The optimal daily step count for each client should be personalized to their current activity levels and needs.

How many steps should a person take each day to promote and maintain health? Recently, we published an article entitled “Using Step Counts to Prescribe Physical Activity: What Is the Optimal Dose?” in ACSM’s Current Sports Medicine Reports that aimed to do just that. We reviewed the literature and hoped to arrive at some basic guidelines for prescribing activity using daily step counts.

Physical Activity Guidelines for Americans

Prior to the last several years, the main guidelines for activity focused mostly on the CDC/ACSM initial guidelines from 1995, which have been updated and widely promoted as the Physical Activity Guidelines for Americans. These state that all adults should get a minimum of either 30 minutes of moderate-intensity physical activity five days per week, 25 minutes of vigorous-intensity activity three days per week, or some combination of the two. While these guidelines have been useful, only about half of Americans achieve this recommended amount of physical activity.

Access resources for meeting the physical activity guidelines here.

With the increasing ability to track steps using smartphones and consumer-based physical activity monitors, researchers have begun to publish more data on the effect of daily step counts on a variety of health conditions including all-cause mortality, cardiovascular disease, cancer, diabetes, weight loss and musculoskeletal disorders. These data are especially useful because they show us that even accumulating light intensity physical activity (LIPA) for several thousand steps per day can impart positive health benefits.

Is achieving 10,000 steps per day necessary?  

Our review article attempts to bring together data showing that significant health benefits can occur at activity levels below 10,000 daily steps, especially if individuals increase their baseline activity by at least 1,000 steps per day. Several studies demonstrate that near-maximal or maximal health benefits can be achieved by engaging in predominantly LIPA totaling approximately 6,000 to 8,000 steps per day. However, there also appears to be continued benefit above that level of activity, although some studies report diminishing returns and others show a more linear relationship with higher activity levels. Many studies indicate that each additional 1,000 daily steps impart additional health benefits. This is relevant for active individuals who may already be achieving 10,000 steps per day or more and is consistent with a common theme that “more is better,” with benefits existing at daily step count levels above 10,000 per day. At the lower end of the activity level spectrum, reaching a minimum of about 4,000 steps per day may be beneficial for many groups if they are at or below this level of activity at baseline. This number may be more appropriate for older individuals, given that few studies in our review looked at adults under the age of 50. Also, we did not review comparisons of health benefits of those achieving high levels of moderate or vigorous activity with those who achieve activity primarily through LIPA.

In our clinic settings we see very active patients but also see some who get only several hundred steps per day, and because of general health or specific musculoskeletal conditions, would not be able to accomplish the more intense current recommendations for physical activity. Determining an optimum daily step count requires an individualized approach, considering both physical and psychological factors. Our review article shows that pursuing a goal of even 4,000 steps per day through light intensity physical activity for those who are not currently achieving this will impart some health benefit.

Ultimately, pursuing or maintaining an activity level that meets or surpasses the moderate and/or vigorous physical activity recommendations will likely keep someone healthier than someone who achieves a lower level of activity. But for some a lower level of activity will still be better than being less active. In order to promote this in the clinic, we commonly discuss daily step counts and often utilize the Exercise is Medicine prescription form. This allows us to discuss not only steps counts, but also the recommendations for aerobic and resistance exercise, both of which are on the form. We also often utilize widely available free smartphone apps or inexpensive activity trackers or pedometers to monitor daily step counts and encourage longitudinal progress toward increased activity levels.

Given how daily steps achieved through LIPA have been shown to improve one’s general health and reduce risk of death and certain common chronic health conditions, it would not be surprising if step counts become part of the general recommendations for physical activity and health in the future.

More ACSM resources on step count:

"Daily Steps and Health: Walking Your Way to Better Health" | Blog

"Daily Step Counts for Measuring Physical Activity Exposure and Its Relation to Health" | Medicine & Science in Sports & Exercise_®

Starting a Walking Program | Handout

Joseph Ihm, M.D., FACSM, is an attending physician at Shirley Ryan AbilityLab and an associate professor in the department of physical medicine and rehabilitation in Northwestern University Feinberg School of Medicine. He has a B.S. in exercise physiology and is on the Exercise is Medicine Clinical Practice Committee.

