing need to establish causation while also considering how this evidence can be incorporated into diabetes prevention and treatment pathways. In particular, care is needed regarding how interventions aimed at reducing sedentary behavior are integrated alongside the well-recognized benefits of participation in regular MVPA. It is plausible that highly sedentary and inactive individuals may benefit from a stepped interventional approach whereby the first step is aimed at reducing sitting time through increasing standing or light ambulation before more purposeful MVPA is introduced.

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

    Joseph Henson, Ph.D., is a research associate in sedentary behavior, physical activity and health at the Leicester Diabetes Centre, University of Leicester, UK. The Leicester Diabetes Centre is an international center of excellence in research, education and innovation, which is a partnership between the University Hospitals of Leicester NHS Trust and the University of Leicester and is led by Professors Kamlesh Khunti and Melanie Davies. His research, which is funded by the National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, focuses on the independent association of sedentary behavior and the impact of interruptions upon chronic disease markers, particularly those affiliated with Type 2 diabetes (T2DM).

    This commentary presents Dr. Henson’s views on the topic of a research article that he and his colleagues had published in the August 2015 issue of
     Medicine & Science in Sports & Exercise® (MSSE).
  • Successful 2016 ACSM Summit on the Books; See You in San Diego in 2017

    by Guest Blogger | Apr 05, 2016
    The 20th Annual ACSM Health & Fitness Summit & Expo wrapped up last Friday in Orlando, Florida. Participants enjoyed outstanding presentations, workouts and more. See all the highlights on the ACSM certification blog and ACSM’s social media accounts: American College of Sports Medicine on Facebook, @ACSMNews on Twitter and acsm1954 on Instagram.

    Mark your calendars for next year's ACSM Summit: April 6-9 in San Diego, California! Proposals for the 2017 summit are due May 15. Click here for more information about 2017 proposals.
  • A Landmark Accomplishment for ACSM & Exercise is Medicine® (EIM) – Implementing the EIM Solution

    by Guest Blogger | Mar 23, 2016
    By Adrian Hutber, Ph.D. & Phillip Trotter
    Adrian Hutber, Ph.D. Phillip Trotter

    A Brief Synopsis of EIM. EIM’s most fundamental mission has been to establish physical activity as an issue to be addressed in every physician-patient office visit and, by virtue of that interaction, engage physicians in writing individual scripts for each patient. The philosophy, concepts and implementation models of EIM are based on scientifically sound and persuasive evidence as to the health values of regular physical activity. Such a system, if implemented in communities across the U.S. and worldwide, holds great promise for disease prevention and controlling ever-rising health care costs.

    In the early going, tireless efforts by many EIM volunteer and staff leaders advanced understanding and enthusiasm for these concepts. As a result, EIM is supported by a global network of collaborating centers – a network that is still growing. Now, moving forward, EIM has developed methods and protocols capable of demonstrating effectiveness and practicality when implemented in health care settings. The next stage, and the subject of this commentary, is the plan for full-scale implementation in a large health system. Two critical components required for this phase include carefully coordinated involvement of community stakeholders and simultaneous integration of a rigorous system to evaluate the real-life effectiveness of EIM program. EIM, as an entity, is complex and has many working parts.

    A Health Care System in Transformation. Today in the U.S., chronic diseases are responsible for 80 percent of health care costs. One major consequence is that payers (employers, insurers, Medicaid and Medicare) are demanding that health systems share fiscal responsibility for interventions that successfully decrease both the prevalence and economic burden of these chronic diseases. A key strategy to bring this about is a transformation of the health care system – from one that is focused on volume to a system focusing on value-based care. So, instead of the longstanding “fee for service” model, there is great momentum building for replacement it with a model that rewards achievement of successful patients’ health outcomes. With this new model has come remarkable opportunities for exercise professionals and facilities, providing them with the opportunity to play a significant role in the prevention and intervention of chronic diseases.

    The National Press Club Announcement of February 23rd. The American College of Sports Medicine (ACSM), American Council on Exercise (ACE) and the Medical Fitness Association (MFA) came together at the National Press Club in Washington, DC to announce that they were uniting under the Exercise is Medicine® (EIM) platform. The purpose of this collaboration is to support the building of what EIM identifies as Community Care Teams – these include trained personnel who can deliver chronic disease prevention and intervention programs. A health care-relevant analogy is that this EIM model builds into each community an “exercise pharmacy,” i.e. referring to personnel, facilities and places where the health care provider, with confidence, sends their patient on a trusted pathway to fill a given prescription for disease prevention. Clinicians have long acknowledged that physical activity, at the very least, is an important factor for both the prevention and management of chronic diseases. With health care systems now widely adopting the Population Health Management (PHM) care model, regular physical activity and exercise is now a must-have lifestyle behavior priority.

    This PHM care model helps to describe the evolution underway that is designed to improve health across the continuum of care. The capacity-building needed to make possible these community-level connections between the PMH model and the “exercise pharmacies” has been underway for several years – through planning and guidance provided by EIM’s Global Center (EIM-GC)and its Global Research and Collaboration Center (EIM-GRCC). The challenge is where to refer these population groups for participation in accessible, safe and uniformly effective prevention and intervention programs. In simple terms, many health systems are reluctant to refer patients to a community resource that cannot demonstrate quality assurance of service equivalent to what patients receive within that same community’s clinical settings. This quality assurance is exactly what the EIM Solution provides. EIM’s programs and credentialed professionals provide the engagement methodology needed for advancing patients toward a physically activity lifestyle – including attention to the duration, frequency and intensity of activity necessary to develop behavior-change outcomes that lead to self-management and a return on investment for health systems.

    Editorial Note: Part II of this commentary will focus on how the EIM Solution will be applied and the role of EIM-GRCC in evaluating and validating a system of metrics to demonstrate effectiveness of implementation.

    Adrian Hutber, Ph.D., has served as vice president of Exercise is Medicine® at ACSM since 2008, after previously serving as vice president of a major fitness corporation and as the director of the distance education division at Human Kinetics. During his time at ACSM, Dr. Hutber has helped to establish seven EIM Regional Centers and 43 EIM National Centers, all with the goal of making physical activity assessment, prescription and referral part of health care systems globally.

    Phil Trotter, B.S., leads the EIM Solution “on the ground.” The EIM Solution is the key component of EIM that brings about implementation of community networks that include local health systems, health providers and resources necessary to make physical activity and exercise a standard element in the delivery of health care to all patients.

    This commentary summarizes perhaps the most exciting news about Exercise is Medicine® since its inception in 2007. For reasons of scope and complexity, the presentation is divided into Parts I and II. Part I presents a short overview of EIM and key details from a special press conference held late last month at the National Press Club in Washington, D.C. (see: This part also identifies the roles of the EIM Solution, the EIM Global Center and the EIM Global Research and Collaborative Center, all of which are key components needed to implement EIM in large U.S. health systems. Part II will follow soon in a future issue of SMB.
  • Active Voice: Placebo Doping to Enhance Endurance Performance

    by Guest Blogger | Mar 21, 2016
    By Ramzy Ross, Ph.D., Cindy M. Gray, Ph.D. and Jason M.R. Gill, Ph.D.
    In competitive sport, athletes are constantly seeking novel methods to improve performance and gain an edge on the opposition. The line between what constitutes a legal or illegal ergogenic aid may not be a sharp one, and the prohibited list of substances and methods from the World Anti-Doping Agency (WADA) continues to evolve and be updated. For example, taking human recombinant erythropoietin (r-HuEPO) to improve the oxygen-carrying capacity of the blood is currently banned. However, sleeping in an altitude tent which elicits a similar physiological effect is not banned. Many athletes delve into the ethically grey area of taking supplements which, although not on the prohibited list, claim to produce similar effects to those substances which are banned. Many of these supplements have no clear evidence supporting an ergogenic effect: however, despite such substances potentially being biologically inert, it is possible that the belief of the athlete that such substances are beneficial may improve physiological performance via a placebo effect. 

    The placebo effect is real and measurable. It is because of this that the placebo controlled trial is the gold standard for medical research. This raises the possibility that some of the benefits of illegal performance enhancing drugs, such as r-HuEPO, may be mediated by a placebo effect.

    In our research, reported in the August 2015 issue of MSSE, we sought to quantify the effect of a placebo on running performance, by providing participants with daily injections of saline but fictitiously informing them that they were receiving a drug with similar effects to r-HuEPO. Our randomized crossover study in 15 club-level runners assessed running performance over 3000m in a “‘real world,”’ field-based, head-to-head competition setting on a 200m indoor track. We found a statistically significant 1.2 percent improvement in performance following one week of daily placebo administration. Qualitative analysis of interviews with participants suggests that the placebo improved performance in two ways. First, by reducing the perception of effort and, second, by increasing potential motivation – in other words, the highest amount of effort that the athlete was prepared to exert during the race. We also found a role for cognitive beliefs and expectations in mediating the placebo effect – those who anticipated the greatest positive change from taking the placebo and perceived decreased physical effort during training, had the greatest improvements in performance. Thus, like lucky horseshoes, you need to believe in the effect for it to work.

    This magnitude of improvement with placebo, at 1.2 percent, was smaller than the reported effect of r-HuEPO on performance in similar competitive events (~5-6 percent). However, this effect is nevertheless of clear sporting relevance. In the 2012 Olympics, the difference between the gold medal and fourth place was less than one percent in all track events from 1500m to 10000m for both men and women. Thus, this real ergogenic effect of placebo perhaps raises an interesting philosophical and ethical issue. Is a coach who provides his/her athlete with “‘supplements”’ to improve performance facilitating a placebo effect by instilling the belief that ergogenic effects will occur? Moreover, if they do this in the absence of objective evidence that the supplement is beneficial, are they engaging in a morally questionable and deceptive practice or simply following their duty, as coaches, to use all (legal) means possible to get the best out their athlete?

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

    Ramzy Ross, Ph.D. Cindy M. Gray, Ph.D. Jason M.R. Gill, Ph.D.


    Ramzy Ross, Ph.D., is an exercise physiology and physical performance specialist currently working with governmental entities of the United Arab Emirates. In addition to physical performance-based research, his roles within the Ministries of Defence, Health and Education involve the health and physical development of youth, enhancement of occupational and military performance, as well as the development of public health initiatives. 

    Cindy M. Gray, Ph.D., is a Lord Kelvin Adam Smith Fellow in Health Behaviour Change at the University of Glasgow in Scotland. She is a psychologist with a main research focus on using social innovation to engage hard-to-reach groups in physical activity and dietary behaviour change, employing both qualitative and quantitative methods. An example of this is the award-winning Football Fans in Training (FFIT) project, and its follow-up, European Fans in Training (EuroFIT). 

    Jason M.R. Gill, Ph.D., is a reader (associate professor) in exercise and metabolic health in the Institute of Cardiovascular and Medical Sciences at the University of Glasgow in Scotland. While the majority of his research relates to the effects of exercise and diet in the prevention and management of vascular and metabolic diseases, he also has an interest in sports performance. He has been a member of ACSM for nearly 20 years. 

    This commentary presents the views of these authors in a research article published in the August 2015 issue of
    Medicine & Science in Sports & Exercise® (MSSE). 

  • Ten Ways to Start an Exercise Program

    by Guest Blogger | Mar 14, 2016
    By Greg Chertok, M.Ed., CC-AASP

    The beginning of the new year is a popular time to start an exercise program, after months of holiday indulgences. Are you ready to start a healthier lifestyle? Here’s 10 recommendations to help you stick to your resolution this year:

    1. Get to Know Your Body Every exerciser must have a basic understanding of the human body. This includes:

    • proper identification of the major muscle groups
    • knowledge about the effects of activity vs. inactivity
    • distinction between stretching and strengthening a muscle
    • distinction between “good pain” (muscle burn and fatigue) and “bad pain” (joint pain, lower back pain/impingement).

    If you know nothing about the workings of the body, you may be putting yourself in a dangerous position. I once worked with an older man who, in response to experiencing soreness from exercise the day prior, decided to address the issue by doing more of what got him sore in the first place. Rather than stretching or resting the muscle, he assumed that working more would do the trick. He was forced to take even more time off to relieve the resulting soreness. This man, a senior vice president for a successful financial firm, was not uneducated. He was simply uninformed.

    2. Understand Why You Are Exercising Pose questions to yourself such as, “Why did I decide to start exercising?” It is suggested that exercisers who are intrinsically motivated experience more positive effects and better adherence than those who are extrinsically motivated. Intrinsically motivated exercisers do so for the satisfaction gained from engaging in the activity itself; in other words, they exercise for the challenge, to gain or learn skills, or to have fun. Extrinsically motivated exercisers do so as a means to an end; they exercise simply to improve their fitness or appearance. The proper reason behind exercising can act as powerful and long-lasting fuel.

    To read the full article, please visit the Fit Society Page archives.
  • Active Voice: Aerobic Exercise Targets Specific Higher-order Brain Functions

    by Guest Blogger | Mar 09, 2016

    By Timothy B. Weng, B.S., and Michelle W. Voss, Ph.D.

    Timothy B. Weng, B.S. Michelle W. Voss, Ph.D.

     The benefits of physical activity and habitual aerobic exercise on cognitive function and brain health are becoming increasingly appreciated both by the scientific community and the general public. These findings stem from a growing body of epidemiological, cross-sectional and long-term intervention studies. Despite the abundance of encouraging scientific evidence, guidelines for establishing public health recommendations remain unclear due to a lack of knowledge regarding the exact mechanisms through which exercise benefits brain function. Furthermore, a concern arising from these studies is the difficulty of discerning the unique brain benefits of physical exercise, as distinguished from those associated with changes in other lifestyle factors, such as dietary and sleep habits.

    In our study, reported in the July 2015 issue of MSSE, we sought to contribute to knowledge on these issues by investigating the acute effects of aerobic exercise on cognitive performance. We reasoned that such acute effects might reflect transient changes that, over time, contribute to more stable adaptations that result from long-term exercise training. Previous research indicates that executive functions are more sensitive to acute moderate-intensity aerobic exercise than are other cognitive processes. However, executive functions are comprised of multiple processes, and advancing mechanistic knowledge requires clarifying whether these are differentially affected by an aerobic exercise bout. Therefore, we tested the specificity of the acute effects of moderate intensity aerobic exercise on two tasks that engage theoretically distinct components of executive function. In our sample of healthy young adults, we found that 30 minutes of stationary aerobic cycling improved their ability to mentally store and update multiple features of information (i.e., working memory). Although we found that their working memory accuracy improved by ~6.4 percent, there were no significant changes in their ability to exert control over irrelevant information (i.e., inhibitory control). Furthermore, no changes in either task occurred when the same participants completed a passive exercise control condition in which their legs were moved by motorized pedals on the same bike and at the same cadence as in the aerobic condition.

    We interpret these findings as evidence that, in healthy young adults, moderate-intensity aerobic exercise affects some specific brain systems more than others. Based on our findings, we suggest that actively engaging the musculoskeletal and cardiovascular systems at a moderate intensity, rather than moving passively, affects brain systems involved in working memory processes. In our study, we observed this specificity in the acute phase after one exercise session. Future investigations that combine acute and chronic exercise paradigms within the same individuals may provide insight into how the specificity of acute effects contributes to long-term adaptations that accumulate with subsequent training. We hope that our findings also encourage others to consider a within-subjects acute exercise paradigm that controls for muscle movement as a method to systematically evaluate which exercise parameters maximize outcomes on a variety of brain and cognitive measures. Ultimately, we anticipate that advancing such knowledge will accelerate the establishment of evidence-based exercise recommendations for improving cognitive and brain health.

