In 1981, my mentor and friend Henry Miller, M.D., FACSM, became ACSM’s 25th president. Early on, Henry urged me to become involved in ACSM and, at the 1983 ACSM Annual Meeting induction reception, personally introduced me as one of the new Fellows. From that time on, one of my professional goals was to follow in his footsteps. It took more than 35 years, but now I am especially honored to be able to serve as your president for 2017-18. I have the good fortune to follow two great ACSM leaders, former President (2015-2016) Larry Armstrong, Ph.D., FACSM, and my leadership mentor, Liz Joy, M.D., FACSM, immediate ACSM past-president. 

ACSM presidents are often asked about their legacy programs, i.e., a unique initiative that they personally conceived, advocated and launched during their leadership year to advance the college’s mission. Exercise is Medicine^® (EIM) and ActivEarth are just two examples of these presidential legacies. Some have had immediate impact, while others take longer to gather momentum. All have had a major positive impact on ACSM. ACSM presidents need to be very careful and highly selective when announcing these legacy programs because not all members will agree. Some will be skeptical, others will be opposed and still others will be very happy to see them (finally) emerge as ACSM priorities. 

It will come as no surprise to anyone who knows me that my presidential priorities will be:

• Achieving greater inclusivity for engagement in physical activity for people with physical impairments; and

• Enhancing effectiveness of the EIM Solution in the Exercise is Medicine^® initiative, focusing resources on innovative networking strategies that link community physicians to well-qualified fitness professionals who live and work in nearby cities and neighborhoods.

As with any ACSM presidential priority, foundational work precedes an announcement and establishes the further development of ideas and programs. Let me briefly overview how each of these initiatives were developed and how we can, together, enrich them. 

Greater Inclusivity for People with Physical Impairments (This is one of those slowly developing legacy initiatives, just now gaining greater momentum.): After having served as the local research coordinator for the International Paralympic Committee (IPC) and for the Atlanta Paralympic Organizing Committee in 1996, I was asked to serve on the IPC Sports Science Committee. This latter committee was responsible for reviewing and coordinating research being conducted during IPC sanctioned events. The 1996 Paralympic Games was my first introduction to sports programs for athletes with a physical impairment; in more recent years, this has been extended to include athletes with an intellectual impairment, as well. I have had the very good fortune of attending every Winter and Summer Paralympic Games since 1996 and have worked with the most elite of athletes. More recently, ACSM has accomplished the following:

• In 2008, ACSM and the IPC signed a memorandum of understanding with the promise to work closely together; part of this agreement called for adding science and practice content on related topics to the ACSM Annual Meeting program;

• The 2017 Joseph B. Wolffe Lecture was delivered by IPC Sports Science Committee Chairperson, Yves Vanlandewijck, Ph.D., with the title “Crossroads and Conflicts: Olympics, Paralympics or Cyborg Olympics;”

• At the 2017 ACSM Annual Meeting in Denver, Cheri Blauwet, M.D. and Paralympic Champion became a member of the ACSM Board of Trustees;

• And, on May 10^th of this year at the National Press Club in Washington, D.C., ACSM and the Inclusive Fitness Coalition (which was formed 10 years ago) announced a continuing partnership with the National Center on Health, Physical Activity and Disability (NCHPAD). The NCHPAD is housed at Lakeshore Foundation in Birmingham, promoting the Partnership for Inclusive Health. This Partnership is a strategic alliance between many organizations including the American Heart Association, the International Health, Racquet & Sportsclub Association (IHRSA), the National Association of Chronic Disease Directors (NACDD) and others.

For this year and beyond, ACSM will continue to find ways to be more inclusive and discover new partners that we can work with to find solutions for the health issues and sports opportunities for people with disabilities. 

