Why Should YOU Attend ACSM's International Health & Fitness Summit?

In addition to CECs and Career Development opportunities, Renee Rogers, Ph.D., describes why infusing science throughout ACSM’s International Health and Fitness Summit benefits ACSM and attendees. 

Learn more and register for the ACSM International Health & Fitness Summit at ACSMSummit.org!

#ACSM #ACSMSummit

Chronic heart failure (HF) is a global epidemic. For the greater than 26 million world-wide patients with HF, this burden does not just cause an impairment in how blood is pumped out of the heart, HF impacts how all organ systems function and interact with one another. This means that HF constitutes a multi-organ syndrome as opposed to a disease of a single organ system, making it difficult to identify a “cure.” Unfortunately for patients, this means the impact of HF is felt daily and universally experienced as exercise intolerance and inability to comfortably perform activities of daily living. Fatigue and shortness of breath quickly overcome patients soon after engaging in even the most basic exercise such as walking to get the mail or climbing household stairs.

Since the seminal work of Weber and Janicki demonstrating that exercise intolerance does not simply impact the quality of life of HF patients, but is also strongly predictive of clinical severity, over 30 years have flown-by and we now know the “cure” for exercise intolerance is indeed the act of exercise itself. Despite this golden era of knowledge, there is a lot to be said about the pure translation of this rich information from “bench to bedside”.

An encouraging and globally impactful effort towards the ACSM Exercise is Medicine approach for the management of HF was recognized at center-stage following the 2009 publication of HF-ACTION. A large number of patients with HF and reduced ejection fraction (HFrEF; left ventricular ejection fraction of 35% or less) were shown to safely and clearly benefit from extended and structured aerobic and strength exercise training (ET) therapy (36 sessions; 3x/week; over 12 weeks). With the findings from HF-ACTION underpinning the support needed for the eventual 2014 policy recommending that Centers for Medicare & Medicaid Services (CMS) provide coverage for cardiac rehabilitation (CR) therapy for patients with HFrEF, it was believed that a “magic pill” for curing exercise intolerance and related signs and symptoms had been found. If only the “cure” was as simple as literally taking a pill.

Despite the exponential growth of studies, both domestic and international, since HF-ACTION supporting the medicinal role that ET therapy plays in managing signs and symptoms of HF, alarming underutilization of CR and ET continues to be reported (see here, here and here). Some important facts highlighted in recent reports focusing primarily on patients with HFrEF include:

• Less than 13% of CMS eligible patients are likely to receive referral for CR at discharge.
• Participation in at least one session of CR may be less than 3% out of all who are CMS eligible.
• Stable outpatients referred to CR (97%) as opposed to hospitalized inpatients (17%) referred to CR upon discharge are more likely to enroll.

What patients may not know is that CR is a Class I recommended therapy for HFrEF. This means CR is at the same status level as traditionally prescribed pharmacotherapies. Nevertheless, the data speaks for itself in illustrating the importance of the CR service-line has not been emphasized across the patient-to-clinician spectra to the point where it is appropriately being utilized.

Although the statistics are disappointing, the temptation for assigning responsibility for shortcomings must be resisted. Instead, it is important to look forward to the future and realize that all of us can still make significant changes to the running narrative of what CR means for HF patients. The well-intentioned hope of CMS coverage for CR should not be lost. There are ambitious campaigns focusing on improving education and awareness for both patients and clinicians highlighting the importance of CR, secondary prevention and life-long participation in exercise and physical activity.

Finally, conventional wisdom should lead all of us to the conclusion that ET therapy and HFrEF are not mutually exclusive events. Patients not classified as HFrEF, such as those diagnosed with HF and preserved ejection fraction (HFpEF; left ventricular ejection fraction of 50% or greater) or mid-range ejection fraction (HFmrEF; left ventricular ejection fraction of greater than 35% and less than 50%) are also logically to benefit from CR and ET therapy. There is no time sooner than now to force the narrative that all HF classes and etiologies stand to benefit from medically guided and individualized ET therapy.

Erik H. Van Iterson, Ph.D., is a member of the clinical staff and is the Director of Cardiac Rehabilitation in the Section of Preventive Cardiology & Rehabilitation in the Heart and Vascular Institute at the Cleveland Clinic, Cleveland OH.

Viewpoints presented in this blog reflect opinions of the author and do not necessarily reflect positions or policies of ACSM.

Gatorade Sports Science Institute (GSSI) and Dr. Mary Jane De Souza recently hosted an industry-presented webinar entitled: The Female Athlete Triad & Sports Nutrition Strategies for Recovery. Watch a free recorded version of the webinar here.

Key Points: 

1. Recovery of the Triad is dependent on nutritional therapy to reverse energy deficiency and low EA.

2. Recovery of bone is dependent on increased body weight, fat mass and menses.

3. Must consider energy status and estrogen for recovery and to make recommendations for return to health. If estrogen therapy is considered, transdermal is the best for women who fail one year of nutritional therapy and with worsening bone health.

Several questions were asked by attendees during the webinar and the answers are below.


Q: What is a normal time frame from chronic low EA to menstrual dysfunction? (when do the first symptoms appear?)

Depending on your current menstrual status, where you are in your cycle, and the magnitude of energy deficiency, it may take weeks to months for menstrual disturbances to be observed. 

Q: Does use of a birth control pill have an impact on energy availability?

Oral contraceptives may be associated with changes in appetite or eating behaviors, but aside from that they do not directly alter energy availability.

Q: Is there a clear relation between menstrual dysfunction and reproductive ability? and if so, will it always be reversible (when menstrual function is back to normal will an athlete have a normal reproduction capacity)?

Anovulation, oligomenorrhea and amenorrhea can impact reproductive ability. We expect reproductive ability to resume once the menstrual irregularity is resolved and cycles become ovulatory again; however, there have not been any studies yet that have looked at fertility itself with respect to the Triad.

Q: kcal/kg/FFM/day - How can this be used in the field where body comp is not known?  vs kcal/kg/bw?

Correcting for body mass rather than fat free mass would likely result in an underestimation of EA.  There are several commercially available tools, such as Bio-electric Impedance Analysis (BIA) devices, that are available to estimate fat free mass that would be recommended in field assessments of EA.

Q: How long should a menstrual cycle be absent before you are considered to have amenorrhea?

Current Endocrine Society Clinical Practice Guidelines define functional hypothalamic amenorrhea as an absence of menses for 3 months or more.

Q: I'm wondering how to identify menstruating and amenorrhea? Compare with themselves, or 28 days?

Eumenorrheic menstrual cycles occur at regular intervals and last approximately 26-34 days.  Oligomenorrhea is characterized by long and irregular menstrual cycles, often longer than 36 days.  Amenorrhea is the absence of menses for 3 months or longer.

Q: At the beginning of the presentation, you mentioned that this can also affect men. In addition to bone health, does this also affect hormones in males?

There is some evidence that metabolic and reproductive hormones may be suppressed in men who have low energy availability or chronic energy deficiency.

Q: Can females who menstruate regularly on the pill still have menstrual dysfunction (if they were not using the pill to regulate hormones) and is this just as dangerous for reproductive function?

Use of oral contraceptives suppresses ovulation and menstrual function, as they are intended to prevent pregnancy and, since you have monthly bleeding, make it seem like you are having regular menstrual cycles. Bleeding while on the pill is not menstrual bleeding it is breakthrough bleeding stimulated by the pills.  The pill is not “dangerous” for reproductive function.  In a small number of women, when you stop the pill you may experience post-pill amenorrhea.  

Q: Did you have a specific recommendation for the increased calorie group? I.e. a certain food or specific source of energy?

For the REFUEL study, the intervention was only focused on increasing the total number of calories by 20-30% of baseline energy expenditure needs. An interesting topic for future research would be to determine if specific macronutrients are needed or if increased calories of any macronutrient composition are adequate to have positive benefits.

Q: Having your athlete be on a birth control pill for regular menses will this prevent bone loss?

OCs are processed by the liver, which leads to decreased hepatic IGF-1 production, contributing to potential negative impacts on bone health.  OC’s are not the best strategy to prevent bone loss.  Contraception in the form of a patch or vaginal ring to avoid first-pass effects on hepatic IGF-1 production likely will yield better outcomes on bone.

Q: Specifically, around the question of 45 kcal/kg/FFM/day? How do we determine this?

EA is calculated as energy intake (kcal) – exercise energy expenditure (kcal) / fat free mass (kg).

Simple assessments of energy availability can utilize diet logs for energy intake, exercise logs or the Compendium of Physical Activity for energy expenditure, and bioelectrical impedance or skinfolds for fat free mass.

Q: In the study, when the calories were increased in the oligo/amenorrhoeic, was the quality of the calories taken into consideration, e.g., calories from fat vs carbohydrate, etc.?

For the REFUEL study, macronutrient composition was not considered.  This intervention was only focused on increasing the total number of calories.

Q. Does phytoestrogen supplementation can alleviate negative impact of subclinical/clinical MD on bone health?

There is some data in postmenopausal women that phytoestrogens may help with bone problems to a small extent.

Q: Do you look at hemoglobin to look at energy levels? Regular menses can affect.

To date, not much research is present to determine the impact of iron status on Triad-related conditions. We do have one study that shows the ovulatory eumenorrheic women do have a higher prevalence of iron depletion compared to amenorrhoeic women, the two groups do not differ in serum ferritin levels, hemoglobin, hematocrit, or total body iron. More research is necessary to investigate whether iron impacts bone health in this population.

Q: Intermittent fasting seems to be the new hot topic. What is your take on athletes taking part in intermittent fasting?

Some studies have begun to look at within-day fluctuations in energy availability.  It is possible that diet patterning which produces severe energy deficits throughout the day, even if 24-hour diet goals are met, may result in negative health outcomes.

Q: Does the recommendation also apply to those who have hypothyroidism? Hyperthyroidism?