Benjamin Washburn, M.D., is an Assistant Professor of Clinical PM&R and Clinical Orthopaedic Surgery at the University of Missouri.

What Exercise Science Programs Need to Know to Get Their Students ACSM Certified

The thought of going through the academic program accreditation process may sound daunting—I get it. You wonder what good it will do or if/how it will affect you directly. Before you pass judgement, let’s go on a journey to learn more about the benefits and importance of academic program accreditation.

The first stop on our accreditation journey is understanding the difference between regional and programmatic accreditation. Regional accreditation recognizes that an institution’s degree requirements meet an expected standard. Programmatic accreditation recognizes that a specialized educational program meets standards that adequately prepare students for the workforce. In the big picture, program accreditation is the first step in establishing and recognizing a profession. The subsequent steps in the process include professional certification, continuing competence and professional registration.

The History of Academic Program Accreditation in the Health Sciences

Our next stop is a little trip down memory lane. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) can trace its roots back to the 1930’s where it was a part of the American Medical Association (AMA). At that time, AMA began playing a role in defining, regulating and supervising the growing field of allied health. CAAHEP evolved into the organization that it is today when in 1994 it accredited programs like Athletic Training, Physical Therapy and Physician Assistant.  The educational preparation for each program was established by a Committee on Accreditation (CoA). CoA’s oversee the day-to-day work of accreditation by reviewing program self-studies, coordinating site visits and formulating accreditation recommendations for the CAAHEP Board of Directors to consider. Sometimes, as a profession matures, they create their own accrediting body like athletic training. Currently, CAAHEP is the largest programmatic accreditor of health sciences professions.

Next up on our accreditation journey:  the Committee on Accreditation for the Exercise Sciences (CoAES), which was first established in 2004 through the creation of the Standards and Guidelines for the Exercise Sciences. CoAES has three separate Standards and Guidelines for different educational levels:

1. Personal Fitness Training standards for those seeking an associate degree
2. Exercise Sciences standards for bachelor’s degree programs
3. Exercise Physiology standards for master’s degree programs.

The three Standards and Guidelines share some common elements but also contain discipline-specific requirements intended to help prepare entry-level practitioners. Therein lies the heart of the profession where specific performance domains and associated competencies can be found. It is important to understand that CoAES was founded and continues to operate under multiple sponsoring organizations, including ACSM, the American Council on Exercise, American Kinesiotherapy Association, American Red Cross, National Academy of Sports Medicine and the National Council on Strength & Fitness, to name a few. CoAES exists to establish standards and guidelines for academic programs that facilitate the preparation of students seeking employment in the health, fitness and exercise industry. CoAES does not dictate the name of your program or inhibit a program’s academic freedom. During the self-study process, programs go through curriculum matching to show where competencies are being taught throughout their curriculum.

As we continue our journey, let’s explore what information CoAES collects. CoAES is an outcome-based accrediting body. CoAES wants to see how the program is preparing exercise science professionals. Thus, outcomes collected include student retention rates, graduation rates, certification exam participation and graduate satisfaction, to name a few. CoAES does not focus on institutional elements like fiscal health, faculty credentials, resource allocation or admissions like a process-based accreditation often does.

Steps Needed to Become and Maintain Accreditation

1. The first step is submitting a no-obligation Request for Accreditation Services (RAS) on the CAAHEP website. This lets them know you want to begin the accreditation journey.
2. After an RAC is submitted, the CoAES executive director contacts the program director (PD) and shares the information to perform a self-study. This can scare programs away. As a program director that has gone through the self-study process, I can say that it is a lot of work. However, if one is diligent, sets goals and asks for help, it can go smoothly and quickly.
3. Once a program submits a self-study, it is reviewed by CoAES and an initial site visit is scheduled and conducted. Following that site visit, CoAES makes its recommendation to CAAHEP regarding accreditation.
4. Upon accreditation, a program must submit a standardized annual report to CoAES outlining any changes that have occurred and reporting on the required outcomes.
5. A program will receive a comprehensive review and site visit at five (5) years and then every 10 years thereafter.

