After two years away, we’re thrilled to be back in person this year in beautiful San Diego, California. It will be wonderful seeing colleagues filling the lecture halls, exploring the posters, viewing the exhibits and gathering for networking.

Featuring both on-site and online programming, the 2022 ACSM Annual Meeting, World Congress on Exercise is Medicine and World Congress on the Basic Science of Exercise and Vascular Health showcases the latest in exercise science and sports medicine.

The in-person program offers 200+ hours of education, with 30.75 CME/CEC credits, 1,800+ scientific abstract/clinical case presentations, networking events, exhibits and more. Over 50 hours of recorded live sessions will be available on the on-demand online program starting June 13, with 90-day access.

Highlights for the meeting include:

• Opening keynote — Joseph B. Wolffe Memorial Lecture delivered by Karin Pfeiffer, Ph.D., FACSM, on “The ABCs of Movement in Early Childhood: Building Blocks for Lifetime Physical Activity”
• D.B. Dill Historical Lecture on “50 Years of Title IX: View through the Eyes of Athlete Turned Orthopaedic Surgeon” presented by Mary Lloyd Ireland, M.D., FACSM
• The Integrative Plenary Lecture on “Team-Based Approach to Treating an Injured Athlete: Integrating Basic Science, Clinical Care and Coaching to Successfully Return an Injured Athlete to Competition” by Kevin R. Vincent M.D., Ph.D., FACSM

Check out the other named lectures, as well as all of the additional outstanding lectures being offered this year.

Our 2020, 2021 and 2022 honor and citation awardees will be recognized during the Friday evening banquet. Be sure to congratulate them as you see them throughout the week.

On behalf of the entire program committee, I hope to see you next month in San Diego and online. Check out your registration options. 

Anastasia Fischer, M.D., is a member of the Division of Sports Medicine in the Section of Ambulatory Pediatrics at Nationwide Children’s Hospital and is a clinical associate professor of pediatrics at The Ohio State University College of Medicine. Dr. Fischer obtained a master’s degree in exercise physiology at the University of Georgia before attending medical school at The Ohio State University College of Medicine. She then completed a family practice residency at University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, and a primary care sports medicine fellowship at Maine Medical Center in Portland, Maine. Dr. Fischer is the current president-elect of ACSM.

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.

Two hot topics for athletes (and anyone interested in feeling/performing their best) right now are mental health and heart rate variability. For mental health awareness month, let’s talk about both!

Mental performance and mental health exist on a continuum, and there’s frequent discussion in the world of sport psychology about distinctions, but one’s performance can impact their mental health and vice versa. An athlete may be so consumed with winning that impacts of performance anxiety bleed from hindered performance, and into general well-being. A soldier with PTSD might be unable to perform when it matters most. And a business executive may feel that they have to be “on” so frequently, that stress leads to obsessiveness, control issues, irritability and even depression. Examples of mental performance and mental health cross-over are limitless. By some estimates, one in five adults face mental health concerns in their lifetime and by other estimates, one in five adults face mental health concerns in a given year.  In June of 2020 (during the pandemic), one estimate indicated that 40% of adults reported struggling with mental health or substance use, and by some recent accounts there is now a mental health crisis among teens. When mental health and/or performance suffers, heart rate variability (HRV) tends to be low; alternatively, higher HRV tends to be associated with reduced symptomology of depression or anxiety, improved cardiac functioning and better situational awareness.

People often say things like, “heart rate variability? Mine is pretty good, usually under 60 or 70.”  However, they’re referring to heart rate (the number of times our heart beats in a minute). Heart rate variability (HRV) is a little bit different. With HRV, we are looking at how much the heart rate accelerates and decelerates, and whether or not fluctuations are rhythmic. While lower heart rate is often a good sign of cardiovascular functioning, higher HRV is a good indicator of both physical and psychological health. There are several ways to measure HRV; sport physiologists often use one metric to optimize training load (i.e., should I train hard today, go light or take a day off?). Psychophysiologists or performance psychologists may tap into other metrics to optimize stress management.