We excluded women with thyroid conditions from our study.

Q: Can any of this be correlated to menopause?  Have there been any studies following this information?

It would be interesting to see how the bone health of previously amenorrhoeic athletes is when they get to be menopausal- but no, we do not have any data to date on this issue.

Q: Even in college athletes you would consider waiting a year before starting hormone replacement knowing they may lose a year of participation?

Because the root of Triad is inadequate energy, the recommended first course of action is to start nutritional therapy for one year to increase energy levels. This should start to recover menstrual status after a few months. If the athlete fails to complete nutritional therapy for a year (i.e. does not consume enough calories to resume normal menses), the physician working with the athlete could then consider hormone therapy, preferably in the form of patch or vaginal ring to avoid first-pass effects on hepatic IGF-1 production.

Q: Is it possible to have amenorrhea or oligomenorrhea without possibility of bone damage?

Not likely. The extent of bone loss with amenorrhea/oligomenorrhea would be dependent on the length of time without regular menses. Estrogen production is extremely important for inhibiting the osteoclasts responsible for bone resorption, and therefore the longer you are without normal estrogen levels (i.e. when you are not menstruating regularly), the more active these cells are at breaking down bone. If energy status is improved relatively early on, this could help prevent the progression of bone loss.

Q: What about postmenopausal athletes and bone recovery with nutrition support - is it possible without pharmacy?

Because estrogen levels are drastically reduced with menopause, bone health is at risk during this time.  Along with proper nutrition and adequate food consumption, the Food and Nutrition Board (FNB) recommends that post-menopausal women supplement with calcium and vitamin D to the recommended daily value of 1200 mg of Calcium and 600-800 IU Vitamin D. But be advised that pharmacological therapy may be necessary for postmenopausal bone loss. 

Q: What impact does age have?  Comparing a 20-year-old to a 40-year-old, with other factors being similar?

Women who are of greater gynecological age (farther from having their first period) seem to be more robust against menstrual disturbances.  Younger women may also still be accruing bone density so it is especially important for them to maximize their peak bone mineral density, whereas older women may only need to maintain their bone mass.

Q: What type of supplement/vitamins do you recommend for low density athletes?

Calcium and vitamin D are important contributors to bone health. The FNB at the Institute of Medicine recommends adults to take between 1000-1200mg calcium and 600-800 IU vitamin D daily.

Q: What are your recommendations for vitamin D supplementation?

The recommended daily allowance established by the FNB at the Institute of Medicine of the National Academies recommends 600 IU daily for people ages 13-50 and 600-800 IU daily for people ages 51 and older. 

Q: What about psychological therapy?

A mental health practitioner should be included in the multi-disciplinary team for Triad treatment, especially when disordered eating behaviors or clinical eating disorders are present.

Q: Can you explain the physiology as to why OA athletes would have a 27% increase in fractures versus an Anorexic athlete?

The 27% increase was specific to stress fractures.

Q: Is it possible that despite a decrease in BMD, bone structure can be maintained so that the bone remains functional and strong with low risk of stress fractures?

One possibility of why jockeys don’t have stress fractures is due to it being a non-loading activity, many of the fractures encountered in this population are of the traumatic type from falls.  We don’t yet know whether bone geometry can be recovered or if it can be maintained despite decreases in BMD.

Q: My question is regarding my personal experience with the F.A.T. I have been recovered from an eating disorder and amenorrhea for one year, but my bone health has not changed. I am still in the osteopenia category. I do have a history of stress fractures in my pelvis. My question is, at the age of 22, if there hope that I can reverse some of the bone loss? Should I consider pharmacological approach with my doctor?

Remember that bone health takes the longest to recover when you are along the spectrum of the Triad, and may also be impacted by the length of time for which you were dealing with the eating disorder and amenorrhea. While there is no current research to suggest that bone loss can be fully reversed, increasing your energy intake and achieving menstrual regularity is the first big step towards improvement. If you aren’t already taking calcium and vitamin D, please consult with your physician to include this in your recovery plan before seeking other pharmacological interventions.

Q: Does bone loss occur in perimenopausal and postmenopausal women on low energy diets?

Because estrogen levels are drastically reduced during the menopausal transition, this leads to decrements of 1-2% of bone mineral density per year. Along with proper nutrition and adequate food consumption, the Food and Nutrition Board (FNB) recommends that post-menopausal women supplement with calcium and vitamin D to the recommended daily value of 1200 mg of calcium and 600-800 IU Vitamin D. 

Q: Does age of athletes (adolescent vs women in their 30's) have any impact on treatment and resolution of symptoms?

Yes, you must check skeletal maturity issues in young athletes.

Q: Did the participants in your study track intake using an online tool e.g. MyFitnessPal or SparkPeople or keep a hand journal?

We utilize hand journals, but online tools can also be useful especially to individuals tracking their own intake.

Q: The menstrual cycle is a great indicator of the FAT in women - is there an equivalent for men and the MAT?

The Male Athlete Triad is likely more difficult to diagnose for that reason.  One symptom that may be readily observed is a decrease in libido.

Q: Women who take part in sports normally should have periods monthly, thus, my question on periods. Let us suppose we are talking about professional long-distance runners. We are aware of the deficits in performance that periods may have on women. Hence, what diets are the most appropriate for women to maintain their training regime and ensure they perform on race day?

There is NO data available to show that menstrual bleeding is detrimental to performance. We NEVER recommend trying to induce amenorrhea.

Q: Is it possible to recover BMD in mater athletes after menopause?

Women should work towards maintaining their bone mineral density as they go through menopause. Along with proper nutrition and adequate food consumption, the Food and Nutrition Board (FNB) recommends that post-menopausal women supplement with calcium and vitamin D to the recommended daily value of 1200 mg of calcium and 600-800 IU Vitamin D.  If losing bone, they should discuss strategies with their Dr.

Q: Transdermal estrogen is associated with increased risk of DVT, isn't it?

There is an increased risk dependent on the type of progestin the preparation.

Q: When you mentioned a 200 approx. increase in calories, for how long do you recommend maintaining this amount before trying to increase a little extra if no effects are seeing?

 If you start small say 200kcals, you can increase kcals after two to four weeks to get a better chance of recovery.

Q: Why in the REFUEL study the increase in energy intake was increased by 20-30% of EEE and not aimed at 45 kcal/FFM/day?

Because that volume of calories would have likely been too high to ask the women to eat and we would likely have been unsuccessful.

Q: Could you address the average kcal per kg to resume menses from your study? You mentioned the highest amount was ~445 kcals, but how many kcals per kg was this?

We are in the process of analyzing the data- watch for our publications.

Q: When calculating EA, what is your recommendation on how to estimate energy intake and exercise energy expenditure?

Energy intake can be assessed by 3-day diet logs or online diet recording tools.  Exercise energy expenditure can be assessed using exercise logs matched with heart rate monitors or using the Compendium of Physical Activity.

Q: Which type of sports are most likely to result in effecting menstrual cycle disturbances?

Menstrual dysfunction is more commonly observed in leanness sports which emphasize a low body weight for competitive or aesthetic purposes, as in endurance, weight-class, or anti-gravity activities.

Q: What do you think about doing screening DEXA scan for BMD and body composition on all incoming collegiate female athletes?

A screening DXA would be a valuable piece of information for these athletes to have, particularly because most do not realize that their eating behaviors/ inadequate consumption have detrimental consequences on bone health. This would also help identify those in need of dietary intervention early in their collegiate career. This would also provide useful information to the athletes regarding their health.

Author: 

Dr. Mary Jane De Souza, Professor of Kinesiology and Physiology at Penn State University.  Dr. De Souza is a preeminent researcher in the area of the physiological basis of exercise and how it modulates reproductive function and bone health through alterations in energy balance.  Dr. De Souza’s specific research “niche” has been defined by a series of studies demonstrating significant associations of menstrual disturbances, metabolic adaptation, and bone health.  Among her many recognitions, Dr. De Souza is a recipient of the prestigious Citation Award from the American College of Sport Medicine for her lifetime achievement in research, and the Honor Award from the New England Chapter of the American College of Sports Medicine.

Earn 6 Continuing Education Credits

Course Overview: Learn how to build an effective heart rate-based training program, along with foundational knowledge of the physiology of heart rate. This course will primarily focus on utilizing five heart rate training zones through the exercise disciplines of cycling and running. In addition, utilizing online platforms such as Polar Flow and TrainingPeaks to manage heart rate training will be addressed.

After completing this course, you’ll understand how to utilize all training heart rate zones to build effective endurance programs and address specific training obstacles that may present themselves throughout a program.

Learning Objectives

•             Learn the exercise physiology of heart rate assessment and how to perform maximal and sub-maximal VO2 field testing.

•             Learn how to effectively build a heart rate-based training program utilizing the five heart rate training zones.

•             Learn the importance of respiratory muscle training within a heart rate-based training programs.

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February is American Heart Month - Celebrate through awareness and education

Heart disease is the number one cause of death in the United States. Approximately 610,000 people die of heart disease in the United States every year—that is roughly 1 in every 4 deaths. For women, the number of deaths is even more alarming. One in every three American women dies from heart disease, which is about one woman every minute!

This resource includes:

• Symptoms of a heart attack
• Risk factors for heart disease
• Tips for preventing heart disease
• Why physical activity is important in preventing heart disease
• Recommendations for appropriate physical activity for the prevention of heart disease

Download the Women and Heart Disease pdf resource for yourself or clients here.

A Critical Go-To Text for Assessment: ACSM’s Health-Related Physical Fitness Assessment Manual, 5th edition

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The recently released ACSM’s Health-Related Physical Fitness Assessment Manual, 5th edition was revised by editor Gary Liguori, PhD, FACSM according to the ACSM’s Guidelines for Exercise Testing and Prescription, 10th edition. Dr. Liguori served as an associate editor on GETP10. This manual provides a comprehensive overview of why and how to perform assessments. Perfect for lab based fitness courses in exercise science, physical therapy, and exercise physiology.

