1. Look Beyond Weight When Determining Health It’s not your weight that matters, it’s what constitutes your weight. Find a way to learn if you have too little muscle or too much fat and find a strategy (exercise and eating well) that increases muscle and lowers fat. The number on the scale might stay the same, but you will look better, perform better and will be healthier.
   
   
2. Building Muscle Takes More Than Just Protein Building muscle requires a combination of:
   • Added resistance to muscles
   • Staying in a good energy balanced state to encourage anabolic hormone production
   • Having a good distribution of nutrients to sustain tissue health
   • Adequate sleep
   • Consuming more protein in the right amounts and at the right times to encourage muscle protein synthesis
3. Protein: It’s Not Just More, But When and How Much If you are an athlete, you need about double the protein as nonathletes, but just eating more protein isn’t enough. It must be consumed in the right amounts, at the right times and when in a reasonably good energy balanced state. Randomly eating more protein doesn’t accomplish what the body needs.
   
   
4. Infrequent Meals Cause Problems Meal skipping, or eating in a pattern that fails to satisfy energy requirements in real time, creates many problems including higher body fat levels, lower lean mass and greater cardiometabolic risk factors. Interestingly, more frequent eating is associated with lower total caloric intake because of better ghrelin (appetite hormone) control.
   
   
5. Eating Good Foods Helps the Microbiome Keep You Healthy Inadequate intake of fresh fruits and vegetables may alter the microbiome, resulting in higher body fat percentage and reduced athletic performance. Consuming plenty of fresh fruits and vegetables helps to sustain good bacterial colonies that live in the gut. Additional benefit: Fruits and vegetables give you the carbs you may lack for maximal performance.
   
   
6. Good Food, Bad Food, Wrong Choice There is no perfect food, and if you keep eating the same food(s) because you believe it’s good for you, you place yourself at nutritional risk. There is no substitute for eating a wide variety of foods that are well-distributed throughout the day. You don’t get too much of anything potentially bad, and you expose tissues to all the nutrients they need.
   
   
7. Relative Energy Deficiency in Sport (RED-S) can be a Problem The best exercise performance occurs when you have enough energy to support the exercise. If you frequently post-load by consuming the energy (calories) after the workout/competition, be aware of the potential health and performance consequences. You can’t drive your car on an empty tank of gas, and neither can you perform well if your tank is empty.
   
   
8. Poor Hydration, Poor Performance Sustaining the best possible fluid balance is important for many reasons, including sustaining heart stroke volume, sustaining sweat rates, enabling delivery of nutrients to working cells and enhancing removal of metabolic waste products from cells.
   
   
9. Recovery from Exercise is Just as Important as the Exercise Putting stress on muscles through exercise isn’t enough to reap the full health benefits. You must give muscles an opportunity to recover from the stress so that they can benefit from the exercise. Adequate sleep is important by helping to sustain appropriate eating behaviors and muscle recovery.
   
   
10. It Is Important to Learn How to Lower Stress Stress levels impact eating behavior. High stress levels can lead to the consumption of energy-dense foods that are high in fat and sugar. Find a strategy for stress-reduction that can help you sustain optimal nutrition, which will positively influence both performance and health.

 

Dan Benardot, PhD, DHC, RD, LD, FACSM is Professor Emeritus at Georgia State University, and Visiting Professor in the Center for the Study of Human Health at Emory University. He is the author of the new title ACSM’s Nutrition for Exercise Science. For more information about the book and to download an excerpt, visit https://www.acsm.org/read-research/books/acsms-nutrition-exercise-science.

When Medicine & Science in Sports & Exercise (MSSE)’s Editor-in-Chief, Bruce Gladden, Ph.D., FACSM, asked me to consider the position as Associate Editor-in-Chief for Contrasting Perspectives (CP) I didn’t need much time for contemplation. I consider that CP articles occupy a position at the very heart of MSSE and ACSM’s missions to review, publish and promote the best science across our fields of interest. The first CP under my watch is published this month (November, 50:2379-82) in MSSE and is already generating substantial readership numbers and letters:

“The respiratory compensation point and the deoxygenation break point are/are not valid surrogates for critical power and maximum lactate steady state”

Proponents: Daniel A. Keir, Silvia Pogliaghi, Juan M. Murias

Opponents: Ryan M. Broxterman, Jesse A. Craig, Russell S. Richardson

As a young scientist in the 1980’s I was captivated at the Federation (Experimental Biology’s precursor) and ACSM meetings by vocal debates from scientific giants. Indeed, watching Brian J. Whipp and George A. Brooks spar over the scientific bases (or not) of the “Anaerobic Threshold” concept helped convince me that a scientific career could be both immensely rewarding and, above all, fun! 

A CP entitled “The anaerobic threshold concept is/is not valid in physiology and medicine” is underway for publication in 2019 and will assess where we are now in this fascinating saga. Not only will this present an intriguing history for our less senior readers but it will also look at the concept’s present utility and future research imperative.

At national scientific meetings, well-posited, contemporary and, above all, pithy debates pack the auditoriums and scintillate audiences much like medieval duels must have done. Recently, at the Integrative Physiology of Exercise meeting in September 2018, the irrepressible Mike Joyner, M.D., FACSM, squared off against legendary genetics researcher Claude Bouchard, Ph.D., FACSM. Their debate will be encapsulated in a CP entitled “Genetics really do/do not influence exercise capacity or trainability.” Until then, you can read a blog recapping the event.  

Following Joseph Joubert’s tenet that “The aim of argument, or of discussion, should not be victory, but progress” CPs by their very nature and eponymous style permit high visibility and, above all, seek scientific clarity.

Given “Strong minds discuss ideas, average minds discuss events, weak minds discuss people” (Socrates), so CPs avoid ad hominem arguments and focus on the data and their interpretation from opposing viewpoints. This serves the time-honored adage that progress emerges more readily from error than confusion.

As Associate Editor-in-Chief for Contrasting Perspectives I am always interested in what MSSE readers and ACSM attendees are interested in seeing debated. Please feel free to send me your ideas (as a brief statement that can be posited in the positive and negative) and also, and most importantly, a short list of potential proponents/opponents. MSSE plans to publish ~two CPs per year.

So, I hope that you will join me in supporting MSSE’s CP initiative and continuing to promote the best science for our journal. For those unfamiliar with the CP mechanism, author guidelines are appended below.

And do please be on the look-out for Glenn Gaesser, Ph.D., FACSM, and Steven Blair, P.Ed., FACSM, facing off against John Jakicic Ph.D., FACSM, Renee Rogers, Ph.D., and Joseph Donnelly, Ed.D., FACSM, in their CP entitled: “The health risks of obesity have/have not been exaggerated” scheduled for publication in the January 2019 edition of MSSE!

Cheers and thanks, David 

Contrasting Perspectives Guidelines and Information

Topic & Authorship selected/invited by Associate Editor-in-Chief for Contrasting Perspectives in consultation with the Editor-in-Chief

Rules and Instructions for Authors

Format:  Initial Perspective Pro (1500 words) followed by Con (1500 words) followed by Responses/Rebuttals (Pro 1000 words, Con 1000 words) which end in a concise (one to five sentences) summary, clearly indicated as: Concluding Statement.  Authors are to use appropriate literature citations to support their arguments, but are encouraged to be selective (references will not be included in the word count).  It is recommended that authors use figures and tables judiciously since these too will be included in the word count using a formula determined by the Managing Editor.

General Details:  Authors will be allowed the widest latitude in interpreting published data in support of their perspective. Each author will be provided the opposing author’s perspective for use in preparing a response/rebuttal, and each author will be encouraged to make specific recommendations for needed research studies, and each allowed a concluding statement. The Editor-in-Chief for Contrasting Perspectives will establish tight timelines for initial and response/rebuttal submissions.

Peer-review:  These papers will not be peer-reviewed in the traditional sense. Editorial review will be limited to format and fact checking (authors must not misrepresent what is published) to expedite publication. The Editor-in-Chief for Contrasting Perspectives will oversee the review process and will appoint Associate Editors, Editorial Board Members, or invited Ad Hoc Reviewers to assist as required.

David C. Poole, Ph.D., FACSM currently serves as the MSSE Associate Editor-in-Chief for Contrasting Perspectives. He is a University Distinguished Professor in the Departments of Kinesiology, Anatomy and Physiology at Kansas State University. 

This is part eleven, and the final installment, in a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the symposium titled "Recent Advances in Exercise and Arterial Stiffness." 

