About the Physical Activity Guidelines course:

The Physical Activity Guidelines (PAG) for Americans provides science-based advice on how physical activity can promote health and reduce the risk of chronic disease for children and adults alike. PAG serves as the benchmark and primary, authoritative voice of the federal government for evidence-based guidance on physical activity, fitness and health for Americans, and provides a foundation for federal recommendations and education for physical activity programs, including the Healthy People objectives and Presidential Youth Fitness Program.

Course contents:

This course includes an online ACSM Partner webinar and a corresponding online quiz. All course content will be presented to you electronically upon completion of your purchase. This includes all webinar videos, quizzes, and certificates (certificates awarded upon successful completion of the quizzes).

Available ACSM CECs 2.0

Learning Objectives for the CEPA Physical Activity Guidelines for Americans course:

• Present the Charge Given to the 2018 Physical Activity Guidelines Advisory Committee
• Discuss the 2018 Physical Activity Guidelines Advisory Committee Process
• Highlight What’s New in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report

Purchase and earn CECs

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Hypertension is a Pervasive Public Health Problem

The American College of Cardiology (ACC)/ American Heart Association (AHA) Task Force on Clinical Practice Guidelines recently redefined hypertension to a lower blood pressure (BP) threshold of 130 mmHg for systolic BP (SBP) or 80 mmHg for diastolic BP (DBP) (1) versus the Joint National Commission 7 (JNC 7) threshold of 140 mmHg for SBP or 90 mmHg for DBP (2). Now nearly half of adults in the United States have hypertension. The authors of the recent ACC/AHA guidelines go on to state that nearly all the newly diagnosed people with hypertension, due to the lower BP threshold, can treat their hypertension with lifestyle therapy rather than medications. In fact, regular exercise participation was rated in the ACC/AHA guidelines as one of the best nonpharmacologic approaches to prevent and treat hypertension (1). Accordingly, the American College of Sports Medicine (ACSM) (3,4), as well as professional organizations throughout the world (5), emphasize participation in moderate, intensity aerobic exercise supplemented by resistance exercise on most days of the week to prevent and treat hypertension.

The Foundations of the American College of Sports Medicine New Pronouncement on Exercise and Hypertension

In June of 2016 the United States Department of Health and Human Services convened the 2018 Physical Activity Guidelines Advisory Committee (PAGAC) under the Federal Advisory Committee Act of 1972. The charge given to the 2018 PAGAC was to independently review, appraise and summarize the current evidence linking physical activity to human health and function adhering to the best practices of systematic reviews, and deliver this information in a Scientific Report (6) that served as the foundation for the policy document, Physical Activity Guidelines for Americans, 2^nd edition (7), released in November of 2018. Hypertension was chosen as a health condition to address in the 2018 PAGAC Scientific Report due to its importance as a public health problem, and the voluminous expansion of the literature on the topic of exercise and hypertension since the 2008 PAGAC Report (8). The ACSM new Pronouncement on exercise and hypertension contains the seminal portions of sections in the 2018 PAGAC Scientific Report on the use of exercise to prevent and treat hypertension (9). This blog highlights what’s new in the Pronouncement about exercise and hypertension (9), presents other new, relevant information from the 2018 PAGAC Scientific Report on exercise prescription for hypertension (6) and concludes with the new ACSM Frequency, Intensity, Time, and Type or FITT recommendations for hypertension.  Of note, the 2018 PAGAC adhered to the JNC 7 blood pressure (BP) classification scheme (2) in the Pronouncement (9) because the literature reviewed was based upon this BP classification scheme. As of Feb 2018, which was the end of our systematic literature search, there were no meta-analyses or systematic reviews published that did not utilize the JNC 7 blood pressure classification scheme. However, BP is a continuous variable and the law of initial values applies regardless of the cutoffs used (i.e., JNC 7 or ACC/AHA). As such, none of the key findings differ in any way regarding the FITT exercise prescription for hypertension. 

What’s New Regarding Exercise and Hypertension?

1. Regular participation in leisure-time physical activity attenuates the development of hypertension among adults with normal BP in dose-response fashion. For each 10 metabolic equivalent of task (MET)-hours per week increment in leisure-time physical activity, the risk of developing hypertension falls by six percent (10). There was insufficient evidence in the 2018 PAGAC Scientific Report to determine whether such a dose-response relationship exists among adults with prehypertension.