Enhancing the EIM Solution: The EIM program has received a lot of attention from ACSM over the past 10 years. However, a significant gap has been identified that has slowed broad implementation in communities. Routinely, doctors now ask their patients about physical activity and exercise. Some, of course, do provide basic exercise information. But, when a patient asks the doctor about community resources, there is a significant knowledge gap. One strategy ACSM has developed to close this gap is to create and deploy an EIM credential for certified fitness professionals. ACSM is also a founding member of the Coalition for the Registration of Exercise Professionals (CREP), which developed the U.S. Registry of Exercise Professionals (USREPS). USREPS provides local doctors with a significant resource to locate qualified fitness professionals right in their own communities, ensuring that their patients will get the very best (and safest) exercise program. This searchable database (www.usreps.org) is not yet well known, but could be one of the first steps for physicians looking to refer patients to well-qualified fitness professionals. My second presidential priority is to create a seamless referral network from physicians to these community resources. This network will enable physicians to answer the patient question, “Okay doc, I get it. I need to get more exercise, but where do I go and whom do I see?” 

These two presidential priorities are ambitious, but both are desperately needed in our communities. With the help of ACSM members who are basic and applied scientists, physicians and educators, as well as our affiliate members, we can get more people all over the world to become more physically active.

ACSM’s new president is Walter R. Thompson, Ph.D., FACSM. He is a regents’ professor and associate dean for graduate studies and research in the College of Education & Human Development at Georgia State University in Atlanta. Walt, a member of ACSM since 1978, has served on and chaired several committees, including the Committee on Certification and Registry Boards and the International Relations Committee. In addition, he has served as chair of the American Fitness Index Advisory Board for 10 years. 

Approximately 70 percent of the deaths among Americans each year are attributable to chronic disease. This trend is not only threatens the wellbeing of our population, but also has serious associated health care costs. The benefits of physical activity mean that exercise professionals are uniquely positioned to help fight the negative trend of chronic disease. It is because of this stark reality that the American Medical Association (AMA)and the American College of Sports Medicine (ACSM) co-launched the Exercise is Medicine (EIM) Initiative in 2007. A global health initiative managed by ACSM, Exercise is Medicine focuses on encouraging primary care physicians and other health care providers to include physical activity "prescriptions" when designing treatment plans for patients. The providers then refer the patients to EIM Credentialed Exercise Professionals for guidance. To learn more about EIM click here. For a quick video overview of the EIM Solution and the role of the credentialed professional, click here.

With nearly half of American adults being affected by chronic disease, there is an increased demand for trained exercise professionals who are prepared to deal with the unique challenges these clients face. Because of these challenges, EIM candidates must have an accredited exercise professional certification and at least one year of documented experience to qualify for the Exercise is Medicine Credential training course. This rigorous process means that an EIM Credentialed exercise professional will be well qualified to work with special population clients.

In terms of career advancement and growth potential, an EIM credentialed exercise professional will be considered a valuable resource to a large potential client audience. Depending on the level of EIM Credential earned, you will be qualified to work with clients who are apparently healthy, have stable chronic disease, or those who are considered high-risk clinical populations. (Reference the chart below for EIM Credential Levels.) Additionally, you will have an opportunity to promote your services to health care providers and develop a strong referral network. On top of this, a diversified set of credentials will make you more attractive to potential employers looking to hire exercise professionals who can serve a wide range of clients.

There are three levels of the EIM Credential designed to match patients' needs with exercise professionals adequately prepared to meet them. Consult the chart below to determine which level suits you best.

Ready to take the next step in your exercise professional career by earning the EIM credential? Check out the preparation materials and eligibility requirements. Those who qualify may then enroll in the online training course. You can also take the training course at an in-person session.

Paul's Perspective

Just like the last 104 Mondays, Eric climbed onto the scale in January of 2017 and together we waited to see what the number would be.

212.8 pounds.

Eric stepped off the scale. We had a moment of silence. Eric stepped back on the scale.

212.8 pounds.

It had been two years since we first met early on a Monday morning and began this ritual. Almost every aspect of our daily lives had changed since then, but Eric's commitment to the plan had produced his 176-pound transformation. We took a few photos and got out the tape measure.

 

At 212.8 pounds, Eric had surpassed his 170 
pound weight loss goal by 6 pounds.

"This isn't over. Nothing changes," I said.

"I know. This is a lifestyle," Eric responded.

As fitness professionals, we know that "maintenance" is where many clients fail. I personally had my own weight loss journey resulting in trimming down 73 pounds many years back, and every day since than I've kept in the back of my head that gaining the weight back would be the worst thing that could ever happen to me.