Highlights of this 5th edition:
• New preparticipation physical activity screening recommendations help ensure that more of the population can begin a safe, healthy physical activity program without first consulting a physician.
• An exclusive focus on assessment makes key information easy to access.
• A new case study format integrated into each chapter, encourages continuous application of the assessment and interpretation skills.

The Translational Journal of The American College of Sports Medicine (TJACSM) was launched in the Spring of 2016 to fill a gap for the ACSM membership and the overall exercise science literature. The purpose of translational science is to move new findings from the laboratory to public use for large-scale impact. The goal of TJACSM is to ultimately become the authoritative journal for translational exercise science and policy.

In 2018, articles published in TJACSM provided new insights and strategies to translate exercise and policy into a wide variety of settings to impact individuals and communities. The most accessed paper was by Ladwig and colleagues “My Best Memory Is When I was Done With It: PE Memories Are Associated With Adult Sedentary Behavior.” The article investigated the dislike of physical education (PE) class and subsequent participation in exercise and sedentary behavior of adults. This article has significance given the well- known association of physical activity and health and was featured in The New York Times (August 22, 2018).

The topic of physical activity in the school setting proved to be a popular topic in 2018. Two other TJACSM articles, by Bartholomew and colleagues and Beemer and colleagues, illustrate in-classroom physical activity and the impact for increasing activity and impacting learning.

Although we frequently link exercise with physical health, there is past and emerging evidence of the importance of exercise for mental health and cognitive function. Rosenbaum and colleagues published an international consensus statement supported by Exercise and Sports Science Australia, ACSM, the British Association of Sport and Exercise Science, and Sport and Exercise Science New Zealand. This statement delineated key factors to be addressed by decision makers to increase access to exercise programs for individuals with mental illness to help close the life expectancy gap compared to individuals without mental illness.  

For the 2019 ACSM Annual Meeting, the subcategory of Translational Research was added as an option for the free communications/posters. Travel awards and on-site recognition will be provided for the top graduate/postdoctoral and new investigator presentations; you can find more information on the awards here.

In 2019, TJACSM will continue to publish papers that provide new insights for translational exercise science and policy. Two theme-based series of papers will be published; one in collaboration with the ACSM’s Strategic Health Initiative on Women, Physical Activity and Sport, and one on physical activity in schools and the classroom. Of note for potential authors is that indexing for TJACSM is in process and once completed all previously published articles will be retroactively indexed. More information will be released once this is completed. 

Most Read Articles Published in 2018

"My Best Memory Is When I Was Done with It":  PE Memories Are Associated with Adult Sedentary Behavior

The Role of Sport, Exercise, and Physical Activity in Closing the Life Expectancy Gap for People with Mental Illness:  An International Consensus Statement by Exercise and Sports Science Australia, American College of Sports Medicine, British Association 

Validity of Activity Tracker Step Counts during Walking, Running, and Activities of Daily Living

The Warrior Wellness Study:  A Randomized Controlled Exercise Trial for Older Veterans with PTSD

Active Learning Increases Children's Physical Activity across Demographic Subgroups

If You Build It, Will They Come? A Quasi-experiment of Sidewalk Improvements and Physical Activity

Feasibility of the InPACT Intervention to Enhance Movement and Learning in the Classroom

An Alternative Approach to Isometric Exercise Training Prescription for Cardiovascular Health

Effects of Task Difficulty on Kinematics and Task Performance during Walking Workstation Use

Preparticipation Screening before Physical Activity in Community Lifestyle Interventions

Conversation Starters: Highest Altmetric Attention Score

Altmetric calculates a score based on the online attention an article receives. The score is calculated based on two main sources of online attention: social media and mainstream news media. 

"My Best Memory Is When I Was Done with It":  PE Memories Are Associated with Adult Sedentary Behavior

The Role of Sport, Exercise, and Physical Activity in Closing the Life Expectancy Gap for People with Mental Illness:  An International Consensus Statement by Exercise and Sports Science Australia, American College of Sports Medicine, British Association 

If You Build It, Will They Come? A Quasi-experiment of Sidewalk Improvements and Physical Activity

Feasibility of the InPACT Intervention to Enhance Movement and Learning in the Classroom

Integrating Exercise into the Electronic Medical Record:  A Case Series in Oncology

The Implementation and Outcomes of Exercise Is Medicine on Campus

Development of a Community Wellness Program for Prostate Cancer Survivors

ACSM Professional Members receive a subscription to the ACSM journals Medicine & Science in Sports & Exercise®, Exercise and Sport Sciences Reviews and the Translational Journal of the American College of Sports Medicine. Additionally, members who are physicians receive a subscription to Current Sports Medicine Reports. Further, members receive discounts on ACSM certification exams, meeting and conference registrations, ACSM continuing education credits and more. Learn more and join today! 

Joseph E. Donnelly, EdD, FACSM, is the Editor-in-Chief of the Translational Journal of the American College of Sports Medicine. He is a Professor of Medicine and Director, Center for Physical Activity and Weight Management at the University of Kansas. 

Recently, the U.S. Department of Health and Human Services published a National Health Statistics Report updating the trends in body weight, height, waist circumference and body mass index (BMI) in the U.S. population. This update uses data from the National Health and Nutrition Examination Survey (NHANES) and primarily focuses on trends from 1999-2000 through 2015-2016.

If you are not familiar with NHANES, it is a program of studies that examines the health and nutrition status of adults and children. NHANES actually began in the 1960s and, since 1999, has collected data every year through interviews and physical assessments with a nationally representative sample of ~5,000 adults.

This report examined the trends in ~45,000 adults over 20 years of age from measures of weight, waist circumference, height and BMI computed as weight (kg) / height² (m).

Report Highlights:

Weight:

There was a significant and linear increase in body weight over time, which means that there has been a steady increase in body weight over the measured years. In general, this pattern was seen in both men and women, for each race and for those of Hispanic origin, and across age subgroups. Overall, men had a body weight in 1999-2000 of 85.9 kg (189.4 lb) and it increased to 89.8 kg (197.9 lb) in 2015-2016. Women had a similar pattern going from 74.3 kg (163.8 lb) to 77.4 kg (170.6 lb).

Summary: Americans gained seven to eight pounds, which is approximately a five percent increase in body weight, over 18 years.

Waist Circumference and BMI:

There were similar patterns for waist circumference and BMI increases just like with weight. The increases were also linear with men increasing their waist circumference from 99.1 cm (39.0 in) in 1999-2000 to 102.2 cm (40.2 in) in 2015-2016. At the same time points, women went from 92.2 cm (36.3 in) to 98.0 cm (38.6 in). The average BMI remains in the overweight category (25.0 to <30.0 kg/m²), but still increased from 27.8 and 28.2 kg/m² to 29.1 and 29.6 kg/m² in men and women; respectively.

Summary: Just like body weight, there has been an upward trend in waist circumference and BMI without any major change in body height over time. When you look at waist circumference and BMI together, the risk of type 2 diabetes, hypertension, and cardiovascular disease is “high” when someone classified as overweight also has a waist circumference greater than 102 cm (40 in) for men and greater than 88 cm (35 in) for women.

What does this mean when we think about prescribing exercise and physical activity?

Being active is a key lifestyle behavior recommended for health and wellness and as a part of comprehensive treatment for weight management in conjunction with diet and behavior therapy. We know this. However, we must not overlook the fact that carrying excess body weight has been associated with other co-conditions such as low back pain, chronic pain, decreased health-related quality of life, lower physical function, balance and mobility issues, depression, body dissatisfaction, obstructive sleep apnea and knee osteoarthritis. The impact (literally) of carrying extra body weight can potentially hinder exercise participation, as every one pound of extra body weight can feel like four extra pounds on the knees (those seven to eight pounds gained can feel like 28-32 pounds). These are important considerations when we think about providing successful, safe and sustainable programs, while ensuring positive experiences for our participants.

It is easy to grab ahold of a position stand or a fitness trend and want to apply that guideline or mode to help a physically inactive participant - but it does not always work seamlessly. For example, the 2009 ACSM Position Stand on Physical Activity Strategies for Weight Loss and Prevention of Weight Gain recommends 150-250 minutes per week of moderate physical activity to prevent weight gain and produce modest weight loss, and greater than 250 minutes per week to achieve clinically significant (5%) weight loss. If you recall, the increase of seven to eight pounds in the U.S. population since 1999 is approaching an increase in weight of almost five percent.

Imagine what would happen if you initially recommended this high volume of activity early with your participants. What would their experience be like and how would they feel? Think about how those co-conditions could interfere and whether or not they are prepared for this volume of activity. In our weight management research programs centered around lifestyle with an emphasis on physical activity, we strategically work with our participants to “ramp up” to the high volumes of physical activity – this can take anywhere from 12-24 weeks, sometimes increasing time by 25 minutes every four weeks, to get to the 250-minute threshold. This strategy allows for eventual achievement of the recommendations of our ACSM Position Stand so we are still following evidence-based guidelines, but also considers the specific needs of the participant carrying extra body weight.  

Let’s take a moment to pull an example from the newest Top 20 Fitness Trends in relation to the population carrying more body weight. I personally loved seeing yoga on this list (#7) and recently engaged in designing a research intervention that used yoga within a weight management program. Early on, we heard concerns related to the co-conditions mentioned above. More specifically, the participants reported not being able to balance in poses or transition into poses as quickly as it would be done in a typical class, and not having the strength to hold poses or lift the weight of their body in and out of poses. So while we were able to successfully engage our participants in a yoga practice over time, it was modified in a way that considered their excess body weight and was likely very different from the general drop-in Yoga studio class. A typical Vinyasa flow class may not have been an option early on for many of our participants.