The first scientific conference I ever attended made me consider quitting graduate school. Everyone was speaking English, but I was convinced that I was the only one who couldn’t speak or understand the language of physiology. Thankfully, I didn’t quit and continued to attend conferences. Each time I do, it gets easier to understand and engage in the conversations about what is new in the world of exercise physiology. I’m entering my second year as a Ph.D. in Biomedical Science, and 2018 was my first time attending ACSM’s Conference on Integrative Physiology of Exercise. My current research focus is on vascular health/function, so I was thrilled to see a symposium on Exercise and Arterial Stiffness!

I love the cardiovascular (CV) system with all my heart (no pun intended) for many reasons, not the least of which are the redundancies that collaborate to keep us alive, oxygenated and able to run, lift or play. The entire system is an intricate dance constantly striving to combat every assault thrown its way, from Type II diabetes to obesity to aging. Arterial stiffness is a problem for many different people and for diverse reasons, and each symposium speaker had a unique contribution to the intricate puzzle we call the CV system.

Rong Zhang, Ph.D., of University of Texas Southwestern Medical Center, presented that his cerebral research witnesses not only an increase in vascular damage with aging, but also mitigation of this damage and a 50 percent decrease in the incidence of dementia from walking about two miles per day. You read me correctly—just walking provides this benefit! Though disease and aging have modified the standard signaling and function of the cerebral vasculature, something as simple as walking enables another redundant system to take over and battle arterial stiffness. 

Douglas Seals, Ph.D., University of Colorado – Boulder, brought up the ever-present “vicious cycle” that is so detrimental to the CV system. A few mitochondria step out of line and BAM! You’ve got endothelial damage, arterial stiffness and CV disease. I do like to think, though, that there can also be a “viciously good cycle” brought about by chronic exercise and, as Dr. Seals suggests, certain nutriceuticals. 

Martin Shultz, Ph.D., of the University of Tasmania, dove into exercise hypertension hemodynamics and discussed measuring blood pressure in order to recognize exercise hypertension; it is normally pretty sneaky and hard to find in resting individuals. His clinical perspective on the CV system was refreshing to me since I work in isolated animal vessels and sometimes forget that all my efforts are in hopes of eventually helping people, not just the pigs (who devote their lives to good CV research and delicious bacon).

What stood out to me the most was the lecture from Kerrie Moreau, Ph.D., from the University of Colorado Anschultz Medical Campus. Maybe it’s because I am a woman, but I geek out over sex-related differences in physiology. I’ve heard, and you probably have too, that the incidence of cardiovascular disease (CVD) has been decreasing over the past few years, which is awesome no matter how you look at it. However, I was surprised to see that the observed decreases have been primarily in men, and though women’s rates of CVD are lower anyway, they’ve stayed consistent over the years. I was even more surprised to see that there may be sex differences between exercise improvements in endothelial function and arterial compliance. There are some studies that have shown improvement in measures of arterial stiffening with exercise in postmenopausal women, but where we see diminished benefit is at the endothelial level. That is, estrogen-deficient postmenopausal women have diminished and even absent responses compared to men. Dr. Moreau presented data from several studies concerning this and the importance of estrogen in vascular response to exercise, which I hope to pursue and implement into my own future studies.

As a student and young researcher, it is exciting to get a glimpse of all we have left to discover and, as a woman, it is exciting to see my own physiology represented in research when it is found to be unique compared to a man’s. This may be my first IPE, but it definitely won’t be my last!

Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 
Read part 3 of this series: "Exercise and Energy Restriction to Improve Health: Recent Research." 
Read part 4 of this series: "Molecular Transducers of Physical Activity (MoTrPac) Update." 
Read part 5 of this series: "Metabolic Flexibility in Health & Disease: A Symposium Summary." 
Read part 6 of this series: "How Exercise Promotes Brain Health in Aging." 
Read part 7 of this series: "Molecular Transducers of Exercise-Induced Muscle Hypertrophy: A Symposium Summary." 
Read part 8 of this series: "Exercise Pressor Reflex Function in Health and Disease." 
Read part 9 of this series: "Do Genetics Influence Exercise Capacity and Trainability?" 
Read part 10 of this series: "Is Mitochondrial Respiration a Limiting Factor of Oxidative Metabolism: A Symposium Reflection." 

Kalen A. Johnson, M.S. is a Biomedical Sciences PhD student in the Coronary Physiology lab in the Department of Veterinary Physiology and Pharmacology at Texas A&M University. She is also a graduate research assistant. 

This is part ten of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the debate titled “Is Mitochondrial Respiration a Limiting Factor of Oxidative Metabolism.”

It is 3:00 P.M. on Saturday; the weather in San Diego is gorgeous; the Aggie football game starts in an hour, but this is one of the last sessions of the IPE conference and something tells me that I should stick around for it. Although many attendees have flights to catch, vacations to begin, or football games to watch, I wasn’t surprised to see that the symposium was well attended. After all, every symposium and debate held during this conference has exceeded my expectations! That being said, I am grateful that I stuck around for this last session! Here is why:

The session was chaired by L. Bruce Gladden, Ph.D., FACSM, of Auburn University and Dr. Michael C. Hogan, Ph.D., FACSM of the University of California, San Diego.

Although mitochondrial respiration is not my area of expertise, Dr. Gladden delivered a great introduction explaining the limiting factors (e.g., pulmonary limitation, matching O₂ delivery to utilization, O₂ diffusion, mitochondrial volume, etc.) to oxidative phosphorylation/metabolism. He then noted that in order to better comprehend the many other controlling/limiting factors responsible for oxidative metabolism, we need to utilize diverse tools to assess different subject populations, exercise/contraction type and sample/analysis size. This set the scene for the first presenter of the symposium, Bruno Grassi, M.D., Ph.D., FACSM, (University of Udine, Italy) who discussed different tools of functional evaluation of oxidative metabolism.

Side note: During Dr. Grassi’s introduction, Dr. Gladden invited him over to the stage with an inside joke. While I may never know what the inside joke was, I was happy to see that scientists of such high caliber still make the time to have a good sense of humor.

“What are the limitations? This has been a question in our field for decades,” Dr. Grassi stated for his opening remark. He then briefly talked about tools previously used for functional evaluation of oxidative metabolism during incremental and constant work rate exercise and suggested some relatively new approaches [i.e., fractional O₂ extraction by near-infrared spectroscopy (NIRS) and mitochondrial respiration by high resolution respirometry]. I won’t go into much detail, but it is important to note that the majority of his data showed hypoxia resulting upstream of mitochondrial respiration. The other takeaway was that there is no change in O₂ extraction during the initial 10 seconds of exercise onset. However, this O₂ extraction is decreased in pathological conditions and metabolic diseases. But, wait, there’s good news! Training does help, and the use of new tools can allow us to place our finger on the complex limitation(s) problem.

Dr. Carsten Lundby (University of Copenhagen), the second speaker, discussed some of his recent work on VO₂max which shows that there is a functional reserve for O₂ diffusion that is not utilized during exercise in normoxia, or when removing the red blood cells that have been gained with exercise training. Furthermore, his data shows that this is also seen when VO₂max returns to pre-training levels. More information is available. 

Dr. Lundby highly recommended reading the Dallas Bed Rest Study to those who are new to this field or for those who have yet to read it. There is a 40-year follow-up of the study.

David C. Poole, Ph.D., FACSM (Kansas State University) followed Dr. Lundby and focused his talk on matching intramuscular O₂ delivery/O₂ uptake and peripheral O₂ diffusion. He began by suggesting that science is dependent on our perspective and provides an image of a frog, or is it a horse? Take a look at the image and decide for yourself. He then suggested that we must take a black box approach to understanding muscle energetics and explained that it may not be what O₂ expenditure reveals, but rather what it conceals. Here are the main three conclusions from Dr. Poole’s talk:

1) Fast twitch fibers regulate QO₂/VO₂ such that PO₂ is lower vs. slow twitch fibers with profound metabolic implications;

2) Exercise training & nitrate supplementation can both increase QO₂/VO₂ ratio and support faster VO₂ kinetics, thereby increasing exercise capacity in health and disease; and

3) Priori studies relating heterogeneity/PO₂ changes to O₂ transport efficacy across physiologic and pathologic perturbations are required.