Why do 95 percent of people that lose the weight gain it back? That answer is simple, the program wasn't sustainable. As personal trainers, we work in and around fitness, and we live a lifestyle drastically different than our typical clients. Far too often trainers design plans for clients that too closely resemble our daily lives and not theirs. Creating a client-centric plan is key for sustainability.

When Eric and I designed his plan, I wanted something that wouldn't considerably change over time. His new lifestyle wouldn't accommodate exercising five hours a day or eating an incredibly calorie-restricted diet. Sure, he might lose the weight faster if he did those things, but as soon as he returned to his "normal" schedule he would gain the weight back. Could his calorie intake goal remain the same after he finished losing the weight? Yes, the 2500 calories daily he had been eating was comfortable for him. Could he continue to workout one hour a day -five to six times a week? Yes. Exercise had become an important part of his daily life that he enjoyed. Additionally, Eric had developed friendships through his gym. They helped keep him accountable, but also enriched his social life and I knew he wouldn't want to lose these relationships.

So, when did we transition into maintenance? Maybe we never did. Or perhaps after we completed that first week two years ago we went directly into maintenance. We created a lifestyle that he could be comfortable with from Day One. Yes, we slowly adjusted as issues arrived. Yes, as his health improved we increased the intensity of his workouts. But we never looked at it as anything other than a permanent lifestyle change: Eric's "new normal."

What did this journey teach me? Simply put there are no gimmicks, there isn't a magic pill, that the path sometimes has barriers, but if you slowly connect the dots you can build a better life.

Eric's Perspective

On Sunday, January 26, 2017, two years after I began my weight loss journey, I stepped on the scale. Not only did I hit my 170 pound weight loss goal, but that I had lost an additional six pounds.

During his 176 pound weight loss journey, Eric gained not 
only physical strength, but mental strength as well.

As happy as I was to surpass my goal, I had to stay focused and continue to look forward. Early on in my journey I had adopted the theory that 170 pounds was just an arbitrary number. It was a measurement that could be quantified to show what a weight loss accomplishment would look like. I often question what the difference in my appearance or my general health would be, if I had lost 160 pounds or 180 pounds? Regardless of the number, the reality always sets in that if I were to stop grinding, stop staying committed, and gain all the weight back, this journey was for nothing. I have the option of being the usual statistical failure, by stopping everything that I am doing and gaining the weight back. Or I can continue to move forward and find new motivations to reach my new fitness potential and grow as a person.

When I was at my biggest, people (and in particular women) would not even look at me, let alone talk to me. I used to have to work very hard, and in some cases go very much out of my way, to get people to realize that I was a human being and a viable option for friendship. As I lost the weight people started to root for me. They started to see me as someone who was chasing a dream and was focused and dedicated to becoming victorious. In social settings people (yes, women too) felt more comfortable approaching me, talking to me, and getting to know me.

When I was at my biggest, my fashion taste was bland and limited. Now that I have lost the weight, I feel more comfortable and enthusiastic about buying new clothes and creating a fashion style that represents who I am. Finally, I think the biggest and maybe the most important lesson I am learning as my journey is progressing, is that I am starting to open my eyes to see and understand the challenges other people face, whether it is obesity related or not. At my biggest I had an "out of sight, out of mind" mentality, so I was unable to understand why certain people acted the way they did. As I was losing the weight, I noticed that there was a lot of hurt in the world. By learning to identify and understand the challenges people face, perhaps I can be a source of inspiration and motivation. Perhaps I can help somebody learn about themselves, so they can face and overcome their challenges too.

As my life is changing for the better, I still look at the mirror and remind myself that 176 pounds is not the end game, it's just part of the journey.

This blog highlights the questions that Eric and Paul had for each other along Eric's two-year journey to a 176 pound weight loss.

Eric: I know low carb diets are popular but I like eating carbohydrates. Is that the kind of diet I will be on? Also, how restrictive will my diet be?

No. Carbohydrates are not the enemy! Carbohydrates provide the necessary energy you will need to be physically active. Overeating is what has led to your weight gain and I want us to create a sustainable plan. What is going to be very important for us, is educating you on serving sizes and making sure that you are consuming a diet with the proper amounts of protein, fats, and carbohydrates. 

Eric: I know we've decided on a 2500 calorie daily intake. The calorie restricted diets I've seen all seem to be based 1500 calories… is 2500 calories too much?