2. Exercise reduces BP among adults with normal BP, prehypertension and hypertension. The BP reductions that result from exercise are dependent upon resting BP, or what BP we start with.  On average, adults with hypertension experience the largest BP reductions of five to eight mmHg (four to six percent of resting BP level) followed by adults with prehypertension of two to four mmHg (two to four percent of resting BP level), and normal BP of one to two mmHg (one to two percent of resting BP level). The good news is the greatest BP improvements following exercise are seen in those with the highest resting BP.

These BP improvements occur: 1) immediately and persist up to 24 hours after a single exercise session, termed postexercise hypotension (4), an exercise session that can be of any duration performed  continuously or accumulated to total > 20-30 minutes per day; 2) with as little as 90 min per week of exercise training; and 3) after aerobic or resistance exercise performed alone or combined, termed concurrent exercise.  Please see the Figure adapted from Cornelissen and Smart (11), MacDonald et al. (12), and Corso et al. (13) that shows resistance exercise now measures up to aerobic exercise as antihypertensive lifestyle therapy. This new finding is a departure from previous exercise and hypertension guidelines that recommended aerobic over dynamic resistance exercise for the prevention and treatment of hypertension (3-5). The evidence for complementary and alternative types of exercise, such as Baduanjin, Qigong, Tai Chi, and Yoga, was promising but too limited to be emphasized alongside aerobic and resistance exercise at this time.  

3. Among adults with hypertension, exercise lowers the risk of: 1) the progression of cardiovascular disease as evidenced by the BP reductions that result from exercise; and 2) cardiovascular disease mortality in dose-response fashion. Hu et al. (14) found adults that the risk of cardiovascular disease mortality was 25 percent lower among highly physically active adults than those that were physically inactive.

 

The New American College of Sports Medicine FITT Recommendations for Hypertension

 

Based upon the findings of the 2018 PAGAC Scientific Report (6) and this ACSM Pronouncement (9), the new ACSM FITT recommendations for hypertension are revealed in the Table. Emphasis is no longer placed on aerobic exercise alone. Aerobic or resistance exercise alone or aerobic and resistance exercise combined (i.e, concurrent exercise) are recommended on most, preferably all, days of the week to total 90 min to 150 min per week or more of multi-modal, moderate intensity exercise. The expansion of the ACSM FITT recommendations to include multi-modal exercise offers variety and more attractive exercise options that may translate to better exercise adherence for adults with hypertension.

Download the FITT Recommendations. 

Learn more about the Physical Activity Guidelines for Americans, 2nd Edition

Linda Pescatello, PhD, FACSM, is a Distinguished Professor of Kinesiology at the University of Connecticut. Her research on topics including exercise and hypertension, physical activity interventions and exercise genomics (among other topics) has been widely published. She was the recipient of an ACSM Citation Award in 2011, and served as the Senior Editor for ACSM's Guidelines for Exercise Prescription and Testing, 9th edition. 

 

References

1. Whelton PK, Carey RM, Aronow WS, Casey DE,Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC,Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA S, Williamson JD, Wright JT,Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018; 71:1269–1324.

2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL,Jr, Jones DW, Materson BJ, Oparil S, Wright JT,Jr, Roccella EJ, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung,and Blood Institute, National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42(6):1206-52.

3. ACSM Guidelines for Exercise Testing and Prescription 10^th Edition.  Riebe, D (senior ed.) and Ehrman, JK, Liguori, G, and Magal, M (assoc. eds.).  Philadelphia, PA:  Wolters Kluwer Health, 2018.

4. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, American College of Sports Medicine. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc. 2004; 36(3):533-53.

5. Pescatello LS. Exercise measures up to medication as antihypertensive therapy:  Its value has long been underestimated. Br J Sports Med 2018 Dec 19. pii: bjsports-2018-100359. doi: 10.1136/bjsports-2018-100359. [Epub ahead of print] PMID: 30567705.

6. Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report, 2018. Washington, DC: U.S. Department of Health and Human Services.

7. US Department of Health and Human Services. 2018 Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: US Department of Health and Human Services; 2018. 

8. Physical Activity Guidelines Advisory Committee. 2008 Physical Activity Guidelines Advisory Committee Scientific Report, 2008. Washington, DC: U.S. Department of Health and Human Services.

9. Pescatello LS, B Bloodgood, D Buchner, W Campbell, S Dietz, L DiPietro, S George, JM Jakicic, WE Kraus, A McTiernan, RR Pate, K Piercy, KE Powell and RF Macko, for the 2018 Physical Activity Guidelines Advisory Committee.  Physical activity to prevent and treat hypertension. On Behalf of the 2018 Physical Activity Guidelines Advisory Committee.  Med Sci Sports Exerc (in press).