Associated Costs

In an era where higher education is struggling for funds, enrollment is down and cuts are being made, exercise science programs need to know the cost. For initial accreditation there is a $750 fee from CoAES and a $600 fee from CAAHEP. These are one-time fees. A program will then pay an annual fee of $500 to CoAES for each program and an annual institutional fee of $600 to CAAHEP (one fee regardless of the number of programs). Thus, an annual fee of $1,100 is due for each program (if there is only one accredited program). Due to the financial hardships that have occurred recently, CoAES has instituted a COVID Relief Program. It will waive the initial $750 accreditation fee for any college or university that submits a new RAS through the spring 2022 semester for Personal Fitness Training, Exercise Science or Exercise Physiology. Any associated site visit fees will also be waived as long as CoAES continues to conduct virtual site visits. This could culminate in a savings between $1,500 to $3,000. 

This has been a long, yet important, journey. As an educator in this field, I value the guidance and academic freedom that programmatic accreditation has provided. As a PD that prepares undergraduate students to become exercise professionals, I see the value of accreditation every day, especially when I speak to former students employed in our field. Finally, as an ACSM Certified Exercise Physiologist (ACSM-EP®), I see programmatic accreditation as the first critical step in moving the profession forward.

Beginning August 15, 2027, the ACSM Certification Board intends to update the minimum requirement for the ACSM-EP and ACSM-CEP certification exams for degrees to be earned from a regionally accredited college or university and CAAHEP accredited program. Learn more.

Ben Thompson, Ph.D., FACSM, ACSM-EP, is a Program Director and Professor of Exercise Science at Metropolitan State University of Denver (MSU Denver). Ben’s journey began when he was hired at MSU Denver and participated in their accreditation which led to being recognized as an accredited Exercise Science program. As his journey continued, he has been involved in many aspects of the exercise profession. He has served on and been the chair of the Committee for Certification and Registry Boards (CCRB) Credential Committee for the Certified Exercise Physiologist, served and presented with the Health and Fitness Summit and has been involved with the Committee on Accreditation for the Exercise Sciences (CoAES) as an at-large member and most recently as the chair. Ben will continue his journey to help move the exercise profession forward.

How the Autism Exercise Specialist Certificate is Helping Fitness Centers Flourish

As customers remain hesitant to return to the gym amid the COVID-19 pandemic, there are some who really need -- and benefit -- from face-to-face training. As I’ve said in previous ACSM blog posts, people with autism learn best with ​​individualized, in-person instruction in both the school and therapy settings.

 So, what if catering to those with autism could actually help you grow your fitness business? After earning the Autism Exercise Specialist (AES) Certificate, these two women did just that.

First, meet Sana Ghawas who owns the Wonder Fitness Gym in Bahrain, a gym specifically for those with autism. As a mother of a child with autism, Sana quickly learned about the benefits of exercise firsthand. At the time of her son’s diagnosis, she was also dealing with an ACL injury.

“Exercise, in general, helped a lot emotionally, to get over all those days of ups and downs,” she said. And Sana wanted to share her knowledge with as many people as possible.

 She did her research and discovered the American College of Sports Medicine / Exercise Connection AES Certificate. Earning the certificate was a turning point.

 “It made all the difference,” Sana said, explaining that having the certificate from two reputable organizations was key to gaining the trust of new clients. Plus, the skills and techniques she learned from the certificate went beyond what she already knew from her own experience.

 “How to give instructions to the athlete, how to assess motivation, how to give him choices in the workout to feel like he's also in control… [it makes] the training session successful in all aspects.”

 The Wonder Fitness Gym celebrated its one-year anniversary this summer, and Sana is having two more coaches virtually earn their AES Certificate this October.