Through paced breathing and through stress management techniques, we can elevate heart rate variability. It’s like doing a workout to strengthen the vagal nerve, impacting nervous system functioning, to allow the sympathetic nervous system (“fight or flight”) to work in harmony with the parasympathetic nervous system (“rest and digest”). It also strengthens the baroreflex (responsible for blood pressure stabilization). In training HRV, the ups and downs in heart rate appear like a sine wave, whereby a rise in heart rate coincides with inhaling and decreases align with exhales; this is called respiratory sinus arrhythmia.

As you can see in the illustration, achieving respiratory sinus arrythmia (RSA) boosts HRV (the difference between max and min heart during rest or recovery). We can take this a step further, achieving RSA and maximizing the difference between peaks and valleys, by systematically determining one’s resonance frequency (RF).  Simply put, this is the pace of breathing where HRV is maximized (according to max-min plus other HRV metrics).  You can determine this with a biofeedback practitioner, and/or increasingly there are apps that will do this for you if you have a heart rate monitor. It can be worth it to go the distance to determine your exact RF rate, but most people tend to have an optimal breath rate in the ballpark of six breaths per minute, meaning: four second inhale and six second exhale. There are simple breath pacer apps that will help you pace your breath exactly, so you can utilize this science-based approach rather than jumping on the latest breathing fad. And if you want to take your breathing regimen to the next level, allow it to be mindful paced breathing.

The next time you feel pulled to be supportive in response to another’s mental health or mental performance concerns by saying something like, “relax, take a deep breath,” consider the following tweak to your thinking/approach:

Mental health and mental performance concerns are common, especially now. Always err on the side of caution. Normalize struggles and validate feelings rather than jumping straight into “fix it mode.” Once they feel some empathy (or self-compassion, if it’s you!), allow your wording to incorporate HRV science. Say, “allow yourself to have a nice long exhale.”  If the person you’re speaking with is intrigued, maybe suggest breathing with four second inhales and six second exhales, and perhaps even point them towards a breath pacer or a means of learning their more precise resonance frequency.

Access Mental Health Resources

Tim Herzog, Ed.D., LCP, CMPC, BCB, is a licensed mental health provider in Maryland, Virginia, Pennsylvania, Rhode Island, Florida and Montana. He works with athletes nationally and internationally, and his practice, Reaching Ahead, is located in Annapolis, MD. Herzog is a Fellow with the Association for Applied Sport Psychology and serves on the organization’s Ethics Committee. He is a Certified Mental Performance Coach (CMPC), is listed on the USOPC Sport Psychology (2012 to present) and Mental Health (2021 to present) Registries and is Board Certified in Biofeedback (BCB). Mindful of the power of relationships, he conducts evidence-based practice, pulling from Cognitive-Behavioral Therapy, Acceptance and Mindfulness based approaches, Psychodynamic Psychotherapy and Interpersonal Process. Herzog also pulls wisdom from his years of coaching, notably having served as Head Coach of the Boston College Sailing Team 2001-2002, when the team placed 5th at ICSA Co-Ed Nationals and received 4 All-American honors (more than ever prior in BC history).

In this series, we’re exploring a variety of client scenarios. We describe a few tips from my science-based coaching toolbox to help you help your clients engage fully in a fit lifestyle that allows them to thrive, whatever thriving means in their lives.

Today, we explore how to coach a client whose work responsibilities bring increased stress, leading to unhealthy food choices and overeating. First, let’s explore how stress leads to poor health choices. The brain’s region for self-direction, self-control, self-management and self-coaching is the prefrontal cortex (PFC), behind our foreheads (the red area in the embedded picture), which could be described as the CEO of the brain. The PFC at its best appreciates and deftly manages our negative emotions and drives our attention and focus so we are calm, organized, creative, wise, strategic and productive.