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

    Timothy B. Weng, B.S., is a Ph.D. student in the Department of Psychological and Brain Sciences at the University of Iowa. His research investigates acute changes in brain and cognitive function following a single session of exercise. He applies this methodology to gain mechanistic insight into the beneficial effects of physical activity and aerobic exercise on brain health.

    Michelle W. Voss, Ph.D., is an assistant professor in the Department of Psychological and Brain Sciences at the University of Iowa. Her research focuses on maximizing the plasticity of the aging mind and brain through interventions such as cognitive training and physical exercise training.

    This commentary presents Mr. Weng’s and Dr. Voss’ views on the topic of a research project that they and their colleagues recently completed. Their research report appears in the July 2015 issue of
    Medicine & Science in Sports & Exercise® (MSSE).

  • Exercise and the Brain: More Reasons to Keep Moving

    by Guest Blogger | Feb 29, 2016
    by Brad A. Roy, Ph.D., FACSM

     The benefits of physical activity in preventing chronic health conditions and as a therapeutic approach for people diagnosed with them are well recognized. There is a plethora of medical and scientific evidence documenting how regular physical activity can help prevent and/or treat hypertension, type 2 diabetes, abnormal blood lipids, coronary artery disease, stroke, osteoporosis, arthritis, certain cancers and other conditions. The strength of this evidence has resulted in the American College of Sports Medicine and U.S. Department of Health and Human Services recommending that all Americans undertake a minimum of 150 minutes per week of moderate-intensity aerobic exercise and that children and adolescents participate in 60 minutes or more of daily physical activity. Unfortunately, most Americans do not achieve these recommended minimum levels. To read the full article, please visit the Fit Society Page archives.
  • Active Voice: Precisely, What Do We Mean— Force, Work & Power?

    by Guest Blogger | Feb 15, 2016
    By Howard G. Knuttgen, Ph.D., FACSM

    Having participated in ACSM’s 2015 annual meeting in San Diego, I was highly impressed with the quality of the science being reported. At the same time, however, I was greatly disappointed with the frequent inappropriate use of the term “work.” While “work” in everyday language can refer to anything from a vocation to a composition of music, for science and medicine it is defined in the international system of measurement as, “the product of a force component by the magnitude of displacement (distance)” and quantified in joules (J). A quantity of work can be performed over any period of time and, if quantified in terms of a unit of time, it must be reported as “power” for which the international system unit is the watt (W). 

    Having lived and worked in the Scandinavian countries for over three years where research into exercise has been carried out vigorously for almost 100 years, I believe that I can trace the problem of the inappropriate use of the term “work” to the fact that there is no equivalent term in any of the Scandinavian languages for “exercise”. Investigators from these countries employ a term for muscular activity that is the same one used in these languages for any vocation (Norwegian - arbeid, Swedish - arbete, and Danish - arbejde). It is, therefore, not surprising that the Scandinavian investigators such as Erling Asmussen, P.-O. Åstrand, Bengt Saltin, and Björn Ekblom have used the term “work” instead of “exercise” when publishing in English. However, it is incorrect. 

    Further support to my objection regarding what I heard at ACSM’s annual meeting is my observation that, in every instance where the presenter inappropriately identified the physical activity as “work” he/she then quantified the performance in watts, the international unit for Power. If an investigator does, indeed, wish to present the total work involved in a physical activity, the international unit must be the joule (J) which is independent of time. Work performed per unit of time is Power, the measure of the exercise intensity. 

    Editorial Note: While serving as editor-in-chief of MSS, Dr. Knuttgen first addressed this topic in an editorial statement. The statement may be accessed by members through the ACSM website. Go to “My Journals” and locate the article “Force, Work, Power, and Exercise”, in the fall 1978 issue. A reminder about this also is presented in ACSM’s online Call for Abstracts each year, as follows: To ensure consistency and clarity, it is directed that authors use the terms as defined by MSSE “Information for Authors,” while utilizing the units of measurement of the Systeme International de’Unite (SI)Additional guidance on terminology and units of measurement for describing exercise and sports performance, as compiled by the Sub-committee on Publications in the Sports Sciences, IOC (International Olympic Committee) Medical Commission, is available online (at the source, see pages xiii-xiv).

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

    Howard G. (Skip) Knuttgen, Ph.D., FACSM, is senior lecturer in physical medicine and rehabilitation at the Harvard University Medical School in Boston, Massachusetts. His research expertise is in skeletal muscle physiology and the related implications for human physical performance and clinical care in sports medicine. He completed his doctoral degree at the Ohio State University in 1959 and was a Fulbright Scholar in Human Physiology at the University of Copenhagen, 1959-1961. 

    Skip has a stellar record of leadership in ACSM, serving as ACSM’s 17th president during an important transformational period for our association. He was editor-in-chief of ACSM’s flagship journal, Medicine and Science in Sports (formerly MSS, now Medicine & Science in Sports & Exercise® or MSSE), from 1974-79. In 1983, Dr. Knuttgen, was responsible for spearheading ACSM’s International Scholars Program, which since has fostered collaborations between young clinicians and scientists from other countries with ACSM members in the United States. 

    The ACSM blog is pleased to present this commentary by Dr. Knuttgen, relating to his impressions and recommendations regarding the importance of precision in scientific communication.

  • Fitting in Fitness: Active Workstations

    by Guest Blogger | Feb 09, 2016
    Decreasing levels of physical activity increases the risk for obesity and various chronic health problems. Dramatic changes in occupational physical activity may be a major contributor to the declining rates of overall physical activity in the United States. For example, there has been a decrease in labor-intensive occupations and a large growth in seated “9-to-5” computerized jobs in a modern office. Health problems due to declining physical activity may be compounded by recent suggestions that prolonged sitting may exert an independent harmful effect on health. Thus, the World Health Organization has now recognized the workplace as a “priority-setting” for health promotion.

    To read the full article, click here to open the March 2015 issue of the Fit Society Page Newsletter.
  • Active Voice: ACSM's New Translational Journal — A First Look from the Editor-in-Chief

    by Guest Blogger | Feb 02, 2016
    By Joseph E. Donnelly, Ed.D., FACSM 

    Translational and policy science is now a priority of major governmental agencies, such as The National Institutes of Health and Patient-Centered Outcomes Research Institute (PICORI). The Translational Journal of The American College of Sports Medicine (TJACSM) will place ACSM in the forefront for translational and policy science related to exercise. TJACSM is designed to close the gap between laboratory and clinical sciences and the application of research findings to the general community. The National Institutes of Health defines translational research as “the movement of discoveries in basic research to application at the clinical level.” It is the attempt to find ways to take established science into everyday practice. A common theme for translational science includes the concept “it works in the laboratory, but does it work in the real world?” In a similar fashion, translational research often seeks to determine how to make established science work effectively in the general population or community. Therefore, this type of research often includes an analysis of comparative effectiveness of approaches and cost analysis. Frequently, attempts to translate science to community involve community participatory methods; however, translational research does not rely solely on this methodology.

    An example of translational research would be an investigation to determine how to install an established and effective health risk management program in the workplace by comparing a face-to-face wellness program to a similar program delivered remotely using technology. Another example would be an investigation to determine the effectiveness of translating new findings in basic science for exercise and blood pressure to effective programs for seniors with hypertension in care facilities. One more example would be an investigation to compare two or more effective strategies used to alter public school policy to establish new policies aimed at increasing physical activity in public schools. In these examples, the objective is to find ways to translate known science into effective applications in everyday practice or communities.

    Many ACSM members are actively engaged in translational research, and TJACSM will provide an outlet for the best scientific findings. Likewise, members involved with direct services to clientele would benefit from an authoritative source of information to guide their approach with individuals and communities. TJACSM will publish research investigations and evidence-based systematic reviews that determine how to put science into practice. We welcome submission of research articles from scientists who investigate the translation of exercise science to practice, including the study of policy that often impacts or determines how translation takes place.

    Note: Submission of papers will begin with editor-invited papers in this month. The first issue of the journal is scheduled for April 1, 2016. As TJACSM develops, articles will progress to open submission. We will alert members when open submission begins and provide specifics on submitting papers via the TJACSM website. The production of TJACSM will take a slightly different format from other ACSM journals. Content will be updated to the journal site regularly, with articles appearing as they are accepted on a biweekly basis. In addition, we plan to capitalize on the digital nature of this journal by also including ancillary digital content with each manuscript.

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

    Joseph E. Donnelly, Ed.D., FACSM, has been an ACSM member since 1978. He is currently professor, internal medicine and director of the Energy Balance Laboratory and Center for Physical Activity and Weight Management, Cardiovascular Research Institute at The University of Kansas Medical Center in Kansas City, Kansas. He is a past president of the Central States Chapter of ACSM, past member of the Board of Trustees, a current member of the ACSM Strategic Health Initiative for Obesity and the first Editor-In-Chief of ACSM’s new Translational Journal. His research has focused on the translation of energy balance science to community settings to impact obesity, diabetes and cardiovascular diseases in children and adults.
  • Creating Walkable Communities

    by Guest Blogger | Jan 25, 2016
    By Heidi Simon, America Walks

    Walkable communities create strong, healthy and livable communities. Infrastructure that facilitates walking, such as sidewalks, safe street crossings and low auto speeds, coupled with access to everyday destinations enables people of all ages, abilities, incomes and ethnicities to walk for everyday transportation. Walking provides access to necessary goods and services, such as grocery stores and parks, and doing so helps address disparities found far too often in cities and towns across America. Walking is also an excellent source of everyday physical activity.

    Walking provides the base level of activity needed for adults and eliminates the disparity gap for Americans that lack the time and ability to dedicate time to workouts. People were made to walk, and in doing so, can take back control of their physical, mental and cognitive health. To read the full article, click here to view the January 2016 issue of the ACSM Fit Society Page.
  • Active Voice: Battle of the Sexes: Are Females More Resistant to Extreme Neuromuscular Fatigue?

    by Guest Blogger | Jan 19, 2016
    By John Temesi, Ph.D., and Guillaume Millet, Ph.D.

    John Temesi, Ph.D. Guillaume Millet, Ph.D.

    Ultra-endurance sports such as running, cycling and adventure racing are rapidly increasing in popularity. The great distances and extreme conditions in these events are uniquely capable of being used to understand the limits of human performance. With the rapid growth of ultra-endurance sports there has also been a huge uptick in female participation. To date, ultra-endurance research has focused exclusively on male participants, resulting in a large knowledge gap pertaining to the physiology and performance of females in such demanding conditions. 

    Our recent study, published in MSSE, is the first to directly compare neuromuscular fatigue in the knee extensors and plantar flexors, both functionally important muscle groups for locomotion, in males and females. There are reports that females may be as good or even better performers than males at extremely long distances. In fact, women have won or placed in the top three overall in such extreme events as the Badwater ultramarathon and Western States Endurance Run. One possibility that has been suggested is that females demonstrate less fatigue than males, and thus can perform better. 

    In this study, the neuromuscular function of 10 male and 10 female ultra-trail runners, were evaluated before and after they completed a 110-km ultra-trail running race with almost 6000 m in positive elevation change. The subjects were matched by finishing time calculated as a percentage of the winning time of their sex. The major neuromuscular parameters that were assessed were the changes in maximal voluntary torque (i.e. indicating the amount of overall fatigue), torques evoked by nerve stimulation in the relaxed muscle state (i.e. indicating fatigue within the muscle) and maximal voluntary activation assessed by nerve and transcranial magnetic stimulations. We also assessed electromyography, including the excitability and inhibition of the corticospinal tract to the knee extensors. 

    After the trail running race, all subjects demonstrated substantial general neuromuscular fatigue in both the knee extensors and plantar flexors (i.e. decrease in maximal voluntary torque). Although overall fatigue in the knee extensors was greater in males than females, the source of this greater fatigue could not be clearly isolated. In the plantar flexors, males also demonstrated greater muscle fatigue than females. In both muscle groups, the magnitude of fatigue within the central nervous system and brain was similar for both sexes. Moreover, similar changes occurred after the event in males and females with regard to corticospinal excitability and inhibition of the knee extensors. 

    The greater general neuromuscular fatigue in the knee extensors and greater muscle fatigue in the plantar flexors for males suggests that differential fatigue between the sexes occurs solely at the muscle level. These differences may partly explain the reports of better performance by females in extremely long duration running races, particularly as the race distance increases.

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

    John Temesi, Ph.D., is a postdoctoral fellow in the faculty of kinesiology at the University of Calgary. His research focuses on neuromuscular fatigue, especially central and supraspinal fatigue, related to locomotor exercise in both athletic and clinical populations. 

    Guillaume Millet, Ph.D., is professor in the faculty of kinesiology at the University of Calgary. His general research area investigates the physiological, neurophysiological and biomechanical factors associated with fatigue, both in extreme exercise (ultra-endurance, hypoxia) and patients (neuromuscular diseases, cancer). Guillaume is also an ultra-marathon runner. 

    This commentary presents Dr. Temesi’s and Dr. Millet’s views on the topic of a research article which they and other colleagues had published in the July 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).
  • Measuring Results from Exercise – How Do You Know It’s Working?

    by Guest Blogger | Jan 11, 2016

    by Clinton A. Brawner, MS, ACSM-RCEP, FACSM

    Two important components to fitness are aerobic endurance and muscular strength/endurance. Laboratory-based tests are available to evaluate these and have been used in research studies to measure the body’s response to various types of exercise training programs. Although these assessments can provide useful information, they are neither appropriate for all individuals nor necessary to document improvements in fitness. The purpose of this article is to review easy ways that individuals can track their own progress or recognize changes in response to having increased their physical activity.

    Priority #1- Sticking With It

    According to the 2008 Physical Activity Guidelines for Americans from U.S. Department of Health and Human Services, adults should participate in at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity, or an equivalent combination of both types. In addition, adults should also perform exercises to enhance muscular strength at least 2 days per week. Unfortunately, only about 25% of adults meet these goals; 50% engage in physical activity irregularly; and 25% of adults do not engage in any physical activity. To read the full article, please click here to visit the Fit Society Page archives.

  • Active Voice: Battle of the Sexes: Are Females More Resistant to Extreme Neuromuscular Fatigue?

    by Guest Blogger | Dec 30, 2015
    By John Temesi, Ph.D., and Guillaume Millet, Ph.D.

    John Temesi, Ph.D. Guillaume Millet, Ph.D.
    Ultra-endurance sports such as running, cycling and adventure racing are rapidly increasing in popularity. The great distances and extreme conditions in these events are uniquely capable of being used to understand the limits of human performance. With the rapid growth of ultra-endurance sports there has also been a huge uptick in female participation. To date, ultra-endurance research has focused exclusively on male participants, resulting in a large knowledge gap pertaining to the physiology and performance of females in such demanding conditions.

    Our recent study, published in MSSE, is the first to directly compare neuromuscular fatigue in the knee extensors and plantar flexors, both functionally important muscle groups for locomotion, in males and females. There are reports that females may be as good or even better performers than males at extremely long distances. In fact, women have won or placed in the top three overall in such extreme events as the Badwater ultramarathon and Western States Endurance Run. One possibility that has been suggested is that females demonstrate less fatigue than males, and thus can perform better.

    In this study, the neuromuscular function of 10 male and 10 female ultra-trail runners, were evaluated before and after they completed a 110-km ultra-trail running race with almost 6000 m in positive elevation change. The subjects were matched by finishing time calculated as a percentage of the winning time of their sex. The major neuromuscular parameters that were assessed were the changes in maximal voluntary torque (i.e. indicating the amount of overall fatigue), torques evoked by nerve stimulation in the relaxed muscle state (i.e. indicating fatigue within the muscle) and maximal voluntary activation assessed by nerve and transcranial magnetic stimulations. We also assessed electromyography, including the excitability and inhibition of the corticospinal tract to the knee extensors.

