The ACSM Foundation awards several grants each year to student and early career professional members who are conducting research in the fields of exercise science and sports medicine. One of those grants is the World Athletics Research Grant, funded by the World Athletics Federation, one of the most globally influential sport governing bodies. The $5,000 grant is made available to a doctoral student whose research proposal is in the area of physical activity, training and human performance relative to athletic events.

The recipient of the 2020-2021 World Athletics Research Grant is Amadeo Salvador, for his research, "Identifying the ideal carbohydrate intake dose for wheelchair marathoners." Learn more about Amadeo and his research:

Have an ACSM certification? Feel confident in performing health and fitness assessments and prescribing the soundest of exercise prescriptions for your clients? These are a must but these alone won’t keep clients sticking around for the long haul. It is your approach that you take with clients at each and every session that will.

1. Connection. Connection. Connection.

Building a level of trust and rapport with your client as they embark on this journey with you is vital to the relationship forming and sticking. Clients want to be listened to and understood and will continue to expect this from you during every session. Demonstrating empathy toward your client will help you to best connect with them for the long-term and will leave your clients feeling taken care of and satisfied. In addition, practicing mindfulness (being present in the moment) when working with your clients is an assured way of connecting with them and meeting them where they currently are.

2. Use Effective Connection Skills.

An active approach to demonstrating empathy and connecting with your clients works best when you choose more open-ended questions, use reflective listening statements and affirmations, and are cognizant of your non-verbal/body language.

• Open-ended questions consist of starting your question words like “how, what, why, who, tell me about, describe to me…” versus close-ended questions like “did you, have you, are you, can you…” This gives the client the platform to tell you their story and allows for more information to come your way so you can better understand their perspective.
• Reflective listening statements are not questions but are statements back to the client that paraphrases what you just thought you heard them tell you. These are great connectors!
• Affirmations are statements intended to give your client a confidence boost and encouragement after they have told us information that is moving in the direction of positive change (or even when they tell you good news).
• Non-verbal/body language includes making eye contact, sitting/standing squarely to the client with an open posture, nodding and smiling.

3. Get to Know Your What Motivates Your Client.

It’s a good idea to use these connection skills to learn what is motivating your client to begin exercising or to keep exercising and why they want to work with a personal trainer. A person who is intrinsically motivated continues to engage in an activity over time because it is what they WANT to do. Listen for the “I want to…” statements as these will be the indicators for the longest lasting form of motivation to continue their exercise pursuits.

4. Provide a Successful Experience for Your Client.

Once you've established the client's WANTS, it is important that you have the client create a vision statement and collaborate with them to set both long-term (outcome) goals and short-term (weekly task) goals. A vision statement is more general in nature and says what the client wants overall. Long-term and short-term goals should be specific, measurable, achievable, action-based, realistic, timely and self-determined (based upon what they WANT). These goals then work toward upholding the client’s vision statement. Too often, what the client wants hasn’t been identified, goals do not match the WANTS and there is not a collaboration of setting goals. This can lead to unsuccessful experiences for your client. Another important feature in setting goals is to ask your clients if they are ready, willing and able for each of the goals that you help create with them. If one or all of these three personal rulers is off, this is a good time to discuss with your client why they do not feel ready, willing or able regarding that goal. This could signal that your client is unsure or has mixed emotions (ambivalence) about their goals. 

5. What to Do when a Client is Hesitant or Not Progressing.

If you find your client is ambivalent about the exercise plans you co-created with them or perhaps they are not progressing with their exercise goals, it’s time to go back to the drawing board and determine what is causing their hesitancy. Use your connection skills to allow your client to open up to you and describe what is halting their exercise plans or actions. It could be a number of things like confusion, uncertainty or a life event. You shouldn't assume what the source is. Once you and your client have had this discussion, you will need to reformulate your collaborative plan. Revising long-term and/or short-term goals may be in order. Having a better understanding of their perceived supports and barriers will help both you and your client identify cues and triggers. Talking with your client about strategies for possible setbacks related to them reaching their goals is also helpful.