In summary, the population continues to gain weight and being physically active may be more important than ever. However, let’s be cautious about recommending that participants engage in modalities of fitness that may be popular or beneficial without considering the impact that extra body weight may have on their ability to engage physically, confidently and, hopefully, for the rest of their lives.

Renee J. Rogers, Ph.D., is an Assistant Professor in the Department of Health and Physical Activity and the Director, Health and Wellness Programming and Moving Health with Media Core in the Healthy Lifestyle Institute at the University of Pittsburgh.

I love it when a plan comes together, don’t you?

As we turned the page to 2019, the ACSM CCRB and staff did so with a great deal of satisfaction and gratitude. In our continuous pursuit to support and serve those who dream of becoming ACSM certified, we achieved historical levels in first-time pass rates last year for the ACSM-CPT and ACSM-EP certification exams.

Probably more impressive than the higher pass rates was the dramatic spike in those rates from 2017-2018. Pass rates for the ACSM-EP exam increased 65 percent over 2017, while pass rates for the ACSM-CPT exam went up 18 percent. Here’s a look at our pass rate percentages over the last several years:

Exam	2014	2015	2016	2017	2018
ACSM-CPT	56%	54%	54%	56%	66%
ACSM-EP	45%	42%	42%	44%	71%

 

Notice I said those results were impressive, not surprising. That’s where our plan comes in.

The increased pass rates for these certifications are the net result of very intentional planning, review and assessment, and updating of the exams’ content by our board. This work included substantive changes to the exam content outline, increased transparency with faculty and exam candidates, and the application of the latest psychometric best practices.

In other words, it’s not about making the exams easier, it’s about increased preparation support and the way you ask questions.

The work began in 2017 when ACSM Certification completed its regularly scheduled job task analysis (JTA) study and update of the exams. The purpose of JTA revisions is to ensure that assessed knowledge, skill and abilities of exercise professionals reflect current professional standards and practice, as well as the latest health and fitness research.

The substantive changes to the ACSM-CPT and ACSM-EP exams mentioned earlier included the removal of business, marketing and management topics, revised weighting of content domains and inclusion of the new pre-participation screening algorithm.

To provide greater transparency, ACSM included levels of cognitive complexity to its exam content outlines, which describe the extent to which a candidate should know or be able to perform a job task. ACSM uses three levels of cognitive challenge: recall, application and synthesis.

Implementing the latest psychometric best practices included, but is not limited to, eliminating negatively worded items, complex multiple-choice items, and/or inclusion of multimedia assets.

In the end, the positive results of this work go far beyond just rising pass rates. Our ultimate success measure is how we support ACSM certified professionals and candidates in achieving professional success. ACSM Certified Professional Liz White provided clear validation that we are doing just that with the ACSM-CPT and ACSM-EP exams when she said “ACSM did a great job wording the questions on this updated exam compared to the last version. I can’t even express how much better the exam was overall!”

So, that was the plan and those are the dramatic results. If you’re interested in more information about our process, including comparative data, the revised ACSM-CPT and/or ACSM-EP content outlines and cognitive complexity examples, visit our information page.

 
Francis Neric, MS, MBA, is the national director of certification for the American College of Sports Medicine (ACSM). Neric leads the development and administration of ACSM's state-of-the-art certification programs. He also serves on the Committee on Accreditation for the Exercise Sciences (CoAES) and Coalition for the Registration of Exercise Professionals (CREP) which directly supports the mission, vision, and values of the college. Neric has a BS degree in exercise science from CSU Long Beach, a MS degree in clinical exercise physiology from CSU Fullerton, and an MBA in management from the University of Colorado at Colorado Springs.

The benefit of Big Data and how to use them

It is well known that physical inactivity is a major health problem that needs to be addressed in many parts of the world and across different demographics. Europe is not any different: the Eurobarometer report (1) showed that participation in sport has flatlined in the past  years, with the only notable distinction of fitness and wellness facilities, which on average have shown a user increase.

The problem of physical inactivity is even more evident for elder demographics. As we age, our bodies take a little longer to repair themselves; moderate physical activity would keep our bodies fit and energetic, less prone to chronic conditions and diseases.

Some of the benefits associated to a balanced physical exercise (2) routine are:

• Boosted Immune Function. A healthy, strong body fights off infection and disease more easily and more quickly.
• Better Respiratory and Cardiovascular Function. Frequent physical activity lowers the risk of heart disease and reduces blood pressure.
• Stronger Bones. Exercise protects against bone loss. Higher bone density reduces the risk of osteoporosis and lowers the risk of falls and broken bones.
• Improved Gastrointestinal Function. Regular exercise helps boost the metabolism, promotes the efficient elimination of waste and encourages digestive health.
• Protection Against Chronic Conditions. Physical activity lowers the risk of developing serious conditions and can actually minimize some symptoms after certain conditions have already developed.

However, trendy, rigorous exercise regimens that younger generations participate in simply are not safe or realistic for many seniors. Therefore, the question of establishing a safe and age-related workout regimen that elderly people can not only adopt, but stick to for a prolonged period of time, becomes of paramount importance.

Through the collection with dedicated systems and the use of Big Data, it is possible to extrapolate important results and establish a workout pattern, thereby testing if elderly gym users can actually follow a customized training regimen, thus making them physically active citizens.

The importance of the right workout schedule: the PAHA project

A European project named PAHA (Promoting Physical Activity and Health in Ageing) was designed and executed to test the effectiveness of physical exercise for the elderly within fitness and wellness facilities. The project interested 7 EU countries — Finland, Germany, Greece, Hungary, Ireland, Portugal and the United Kingdom — and by special arrangement, in three fitness centers in Denmark, where three trial sessions of supervised exercise of 6 weeks duration were run, with around 15 participants at each session.

Through a supervised and structured exercise program for senior citizens (55 to 65 years old), the aim of PAHA was to convert self-reportedly inactive people into regular exercisers at a level that was beneficial to their health, supporting the EU Guidelines on Physical Activity.

The 6-week program included a high level of prebooked fully supervised training sessions with fitness staff who had previously completed additional training in active ageing and behavioural change. The content and intensity of the scheduled training programs were gently increased over the six-week period, following the different workout outcomes of the different users.  From the 669 people who took part in the project, 89 percent completed the full six weeks. Out of this number, 208 participants were tracked using Technogym Mywellness Key and had their data stored in the Technogym Mywellness Cloud database.

The end goal of this project was to establish a pattern between a training regimen fit for an elderly user and the continuation of said workout over time. In that regard, the project yielded remarkable results, especially in the case of tracked participants, who reported to have continued their physical activity routine three months after the project ended in 78 percent of the cases, thus establishing a positive motivational pattern between tracking results and continuing training.

How Big Data can change the wellness industry

The success of the project led Technogym to investigate further the role of Big Data in workout routines. When we decided to design this study we realized that there was limited data at the European level to investigate whether the volume and intensity of physical activity executed in health and wellness centers was compliant or exceeded the recommended level of physical activity suggested by international guidelines.

There were indeed some studies that reported the physical activity level of senior citizens,  but these were based on self-reported data and on a limited number of subjects. Considering that Technogym has established a cloud-based technology than can automatically track the exercise executed by members using connected devices, this solution was utilized to overcome the well-known problems related to self-reported data.

Thus, using a “big data approach,” we conducted a baseline descriptive analysis of  the “exercise behavior” on a large scale of a sample of European health and wellness centers.

Some interesting results at a glance

The results of the analysis came from data collected from a typical week of the past year, extracted from the Technogym MyWellness Cloud.

During the chosen week, clubs across 31 European countries automatically uploaded data on the wellness cloud through connected equipment. In the analysis, a total of 175,506 subjects were analyzed: 92,145 women and 83,361 men. The total number of analyzed training sessions was 349,568.

The average session/week attendance at the centre was 1.92 for women and 2.07 for men. The average intensity per session, expressed in Metabolic Equivalents, the ratio of the rate at which a person expends energy to the person's mass, while performing some specific physical activity, was 5.78 ± 1.82 for women and 6.01 ± 2.11 for men.

The average weekly duration expressed in minutes was 113.2 ± 81.2 for women and 124.2 ± 89.5 for men. Minutes accumulated during the exercise sessions were divided into Aerobic (women 32.6 ± 16.8; men 32.7 ± 18.3), Resistance (women 27.6 ± 16.9; men 32.1 ± 18.8), Flexibility (women 3.32 ± 3.26; men 3.38 ± 3.12) and Body Weight Exercises (women 22.8 ± 20.9; men 17.9 ± 17.0).

Let’s discuss the results

The results of this preliminary descriptive analysis show that in health and wellness centers both men and women far exceeded the World Health Organization minimum recommended dose of physical activity to be considered moderately active.

Both aerobic, resistance and body weight exercises were well represented in duration, whilst very little time was devoted to stretching.

References

1. Special Eurobarometer 472: Sport and physical activity Report. December 2017. Directorate-General for Communication. March 2018.

2. American College of Sports Medicine, Chodzko-Zaijko WJ, Proctor DN, Fiatarone Singh MA, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009 Jul;41(7):1510-30.

Author:
Dr. Silvano Zanuso is Scientific Research & Communication Manager at Technogym and visiting professor at the University of Coventry (UK). Dr. Zanuso’s primary scientific and research interest is on the effects of physical activity and exercise in those with metabolic disorders, and he publishes regularly on this and other topics in recognized scientific and clinical journals. Dr. Zanuso has been a consultant for health promotion for different governments and public institutions, and he has held conferences and educational programs in more than twenty countries.

I am an avid hiker. I don’t travel long distances to hike, the Sandia Mountains are located on the east side of Albuquerque and I can enjoy myriad trails year round.  I know, many places don’t have mountains to hike it, but this isn’t about hiking per se, more about noticing your surroundings while getting a great all over workout.  It’s about learning to focus on your surroundings, breathe deeply and learning to live in the moment, meditating without sitting.