    After the trail running race, all subjects demonstrated substantial general neuromuscular fatigue in both the knee extensors and plantar flexors (i.e. decrease in maximal voluntary torque). Although overall fatigue in the knee extensors was greater in males than females, the source of this greater fatigue could not be clearly isolated. In the plantar flexors, males also demonstrated greater muscle fatigue than females. In both muscle groups, the magnitude of fatigue within the central nervous system and brain was similar for both sexes. Moreover, similar changes occurred after the event in males and females with regard to corticospinal excitability and inhibition of the knee extensors.

    The greater general neuromuscular fatigue in the knee extensors and greater muscle fatigue in the plantar flexors for males suggests that differential fatigue between the sexes occurs solely at the muscle level. These differences may partly explain the reports of better performance by females in extremely long duration running races, particularly as the race distance increases.

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

    John Temesi, Ph.D., is a postdoctoral fellow in the faculty of kinesiology at the University of Calgary. His research focuses on neuromuscular fatigue, especially central and supraspinal fatigue, related to locomotor exercise in both athletic and clinical populations.

    Guillaume Millet, Ph.D., is professor in the faculty of kinesiology at the University of Calgary. His general research area investigates the physiological, neurophysiological and biomechanical factors associated with fatigue, both in extreme exercise (ultra-endurance, hypoxia) and patients (neuromuscular diseases, cancer). Guillaume is also an ultra-marathon runner.

    This commentary presents Dr. Temesi’s and Dr. Millet’s views on the topic of a research article which they and other colleagues had published in the July 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).

  • Moving Through the Cure: How Exercise Benefits Cancer Survivors

    by Guest Blogger | Dec 21, 2015
    Exercise isn’t a cure for cancer, but for more than 14 million Americans diagnosed with cancer, daily life often improves when the body is engaged in regular physical activity. What’s more: recurrence of certain cancers may be lowered significantly for those who exercise. The medical community recognizes that, for many people, cancer is a chronic disease, and people often continue the treatment or management of their cancer for many years, even decades. A recent shift in perspective means that now a person is considered a “survivor” from the time of diagnosis. The seismic shift from passive recipient to active participant has come of age.

    To read the full article, please view the ACSM Fit Society Page archives.
  • Active Voice: Does Drink Temperature Matter?

    by Guest Blogger | Dec 14, 2015

    By Dallon Lamarche, B.SC., and Glen P. Kenny, Ph.D.

    Dallon Lamarche, B.SC. Glen P. Kenny, Ph.D.

    Hydration is of particular importance for everyone participating in exercise and/or work-related tasks. This is especially relevant in hot environments when the body will store excess heat. Recently, researchers have considered whether the temperature of ingested water could play a factor in regulating the amount of heat stored and thereby alter core body temperature. Prior to our publication in the June 2015 issue of MSSE, the media has outlined that consuming hot water resulted in a lower amount of heat stored in the body compared to cold waterdue to an over-compensatory increase in sweating. This counterintuitive notion was based on a recent study which suggested that hot water may help cool the body. However, our recent findings show that ingesting hot or cold water does not influence body heat storage, and thus core temperature regulation during exercise. 

    In our study, 10 males (19-32 years) cycled for 75 minutes at normal room temperature (25°C) at 50 percent of their maximal oxygen uptake. The exercise was performed in the Snellen whole-body direct calorimeter, which is a device that precisely measures the amount of heat lost over time (through sweat evaporation and dry heat exchange). During exercise, participants consumed either hot (50°C) or cold (1.5°C) water every 15 minutes. We observed a continuous separation in whole-body sweating such that sweating was higher with hot relative to cold water ingestion. However, this difference in sweating was proportionate to the difference in heat content of the ingested water between the temperature conditions, resulting in similar changes in body heat storage. Therefore, we showed that, during moderate prolonged exercise, the human body adjusts the sweating response to compensate for the heat content of the ingested water—no less and no more—such that heat balance is maintained. 

    Our findings indicate that the temperature of ingested water does not have a direct influence on body temperature during exercise. However, one cannot ignore the different behavioral and psychological effects that water of different temperatures may have on maintaining adequate hydration. For instance, the palatability of cold water is shown to clearly be more favorable during prolonged exercise in comparison to hot water. When provided the option to drink cold water at will in one session and hot water in another, a group of investigators demonstrated several years ago that individuals will ingest much more cold water (by about 37 percent). This has important implications for the athlete and the worker because individuals are more inclined to drink cold water during physical activity which leads to a better maintenance of hydration and core body temperature regulation. In addition, cold water ingestion has been shown to improve performance, as evidenced by extended time to exhaustion and lower perceived exertion in performance based events when compared to ingesting hot water. On the other hand, drinking hot water during exercise is not pleasant as anecdotally reported by the participants in our study and, consequently, may hinder performance through behavioral and psychological modifications. 

    Ultimately, our message is clear: athletes and workers should consume water at cooler (or “more comfortable”) temperatures during physical tasks as opportunities allow. In the end, the consumption of water itself is the most important consideration for hydration status.

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

    Dallon Lamarche is a recent bachelor of science graduate with specialization in human kinetics at the University of Ottawa, Canada. He completed the study highlighted in this commentary at the Human and Environmental Physiology Research Unit as part of his senior year research project requirements under the supervision of Dr. Glen P. Kenny. 

    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 the 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 Mr. Lamarche’s and Dr. Kenny’s views on the topic related to a study which they and colleagues recently completed. Their research report appears in the June 2015 issue of
     Medicine & Science in Sports & Exercise® (MSSE)

  • From seed to forest, EIM is positively impacting lives

    by Guest Blogger | Dec 14, 2015

    By Adrian Hutber, PhD, Vice President of Exercise is Medicine

    Exercise is Medicine (EIM) began as a seed of an idea just over eight years ago. As part of a presidential legacy program, ACSM leadership, together with incoming President Ron Davis of the American Medical Association, developed a vision for a global health initiative that would facilitate physical activity as a chronic disease health intervention through physician-patient interactions. Further, EIM would work with the medical community, health systems and exercise professionals to expand the breadth of these interventions by incorporating physical activity into treatment plans.

    The seed took root in December 2007 at the National Press Club when EIM was formally announced, and the initiative has been growing ever since. Consider:

    • EIM is now in more than 40 countries
    • More than 6,000 physicians have been trained
    • 9,000 exercise professionals have been trained to receive patient referrals
    • EIM has been promoted in the Wall Street Journal
    • The EIM Global Research Center has been established in partnership with Emory University to track progress and gain insights for continuous improvement
    • Early in 2016, the first major health system will launch using all the major components of the EIM Solution

    How has so much been done so fast? It took a solid vision that aligns with ACSM’s mission, a passionate advisory board and support staff, and a number of corporate partners who understood the value of promoting physical activity as a means for combatting chronic disease. Soon after the announcement at the National Press Club, ACSM began the process of identifying sponsors who could help fund the implementation of the EIM plan. Over the last eight years, several organizations have provided their support to EIM, including companies representing the fitness, health care, medical equipment, food and beverage, and personal hygiene industries. As is our practice, all of these relationships are transparent and allow total independence in the expansion of physical activity and health worldwide. We’re grateful for this cross-industry collaboration that fertilized that initial seed and helped it grow into a forest of healthy interventions all around the world.

    At the end of the day, it’s about impacting lives. Here are some quotes from real people whose lives were changed through the principals of EIM:

    • “The EIM program has helped motivate me to start exercising regularly.”

         -Samantha, age 31

    • “I just had a call from my doctor after last Friday’s physical. My weight is down, I have been declared free of pre-diabetes and for the first time in 10 years all my cholesterol numbers are as they should be. My blood pressure is 107/71 and I’m coming off the medication, whoo hoo!”

         -Richard, age 60

    • “EIM has completely changed my life. You know what to do to improve your health because a trained professional is now in your corner helping you every step of the way. 

         -Lynn, age 62

    • “The program has been a great resource for my patients. The guidance the program provides gives my patients the confidence to exercise. They have improved their exercise tolerance, feeling of well-being, weight and blood pressure.”

         -Joseph H. M.D.

    If you’re not familiar with EIM or would like an update, please visit the EIM website and learn more about this great program. Or read this article about exercise prescription and EIM from The Pharmaceutical Journal. For more about ACSM’s Approach to Partnerships, go here



  • Many reasons to be excited about our upcoming world congress

    by Guest Blogger | Dec 11, 2015

    By Liz Joy, MD, FACSM, ACSM President-elect

    As chair of the 2016 ACSM Annual Meeting Program Committee, I’m looking forward to The World Congress on the Basic Science of Energy Balance: A Global Perspective on the Combined Importance of Diet and Physical activity  that will be happening in conjunction with the annual meeting.

    According to The National Institutes of Health website, energy balance is “the balance of calories consumed through eating and drinking compared to calories burned after physical activity.” Read More.

    So why am I excited about a World Congress on energy balance? There are several reasons:

    • Energy balance is a hot topic today, timely and relevant to our profession and a variety of health-related issues. As leaders in facilitating open dialogue about subjects important to our industry and public health, the congress will bring the brightest minds together to discuss how both a healthy diet and adequate physical activity are needed for effective weight management.
    • As experts on the health benefits of physical activity, ACSM members have a great deal to bring to this discussion. We’re excited about collaborating with others on the essential relationship between dietary intake and physical activity to achieve healthy energy balance and healthy weight.
    • Hosting the congress aligns with our long-held position stand on energy balance. First published in 2001, our position stand is based on scientific evidence and concludes that, for successful long-term weight loss, both physical activity and dietary change are important. This position was endorsed by the Academy of Nutrition and Dietetics.
    • Finally, our congress will help re-focus the conversation as it relates to the vital topic of energy balance. Recent negative news coverage regarding an organization called the Global Energy Balance Network- which had no affiliation with ACSM – may have detracted from the fact that energy balance is, indeed, a basic science that acknowledges the dual importance of diet and physical activity.

    I hope you’ll join me for this great congress on May 31, 2016 in Boston, Massachusetts. See you there!

    For more about the 2016 ACSM Annual Meeting and World Congresses, please visit the website.

  • Physical Activity for Men with Osteoarthritis

    by Guest Blogger | Dec 07, 2015
    by A. Lynn Millar, PT, Ph.D., FACSM

    The most common form of arthritis is osteoarthritis (OA) — joint-specific degeneration which causes pain and stiffness. Approximately 27 million adults in the U.S. have OA. While men have lower rates of OA as compared to women, it is still one of the leading causes of disability and movement limitation. The most common symptomatic joints for men include the knee, hip, and hands, with the knee being the most common (13.5% in men 45 years or older). Guidelines for management of OA include physical activity, weight control and joint protection.

    This article originally appeared in the 2014 issue of the Fit Society Page newsletter. To read the full article, please visit the web archive.
  • Active Voice: Strength Fitness, Body Weight and Cardiometabolic Health

    by Guest Blogger | Nov 30, 2015
    By Christian K. Roberts, Ph.D., FACSM 

    Obesity is associated with increased risk of type 2 diabetes, cardiovascular disease, metabolic syndrome, fatty liver disease and certain forms of cancer, as well as reduced quality of life and increased mortality. However, many of these same conditions also are linked to decreased fitness. Consequently, there is much debate about the relative roles of body weight and fitness indicators in determining the risk of the aforementioned cardiometabolic diseases. This debate was fueled with the U.S. Centers for Disease Control-published meta-analysis in 2013, which suggests that individuals with a body mass index (BMI) <35 do not exhibit higher mortality risk compared with normal weight subjects. Furthermore, we know that higher levels of adiposity are correlated with increased mortality, although fitness also attenuates this association. Ultimately, it is critical that we understand the true underlying contributors to disease risk and untangle these factors from others that, although traditionally thought to be important, are secondary to the true primary factors. To accomplish this we need innovative approaches in how we look at the roles of body weight, obesity and weight loss in the context of health and disease. 

    To date, there has been a general focus on cardiorespiratory fitness and its comparison with weight status in the context of mortality risk. Because strength training can often lead to increases in body weight, there is the possibility that those who present as “overweight” or “obese” may display healthy cardiometabolic phenotypes despite their weight status classification. We designed a cross-sectional study to investigate whether overweight/class I obese individuals exhibiting high muscular strength display cardiovascular and metabolic phenotypes similar to overweight/class I obese, untrained individuals or normal weight individuals with high strength fitness. 

    In our study, as reported in the June 2015 issue of MSSE, young adult men (ages 18-30) were categorized into three phenotypes based on training status and BMI. Normal-weight trained (NT) subjects performed =4 d/wk of structured strength training and had a BMI <25 kg/m2. Overweight trained (OT) subjects also performed =4 d/wk strength training and had a BMI >27 kg/m2. Finally, overweight untrained (OU) subjects performed no structured exercise program and had a BMI >27 kg/m2. Thus, two groups exhibited similar strength training frequency and two similar body weights. 

    Using this design, we set out to shed light on two aspects related to the fitness and body weight conundrum. The first was whether the strength-trained groups, NT and OT, would display better metabolic and cardiovascular phenotypes compared to the OU group. The second was if the strength-trained groups with similar strength fitness levels, would exhibit similar metabolic and cardiovascular phenotypes, despite higher weight and fat mass in the OT group. As young individuals are at low risk of mortality, we used a variety of phenotypes associated with disease risk, including central and brachial blood pressures, indices of arterial stiffness, serum lipids, inflammatory and metabolic markers, and steroid hormones. 

    Our findings indicated that overweight/class I obese and normal weight individuals who are both strength-trained exhibit remarkably similar cardiovascular and metabolic phenotypes and both better than overweight/obese untrained individuals. Interestingly, the similar phenotypes in the OT and NT groups were present despite the elevated body fat mass in the OT group. This new evidence challenges the existing view of the importance of body weight classification per se and suggests that strength fitness may have more influence on metabolic and cardiovascular health than previously appreciated. Furthermore, strength fitness may be an alternate therapeutic target, especially in those unable to normalize body weight. Ultimately, it may be time for a paradigm shift in how we think about the relative roles of fitness and body weight in the context of health.

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

    Christian K. Roberts, Ph.D., FACSM, is an integrative exercise physiologist, and his research investigates the efficacy and mechanisms by which exercise training and diet interventions prevent metabolic diseases, including cardiovascular diseases and type 2 diabetes, as well as the impact of metabolic health improvement independent of obesity reversal. He has been a member of ACSM for 20 years. 

    This commentary presents Dr. Roberts’ views on the topic related to a study which he and his colleagues recently completed. Their research report appears in the June 2015 issue of 
    Medicine & Science in Sports & Exercise® (MSSE). 
  • Active Voice: Caffeine and Endurance Time Trial Performance— Effects and Mechanisms of Action?

    by Guest Blogger | Nov 24, 2015
    By Christopher D. Black, Ph.D. and Alexander R. Gonglach, M.S. 
    Christopher D. Black, Ph.D. Alexander R. Gonglach, M.S.

    Christopher D. Black, Ph.D., is an assistant professor of exercise science at the University of Oklahoma in Norman, Oklahoma. He is a member of ACSM, with research interests and training in the area of muscle physiology and the causes and performance/adherence consequences of exercise-related musculoskeletal pain. 

    Alexander R. Gonglach, M.S., is an exercise physiology graduate student at the University of Oklahoma in Norman, Oklahoma.