The last talk began with Russell T. Hepple, Ph.D., (University of Florida) disclosing that he is a mitochondriac. Dr. Hepple states that he believes the following statement is inaccurate:  mitochondrial O₂ availability during exhaustive contractions directly constrains mitochondrial respiration. He then provides data to support his argument, including unpublished data showing that muscle is sensing metabolic disturbances rather than O₂. Moreover, he shows an image published in 2013 depicting the mitochondrial interconnections which just happens to be the same interconnections suggested by the great George Brooks in an image published in 1986[i]. Dr. Hepple then suggested that we all read a recent 2017 study which shows the super-complex, higher order organization of the mitochondrial electron transport chain, and does a phenomenal job tying this into Dr. Brian Glancy’s work on the mitochondrial grid structure which was presented in one of the initial symposiums of this IPE conference.

In closing, I’m very happy that I decided to stay for this last symposium as I gained a lot of knowledge and a new interest for mitochondria. Who knows, maybe I’ll even become a mitochondriac one day!

Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 
Read part 3 of this series: "Exercise and Energy Restriction to Improve Health: Recent Research." 
Read part 4 of this series: "Molecular Transducers of Physical Activity (MoTrPac) Update." 
Read part 5 of this series: "Metabolic Flexibility in Health & Disease: A Symposium Summary." 
Read part 6 of this series: "How Exercise Promotes Brain Health in Aging." 
Read part 7 of this series: "Molecular Transducers of Exercise-Induced Muscle Hypertrophy: A Symposium Summary." 
Read part 8 of this series: "Exercise Pressor Reflex Function in Health and Disease." 
Read part 9 of this series: "Do Genetics Influence Exercise Capacity and Trainability?" 

Jorge Granados, M.S., is a Ph.D. Student studying Exercise Physiology at Texas A&M University. He is also a Graduate Research Assistant in the Biology of Physical Activity Laboratory. 

They’re baaaaaaaaaaack! 

School is in session once again. It’s fall, and now is the time for businesses in college towns to engage with both new and returning students. Students often represent a large portion of the population come the start of fall semester -- to miss out on them as potential customers would be a mistake. Students are prime candidates for fitness studios and gyms; they need to work out more, and there is always a new incoming class of new students.

 

“While most campuses have onsite fitness centers … 38% of students reported (2) spending money every month off campus at gyms and fitness studios”

College students aren’t working out enough

A recent study (1) at Northwestern found over 60% of college students failed to get the recommended physical activity. Many are high school athletes finding themselves without regular practice for the first time in their lives. While most campuses have onsite fitness centers, self-directed workouts at the school fitness center aren’t going to be the best option for everyone. It turns out, students aren’t afraid to leave the quad for their workouts; 38% of students reported (2) spending money every month off campus at gyms and fitness studios, and 11% of those students said they spend $50 or more. Your studio’s approach to working out might be the perfect option to stay healthy at school -- and provide a much-needed great study break! Make sure students are aware of the great workout options at your studio or gym.

“North Carolina State University (5) found that for every hour increase in weekly activity, students saw GPA increases of 0.06.”

Marketing to students allows you to try something new

College campuses allow you to experiment with your marketing strategy. With new freshmen each year, you have the chance to play with and perfect your first impression. While students are trying out new electives, you can try out your new marketing strategies. Does a student discount draw them in? Would a pop-up event on campus best introduce your business to the school? This is a perfect chance to get creative! You don’t need to feel locked into anything, as you can always hit restart next term. 

Red Bull (3) took marketing on campus to an extreme and created a memorable, fun experience -- “airdropping” a crate of energy drinks for students to try. This campaign was so successful they replicated it in popular college spring break destinations the following year. Students helped the campaign go viral, posting about the surprise drop on their campuses and further spreading brand awareness. While your fitness studio or gym might not be in a position to airdrop inventory, there is clearly immense potential in big statements on campus. This is the perfect demographic for trying grassroots marketing. 

To jumpstart your creativity, we’ve come up with a guide with our top eleven ways to market your fitness business to college students. Keeping college schedules and budgets in mind can help you appeal to this critical market and bring additional business through your door. And, remember, if all else fails, remind students that numerous studies (4) indicate that higher GPAs and better study habits are correlated with working out. North Carolina State University (5) found that for every hour increase in weekly activity, students saw GPA increases of 0.06. Working out at your studio is the smart choice! 

For more insight on how to market your fitness business to college students, you can download the free guide at MINDBODY!

Learn more about MINDBODY

Citations:
1. https://news.northwestern.edu/stories/2014/05/college-kids-need-to-change-unhealthy-ways
2. http://www.prweb.com/releases/studybreaks-college-media/college-student-spending/prweb11994508.htm
3. http://www.archrival.com/work/90/airdrop/
4. https://well.blogs.nytimes.com/2010/06/03/vigorous-exercise-linked-with-better-grades/
5. https://www.insidehighered.com/news/2016/05/04/study-recreational-physical-activities-increase-odds-academic-success

 

This is part nine of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the debate titled "Do genetics influence exercise capacity and trainability?"written by Dr. John Quindry.

If you didn’t happen to witness the debate between Claude Bouchard, Ph.D., FACSM, and Michael Joyner, M.D., FCASM, titled “Do genetics influence exercise capacity and trainability?” you missed an event to behold. This debate was arguably the highlight of ACSM’s Conference on Integrative Physiology of Exercise in San Diego.

The two pillars of exercise science, Bouchard and Joyner, sparred on three questions:

1) genetic causation of exercise capacity,

2) the genetic influence on trainability, and

3) why is it so hard to pin down the respective genetic signatures.

On all three pre-arranged topics the debate was lively.

Given the scientific positions of a physician-physiologist and a geneticist, the arguments were prescribed by their unique perspectives. Dr. Bouchard provided clear examples from mouse strains, low/high volume rats and human twin studies that reinforce the fact that 40 to70 percent of exercise capacity is genetically heritable. By virtue of his approach, Bouchard’s arguments were at the “40,000 foot” level, whereas Dr. Joyner’s were at ground level – asking pointedly, “where are the genetic weeds” to verify these claims? Stated differently, Joyner’s arguments were of the holistic physiologist variety and centered on the fact that understanding of exercise capacity and trainability are irreducible in terms of identifying causative gene variants. Both agreed that the matter is far more complex than has long been predicted by medical science.

Who won?

Opinions differ, but I’d call it a draw. In terms of debate form, I’d give Bouchard the edge on exercise capacity and Joyner the edge on trainability. Like many in attendance, I flip-flopped on topic three, favoring whoever was at the microphone. But you want me to pick a side, and since Joyner was the last to speak I’ll say that he may have won…by a genetic hair. As Joyner stated in his closing argument, “context is everything.” Given that both scientists provided the strongest of evidence-based positions, the lesser talented me prefers the guiding hand of nurture.

Given their stature as gentlemen scientists, neither Bouchard nor Joyner took a cheap shot. But then again, neither backed down. The best barb of the day definitely goes to Bouchard when he quipped to Joyner – known for repeatedly calling mechanistic science to task – “to solve these matters we have to indulge extensively in the sin of reductionism.” Pure gold! What may have been missed by those of us that are peripheral to the debate is the fact that big data analyses, and recently heralded approaches such as GWAS and SNP analyses, have recently lost stock value for an inability to reveal causative links between the genetic code and exercise outcomes.

Don’t miss out when this debate unfolds a second time in a contrasting perspective to be featured in a future issue of Medicine and Science in Sports and Exercise.

Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 
Read part 3 of this series: "Exercise and Energy Restriction to Improve Health: Recent Research." 
Read part 4 of this series: "Molecular Transducers of Physical Activity (MoTrPac) Update." 
Read part 5 of this series: "Metabolic Flexibility in Health & Disease: A Symposium Summary." 
Read part 6 of this series: "How Exercise Promotes Brain Health in Aging." 
Read part 7 of this series: "Molecular Transducers of Exercise-Induced Muscle Hypertrophy: A Symposium Summary." 
Read part 8 of this series: "Exercise Pressor Reflex Function in Health and Disease." 

John Quindry, Ph.D., FACSM, is a member of the faculty at the University of Montana, Department of Health and Human Performance. He served as a co-planner of ACSM's Conference on Integrative Physiology of Exercise. 

This is part eight of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the symposium titled "Exercise Pressor Reflex Function in Health and Disease" by Joseph Watso. 

When we hit the trails or hop on the treadmill for a run we rely on complex mechanisms that provide blood flow to deliver nutrients (such as oxygen) to our active muscles. Unfortunately, disease states like heart failure, hypertension and peripheral artery disease (PAD) affect the reflexes vital for keeping enough blood flow to our muscles. Therefore, it is essential that we understand what might be going wrong to inform disease prevention, maintenance and treatment strategies.