Having calculated your basal metabolic rate we know that you burn somewhere around 2,500 calories daily, and you are about 200 pounds overweight. You have a lot of stored potential energy in the form of adipose tissue. I want us to create a plan where you can eat a comfortable number of calories daily. This is a calorie goal I'm hoping we can establish and stay with for the rest of your life. 1500 calories a day would be far too limited for a person of your size and I fear that although you might lose weight at the beginning it wouldn't be sustainable.

 

One of the many benefits of Eric's weight loss was his 
ability to ride theme park attractions that he has
previously been too large to ride.

Eric: I work two jobs and I'm extremely busy. How time consuming is this going to be?

This is about creating a new lifestyle. I want you to work out a comfortable amount for your schedule. Could you commit to being in the gym one hour a day, five times per week?

Eric: Yes, that seems reasonable. Will, I still have a social life or do I just have to sit at home hungry?

It's incredibly important for this process to create a new lifestyle for you. I want you to start molding your social life around activities not meals. Instead of inviting your friends out to the local bar or restaurant, could you meet them for walks around downtown? On days off from the gym can you find other ways to be active?

Eric: Will I feel any lack of energy? When can I expect to have more energy?

At first you are going to notice a drop in energy. You consume a lot of sugar sweetened beverages and you consume too many calories. You are going to feel a temporary lag while your body is getting use to its new normal. Moreover, you may experience withdrawal symptoms from the lack of sugar and caffeine. This is completely normal and will go away after a week or two. Slowly as weeks pass, you will feel more energy as your body becomes stronger and you get more restful sleep. 

Eric: I often see these traditionally popular diet snacks that, although low in calories are high in carbohydrates. Why do you want me to have focus on high protein snack options?

For two important reasons: First, one of the ways that you burn calories is through dietary thermogenesis. Put simply, the hotter your body gets when digesting food, that more calories you ultimately burn. We know that protein requires your body to get the hottest, so if we focus on high protein snacks we should see improved dietary thermogenesis and you will be burning more calories! Second, we know that protein leads to higher levels of satiety, so you will feel satisfied longer and not have the desire to eat more.

Eric: Do I need to take any multi vitamins or other supplements?

I'm a strong believer that you can get everything you need from a diverse diet. With that being said, I would prefer you spend your money on getting good quality food and vary your diet as much as possible. Don't get stuck eating the same thing every day. Try as many different sources of protein and vegetables as you can.

Eric: When is a realistic time frame for me to see changes?

It took 10 years for you to get to this weight. You aren't going to change the way you look or feel in a day, a week or a month. I want you to plan on losing one to two pounds each week, and if we can get 50 pounds off in the first year that's going to be a great accomplishment.

When Eric hit the 100 pound weight loss point he, 
Paul and some friends went on a cruise to celebrate.

Eric: Now that I have lost some weight when will people start to notice changes?

This is a very tough question to answer. People that see you every day will have trouble noticing your weight loss as it's been very gradual. Recognition will come with time and as you purchase new and smaller clothing. But the important thing is that you see and feel the changes and that you don't focus on what others think. With more time, they will notice.

Eric: I just fit on a ride at a theme park that I couldn't fit into when I was heavier! I've noticed that its easier for me to get into airplane seats and walk around tight areas. But I still feel very nervous whenever I'm in those situations. When will these feelings fade?

Research shows that it takes two to three years after you lose a significant amount of weight to be able to see yourself at that lower weight. I often refer to this as "phantom weight." You were at that heavier weight for considerable amount of time, so it's going to take time for you to see yourself as you are. I would encourage you to challenge your perceptions and if you aren't sure if you are going to fit into something than you should certainly try it. You will either fit or have a new goal.

Eric: Are there exercises that can help reduce the fat in certain parts of my body? I'm very unhappy with the weight around my midsection. How many crunches should I do daily?

I get this question from everyone, and the harsh truth is that there's no such thing as spot-based weight reduction. As you slowly lose weight the inches will come off from everywhere. Trust the process and before you know it your mid-section will be flatter. As for the crunches, I would suggest that you don't do any type of focused abdominal exercise this early in your weight loss journey. They won't give you the results you want. Abs are built in the kitchen. Once your body fat becomes much lower you will start to see definition. At that point if you want to start abdominal focused exercises we can add that into your program.