 

It’s about learning to focus on your surroundings, breathe deeply and learning to live in the moment, meditating without sitting.

Walking out the front door is easy.  Put on a pair of shoes and go!  I will attempt to talk about how to meditate while working out.  As you start to walk notice your surroundings, each yard is different, people are walking their dogs, different cars go by, the ever changing cloud patterns…  Walk at different speeds, find hills, include a jog once in awhile.  Take time to think about what your body is doing.  Focus on your breath.  Try slow deep breaths through the nose, try faster deeper breaths, not too fast, through your mouth.  As you settle into a pattern and focus on your breath your walk becomes meditative.  Breathe in, breathe out…  In time you become aware of every step, every breath, every blade of grass, every tree, every cloud. 

Even a cardio workout at the gym can be meditative.  You step onto the elliptical trainer, set your time, resistance and incline, and you start to move.  Right, left, right, left, breathe deep, find a cadence.  If you listen to music you can keep time with the beat.  Try breathing in time with your feet, every right and left is one breath, or slow it down to every two or three revolutions.  Follow the cadence of someone next to you while you look out the window and admire the clouds.  The focus is on the breath.

As I hike I try to stay in the moment.  I listen to each breath, hear each footstep as it lands on the ground and notice each twig I break as I look at the vegetation that has changed from green and lush to sparse and dry in the winter months, and back to green in the spring and summer  I can hike the same trail ten times in three months and see something different each time.  The world is amazing - pay attention to everything!

I teach my students and clients to be mindful and present.  We work on breath, focus and mindfulness.  Of course we work on strength, cardio, nutrition and general fitness too but our lifeline is our breath, we need to focus to be present and enjoy our life, and mindfulness is just plain good karma.  It can take a lifetime to learn to master, but with daily practice we can achieve the things we want and enjoy every moment.  Learning to meditate teaches us patience and calmness.  This patience and calmness can help us in many aspects of our life. 

You don’t need mountains to walk.  Head out the front door and breathe in the day.

 

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.

2018 was another great year for Current Sports Medicine Reports (CSMR) as we continued to publish timely, peer-reviewed, clinically relevant information that is useful for busy sports medicine and primary care providers. The journal saw two big changes in 2018; 1) it went from publishing bimonthly (six issues annually) to publishing monthly (12 issues annually) and 2) Shawn F. Kane, MD, FACSM, assumed the role of editor-in-chief from William O. Roberts, MD, MS, FACSM, who led the journal for eight strong years. Each edition of CSMR contains a combination of section articles and case reports from one of our 12 topical sections, a special communication, an invited commentary that covers a variety of emerging and interesting topics, and a few rotating columns. Five times per year CSMR highlights sports medicine clinicians who are involved in the journal and the college. 2018 also marked the second year of our partnership with the International Federation of Sports Medicine (FIMS), helping CSMR expand its international focus on sports medicine.

The most frequently viewed article in 2018 was “Exercise is Medicine for Concussion,” written by John J. Leddy, MD, et al. and covered the emerging role for sub-maximal exercise in the treatment of concussions. For years the standard of care for a patient with a concussion could be described as cocoon therapy with the patient staying in a dark room and not exerting themselves until they were totally asymptomatic and had recovered. Dr. Leddy and his team have challenged this dogma and through multiple studies have shown that sub-maximal is highly beneficial in the recovery of concussions. 

The article most accessed through the journal website was “Energy Drinks:  A Contemporary Issues Paper,” written by John P. Higgins, MD, MBA, M.PHIL, FACSM; Kavita Babu, MD; Patricia A. Deuster, PhD, MPH, FACSM; and Jane Shearer, PhD. The consumption of energy drinks continues to rise, and we are learning more and more about their potentially negative consequences. This paper gives clinicians excellent information to better discuss the negative impacts of these products with our patients. This article also was our most mentioned across our various social media platforms and in the mainstream news media.

2019 looks to be another great year as CSMR strives to continue to publish articles that continue to make a difference in clinical practice. Planned content for 2019 looks to include the following topics

• Developing Physician Leaders
• Fighting in Ice Hockey
• Injury Prevention
• Concussion Subtypes
• Ketogenic Diets
• Dogs as Motivation for Physical Activity and Health

We hope you enjoy our content as much as our team enjoys putting it together. If there are topics or authors you would like to see published in CSMR please contact us via email.

Most Read Articles Published in 2018

Exercise is Medicine for Concussion

Pediatric Inactivity Triad: A Risky PIT 

Multiple Sclerosis and Exercise: A Literature Review

Energy Availability, Macronutrient Intake, and Nutritional Supplementation for Improving Exercise Performance in Endurance Athletes

Energy Drinks: A Contemporary Issues Paper

Sports Drinks on the Edge of a New Era

The Application of Blood Flow Restriction: Lessons From the Laboratory

Interval Training for Cardiometabolic Health: Why Such a HIIT? 

Female Athlete Issues for the Team Physician: A Consensus Statement - 2017 Update 

Nutritional Supplements for the Treatment and Prevention of Sports-Related Concussion - Omega 3 Fatty Acids: Evidence Still Lacking? 

Physical Effects of Anabolic-androgenic Steroids in Healthy Exercising Adults: A Systematic Review and Meta-analysis

Core Muscle Injuries in Athletes 

Sacroiliac Joint Dysfunction in the Athlete: Diagnosis and Management

Conversation Starters: Highest Altmetric Attention Score

Altmetric calculates a score based on the online attention an article receives. The score is calculated based on two main sources of online attention: social media and mainstream news media. 

Energy Drinks: A Contemporary Issues Paper

Zurich to Berlin—“Where” Are We Now with the Concussion in Sport Group?

Exercise is Medicine for Concussion

Energy Availability, Macronutrient Intake, and Nutritional Supplementation for Improving Exercise Performance in Endurance Athletes

Optimal Running Dose and Cardiovascular Risk

Pediatric Inactivity Triad: A Risky PIT 

The Application of Blood Flow Restriction: Lessons From the Laboratory

Interval Training for Cardiometabolic Health: Why Such a HIIT? 

Sports Drinks on the Edge of a New Era

Football Team Rhabdomyolysis: The Pain Beats the Gain and the Coach Is to Blame


ACSM Professional Members who are physicians have an electronic subscription to Current Sports Medicine Reports, as well as additional ACSM journals Medicine & Science in Sports & Exercise®, Exercise and Sport Sciences Reviews and the Translational Journal of the American College of Sports Medicine. Further, members receive discounts on ACSM certification exams, meeting and conference registrations, ACSM continuing education credits and more. Learn more and join today! 

Shawn F. Kane, MD, FACSM, graduated from Gettysburg College with a BS in Biology and was commissioned a second lieutenant in the U.S. Army. He attended medical school at the F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences (USUHS) and graduated in 1995. He completed his internship and residency in Family Medicine at Womack Army Medical Center at Fort Bragg, NC, and his Sports Medicine Fellowship at Fort Belvoir, VA. He retired from the U.S. Army in 2018 after having served almost his entire career in the U.S. Army Special Operations Community, including 12 deployments in support of combat operations. He currently serves as an associate professor and physician at the University of North Carolina Chapel Hill Family Medicine Center. He has been a member of ACSM since 1993 and currently serves as the editor-in-chief for Current Sports Medicine Reports.

Scientific findings emerge constantly, and a field of study can change rapidly. As such, it is important to ACSM that our official statements are as current and accurate as possible. Historically, the Position Stand (PS) has been ACSM’s most authoritative “official” statement. Our PS span a variety of research and clinical topics and provide a scientific summary and guidance to our members and the general public.

Unfortunately, many of our PS are now quite old and in need of updating. We are often asked, “When will the position stand be updated?” This has been a complex issue for ACSM to tackle. ACSM’s desire to maintain its leadership in providing highly influential scientific statements for the fields of exercise science and sport medicine has prompted us to thoughtfully consider how we develop a PS. Ensuring that we are using gold-standard methodology and evidence-based procedures has been a priority. As a result, we have new protocols for the development of PS that standardize the process and improve transparency, accuracy, and consistency in the reporting of methodology and results.

In addition, the ACSM Pronouncements Committee (Michael Deschenes, PhD, FACSM, Chair) recognized the limitation of relying so heavily on the use of the PS as our primary means to communicate these scientific summaries. Thus, the committee developed four additional “official statements” of the college: Umbrella Review, Expert Consensus, Contemporary Issues and Call to Action. Consequently, the college now has several mechanisms, in addition to the PS, to release an official stance. Other prominent organizations use a similar approach, publishing a variety of types of statements that have different development protocols and different purposes. This structure will give ACSM greater flexibility to comment, take a stance, and update existing documents in a well-timed manner. We are happy to report that the answer to the question, “When will the position stand be updated?” is soon.

In fact, thanks to the work of the Pronouncements Committee, in the very near future you will start to see many of these older PS updated with current and emerging scientific and clinical content. During 2018, the Pronouncements Committee used a multi-step process to conduct a thorough review of the existing PS.

First, Web of Science was used to gather metrics on each PS to determine how often it is being cited and/or downloaded. Additional citation information and altmetric scores were obtained from the publisher. Next, the committee invited content experts to review the papers to provide their thoughts and recommendations as to whether the paper’s content was current or outdated, whether the paper should be updated and, if updated, what format the update should take. In addition, they were asked to comment on the perceived urgency of a needed update. When possible, members of the original PS writing group participated in the review process. Finally, the committee members discussed the reviewers’ comments and recommendations and considered a variety of additional factors (e.g., age of the paper, interest of the topic to our members, whether the topic remains “core” to ACSM’s mission, the existence of current statements on the topic by other organizations).