To help appreciate the processes of which the body is capable, check out the image below. Each circle represents the amount of blood flow going to each organ. We can have tremendous increases in blood flow delivery during exercise (light blue areas).

 

 

At ACSM’s Conference on Integrative Physiology of Exercise, Marc Kaufman, Ph.D., of Penn State Hershey pulled together a group of experts to discuss the mechanisms underlying exercise pressor reflex dysfunction.

Donal O’Leary, Ph.D., a professor at Wayne State University, and Dr. Kaufman discussed the intricate research projects they have completed using animal models to better understand the altered blood flow and blood pressure responses during exercise exhibited in heart failure and PAD. Specifically, Dr. O’Leary showed the results from a line of studies focused on how metabolite build up from exercise affects the integrative control of cardiac and peripheral blood flow in an animal model of heart failure. Namely, there is a pronounced switch from cardiac output mediated increases in blood flow/pressure to a compensatory reliance on systemic vasoconstriction.

University of Utah investigator Markus Amann, Ph.D., described the multifaceted ongoing research projects in human heart failure and exercise pressor reflex function. These experiments include a range of invasive techniques that provide an understanding of the role of the central nervous system in blood pressure control during aging and in heart failure.

Hypertension affects a great deal of individuals in the United States. Dr. William Farquhar, FACSM, from the University of Delaware, described how microneurography has allowed scientists to link sympathetic nervous system overactivity to altered cardiovascular reflexes during exercise in hypertension. Dr. Farquhar also presented data demonstrating the importance of chronic exercise training to prevent the development of high blood pressure.

Together, these scientists, and others in the field, will continue to carry out clinically relevant research to better understand how different cardiovascular disease processes affect exercise blood flow and pressure regulation.

Scott Powers, Ph.D., FACSM, and other conference organizers did an excellent job setting up thought-provoking scientific sessions at the 2018 Integrative Physiology of Exercise conference. We hope you can attend and join in on the conversation next time.

Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 
Read part 3 of this series: "Exercise and Energy Restriction to Improve Health: Recent Research." 
Read part 4 of this series: "Molecular Transducers of Physical Activity (MoTrPac) Update." 
Read part 5 of this series: "Metabolic Flexibility in Health & Disease: A Symposium Summary." 
Read part 6 of this series: "How Exercise Promotes Brain Health in Aging." 
Read part 7 of this series: "Molecular Transducers of Exercise-Induced Muscle Hypertrophy: A Symposium Summary." 

Joseph C. Watso, B.S., is a doctoral candidate at the University of Delaware, in the Department of Kinesiology and Applied Physiology. Joe is currently serving as the graduate student representative for the Mid-Atlantic Regional Chapter of ACSM. Joe is interested in studying human health and performance, with specific interests in maintaining cardiovascular health throughout aging.

This is part seven of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the symposium titled "Molecular Transducers of Exercise-induced Muscle Hypertrophy" by Sarah Little. 

On the last day of the Integrative Physiology of Exercise conference in San Diego, Marcas Bamman, Ph.D., from the University of Alabama-Birmingham, chaired the symposium on Molecular Transducers of Exercise-induced Muscle Hypertrophy. Normally, I would be pretty intimated by a symposium on muscle biology and molecular pathways. However, this highly respected panel of scientists led talks that were complex yet easy to follow.

Overall, the main take away from the session was that exercise leads to the activation of multiple molecular pathways that are being unraveled by absolute geniuses in order to better understand how to grow and maintain muscle mass over the lifespan. 

Scott Trappe, Ph.D., FACSM, of Ball State University opened the symposium with a series of findings describing the transcriptome response to exercise in the aging athlete. Using a life-long exercise model, Dr. Trappe’s group looked at the differences between life-long exercisers, old healthy and young exercise subjects. As expected, the young athletes showed greater VO₂Max and muscle cross sectional area than life-long exercisers, but these life-long exercisers demonstrated exercise capacity and skeletal muscle health indices that were far superior to untrained old healthy subjects. Interestingly, this same hierarchical pattern was seen with fast fiber responsiveness to exercise, as well as transcriptome coordination and effectiveness, suggesting a preservation of a muscle metabolic phenotype with exercise through aging. Further, through analyzing the transcriptome signatures of each subject group, it was discovered that the function of the responding genes varies with age and exercise, with young exercisers primarily involving growth, life-long exercisers involving metabolism and the old healthy involving stress. Overall, Dr. Trappe’s group demonstrated, both at the molecular and functional levels, that exercise really is medicine.

Blake Rasmussen, Ph.D., of the University of Texas Medical Branch – Galveston discussed the role of protein turnover and anabolic signaling in exercise-induced muscle hypertrophy. Dr. Rasmussen did an excellent job of “unpacking” and simplifying some complicated intracellular signaling pathways to focus on a few key components: insulin, mTORC1 activation and translocation, and specific effects of exercise on the mTOR signaling pathway. Together, these led to three main points:

1. both inactivity and aging have been linked to reductions in mTORC1 signaling and anabolic resistance,
2. physical activity, capillary density and muscle perfusion may all be predictive of anabolic resistance, and
3. genetic manipulation of the nutrient sensing anabolic pathway can lead to muscle hypertrophy, but without concurrent exercise, it cannot improve muscle function.

John McCarthy, Ph.D., of the University of Kentucky focused on the role of ribosome biogenesis in skeletal muscle hypertrophy. For someone who has never heard of ribosome biogenesis, Dr. McCarthy provided a wonderfully clear explanation of the various methodologies to measure ribosomal RNA from in-vitro to in-vivo models, as well as the translational application of the resulting data. Linking back to muscle hypertrophy, several human and animal studies were described focusing on the effects of resistance exercise and rDNA transcription (to rRNA) and the translation of key ribosomal proteins. Interestingly, exercise-induced increases in ribosomal content (i.e. rRNA abundance) are highly correlated with the magnitude of muscle hypertrophy, and the inhibition of ribosome biogenesis prevents hypertrophy of myotubes in vitro.

Last but not least, Marni Boppart, Sc.D., FACSM, of the University of Illinois-Champaign-Urbana spoke on integrin regulation of muscle growth. Using knock out and transgenic mouse models, Dr. Boppart’s research has elucidated the mechanisms with which integrin, specifically the α7β1 complex, maintains cellular integrity and interacts with the mTOR signaling pathway to alter adaptation. While it does not facilitate load-induced growth via mTORC1, the α7β1 integrin complex may enhance growth via preservation of mTORC2 localization and signaling.

Though all four presentations had varying areas of emphasis among molecular transducers, the main take away was clear: Exercise regulates multiple molecular mechanisms in skeletal muscle, which may be protective or preventative with aging. Ultimately, this symposium fit wonderfully within ACSM’s emphasis of exercise as medicine, while summarizing groundbreaking new studies that will help to further understand the biology of muscle hypertrophy.

Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 
Read part 3 of this series: "Exercise and Energy Restriction to Improve Health: Recent Research." 
Read part 4 of this series: "Molecular Transducers of Physical Activity (MoTrPac) Update." 
Read part 5 of this series: "Metabolic Flexibility in Health & Disease: A Symposium Summary." 
Read part 6 of this series: "How Exercise Promotes Brain Health in Aging." 


Sarah Little is a doctoral student at Texas A&M University. She earned her Bachelor of Science degree from Virginia Tech and her Master of Science in Kinesiology with an emphasis in Exercise Physiology from Texas A&M University. 

Bottom Line Upfront:

Working with individuals with special needs can be both a rewarding and challenging opportunity.  If this is something that you feel you might be interested in, it’s important to get experience and make sure that you have the skillset to make a positive impact on the lives of these individuals.

Working with special needs individuals can be a very challenging but rewarding opportunity.  As I indicated in a previous post, it takes a special skillset to be able to do it.  I have coached for over 20 years now and for the last six I have also worked with special needs athletes.  I teach special education.  I am also the parent to a child with Down Syndrome, so I have a different perspective on this than most people do.  To me the most important thing, if you are thinking of working with individuals with special needs, is to have the skills set to make a positive impact on their lives.

It’s important to understand that sports, fitness, programs, academic programs, service, and leadership programs for individuals with special needs are about developing them as men and women.  It’s about teaching them skills that they can use in life.