    Caffeine improves endurance performance — on this expected response, most researchers, athletes and weekend warriors agree. For a small subset of the population, an ergogenic effect of this magnitude has large practical significance, since a two to four percent increase in performance could equate to a 40 to 80 second improvement in a 35-minute race. Such improvement would easily represent the difference between medaling in a highly competitive race versus not even finishing among the upper tier of runners. Despite 30- plus years of research demonstrating that caffeine improves endurance performance, the mechanism(s) of action remain somewhat a mystery. Several hypotheses have been put forth, including: 1) alterations in fat metabolism leading to glycogen sparing; 2) direct actions on skeletal muscle leading to increased force production, perhaps through alterations in calcium release from the sarcoplasmic reticulum; 3) central and/or peripheral nervous system actions leading to increased skeletal muscle force production; and 4) reductions in perceptions of muscle pain and sense of effort. While there is growing scientific support for certain hypotheses, scientific evidence supporting each of these hypotheses may be found in the recent literature.

    The results of our most recent study were published in the June 2015 issue of Medicine & Science in Sports & Exercise®. We wanted to explore the role of improved strength and reductions in muscle pain, as possible mechanisms by which caffeine might act to improve performance. We used a novel approach by having participants perform leg and arm crank cycling on separate days and, in a different set of experiments, by assessing strength, motor-unit recruitment, ratings of muscle pain and endurance performance (See the abstractfor details of methodology). This was done because previous research has indicated that caffeine improves motor-unit recruitment and strength to a greater and more consistent extent in large leg muscle groups, such as the quadriceps, compared to smaller muscle groups in the arms. Using this approach, we successfully manipulated strength and motor-unit recruitment at 60 minutes following caffeine ingestion (5mg·kg-1 body weight) with the quadriceps, but not the biceps, showing an increase. Our participants then performed 30 minutes of moderate-intensity (60 percent of V?O2 peak) leg or arm crank cycling, followed by a 10-minute maximal effort time trial. Consistent with other studies, ratings of muscle pain were reduced during moderate intensity cycling, regardless of muscle group used following caffeine ingestion. Interestingly, this effect was lost during the time trial. Work performed during the time trial increased following caffeine ingestion with leg cycling, but not during arm crank cycling. Our findings point toward caffeine-induced changes in strength being more important for explaining the increased performance than were reductions in muscle pain. 

    The mechanism of caffeine’s action is likely of little interest to an athlete or a person who simply wants to perform/train at a higher level on a given day. The “how” and “why” it might induce improvements does not concern them. Their concern is simply “does it work?” Based upon a wealth of research, including our own, the answer to that question is clearly “yes,” especially for events such as running and cycling which use the large muscles of the legs. So that cup of coffee isn’t helpful just for getting you going in the morning, but perhaps it also should become part of your pre-workout and pre-race routine.

    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. 
  • Exercise During Pregnancy and Post-Partum

    by Guest Blogger | Nov 20, 2015
    The American College of Sports Medicine (ACSM) and American Congress of Obstetrics and Gynecology (ACOG) have similar guidelines that encourage pregnant women to engage in health-related physical activity during pregnancy. Before beginning an exercise program, pregnant women should complete a screening questionnaire (e.g., PARmed-X; and discuss exercise options with their obstetric provider to ensure it is safe for her (and her baby) to exercise. During pregnancy, the goals are to maintain/ increase fitness and avoid exertion that could be harmful to mother or fetus. The intensity of exercise that is safe and appropriate varies among individuals and changes across the length of the pregnancy. To read the full article, click here to revisit the October 2014 issue of the ACSM Fit Society Page newsletter.
  • Breaking News Member Editorial: New Report Suggests Doping by Russian Sports Teams

    by Guest Blogger | Nov 12, 2015

    The World Anti-Doping Agency released a concerning report earlier this week, outlining findings that suggest the Russian government is running a state-run doping program. The report details serious allegations including bribery and intimidation of doping testers, destruction of laboratory materials and police intervention in laboratory work. The report suggests disciplinary measures including banning Russia from participating in next year’s Olympic Games in Rio de Janerio. Russia will also face scrutiny as the host of the 2018 FIFA World Cup after reports of misconduct at the Sochi Olympics. For more information, see this recent news article from the New York Times.

    In response to this news, and based on his expertise and experience with the World Anti-Doping Agency, Gary Wadler, M.D., FACSM shares his opinion in the following blog post. This viewpoint reflects the opinion of the author and does not necessarily reflect positions or policies of ACSM:

    "Once again, the world of sport has been wracked by the scourge of institutionalized and state sponsored/supported doping. This time it is neither the East Germans nor FIFA. This time it is Russia and it is International Track and Field- and who knows what doping practices and violations lie beneath the surface of the field of play? We are now faced with another crisis of confidence in sport with the potential to destroy sport as we know it. What is particularly disconcerting is the depth and the pervasiveness of the allegations and the fact that all this has been occurring in the context of worldwide comprehensive antidoping programs and practices. The independent WADA commission amongst other violations confirmed allegations that some Russian doctors and/or laboratory personnel acted as enablers for systematic cheating along with athletics coaches. The commission identified the intentional and malicious destruction of more than 1,400 doping samples by Moscow laboratory officials after receiving written notification from WADA to preserve target samples. This multipronged doping scandal once again threatens the very existence of sport."

    Dr. Wadler practices internal medicine and sports medicine in Manhasset, New York. He is also a clinical associate professor of medicine at the Hofstra North Shore-LIJ School of Medicine. He has served as medical advisor to the White House Office of National Drug Control Policy and recently served as chairman of the World Anti-Doping Agency (WADA) Prohibited List and Methods Committee. Dr. Wadler is an expert on sport and substance abuse and has provided medical leadership and served as a policy advisor on these matters at the highest levels nationally and internationally for many years.

  • ACSM Reveals 2016 Fitness Trends, New #1

    by Guest Blogger | Oct 26, 2015

    ACSM Reveals 2016 Fitness Trends, New #1

    Are you tracking your running mileage, calories burned or average heart rate using a wearable device? The American College of Sports Medicine (ACSM) has announced its annual fitness trend forecast and, for the first time, exercise pros say wearable technology will be the top trend in fitness. The results were released in the article “Worldwide Survey of Fitness Trends for 2016: 10th Anniversary Edition” published yesterday in the November/December issue of ACSM’s Health & Fitness Journal®.

    Now in its tenth year, the survey was completed by more than 2,800 health and fitness professionals worldwide, many certified by ACSM, and was designed to reveal trends in various fitness environments. Forty potential trends were given as choices, and the top 20 were ranked and published by ACSM, including a few new additions to last year’s list. The full list of top 20 trends is available in the article.

  • The ACSM Foundation in Action

    by Lauren Johnson | Oct 21, 2015
    By James M. Pivarnik, Ph.D., FACSM

    The American College of Sports Medicine Foundation was formed to pursue resources needed to advance the work of the College. One of our goals has been to involve individuals, foundations and those in the corporate world who share ACSM’s interests in furthering exercise physiology, sports medicine, policy and public health issues to support our mission to advance health through science, education and medicine. 

    Student AwardsIndividual members of ACSM have made a difference for the College and the programs it supports. In 2014, nearly $61,400 was received in individual gifts thanks to ACSM member donors. As you reflect on what ACSM means to you personally and professionally, I encourage you to consider joining me in making a gift to the ACSM Foundation anytime throughout the year. One outcome of these donations is the creation of additional endowments to fund research grants, scholarships and awards. I’d like to recognize 2015’s foundation scholarship and travel awards winners:

    • The 2015 Michael L. Pollock Student Scholarship -- (Jaquelyn Holt and Ryan Pettit-Mee)
    • The Steven M. Horvath Travel Award (Riana Pryor and Scott Crawford)
    • The Gail E. Butterfield Nutrition Travel Award (Jessica Knurick and Paddy Dempsey)
    • The Lisa Stroud Krivickas Clinician-Scholar Travel Award (Dina Christina Janse van Rensburg)
    • The Priscilla M. Clarkson Undergraduate Travel Award (Mateus da Silva Bezerra)
    • The GSSI-ACSM Sport Nutrition Award (Louise Turner)
    • The GSSI-ACSM Young Investigator Award (David Clayton)
    • And finally, the GSSI-ACSM Young Scholar Travel Award (Benjamin Ryan and Jenna Gillen)

    The Foundation has a strong commitment to funding research and disseminating the findings. We are very pleased to honor the researchers who competed successfully for the 2015 Foundation Research Grant Program:

    ACSM Foundation Research Grants:

      • Youngdeok Kim


      • Marcia J. Abbott
      • Daniel Gagnon
      • Nathan T. Jenkins
      • Anna E. Stanhewicz


      • Robert C. Lynall


      • Matthew T. Wittbrodt


      • Anita V. Mantri
      • Amanda L. Zaleski


      • Jacob M. Allen
      • Daniel H. Craighead
      • Aaron J. Done
      • John J. Guers
      • Justin Perry Hardee
      • Jin Hee Jeong
      • Hawley E. Kunz
      • Sanghee Park
      • Meghan G. Ramick
      • Lindsay A. Tanskey
      • Heather L. Vellers
      • Zachary M. Zenko


      • Elena L. Ivanova

    During the 2015 ACSM Annual Meeting we awarded $135,504 to these talented young investigators, a total of 23 grants. Two years ago, ACSM entered into a multi-faceted partnership with the American Medical Society for Sports Medicine (AMSSM), in part to fund a joint research venture. The 2015 recipient of the ACSM- AMSSM Clinical Research Grant was Dr. M. Kyle Smoot.

    As we look to the future, I challenge each of you to participate by giving of your time, talent and resources to the Annual Fund and other programs of the ACSM Foundation. 

    I encourage those researchers and young investigators to apply for any of these opportunities provided by the ACSM Foundation today!

  • Active Voice: Leisure Time Sitting and Cancer Risk

    by Guest Blogger | Oct 13, 2015
    By Alpa V. Patel, Ph.D. and Lynette L. Craft, Ph.D, FACSM

    Alpa V. Patel, Ph.D.

    Lynette L. Craft, Ph.D., FACSM
    Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Alpa V. Patel, Ph.D., is a cancer epidemiologist and principal investigator of the Cancer Prevention Study-3 at the American Cancer Society in Atlanta, Georgia. Her research broadly focuses on physical activity, sedentary behavior, obesity and disease risk. More specifically, she is interested in understanding these factors in relation to cancer risk and survival, as well as better quantification of the amount and type of activity needed for optimal health.

    Lynette L. Craft, Ph.D., FACSM, is the vice president for evidence-based practice and scientific affairs at ACSM. Her Ph.D. is in kinesiology and she is an adjunct faculty member in the Department of Preventive Medicine at Northwestern University, Feinberg School of Medicine in Chicago, Illinois. Her research focuses on the mental and physical benefits of exercise. Specifically, she examines how intervening on lifestyle factors, such as physical activity and sedentary behavior, are related to chronic disease risk and quality of life in breast cancer survivors.

    This commentary presents the views of Drs. Patel and Craft on the topic of a research article which they and their colleagues recently published in the journal Cancer Epidemiology, Biomarkers & Prevention, which has received extensive attention in the public media over the last two weeks.

    In recent decades, there has been a dramatic increase in leisure time where people sit while using technology advancements such as computer use, television viewing, transportation and other factors. Many individuals who meet physical activity guidelines are sedentary for the majority of their remaining awake time (they often are referred to as “active couch potatoes”). Thus, in recent years, sitting time has been examined in relation to health outcomes as a distinctly different behavior than physical inactivity. In fact, numerous epidemiologic studies have shown that sitting time is independently associated with higher risk of premature death from any cause and risk of various chronic diseases such as cardiovascular disease, type II diabetes and some types of cancer.

    While the benefits of physical activity in relation to cancer prevention are well documented, the evidence to support an association between sitting time and cancer risk is in its infancy. Using data from the American Cancer Society’s Cancer Prevention Study-II (CPS-II) Nutrition Cohort, we conducted a detailed analysis of leisure time spent sitting in relation to total and site-specific cancer risk. This study builds upon previously published work (see: Patel et al., 2010) where we documented an association between sitting time and total mortality in men and women. However, in that study, excess risk of cancer-specific mortality associated with sitting time was observed only in women.

    The analysis in this, our current study, is comprised of 69,260 men and 77,462 women on the CPS-II Nutrition Cohort who were cancer free at enrollment in 1992 and have been followed for cancer incidence (the current analysis is with follow-up complete through 2009). During that time, 18,555 men and 12,236 women were diagnosed with cancer. Overall, we observed a 10 percent higher risk of total cancer among women who sat six or more hours versus less than three hours in their leisure time (95 percent CI 1.04-1.17). We further examined risk in 17 individual cancer sites in women and found positive associations between sitting time and multiple myeloma, invasive breast cancer and ovarian cancer. We found no overall association between sitting time and total cancer nor with any of the 15 individual cancer sites examined in men. The lack of any observed associations in men may be a real biologic difference or may be due to some limitation in the data available for this analysis. For example, we lacked occupational sitting time data, but this was likely to have a minimal effect on associations in women, since the vast majority of the women in our study were either retired or never worked outside of the home. The majority of men were retired at study entry, but their sitting patterns at enrollment may not reflect their usual sitting patterns during most of their adult years. Given the potentially long latency period of most cancers, it is possible that we did not capture the relevant sitting time exposure. Thus, as we stated in the conclusions of this recent paper, further research is needed to understand the gender difference in the relationship between sitting time and cancer.

    Some physical activity guidelines, including those set forth by ACSM and the American Cancer Society, recommend limiting time spent sitting whenever possible. Nonetheless, there is a need to better understand the benefits of reducing sitting time along with meeting recommended levels of physical activity in relation to optimal health. With the widespread interest in the general public and media to understand the health effects of too much sitting, there may be an opportunity to improve population health via messaging about sitting time, especially among the large proportion that is otherwise physically inactive.
  • Active Voice: From San Diego 2015 to Boston 2016 – ACSM Soars!

    by Guest Blogger | Sep 28, 2015
    By ACSM President-elect Elizabeth A. Joy, M.D., M.P.H., FACSM

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

    Elizabeth A. Joy, M.D., M.P.H., FACSM, is medical director for Community Health at Intermountain Healthcare in Salt Lake City and practices family medicine and sports medicine at the Salt Lake Clinic LiVe Well Center. She is an adjunct professor at the University of Utah in the Department of Family and Preventive Medicine. As ACSM’s current president-elect, Dr. Joy chairs the Program Committee – leading thematic focus and planning for the 2016 ACSM Annual Meeting. She has had extensive leadership experience with ACSM, including as a board of trustees member, vice president and, currently, as an associate editor for Current Sports Medicine Reports and chair of the Exercise is Medicine® Clinical Practice Committee. Dr. Joy is widely published in several areas related to her expertise, including physical activity assessment and promotion, the Female Athlete Triad, sports injury prevention and diabetes prevention.

    The 2015 ACSM Annual Meeting in San Diego was the largest meeting in ACSM’s history in regard to total attendance. Thanks to the outstanding program, under the leadership of Larry Armstrong, Ph.D., FACSM, and the ACSM Program Committee, more than 82 percent of attendees rated the annual meeting very good or exceptional. More than 70 percent of basic and applied science attendees applauded program content in their specialties, and 85 percent of physician attendees reported very good or exceptional chances to have their questions answered.

    The opportunities to learn and network with colleagues are key drivers for attendance at the annual meeting — and San Diego was no exception. The multidisciplinary environment at the annual meeting creates an unprecedented opportunity for scientists, clinicians and students to engage and learn from another. 2015 saw an increase in student participation at the annual meeting, representing one-third of all attendees.

    The Exercise is Medicine® (EIM) World Congress and the Basic Science World Congress on Fatigue were centerpieces of the meeting. Physician attendees noted that they would “adopt new exercise participation guidelines” as a part of their clinical practice and would “encourage more EIM treatments.” Feedback on the Basic Science World Congress was equally positive, extolling the quality of the speakers and content.