Eric: Prior to meeting you, I had "personal trainers" suggesting I work out two plus hours a day to see results. They had me doing high intensity cardio and things like box jumps. However, your program focused at first with me walking and doing activities in the pool, and then progressively add in strength training as I started to lose the weight. Why did you take that approach?

First, do no harm. When we met you weighed nearly 400 pounds. Honestly, my biggest concern was making sure you didn't hurt yourself. I wanted to create a plan that you felt comfortable with and that you could sustain. We slowly added more exercises as your confidence in the gym and your abilities improved. Frankly, when I see trainers having extremely overweight clients doing HIIT or plyometric-type exercises, I wonder what kind of stress they are unnecessarily putting on their clients' bodies.

Eric: As I have now come to my goal weight, how do I transition from losing weight to maintenance?

Nothing changes! This is a lifestyle! I still expect you to track your calories in the mobile app. I still expect you to go to the gym as you did before. Occasionally you might want to eat an unhealthy meal, just keep tracking your meals. If you go out, have fun but be responsible. Associate yourself with people that live a healthy lifestyle and you will find a balance that works for you.

First Steps - Eric's Perspective

There was a point in my life where I wasn't always big. In fact, I was becoming fairly athletic. I felt I had a good grasp on my health and the thought of obesity never crossed my mind.

However, when I started a career in restaurant management in a casino in Las Vegas, I put myself into a vicious cycle of work more, eat more-blocking everybody and everything else out. That first year in management I gained about 100 pounds. I felt I was wrapping myself tightly in heavy chains. Over the next eight years, I continued to gain weight and the chains got tighter, and no matter what I tried to do on my own, I could not get loose from the chains.

 

Prior to beginning his weight loss journey, 
Eric weighed nearly 400 pounds.

I woke up one morning in February 2014, after only 4 hours of sleep. I had previously worked a 15-hour shift, and I had to get ready for another 12-hour shift. I had trouble getting out of bed. As I made my way to the bathroom, I looked at myself in the mirror and said to myself, "I look horrible, I feel horrible, but how did I get here?" The light in my head came on!! I needed to make some serious changes and I needed to make them quickly. Shortly thereafter, I put in my resignation, and, for the first time, I felt those chains were starting to loosen up. I felt this was the beginning of me getting my life back.

When starting from rock bottom, desperate for information, and seeking the secrets of weight loss, it was fairly easy to fall into those "lose weight quick" schemes of pills, wraps, and patches, the allure of "simple" cookie cutter diets, and being misled into believing that if I would spend two hours at the gym, I would see instant results. There was so much "information" out there, I didn't know where to begin.

As I started a new job as a server at a new restaurant, I met Paul, who at the time was going to school for exercise physiology. Paul started to do a significant amount of research on how to properly lose weight from a scientific standpoint, in conjunction with all the other fitness research he was doing for school. Eventually he started putting theory to practice and began his own 70-pound weight loss journey.

The wheels in my head started to turn; despite how much heavier I was versus the weight Paul started at, I wondered, "could he use his research and adapt it to me?" I sat down with him to understand what he was doing. He started by going over the basics, as well as some of the tools that he used. He said that once I picked a date to start, he would help guide and coach me, but I had buy in to his theories and to do it his way.

It took the final months of 2014 to prepare myself for the journey, even though I wasn't sure where it would lead. I looked at other weight loss stories to try and get some guidance and perspective. Paul also reminded me how hard the first week was going to be, and the different factors that would contribute to how I was feeling. We started to take a deeper look at all my habits. Whether good, bad, or neutral, we needed to understand what may be causing me to binge eat or be unsuccessful at losing weight. Finally, I felt like I was getting the necessary tools that would help me be successful.

First Steps - Paul

"The journey of a thousand miles begins with a single step." ― Lao Tzu

Before losing weight, Eric was sidelined
when visiting theme parks as he was too
heavy to ride most of the attractions.

How do you summarize one man's 176 pound weight loss? I don't want to make it seem too simple or too complicated. Honestly, Eric and I's partnership started quite organically with small conversations over many months. I wasn't trying to sell him a training package or a diet plan. I was building a friendship with someone that had a similar background to my own and it turned into an incredible weight loss journey.