The conditions that enable optimal function of the prefrontal cortex include a calm, positive and energetic mindset supported by a healthy, fit, well-nourished and well-rested body. When we are tired, stressed, unfit and poorly nourished — when our emotional weather report is cloudy — the PFC is impaired. It struggles to stay in control and on top of distractions and impulses, and stay focused on doing a good job on the task at hand.

A calm and energetic PFC can:

• Set the feeling of being overwhelmed aside to focus on the task at hand;
• Stay focused on meaningful goals and a higher purpose, resisting temptations that are in fact “error” messages;
• Recognize that cravings (checking texts, junk food, etc.) and negative emotions fade away like clouds in the sky;

• Be self-compassionate and not indulge the inner critic;
• Find the positive silver linings in stressors and negative emotions, thoughts and events; and
• Detach from a negative emotional weather report to get a strategic perspective. (“Maybe I’m overreacting …”).

A depleted PFC is hijacked easily by:

• A feeling of being overwhelmed caused by a daunting to-do list;
• Cravings for “addictive” foods and drinks;
• The negative self-talk of a mean inner critic, triggering the inner rebel to make an unhealthy choice;
• A negative emotional weather pattern, clouding the ability to notice and savor positive moments; and
• An overdose of stress, leading us to feel out of control.

How can you help your clients improve the function of the PFC and stay confidently in control, happily making healthy choices? Be a great role model, and suggest they experiment with one or more of the following to discover what combination of habits works best:

• Drive. Create a compelling vision and goal for the moment, the day, month or year (e.g., to radiate energy and health) to bring to mind at the moment you have a choice to make, dozens of times each day. Design the vision and goal (e.g., picture, poem or statement) so that it energizes you when you recall it and inspires you to make a healthy choice most of the time.
• Exercise. Over time, regular exercise leads to a strengthening of the PFC and its capacity to manage negative emotions and stress.

• Brain breaks. Take brain breaks where you allow your mind to wander, or move your mind’s attention to your heart through deep breathing — or move your muscles through a few stretches or strength exercises. Even two to five minutes of walking, stair-climbing or yoga will refresh the PFC. Nothing is better than a good night’s sleep, or even a catnap, to hit the PFC’s reset button.
• Self-compassion. Turn your inner critic into your inner friend. Be kind to yourself. Negative self-talk is particularly depleting.
• Mindful practices. Take deep breaths or do short meditations to unhook the mind from the frenzy of out-of-control thoughts and emotions. Create mental pauses when making decisions about eating and exercise to give the PFC a moment to get back into the driver’s seat. Regular meditation also improves PFC function over time.
• Savor and cultivate positive emotions. Positive emotions were designed to be fleeting, like butterflies, in contrast with negative emotions, which move lightning fast and stick like Velcro. Positive emotions improve cognitive function, in contrast with the impairment caused by negative emotions. Cultivate positive emotions (check out your ratio at positivityratio.com) so that you have the cognitive resources to manage or overcome the negative in your life.
• Connect with people you care about. The most powerful positive emotions “lighting up” our brains are those we share with others. Express gratitude for someone’s contribution to your life, do something nice and unexpected for someone, or harvest and celebrate what’s going well with people you care about.

• Nourish your brain. Feed your brain a nice steady dose of glucose, enabled by a good balance of lean protein, healthy fats and complex carbohydrates. A well-nourished brain is a brain that wants to make healthy choices.

Thankfully, the field of neuroscience has caught up with the mind/body practices. Here’s to a world full of high-functioning prefrontal cortexes — calm, positive, energetic, healthy, fit, well-nourished and well-rested.

