By popular demand, ACSM’s Guidelines for Exercise Testing and Prescription – our flagship title- is available for pdf download.

For this month’s featured download, we’re offering Chapter 1 of the 10th edition. This introductory chapter serves as a great example of what you'll find in the most recent edition.

 

Visit our dedicated ACSM Guidelines for Exercise Testing and Prescription page for the download and more details

ACSM’s Guidelines for Exercise Testing and Prescription is the flagship title from the American College of Sports Medicine, the prestigious organization that sets the standards for the exercise profession. This critical handbook delivers scientifically based standards on exercise testing and prescription to the certification candidate, the professional, and the student. This manual gives succinct summaries of recommended procedures for exercise testing and exercise prescription in healthy and diseased patients.

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ACSM Strength Training Guidelines Infographic


ACSM Scientific Pronouncements | Physical Activity Guidelines for Americans

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Important insight for the ACSM Personal Trainer Exam and ACSM Exercise Physiologist Exam, from the National Director of ACSM Certification, Francis Neric, along 3 new members studying for these ACSM Certification exams.

Some of the most common questions ACSM receives regarding personal trainer certification are: "which certification is right for me?"; "how long does it take to prepare?", and, "what material should I use to study?" ACSM's National Director of Certification, Francis Neric, will introduce you to three folks who are planning ACSM's exams and document their journey in becoming certified. Francis will also provide you valuable test insight in how to get started.

Special thanks to: Whitney Leyva, Cat Perry, and Jen Aragon

✅ For more information on how to start your ACSM Certification journey, visit us at http://www.acsm.org/get-stay-certified

It is not too late to register and attend the 2018 ACSM Specialty Conference, “Integrative Physiology of Exercise (IPE),” to be held at the Sheraton San Diego Hotel and Marina in San Diego, California on September 5-8, 2018.

This exciting meeting will begin with a keynote lecture, "Can Exercise Physiology Help Fill the Reductionist Gap?" presented by Dr. Michael Joyner at 6:30 PM on Wednesday, September 5, 2018, with a welcome reception to follow. 

To emphasize the rapid research developments in key areas of exercise physiology, the IPE 2018 symposia program and debates will address the following major topics:

• Cancer Prevention by Exercise: Role of Endocrine and Immune Function
• Interactions between Mitochondrial Morphology and Turnover in Healthy and Diseased Skeletal Muscle
• Understanding the Physiological Basis for Sex Differences in the Response to Exercise and Pathological Stimuli: A Role for Estrogen and Ovaries
• Debate: Are Exercise Mimetics a Realistic Substitute for Exercise Training?
• Debate: Do Genetics Really Influence Exercise Capacity or Trainability?
• Recent Advances in Exercise and Arterial Stiffness
• Metabolic Flexibility in Health and Disease
• Exercise Pressor Reflex Function in Health and Disease
• Exercise and Energy Restriction to Improve Health: The Crossroads of Energetics and Protein Turnover
• The Role of Exosomes in Skeletal Muscle and Systemic Adaptation to Exercise
• Men ≠ Women: Effects of Sex Hormones and Physical Activity on Vascular Function
• Molecular Transducers of Exercise-induced Muscle Hypertrophy
• How Exercise Promotes Brain Health in Aging
• Is Mitochondrial Respiration a Limiting Factor of Oxidative Metabolism? An Integrated Approach to Exercise

To achieve a balanced schedule, both the symposia and debates have been organized to cover a broad array of important topics in exercise physiology. The symposia lectures will be given by internationally recognized scientists and are intended to provide a springboard for dynamic scientific exchanges. Importantly, each symposium will include aspects of how advances in basic science lead to changes in practice. 

Scientific poster sessions are scheduled on each day of the conference, and these unopposed poster presentations will comprise a key component of the conference. Indeed, the outstanding abstracts presented at this meeting will shape the exchange of information and ideas that transpire in this exciting venue. We are confident that you will thoroughly enjoy this outstanding scientific meeting in beautiful San Diego. For more information on program content, registration and the venue, please see the IPE Conference webpage.

Scott K. Powers, Ph.D., FACSM, is a UAA-endowed professor and distinguished professor in the Department of Applied Physiology and Kinesiology at the University of Florida in Gainesville. He investigates effects of muscular exercise and inactivity on both cardiac and skeletal muscle. His research is focused on exercise-mediated changes in cardiac and skeletal muscle antioxidant systems and the role of these changes in protecting against ischemia-reperfusion injury. 

*Dr. Powers is chair of the 2018 Program Committee for ACSM’s Integrative Physiology of Exercise Conference. He is joined on the committee by three additional highly accomplished scientists who have contributed to the planning process: L. Bruce Gladden, Ph.D., FACSM; Karyn Hamilton, Ph.D., FACSM; and John Quindry, Ph.D., FACSM. 

