Four years after the Winter Games in Sochi were corrupted by one of the largest and most egregious doping scandals in history, the best athletes from around the world once again are gathered to compete atop snow and ice. In PyeongChang, South Korea, they are competing in sports that demand speed, precision, endurance, and big air. With the 2014 Winter Games now synonymous with a Russian doping scandal that involved cocktails of performance-enhancing drugs and swapping urine samples through mouse holes, athletes and fans worldwide have never been more aware of the need for meaningful action to protect the integrity of the Olympics. 

Motivated by these events, athletes from at least seven countries have united behind #MyMoment in a global movement to explain why clean sport matters to them, and to demand that their irreplaceable Olympic moments be protected from doping. Olympians and Paralympians of all ages and disciplines have taken a stand for the moments they’ve earned as clean athletes, including biathlete Lowell Bailey, who lost the medal he earned in 2014 to an athlete who doped. These athletes exemplify both the power of the athlete voice and the many reasons why clean sport is worth fighting for. 

In this turbulent and frustrating environment, it is perhaps more important than ever that the PyeongChang Organizing Committee for the 2018 Olympic and Paralympic Winter Games (POCOG) in South Korea execute a comprehensive and effective doping control program. During the Games, the POCOG is utilizing highly trained Doping Control Officers (DCOs) from experienced anti-doping organizations worldwide to collect samples from athletes at any time and location throughout the Games. The International Olympic and Paralympic Committee policies also allow for long-term storage and reanalysis of samples, meaning a sample can be pulled from a freezer vault and analyzed using the latest technologies for a period of 10 years after the Games. This serves as a significant deterrent to any athletes who believe that their legacy cannot be tarnished due to discovery of doping long after the Games. 

For most of the athletes at the Games, the doping control process is very familiar because elite athletes must comply with anti-doping rules throughout their athletic careers. Many athletes will provide dozens of urine and blood samples, both in and out of competition and without advance notice, during their careers. Even after they arrive in PyeongChang, athletes must continue to submit Whereabouts information so DCOs can find them — anytime, anywhere — in the athletes’ village, dining hall, training venue or at a competition. 

For in-competition testing, athletes are notified as soon as they step off the field of play. The athlete is closely chaperoned, even during media interviews and medal ceremonies, until the urine and/or blood sample is provided and secured. 

The WADA-accredited laboratory based in Seoul is then responsible for all the sample analysis. Working around the clock, and reporting many results within 24 hours, scientific experts conduct analysis to identify more than 250 prohibited substances and methods that are included on the WADA Prohibited List. Athletes will also have their biological passports scrutinized, which could lead to further target testing or additional sophisticated analyses. 

If there is an adverse analytical finding, or positive test, an athlete may face repercussions unless they have a valid Therapeutic Use Exemption (TUE), certifying a legitimate therapeutic need to use a prohibited substance. In the absence of a TUE, athletes can choose to have their B sample tested to confirm the positive finding of their A sample. To ensure due process, the athlete is afforded the right to present their case before an independent Court of Arbitration for Sport panel. 

In addition to advocating for clean athletes’ rights both nationally and internationally, USADA provides our U.S. Olympic and Paralympic athletes with comprehensive education and resources, including Supplement 411 andGlobal Drug Reference Online, to ensure they are equipped with the information they need to compete clean. To further prepare them for the Games, USADA required U.S. Olympians and Paralympians to complete educational programs to learn about Games-specific doping control measures. 

In partnership with Stanford University, USADA also developed HealthPro Advantage: Anti-Doping Education for the Health Professional, which is designed to help physicians learn about anti-doping rules so they can better serve athlete patients. All ACSM members can take the HealthPro course for free and physicians can earn CME credits for completing the corresponding evaluation materials. 

The voices of athletes and their support networks are critical in the fight for clean sport, but it remains crucial that all who believe in a level playing field stand together to demand that sport leaders protect the integrity of sport. Clean athletes train their whole lives for their irreplaceable podium moments and every moment matters in PyeongChang! 

Editorial Note: USADA is the national anti-doping organization in the U.S. for Olympic, Paralympic, Pan American, and Parapan American sport. For more on USADA’s mission, responsibilities, programs, and resources, see U.S. Anti-Doping Agency on the web. SMB is grateful to Dr. Fedoruk for sharing with our readers his insightful views in this commentary on doping control – an undertaking inherent to providing fair and clean competition for athletes at the Winter Games in PyeongChang.