    Submissions for the 2016 ACSM Annual Meeting in Boston are outstanding. The Program Committee met in Indianapolis earlier this month to sift through these submissions. Annual meeting submissions are reviewed by the 12 topical representatives who reflect the broad categorical interests of our members (e.g., biomechanics and neural control of movement, epidemiology and biostatistics, metabolism and nutrition), in addition to Program Committee members representing clinical medicine and EIM. We repeatedly heard from reviewers regarding the high quality proposals and the difficult task of deciding what to include. The EIM World Congress will kick off the Boston meeting on Tuesday, May 31, 2016 including the first Morris/Paffenbarger EIM Keynote lecture by Mike Pratt, MD, MPH, FACSM, who will talk about the economic costs of physical inactivity. John M. Jakicic, PhD, FACSM, is leading the Basic Science World Congress, which will be focused on energy balance. He shared a sneak peek of the sessions that will be included, and the congress will be nothing short of cutting-edge science in this critically important area.

    The 2016 meeting, which will be held May 31-June 4, is ACSM’s first ever trip to Boston for the annual meeting. Held at the Hynes Convention Center, attendees and their family members will have access to three attached hotels and two shopping destinations for an all-inclusive convention experience. Attendees will be thrilled to learn that the Hynes Convention Center offers free Wi-Fi access and boasts complete cell phone coverage throughout the building.

    As chair of the Program Committee for 2016, I can assure you that Boston will be an outstanding meeting. I encourage you to submit your abstracts and case presentations by the November 2 deadline — you will receive advance information in future issues of SMB, the September issue of Medicine & Science in Sports & Exercise® and in timely e-blast notices as the deadline approaches. The meeting also will include wonderful social and networking opportunities throughout the week in Boston, including the annual meeting banquet on Friday evening, where attendees have the opportunity to rub shoulders with ACSM leaders and enjoy a wonderful evening hearing from our award winners.

    I hope to see you in Boston in 2016. Please feel free to email me directly with thoughts on how we can make Boston the best meeting ever –

    In the words of Boston native, John Adams, “Let us dare to read, think, speak and write.” I look forward to hearing from many of you in Boston 2016.
  • Input Needed on Proposed Revisions in Federal Policies on Human Subjects Protections

    by Guest Blogger | Sep 23, 2015

    By: Kevin Heffernan, Ph.D.

    While the scientific method has remained largely the same for hundreds of years, the dissemination of science has changed drastically. The digital era now provides unbridled access to information at the click of a button. Complete literature reviews and even advanced statistical analyses can be done on powerful hand-held devices from any place and at any time. Research is on the go and like so many aspects of our day-to-day lives, it can be hard to detach.  

    Pressures mount to secure funding to keep research agendas afloat. Age-old mantras like “publish or perish” are stuck in our psyche. Grant submission deadlines are on our calendars alongside holidays, birthdays and anniversaries. Papers need to be published to help secure the next grant.  Progress reports need to be generated to appease funders. Write, write, write…submit, submit, submit… 

    Sometimes researchers may forget why we do what we do. Whether to prevent/treat disease, augment athletic performance, enhance recovery from injury or improve overall health, wellness and quality of life, our scholarship seeks to help others. Our undertaking is one of service and at the very foundation of our research lies (sometimes literally) the participant. We are indebted to those individuals that graciously give of their time and effort to participate in our research projects so that we may hopefully use our findings to help others. 

    Earlier this month, the Department of Health and Human Services (DHHS) released its most recent Notice of Proposed Rulemaking (NPRM) regarding Federal Policy for the Protection of Human Subjects. This expansive document seeks to maintain research ethical standards at the highest level while improving the overall research experience for participants and researchers alike. Members of ACSM are highly encouraged to explore this document, as guidelines put forth will directly impact how ACSM navigates its scholarship. Opportunities will be made available to share our views and concerns with DHHS. Comments will be accepted until December 1, and we invite and encourage your input.

    ACSM is the largest sports medicine and exercise science organization in the world and our mission is to advance and integrate scientific research to provide educational and practical applications of exercise science and sports medicine. We believe in the power of exercise as medicine and we entrust that our medicine heals; and our vessel to share this message is research. It is our duty as scientists and our responsibility as citizens of inquiry and exploration to protect our research participants’ rights and ensure their safety. Without research participants, research itself comes to a screeching halt.  

    Kevin Heffernan, Ph.D.

    Syracuse University, Department of Exercise Science
    Director of the Human Performance Laboratory and member of the SU Institutional Review Board

  • Surgeon General Announces Call to Action to Promote Walking; Resources Now Available

    by Guest Blogger | Sep 17, 2015
    In a landmark announcement on September 9, U.S. Surgeon General VADM Vivek H. Murthy, M.D., unveiled his Step It Up! Call to Action to Promote Walking and Walkable Communities.

    As a leader in the promotion of physical activity, ACSM was pleased to play an integral role in both the conceptual development of the call to action and the official announcement. Former ACSM Presidents Robert E. Sallis, M.D., FACSM and Russell R. Pate, Ph.D., FACSM; ACSM Fellows Brian W. Hainline, M.D., FACSM and Jack L. Groppel, Ph.D., FACSM, as well as CEO Jim Whitehead all had prominent roles in the event.

    This announcement is a huge step forward for the cause of physical activity and health and we invite you to join ACSM in enthusiastically supporting this call to action. To assist in this effort, a number of resources are now available for you and your organization. Visit our ACSM Call to Action web page and find a partner's guide, videos, social media messages, web banners, customizable press release to announce your organization’s support, and more. America Walks and the Every Body Walk! have also launched an exciting new collaborative micro grant program designed to assist local walking advocates to build on the momentum of the newly released Surgeon General's Call to Action. Applications are due by 5 p.m. EDT on October 15th.
  • Active Voice: Features of Prolonged Sitting Behavior Correlate with Cardiometabolic Disease Risk Markers

    by Guest Blogger | Sep 14, 2015
    By Kate Lyden, Ph.D. and Sarah Kozey Keadle, Ph.D., M.P.H.

    Kate Lyden, Ph.D. Sarah Kozey Keadle, Ph.D.

    This commentary presents Drs. Lyden’s and Kozey Keadle’s views on the topic related to a research article they authored with their colleagues and which appears in the May 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).

    Based largely on epidemiologic evidence that sedentary behavior increases risk of chronic disease and premature mortality, some have suggested that physical activity guidelines, which currently focus on moderate-to-vigorous physical activity (MVPA), should also include recommendations to reduce sitting. While a basic message of “sit less” may be possible given the current evidence, we believe there are important research questions that need to be answered before specific evidence-based recommendations are warranted. First, what “dose” (or amount) of sedentary behavior is bad for health? Certainly, it is unrealistic to recommend that people never sit, but what is the threshold at which sedentary behaviors begin to negatively influence health? Is this threshold different for specific groups (e.g., young vs. old, exercisers vs. non-exercisers?) Second, does reducing and/or changing patterns of sedentary behavior impact relevant health outcomes? If we recommend to individuals that they reduce their sedentary time, how much should they reduce it, and does it matter what type (e.g., standing vs. walking) and intensity of activity they perform instead?

    To answer these questions, experimental trials that manipulate sedentary time are needed. However, previous experimental studies have primarily relied on bed rest or other extreme sedentary conditions (e.g., 24 hours confined to a wheel chair) in part due to the challenge of measuring sedentary behavior. While these studies provide evidence of the possible mechanisms linking sedentary behavior to poor health, they are not representative of “real-world” sedentary behavior. Even the most sedentary, but otherwise healthy individuals, take breaks from sitting to perform activities of daily living. The frequency, type and intensity of these breaks are potentially important factors impacting health. Technological advances that improved the precision of body worn activity monitors now make such studies of habitual patterns of sedentary behavior feasible. These devices enable researchers to link specific behaviors with health-related outcomes, which was the purpose of our article published in the May 2015 issue of MSSE.

    Our study was designed to reflect “real-world” sedentary behavior patterns where people are constrained by their job, mode of transportation or other factors that promote sitting. We enrolled 10 participants who were recreationally active and measured their baseline levels of sedentary behavior and physical activity for seven consecutive days using a well-validated activity monitor. During a second seven day period, they were instructed to sit as much as possible, to limit standing and walking, and to refrain from structured exercise. At the end of each week, we conducted an oral glucose tolerance test to assess blood glucose and insulin in response to a glucose load. In the sedentary condition, insulin levels 10 hours post-glucose load, the area under the insulin curve and a composite insulin sensitivity index were all significantly elevated. Because we included data from the activity monitor, we were able to assess whether these changes were linked to specific behaviors. We found that change in the 2-hour insulin was negatively associated with change in light-intensity physical activity (r = -0.62) and positively associated with change in time for sitting bouts that were longer than 30 min (r = 0.82) and 60 min (r = 0.83).

    We think our study is an important first step. However, there is much more work needed in this area. We included a small sample of healthy young adults who changed both their exercise and sedentary behaviors. It is plausible that the effect of changing sitting time may differ for people who are not active at baseline or for older adults. Activity monitoring allows researchers to measure relevant behavioral patterns and answer research questions that we believe have important public health implications. We anticipate, and hope, that these tools will be widely used in the future to identify novel behaviors that are important in disease initiation and development.

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

    Kate Lyden, Ph.D., is a research scientist at the University of Colorado, Denver. Her research is funded by the NIH and examines the effects of interrupting sedentary time with short and continuous bouts of moderate intensity walking on metabolic outcomes in overweight adults. She has developed methodologies to quantify physical activity, sedentary behavior and sleep using wearable sensors and uses these techniques to understand the dose-response relationship between physical activity, sedentary behavior and chronic disease.

    Sarah Kozey Keadle, Ph.D., M.P.H., is a cancer prevention fellow in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute in Bethesda, Maryland. Her research broadly focuses on the relationship between physical activity, sedentary behavior and disease prevention, with a specific interest in improving measures of active and sedentary behaviors and applying novel methods to further our understanding of the associations between these behaviors and health risk.
  • Active Voice: Barefoot Running, Hip Movements and Knee Injuries

    by Guest Blogger | Sep 03, 2015
    By Colm McCarthy, MRCPI, MICGP, FRACGP, MSc.

    Barefoot running, or running in minimalist shoes, is a somewhat controversial topic— often polarizing both researchers and clinicians. Debate continues about the role of footwear in running performance and injury. Two of the most common running injuries are patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS), both causing pain around the knee.

    There is growing evidence for the role of hip movements in both the causation and successful treatment of PFPS and ITBS. A greater degree of hip adduction and/or hip internal rotation during running has the effect of the distal femur moving “inwards” toward the midline during the stance phase of running, when the leg is supporting the body’s weight. When excessive, this movement may increase strain on the ITB and affect the movement of the patella over the femur, leading to pain.

    Strengthening the hip muscles (especially the gluteals) or teaching the runner to control the “moving in” of the knee during running and other activities have proved effective in studies aimed at treating both PFPS and ITBS. “Gait retraining” has gained in popularity both in research and clinical practice. Here, instructions or “cues” often focus on encouraging the runner to run with reduced hip adduction/internal rotation. Changes to foot strike pattern and stride length/cadence are also sometimes advocated.

    For our recent study reported in MSSE, we examined if something very simple— running without shoes— would bring about changes in kinematics (how a joint moves) at the hip; and thus potentially modify a risk factor for knee injury. Twenty-three healthy female runners with no experience with barefoot running were tested in a gait laboratory, running first in regular running shoes and then barefoot. No instructions, cues or other information were provided.

    When running barefoot, our participants took shorter strides and landed more toward the forefoot, with less flexion at the knee than they did in shoes. This agrees with the findings of other researchers. Most interestingly for us, hip adduction and hip internal rotation, along with contralateral pelvic drop, were significantly reduced at foot strike and at 10 percent of stance (corresponding to the vertical impact peak) when running barefoot compared to shod.

    Our study is the first to report on 3-D hip kinematics during barefoot running in recreational female athletes— the group most affected by PFPS and ITBS. We postulate that bringing about a reduction in hip internal rotation and adduction using barefoot running could help runners with PFPS or ITBS return to running or prevent the injuries in the first place.

    Full-time barefoot running is not always practical and carries risks for runners used to running with shoes. However, from our own previous research, we know that runners who trained in very minimalist shoes for 12 weeks “carried over” some of the new gait characteristics when they returned to their regular footwear. We suggest that barefoot running could be incorporated as a training tool to encourage good form that prevents knee injuries or as a treatment and rehab tool for runners recovering from PFPS or ITBS. It also may serve as an adjunct to gait retraining programs, where reducing hip adduction and internal rotation are treatment goals.

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

    Colm McCarthy is a general practitioner and sports doctor. He trained in Ireland and currently works in Perth, Western Australia. He completed a MSc. in sports and exercise medicine at Trinity College Dublin. He has worked with teams in the codes of soccer, Australian rules and Gaelic football. His clinical and research interests focus on running; in particular, knee injuries and rehabilitation and the effect of footwear and gait on performance and injury.

    This commentary presents Dr. McCarthy’s views on the topic related to a research article he authored with his colleagues and which appears in the May 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).

  • Active Voice: Does Exercise Protect Against Sleep Complaints During Middle Age?

    by Guest Blogger | Aug 14, 2015

    By Rod K. Dishman, Ph.D., FACSM, and Shawn D. Youngstedt, Ph.D.

    Rod K. Dishman, Ph.D.,
    Shawn D. Youngstedt,

    Poor sleep is a burden on public health. It is associated with medical conditions such as coronary heart disease, hypertension, obesity, diabetes and metabolic syndrome. Poor sleep also contributes to emotional distress and impairment of daytime function. Nearly one in four middle-aged adults in the U.S. say they recently had trouble falling or staying asleep, or sleeping too much. About half the people who seek treatment for sleep problems will be prescribed a drug that will have poor efficacy and adverse risks with long-term use. Many people who don’t seek treatment will purchase over-the-counter sleep aids or use alcohol to get to sleep at night. Neither is effective or healthy in the long run.

    Trials of exercise training have shown improved reports of sleep quality and objective measures of better sleep in middle-aged adults who already complained of sleep problems. However, whether regular exercise protects against the onset of sleep problems hasn’t been studied much. The scientific advisory committee for the federal 2008 Physical Activity Guidelines for Americans concluded there was moderate evidence to support that physical activity improves sleep. However, the committee recommended that physical activity exposures and outcomes need to be measured frequently to properly examine change. None of the epidemiological studies included in their review had concurrently assessed objectively measured change in physical activity exposure and sequential measures of sleep outcome, or accounted for other risk factors that can vary across time to confound the association between physical inactivity and the odds of sleep disturbance.

    Change in cardiorespiratory fitness during middle age provides a proxy measure of cumulative physical activity exposure. Our collaboration with Steven N. Blair, P.E.D., FACSM, now at the University of South Carolina, let us follow 7368 men and 1155 women from the Aerobics Center Longitudinal Study that had not complained of sleep problems, depression or anxiety at their first visit to the Dallas clinic. Cardiorespiratory fitness (minutes of graded treadmill endurance) was assessed then and at three subsequent clinic visits, each separated by an average of two to three years.

    There were 784 incident cases of sleep complaints in men (11 percent) and 207 cases in women (18 percent). After adjustment for initial fitness, age, time between visits and other risk factors for poor sleep assessed at each visit, each minute decline in treadmill endurance between ages 51 to 56 (about one-half MET) increased the odds of incident sleep complaints by 2 percent in men and 1 percent in women. Odds were approximately 8 percent higher per minute decline in fitness among people with sleep complaints at two or three visits.

