Cardiovascular health is, if you’ll excuse the pun, at the heart of physical fitness. Appropriate, then, during American Heart Month to have a look at the ways we can monitor our hearts as well as those of our clients. 

For clients, getting ahold of an at-home blood pressure monitor can be a good start, as well as considering a smartwatch or similar wearable that charts heartrate and related data. This may seem like an unnecessary step for the healthy gymgoer, but keeping track of baseline cardiac data can be quite helpful in the long term, from something as simple as charting how persistent exercise improves pulse rate over time to giving you a good point of comparison to fall back on for when you suspect something might be wrong. It’s hard to know if you’ve suddenly developed unusual symptoms if you don’t have a history of data points. Plus, many of our clients are dealing with ongoing medical issues. Particularly since older adults comprise one of the fastest-growing groups of gymgoers. (Note that ACSM follows the American Heart Association’s blood pressure guidelines, as do ACSM’s certification exams. They are a great reference point for you and your clients.) 

Different monitoring devices serve different purposes, of course. Wearable tech in particular has seen a steady increase in popularity in recent years, according to ACSM’s Worldwide Survey of Fitness Trends, in fact ranking No. 1 on the survey for 2022. Think Apple Watches, Fitbits, Google Pixel Watches, Garmins and the like.  

Is this the right choice for you? It depends. Some of these offerings require you to pay a fee to pair them with various apps. And your mileage may vary in terms of how useful you find the device’s software: People’s tastes differ, and the interface that works well for one may not work for another. And how you and/or your client feel about an app will necessarily have a big impact in the gym. Some people have a favorite workout shirt, leggings or even pair of socks that gives them an extra psychological boost during their routine. You better believe that your fitness tracker needs to be engaging rather than off putting. If it seems like the device and app you or a client has chosen is bogging things down, and it’s financially feasible to switch, make sure to do so. 

If wearables aren’t you or your client’s thing, consider a blood pressure monitor or a pulse oximeter, depending on the circumstances. Wrist-worn and upper-arm blood pressure monitors, as well as finger-worn pulse oximeters, are often available at your local pharmacy, and though not exactly inexpensive (my local drug store lists various types and models between $60 and $100 at the time of writing), they’re much more affordable than most wearables. Some clients may also be able to purchase blood pressure monitors or pulse oximeters using their health flexible spending account (FSA) from work.  

Depending on the model, digital wrist-worn and upper arm blood pressure monitors generally track diastolic and systolic blood pressure as well as pulse and can sometimes detect potential arrhythmias. Fingertip pulse oximeters measure pulse — heartbeat — and the amount of oxygen in the blood. 

If you or your client opts for a blood pressure monitor, there are a few things to bear in mind: According to the Mayo Clinic, you’ll want to have the device checked against those of a medical professional before using it. No sense in taking readings with a poorly calibrated diagnostic tool. You’ll also want to take multiple readings at a time to ensure that you’re not recording an outlier. And best not to take a reading right when you wake up. Instead, wait a little while. Don’t eat or drink — especially not caffeinated beverages — before you take your readings, and if you have to pee, make sure you take care of that beforehand. Needing to go can raise your blood pressure a bit. Also, taking your readings at two different and consistent times of day are probably best: in the morning and in the evening. Finally, and obviously, make sure you’re using the device as recommended. For wrist-worn blood pressure monitors, this often includes resting the arm you’re using to measure on a table or other surface so that the monitor is at the same level as your heart. 

If opting for a pulse oximeter, a device you generally clip on the end of your finger and that uses light to take its readings, the FDA recommends sitting still, making sure the hand you’re using is warm and resting below your heart, and interestingly and importantly, that you make sure to remove any nail polish on the finger you’re measuring since this might interfere with the device’s readings. 

Remember of course that at-home technology, which is subject both to its own potential defects as well as human error, is no substitute for medical expertise, and no one should be making medical decisions outside the care of a certified medical professional. These tools should be used to track a general baseline or progression over time and serve as potential indicators that someone should seek proper medical attention and care. 

This American Heart Month, consider incorporating heart monitoring into you and your clients’ programming. With benefits ranging from something as simple as tracking improvements in pulse and blood pressure over the course of an exercise prescription to potentially catching a problem early and allowing your client to seek appropriate medical attention, why not add it to your repertoire? 