Matthew N. Fedoruk, Ph.D., is an ACSM member and the current science director at the U.S. Anti-Doping Agency (USADA). Next month, Dr. Fedoruk will support doping control oversight at the Paralympic Winter Games as a member of the Anti-Doping Committee for the International Paralympic Committee. Dr. Fedoruk was responsible for managing anti-doping operations at the Vancouver 2010 Olympic and Paralympic Winter Games. As a recognized expert in the field of anti-doping science and doping control, Dr. Fedoruk also serves as a member of numerous World Anti-Doping Agency (WADA) Expert Groups.

One of the most anticipated events of the Winter Games is men’s and ladies figure skating, where we will be treated to grace and athleticism. Skaters glide across the ice, seemingly effortlessly, maintaining their balance in dizzying spins, quadruple jumps, and intricate footwork sequences. Landing a jump known as a quadruple flip on opening day, American Nathan Chen is the first man to complete a “quad flip” at any Olympics. Two days later, Mirai Nagasu landed a triple Axel, the first American woman to complete at triple Axel at any Olympics.

How do skaters jump over 24 inches in the air, rotate faster than six revolutions per second, and land on one foot while balancing on a 3/16-inch wide blade and skating over 15 mph? Within the field of sports science and medicine, biomechanists work to answer these questions, studying the forces and motion of athletes to advance training, improve equipment design and prevent injuries. 

The science behind the jumps

To land a quadruple jump, skaters must trade-off the needs for both height and rotation. Too much effort driving upwards with their arms for height can mean slower rotations in the air. A stronger rotation pushing off the ice can mean less force to jump high. While never measured directly in a quadruple jump, calculations from 3D motion analysis suggest skaters average close to 150 foot-pounds of torque and 300 pounds of force against the ice as they spring into the air to complete a “quad”, and that is for a 150-pound skater!

To rotate fast in the air, skaters tend to be small, because that helps them spin quickly.  But don’t be deceived! Despite their size, skaters are strong—not only with their legs for jumping, but with their arms too. During a quadruple jump, a 150-pound skater is rotating so quickly that their arms are being pulled away from their bodies with 180 pounds of force. It’s the same sensation you feel in your arms when you’re on a merry-go-round, only much greater. To maintain their rotation speed and get four rotations in the air before their skate hits the ice, skaters must counteract this “centrifugal” force by pulling their arms tightly into their body with 180 pounds of force. Any space between their arms and body means their rotation will be slow and they may not get around to the proper position to land the jump. 

Being short of rotation can cause a skater to fall, but so can being “óff-axis.” If the skater leans too much to one side during take-off, they will be tilted in the air and land with their body too far inside or outside of their foot to maintain balance. Once in the air, skaters can’t fix any take-off mistakes. They can’t get more height, and they can’t straighten an axis that is tilted. They may be able to “pull-in” tighter and hold their rotation longer, but most skaters are already holding the smallest body position for as long as possible. 

To land, pushing out with the leg and arms stops the rotation and bending the knee of the landing leg absorbs the impact force on the ice allowing the skater to land smoothly.  These intricate components of a successful jump come together in less than one second.  So, as you watch competitive figure skating, marvel at the grace and athleticism knowing the strength and power demands of sport and a bit of physics behind a successful jump.

You can learn more about the biomechanics of figure skating via this recorded webinar presentation from this blog author Deborah King, PhD, by clicking here. 

Deborah King, PhD, is a professor in the Department of Exercise and Sport Sciences at Ithaca College in Ithaca, New York. She earned her bachelor's degree from Bates College, M.S. in Exercise Science from University of Massachusetts, Amherst, and her PhD in Biomechanics from The Pennsylvania State University. Her research focuses on applied sport biomechanics, landing mechanics, 3D analysis of human movement, balance control and strategies and figure skating. 

How old is too old to begin exercising? Recent findings from our group suggest that middle age is not only a good time to get started with exercise training, but it also can help you overcome the negative impact of years of being inactive or sedentary.