Related links:
Free, downloadable handout | How to Select the Right Personal Trainer
Book | ACSM's Resources for the Personal Trainer
Book | Coaching Psychology Manual


Mindy Hartman Mayol, Ph.D., ACSM EP, is an associate professor of kinesiology at the University of Indianapolis. She is a member of ACSM’s ad hoc Certification-Related Content Advisory Committee. Her teaching and scholarly interests include sport, exercise and health behavior, motivation, coaching psychology and multi-dimensional wellness. She also published an eBook focusing on multi-dimensional wellness for emerging adults.

Technogym and ACSM recently hosted an industry-presented webinar with Sheri Colberg, Ph.D., FACSM, entitled The Role of Physical Activity in Type 2 Diabetes Management and Prevention.

 

---

One Continuing Education Credit (CEC) is available as part of this webinar.

To earn your CEC, you will view the course content, pass the quiz (you must earn 70% or better to pass), and print your certificate of completion.

Learn more here

---

 

Q: Can you speak to the ability or inability to “cure” T2D? Does it have to do with the loss of the pancreatic beta cells?

A: Yes, it has generally been shown that new-onset type 2 diabetes is easier to “reverse,” meaning that blood glucose levels can be so well managed that it appears diabetes has been cured. Over time, a loss of some insulin-making capacity occurs in people with long-standing T2D, particularly if it has not been well-managed, related both to the impairment of pancreatic β-cell function and the decrease in β-cell mass. (PMID: 27615139)

 

Q: Isn't insulin resistance now found to be in T1DM as well?

A: Yes, anyone can develop insulin resistance, and it occurs in at least a third of people with type 1 diabetes as well, although it is not always associated with excess weight gain or overweight. Since people with T1D lack insulin due to the body’s own immune system killing off the pancreatic β-cells, greater resistance increases the total doses of insulin needed (whether injected, pumped, or inhaled). Thus, they have developed characteristics of both types and have “double diabetes.” (PMID: 34530819)

 

Q: Under lifestyle goals, would you include stress management?

A: Stress management was not assessed in the large multi-center clinical trials on type 2 diabetes prevention, but mental stress can certainly raise blood glucose levels due to the greater release of glucose-raising hormones like cortisol and adrenaline. It certainly would be beneficial to address better ways to manage mental stress as part of lifestyle goals for optimal blood glucose outcomes. (PMID: 29760788)

 

Q: As each person has their own limitations how important is it to get a physician clearance and exercise guidelines before working with the client?

A: It really depends on the person’s circumstances. How intense will the planned activities be? Is the person currently sedentary? Has he/she been getting annual checkups to monitor blood glucose management and to check the status of any complications? Does he/she have diabetes-related or other health complications that could be worsened by physical activity? The lower the intensity, the more active an individual has been, and the lower the risk for cardiovascular complications, the less likely medical clearance is absolutely necessary.

The latest ACSM Consensus Statement on activity and T2D will be released in early 2022 in Medicine & Science in Sports & Exercise and states, “For most individuals planning to participate in a low- to moderate-intensity physical activity like brisk walking, no pre-exercise medical evaluation is needed unless symptoms of cardiovascular disease or microvascular complications are present. In adults who are currently sedentary, medical clearance is recommended prior to participation in moderate- to high-intensity physical activity.”

 

Q: Can flexibility training be used for warmups, or do you recommend it only after the workout?

A: While it is possible to do flexibility training at any point during a workout, joints tend to have a greater range of motion after blood flow to those areas has been increased with a light or short aerobic warmup. It may be prudent to do a quick aerobic warmup, some stretching, the full workout, and then more extensive stretching afterwards for optimal results.

 

Q: Was there any particular protocol for strength training? sets, reps, periodization? What is considered "intense" resistance work? Would fatigue based off of several sets of moderate intensity be recommended then?

A: That is a tough question, and it depends on who you ask. I have seen a lot of debate over the optimal strength training protocol during the many years I have been in the exercise/fitness world. If people are just starting out with resistance training, they will gain from doing even a minimal amount of training.

Starting out with 1-3 sets of 8 to 10 main exercises that work all of the large muscles groups at a light to moderate intensity is considered appropriate for most older or sedentary adults, many of whom have joint limitations or health issues. Moderate intensity is considered 50%-69% of 1-RM (1 repetition maximum) and vigorous is 70%-85% of 1-RM. Both intensity (fewer reps at a higher intensity) and the number of sets (3-5) or days of training (starting at 2, progressing to 3 nonconsecutive days) can increase over 2 to 3 months. Periodization is usually not undertaken by older adults, but may be appropriate for younger, fitter ones.