 Back here in the U.S., Adapted Physical Education teacher Kristin Kmack launched her own business shortly after earning the AES Certificate. She said her company Maur Movement “provides personal and small group training to individuals of all ages and abilities throughout the capital region of New York state.”

 “The AES certificate provided a foundation for operation and connected me to a network of reputable and respected professionals in the field,” Kristin said. “Earning the AES Certificate was the catalyst for starting Maur Movement and having the credential has undoubtedly supported its growth.”

 Both Kristin and Sana said they have recommended the AES Certificate to others. You can earn the certificate yourself this fall by first completing the online course. And in October Exercise Connection is offering a virtual workshop series needed to fulfill the other half of the virtual workshop series needed to fulfill the other half of the Certificate.

 “In my role as both a personal trainer and an APE teacher, my ultimate goal is to empower individuals with autism through exercise,” Kristin said. “The AES certificate serves to equip more professionals with the skills and resources to do the same, creating a broader impact.  I take pride in holding the AES certificate and reference it often with high regards to parents, colleagues and administrators alike.”

Grow your business AND change lives for those with autism in your community by earning the Autism Exercise Specialist Certificate.

More resources

Register for the online course.

Read about "3 Key Elements to Successfully Training Children with Autism."

Read "Challenging Autism with Exercise: An Opportunity Worth Stretching For," from ACSM's Health & Fitness Journal^®.

Read "Exercise is a Life-Changer for Those with Autism," from ACSM's Health & Fitness Journal^®.

David Geslak, ACSM EP-C, graduated from the University of Iowa with a degree in Health Promotion. As a Para-Educator and Fitness Coordinator at a school for children with autism, Coach Dave experienced first-hand the challenges of teaching exercise. By understanding that students with autism learn differently, he developed a system that has become a breakthrough in effectively teaching exercise. Twelve universities have incorporated his program into their Adapted Physical Education and Special Education Programs.

Dynamic flexibility exercises can be used in many programmed warm-ups for exercise and athletic performance. They are particularly useful when incorporated into the specific warm-up for resistance exercise.

Although reduction of injury is not a scientifically established benefit of a warm-up, it is widely accepted that warming-up prior to exercise is vital for performance. The main goal of the warm-up is to improve muscle temperature, VO2, neuromuscular control and flexibility and minimize fatigue. When designing an effective warm-up, you can select from a variety of dynamic flexibility exercises, including:

• Arm circles (front and back)
• Neck rotations
• Hip circles (standing or kneeling)
• Overhead medicine ball lassos
• Toe touches
• Medicine ball front raises
• Medicine ball figure eights
• Arm cross-face circles
• Quadruped
• Crab kicks
• Truck circles from a straddled position
• Wrist “praying” flexion/extension
• Ankle rolls
• Torso rotations/ side bends/ bent-over T-rotations
• 3-point thoracic rotation
• Knee circles
• Standing/walking knee hugs
• Cross-body kicks
• Side leg swings
• Shoulder crossovers (horizontal adduction/abduction)
• Straddled medicine ball rollouts/ circles
• Lunge/ lateral lunge with or without rotation
• Groiner/ groiner with rotational reach
• Catcher-squat to hamstring stretch
• Supine or standing hip medial/ lateral rotation
• Fire hydrant
• High-knee crossovers
• Windshield wipers
• Body weight squats
• Mountain climbers
• Glute bridge
• Triceps extensions with medicine ball (with posterior reach)
• Stability ball arm circles (from kneeling, flexed position)
• Press-ups
• Stability ball supine slides (into bridge)
• Overhead claps
• Diagonal reaches
• Rockers (with knees/ hips flexed)
• Woodchops

To learn more about programming effective exercise training programs, check out ACSM’s Foundations of Strength Training and Conditioning, which contains 600+ pages of information on physiology and program development.

Nicholas Ratamess Jr. Ph.D., Department of Health Exercise Science, The College of New Jersey. Dr. Ratamess is the author of ACSM's Foundations of Strength Training and Conditioning, Second Edition.