There is a growing recognition of the negative impacts of sedentary behavior in academic research. My team of researchers has previously demonstrated that “sedentary behavior” compounds the effect of aging on cardiovascular function and increases the risk of heart disease. We have also shown that very high levels of exercise training performed over a lifetime can offset these effects, and preserve cardiovascular function to levels similar to healthy young individuals. Importantly, evidence from bedrest studies, which are useful models of accelerated aging characteristics, suggest that exercise training is an extremely effective countermeasure to the effects of inactivity on cardiovascular health.

Based on these studies, we decided to investigate whether exercise training could in fact overcome the effects of sedentary behavior on cardiovascular health.  We recruited a group of healthy, but sedentary middle-aged individuals to participate in a two-year exercise training study. Each participant was prescribed an individualized exercise program, based on their fitness levels as summarized in Table 1.  The amount of exercise prescribed was progressed gradually from three sessions of moderate exercise per week for the first couple of months after which high intensity interval training was included. We employed this strategy for several reasons, including: 

1) to build an exercise routine, and 

2) to minimize the risk of musculoskeletal injury.

Table 1. Weekly exercise program to improve cardiovascular health

What did we observe? After two years of training, cardiovascular health was dramatically improved! Fitness increased by almost 20 percent, meaning on average the cardiovascular age of participants decreased by about five - ten years. Importantly, no one in the exercise training group decreased fitness – although of course there was variability in the response. We also observed a large (about 25 percent) reduction in heart stiffness. 

What does this mean for you? This study demonstrates that exercise can improve your health and quality of life, no matter what age you are. It also provides support for the current physical activity guidelines. If you have been thinking about starting an exercise program, there is no better time to begin than today.

Dr. Erin Howden is a Postdoctoral Research Fellow at the Baker Heart and Diabetes Institute in Melbourne, Australia. She completed her PhD at the University of Queensland, and then took a post doctoral position at the Institute of Exercise and Environmental Medicine in Dallas, Texas, where she worked in Benjamin Levine's laboratory. Dr. Howden's current research seeks to determine whether exercise training can improve physiological function in various diseases, which represent an advanced ageing phenotype.

The New York Times (NYT) last week published an article asserting that preventive care measures cost money and do not lead to reduced health care expenses over time. As a leader in promoting preventive measures like physical activity and its cobenefits, the American College of Sports Medicine disagrees with the author’s opinion in the article. On behalf of members, advocates and other stakeholders, ACSM submitted a response to NYT editors that shares the college’s position on the issue. The focus of the ACSM response is that sound programs have a profound ability to improve health, prevent disease, and avoid premature deaths, and moderate increases in physical activity can improve physical fitness and quality of life, while costing nothing.

ACSM President Walt Thompson’s response to The New York Times:

The article by Aaron E. Carroll, “Preventive Care Saves Money? Sorry, It’s Too Good to Be True” on the possible cost effectiveness of disease prevention measures makes a good point -- not all prevention efforts work, not all are cost-effective, and not all are based soundly in science and best practice.  But prevention efforts that work can be powerful, and can cost little or even nothing!  For instance, simply adopting a more active lifestyle by walking more can decrease high blood pressure and heart disease development. Lifestyle counseling can be highly effective in preventing type 2 diabetes, especially in high-risk adults. A powerful example: The Diabetes Prevention Program (DPP) for Medicare enrollees has identified a savings of $2,650 over 18 months for those enrolled in the DPP compared to matched members who did not enroll in the program. The DPP is a profound demonstration of the cost effectiveness of prevention through healthy lifestyle interventions around diet and physical activity.  Further, intensive clinical programs to improve fitness through exercise can reverse heart disease.  Workplace health promotion programs can improve health behaviors and health conditions.  Strength training programs can reduce the risks of older adults falling and sustaining severe or even fatal injury.

Not all prevention programs are well-designed, implemented by professionals with the needed training and expertise, with the necessary community support to sustain them.  But sound programs have a profound ability to improve health, prevent disease, and avoid premature deaths.  Even moderate increases in physical activity such as taking the stairs instead of the elevator, walking instead of riding, or doing simple strengthening can improve physical fitness and quality of life. These changes cost nothing! 