 

Q: Do you have any insight or are aware of any studies that involve high intensity (%1-RM) resistance training and T2DM? Or any studies that compare resistance training volume (Sets x Reps x Load)?

A: Some older studies have determined that glycemic management is improved by supervised high-intensity resistance training in people with type 2 diabetes (PMID 12351469). Others have also found that home-based (and, therefore, unsupervised) resistance training results in a lesser impact on blood glucose levels, likely due to reductions in adherence and exercise training volume and intensity (PMID 15616225).

 

Q: I'm still confused about glucose response to acute exercise. Which is better if you want to bring down your BG right now? Can you speak to the possibility of increased blood sugars with intense aerobic exercise?

A: Most light-to moderate-intensity aerobic exercise will lower blood glucose levels, assuming that some insulin is present in the body. (People who are very insulin deficient may have a rise in blood glucose from doing any activity.) Any activity that gets up into the intense/vigorous range, even if only during occasional intervals, has the potential to raise blood glucose due to a greater release of glucose-raising hormones during the activity. This is particularly true if the activity is short and intense. In individuals with any type of diabetes, declines in blood glucose during high-intensity interval exercise are smaller than those observed during aerobic exercise.

That said, if someone wants to lower blood glucose right now with exercise, it also depends on the timing of exercise. Doing something light to moderate for at least 10 to 30 minutes is the best bet, particularly after a meal when insulin levels are generally higher. Avoid doing intense aerobic or heavy resistance training as those may have the opposite effect. For early morning exercise, any intensity can potentially raise blood glucose due to higher levels of insulin resistance then and lower circulating levels of insulin in the body.

 

Q: I had an endocrinologist say that long runs or walks are better, and another one said to do a bit of weights.

A: Which activities someone chooses to do should depend on the goal of the training. Is it increased fitness, lowering blood glucose levels acutely, or gaining strength and improving overall blood glucose management? Long, slow aerobic training does have the benefit of increasing cardiorespiratory fitness and lowering blood glucose levels (in most cases). Resistance training, on the other hand, increases muscular strength and endurance and helps people gain and preserve muscle mass, which is where most carbohydrates are stored in the body. It may not, however, lower blood glucose levels, at least not acutely.

Both have their place in a weekly training regimen. Insulin resistance is lowered for 2 to 72 hours following a bout of aerobic training. Resistance training has more of a long-term impact on insulin action by enhancing carbohydrate storage capacity. The best advice is to do some aerobic training at least every other day and some resistance training at least 2, and preferably 3, nonconsecutive days per week. These activities can be done on the same days or different ones.

Muscle strength refers to the ability of the muscles to produce maximal force. One assessment method is to measure handgrip strength, which involves the maximal isometric force of the finger flexors using a handheld device. Handgrip strength is a convenient, reliable, valid and safe measure that is an important indicator of general health and sports performance. For example, low adult handgrip strength is associated with an increased risk of early death from all-causes and cause-specific chronic conditions such as heart disease. It is also associated with performance in sports requiring gripping and force application like hockey, weightlifting and wrestling. These reasons help explain why handgrip strength is widely used in clinical, health/fitness and sport settings, as well as for population health surveillance.

Using handgrip strength to accurately measure muscle strength is an important challenge for sports medicine and exercise science professionals. This is because handgrip strength is strongly associated with body size, suggesting that handgrip strength should be corrected (or normalized) for differences in body size to obtain a more sensitive measure of muscle strength. Various normalizing methods have been used, with handgrip strength often divided by body mass or body mass index. In our study, published in the January 2022 edition of Medicine & Science in Sports & Exercise_®, we examined the optimal way to normalize adult handgrip strength for differences in body size.

We used a nationally representative sample of 8,690 American adults aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES). Handgrip strength was measured using handheld dynamometry, with body size measured as body mass, height and waist circumference. The most appropriate dimensions associated with handgrip strength were identified using allometry. We found that neither body mass nor body mass index were appropriate, and that height was the best single measure of body size associated with handgrip strength. As a result, we recommend that handgrip strength be divided by height² to best normalize handgrip strength. We also developed normative-referenced centile values for handgrip strength normalized using height².