Here are the raw numbers: When I met Eric he weighed nearly 400 pounds. Research shows that only about seven percent of the population is this heavy, and unfortunately the route that most people at this weight resort to is bariatric surgery. Moreover we do know that only about five percent of people that lose more than 10 percent of their starting weight are able keep it off. So 95 percent of people gain all the weight back and this fact filters through every decision I make with my clients. I constantly ask myself: "Is this sustainable for them?"

I remember seeing Eric for the first time. I'd like to say I thought incredibly positive thoughts, and that I thought,"I can help him," but the truth is my first thought was "that's an extremely heavy guy…. I wonder if he feels comfortable walking around." At the time I was working a second job outside of the fitness industry and we worked together side by side. We became friends over late night dinners and work related small talk. Eric is smart, funny and was a good drinking buddy. As I remember it, a year would pass before we ever talked about his weight.

"I've been trying to lose some weight," Eric said while we were eating a late evening dinner.

Late night meals sparked Eric and Paul's friendship
and lead to conversations about Eric's habits and
their decision to work together for his weight loss.
(Eric on left in blue shirt, Paul on the far right.)

"Oh, yeah? What's the plan?" I asked without much thought.

"I'm going to do some cardio in the morning, and then a spin class, maybe lifts some weights after that, and finish with the treadmill while The Price is Right is on" Eric stated very matter-of-factly.

"Yeah…I think that might be too much," I said.

Eric shrugged and went back to eating his Chinese takeout. I knew what he was talking about wasn't sustainable. But I wasn't sure if it was my place to talk to him about his weight.

A few nights later over another meal, Eric brought it up again and I decided to speak up.

"Eric, I really feel like I could help you."

"Hmm, what are you thinking?" Eric asked cautiously.

To be honest the plan was simple.

Step One: Research shows that you are 30-40 percent less likely to be overweight if you track your calories so Eric was to track everything he consumed via a fitness app on his phone.

Step Two: I knew Eric was fairly active so I wanted to track his activity levels, so we used an activity tracker to monitor everything he did. "This will work, if you work the numbers," I told him.
When we synced those two things together, Eric could actively see how eating less and being more active helped him burn more calories each day. Each night when he completed his diet log, the app would give him a positive message: "If every day was like today… you will weigh _____ in five weeks." I felt this allowed him to see how making each day count led to long term progress.

Step Three: Perhaps the most crucial step was changing Eric's mindset. Instead of Eric focusing on attempting to lose nearly 200 pounds, I wanted Eric to focus on a very small goal of one to two pounds per week. Each Monday first thing in the morning Eric would wake up and weigh himself. He would write that number down, and good or bad, that was his number for the week. His focus would then become losing just one or two pounds from that Monday number.

To prevent Eric from burning out we kept the focus on small daily accomplishments. Did you nail your calorie goal that was provided by the mobile app? Did you hit your step goal as we had established with your activity tracker? Did you get the proper amount of sleep? Did you drink enough of water? We considered it a perfect day when Eric could answer "Yes" to all of those questions and then we just pushed to make every day perfect.

On Day One I met with Eric first thing in the morning. He weighed in and we took measurements and three photos. He told me what his day was going to look like, where he was going to be, what he was going to eat, and when he would be in the gym. I encouraged him to text me at each stop along the day. This started the journey that would result in him losing 176 pounds in a healthy and positive manner.

I consider myself first and foremost to be a scientist, and I wanted Eric to understand things like energy balance and how the human body burns calories. I felt that if he understood why he was doing all of this it would be easier for him to commit to it. I accomplished this with daily text messages and positive affirmations. I strongly believe that mantras can change your mind and I encouraged Eric to develop daily positive mantras that he could focus on when going about his day. Eric knew to text me recaps of his day and when he had questions about nutrition or fitness he should text or call right away.

It's important that we never referred to these changes as a "diet." It wasn't a diet. Eric made a long-term lifestyle change. Constantly along the way we both asked ourselves, "Are these decisions/choices sustainable?" If it wasn't something that could be sustained than we knew it wasn't a positive decision.

It's not a sprint, it's an ultra-marathon. It's about making the rest of your life the best it can be.