Long Term Athletic Development (LTAD) Paraphrased:  Coaches should be cognizant of the principles and train their athletes accordingly.  Again, basics first – walk before you run.

Certifications are awesome!  They certainly serve a purpose of continuing education and constant growth for professionals.  However, it is one thing to know the material but can you actually teach it?  Do you have the knowledge of the teaching methods to actually get the point across to the students?  Bridging the gap between the academic and the practical is essential but doesn’t often happen, particularly in the more “academic” of certifications.

One of the problems that we in the U.S. face is the lack of coaching/teaching education.  Everyone gets the knowledge to get the letters after their name, but it is difficult to find programs that actually show you how to break it down and teach it.

That being said, it is important to get back to the beginning.  Where do we start?  If you check out YouTube you will find the latest, greatest videos of what the best in the world are doing or should be doing.  But do they really get to the basics of how to teach the concepts you see?

“…we are responsible for getting kids caught up with the basic skills that they have sorely missed in their upbringing."

 

For coaches, the concept of “walk before you run” is a pretty effective way to go.  Teach the basics before trying to have your students do the more advanced stuff.  In all fairness, the coaches are not all at fault for the need for immediate gratification that most of us are used to, and have the tendency to just skip right to the more advanced skills. 

The problem goes back as early as training and educating our youth.  How many elementary physical education classes have gone by the wayside?  How often do you see sport coaches pushing their young athletes to compete year-round and specialize way too early?  Heck, for that matter, how many times do you see kids sitting inside playing on their video games rather than being outside playing?

Having taught high school physical education and weight training for many years, it was frustrating to ask the kids to do a simple “power skip” down the gym for a dynamic warmup and a handful of the students didn’t know how to skip!  Forget trying to do anything more advanced when they didn’t even know the basics.

Unfortunately, with our education system deleting physical education programs, these basic skills are not being taught.  It is being left up to the “professionals” who are certified as coaches and trainers to catch up with skill development that should have been covered long ago.  But, is your academic background preparing you to go out and teach what you are learning from those certifications?  Can you “bridge the gap” between the knowledge and the practical application.

To paraphrase some of the concepts of LTAD (Long Term Athletic Development), coaches should be cognizant of the principles and train their athletes accordingly.  (Again, basics first – walk before you run). 

For example:

                FUNdamental Stage:   Males age 6-9 / Females age 6-8

• Basic overall sports skills leading to physical literacy
• Introduced through fun and games
• Developmental progression of fundamental movements and skills
  • Fundamental locomotor movement
  • Speed and agility
  • Strength and power
  • Endurance
  • Balance and stability
  • Body control
  • Object control

                Learning to Train Stage:   Males age 9-12 / Females age 8-11

• Further develop all fundamental movement skills and teach general, overall sports skills.
• Further develop endurance, flexibility, speed and change of direction
• Develop strength with bodyweight exercises as well as medicine balls and swiss balls
• Structure competition to address differences in training age and ability
• Ratio of 70% training to 30% competition
• Still continue to encourage unstructured play

The reasoning behind showing this general information on the LTAD strategies is to let our certified professionals know that there is more to be done than just learning the science or the academics behind training.  It is to reiterate to professionals in the field that we are responsible for getting kids caught up with the basic skills that they have sorely missed in their upbringing.  And, even more importantly, getting our professionals caught up on the basic teaching skills that they have been missing in their educational “upbringing”.

Stay tuned for more detailed information in later blogs on some of the strategies to make these basic skills teachable.


Bio: Coach Leo Totten MS, USAW 5
He is a Senior International Weightlifting Coach (USAW 5), and has been named as one of 65 Most Influential Strength Coaches of All Time. Coach Totten has been inducted into the USA Weightlifting Hall of Fame, and is the Head Coach for the East Coast Gold Weightlifting Team, with 20 time National Team Champions. He is the owner of Totten Training Systems, LLC  2012-current, and  Director of Strategic Outreach for Elite Sports University.

The prevalence of Type II Diabetes (T2D) continues to rise globally, and particularly in Western nations (1).  Without proper treatment, T2D may lead to cardiovascular diseases, neuropathy, kidney failure, and death (2).

Authors: Gabriel Zieff, B.S., Andrew Borror, B.A., Claudio Battaglini, Ph.D., FACSM, Lee Stoner Ph.D., ACSM-CEP, ACSM-EIM

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill

BACKGROUND

The prevalence of Type II Diabetes (T2D) continues to rise globally, and particularly in Western nations (1).  Without proper treatment, T2D may lead to cardiovascular diseases, neuropathy, kidney failure, and death (2).