Before working with individuals with special needs, you need to understand what you are getting yourself into, because this is not for everyone.  This requires you to be both cheerleader and stern taskmaster.  Many people get into this field for the wrong reason, they find special needs individuals to be cute.  This results in a terrible experience for the fitness/sports professional and it results in an experience that does not contribute positively to the growth and development of the individual with special needs.

It’s important to understand that sports, fitness, programs, academic programs, service, and leadership programs for individuals with special needs are about developing them as men and women.  It’s about teaching them skills that they can use in life.  If you are not doing that then you have wasted everyone’s time.

Get some experience.  This is best done by volunteering.  Everyone wants to jump straight into making money, but this is a mistake.  Volunteering gives you a chance to understand what working with the special needs population is like, it allows you to make contacts, and it gives you credibility.

Where do you find volunteer opportunities?
There are several places that you can find these.  The First is Special Olympics (www.specialolympics.org).  There are also national and state organizations.  At the local level there are Special Olympics teams that compete in multiple sports, usually clustered around cities or school districts.  The state organization usually has the contact information for the local levels.  Here you have the opportunity to do everything from just helping out at competitions all the way to coaching teams on a day-to-day basis.

Second are different service/not-for-profit organizations geared towards individuals with special needs.  For example, in the Dallas/Fort Worth metroplex we have the Down Syndrome Guild of Dallas (www.downsyndromedallas.org) and the Down Syndrome Partnership of North Texas (www.dspnt.org).  These are things you just have to search out and find something that offers programming that aligns with your interests and skills set, then you have to reach out and volunteer.

Third, there are always local opportunities to be on the lookout for.  For example, when I run my programs for children with Down Syndrome I advertise that I need help through my church’s weekly news bulletin.  

Now for the big question: Are there opportunities to make this a profitable niche for a fitness or sports professional? 
That’s a tough question to answer. 
Special needs individuals, as a population, may have more medical expenses than the “normal” population.  They may be receiving speech therapy services.  They may be receiving occupational and/or physical therapy services.  They may require medical devices, prescription medications, and other services (like a therapy dog).  All of these are costs that these families incur. 

The point to keep in mind here is that many families may already be stretched to a financial breaking point and while they’d like to take advantage of services they may be unable to do so financially.  By definition, this is a small group of people to begin with, once you start narrowing it down by people that have the ability to afford services it gets really small, all of which makes this a difficult niche to work in and find enough business to support yourself.

Author: John Cissik teaches special education at McKinney ISD in McKinney, Texas. He coaches baseball, basketball, strength and conditioning, Special Olympics, and Miracle League. John has written 14 books and over 100 print articles on strength and conditioning, fitness, and coaching.

Keys to embarking on a path toward reduced stress and improved well-being

1. Pay attention to your breath
2. Yoga is a great way to learn breath work and relaxation
3. Physical fitness promotes mental fitness

Breath.  Have you ever thought about how your breath changes when you are stressed, exercising, or relaxed?  Learning how to relax is an integral component of stress reduction that is often overlooked.  Experts have learned over the years that exercise plays a key role in the ability to relax, but as yoga has become more popular we are finding out that the breath can also help maybe even more.

Methods of stress reduction…”tend to reduce anxiety, depression, heart rate and blood pressure, and enhance a feeling of relaxation and well-being.”

Let’s start with relaxation exercises.  Spring is a great time to check in with your mind and body to see how you are feeling.  Winter is a time when more people are inside and sedentary, but once the weather begins to warm up spending time outside is mentally refreshing and relaxing.  Notice where you are holding tension in your body, and think about your breath paying attention to whether or not you tend to hold your breath or take shallow breaths.  Mental stress tends to tighten the muscles in the body, which in turn creates more tension then raises the heart rate and tightens the muscles creating even more physical stress.  Soften the jaw and watch how the shoulders and hips relax.  Breathe slowly and deeply and notice how the body relaxes.

Yoga is a perfect stress reducer and mind/body relaxer.  If practicing yoga on a regular basis is not in your daily routine just learning diaphragmatic breathing will help tremendously.  Find a comfortable place to sit, close your eyes and take slow deep breaths, expanding the diaphragm with every inhale and exhaling completely.  “Talk” to the muscles in your body and tell them to relax and melt.  Softening the jaw releases tension in the neck, shoulders and hips and leads to total body relaxation.  Deep breathing can be done any time, anywhere.

Aerobic exercise raises the heart rate while engaging in the activity, but with regular cardiovascular exercise comes a mental and physical relaxation.  When the heart rate is elevated for extended periods endorphins, or natural pain killers, are released and in time a relaxation occurs after the exercise is completed.  If regular exercise is practiced, weight begins to shed and stress about weight is reduced.  Physical fitness promotes mental fitness, and if activities are enjoyable you will make time to exercise on a regular basis.  Exercise doesn’t always have to be in the form of aerobic exercise.  Lifting weights, pilates, yoga, and any other physically demanding exercise will help to relax the body if a regular exercise routine is followed.

Many methods of stress reduction exist, including breathing, meditation, progressive relaxation, and exercise. All tend to reduce anxiety, depression, heart rate and blood pressure, and enhance a feeling of relaxation and well-being.

Author: Mindy Caplan ACSM-EP is a New Mexico-based Fitness Instructor, Personal Trainer, Wellness/Lifestyle Coach, and Yoga Instructor.

Disclaimer: Opinions expressed in the Certification Blog are the authors’ and do not necessarily reflect positions of ACSM.

This is part six of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the session titled "How Exercise Promotes Brain Health in Aging" by session co-chair Dr. Jill Barnes. 

At ACSM’s Conference on Integrative Physiology of Exercise, a common theme was how regular exercise is beneficial for multiple organ systems, and how exercise may prevent or delay the onset of age-related diseases. The last session of this conference discussed how exercise may promote brain health and reviewed recent evidence from exercise-based randomized clinical trials (RCTs) in humans.

In the U.S., physical inactivity is the number 1 modifiable risk factor for Alzheimer’s disease (AD). Barnes & Yaffe calculated that 21 percent of AD cases in the U.S. could be attributable to physical inactivity and increasing the proportion of the U.S. population who are physically active by 25 percent may prevent more than 200,000 AD cases. As with many diseases, increasing physical activity could also have a substantial impact on the social and economic impacts of AD!

At this conference, Drs. Marcelo Wood and Carl Cotman, both from University of California-Irvine, reviewed studies in mice demonstrating hippocampal neurogenesis and enhanced learning and memory after access to a running wheel. These studies are quite convincing (see this recent review), and the work of Drs. Wood and Cotman seeks to understand the underlying mechanisms by which exercise enhances brain health. Dr. Wood discussed the role of histone deacetylase 3 (HDAC3) in inhibiting new memory formation in older mice and proposed the hypothesis that exercise stimulates epigenetic mechanisms that may include histone modifications. Dr. Cotman spoke about how increases in brain-derived neurotrophic factor (BDNF) with exercise may enhance the sensitivity of downstream signaling cascades to promote memory and learning. In addition, previous exercise training may “prime” the system so that BDNF levels are quickly restored with subsequent exercise, promoting neuronal adaptations.

Despite the evidence on the benefits of exercise on brain health, and specifically animal models demonstrating hippocampal neurogenesis, angiogenesis and enhanced cognitive function with exercise, the translation to aging humans is less convincing. In fact, recent systematic reviews state that the strength of the data showing that aerobic exercise increases hippocampal volume in humans is modest at best and that conclusions regarding exercise on the default mode network (an important brain network relevant to AD) could not be made. Additionally, a recent trial in individuals with dementia concluded that exercise training did not slow cognitive impairment.  

As an exercise physiologist, this is difficult to comprehend! Why is there a difference in effectiveness between animal studies and cross-sectional studies in humans vs. RCTs utilizing exercise interventions?

Next, Dr. Fang Yu from the  University of Minnesota and Dr. Jeffrey Burns from the University of Kansas Medical Center spoke on their recent work. Both investigators are at the forefront of this area with substantial expertise in conducting RCTs on exercise and brain health. They reviewed the evidence regarding frequency and duration of exercise and the relationship to risk of dementia. Many of the studies that do show a beneficial effect of exercise on hippocampal volume or memory also demonstrate a measurable change in fitness (such as VO₂ peak). So, for exercise to have a detectable effect on the brain, the dose should be high enough to improve fitness. It seems intuitive that a significant exercise dose is necessary for an effect on the brain, but we must consider that exercise-based RCTs, especially in adults with cognitive impairment, are difficult to conduct due to logistical and ethical issues.