    Said another way, the decline in fitness was less for those who never reported sleep complaints – for men, only about 6 percent and only about 4 percent for women. It was about 8 percent in incident cases of sleep complaints, i.e., an additional loss of about one-half minute of maximal treadmill time. That smaller decline observed for those without sleep complaints is an amount easily retained in most people by regular, moderate-to-vigorous physical activity consistent with ACSM recommendations for healthy physical activity. Although a large randomized trial is needed to determine how many cases of sleep complaints might be prevented by mitigating this decline in fitness, our results suggest that maintenance of cardiorespiratory fitness during middle age, when decline in fitness typically accelerates and risk of sleep problems is elevated, helps protect against the onset of sleep complaints made to a physician in both men and women.

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

    Professor Rod Dishman, Ph.D., FACSM, is an exercise scientist and is co-director of the Exercise Psychology Laboratory at the University of Georgia in Athens. One of his research lines has examined mental health outcomes associated with physical activity, focusing on neurobiological mechanisms. He chaired the mental health section of the scientific advisory committee for the federal 2008 Physical Activity Guidelines for Americans. He has been a member of ACSM since 1978. Professor Shawn Youngstedt, Ph.D., is a sleep scientist in the College of Nursing and Health Innovation and with the program in Exercise Science and Health Promotion, Arizona State University in Phoenix. His research has focused on morbidities and mortality associated with sleep problems and non-pharmacologic means of improving sleep and mental health. His group has conducted research on the effects of exercise and bright light on insomnia, sleep apnea and Posttraumatic Stress Disorder. He has been a member of ACSM since 1989.

    This commentary presents the views of Drs. Dishman and Youngstedt on the topic of a research article which they and their colleagues published in the May 2015 issue of
    Medicine & Science in Sports & Exercise® (MSSE).
  • Fitness is Fiscal

    by Guest Blogger | Aug 05, 2015

    Dear 2016 Presidential Candidates:

    We believe there is an issue in this campaign that so far has received only limited attention. We hope to change that by urging you include a strategy to promote increased physical activity for Americans as a central component of your health care policy platform.     

    The Centers for Disease Control and Prevention (CDC) indicate that poor diet and physical inactivity cause over 400,000 deaths each year, yet still 68% of adults and 16.9%  of children in the United States are obese or overweight. The link between the rise in obesity and ballooning increases in health care spending could not be more apparent.  

    According to Department of Health and Human Services data, physical inactivity is responsible for between 20 and 30% of most major diseases and conditions. For example, 25-35% of coronary heart disease and cardiovascular diseases are attributed to this root cause. Similarly, 30-40% of type-2 diabetes; 30% of colon cancer; 20% of breast cancer; 20-30% of depression; 30% of falls; and 36-58% of hip fractures link back to a lack of exercise.1  The economic price of inadequate levels of inactivity is estimated at $131 billion per year2 – costs borne by federal and state governments as well as individual citizens. 

    In effect, physical fitness IS fiscal responsibility, and improving fitness by regular physical activity dramatically reduces the risk of morbidity and mortality in normal weight, overweight, and obese individuals.  

    Empowering Americans to increase their level of physical activity is part of the solution to both our health care and budgetary challenges. To this end, we urge you to include the following principals in your national health strategy:

    •    Ensure that exercise is front and center in public discussions on disease prevention, health, and wellness and that health care providers assess and review every patient’s physical activity level at every visit.  
    •    Expand research programs at the National Institutes of Health and other federal science agencies directed at sports science and physical activity matters.
    •    Promote walkability in public spaces and in the design of America’s infrastructure.
    •    Establish a regular requirement for periodically updating Physical Activity Recommendations for Americans.

    In far too many cases, preventable conditions are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition that keep people healthy and out of the hospital.

    We urge you to use your voice in this presidential campaign to raise these critical issues for the future of our nation.  


    Jim Whitehead
    CEO, American College of Sports Medicine

    1 2012 Advisory Committee Report, U.S. Secretary of the Department of Health and Human Services for the National Physical Activity Guidelines , pages E5-E17
    2 S. Carlson et al., Progress in Cardiovascular Diseases 57:315-323, 2015

  • Active Voice: Television Viewing Time Predicts Usual Walking Speed — But Is It the Sitting That’s Important?

    by Guest Blogger | Aug 03, 2015
    By Victoria L. Keevil, BMBCh and Katrien Wijndaele, Ph.D.

    Victoria L. Keevil, BMBCh Katrien Wijndaele, Ph.D.

    Sedentary behavior, i.e., time spent sitting or lying when energy expenditure is low, has been proposed as an independent risk factor for poor health and is acknowledged in a recent ACSM Position Stand on physical activity recommendations. In particular, both total sitting time and specific sedentary behaviors, such as watching television (TV), have been associated with type 2 diabetes, cardiovascular disease, specific cancers and premature mortality. However, little is known about the potential impact of prolonged sitting on physical function. This is somewhat surprising given the established link between prolonged bed rest and muscle atrophy, the importance of maintaining optimal physical function later in life and the high volumes of sitting time observed among older adults. Therefore, sedentary behavior is potentially an attractive target for public health intervention.

    In our research article published in April 2015 issue of MSSE, we utilized the infrastructure of a large prospective cohort study, the European Prospective Investigation of Cancer (EPIC)-Norfolk study, to investigate associations between television viewing time and objective measures of physical capability in community-based adults aged 48-92 years old. Television viewing time, the most common leisure time sedentary behavior in Western cultures, was measured in more than 6000 participants at two time periods: in 1998-2000 and again in 2006-2007. Usual walking speed, grip strength and timed chair stands speed also were measured at a central research clinic between 2006 and 2011. These objective measures of physical function have been extensively validated in clinical and epidemiological cohorts and usual walking speed and grip strength also are featured in the motor domain of the National Institutes for Health toolbox.

    We found that men and women who watched TV for less than two hours per day, either in 1998-2000 or 2006-2007, had faster usual walking speeds compared to those who watched TV for four or more hours per day. In analyses combining men and women and using the average of both TV viewing time measurements, a clear dose-response association was evident across TV viewing time categories. Those who watched less than two hours per day walked 2.4 m/min faster than those who watched four or more hours/day, a difference in usual walking speed equivalent to around four years difference in age. TV viewing time was not consistently or strongly associated with either grip strength or timed chair stands speed, the latter being a proxy measure for lower body strength.

    Usual walking speed has been proposed as the “sixth vital sign” of health in older people. It is associated with a range of health parameters, including cognition and premature mortality. Therefore, the observed association of less TV viewing time with faster usual walking speed, which persisted when TV viewing time was measured nearly a decade before, is of great public health interest. These findings add valuable evidence to the existing literature in this area, which is mainly cross-sectional and often based on self-reported measures of physical function, which come with substantially more measurement error.

    We do, of course, have to carefully consider the interpretation of our findings before recommending change in public health policy. TV viewing time is not a measure of overall sitting and it is associated with a complex range of socioeconomic and behavioral factors. Although we aimed to account for these variables in our analyses, we cannot be certain that it is the “sitting” per se, while watching TV that is solely contributing to the association we observed. Future studies with objective measures of overall sitting time should explore prospective associations with physical function.

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

    Victoria L. Keevil, BMBCh, is a clinician specializing in medicine for older people and was awarded a Wellcome Trust clinical training fellowship to undertake a Ph.D. under the supervision of Prof Kay-Tee Khaw, at the Department of Public Health and Primary Care, University of Cambridge (UK). She is interested in the heterogeneity of physical functional health in later life and in establishing links with modifiable risk factors, including sedentary behavior. Her research was inspired by the need for evidence-based public health policy to promote good health in older age.

    Katrien Wijndaele, Ph.D., is a British Heart Foundation (BHF) intermediate basic science research fellow at the Medical Research Council Epidemiology Unit, University of Cambridge (UK). Her primary research interest lies in the potential health consequences of prolonged sitting in adults and children, with an additional focus on sedentary behavior measurement and development of intervention strategies to decrease prolonged sitting.

    This commentary presents Drs. Keevil’s and Wijndaele’s views on the topic of a research article which they and other colleagues had published in the April 2015 issue of
    Medicine & Science in Sports & Exercise® (MSSE).

  • Special Olympics: A Sports Medicine Perspective

    by Guest Blogger | Jul 28, 2015
    Aaron Rubin, M.D., FACSM, FAAFP, Medical Director
    Special Olympics World Games
    Los Angeles 2015

    The mission of Special Olympics is to provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities. Doing so gives them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community.

    In the 1950s and 60s, Eunice Kennedy Shriver noted how unjustly people with intellectual disabilities were treated and started a summer day camp in her backyard. The first Special Olympics Summer Games were held in 1968 at Soldier Field in Chicago for one thousand people with intellectual disabilities. Participants came from 26 states and Canada and competed in track and field and swimming.

    In summer 2015, 7000 athletes and 3000 delegates from 177 countries will be in Los Angeles for the World Games. More than 30,000 volunteers and 500,000 spectators will be attending the largest sports and humanitarian event in the world to cheer on these amazing athletes who will compete in 25 events. Although this large event creates attention, the Special Olympics movement is much more. In 2013, more than four million athletes participated in 81,000 competitions around the world. This works out to 222 games per day, or nine games per hour. Some 1.4 million free health examinations have been provided in more than 120 countries through the Special Olympics Healthy Athletes program. Screenings are done in seven disciplines:

    1. Fit Feet provides podiatric screenings, including checking shoe size (many athletes compete with ill-fitting shoes) and a variety of foot problems.
    2. FUNfitness provides physical therapy evaluation for balance and flexibility, with recommendations for improvements and preventing injuries.
    3. Health Promotion teaches better health and well-being, including hand washing, sun protection, diet and hydration.
    4. Opening Eyes provides vision screening and eyeglasses when needed.
    5. Healthy Hearing screens for audiology problems and provides evaluation for hearing aids as needed.
    6. Special Smiles provides dental screenings and recommendations.
    7. MedFest performs sports physical exams.

    As medical director of the 2015 Games, I’ve experienced many challenges in putting together a medical plan for such a large multi-day event spread over a large geographic area. The medical team has to consider providing medical care for athletes at events, but with a higher number of medical conditions including diabetes, heart disease, and seizure disorders. We also had to give special attention to communicating with athletes with intellectual disabilities. The Special Olympics World Games partnered with medical groups and hospitals to provide medical expertise and oversight for the athletes and delegations during the entire course of the games. Teams are working on the medical care for athletes arriving at the Los Angeles Airport, with a welcome center medical station set up to assure that the athletes are doing well after their trips and have all medications and other needs met. The delegations spend several days at local communities called Host Towns to acclimate to and enjoy Southern California. They will then come to the Olympic Villages at UCLA and USC and have medical care available as needed in the dorms and during non-competition times. Medical teams will be available at each venue to care for minor medical issues that may arise, with sports medicine consultants available to come to the field as needed. Any condition requiring further lab or x-ray testing can be referred to a local “poly clinic” on the campuses or a local hospital clinic or emergency department.

    The goal of the medical staff at this event, as at all sporting events, is not to limit or restrict participation, but to allow and encourage safe participation. This is especially true for this population which is often looked at for their disabilities instead of their abilities. As with any such event, the hope is that the medical staff is able to take away more than they put into providing culturally appropriate, current and empathetic medical care with an increased awareness of the medical needs for this underserved population.
  • Active Voice: Football and FIFA – It’s Still a Game, Right?

    by Guest Blogger | Jul 28, 2015
    By Michael F. Bergeron, Ph.D., FACSM

    Here we go again. Another sports scandal. The soccer world (international football) has been shocked over the past several days by numerous reports of bribery and corruption in the sport’s premier governing body, The Fédération Internationale de Football Association (FIFA). FIFA is an old and venerated institution, established in 1904 with a global mission of protecting the integrity, growth and financial stability of football. FIFA has become a powerful empire, reportedly worth some $2.8 billion. Ironically, and despite its self-declared responsibility to “tackle current challenges to football, such as illegal betting and bribery,” officials at the highest levels of the organization now have been accused of agreeing to accept bribes in connection with selection of the host countries for the 1998 and 2010 World Cup. For more on the latest news, see:

    No question, sport is big business, which makes it and those in charge vulnerable to the temptations and misguided choices that too often are characteristic in business whenever big money and individual or national prestige are involved. Even youth sports has become inappropriately and exceedingly adult- and media-centered. But youth sports is still really about the kids who play sports, with football having recognized worldwide appeal. Adult football heroes are followed and admired by the boys and girls who find it simply thrilling and fun to run up and down the field while dribbling a ball in the imagined footsteps of these great players.

    But an important concern that perhaps is lost in all the media is the impact of this disappointing conduct on the many youth athletes who are heavily invested in football and have probably viewed FIFA as a high-minded leadership group. What does a scandal like this do to the children and adolescents who see football as the game they love? What is the unintended message and resulting consequence? Sadly, this demonstrated “leadership” distracts from, even deprecates, the core purpose of sport which is to promote healthy play, enjoyment, development, fitness, socialization and the dignity of ethical conduct.

    So we’ll do what responsible adults – parents, coaches, teachers and others who care about our children and the sports they love – always do. We’ll use this scandal as a lesson and a timely opportunity to emphasize that football (like all sports) is still a great game where commitment, hard work, character and respect are the tenants of success at any level of play. The IOC has made a commitment to re-emphasize healthy youth athlete development by critically evaluating the current state of youth sports and providing specific recommendations for developing healthy, resilient and capable youth athletes. This international consensus (available next month) comprises an emphasis on the whole athlete in developing character. This encompasses commitment and respect to self, other athletes, the community and the game, while providing opportunities for all levels of sport participation and success. The IOC further challenges all youth and other sport governing bodies to embrace and implement these guiding principles. The National Youth Sports Health & Safety Institute and the newly formed Youth Sports of the Americas enthusiastically support the IOC’s commitment to the positive values of sports and healthy youth athlete development.

    We have the obligation to, once again, save a sport, at least in the minds of those who matter the most: our children. They are watching, and counting on us.

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

    Michael F. Bergeron, Ph.D., FACSM, is president and CEO of Youth Sports of the Americas, Birmingham, Ala., as well as executive director of the National Youth Sports Health & Safety Institute. He is a past trustee of ACSM and currently a member of the Medical Advisory Committee for Pop Warner Little Scholars, Inc. that provides youth football and cheer and dance programs with an emphasis on maintaining academic standards. Dr. Bergeron also serves on the academic advisory board for the International Olympic Committee’s postgraduate diploma program in sports medicine, and he recently co-chaired the IOC Consensus Meeting on youth athletic development which will be highlighted in a special edition of the
    British Journal of Sports Medicine in July 2015.

  • Active Voice: Does Return to Activity after Concussion Impact Recovery of Gait Stability?

    by Guest Blogger | Jul 20, 2015
    By Li-Shan Chou, Ph.D.

    The relative re-injury risk for individuals who have sustained a concussion has been reported to be almost six times greater than those with no history of concussion. However, the factors, which contribute to this increased risk, are not clearly understood. Hence, the clinical decision of when to allow individuals to return to pre-injury levels of activity remains among the most difficult decisions in sports medicine.

    Previous research has reported that student athletes with concussion may experience a worsening of symptoms if they return to sports or school prematurely. Therefore, proper timing of activity resumption after a concussion is of critical importance to reduce the risk of prolonging the course of recovery. As deficits in physiologic functions have been documented to persist beyond patient-reported recovery of symptoms, additional objective measurements may be assistive in determining full recovery of the brain after injury.