10. Liu X, Zhang D, Liu Y, et al. Dose-Response Association Between Physical Activity and Incident Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies. Hypertension. 2017; 69(5):813-820.

11. Cornelissen,  VA, Smart,  NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013b. 2(1):e004473

12. MacDonald,  HV, Johnson,  BT, Huedo-Medina,  TB, et al. Dynamic Resistance Training as Stand-Alone Antihypertensive Lifestyle Therapy: A Meta-Analysis. J Am Heart Assoc. 2016. 5(10):#pages#

13. Corso,  LM, Macdonald,  HV, Johnson,  BT, et al. Is Concurrent Training Efficacious Antihypertensive Therapy? A Meta-analysis. Med Sci Sports Exerc. 2016. 48(12):2398-2406

14. Hu G, Jousilahti P, Antikainen R, Tuomilehto J. Occupational, commuting, and leisure-time physical activity in relation to cardiovascular mortality among finnish subjects with hypertension. Am J Hypertens. 2007; 20(12):1242-50. 

Key Points:

1. Recognize culprits of employee dissatisfaction 

2. Identify strategies to drive employee morale and retention

3. Utilize basic strategies to support the needs of employees

What do you and your departmental leaders do to enhance staff retention and drive morale? Lackluster support, not having a voice, and respect not always being reciprocated by leadership are a few culprits of employee dissatisfaction.

Consider the following strategies if you’re interested in learning more about how you can drive support, morale and trust in management:

          1. Empower Your Team: Be a transformational leader that drives trust and respect.

          2. Hire with Care: Adopt unique hiring practices to help identify employee tendencies related to teamwork, communication and confidence.

          3. Encourage Career Development: Create the right atmosphere to promote growth and success in employees.

          4. Develop a Culture of Appreciation: Build a culture of recognition and reward solid performance through acknowledgement.

          5. Nurture Potential: Apply gentle pressure positively while exploring options to come to a collaborative solution.

Most people want to contribute, they want to experience competence and many want to feel like a meaningful part of a collaborative organization.

Take Aways

A thriving and motivated employee will try every day to do his or her best. Most people want to contribute, they want to experience competence and many want to feel like a meaningful part of a collaborative organization. It’s important to attend to the needs of employees and shake off the idea that top-down control is how to keep employees productive and engaged. Rather, organizational leaders must be able to support the needs of employees through individualized consideration without being controlling. Learn how to give more informational positive feedback and support competency experiences, encourage exploration and self-initiation and provide meaningful rationales when requesting a behavior.

The goal of any workplace should be to empower your team and create the right atmosphere for growth and retention in employees.

There is no one size fits all approach to promoting a thriving workplace, but these simple strategies can improve the long-term success in many workplaces. Explore these strategies in further detail by reading Patrick Freeman’s article “Are You Serving Your Internal Customers?” in the May/June 2019 issue of ACSM’s Health & Fitness Journal^®. The goal of any workplace should be to empower the team and create the right atmosphere for growth and retention in employees.

Become an Alliance Member or Student Member to access this article and the full ACSM's Health & Fitness Journal® library 

Article based on: Are You Serving Your Internal Customers? Freeman, Patrick, B.S. ACSM's Health & Fitness Journal: May/June 2019 - Volume 23 - Issue 3 - p 36–37 doi: 10.1249/FIT.0000000000000475 Columns: Business Edge (Members only)

Author:

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EXOS and ACSM recently hosted an industry-presented QnA webinar with Performance Specialist Tristan Rice.

View the full webinar here

Several questions were asked by attendees during the webinar and the answers are below.

Q: Are the free CEC courses valid in Canada?

Absolutely!

We're working on finding a host site to deliver our courses live in Canada, but the XPS (online equivalent to our phase 1 performance mentorship) offers 24 CEU hours through the ACSM. There are several webinars on the ACSM website that provide free CECs/CEUs to ACSM certified and members; these include, but not limited to, movement preparation, the behavior upgrade model, multidirectional speed, and integrating nutrition into training.

View the free CECcourses at ACSM ceOnline 

Q: How do you motivate a client that starts out with enthusiasm but within a month or so loses their motivation?

Every person has a reason for coming in the door on day one.  The point of the initial evaluation is to figure out what that is.  "Hi my name's Tristan, I'll be your coach.  How can I help?"  Day 1 week 1 you're likely to get a pretty thin answer "coach I want to lose weight" and that's fine!  Day 1 week 1 that's all you need, because (as you noted) that'll get you about two weeks or so.