This session highlighted the fascinating physiology underlying exercise-induced adaptations in the brain and brought up many unresolved questions in humans: 1) what is the appropriate dose of exercise for brain health? 2) how can adherence be enhanced in adults with cognitive impairment? and 3) what ways can exercise be optimized to increase the effectiveness of exercise? These questions require more research in humans. There are numerous ongoing clinical trials that will attempt to address these research questions and, hopefully, provide convincing evidence that regular exercise in humans plays an important role in the prevention of age-associated cognitive decline and AD.

Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 
Read part 3 of this series: "Exercise and Energy Restriction to Improve Health: Recent Research." 
Read part 4 of this series: "Molecular Transducers of Physical Activity (MoTrPac) Update." 
Read part 5 of this series: "Metabolic Flexibility in Health & Disease: A Symposium Summary." 

Jill Barnes, Ph.D., FACSM, is an Assistant Professor at the University of Wisconsin-Madison in the Department of Kinesiology, and has an affiliate faculty appointment in the Division of Geriatrics and Gerontology in the School of Medicine and Public Health. She served as co-chair of the “How Exercise Promotes Brain Health in Aging” symposium at ACSM's Conference on Integrative Physiology of Exercise.

Physical inactivity has become a pandemic according to a recent report in The Lancet, one of the most respected medical and health journals in the world. The report’s authors are all members of the World Health Organization (WHO) and are experts in collecting and analyzing large-scale data. A pandemic means that the condition is prevalent all over the world. The impact of the WHO study is not limited to the USA or even to economically developed countries. It reaches both affluent and struggling economies all over the world. We have a lot of work to do.

In a recent CNN report, the lead researcher, WHO’s Dr. Regina Guthold, said "Levels of inactivity are more than twice as high in high-income countries as compared to low- income countries, with an increasing trend in high-income countries. Latin America and the Caribbean, and high-income Western countries are the two regions with the highest levels of inactivity, and with increasing trends in inactivity." Dr. Guthold went on to say that in 2016 (the last year of data collection) more than 25 percent of the world’s population (1.4 billion people) were physically inactive compared to 23 percent in 2010, putting more people at risk for cardiovascular disease, Type 2 diabetes, dementia and some forms of cancer. The WHO study was a review of 358 published surveys and included 1.9 million adults living in 168 countries between 2001 and 2016.

Despite some very well-intentioned work by many international sports medicine and exercise science organizations around the world, physical inactivity is a continuing problem. Here are some important facts revealed by the report:

• 16% of people surveyed in low-income countries get an inadequate amount of exercise
• 37% of people surveyed in high-income countries get an inadequate amount of exercise
• In east and southeast Asian countries, 26% of adults had insufficient physical activity in 2001, but just 17% in 2016 (the report credits China with leading the way to healthier lifestyles in that region)
• There is a gender difference when it comes to physical inactivity:
  • In south Asia, 43% of women are inactive compared to 24% of men
  • In the Middle East and North Africa, 40% of women are inactive compared to 26% of men
  • In upper income Western countries, 42% of women are inactive compared to 31% of men
  • In the USA, 48% of women are inactive compared to 32% of men, and the same or similar differences exist for the United Kingdom, India, the Philippines, South Africa and Turkey.

There have been many inspirational efforts to increase physical activity from Healthy People 2000 (and repeated reports in 2010, 2020 and a new one in preparation for 2030) in the USA, to Healthy China, to many other country-specific initiatives. These are all well-intentioned programs. However, the WHO 2025 goal of increasing global physical activity by 10 percent of the population is in jeopardy. As sports medicine and exercise science experts, we can make significant changes, and we need to do it now.

When I was interviewed for the CNN story, I suggested that we need to focus on lifestyle and behavior modification to overcome some sedentary behaviors. We cannot and should not be telling our chronically inactive friends, neighbors, clients, patients or students to simply go to a gym or get more exercise. For some that will work, but for most it will not. An alternative is to make small changes in behavior and small changes in lifestyle to increase physical activity. Taking the stairs instead of the elevator when going up or down one or two flights or parking the car in the last row instead of the first one at the grocery store are just a couple of examples.

Finally, we must make that critical connection between health care and fitness professionals. No longer is it acceptable for a physician to tell a patient to “get more exercise.”  Patients want more guidance. Through the ACSM Exercise is Medicine program, that connection can be made.  Doctors can find fitness professionals by using the United States Registry of Exercise Professionals or the ACSM ProFinder. Time to get moving!


Walter R. Thompson, Ph.D., FACSM, currently serves as the Immediate Past President of the American College of Sports Medicine. He is a Regents' Professor and Associate Dean in the College of Education and Human Development at Georgia State University. He also serves as the Executive Director of After-School All-Stars in Atlanta, Georgia. 

This is part five of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the symposium "Metabolic Flexibility in Health and Disease" by Ayland Letsinger. 

Carbohydrate and fat are the dominant fuel sources for energy production in our bodies. Everyone needs energy – from the most sedentary individual to the most elite athletes. On the one hand we often have trouble getting athletes to eat enough food given their high daily energy needs, while on the other hand many sedentary people who do not move much are consuming more energy than they need. In a world where individuals crave the best diet for their needs, Lawrence Spriet, Ph.D., FACSM, of the University of Guelph led a symposium on metabolic flexibility at ACSM’s Conference on Integrated Physiology of Exercise. The discussion provided science-based advice for elite athletes, sedentary people and individuals with obesity and type II diabetes. 

Dr. Spriet opened with a complex image outlining the major pathways that allow the tissues in the human body (i.e. skeletal muscle) to use fat and carbohydrate to produce energy. He commented that, “My students hate when I show this diagram, but it is important to see the whole picture of fat and carbohydrate metabolism in order to make informed choices. They call it the ‘Dreaded Metabolic Pathway Diagram.’” The key point was clear: the impressive and tremendous “flexibility” to alternate between carbohydrate or fat utilization to meet the energy demands of the body is critical for optimal performance and health. And this is most impressive when responding to single and repeated bouts of exercise. The following impressive cast of scientists supported this point with elegantly performed studies.   

Carbs: Friends or Foe? 

The high fat/low carbohydrate diet is being touted as a game changer for improving endurance performance and has become common among non-athletes. Louise Burke, Ph.D., FACSM, presented very convincing evidence showing that low carb/high fat diets had no clear benefit for low intensity exercise and simultaneously ruined high intensity performance in endurance athletes. She let the audience know her studies were followed by a barrage of angry Twitter warriors calling her work poor and claiming the studies were not long enough for the athletes to adapt to the diet. However, Dr. Burke and others have shown humans on a low carb/high fat diet DO in fact adapt and have increased ability to utilize energy from fat. Although, primarily using fat as fuel is less metabolically efficient than using glucose (the total energy yield is lower), glycogen (stored glucose) utilization is impaired, and certain high intensity points in endurance races (think of uphill portions or the final sprint to the finish line) requires carbohydrate usage for optimal performance.  In other words, the improved utilization of fat for fuel means losing vital efficiency in glucose utilization. 

The work of Bret Goodpaster, Ph.D., in studying individuals with type 2 diabetes, has revealed a decreased ability to store fuel (fat and carbohydrate) after a meal and severely impaired metabolic flexibility in utilization of fat and glycogen.  Simple exercise and weight loss programs, individually and together, restored much of the lost ability to store fuel and the flexibility to use it in skeletal muscle and the whole body. The messages were clear: you have to move more, and don’t overeat.  

Deb Muoio, Ph.D., closed the symposium by giving a great illustration of how important the mitochondria are for maintaining metabolic flexibility and health. These are the organelles in all of our cells where the majority of our energy is produced. The mitochondrial volume in cells increases when you are physically active and shrink when you are not. She showed that metabolic inflexibiliy is like a traffic jam in the common carbohydrate and fat utilization pathways that exist in the mitochondria. In simpler terms, a high fat/low carb diet is not the secret to health improvement, as exercise is proven to improve optimal metabolic function.

Finding the “perfect diet” for everyone is likely fleeting, but all four presenters agreed on a similar theme: the body’s ability to utilize both carbohydrates AND fats is critical for optimal performance and health. If you decide to remove either substrate, your body will miss that critical fuel.


Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 
Read part 3 of this series: "Exercise and Energy Restriction to Improve Health: Recent Research." 
Read part 4 of this series: "Molecular Transducers of Physical Activity (MoTrPac) Update." 