With this review completed, work to update these papers will begin shortly. Several of the older PS will be updated with a new PS. However, several other PS were identified as needing a quicker update than can be achieved via a new PS. Thus, several of those papers will be updated with Expert Consensus Statements. Similarly, other PS will be updated with Umbrella Reviews or Call to Action statements.

You may notice that the titles and focus of these updates vary slightly from the original PS. Nonetheless, the goal is to provide a timely update with current information that extends the conclusions of the original PS. The Pronouncements Committee has prioritized the order of these updates and work will begin in the first quarter of 2019.

Finally, of note, the recent update of the acsm.org website provides greater flexibility to retain our older papers (e.g., archive), while also directing viewers to updates and current content. You can find that content here. Stay tuned as the college works to update these seminal and highly influential papers.

Lynette L. Craft, Ph.D., FACSM completed her Ph.D. in Kinesiology at Michigan State University and post-doctoral training in Health Psychology at Boston University School of Medicine. She currently serves as the ACSM Chief Science Officer.

ACSM’s Health & Fitness Journal® strives to provide health and fitness professionals with accurate, unbiased and authoritative practical information that will enhance their day to day work with clients and patients. Beginning in 1997, the journal has published six issues per year that cover a wide variety of exercise, nutrition and other topics that are of interest to the health and fitness industry. Additionally, each issue of the journal provides continuing education credit opportunities. Each issue consists of special columns written by the journal’s associate editors and two to six feature articles that have gone through a peer review process.

Since 2015 the September/October issue of ACSM’s Health & Fitness Journal® has focused on a specific theme (weight loss, resistance training, and behavior change). In 2018 the journal published two themed issues with the September/October publication a special issue on nutrition followed by special fitness trends issue in November/December that highlighted ACSM’s Worldwide Survey of Fitness Trends.

In 2018 the journal published 23 feature articles and a total of 38 columns penned by the journal’s associate editors. The relative interest in these 61 articles can be quantified by comparing the numbers of times the online version of the article is viewed and/or referred to through social media platforms and the mainstream news media.

The most accessed article through the journal website was a feature article written by Joel E. Williams, MPH, Ph.D.; Brian Helsel, M.S., CSCS; Bryce Nelson, M.D., Ph.D.; and Ransome Eke, M.D., MPH, Ph.D. titled “Exercise Considerations for Type 1 and Type 2 Diabetes.” With the incidence of diabetes continuing to increase throughout the world this article was timely and presented important considerations that health and professionals must be aware of when working with these populations. The authors provide a number of practical application strategies that fitness professionals can utilize with clients and patients.

The most popular paper referred to by social media platforms and mainstream media was our annual “Worldwide Survey of Fitness Trends for 2019” penned by Walter R. Thompson, Ph.D., FACSM. The 13^th annual survey conducted by Dr. Thompson continued the tradition of the article being one of the most referred to articles published in the journal. This year’s survey was the basis of a special trends issue that featured a number of the top trends and compared U.S. survey results with those collected in China and Spain.

Outlook for 2019

The articles and columns to be published in 2019 will continue to present topics and associated practical applications that will be of interest to health and fitness professionals and supportive of their work with clients and patients. The planned content will once again include two themed issues:

• September/October: Combating Physical Inactivity
• November/December: Special Trends Issue with an expanded international focus

Upcoming 2019 feature articles will include topics on aquatic exercise/water-based training, children and youth, connecting healthcare and fitness professionals, resistance training, lifestyle medicine and more. We appreciate each health and fitness professional that has submitted their work for publication in the journal and encourage you to consider sharing your expertise with our readers. If you are interested in submitting an article to ACSM’s Health & Fitness Journal®, details on how to write and submit a feature article can be found on the website.

Additionally, our exceptional associate editor team will continue to provide quality practical health and fitness information through their respective columns:

Column	Author	Description
Fitness Focus	Grace T. DeSimone, BA	A clip and distribute article that health and fitness professionals can give to clients/patients.
Take Ten	James A. Peterson, Ph.D., FACSM	Ten specific insights into a pertinent health and fitness topic.
Wouldn’t You Like to Know	Barbara A. Bushman, Ph.D., FACSM	A practical review focused on answering a specific question based on a topic of interest to health and fitness professionals.
A Nutritionist’s View	Stella L. Volpe, Ph.D., R.D., LDN, FACSM	A concise column that covers a hot topic in nutrition.
The Legal Aspects	Anthony A. Abbott, Ph.D., Ed.D., FACSM, FNSCA	An important column that addresses legal issues that affect the health and fitness professional.
Business Edge	Jennifer L. Bacon, M.S.	A practical column that covers relevant business-related topics that affect the health and fitness professional.
Research Bites	Mary M. Yoke, Ph.D., M.A., FACSM	Translates three or four pertinent research articles into information that the health and fitness practitioner can use.
Worksite Health Promotion	Nico P. Pronk, Ph.D., FACSM, FAWHP	This thoughtful column covers all aspects of employee wellness in the context of the worksite.
Do It Right	Peter Ronai, MS, FACSM	Each column illustrates a specific resistance training exercise with photos and videos and explains how to correctly teach the activity.
Health & Fitness A to Z	Gary Liguori, Ph.D., FACSM	Reviews an important topic from its inception to today and where it may be headed in the future.
Enhancing Your Behavioral Tool Kit	Janet Buckworth, Ph.D., FACSM	Provides insights into behavioral change and coaching strategies health and fitness professionals can utilize with their clients/patients.
ACSM Certification	Yuri Feito, Ph.D., MPH, FACSM	For 2019 this column will focus on presenting case studies that will provide insight into working with clients/patients from the initial referral forward.
Celebrate Success	Dixie Stanforth, Ph.D., FACSM	An inspirational column that highlights real-world, positive change that is happening in many communities through individuals, organizations, and/or improved public policy.
Clinical Applications	Kristi M. King, Ph.D., CHES	Covers the clinical aspects of the health and fitness profession.
Medical Report	Written by various clinicians	Provides practical medical information the health and fitness professional needs to know.

Columns shown in blue publish in each issue of the journal. Columns in purple publish in the January/February, May/June and September/October issues. Columns in green publish in the March/April, July/August and November/December issues.

Most Read Articles of 2018

Exercise Considerations for Type 1 and Type 2 Diabetes

Targeting Abdominal Obesity Through the Diet: What Does the Evidence Say?

Lifestyle Modifications to Promote Healthy Blood Pressure *associate editor column, Wouldn’t You Like to Know?

The Evolution of Exercise-Associated Muscle Cramp Research *associate editor column, Health & Fitness A to Z

The Four Social Media Apps That Rule Digital Fitness Marketing and How Best to Use Them

Behavioral Strategies, Including Exercise, for Addressing Insomnia

Developing the P (for Progression) in FITT-VP Exercise Prescription *associate editor column, Wouldn’t You Like to Know?

Food with Benefits: Gain the Competitive Edge With a “Food-First” Approach

Twelve (Plus One) Thoughts from Our Nutrition-Themed Issue *editor column

Shareable Resource: What to Eat Before, During and After Exercise *associate editor column, Fitness Focus

Conversation Starters: Highest Altmetric Attention Score

Altmetric calculates a score based on the on-line attention an article receives. The score is calculated based on two primary sources of on-line attention: social media and mainstream news media.

Worldwide Survey of Fitness Trends for 2019

Interval Training for Cardiometabolic and Brain Health 

Physical Inactivity in Youth: Can Exercise Deficit Disorder Alter the Way We View Preventative Care? 

Targeting Abdominal Obesity Through the Diet: What Does the Evidence Say? 

Stimulant-Containing Energy Drinks: What You Need to Know

Biology of Aging: Identified Drivers and Interventions for Optimal Healthspan

Gluten-Free Diets and Exercise Performance *associate editor column, A Nutritionist’s View

Developing the P (for Progressions) in a FITT-VP Exercise Prescription *associate editor column, Wouldn’t You Like to Know?

Food With Benefits: Gain the Competitive Edge with a "Food-First" Approach

The Evolution of Exercise-Associated Muscle Cramp Research *associate editor column, Health & Fitness A to Z

ACSM Alliance of Health and Fitness Members receive each issue of ACSM's Health & Fitness Journal® in both print and digital formats. Additionally, Alliance members receive discounts on ACSM Certification exams, continuing education credits, the ACSM health & Fitness Summit and consumer products. Learn more and join today!

Brad A. Roy, Ph.D., FACSM, is an administrator/executive director at Kalispell Regional Medical Center. He is responsible for The Summit Medical Fitness Center, a 114,800 sq ft medical fitness center located in Kalispell, Montana, and a number of other hospital departments. He is the editor-in-chief of ACSM’s Health & Fitness Journal®.

Viewpoints presented in this blog reflect opinions of the author and National Dairy Council and do not necessarily reflect positions or policies of ACSM.

National Dairy Council

National Dairy Council recently hosted an industry-presented webinar entitled: Fuels of Engagement: Myth Busting and Science Trusting. Watch a free recorded version of the webinar. The webinar is also available for two (2) CEC’s via ACSM ceOnline.

Several questions were asked by attendees during the webinar and the answers are below.

Q 1: Why do we drink cow’s milk?

For several reasons. Here’s some food for thought:

• We’ve enjoyed drinking cow’s milk for centuries: Archaeologists and anthropologists have found evidence of people drinking cow’s milk dating back several thousand years, according to “Dr. Dairy,” Greg Miller, PhD, FACN, who recently wrote about this topic.

• It’s not just about taste: While milk tastes great, it’s also good for us – it packs a nutrient punch,plus it’s affordable, readily available and versatile. Plus, Milk is the leading food source of 3 of the 4 nutrients of public health concern for children[1] and adults[2] (calcium, potassium[3] and vitamin D) in the American diet.
• We’re not only enjoying cow's milk, but other dairy foods, too: Thanks to milk, we also can enjoy other dairy foods from cheese to yogurt. Dairy offers many delicious ways to get essential nutrients into our day-to-day diet (or meals) from enjoying a yogurt for breakfast to noshing on a grilled cheese sandwich for dinner. 