    The ability to effectively execute motor tasks under conditions of divided attention (dual-task) is an important element for successful sport performance. Of particular interest to our research, this ability has been shown to be particularly sensitive to a concussion and remains impaired for several weeks after injury. In our April 2015 MSSE article, we addressed the questions of how return-to-activity (RTA) affects the recovery of single and dual-task gait balance control as well as recovery of cognitive functions and clinical symptoms. We employed a dual-task gait paradigm, which involved a recorded voice played over speakers. The voice expressed the words “high” or “low,” at pitches that were occasionally inconsistent with the meaning of the word (e.g., a low-pitched voice might say the word “high”). The subject, while walking, was required to identify the correct pitch, regardless of the word that was heard. In a prospective-longitudinal study, we followed 19 concussed high school students over a period of two months post-injury and measured these variables in the acute post-injury period (within 72 hours of injury) and at systematic intervals thereafter (one week, two weeks, one month, two months post-injury) against 19 uninjured matched controls. To test the effect of activity resumption within this two-month testing period, we examined the recovery trajectory of the variables immediately prior to and immediately after RTA clearance for each concussed subject. The results revealed improvement in dual-task gait medial-lateral balance control during the period immediately prior to RTA, but a worsening immediately after RTA. All other variables showed improvement in the pre-RTA period, and these continued to improve or remain stable post-RTA. This study concurs with findings from our group reported previously in MSSE, which showed a recovery reversal in side-to-side stability when walking with a divided attention following RTA in concussed college-age students.

    The finding that regression of recovery was only observed in dual-task gait balance control immediately following the clearance for activity resumption, but not in cognitive, symptom or single-task walking variables suggests that dual-task medial-lateral sway is particularly sensitive to a concussion and its recovery may be influenced by premature RTA. This study also suggests that examination of dual-task gait stability may be able to detect important residual concussion-related impairments after cognitive and symptom resolution. Moreover, these findings reinforce the need for a multifaceted approach to concussion management.

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

    Li-Shan Chou, Ph.D., is a professor and department head in the Department of Human Physiology at the University of Oregon. He directs the Motion Analysis Laboratory, and his research falls under general areas related to biomechanics and motor control of human movement, with focuses on the investigation of mobility impairments associated with ageing, musculoskeletal diseases or injuries and traumatic brain injury.

    This commentary presents Dr. Chou’s views on the topic of a research article which he and his colleagues published in the April 2015 issue of
    Medicine & Science in Sports & Exercise® (MSSE).
  • The Historic NIH Common Fund Announcement: Door to Physical Activity Research and Opportunities Swings Open

    by Guest Blogger | Jul 13, 2015
    By Lawrence E. Armstrong, Ph.D., FACSM

    Game-changer. Watershed moment. Key milestone. Turning point. Whatever you may call it, the positive ramifications of the decision cannot be overstated. I’m talking, of course, about last Thursday’s announcement by the National Institutes of Health (NIH) that physical activity research is being added to the NIH Common Fund.

    For those unfamiliar with the fund, it encourages collaboration and supports a number of high-impact, trans-NIH programs. These programs are designed to pursue major opportunities and gaps in biomedical research that no single NIH Institute could tackle alone, but that the agency as a whole can address to make the biggest impact possible on the progress of medical research. The NIH Common Fund was enacted by Congress in 2008 to support high priority and the most promising research areas in NIH. The inclusion of physical activity research in the Common Fund is important not only to the science and health communities, but to the elected U.S. leadership as well. It’s extraordinary in its significance for the future of the field.

    Adding physical activity to the Common Fund will have a profound effect and create numerous opportunities for ACSM members. And while the decision to include physical activity research is exciting, the NIH’s long-term commitment is stunning. Over the next five years, NIH will invest $170 million in the physical activity research program - the largest targeted NIH investment of funds into the ways that physical activity improves health and prevents disease. ACSM is committed to keeping members informed about the new physical activity research program and the opportunities it will provide for research funding. At this time, request for applications (RFAs) are expected to be released next month.

    Decisions and financial investments like these don’t happen randomly. Foremost, this reflects the decades of research and scientific discovery to which so many of you have been powerfully and continuously contributing. We also are indebted to our colleagues at the NIH who have worked tirelessly over the past several years to promote this initiative. I am proud that ACSM, the leading sports medicine and exercise science organization in the world, also helped lead the way. Our esteemed researchers provided important scientific input to the proposal, and ACSM rallied support among more than 500 individuals and organizations that joined us in signing a letter of support. There were a series of meetings with NIH leaders, demonstrating that ACSM is no stranger to the NIH. Our organization is highly credible and influential, and the acceptance of physical activity into the Common Fund is due, again, to the incredible reputation and trail-blazing efforts of ACSM researchers. Broadly speaking, this new initiative will change the landscape in which we work and ACSM members can be excited about the contribution our organization has made, and will continue to make, moving forward.

    So why this, and why now? ACSM is all about integrating scientific discovery into practice and driving positive outcomes. Because the NIH Common Fund is a gateway for helping our members achieve this mission, pursuing opportunities through the fund is strategically reasonable. Using federal resources to support high-impact research in areas of emerging scientific opportunity such as the biomedical sciences is critical for moving society forward and improving public health. The knowledge that physical activity induces biological responses that are critical to the prevention and treatment of numerous diseases is a fundamental aspect of ACSM’s mission. However, the molecular and cellular mechanisms underlying those health benefits are largely unknown. That’s what makes this achievement thrilling. The biomedical discovery potential of a focused effort like this is clear.

    With the NIH announcement behind us, ACSM is already building on this momentum and will continue to play a leadership role to ensure the success of the Common Fund physical activity program. We are looking to make this a uniquely integrated and enduring effort that will sustain the growth and acceleration of physical activity research on a continuous basis, long past the Common Fund designation. This will involve, for instance: the NIH Strategic Plan that will be developed for submission to Congress at the end of this year; and the bipartisan 21st Century Cures Congressional bill that will greatly enhance funding for targeted areas of research. Next on-going steps for our organization include:
    • Continued collaboration with NIH leadership
    • Producing an informational webinar about program goals and benefits
    • Facilitating a network of basic and clinical scientists that will allow ACSM researchers to collaborate on Common Fund physical activity research
    • Developing a grant writing series to provide training and visibility for new investigators
    • Making members aware of Common Fund updates, opportunities to serve as NIH grant reviewers, RFAs and important deadlines
    • An on-going commitment to ensure that the NIH Common Fund priorities are reflected in a collaborative research roadmap, which ACSM will be coordinating
    The future of physical activity research, as well as the health of individuals and communities and nations, is now considerably brighter. Let’s seize this opportunity as leaders in scientific discovery. Carpe diem… and then some!

    You can learn more about the Common Fund announcement by reading the NIH news release.

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

    ACSM President Lawrence E. Armstrong, Ph.D., FACSM, is a professor and director of the Human Performance Laboratory in the Department of Kinesiology, University of Connecticut in Storrs, Conn. Much of his research has focused on human fluid-electrolyte balance and effects of dehydration and fluid consumption on physiological responses and physical performance in athletic, firefighting and military contexts. In recent years, he has completed research studies that focused on effects of mild dehydration on cognitive performance and mood in men and women and on hydration status of women across the term of pregnancy and during breastfeeding.

  • Active Voice: Does Return to Activity after Concussion Impact Recovery of Gait Stability?

    by Guest Blogger | Jul 06, 2015
    By Li-Shan Chou, Ph.D.

    The relative re-injury risk for individuals who have sustained a concussion has been reported to be almost six times greater than those with no history of concussion. However, the factors, which contribute to this increased risk, are not clearly understood. Hence, the clinical decision of when to allow individuals to return to pre-injury levels of activity remains among the most difficult decisions in sports medicine. 

    Previous research has reported that student athletes with concussion may experience a worsening of symptoms if they return to sports or school prematurely. Therefore, proper timing of activity resumption after a concussion is of critical importance to reduce the risk of prolonging the course of recovery. As deficits in physiologic functions have been documented to persist beyond patient-reported recovery of symptoms, additional objective measurements may be assistive in determining full recovery of the brain after injury. 

    The ability to effectively execute motor tasks under conditions of divided attention (dual-task) is an important element for successful sport performance. Of particular interest to our research, this ability has been shown to be particularly sensitive to a concussion and remains impaired for several weeks after injury. In our April 2015 MSSEarticle, we addressed the questions of how return-to-activity (RTA) affects the recovery of single and dual-task gait balance control as well as recovery of cognitive functions and clinical symptoms. We employed a dual-task gait paradigm, which involved a recorded voice played over speakers. The voice expressed the words “high” or “low,” at pitches that were occasionally inconsistent with the meaning of the word (e.g., a low-pitched voice might say the word “high”). The subject, while walking, was required to identify the correct pitch, regardless of the word that was heard. In a prospective-longitudinal study, we followed 19 concussed high school students over a period of two months post-injury and measured these variables in the acute post-injury period (within 72 hours of injury) and at systematic intervals thereafter (one week, two weeks, one month, two months post-injury) against 19 uninjured matched controls. To test the effect of activity resumption within this two-month testing period, we examined the recovery trajectory of the variables immediately prior to and immediately after RTA clearance for each concussed subject. The results revealed improvement in dual-task gait medial-lateral balance control during the period immediately prior to RTA, but a worsening immediately after RTA. All other variables showed improvement in the pre-RTA period, and these continued to improve or remain stable post-RTA. This study concurs with findings from our group reported previously in MSSE, which showed a recovery reversal in side-to-side stability when walking with a divided attention following RTA in concussed college-age students. 

    The finding that regression of recovery was only observed in dual-task gait balance control immediately following the clearance for activity resumption, but not in cognitive, symptom or single-task walking variables suggests that dual-task medial-lateral sway is particularly sensitive to a concussion and its recovery may be influenced by premature RTA. This study also suggests that examination of dual-task gait stability may be able to detect important residual concussion-related impairments after cognitive and symptom resolution. Moreover, these findings reinforce the need for a multifaceted approach to concussion management.

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

    Li-Shan Chou, Ph.D., is a professor and department head in the Department of Human Physiology at the University of Oregon. He directs the Motion Analysis Laboratory, and his research falls under general areas related to biomechanics and motor control of human movement, with focuses on the investigation of mobility impairments associated with ageing, musculoskeletal diseases or injuries and traumatic brain injury. 

    This commentary presents Dr. Chou’s views on the topic of a research article which he and his colleagues published in the April 2015 issue of
     Medicine & Science in Sports & Exercise® (MSSE). 
  • Active Voice: AHA Frames Guideline for Non-Physician Supervisors of Clinical Exercise Tests

    by Guest Blogger | Jun 29, 2015
    By Jonathan N. Myers, Ph.D., FACSM, and William G. Herbert, Ph.D., FACSM 

    The exercise test continues to have an important place in clinical medicine. Not only does the test help guide decisions regarding diagnosis and/or medical interventions, it remains valuable for evaluating the effects of therapies and setting exercise recommendations for patients. The knowledge and training required to properly conduct an exercise test are of central relevance to the clinical exercise physiologist. However, previously published guidelines on clinical competency for performing exercise testing have been directed toward physicians. If and when a non-physician should independently supervise a clinical exercise test and among which types of patients has remained uncertain. Early versions of exercise testing guidelines, beginning in the 1970s, recommended that a physician be available at all times to directly supervise an exercise test. This was due to the perceived risk associated with the test, particularly among patients with known disease. Since that time, surveys of event rates during exercise testing have consistently indicated that attendant serious events are extremely rare. In addition, significant changes in clinical practice patterns with exercise testing have continued to evolve over time. In contemporary exercise laboratories, physicians often provide supervision or oversight, but are less frequently present in the testing room. In fact, the majority of such tests today are administered by non-physicians (exercise physiologists, nurses, physical therapists or technicians)?including those tests performed among high-risk patients. As these changes have evolved, ambiguity has arisen regarding the physician's role relative to the non-physician. While ACSM has provided the standard for certification programs for clinical exercise physiologists, there remains uncertainty regarding the cognitive and procedural skills necessary from both a practical and legal standpoint regarding who should supervise an exercise test in clinical settings. 

    In September 2014, the American Heart Association (AHA) published a Scientific Statement entitled, "Supervision of Exercise Testing by Non-physicians." This document provides guidance for the clinical performance and supervision of exercise testing by non-physicians in the current era, while extending prior recommendations from the ACSM, AHA and American College of Cardiology directed toward physicians. Importantly, the document also provided specific guidance in terms of the type of physician supervision required. Three categories of supervision were defined, depending on the type of patient being tested: (1) personal supervision, requiring a physician's presence in the room; (2) direct supervision, requiring a physician to be in the immediate vicinity or on the premises or the floor and rapidly available should emergencies arise; and (3) indirect supervision, requiring physician availability by phone or pager. The statement responds to the need to specify the appropriate education, training, experience and cognitive and procedural skills necessary for non-physicians to conduct exercise testing and to delineate standards that maintain patient safety. The statement also responded to the need to provide physicians with guidance in terms of cognitive and procedural skills that strengthen their ability to supervise non-physician health professionals who perform exercise testing. 

    One of the key consensus recommendations from the document was that, in most cases, clinical exercise tests can be supervised safely by properly trained non-physician health professionals. This recommendation, however, is predicated on the individual non-physician meeting competency requirements for exercise test supervision, being fully trained in cardiopulmonary resuscitation, and supported by a physician skilled in exercise testing or emergency medicine. Other key features in this document include: (1) the expectation that the supervising physician will maintain competency standards for exercise testing; and (2) the requirement that the non-physician supervisor is competent and able to effectively screen for high-risk patients and alert the physician supervisor, when appropriate. For further important features, see the full-text article online. 

    The statement provides support for practices that have been routine in clinical settings for nearly two decades, wherein the non-physician often has been the supervisor who is present in the exercise lab and conducts the test. Importantly, however, it also confirms the physician's paramount role as final authority for the safety and quality of testing and interpretation. Thus, the statement acknowledges the non-physician's value, not merely as a less expensive physician surrogate, but also as a highly trained professional who brings skills that are complementary to those of the physician. This new scientific statement from the AHA brings some long-needed clarity to a procedure that remains a major part of many clinical practices.

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

    Jonathan N. Myers, Ph.D., FACSM, completed his doctoral studies in exercise physiology at the University of Southern California. He is coordinator for the cardiology department's exercise laboratory at the Palo Alto VA Medical Center and is a clinical professor of medicine at Stanford University. Much of his work has focused on epidemiology studies that have demonstrated the importance of exercise tolerance and physical activity in modulating risk for cardiovascular events. Dr. Myers has authored or co-authored guidelines on exercise testing and related topics for numerous organizations, including ACSM, the American Heart Association and the American Thoracic Society.

    William G. Herbert, Ph.D., FACSM, is professor emeritus in the Department of Human Nutrition, Foods and Exercise at Virginia Tech in Blacksburg. Much of his research and writing relates to exercise testing and physical activity interventions in coronary heart disease and obstructive sleep apnea, but he also has contributed to the literature on standards of care, legal issues and safety in adult exercise programs. He has been a member of the writing teams for several ACSM publications, including ACSM's Guidelines for Exercise Testing and Prescription, and chaired the Committee for Certification and Education, ACSM Clinical Exercise Physiology Practice Board and chief editor of ACSM's Sports Medicine Bulletin.

    This commentary presents the authors' views on the above-titled American Heart Association Scientific Statement that was recently published in the journal Circulation. Dr. Myers chaired the multidisciplinary writing team and Dr. Herbert was a contributor.

  • Active Voice: The Tortoise and the Hare - A Sex Difference in Marathon Pacing

    by Guest Blogger | Jun 22, 2015

    By Robert O. Deaner, Ph.D. and Sandra K. Hunter, Ph.D., FACSM

    Robert O. Deaner, Ph.D. Sandra K. Hunter, Ph.D.
    Distance running is one of the most popular forms of exercise in the U.S. and, for many recreational runners, participating in races is a major motivator. A key aspect of successful racing is selecting an appropriate initial pace, given one’s ability and training. An initial pace that is too slow may not allow a runner to achieve their time goals, but starting too fast may result in pronounced slowing and also great discomfort. Outstanding endurance performances involve almost even pacing. The current marathon world records for men (Dennis Kimetto, Berlin, 2014) and women (Paula Radcliffe, London, 2003), for example, were achieved by running the second half of the race just 30 to 40 seconds faster than the first half. Despite the importance of pacing to all runners, most pacing studies have only considered elite competitors.