Ayland Letsinger is a Doctoral Student at Texas A&M University. Ayland was presented with an award for poster presentation at ACSM's Conference on Integrative Physiology of Exercise in 2018 for the abstract titled: A High Fat/High Sugar Diet Alters the Gastrointestinal Metabolome in a Sex Dependent Manner. 

This is part four of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the update regarding the Molecular Transducers of Physical Activity investigation by John Quindry, Ph.D., FACSM. 

In case you missed the Molecular Transducers of Physical Activity (MoTrPac) update at ACSM’s Conference on Integrative Physiology of Exercise (IPE) meeting in San Diego, here’s what you need to know:

Presenters were Marcas Bamman, Ph.D., FACSM, and Karyn Esser, Ph.D., FACSM, two principle investigators in the massive $170 million multi-site investigation. Funded by the NIH Common Fund, both human and animal research will be conducted over the next several years.

The primary points of the IPE update were to convey the phase one timeline and final methodologies determined by the MoTrPac steering committee (the investigators and outside consultants). Dr. Bamman provided updates on the human models (2,600 research volunteers), while Dr. Esser detailed the animal arms (many hundreds of Fisher 344 rats, 19 organs sampled post mortem). I encourage you to check out the particulars for yourself.

Another key point of the update was to share that, in the coming years, outside investigators can petition for tissue access in a grant-specific way. There is no doubt that the outcome of this work will set the stage for the next generation of mechanistic understanding of exercise and physical activity on total body health. In question, however, is whether the respective human and animal study designs will be robust enough to flush out all the potential new leads. The answer is probably not. By virtue of scale, Drs. Bamman and Esser conveyed that this research phase is the best overall study design, but a compromise to say the least. During the Q&A, many top scientists within our ranks raised key points of concern, all of which were conceded by the presenters.

We’re taught in first semester graduate school that no study design is an “end all,” and MoTrPac is no exception. People may find this alarming given the $170 million price tag, but it is worth noting that this investment in preventative exercise has been long coming and is a fraction of a percent of past expenditures directed to curative medicine. I happened to be on the NIH ad hoc review of the original MoTrPac submissions, and we debated many of these same points in the room and wondered more among ourselves quietly in smaller groups during the down time. Having managed my own grant budgets for years, I’m still amazed that $170 million is just as finite a sum as the grant totals for other studies. I trust that the outcomes are going to be revealing and that the next generation scientists in the field will leverage these findings into **BILLION** dollar follow-up studies and even more impactful future discoveries.  

Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 
Read part 3 of this series: "Exercise and Energy Restriction to Improve Health: Recent Research." 

John Quindry, Ph.D., FACSM, is a member of the faculty at the University of Montana, Department of Health and Human Performance. He served as a co-planner of ACSM's Conference on Integrative Physiology of Exercise. 

This is part three of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the symposium "Exercise and Energy Restriction to Improve Health: The Crossroads of Energetics and Protein Turnover" by Karyn Hamilton, RD, PhD, FACSM.

What an honor to be part of the IPE symposium “Exercise and Energy Restriction to Improve Health: The Crossroads of Energetics and Protein Turnover” on Friday afternoon. Despite the happy hour time slot and the outstanding weather in San Diego providing a tempting distraction, the session was well-attended.

Dr. Colin Selman served as a perfect chairperson for the event, keeping the speakers on schedule and on task. One notable characteristic of this session, and all of the symposia I attended, was how perfectly focused the collective presentations were—as if the speakers had been working together on the content for weeks.

Dr. John Speakman runs two research groups: one in Beijing China and the other in Aberdeen, Scotland. His contribution to the symposium focused on altering energetics with exercise and energy restriction to impact healthspan. One overriding question of Dr. Speakman’s talk, and this area of research in general, is: Can interventions such as energy restriction and exercise increase human lifespan? Dr. Speakman made compelling arguments about genetic pleiotropy and provided terrific “food for thought” that even attendees who do not focus their work on this area of research could appreciate, such as “What makes you healthy and live a long time, might also make you run more!” I heard some attendees quipping that it doesn’t really matter if calorie restriction makes humans live longer when it makes the adorable grey mouse lemur live longer.

Dr. Tracy Anthony of Rutgers University did an outstanding job of framing the cutting-edge research she does with the integrated stress response, in the context of “Exercise is Medicine.” She pointedly provided an overview of how Exercise is Medicine is actually hormesis in action; The complex physiological stresses evoked by exercise stimulate integrated adaptations that, in turn, provide protection or “resilience” to future stresses. As Dr. Anthony pointed out, “The metabolic path to health is complicated,” but the work in her lab is going a long way to help unravel the complex responses to exercise and other energetic stresses.

I was the final speaker in the symposium—quite intimidating to follow Drs. Speakman and Anthony. This was a perfect opportunity to provide an overview of our findings using four long-lived murine models that have in common both extended healthspan and activation of energetic stress signaling. The work our research team carried out clearly demonstrates activation of mechanisms favoring mitochondrial proteostasis during energetic stress, with the trade-off being slower cell proliferation or growth.

ACSM’s Conference on Integrative Physiology of Exercise provided the perfect opportunity to share published and unpublished data demonstrating the importance of understanding interactions between exercise and pharmacological interventions that also extend healthspan. It is fair to say that if you are interested in the crossroads between energetics and health, you should keep your eye on work emerging from the labs directed by the speakers in this symposium.

Website for Dr. Speakman's lab at the University of Aberdeen. 
Information on Dr. Anthony's lab. 
Website for Dr. Hamilton's lab. 

Read part 1 of this series: "Can Exercise Fill the Reductionist Gap? Reflections on Dr. Michael Joyner's Keynote."
Read part 2 of this series: "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training? Reflections on the Debate." 


Karyn L. Hamilton, RD, PhD, FACSM, is a member of the faculty at Colorado State University. She serves as a professor in the Health and Exercise Science department, the Director of the Translational Research on Aging and Chronic Disease Lab and Associate Director of the Center for Healthy Aging. She earned her bachelor's and and master's degrees at Montana State University and her Ph.D. at the University of FLorida where she worked in Scott Powers' lab. 

This is part two of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the debate, "Are Exercise 'Mimetics' a Realistic Substitute for Exercise Training?" between Ron Evans, Ph.D., and John Hawley, Ph.D.

 

The first debate of ACSM’s Conference on Integrative Physiology of Exercise, “Are exercise 'mimetics' a realistic substitute for exercise training?” is in the books, and it was a conversation starter to say the least. Pro-mimetic commentary was provided by Ronald Evans, PhD, of the Salk Institute, while John Hawley, PhD, of the Mary MacKillop Institute for Health Research gave counter arguments on behalf of exercise.

My humble opinion of the session is that both presenters approached the topic from opposite ends on a spectrum of the human condition, albeit providing variable interpretations of the same data. Imagine a Venn diagram where Evans’ mimetics and Hawley’s exercise intersect modestly, but with spirited debate over common ground. At the crux of this particular debate is PPARg, or peroxisome proliferator-active receptor gamma – a name only a scientist could love.

If you haven’t been keeping score at home, PPAR activation is central to many of the well described adaptive responses to aerobic exercise. Staying out of the molecular weeds, it is fair to summarize that PPAR activation results in dramatic alteration in metabolic function to the extent that human exercise capacity is improved in elite athletes, mall walkers and type 2 diabetics alike. Perhaps ten seconds after characterizing this cellular pathway, the search for a medicinal approach to PPAR activation (agonist) began. Think of the potential: countless lives saved or improved, Nobel prizes, swimming pools of cash! Proof of concept experiments were first conducted by Ron Evans’ research team in which “couch potato” mice receiving newly formulated PPAR activators were suddenly running literal circles around their untreated cage mates.

Remarkable as this landmark discovery was, it immediately raised the ire of some in the exercise field. Correction – media-generated overstatements that “exercise in a pill had been discovered” rightfully inflamed the those of us who promote physical activity and exercise a as means to improved health.

So what’s the wrinkle? In short, PPAR agonists (and presumably other exercise mimetics not discussed currently), amazing as they are, are not as robust a stimulus when compared to formal exercise. The metabolic and exercise performance responses to the current forms of these pills are many fold lower than good old fashioned exercise training (think ACSM prescriptive criteria for furry critters).

But you want to know who won the debate.

Sorry, but they both did. Evans very clearly defended the position that PPAR activation, should it be scalable to humans, would be revolutionary to those who can’t exercise due to disease, severe deconditioning or extreme risk for precipitating a medical event with exercise. More pragmatically, most people in the developed world won’t exercise, and there is a solid rationale to suspect that this pill is better than nothing.

