In 2022 we celebrate the 25th anniversary of the HERITAGE (HEalth, RIsk factors, exercise Training And GEnetics) Family Study. The May issue of Medicine & Science in Sports & Exercise_® (MSSE) highlights a multitude of the more than 200 publications and other dissemination products from data generated from this groundbreaking and important research program. The HERITAGE study described the role of genetics in cardiovascular, metabolic and hormonal responses to exercise training in Black and white adults and children. It was the first study of its kind and the largest exercise-focused study ever that recruited Black and white people for hereditary comparison. While revolutionary in its purpose, scope and implementation, two-and-a-half decades later, some language in the HERITAGE study protocol paper raises eyebrows at best and expressions of concern at worst.

We have dedicated our professional service and scholarly activities to improving social justice, equity, diversity and inclusion in science, education and our professional activities within and external to the American College of Sports Medicine_® (ACSM). Thus, we were invited to contribute a commentary to preface the papers in the MSSE supplement. The invitation to comment was motivated by concern expressed by a group of students and their faculty instructor in a kinesiology department at an R1 institution in the United States who read the HERITAGE study protocol paper as part of a course. These individuals found the paper’s language to be racist and insulting to people who value racial diversity in research and in society as a whole. ACSM’s leadership decided to be proactive in prefacing the current supplement by addressing concerns about the description of Black families in the original paper and the potential of this supplement to reinforce negative stereotypes about Black people.

Approaching this topic took careful consideration in order to celebrate the knowledge produced by this rigorous and historic research, coupled with the stellar reputations of the scientists who delivered this work, while recognizing the problematic language in the original paper. We invited two other contributors, a biological anthropologist who studies primate and human evolution (Nina Jablonski), and another exercise physiologist who uses human and cell models to focus on vascular health in Blacks (Michael Brown), to join us in authoring this paper.

In our commentary, we acknowledge and celebrate the many contributions of the HERITAGE study while drawing attention to the fact that language in the original paper could add to the historic harm that Blacks have experienced in science and practice. We cite examples of two historic incidences in research and medicine that led to many Black people’s unwillingness to participate in scientific investigations based on their mistrust and concerns about their treatment by health care systems and providers, as well as researchers. The commentary indicates that over the 25 years since the HERITAGE study, society has witnessed myriad accomplishments in research and medical practice. We must never lose sight of the accomplishments in social justice, diversity, equity and inclusion within our professions. We must also continue the ethical imperative that everyone persists in implementing these important features while designing, conducting and disseminating research and delivering quality clinical care.

NiCole R. Keith, Ph.D., FACSM, is a research scientist in the Center for Aging Research, a Regenstrief Institute Investigator, a professor of kinesiology and the associate dean of faculty affairs in the School of Health and Human Sciences at Indiana University-Purdue University in Indianapolis, Indiana. She was the 2020-21 president of ACSM. Dr. Keith addresses heath equity by researching methods through which physical activity can positively influence the health outcomes of individuals who are underrepresented minorities as well as those who reside in socioeconomically challenged communities.

W. Larry Kenney, Ph.D., FACSM, FAPS, is the Marie Underhill Noll Chair in Human Performance and professor of physiology and kinesiology at the Pennsylvania State University. Dr. Kenney studies human responses to exercise, heat and cold stress, and dehydration as well as the biophysics of heat exchange between humans and the environment. He served as ACSM president from 2003 to 2004. He is also the primary author of Physiology of Sport and Exercise, a bestselling textbook in exercise physiology now in its eighth edition.

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily represent ACSM positions or policies. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for SMB.

Physical activity improves both physical and cognitive health, especially among older adults. Cognitive health encompasses many aspects of our daily functioning: memory, maintaining attention and concentration, dealing with distractions, solving problem and making decisions. Those cognitive functions tend to decline as we age, and physical activity can greatly prevent cognitive decline. For example, a meta-analysis has shown that adults participating in higher levels of physical activity had a 38% lower risk of cognitive decline in follow-up years. For low to moderate activity, there is still a 35% lower risk of cognitive decline. So, the message is simple: any physical activity can help. No need to lift heavy weight at the gym or run marathons to reap the benefits. For those looking at a more specific program that could be done at the gym, an example could be five to seven movements at 60-80% 1 RM, two sets, with two minutes rest, twice a week. For older adults with more limited mobility, some exercise with resistance band, or/and with a chair can be helpful. Aging is also associated with arthritis, so doing exercises that require fine motor skills with fingers can help maintain finger joint function. This is especially important for being able to grab and manipulate small objects such as silverware or a pen or opening a water bottle. Ideally, an exercise program for older adults should include some aspects of aerobic and resistance training, along with balance exercises to prevent falls.

Studies with older adults have shown that physical activity specifically impacts executive functions. Executive function refers to processes that control, direct and coordinate other lower cognitive processes and goal-directed behaviors associated with the frontal lobe. Examples of tasks requiring executive function include scheduling, inhibition, planning, working memory, problem solving and task switching. Those skills are critical for the activities of daily living, and this is why physical activity can help prevent cognitive decline and promote healthy aging.