The major goal of T2D treatment is the regulation of hyperglycemia (high blood sugar). Lifestyle behaviors such as eating a healthy diet and engaging in exercise can be effective strategies for mitigating hyperglycemia and improving insulin sensitivity in T2D (3, 5). In terms of exercise, muscle-contraction-mediated glucose uptake provides a means for glucose to exit the bloodstream and enter the muscle tissue independent of insulin. Specifically, repeated muscular contractions stimulate transient translocation of the GLUT-4 transporter protein to the cell-membrane to facilitate the uptake of glucose from the circulation into the muscle.

Given the importance of managing hyperglycemia in T2D, it is not surprising that glucose elevation following meals is of particular concern for this population. Thus, postprandial exercise may be a useful strategy to combat the glycemic response to a meal while preserving insulin sensitivity. Unfortunately, the optimal timing and prescription of postprandial exercise to maximally reduce postprandial hyperglycemia have not been clearly elucidated.

Recently, a systematic review was conducted to assess the effects of postprandial exercise on glucose regulation in T2D (6). This article: i) reports the outcomes of the systematic review; ii) discusses the appropriate timing, modality, intensity, and duration of exercise; and iii) addresses the practical considerations that need to be accounted for when prescribing and monitoring exercise in this population.

SYSTEMATIC REVIEW FINDINGS

The systematic review identified 12 randomized crossover trials, with a total of 135 participants (108 males, 20 females, 7 unknown), none of whom were being treated with insulin. The crossover trials included an acute exercise bout, and a non-exercise control. The exercise bouts were performed within a three-hour period following a standardized meal.

The analysis revealed that postprandial aerobic exercise (11 studies) decreased short-term glucose area under the curve (AUC) by 3.4% to 26.6% and 24-hour prevalence of hyperglycemia by 11.9% to 65% (6). Resistance training (2 studies) decreased short-term glucose AUC by 30% and 24-hour prevalence of hyperglycemia by 35% (6–8). Further, the review showed that while pre-prandial exercise also conferred beneficial effects on glucose regulation, greater improvements occurred with postprandial exercise (6-10). It is likely that when postprandial exercise is performed, maximal exercise-induced glycemic regulation is most aligned with peak blood glucose (11). In contrast, pre-prandial exercise may not allow for such coordination between exercise-induced glycemic regulation and blood glucose elevation.

Unfortunately, as far as we know, no studies have examined whether the attenuation of postprandial glucose improves clinical outcomes, such as cardiovascular events. However, the evidence from the review suggests that postprandial exercise decreases blood glucose levels to below 8.6 mmol/L for up to 24 hours, which approximately corresponds to a glycated hemoglobin (HbA_1C) level of 7% (8–10, 12–14). Chronic decreases in HbA_1C to this extent are associated with a reduced risk of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke (12). While the findings from the systematic review should be considered preliminary, the 24-hour reduction in blood glucose is potentially clinically meaningful.

APPROPRIATE TIMING, INTENSITY AND MODALITY OF EXERCISE PRESCRIPTION

Timing and Intensity: Longer duration (30 to 60 minutes), moderate-intensity, aerobic exercise in the 3-hour period following a meal seems to most consistently result in improved glucose regulation among individuals with T2D (6). Lower intensities and shorter durations of exercise were not as effective in promoting glucose regulation (6). A likely explanation is that a driving factor behind the glucoregulatory effects of postprandial exercise is total energy expenditure.

Modality: While less evidence exists regarding the glucose improvement related to postprandial resistance training, the available evidence does suggest resistance training and moderate-intensity aerobic exercise are similarly effective (6).

CONSIDERATIONS FOR EXERCISE PRESCRIPTION

The American College of Sports Medicine (ACSM) recommends accumulating 150 minutes of moderate intensity or 60 minutes of vigorous intensity aerobic exercise per week. It also recommends performing 2 to 3 non-consecutive days of resistance training per week at intensities between 50% to 80% of 1-repetition maximum (1-RM) and targeting all major muscle groups using a scheme of 1 to 4 sets of 8 to 15 repetitions per exercise. We recommend that the current ACSM guidelines, which are similar to those provided by the American Diabetes Association (ADA), be adhered to. However, we suggest that exercise be performed within three hours of the largest meal of the day. We also suggest that several other minor modifications to these guidelines be considered, as discussed below.