More content from Wellcoaches:
How Coaching Works: Exclusive Script
How Coaching Works for the Exercise Professional

The majority of adolescents aged 11–17 years are insufficiently physically active globally, with differences found across sexes and countries. In addition, time spent using digital media, a common sedentary behavior, has increased and sleep duration has decreased among youth in recent decades. Simultaneously, the prevalence of depressive and anxiety disorders has increased among adolescents in many countries.

Achieving higher levels of physical activity, lower levels of sedentary behavior, better sleep quality, adequate sleep duration and shorter sleep latency associate with better mental health and wellbeing among adolescents. Cross-sectional studies often assume movement behaviors represent the causal factor, that is, they affect mental health. However, the association may also be reverse; adolescents with poorer mental health may be less likely to engage in favorable behaviors. For example, a study by Gunnell et al. examined bidirectional relationships between physical activity, screen time and symptoms of anxiety and depression over time during adolescence. They found that greater initial symptoms of depression predicted greater decreases in physical activity, but no other relationship between physical activity, screen time and anxiety or depression were detected.

Despite widespread public attention to the assumed negative consequences of digital media use on mental health, existing research evidence among young people is primarily cross-sectional. In addition, many existing studies do not differentiate between different types of digital use, such as between active use (participatory media use, e.g., chatting, messaging and liking) and passive use (media consumption, e.g., viewing programs), although different types of digital media use may be differentially associated with mental health, and recent studies have questioned the use of total screen time.

Research on movement behaviors, including physical activity, sedentary behavior and sleep, has traditionally concentrated on examining individual behaviors and their associations with health. Current research, however, is moving towards identifying different combinations of these behaviors, which may have important implications for health already during childhood or adolescence. A person-oriented approach seeks to identify unique latent groups within a population, and focuses on profiles across characteristics to describe a certain phenomenon. Recent studies using this approach in movement behavior research have identified several distinct profiles or patterns indicated by sedentary behavior and physical activity among children and adolescents.

The relationship between different combinations of movement behaviors and mental wellbeing among youth remains relatively unstudied until recently. In their two recent studies, Brown et al. identified four distinct movement behavior profiles among adolescents and observed that a profile characterized by high amounts of physical activity and low amounts of digital media use was consistently associated with the highest levels of current mental wellbeing and with lowest depressive symptoms, both currently and one year later. Further, Brown and Kwan showed that replacing 60 minutes of screen time with either moderate-to-vigorous physical activity or sleep associated with better self-esteem and resiliency among adolescents.

In our very recent longitudinal study, we first wanted to examine behavior profiles indicated by leisure-time physical activity and different types of digital media use (active and passive use, gaming and bedtime delay because of digital media use) among 1,500 15-year-old Finnish adolescents. We identified four different behavior profiles. About 30% of adolescents belonged to the “healthiest” behavior profile characterized by moderate digital media use and high physical activity, whereas 23% belonged to the “unhealthiest” behavior profile characterized by high passive digital media use and gaming with low physical activity. Secondly, we wanted to examine whether mental health indicators assessed at 11 years of age predicted belonging to these behavior profiles four years later. After taking into account confounding factors, such as physical activity and digital media use at 11 years of age, symptoms of depression or anxiety did not associate with later behavior profiles. However, higher amount of physical activity and better perception of athletic competence among the 11-year-olds predicted belonging to any other profile than to the “unhealthiest” profile characterized by high passive digital media use and gaming and low physical activity.

Our results suggest that physical activity and related self-esteem may be stronger predictors of future physical activity and digital media use behavior during adolescence than mental health symptoms alone. At present, relatively little is still known about how digital media use, physical activity and sleep behaviors interact among adolescents, or how the interplay of these behaviors and mental health relate with each other over time. Hopefully this area of research will receive further attention to deepen our understanding on the direction of the relationship between movement behaviors and mental health among children and adolescents.

More Mental Health Research & Resources

Elina Engberg, Ph.D., is a postdoctoral researcher and project leader of the SUNRISE Finland Study. She is a member of ACSM's Psychobiology and Behavior Special Interest Group.