 

Q 2: What is Lactose Intolerance? Does it mean I should avoid dairy?

Lactose is the natural sugar found in milk and many other dairy foods made from milk, like yogurt and cheese. The body makes a natural enzyme called lactase to help digest lactose. If your body doesn’t make enough lactase, you may not be able to digest lactose properly (called lactose intolerance). Lactose intolerance is characterized by several symptoms, which could include abdominal pain, bloating, gas and/or diarrhea, that may happen after some people eat or drink dairy. It’s important to make sure your symptoms are not from another problem with the help of your doctor.

Lactose intolerance is a very individual condition, which means people can tolerate different amounts of lactose. Many people often don’t have to miss out on the great taste and health benefits of low-fat and fat-free dairy foods, because there are many options available with varying amounts of lactose, even lactose-free. Some milk companies make lactose-free milk, which is easier to digest. The process to make it starts with real cow’s milk. Then the lactose is broken down into its two simple sugars. This makes it easier to digest for those who may not have enough lactase in their systems. Other milk companies may choose to filter out the lactose. Lactose-free milk provides the same essential nutrients, such as calcium, protein, vitamin D and B vitamins, as regular milk and can be used in the same delicious ways. 

In addition to lactose-free milk, many with lactose intolerance can work small amounts of dairy into daily meals or choose dairy foods with minimal lactose. Here are 12 tips you can try to see what works for you so you may not have to give up your favorite dairy foods and the great taste and health benefits that come with them.

 

Q 3: Can dairy foods increase my risk of cancer? 

Most of us have had an experience with cancer either personally or through family, friends or coworkers. It can be scary and confusing, so it’s understandable people are searching for ways to reduce their risk, which may include watching the foods they eat. When it comes to dairy foods and the risk of a complex disease like cancer, according to a comprehensive review, the evidence is not conclusive.[4] But “the proven health benefits of dairy foods greatly outweigh the unproven harm.”   

Because each cancer is different, it can be difficult to establish dietary recommendations. Rather than focusing on removing specific foods or nutrients, which may do more harm than good, it’s important to concentrate on a healthy eating plan that contains all food groups, including dairy foods.

The American Cancer Society encourages consumption of a healthy diet to help maintain a healthy weight, which is important for overall health.[5] These recommendations are consistent with the 2015-2020 Dietary Guidelines for Americans (DGA) which recommends Americans 9 and older consume three daily servings of low-fat or fat-free milk and milk products every day as part a healthy eating style such as the Healthy U.S.-Style eating pattern.[6] The DGA acknowledges the role of healthy eating styles, which include low-fat and fat-free dairy foods, as being associated with a reduced risk of cardiovascular disease, Type 2 diabetes, certain types of cancer and overweight and obesity.

 

Q 4: What's the latest science regarding the relationship between dairy and cardiovascular disease?

A recent study published in The Lancet of adults from 21 countries found eating dairy foods is linked to reduced risk of major cardiovascular disease events and mortality.[7] The results of this large prospective cohort study add to the existing body of research that dates back nearly 25 years, where several studies show dairy foods are associated with a neutral or reduced risk of heart disease. The study involved more than 136,000 adults ages 35 to 70 years old across five continents who completed food frequency questionnaires to record dairy consumption of milk, cheese and yogurt and other dairy-based foods. This was further categorized into low-fat and whole-fat dairy. Why the distinction? The researchers noted they wanted to examine if dietary guidance to choose only low-fat over whole-fat dairy, due to its saturated fat content and potential adverse effects on heart health, would hold up if tested among diverse populations from low- and middle-income countries.

The main findings include:

• Higher consumption of total dairy (more than two servings per day compared to 0.5 servings) was associated with reduced risk of total mortality, non-cardiovascular mortality, cardiovascular disease mortality, major cardiovascular disease and stroke, while no association was observed with myocardial infarction
• Higher milk and yogurt consumption (more than one serving per day compared to none) was associated with reduced risk of total mortality;
• Cheese and butter (butter intake was low) consumption was not associated with risk of total mortality.

These results are consistent with the growing body of scientific evidence that has shown eating dairy foods from a variety of fat levels are associated with neutral or reduced risk of cardiovascular disease outcomes[8] and mortality.[9] Additionally, this new evidence indicates that dietary recommendations to include dairy foods — within caloric and physical activity recommendations and regardless of fat level — as part of healthy eating patterns could be made globally.

 

Q 5: Is dairy environmentally friendly?

Producing dairy foods requires natural resources such as energy, land and water so food can travel through the supply chain from farm to table. The dairy community takes environmental stewardship seriously and is committed to contributing to sustainable food systems. Becoming environmentally friendly is a journey that evolves with science and new innovations and demands commitment and continuous improvement. Here’s a snapshot of what the dairy community has done, is doing and is planning to do in the future to continuously improve its environmental efforts:

• Dairy farmers have a long legacy of environmental stewardship. Even before anyone knew what a carbon footprint was, dairy farmers have improved breeding techniques, quality animal care, specialized feeding practices and technology. As a result, each gallon of milk produced in 2007, for example, required 90 percent less land and 65 percent less water, with a 63 percent smaller carbon footprint than it did in 1944.[10]
• Building on this legacy, the Innovation Center ― a collaboration of U.S. dairy companies, cooperatives and stakeholders ― made a shared commitment to sustainability in 2008 by creating the Sustainability Alliance. Among other things, members agreed to make dairy foods available in ways that enhance and protect our natural resources to nourish a growing population.
• The goals of the Sustainability Alliance are grounded in sound science. Before the Alliance was formed, the Innovation Center conducted a comprehensive life cycle assessment of farms, transportation and dairy companies to measure the industry’s carbon footprint. This baseline data, published in 2007, showed that the dairy sector contributed about 2 percent of total U.S. green-house gas (GHG) emissions and used about 5 percent of total water withdrawal. Understanding the LCA allowed the dairy community to set a voluntary goal to reduce GHG emissions 25 percent from 2007 to 2020.[11]
• Guided by research and input from stakeholders, the Innovation Center board identified three environmental priorities to address: GHG emissions, energy use and water quality and quantity. They developed and completed several projects to reduce emissions and energy use and fostered partnerships to accelerate progress toward common goals of environmental stewardship.

Looking ahead, dairy farms and companies will continue to use the Stewardship and Sustainability Framework for U.S Dairy to set performance baselines and measure improvements on the field, on the farm and in dairy companies along the supply chain. Ongoing research will continue to advance the science and understanding of dairy’s environmental impact and help evolve best management practices.

Of course, dairy’s environmental footprint is part of a multi-dimensional approach to achieving sustainable food systems ― it’s also about the contribution to nutrition, public health, social wellbeing, economics and thriving communities.

For more commonly asked questions and answers about dairy, visit: https://dairygood.org/content/2016/myths.

As is typical in each calendar since 2000, ACSM published four issues of Exercise and Sport Sciences Reviews (ESSR) in 2018: at the beginning of January, April, July, and October. The journal publishes forward-looking content that either provides the rationale for a novel hypothesis or summarizes work on a contemporary issue and then identifies the key gaps in knowledge that need to be addressed to move the field forward. Critically, the content encompasses the 11 topical areas that comprise the foundation for the annual ACSM meeting. 

To illustrate the scope of this content, the image (right) shows a word cloud constructed from the key words for the 32 papers that were published in 2018. The size of each word in the diagram indicates the frequency with which it was mentioned in these papers. Not surprisingly, the most frequently used key word was “exercise,” which is appropriate given the name of the journal. Note also that the key words range from the molecular to population levels of analysis.  

The relative interest in these 32 papers can be quantified by comparing the numbers of times the online version of each paper is viewed. The online content can be viewed either through an institutional subscription to the journal (Ovid) or through the journal website itself. The most frequently viewed 2018 paper differed for the two platforms. The most popular paper through Ovid was a provocative perspective written by Mike Joyner and Carsten Lundby on the topic of maximal oxygen consumption and trainability. They challenged the findings that claim some humans are less responsive than others to training interventions designed to increase maximal oxygen consumption. The responsiveness of individuals to this specific training stimulus has public-health implications due to the association between fitness and all-cause and cardiovascular mortality. They discuss the factors that can contribute to the variation in the response to training among middle-aged and older adults and suggest that another wave of twin studies is needed to resolve some of these issues.

The most accessed paper through the journal site was written by Amanda Tyndall and colleagues and presented a novel hypothesis on the influence of exercise on cognition and brain health in older adults. The specific issue they addressed was the moderating influence of exercise on the association between declines in cognitive function with advancing age and the risk of developing Alzheimer disease and related dementias. They propose that exercise has a beneficial impact on cognitive function through multiple mechanisms that together promote healthy aging of the human brain. Their model provides the foundation for a range of studies that can disentangle the influence of specific exercise attributes on the various features of cognitive function.

The papers to be published in 2019 will continue this format of synthesizing contemporary knowledge in our field and suggesting directions for future research. The planned content will include authoritative perspectives on:

• strategies to increase population levels of physical activity,
• the role of physical activity in vascular insulin resistance in skeletal muscle and brain,
• the influence of exercise on the gut microbiome,
• blood pressure control during dynamic exercise,
• the periodization of carbohydrate performance availability to augment sports performance, and
• a framework for evaluating wearable sensors.

We hope our content will continue to be of interest to you and, as always, encourage you to send us suggestions on topics and authors we should consider for inclusion in the journal.