Most medical spending in the US is tied to chronic diseases. Many of those diseases are associated with tobacco use, poor diet, and physical inactivity.  The American College of Sports Medicine’s Exercise is Medicine® initiative supplies health care providers with tools to help their patients achieve adequate activity to prevent the onset of diseases related to sedentary lifestyles. It works, it’s inexpensive, and it can make a major difference in a person’s health. Not all prevention efforts produce cost savings, but do yield other benefits important to individuals and American society. And some prevention initiatives, like the Diabetes Prevention Program, produce extraordinary cost effectiveness. To abandon or discount continuing progress in prevention efforts is not only unwise, it actually will doom the American economy. According to the Congressional Budget Office’s long-term budget scenarios, the economy can’t grow enough to cover the rising costs of treating people with preventable diseases, especially diseases related to lifestyle and health habits. Does well-designed preventive care save money?  Yes.  Can we afford (literally) to ignore that fact?  No. 

Preventive care saves money?  Happily, it CAN!

Walt Thompson, President
American College of Sports Medicine

Risk stratification, risk classification and preparticipation screening explained.

Public health officials have long encouraged adults to be physically active on most, if not all, days of the week to realize the many health benefits associated with regular exercise. At the same time, exercise professionals have been taught that preparticipation health screening was necessary to identify those individuals with certain known risk factors for an unexpected event during or immediately after exercise. To accomplish this, exercise preparticipation screenings were developed, resulting in risk stratification models (now risk classification models).

"...exercise preparticipation screenings were developed, resulting in risk stratification models (now risk classification models)."

Risk classification allows the exercise professional to identify individuals with cardiovascular or pulmonary disease, or those at risk for sudden cardiac death (SCD) or other life-threatening conditions. Through classification protocols, at-risk individuals would be referred to a physician for medical testing and clearance before starting an exercise program.

Download the preparticipation screening (aka Risk Stratification, aka Risk Classification) chart from the ACSM Resource Library.

Risk classification became a best practice for exercise preparticipation screening and has been used broadly to determine who is safe to start exercising and who needs to seek medical clearance. However, as public health efforts encouraging regular physical activity have increased over the past few decades, there has been an associated effort to identify barriers keeping people from starting exercise. One area thought to be a substantial limiting factor in these efforts to increase physical activity (PA) participation was an over-prescription for medical clearance prior to participation.

In 2014, Whitfield and colleagues published a paper using a long-recommended preparticipation health screening checklist. Based on their findings, they concluded that nearly 95 percent of men and women older than 40 years of age would be directed to consult a physician before engaging in any form of exercise. This practice likely leads to a needless referral to a health care provider, thereby creating a burden to an individual who wants to begin exercise -- even something as simple as walking.

Consequently, ACSM convened a scientific round table in June of 2015 to evaluate, refine and define its exercise preparticipation health screening procedures; the updated recommendations of this expert panel were published. For a determination about whether medical referral is recommended or not, these new screening guidelines rely on the following:

• current exercise participation
• history and symptoms of cardiovascular, metabolic or renal disease
• the desired exercise intensity for the person who wants to initiate a PA program.

The purpose of our paper was to compare the referral proportion of the new ACSM algorithm to that of previous screening tools in the same representative sample of US adults used in the original Whitfield et al. paper (NHANES data). Our results demonstrated that the number of individuals who would be referred to a physician before beginning exercise was decreased by approximately 41 percent. This finding suggests that the new prescreening procedures have achieved the intended outcome - decreasing the barriers to PA participation by decreasing the number of individuals who require medical clearance prior to engagement.

Further information for exercise professionals regarding preparticipation screening:

Authors

Gary Liguori, Ph.D., FACSM, is the dean of the College of Health Sciences and a professor of kinesiology at the University of Rhode Island in Kingston, Rhode Island. He also was an associate editor of the 10th edition of ACSM's Guidelines for Exercise Testing and Prescription (GETP10).

Meir Magal, Ph.D., FACSM, is the chair of the School of Mathematics and Sciences and an associate professor of exercise science at North Carolina Wesleyan College in Rocky Mount, North Carolina. He also served as an associate editor of GETP10.

Deborah Riebe, Ph.D., FACSM, is the associate dean of the College of Health Sciences and a professor of kinesiology, at the University of Rhode Island in Kingston, Rhode Island. Dr. Riebe was the senior editor of GETP10.

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