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High blood pressure (BP) or hypertension is the most common costly but modifiable major risk factor for the development of cardiovascular disease and premature mortality, affecting nearly half (47%) of the U.S. adult population. A recent scientific statement from the American Heart Association (AHA) reinforces physical activity as a critical component of first-line treatment for individuals with mild- to moderate-risk BP. In addition, individuals with elevated BP are encouraged to self-measure BP in the home to (a) confirm a diagnosis of hypertension, (b) rule out white-coat hypertension and (c) evaluate the treatment response of interventions such as exercise. Just the act of BP self-monitoring is associated with improved BP control, but when performed in conjunction with co-interventions (e.g., education, clinician involvement, lifestyle modification) translates to superior BP reductions than self-monitoring alone. 

This all sounds great on paper, but putting these guidelines into practice can be challenging. The default care model offers few resources or tools to support patients who are going from 0 to 1. In addition, providers have diminishing bandwidth and incentive to provide initial and/or ongoing behavioral counseling for interventions like exercise or BP self-monitoring. The result is often a very overwhelmed patient who has just been told they have 12 weeks to lower their BP on their own but with no clue where to begin. How much exercise is enough? What BP monitor should I buy? How often should I take my BP? Should I be recording all this data somewhere? 

After 12 weeks, the same patient returns for a follow-up visit clutching a crumpled piece of paper with a few BP values scribbled on it, with no corresponding date or documentation of physical activity, rendering this data difficult to make any sense of. Lifestyle intervention never stood a chance!  

How can we do better to make sure our most vulnerable patients aren’t “left to their own devices”? Currently, there are few resources for the co-implementation of a structured BP self-monitoring and exercise program. However, exercise professionals are well positioned to serve as a trusted partner in care to unlock the value of patient-generated data into actionable insights that facilitate guideline-directed care. As such, it’s imperative that our field is prepared to support commonly experienced scenarios encountered when working with individuals with hypertension embarking on a behavior-change journey. Table 1 presents an overview of evidence-based best practices (when available) and common sense recommendations derived from clinical and research experience. Note that these guidelines are geared toward exercise professionals but may be useful for any qualified health care professional coordinating a multi-component, condition-specific lifestyle intervention for adults with hypertension.  

Table 1. Key Clinical Levers to Support Individuals Initiating an Exercise-Based, Hypertension Self-Management Program 

Antronette (Toni) Yancey, M.D., was born in Kansas City, Kansas, in 1957. She studied biochemistry and molecular biology at Northwestern University before attending Duke University for her M.D. and going on to pursue a long and successful career in public health and public health education. Dr. Yancey received a posthumous ACSM Citation Award in 2014. 

In her letter in support of Dr. Yancey’s nomination for the award, ACSM Past President NiCole Keith, wrote, “Dr. Yancey was certainly a luminary whose influence will continue to span decades. She was, to my knowledge, the only African American female physical activity researcher who also was a full professor at her academic institution. She mentored a core group of us to continue to strive for leadership opportunities that would put ourselves in positions to be decision makers to help make the world a better place — just as she did. Her creative inspiration spread through us and beyond us.” 

While serving as the director of public health for the city of Richmond, Virginia, Dr. Yancey championed a campaign called Rock! Richmond to encourage physical activity throughout the city. Then as director of chronic disease prevention and health promotion for Los Angeles County, she initiated LA Liftoff, which encouraged overweight and sedentary workers to take a 10-minute exercise break based on low-impact dance. The program later evolved into the concept of “Instant Recess,” which Dr. Yancey ultimately outlined in her 2010 book Instant Recess: Building a Nation 10 Minutes at a Time, focused on the nation’s health and fitness, particularly obesity and sedentary behavior, and the policies she laid out in it have been adopted at least 37 cities. Instant Recess earned Dr. Yancey a number of awards, in particular the 2012 Pioneering Innovation Award from the Centers for Disease Control and Prevention. 

Dr. Yancey, a professor in the UCLA Fielding School of Public Health, was a co-founder of the school’s UCLA Kaiser Permanente Center for Health Equity, which promotes social justice and whose mission “focuses on eliminating disparities in incidence, prevalence, mortality and burden of disease experienced by disadvantaged and underserved populations.” 

Dr. Yancey’s passions extended far beyond her work, and she lived an interesting and multifaceted life: She was variously a D1 basketball player at Northwestern, a poet and a fashion model. And among other awards, she received a Lifetime Achievement Award from the Association of Black Women Physicians; the California State Assembly 47th District's Woman of the Year honor; an Award for Excellence from the American Public Health Association; a WNBA Los Angeles Sparks Lisa Leslie Inspiring Women Award; a Women Who Dared Award from the California Black Women’s Health Project; a Champions of Health Professions Diversity Award from the California Wellness Foundation; a Joint Health Promotion Award from the California Public Health Association; a Lifetime Achievement Award from the President’s Council on Fitness, Sports and Nutrition; and a Health Education Achievement and Leadership Award from the Henry Ford Health System. 