On the other side of the argument, Hawley deftly defended the fact that there is no substitute for exercise. No single pill discovered to date can provide the robust multi-tissue, multi-system benefits of a brisk walk.

And by the nature of this meeting, Hawley came to the podium wearing the white hat, but that doesn’t mean Evans had a black hat. Indeed, journalistic irresponsibility in overstating the claims of exercise mimetics has nothing to do with Evans’ position. Evans’ intentions are as altruistic as Hawley’s and it’s worth noting that Evans promoted exercise alongside his mimetic discoveries. In the end Evans mostly spoke to diseased applications while Hawley addressed healthier populations. The Venn diagram overlap, still to be negotiated, pertains to those that won’t exercise—a debate for another day.

Read Part 1: "Can exercise fill the reductionist gap? Reflections on Dr. Michael Joyner's Keynote."

John Quindry, Ph.D., FACSM, is a member of the faculty at the University of Montana, Department of Health and Human Performance. He served as a co-planner of ACSM's Conference on Integrative Physiology of Exercise. 

This is part one of a series of blogs from attendees at ACSM's Conference on Integrative Physiology of Exercise. The following blog is a reflection on the Opening Keynote delivered by Michael Joyner, M.D, FACSM. 

Having just sat through the Michael Joyner keynote talk, the opening event at the ACSM Integrative Physiology of Exercise meeting in San Diego, I’m left wondering if I can go back to graduate school. (I just checked with my wife…the answer is “NO!”) But Joyner’s talk was that inspiring.

As with any engaging academic lecture, Dr. Joyner had three points to make—the first being that the luminaries of modern science have crafted more than a few hollow promises about how omics and big data will solve societies medical woes. Indeed, there is a drug discovery gap, a health outcomes gap and the undeniable reality that when science removes a singular mechanism from a biological system, parallel mechanisms take up the slack.

Dr. Joyner’s second point was refreshingly made from the perspective that genetics do not rule all outcomes. In essence, humans are “plastic.” In true Joyner fashion, the “exercise is good medicine” message was packaged in a nuanced way that I’ll admit I’ve never before heard. The middle point was topped by reassuring the audience that phenotyping is hard—a strong call to do more research that overlaps mechanistic, parallel human and animal models, clinical and translational.

The final point was perhaps best of all: Dr. Joyner shared eight novel research ideas. Each idea, if performed correctly, would likely prove to be a landmark study. Are you sure I can’t go back to grad school?! He also coined the “Joyner criteria” for whether regenerative medicine is a success: benefits of new interventions should exceed that of exercise training.

So yes, I was inspired. Safe to state that in a room of smart people (everyone has or is earning a terminal degree of one type or another), Dr. Joyner is quite probably the brightest. His ability to bring food for thought is unparalleled within the ACSM umbrella. His talk was definitely worth the price of admission.     

See this news release for more details on Dr. Joyner's keynote. 

John Quindry, Ph.D., FACSM, is a member of the faculty at the University of Montana, Department of Health and Human Performance. He served as a co-planner of ACSM's Conference on Integrative Physiology of Exercise. 

The ACSM-GEI Exam update may affect you - this FAQ explains how and why

Summary:

• The ACSM-GEI exam will change on December 3, 2018.
• The exam crosswalk document (below) compares the 2010 and 2018 versions of the ACSM-GEI exam.
• The exam content outline (below) provides specific topics you need to know and/or be able to perform.

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Why is the exam changing?
The ACSM Committee on Certification and Registry Board (CCRB) performs job task analyses (JTAs) of its exams on a regular basis. JTAs survey currently practicing professionals in what they are expected to know and be able to perform for their job. In addition, the JTA captures important changes in industry and standards of practice.
The role of a Group Exercise Instructor has undergone tremendous change in the past decade. As a result, the ACSM CCRB has revised the ACSM-GEI exam to be consistent with the ever-changing demands of a Group Exercise Instructor.

How do I get started?
STEP 1. A good place to start is to review the exam crosswalk document. The crosswalk provides an overview and side-by-side of exam changes from 2010 to 2018. 

2010-2018 ACSM-GEI crosswalk

STEP 2. Next, you should review the 2018 exam content outline. This document provides a deeper dive into job tasks and specific knowledge and skill statements.

2018 ACSM-GEI Exam Content Outline

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FAQ: Do current ACSM-GEIs need to retake their exam?

They do not.

FAQ: What are cognitive levels?
The ACSM CCRB included a new section on the exam content outline called “cognitive level.” The job of a Group Exercise Instructor can range between simple to complicated tasks. Much in the same way, the ACSM-GEI exam is written at different levels. Cognitive level is a way to describe how complex certain job tasks are.

ACSM uses three cognitive levels: recall, application and synthesis.

Recall is remembering certain facts.
Application requires you to understand a process and know what to do with it.
Synthesis requires you to examine a complicated situation and provide an answer based on new information.

You can find sample questions in the Exam Content Outline. 

Be sure to connect with us on Twitter, Facebook, and LinkedIn to keep up with the latest updates, expert insights and more. 

Good luck on the ACSM exam! We look forward to you becoming a part of the ACSM-certified family!

In health,
Francis Neric, MS, MBA
ACSM National Director of Certification

How to increase your success as a fitness professional, using the 5 Step Sales framework, and identifying the 4 key behavior styles.

The sales process is a skill that can be learned and developed by anyone and is especially useful to be aware of when you are interacting face to face with people. I have always thought about the sales process as thinking about what you are going to do before you do it. I learned the hard way through trial and error in my early years as a personal trainer and medical sales professional and wondered what I was doing wrong until I had some training on the sales process.

"Knowing your sales target involves understanding your own behavior style"

5 Step Sales Framework

The sales framework breaks down a sale into a five-step process from establishing a relationship, demonstrating a need, working through concerns, and, eventually, closing a sale:

Approach – establish rapport and break the barriers of pre-occupation

Interview – identify needs, challenges and motives

Demonstrate – show how your products and services fill identified needs

Validate – cause people to trust you and believe your claims

Negotiate – understand and work through problems and concerns

Close – ask for an appropriate commitment to action

4 Behavior Styles

Knowing your sales target involves understanding your own behavior style, identifying the style of the potential customer and adopting your style to mirror that of the potential customer. Mirroring essentially is where you mimic verbal and physical behaviors of a potential customer to build rapport. While this seems strange at first, it happens naturally among like-minded people. Imagine seeing your high school friend that you haven’t see in years. You will often speak with same cadence and tone, use the same physical gestures, etc. People tend to let their guard down and open up to when using this method*:

Talker - Outgoing and friendly, not as interested in details, values personal relationships, makes decisions based on emotions and facts.

Doer - Direct, forceful and results oriented. Requires concise, focused information. Makes quick decisions. Has clear objectives to achieve.

Supporter - Needs time to process information. Likes to establish trusting relationships. Reluctant to change current buying habits. Laid-back and friendly.

Controller - Detail-oriented, deliberate and organized. Relies on facts, evidence and data. Weighs all options before making a decision. Lower manifestation of energy and emotion.

*Which one are you? Try identifying the behavior style of those around you.

My Personal Experience:
Identifying as a Doer, the biggest mistake I have made, and still make from time to time is skipping the approach. Being too direct and forceful makes it harder to mirror and build rapport with the potential customer. A terse communication indicates an awkward negotiation that comes across as forceful, which makes it even harder to close. Recognizing and becoming aware of this mistake as part of my behavior style has taught me to spend more time on the approach, listen more during the interview process, and ultimately make a better sale. Coming across as a real person instead of a sales person, identifying what the potential customer needs, and demonstrating that what you have provides value, using the framework above, will increase your success as a fitness professional.

Author 
William Coale is a fitness and health education professional who wears many hats, but still has time to get at least 30 miles of running and a few thousand kettlebell swings into his week. 

William collaborates with orthopedic trauma surgeons and podiatrists to determine the best medical device and bracing solutions for their patients and help GPs and cardiologists learn more about diagnostic solutions for improved patient care. 

At his private practice, Proprius, William focuses on training and motivating individual clients to achieve their personal goals, perform their best, prevent overuse injuries, execute physical rehabilitation plans, and maintain mobility and flexibility. 

William graduated with a B.S. in Kinesiology from Indiana University where he also competed as a varsity cross country and track and field athlete. He is a licensed massage therapist and has a Corrective Exercise certificate.