With regards to ACSM guidelines, the findings of the systematic review lead to several important considerations. First, while the ACSM recommendations for aerobic exercise are stated in terms of cumulative minutes of exercise achieved per week, due to the transient (≈ 18 to 48 hours) nature of contraction-mediated glucose uptake, we suggest that no more than two days should occur without engaging in aerobic exercise (15). In line with this we suggest that, between aerobic and resistance exercises, only one “rest-day” be taken each week. In terms of resistance training, we suggest that a moderate-intensity range of 50% to 60% 1-RM be maintained to prevent large increases in blood pressure and minimize delayed-onset muscle soreness. These recommendations will help to optimize safety and compliance. Lastly, clinicians should aim to help individuals with T2D work up to a duration of 60 minutes of exercise (regardless of aerobic or resistance) at least 6 days per week to maximize energy expenditure.

It is important to note that these guidelines are ideals and rigid adherence to them may be unrealistic. Therefore, the most important underlying themes of lifestyle-based glycemic regulation should be prioritized. In particular, strategies for relapse prevention should be prioritized. For example, if the prescribed exercise following the largest meal cannot be achieved for a given day, engagement in any form of physical activity, such as taking the dog for a walk or gardening, should be encouraged.

CONCLUSION

Postprandial hyperglycemia is a significant problem for individuals with T2D. The current evidence indicates that postprandial exercise may help reduce hyperglycemia, thus preventing the progression of T2D and associated complications. Although the optimal intensity and timing of initiation are not clear, energy expenditure seems to be an important factor.

Based on this, we suggest that clinicians and fitness professionals help individuals with T2D adhere to the current ACSM and ADA guidelines. However, we suggest that a greater emphasis be placed on meeting these recommendations during the three-hour period following the largest meal of the day.

References:

1.        World Health Organization. Diabetes [Internet].WHO. 2017

2.        Cavalot F, Pagliarino A, Valle M, et al. Postprandial blood glucose predicts cardiovascular events and all-cause mortality in type 2 diabetes in a 14-year follow-up: lessons from the San Luigi Gonzaga Diabetes Study. Diabetes Care. 2011;34(10):2237–43.

3.        Rabi DM, Edwards AL, Southern DA, et al. Association of socio-economic status with diabetes prevalence and utilization of diabetes care services. BMC Health Serv Res. 2006;6:124.

4.        Oberlin DJ, Mikus CR, Kearney ML, et al. One bout of exercise alters free-living postprandial glycemia in type 2 diabetes. Med Sci Sport Exerc. 2014;46(2):232–8.

5.        Goodyear LJ, Kahn BB. Exercise, glucose transport, and insulin sensitivity. Annu Rev Med. 1998;49(1):235–61.

6.        Borror A, Zieff G, Battaglini C, Stoner L. The effects of post-prandial exercise on glucose control in individuals with type 2 diabetes: A systematic review [Internet]. Sport Med. 2018; In Press.

7.        Heden TD, Winn NC, Mari A, et al. Postdinner resistance exercise improves postprandial risk factors more effectively than predinner resistance exercise in patients with type 2 diabetes. J Appl Physiol. 2015;118(5):624–34.

8.        van Dijk J-W, Manders RJF, Tummers K, et al. Both resistance- and endurance-type exercise reduce the prevalence of hyperglycaemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type 2 diabetic patients. Diabetologia. 2012;55(5):1273–82.

9.        Haxhi J, Leto G, di Palumbo AS, et al. Exercise at lunchtime: effect on glycemic control and oxidative stress in middle-aged men with type 2 diabetes. Eur J Appl Physiol. 2016;116(3):573–82.

10.      Colberg SR, Zarrabi L, Bennington L, et al. Postprandial walking is better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals. J Am Med Dir Assoc. 2009;10(6):394–7.

11.      Poirier P, Tremblay A, Catellier C, Tancrède G, Garneau C, Nadeau A. Impact of time interval from the last meal on glucose response to exercise in subjects with type 2 diabetes. J Clin Endocrinol Metab. 2000;85(8):2860–4.

12.      Zoungas S, Chalmers J, Ninomiya T, et al. Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds. Diabetologia. 2012;55(3):636–43.

13.      Gillen JB, Little JP, Punthakee Z, Tarnopolsky MA, Riddell MC, Gibala MJ. Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes. Diabetes, Obes Metab. 2012;14(6):575–577.

14.      Manders RJF, Van Dijk J-WM, Van Loon LJC. Low-intensity exercise reduces the prevalence of hyperglycemia in type 2 diabetes. Med Sci Sport Exerc. 2010;42(2):219–25.

15.      Lehnen AM, De Angelis K, Medeiros Markoski M, D´Agord Schaan B. Changes in the GLUT4 expression by acute exercise, exercise training and detraining in experimental models [Internet]. J Diabetes Metab. 2012 [cited 2018 Jan 22 ];(10) available from: http://dx.doi.org/10.4172/2155-6156.S10-002. doi:10.4172/2155-6156.S10-002.