Dr. Yancey passed away in 2013 at the age of 55 after a fight with lung cancer, but her legacy lives on in the communities she served and in the careers and achievements of those she mentored and inspired. 

We hear the phrase “It’s not what you know, but who you know.”  

This couldn’t be any truer when we’re talking about networking.  

I’m Dane Robinson, certified fitness professional, TV fitness coach and ACSM Health & Fitness Summit presenter. If you want to take your career further and faster, it’s all about networking. And here are my top three reasons why it works to network: 

No. 1 

Networking helps create ideas and turn them into action: When you’re thinking about a program you weren’t too sure about starting. Maybe you’re thinking about a career move. You need a little bit more insight. There’s always somebody that can help validate and create a little bit more insight to those ideas that you're ready to take action on, but only if you network! 

No. 2 

Networking creates so many opportunities you would never imagine you’re the perfect fit for! You are the ideal person for somebody’s program, for their leadership conference — heck, for their company! I wouldn’t have so many opportunities to educate, present and motivate fitness professionals across the country if I didn’t network at premiere events like the health and fitness summit. And that is not opinion — that is a fact! 

No. 3 

Networking undoubtedly creates collaboration. When we share our successes and we share our failures, we share our aspirations for where we hope to take the fitness industry. It allows us to make bigger and bolder moves. But we can only do that together when, yes, you guessed it: we network. 

Are you ready to take your networking to the next level? Join industry leaders like Dane at ACSM’s International Health & Fitness Summit!

Persistent pain is among the most common adverse effects to breast cancer and its treatments. It affects 25-60% of patients and can linger for several years as a source of considerable physical and psychological distress. Among other things, pain after breast cancer is a primary source of upper limb dysfunction and has been associated with greater levels of depression. These and other persistent pain-related issues collectively reduce the quality of life and perceived physical function of the patient, which is associated with increased breast cancer-related mortality. Unfortunately, there is currently a lack of knowledge on optimal management of persistent pain after breast cancer treatment. Consequently, the development of new and effective treatment strategies is of major clinical importance. 

In our study conducted at Aalborg University, published in the February 2023 issue of Medicine & Science in Sports & Exercise^®, we performed a randomized controlled trial to investigate the effect of a 12-week supervised resistance training program using free weights on persistent pain after treatment for breast cancer. We randomly allocated 20 survivors of breast cancer with self-reported pain into either a control group or an experimental group. The time frame for this study was six months (three-month intervention and three-month follow up). We assessed muscular strength, pain intensity during everyday life and mechanical pain sensitivity at baseline, three and six months. Participants allocated to the experimental group trained twice a week, in groups of two to four individuals, supervised by a certified strength and conditioning coach. They performed five multi-joint free weight exercises in sequential order, each for 2-4 sets separated by 3-5 minutes of rest. The number of repetitions decreased from 10-12 down to 2-4 over the course of the 12 weeks, while load started at 60% of 1RM and increased according to the individual training response. 

The most important observations in this study were that our 12-week supervised resistance training program resulted in a 48% increase in 1RM, along with a 35% decrease in pain sensitivity. In addition, half the participants reported a decrease in everyday pain intensity of 20% or more. We found the gains in maximum strength largely remained following three months of detraining; however, the positive effects on pain had disappeared. Most notably, this suggests that resistance training can provide a clinically relevant improvement in persistent pain after breast cancer treatment. However, these benefits also appear to require consistent exposure and emphasize that resistance training for pain management is most likely a long-term commitment. 

In short, resistance training is a valuable tool in the arsenal of clinical professionals to combat persistent pain after breast cancer. As previously highlighted by the American College of Sports Medicine, it is a safe and well tolerated exercise modality for this population, with an ever-growing base of evidence for its potential. For all these reasons, investigators at Aalborg University and elsewhere will continue to pursue this work in other clinical populations. 

Gorm Henrik Fogh Rasmussen, Ph.D., is originally trained as a sports scientist with emphasis on biomechanics and neuroscience at Aalborg University, Denmark. His research area focuses on the clinical application of resistance exercise for managing adverse effects of cancer and its treatments, with a special emphasis on resistance training and pain. Dr. Rasmussen utilizes both qualitative and quantitative research methods in his work and completed his Ph.D. with supervision from Professor Pascal Madeleine (Dr. Scient, Ph.D.) and Associate Professor Mathias Kristiansen (Ph.D.).