So, in that time, you have another conversation "why do you want to lose weight?" and they may respond "Well, I've gained a couple of pounds since college, and I really just want to get back down there."  Cool!  You just bought yourself another two weeks (or so).  Then, "why do you want to get back down to your college weight?" "Well, I used to play (sport) and play pickup on the weekends, and just don't feel like I can do the things that I used to be able to."  Cool, two(ish) more weeks.

"Why do you want to be able to do the things you did in college?" "Well, that's when I met my wife, and she just doesn't look at me like she used to."  Now you're getting somewhere.  Of course, that's all hypothetical, but also based on my experience with that conversation working with general population for five years.  People come to us for some deeper reason than "I want to lose weight."  That may have gotten them through the door, but that's definitely not what it's about for them.

Coaching ultimately is about helping people figure out what that reason is, because most of the time, they don't even know (even though it's driven them to sign up with you in the first place).  Motivation is the reason or reasons that anyone has for doing anything, and exists on a continuum of extrinsic (something external to the person "coach I want to lose weight") to intrinsic (something internal to the person "I workout because it's part of my self-identity").  Coaching is about moving someone along the continuum from extrinsic, to intrinsic motivation.  If you're interested more in specific ways to do this, research the "Self-Determination Theory" by Deci and Ryan. 

Q: What made you want to work at EXOS?

When I did my internship, something that I realized right away was that EXOS was a company that was founded on humility.  It wasn't just another "Body by..." cult of personality places.  One thing that stood out to me right away was that it wasn't just Mark (Verstegen) sitting at the top writing all the programming and the coaches just delivering it, but rather it was Mark and a team of like-minded coaches who had this idea back in the mid-90s that became the EXOS training system.  It's like they drew the lines, and the coaches were there to color it in however they saw fit.

It wasn't just a place where one person, or a small crew of people were solving all of the issues, but a system which was based on the principle that what became the training system was founded on the idea that those coaches were capable of taking it to its full potential.  That there would need to be a team of like-minded coaches who would be able to seamlessly integrate to really stretch, and test the boundaries of the system. 

Q: As a recent college grad, what are some options for us in relation to clinical/S&C opportunities?

Depends on what you mean by college.  Internships are always available, and if you're looking to get into the strength and conditioning world, they're all-but mandatory.  If you've just finished your undergrad and are looking to go into a masters program, seeking out schools with a GA program as well where you'll be able to work in performance with the school's athletes to gain real-world experience. 

Q: Hello. I have 2 questions: I am a CPT and going to school to be a dietitian in LA, are there internship opportunities for nutrition with your facility?

Second question is, how did you find yourself in EXOS?

1. Yes absolutely.  Go to this page for more information

2. By accident really.  I was working as a personal trainer at a YMCA in Los Angeles, and wanted to get into the performance world.  So, I did some searching online for internships with the professional sports teams in LA and found EXOS (Athletes' Performance back then) and applied.

That was the summer before my last year at school, so I was lucky enough to work part-time for the next year and a half as I finished at university (and a bit beyond).  From there I moved to Chicago to work at a temporary facility that we had there for a year before moving to Phoenix, AZ in 2011.  I was a full-time coach 2008-2015 and have been full-time in education ever since.

Q: I'm a Physical Activity in Public Health Specialist & I'm wondering what specific communal & systematic benefits I can learn from the EXOS online courses.

So, our courses are based on the fundamental premise that while "coach I want to improve my fitness" is an incredibly easy request to make, it's an incredibly difficult request to fulfill.  For example, are you a football player that needs to be quicker, and more agile?  Are you general population, and need to drop some body fat, or reduce your cholesterol?  Context ends up being incredibly important.  But, for arguments sake, let's say you wanted to get stronger.  Cool, let's program some push-ups.  But how many different versions of push-ups are there?  Feet elevated (to make them harder) hands elevated (to make them easier) knees/shins/ankles on a foam roll to progressively add body weight/load to someone as they gain strength.  Hands on kettlebells, or medicine balls to work on wrist/shoulder stability, how about a band from hand to hand around your back to add resistance, and any and all combinations?

The fact of personal training/strength and conditioning is that we've got a lot of options.  Our education programs are an attempt to show the logic and organization to how we organize the tools in our toolbox so that we're best able to meet our clients where they are, and work on their individual definition of fitness. 

Q: What type of students are you looking for when looking at internship applications?

US based students who are near the end of their curricula and are looking for a capstone type experience to give practical application to the theoretical content that's covered in most university programs.  You need to receive university credit for your time, and also be able to provide your own housing.  Apart from that, it's like I borrowed from Mike Boyle, “I can teach you to be smart, I can't teach you to be nice.”