Normalizing handgrip strength to height² not only helps to create a level playing field for population-based research, but also provides a simple way to compare the handgrip strength of people who differ in body size. Our normative values can also be used by sports medicine and exercise science professionals to determine a person’s percentile rank in comparison with the U.S. adult population. Further, because inferior normalizing approaches have generally been used, researchers should examine whether normalizing handgrip strength to height² impacts the associations between handgrip strength and health or sports performance.

Grant R. Tomkinson, Ph.D., is a professor in the Department of Education, Health and Behavior Studies at the University of North Dakota. His research mainly focusses on the assessment and interpretation of physical fitness. Dr. Tomkinson is an ACSM member.

Alan M. Nevill, Ph.D., is the research professor in the Faculty of Education Health and Wellbeing at the University of Wolverhampton in the United Kingdom. His specialization is in biostatistics applied to health, sport and exercise sciences. His most recent research focusses on multilevel and allometric modelling of large data sets, analyzing human health and performance associated with body size.

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. 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.

Glucose metabolism during pregnancy plays a pivotal role in maternal and fetal health. Impaired glucose tolerance in pregnancy, such as gestational diabetes, is at the center of the “diabetes begetting diabetes” intergeneration vicious circle. It has been related to not only adverse obstetrics and perinatal outcomes, but also substantially increased risk of cardiometabolic disorders in both mothers and their children over their life span. A large portion of childhood obesity and pediatric type 2 diabetes may be explained by intrauterine exposure to gestational diabetes. As such, it is important to identify modifiable risk factors for the improvement of glucose metabolism in pregnancy and for the prevention of gestational diabetes. Among women with gestational diabetes, physical activity has been demonstrated to improve glycemic control and decrease the need for insulin therapy. However, from a prevention perspective, it remains unclear whether the time physical activity is performed (e.g., before and/or during pregnancy and longitudinal trajectory) is related to glucose metabolism in pregnancy and the risk of gestational diabetes.

Our study, published in the December issue of Medicine & Science in Sports & Exercise_®, sought to address the physical activity timing question. The study population consisted of 2,388 women from the National Institute of Child Health and Human Development Fetal Growth Studies–Singletons. Physical activity data was collected at each study visit using the Pregnancy Physical Activity Questionnaire. This is a semi-quantitative questionnaire validated for pregnancy. Reported sports/exercise activity types and duration were used to determine levels of weekly moderate and vigorous physical activity. Women were asked to recall types and duration of their physical activity during the periconception period (past 12 months, inclusive of first trimester), 13 to 20 weeks of gestation and 20 to 29 weeks. Glucose challenge and oral glucose tolerance test results were abstracted from the medical record. Gestational diabetes was diagnosed using the Carpenter and Coustan criteria.

The key take-away from this study was that both the timing and the dose of physical activity were related to glucose metabolism during pregnancy. High levels of moderate and/or vigorous physical activity (=75th percentile; =760.5 MET·min·week^-1) in the early-to-mid and mid-to-late second trimester were associated with lower glucose concentrations. Further, pregnant women who maintained levels of moderate and/or vigorous physical activity as recommended by the American College of Obstetricians and Gynecologists (500 MET ·min·week^-1) from pre-pregnancy through the second trimester had significantly lower glucose concentrations.

Taken together, our study demonstrated that participation in higher levels of moderate and/or vigorous physical activity in early-to-mid second trimester of pregnancy elicits improved glucose metabolism. Our findings also highlight the importance of persistently engaging in an active lifestyle from preconception period throughout pregnancy. Yet, the remaining critical questions are 1) how to translate these findings into practice to guide pregnant women or women who are planning pregnancy and 2) what specific physical activity programs are accessible, safe and time-efficient for pregnant women to improve cardiometabolic health. Future endeavors along these lines are clearly warranted.

Cuilin Zhang, M.D., Ph.D., M.P.H., is a senior investigator with tenure in the Division of Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health. She is also an adjunct professor in the Department of Population, Family and Reproductive Health at Johns Hopkins University. Dr. Zhang leads a transdisciplinary research program designed within a life course health paradigm so that the etiology and prevention of complex diseases may be investigated during multiple critical time windows over life plan and across generations. Her research has focused on nutrition and lifestyle, metabolic and genetic determinants, as well as health consequences of gestational diabetes, type 2 diabetes, obesity and related comorbidities.

^{Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. 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.}