    In the March 2015 issue of MSSEwe reported our findings from a pacing study based on all finishers at 14 recent U.S. marathons. Collectively, those races included almost 92,000 performances. The strongest predictor of even pacing was overall performance: slower runners were much more likely than faster runners to reduce their speed in the second half of the marathon. Another key predictor of pacing was sex: on average, men ran the second half of the marathon 15.6 percent slower than the first half, whereas women slowed by an average of 11.7 percent. The sex difference was especially clear when considering runners who slowed by 30 percent or more: men were about three times as likely as women to experience such dramatic slowing. Similar effects have been reported by others in one earlier study, which employed a smaller sample.

    We also investigated whether racing experience was related to pacing and whether it might contribute to this sex difference. For more than 2,900 runners, we acquired information on racing experience from the web source We found that years of racing experience and number of previous marathons finished were both associated with more even pacing. However, these experience effects were similar for men and women, so that controlling for experience did not eliminate the observed sex difference in marathon pacing. In addition, we showed that, although older runners tended to pace more evenly, the sex difference in pacing held across age groups.

    Our results raise many questions, including why men tend to slow their pace more than women do. One possibility is that this reflects men being more likely than women to decide to undertake a risky, aggressive pace. A risky pace may pay off by allowing a runner to achieve a superb performance, but it also increases the risk of dramatic slowing. A second possibility is that physiological factors cause the sex difference in pacing. Women typically use more fat and less carbohydrates during endurance exercise of similar intensity. This should make them less likely to ‘bonk’ or ‘hit the wall’ because they are less likely to have their muscles depleted of glycogen.

    To better address the predictors of successful pacing in non-elite runners, we suggest that future studies obtain data on runners’ training, targeted pace, subjective feelings and measures of physiological status. Such studies might go a long way toward clarifying reasons for these sex- related pacing differences, helping runners achieve more even pacing and better performances, and enjoy their racing more.

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

    Robert O. Deaner, Ph.D., is an associate professor in the Department of Psychology at Grand Valley State University in Allendale, Mich. His overarching goal is to contribute to a scientific understanding of human nature, especially by demonstrating the value of evolutionary theory. Most of his current projects involve sex differences and sports.

    Sandra K. Hunter, Ph.D., FACSM, is a professor in the exercise science program with the Department of Physical Therapy at Marquette University in Milwaukee, Wisc. Her research focus includes understanding the mechanisms for (1) sex and age differences in motor control, neuromuscular fatigability and human performance in healthy and clinical populations; and (2) the added effects of stress and exercise training on motor control and fatigability of old adults and clinical populations.

    This commentary presents Drs. Deaner’s and Hunter’s views on a topic related to the research report that they and their colleagues recently authored. The report of their original investigation appears in the March 2015 issue of
    Medicine & Science in Sport & Exercise® (MSSE).
  • Active Voice: Physical Activity, Metabolism and Brain Morphology in Twins

    by Guest Blogger | May 06, 2015
    By Urho Kujala, M.D., Ph.D.

    In exercise science, long-term intervention studies are challenging to accomplish, and observational follow-up studies, even in a longitudinal setup, also present problems in establishing cause and effect relationships. A monozygotic (MZ) twin-pair co-twin control study design presents a highly effective means to establish controls for genetic predisposition and largely controls for childhood home environment.

    In our co-twin control study (part of the FITFATTWIN study), recently published in MSSE, we investigated how physical activity level is associated with body composition, glucose homeostasis and brain morphology in young adult male MZ twin pairs – pairs that have been discordant for physical activity during the past three years. Identifying MZ co-twins who have long-term discordance in their physical activity habits is challenging because participation in physical activity has a rather high heritability.

    First, 10 adult male MZ twin pairs whose members were clearly discordant for their leisure time physical activity during the past three years were comprehensively identified from a population-based Finnish twin cohort. As expected, active twins had higher cardiorespiratory fitness, a lower body fat percent and better glucose homeostasis compared to inactive co-twins. Findings on body composition show that long-term physical activity may clearly reduce percent body fat without having a significant effect on body weight. The pairwise difference in insulin resistance/sensitivity also was seen, as measured by both a steady state (fasting/HOMA) index and a dynamic (Matsuda) index.

    Based on whole brain magnetic resonance imaging with voxel-based morphometry and use of preprocessing algorithms, we determined that physically active co-twins had larger striatal and prefrontal cortex gray matter volumes compared to their inactive co-twins. These regions are heavily involved in motor control networks. Other brain regions also may differ between active and inactive members of twin pairs, but the differences were not great enough to reach statistical significance in our “global” brain analysis. As MZ twins usually have a high-degree similarity in brain structure, our finding provides novel evidence for the structural region-specific effects of long term physical activity on the healthy adult brain.

    The findings pointing toward enlarged areas involved with controlling motor abilities may have health implications in the long-term, such as possibly reduced risk of falling and mobility limitations at older age. As the study also showed beneficial effects on cardio-metabolic risk factors, exercising seems to have multidimensional, site-specific and systemic effects on health-related factors.

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

    Urho Kujala, M.D., Ph.D., is a specialist in sports and exercise medicine and professor at the Department of Health Sciences, University of Jyväskylä, Finland. His research focuses on different health benefits and adverse effects of sports and exercise. He has been a member of ACSM for 25 years.

    This commentary presents Dr. Kujala’s views on the topic of a research article which he and his colleagues published in the March 2015 issue of
     Medicine & Science in Sports & Exercise® (MSSE). This research study also was covered in a recent article in The New York Times.
  • Active Voice: Weight Loss and Obstructive Sleep Apnea - What Lies Ahead?

    by Guest Blogger | Apr 27, 2015
    By Devon A. Dobrosielski, Ph.D.

    Weight loss is recommended by the American Academy of Sleep Medicine for all overweight adults with obstructive sleep apnea (OSA), a disorder associated with obesity and characterized by repeated episodes of upper airway obstruction, recurrent arousals and episodic oxygen desaturations during sleep. This recommendation has been bolstered in recent years by several large clinical trials that have demonstrated improvements in OSA severity with intensive lifestyle modification (e.g., dietary change and increased physical activity). These improvements are dose-dependent and are sustained once an intervention has ended or even when weight regain occurs.

    Less well established is whether improvements in OSA severity, despite weight regain, translate into improved cardiovascular outcomes. OSA is linked to cardiovascular morbidity and mortality through a number of mechanisms that include endothelial dysfunction, inflammation and sympathetic activation. Moreover, abdominal obesity is an established risk factor for both OSA and cardiovascular disease.

    Our most recent report, published in MSSE, is one of the first investigations to examine potential cardiovascular disease mechanisms in the context of an OSA intervention that reduces weight, alters body composition and increases fitness simultaneously. We found that after undergoing a 12-week intervention that included exercise and dietary-induced weight loss, older men and women with OSA had reduced disordered breathing events and showed improvements in nightly desaturations. These changes were accompanied by reductions in body fat and increased fitness. Uniquely, we also found that improved arterial distensibility (a marker of vessel wall damage) was related to improvement in the severity of nightly desaturations. These findings suggest that beneficial cardiovascular outcomes accrued through a lifestyle program may be influenced to a greater extent by OSA severity rather than body weight or composition. They also imply that vascular impairments existing in many patients with OSA may not be the cause or consequence of physical inactivity.

    We remain cautious in the interpretation of these data, but feel that testing the above hypotheses are important, especially since weight loss and increased physical activity are generally regarded as cornerstone therapies for reducing the burden of chronic diseases. Yet, clinicians and scientists also might want to consider the possible role that OSA may have in mediating the associations between reduced obesity and cardiovascular health. Indeed, there is evidence that OSA actually impairs weight loss. Moreover, while exercise is thought to confer cardioprotection through direct effects on endothelial function, this benefit may be lost, or at least attenuated, in the presence of undiagnosed OSA. Accordingly, screening for and treating OSA with continuous positive airway pressure might actually facilitate weight loss and allow for exercise to result in more beneficial cardioprotective outcomes. Clearly, there is much to be learned about long-term effects of lifestyle modification on cardiovascular health in OSA patients. The stage is set for continued research designed to explore the most effective treatment strategies for reducing OSA, with regard to weight loss and exercise programing. Addressing this would undoubtedly have major implications for reducing cardiovascular disease risk among obese patients with and without OSA.

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

    Devon A. Dobrosielski, Ph.D., is an assistant professor of exercise science in the Department of Kinesiology at Towson University in Maryland. Dr. Dobrosielski is an ACSM member, focusing his research on examining the impact of exercise and sleep on the cardiovascular consequences of chronic disease. In particular, he is interested in determining whether exercise can serve as an effective countermeasure to vascular impairment commonly observed in the presence of sleep disorders.

    This commentary presents Dr. Dobrosielski’s views on the topic of the research article which he and his colleagues published in the January 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).

  • Active Voice: Fitness and Academic Achievement in Children – Not Necessarily a Straightforward Association

    by Guest Blogger | Apr 20, 2015
    By Stephen D. Herrmann, Ph.D. and David Hansen, Ph.D.

    Finding an association between academic achievement and physical activity (PA) or aerobic fitness (fitness) would surprise few these days. In general, the research literature indicates higher PA and fitness tend to correlate with higher academic achievement, and vice versa. That is, children who are more physically active and those who are more aerobically fit tend to have higher academic achievement. This positive, linear association adds to a growing list of PA/fitness benefits for children’s health. But is this association of PA/fitness with academic achievement as straightforward—linear—as it seems? Is the association basically the same across subject matter? Furthermore, who benefits most academically by increased PA/fitness? These questions were the impetus for our recent publication in MSSE.

    Our analyses were derived from baseline data from a larger, three-year randomized trial titled “Academic Achievement and Physical Activity across the Curriculum” (A+PAAC). Seventeen schools enrolled in A+PAAC with 687 2nd and 3rd grade children included in baseline assessments. Briefly, the goal of A+PAAC is to improve students’ academic achievement and health by incorporating 100 minutes/week of moderate-to-vigorous physical activity into classroom lessons delivered by the A+PAAC trained teacher (click here for further details).

    Here are the highlights of what we found. First, only fitness, not PA, was significantly associated with academic achievement and only for mathematics and spelling (no association with reading achievement). Fitness was measured by number of laps completed from the 20 meter shuttle run (PACER) laps. Second, the pattern of association for mathematics and spelling was not a straight line. Instead, a positively sloping line was found up to a particular fitness level for math (22 laps) and spelling (28 laps), but the line plateaued beyond those fitness levels. In percentiles, these laps translate into the 50th-75th fitness percentiles.

    There are several implications of these findings worth noting. First, these findings are a cross-sectional snapshot of associations and do not indicate a cause-effect relationship. Further research is needed, in particular, to examine how changes in fitness may or may not influence this fitness/academic achievement relation. However, our findings do suggest that improving fitness for those children below the 50th fitness percentile could have substantial benefits for their achievement. The good news is that this level of fitness is achievable for most children. That said, we still understand very little about how fitness might produce such benefits. These findings do provide clear guidance on the next set of research questions we need to ask.

    Despite emerging evidence that PA and fitness are associated with higher academic achievement, there has been a trend in recent years toward reducing physical education opportunities in schools, sometimes with the intent of increasing classroom academic time. This strategy could backfire, however, if it contributes to increased sedentary patterns that, over time, can decrease or limit improvements in fitness. Thus, one pressing question is whether increasing students’ fitness levels through greater PA, especially among those in the lower fitness percentiles, can help improve academic achievement. Thus, we suggest schools may benefit from a proactive approach and aim to increase opportunities for students to be active and promote fitness that will improve health and may improve academic achievement.

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

    Stephen D. Herrmann, Ph.D., is a researcher at Sanford Research in the Children’s Health Research Center and is the director of program development and training for profile by Sanford. His research is focused on understanding individual response to exercise and diet interventions— more specifically, why certain people respond positively to exercise and diet interventions and others do not. Dr. Herrmann is a member of ACSM.

    David Hansen, Ph.D., is associate professor at the University of Kansas School of Education. His expertise is on adolescent development and learning in a variety of in and out-of-school settings, including the full range of organized youth activities (e.g., extracurricular, community-based programs). This commentary presents the views of Herrmann and Hansen on the topic of their research article, which they and their colleagues published in the December 2014 issue of Medicine & Science in Sports & Exercise® (MSSE).

  • Active Voice: A Novel Strategy for Promoting Recovery of Muscular Strength after Strenuous Exercise in Competitive Athletes

    by Guest Blogger | Apr 13, 2015
    By Kazushige Goto, Ph.D.


    As athletes commonly perform intensive physical training or compete on consecutive days, rapid recovery of exercise capacity is important to maximize competitive success and to prevent excessive fatigue. The wearing of compression garments (CG) after exercise promotes recovery of muscular strength and attenuates exercise-induced muscle damage. I established research projects with Takuma Morishima, M.Sc., to demonstrate the effects of CG during exercise or the post-exercise period.

    In our latest paper published in MSSE, we explored the effects of wearing a CG for 24 hours on the detailed time course of changes in muscular strength, muscle damage and inflammatory responses after strenuous resistance exercise. Nine recreationally trained males completed two exercise trials, wearing either a CG or a normal garment (CON) for 24 hours after exercise.

    We clearly showed that wearing a CG after resistance exercise promoted recovery of upper body and lower limb muscular strength. In particular, upper body strength improved within 3 to 8 hours after exercise, while significantly greater recovery of lower limb muscular strength was evident within 24 hours after exercise. Muscle soreness also was reduced by wearing the CG during the post-exercise period.

    The good news is that it is very easy to simply wear a CG; this renders the popular recovery procedures (massage, active recovery and water immersion) unnecessary. In terms of the mechanism involved, the CG is hypothesized to attenuate exercise-induced muscle damage and swelling by applying pressure to the exercised muscles. As our experimental subjects wore CG during the post-exercise period only, it appears that the CG protected against secondary muscle damage, which causes delayed-onset muscle soreness. Although we did not detect marked between-group differences in biomarkers of exercise-induced muscle damage and inflammatory responses (e.g., myoglobin, interleukin-6), further examination of blood flow and/or intramuscular metabolism in future studies may allow us to elucidate the detailed mechanism behind the observed effect.

    From a practical viewpoint, two research questions arise. First, is wearing a CG between multiple training sessions over a single day helpful in terms of recovery? Second, is use of a CG beneficial during recovery from endurance exercise? In our latest experiments, two graduate students (Ayaka Mori, M.Sc., and Sahiro Mizuno) have explored these two questions, and original research articles are being developed that will report those answers.

    The idea of using a CG to aid recovery came from the observation that a CG is commonly employed in clinical settings to treat chronic inflammatory disorders or peripheral swelling in patients with vascular disease. Our novel research in sports science indicates that wearing a CG during post-exercise periods facilitates the recovery of athletes who engage in strenuous training several times a day, or on consecutive days.

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

    Kazushige Goto, Ph.D., received his Ph.D. degree in 2004 from the University of Tsukuba, Ibaraki, Japan. He followed this with a four-year postdoctoral fellowship at the University of Tsukuba, Tokyo University (Japan), which included collaborations with the Bispebjerg Hospital in the Capital Region of Denmark. He began his academic career at the Waseda University in Saitama, moving to the Ritsumeikan University in Shiga in 2010, where he accepted his current appointment as an associate professor. His research interests include exercise-induced endocrine and metabolic changes, post-exercise recovery strategies and the effects of exercise training in hypoxia.

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

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

    by Guest Blogger | 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 User Not Found | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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 Guest Blogger | 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.

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  • 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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