Above all, we're looking for students who are willing to learn, who are willing to work, who are looking to take advantage of the opportunity to work with professional athletes, general population, and youth athletes all in the same shift.

I’ve found the use of Twitter to be an immensely powerful tool for professional advancement and my own personal edification. My Twitter presence has resulted in multiple job offers, offers to sit on journal editorial boards and new research collaborations. I have also had the opportunity to interact with researchers and practitioners from a multitude of disciplines across the world. While LinkedIn is a great repository to showcase your professional background and skills, Twitter is where real conversations take place about what is happening in your field.

Become part of the conversation

A ton of great resources are already out there with tips on how to use Twitter for professional advancement (links at the bottom of the blog post to my favorites). This post on the ACSM blog will focus on using Twitter for exercise scientists who are students (undergraduate/graduate) and early career professionals. The best part about using Twitter as a student or early career professional is that most of life is hierarchical (your teacher is above you, your advisor is above you, your boss is above you, etc.), but Twitter has a flat structure which enables you to join any conversation as an equal voice (more on this later). Of course, there is a lot that goes into using Twitter successfully, but I hope you’ll find that most of my tips are just modifications how you behave in real life. 

1. Be yourself, warts and all. You’re a person (unless you build a “Twitter Bot”), so show your personality on Twitter. There are certainly those researchers on Twitter who only use it to say, “My lab published this new paper in MSSE…” but most of those accounts have little impact (few followers, low interaction with tweets, etc.) Going that route is low risk, but also low reward. I keep my Twitter activity professional (staying away from politics, religion, etc.), but I won’t shy away from openly questioning the status quo (e.g. “No scientific journals should allow bar charts because they hide problems in data and are uninformative to the reader.”) or asking if our field is moving in the right direction (e.g. “Why are we re-labeling everything that is simply statistics as machine learning?”). People want to see what you’re passionate about and also disagree with your opinions. This is a dialogue—you don’t need to “win” the discussion.

2. Join contentious conversations or make controversial statements…intelligently. My philosophy is to have Twitter be part of my internal monologue. I’m okay with being wrong, and I’m also okay with saying publically that others are wrong when I can make a valid point. Emphasis on valid point. When there was a discussion about the validity of Magnitude Based Inference (MBI) statistical procedures arising from a paper published in MSSE by Kristin Sainani (@KristinSainani), I jumped in head-first because it combines my two passions: exercise science and analytics. I’ve also long had a queasy feeling about many of the assertions made about MBI and the fact that it is not an accepted statistical practice outside sport science. On the flipside, I’m not an expert in nutrition or supplements, but I’ve always been interested in this area. I love following and interacting with colleague experts in this area such as @NutritionNerd, @EricRawsonPhD and @DylanMacKayPhD, among others. Who doesn’t enjoy a wise crack about Himalayan sea salt among friends?

3. Acknowledge and promote great ideas of others, especially if they’re better than yours. No one wants to be in a conversation where the other person only talks about themselves or how great they are. Recognize when others (other grad students, post-docs, professors, random people on the street) have an idea that is better than one you’ve previously espoused. Some people like to engage in the #FridayFollow tradition where you list people you think are worthy of being followed. I don’t personally tweet #FridayFollow lists, but I love to “like” and retweet others when they make a good point or announce something where recognition is warranted. This builds goodwill and shows how you engage with others on your personal Twitter timeline.

4. Make media and create threads. Twitter has done a really good job in recent years of making it easy to add GIFs and images as well as threading your tweets to turn a series of tweets into a “storyline.” The images and GIFs add action to what may be an otherwise contentious or dry topic. Everyone has their own style. I use GIFs and images in maybe 20% of my tweets; others seem to use them in up to 75%. Remember, it should be professional but still fun. Telling an interesting story with threaded tweets is what gets the most attention once you have at least 500 followers. Psychologist Dan Quintana (@dsquintana) is a master of telling a story through threaded tweets (and GIFs). I was actually asked to write this blog post for ACSM because of one of my threaded tweets about using Twitter professionally!

In summary (TL;DR)

Have fun, be yourself, make intelligent but bold statements you don’t mind defending, promote others when you share a common cause and tell your story through Twitter’s many avenues. Did I miss anything? Do you disagree with my tips? I’m on Twitter (@TenanATC,) so you know where to find me!

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Twitter Etiquette: The Rules

How to Use Twitter as a Professional

5 Ways Twitter Can Help You Reach Your Career Goals