During strenuous exercise, the neuromuscular system is repeatedly stressed, causing impairments to occur at various potential sites along the brain-to-muscle pathway. These perturbations cause a reduction in the ability of our muscles to generate force, which can increase our sense of effort, cause us to slow down and reduce our capacity to perform high intensity exercise. There are, globally, two primary causes of this “neuromuscular fatigue.” First, voluntary activation of the muscles by the nervous system can be reduced. Second, contractile function, or the muscle’s intrinsic ability to respond to neural input, can be reduced owing to perturbations occurring within muscle cells. Using neurostimulation methods, the contribution of both the nervous system and muscle to reductions in maximal muscle force-generating capacity can be measured.

In recent years, research has focused on how the characteristics of the aerobic exercise we perform, such as the intensity and duration, influence neuromuscular fatigue and its mechanisms. However, research focused on how the modality of exercise influences the magnitude and mechanisms of neuromuscular fatigue is lacking.

In our study, published in the May 2022 issue of Medicine & Science in Sports & Exercise_®, we compared the effects of the two most common types of whole-body dynamic exercise, running and cycling, on neuromuscular fatigue. To do so, we recruited 17 males trained in both endurance running and cycling, and had them perform running and cycling at a matched intensity (105% of the gas exchange threshold) and duration (three hours) using a crossover design. Neuromuscular function was assessed in the right knee extensor at pre-, mid- and post-exercise, and included isometric maximal voluntary contraction force, voluntary activation, contractile function and alpha-motoneuron excitability.

Our results demonstrated that the magnitude of the decrease in maximal force-generating capacity of the knee extensors was similar between the two modalities. Specifically, maximal force was reduced by ~ 25% following both cycling and running. However, the mechanisms contributing to this force loss were distinct between cycling and running. Specifically, the reduction in muscle force in response to cycling was primarily due to mechanisms residing within the muscle. In contrast, the reductions in response to running were due almost exclusively to impairments in the capacity of the nervous system to activate muscle, concurrent with greater reductions in motoneuron excitability. These results can likely be explained by differences in the mechanical and metabolic demands imposed on the quadriceps during the respective exercise modalities.

An interesting finding was that, despite a substantial reduction in force-generating capacity, contractile function of the quadriceps was well preserved following three hours of running. This emphasizes the important role of the nervous system in contributing to neuromuscular fatigue, with the substantial loss in motoneuron excitability indicating that spinal mechanisms might have been implicated. Moreover, the limited change in contractile function in response to running indicates low metabolic stress. As exercise-induced peripheral adaptations occur in response to the degree of local perturbation, this result has potential implications for adaptations to running and cycling. Our results highlight the importance of aerobic exercise modality in determining the causes of neuromuscular fatigue. 

Callum Brownstein (@CGBrownstein), Ph.D., is a postdoctoral researcher at Jean Monnet University (Saint Etienne, France). He completed his Ph.D. at Northumbria University (Newcastle, U.K.), where he assessed recovery of neuromuscular function following high-intensity intermittent exercise. His current research focuses on the acute integrative response to whole-body exercise in athletes, healthy active populations and clinical populations, with a focus on neuromuscular perturbations.

Guillaume Millet (@kinesiologui), Ph.D., is a professor of exercise physiology at Jean Monnet University (Saint-Etienne, France). After graduating from the University of Franche-Comté in 1997, he held various positions in Dijon, Saint-Etienne and Grenoble. Between 2013 and 2018, he was professor in the Human Performance Laboratory and the Faculty of Kinesiology at the University of Calgary (Canada) where he led a research group on neuromuscular fatigue. In 2019, he was named a senior member at the Institut Universitaire de France. His general research area investigates the physiological, neurophysiological and biomechanical factors associated with fatigue, both in extreme exercise (ultra-endurance) and patients (neuromuscular diseases, cancer, multiple sclerosis, ICU).

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.