How does exercise impact cognitive functioning? Mechanisms are still being investigated but the main ones with empirical support include improvements in cardiovascular function and the associated influence on the cerebrovascular system, reduction in stress and anxiety, reduced inflammation and improved insulin sensitivity. When focusing on the brain, molecular and cellular mechanisms are the two main explanations for improved cognitive functions. Regarding molecular mechanisms, being physically active increases brain-derived neurotrophic factors, which regulates synaptic plasticity and memory. Exercise also alleviates growth factors such as insulin-like growth factor and vascular endothelial growth factor, important for vascular health. Exercise also improves cognitive functioning via cellular mechanisms. Specifically, exercise promotes neurogenesis (development of new neurons) and synaptogenesis (formation of synapses). Those molecular and cellular benefits are also associated with neuroelectric changes. Indeed, it appears that increased fitness and greater participation in long-term exercise is associated with a larger P300 amplitude (more attention resources) and shorter P300 latency (faster information processing), but more studies are needed to provide more definitive recommendations.

What activities should be considered for older adults? Any activity that is safe and enjoyable. This could include walking, gardening, dancing, swimming, biking or any other activity that gets them moving. The best activity is the one that is enjoyable, and often doing it with other people helps to make it more fun. Being active with others also helps with cognitive benefits and mood as social interactions are important for healthy aging. If you cannot find anyone to exercise with, walking your dog could also be a good way to make yourself accountable and integrate physical activity in your daily routine.

Jean-Charles Lebeau, Ph.D., CMPC, is an assistant professor of sport and exercise psychology in the School of Kinesiology at Ball State University. He is also a Certified Mental Performance Consultant^® through the Association for Applied Sport Psychology.

If you or someone you know is managing a mental illness, then you or they are not alone. Many Americans struggle with mental illnesses. Almost one in five adults live with a mental illness (52.9 million in 2020). Mental illness is defined by the National Institute of Mental Health as a mental, behavioral or emotional disorder that can vary in impact from mild to severe. Mental health problems are equal opportunity, regardless of your race, gender, age, income or education, mental illness can affect all of us. Exercise has been shown to positively affect mood, quality of life and overall mental health. This can include walking around the block, giving your body a good stretch or even doing some pushups or squats. The intensity can vary as well—just the act of movement can have profound effects!

Certain vulnerable populations are at even greater risk for having poor mental health or mental illness. Pregnant women, cancer patients, inmates and substance users are groups that are likely to have mental health struggles and lower levels of physical activity. These groups do not often receive the attention that is warranted.

The World Health Organization (WHO) acknowledges that 10-16% of pregnant women and 13-20% of postpartum women experience mental disorders. Pregnant women can suffer from mental health issues including depression, anxiety or bipolar disorder. When these illnesses are severe enough, they can lead to negative pregnancy outcomes. These can be a result of low social support, a history of depression or anxiety, life stress, unintended pregnancy or intimate partner violence. Pregnant women can improve their mental health by adding exercise into their routine. Exercise has also been shown to lower rates of antenatal depression and anxiety.

The number of cancer patients dealing with psychological disorders is high, affecting approximately 33%. Rates of major depressive disorder in cancer patients are thought to be up to three times as high as the general population. Cancer patients can experience depressive symptoms because of their diagnosis. Life may look bleak, or patients might be overcome with despair following this traumatic news. For these reasons it is even more important that their mental health needs are met. Just participating in leisure time physical activity has been shown to increase well-being, mental health and overall outlook on life.

Prison inmates may also be more prone to dealing with mental health struggles because of their incarceration. High rates of mental illness are seen in this population, with a study showing that 64% of jail inmates, 54% of state prisoners and 45% of federal prisoners reporting mental health concerns. A survey showed that structured exercise within the prison population reduced rates of depression, anxiety and hostility scores.

Unfortunately, substance use and mental disorders can go hand and hand. Numerous national surveys found that about half of those who abuse substances will also experience a mental illness during their lives, and vice versa. There is a high co-occurrence of substance use and anxiety, depression, bipolar disorder and borderline personality disorder. This overlap is concerning. Research suggests that physical activity programs and even mind-body programs can positively effect depression, anxiety, stress and even cravings.

If you don’t know where to start, getting the heart pumping doing some aerobic activity and resistance exercise you enjoy has been shown to be associated with lowered depression and anxiety levels. Jogging, swimming, cycling, walking, gardening, lifting weights, playing sports and dancing can all have an impact on improving your mental health. ACSM, the CDC and WHO recommend cancer patients, pregnant women and general population adults get at least 150 minutes of moderate-intensity aerobic physical activity each week. Aerobic activity has also been shown to reduce drug cravings, depression, anxiety and increase drug withdrawal rate among drug users. Lastly, prison inmates should be getting one hour of physical activity a day, five days per week. Most importantly, this should include outdoor recreation and sport activities, which can help to eliminate feelings of hopelessness and increase social opportunities which can lead to better mental health. Mind-body exercises such as yoga and meditation can have profound effects on our mental states. In addition to the benefits of the yoga movements that include creating a more positive mood and increasing endorphins, yoga can strengthen connections in your brain that allow you to have better memory, attention, awareness, thought and language. Yoga can also be an effective long-term remedy for depression and anxiety.

During Mental Health Awareness Month, we should take some time to remember how life stressors can affect us all differently. Take some time for self-care and to care for and support one another. Keep in mind those who are in challenging situations and how their mental health can be affected. Even though someone may not feel comfortable talking about their mental health, doesn’t mean they aren’t facing challenges.

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Jordan Taylor, MPH, is a graduate from The University of Memphis with his bachelor’s in psychology and master’s in public health. He is a member of the ACSM Leadership & Diversity Training Program and currently works as a fitness coach in Memphis, TN. Jordan has a passion for helping people achieve their best selves physically, emotionally, and mentally through health and fitness.