Most Read Articles of 2018

Concepts About VO2max and Trainability Are Context Dependent

Protective Effects of Exercise on Cognition and Brain Health in Older Adults *Journal Club

The Impact of Aerobic Exercise on the Muscle Stem Cell Response *Journal Club

Exercise and the Tumor Microenvironment: Potential Therapeutic Implications *Journal Club

Dietary Nitrate Enhances the Contractile Properties of Human Skeletal Muscle

Sedentary Behaviors and Adiposity in Young People *Video Abstract

Potential Role of MicroRNA in the Anabolic Capacity of Skeletal Muscle With Aging *Video Abstract

Identifying Novel Signaling Pathways: An Exercise Scientists Guide to Phosphoproteomics *Journal Club **Supplemental Digital Content

Modulation of Energy Expenditure by Estrogens and Exercise in Women *Video Abstract

The Microvasculature and Skeletal Muscle Health in Aging *Video Abstract

Specificity of "Live High-Train Low" Altitude Training on Exercise Performance

Exercise Is an Adjuvant to Contemporary Dystrophy Treatments

Skeletal Muscle Function in the Oldest-Old: The Role of Intrinsic and Extrinsic Factors 

Conversation Starters: Highest Altmetric Attention Score

 

Altmetric calculates a score based on the online attention an article receives. The score is calculated based on two main sources of online attention: social media and mainstream news media. 

Modeling Overuse Injuries in Sport as a Mechanical Fatigue Phenomenon

Protective Effects of Exercise on Cognition and Brain Health in Older Adults *Journal Club

Mechanical Coupling Between Muscle-Tendon Units Reduces Peak Stresses

Resistance Exercise’s Ability to Reverse Cancer-Induced Anabolic Resistance

Potential Roles of Vascular Endothelial Growth Factor During Skeletal Muscle Hypertrophy

Dietary Nitrate Enhances the Contractile Properties of Human Skeletal Muscle

Skeletal Muscle Function in the Oldest-Old: The Role of Intrinsic and Extrinsic Factors 

Sedentary Behaviors and Adiposity in Young People *Video Abstract

The Importance of mTOR Trafficking for Human Skeletal Muscle Translational Control

Exercise and the Tumor Microenvironment *Journal Club


ACSM Professional Members have access to both print and digital subscriptions to ESSR, as well as additional ACSM journals Medicine & Science in Sports & Exercise®, Current Sports Medicine Reports(Physician Members Only) and the Translational Journal of the American College of Sports Medicine. Further, members receive discounts on ACSM certification exams, meeting and conference registrations, ACSM continuing education credits and more. Learn more and join today! 

Roger M. Enoka, Ph.D., is a professor of integrative physiology at the University of Colorado Boulder.  He is the current Editor-in-Chief of Exercise and Sport Sciences Reviews (ESSR).

 

Each Tuesday ACSM members receive the Sports Medicine Bulletin (SMB) via email. Every edition of SMB includes links to relevant news articles that feature ACSM members, discuss research published in ACSM journals, or report on facts that are relevant to the exercise science and sports medicine industries. 

These are the most read articles from the SMB In The News section in 2018:

The Physiology of a Six Pack U.S. News & World Report, April 26  
ACSM President Walt Thompson is quoted as a subject matter expert in this article.

20 Ways to improve your health in under 20 minutes Business Insider, April 16
Guidelines from the American College of Sports Medicine are cited in this article.

Lift Weights, Eat More Protein, Especially is You're Over 40 The New York Times, February 7
This article discusses research published by ACSM members.

Even shorts bursts of exercise can reduce Americans' risk of disease and death, study says ABC News, March 25 
ACSM President-elect, Bill Kraus, M.D., is interviewed as the subject matter expert for this article.

Ranked: The 25 Unhealthiest Cities in America Newsweek, September 26
This article is based on results of ACSM’s 2018 American Fitness Index and includes a quote from ACSM Past President, Honorary Fellow and Current Chair of the ACSM American Fitness Index Advisory Board Barbara Ainsworth. Ph.D., M.P.H., FACSM.

This is How Many Squats it Takes to See Results Reader's Digest, August 7
ACSM exercise physiologist and personal trainer Jim White is quoted in the article as a subject matter expert.

Underdosing, Overdosing, and Structural Barriers -- Exercise is Medicine Population Health, August 8 
This article features research by ACSM member and fellow Ben Levine.

If you're interested in receiving SMB each week, you can learn more about becoming an ACSM member here. 

Each Tuesday ACSM members receive the Sports Medicine Bulletin (SMB) via email. Every edition of SMB includes an Active Voice article that is written by a researcher or subject matter expert and is dedicated to sharing the latest news on important research and relevant topics to the exercise science and sports medicine community. 

Introducing, the top 10 most read Active Voice articles from 2018: 

 

1. Q&A – Updated Physical Activity Guidelines for Americans Released by Katrina L. Piercy, Ph.D., R.D., ACSM-CEP^® on November 13, 2018. 

2. Does Caffeine Enhance Tolerance to High-Intensity Exercise? by Adriano E. Lima-Silva, Ph.D., and Romulo Bertuzzi, Ph.D. on May 1, 2018. 

3. A Novel Therapeutic Exercise Mode for Managing Knee Osteoarthritis by Hamilton Roschel, Ph.D. on July 31, 2018. 

4. HIIT in the Real World – Effective, but Not for Everyone? by Melyssa Roy, MBChB, MMSc on November 27, 2018.

5. Resistance Training and the Nervous System by James L. Nuzzo, Ph.D., CSCS®, and Janet L. Taylor, M.D. on February 6, 2018. 

6. Exercise Training Modifies Our Gut Bacteria by Jacob Allen, Ph.D., and Jeff Woods, Ph.D., FACSM on July 3, 2018. 

7. Physical Activity for Healthy Aging: The Intensity Matters for Combating Chronic Inflammation in Older Adults by Andreas Nilsson, M.P.H., Ph.D. on October 9, 2018. 

8. Cardiometabolic Impact of Changing Sitting, Standing and Stepping in the Workplace by Elisabeth A.H. Winkler, Ph.D., and Genevieve N. Healy, Ph.D. on June 19, 2018. 

9. ACSM’s New Exercise Preparticipation Screening - Removing Barriers to Initiating Exercise by Gary Liguori, Ph.D., FACSM, Meir Magal, Ph.D., FACSM, and Deborah Riebe, Ph.D., FACSM on January 16, 2018. 

10. Does Estrogen Modulate Physical Activity in Women? by Edward L. Melanson, Ph.D., FACSM, and Wendy M. Kohrt, Ph.D., FACSM on October 16, 2018. 


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

Clif Bar & Company recently hosted an industry-presented webinar where Dr. Mike Ormsbee dispelled common myths about protein and discussed the latest research and recommendations on the amount, type and timing of protein needed to maintain overall health, improve body composition and maximize exercise performance. Watch a free recorded version of the webinar. The webinar is also available for two (2) CECs via ACSM ceOnline.

Several questions were asked by attendees during the webinar. This post serves as an extension to the Q&A portion of the webinar – providing answers to questions that were asked but were left unanswered due to time constraints.

1. Are proteins from animal or plant sources better for active individuals?

   Both sources provide high-quality protein that meet the needs of active people. However, animal- and plant-based protein sources differ in their amino acid profiles. Animal proteins and soy protein are considered complete proteins because they contain all nine of the essential amino acids necessary for protein synthesis. Most plant-based proteins are considered incomplete proteins and may not contain one or two essential amino acids. Studies show that greater amounts of plant-based proteins need to be ingested compared to animal proteins to achieve the same level of muscle protein synthesis.^1,2 In the end, both types will meet overall protein needs and have varying health benefits. There are a variety of factors that impact protein selection (e.g., quality, taste and environmental impact), so it’s recommended to consume a variety of sources to optimize protein synthesis, particularly for those choosing more or all plant-based options.

    

2. I have heard that higher-protein diets increase calcium excretion; will eating above the RDA in protein damage my bones?

   No, eating protein will not damage your bones. In fact, the evidence shows that increased protein intake is associated with increased bone mineral density when calcium intake from your diet is normal. One study found that even during an energy deficit (when you eat fewer calories than you burn), protein intake did not affect urinary calcium excretion.³ The National Osteoporosis Foundation concludes that higher protein intakes have no adverse effects on bones and may even benefit bone density.⁴

    

3. Can increased protein intake affect kidney function?

   In healthy individuals who do not have kidney disease, protein intake will not harm kidney function. There is also no evidence that a higher-protein diet will influence kidney function. In protein overfeeding studies that lasted for up to one year, there were no reported changes in kidney function.⁵ Furthermore, a recent meta-analysis that pooled all the available data on this topic concluded that higher-protein diets had no influence on kidney function (glomerular filtration rate) in adults without kidney disease.⁶

    

4. What resources can help me determine how much protein my clients need (and ways they can achieve this amount) based on their level of activity?
   The Active Nutrition Guide is a comprehensive resource for health professionals working with a wide range of active people. The guide helps explain the role of food in fueling healthy, active bodies. All active people benefit from nutrition that considers their fitness goals and is personalized to the day-to-day intensity, frequency and duration of their activity. Using the guide, you can develop custom nutrition plans to best support the changing energy and nutrient needs of each day. The guide includes sample performance meal patterns – examples that showcase how the nutrition recommendations translate into real-life meal patterns across various activity scenarios in four popular sports- running, triathlon, mountain biking and cycling. The Active Nutrition Guide is also accompanied by a series of modules that provide activity-specific nutrition advice from spots nutrition experts, alongside real-world tips from athletes. Currently, modules are available for running, cycling and soccer, with more to come in the future.

    

5. How do endurance cardio exercise events impact net protein breakdown? Should protein requirements remain at 1.6-2.0 g/kg/d?
   Intense or prolonged activity causes an increase in muscle protein breakdown, which is typically followed by an increase in muscle protein synthesis over the next 24 hours. The consumption of high-quality protein during this period enhances this process – accelerating the recovery process and stimulating skeletal muscle growth. While 1.6-2.0 g/kg/d should be used as the base recommendation on days with prolonged cardio exercise, additional protein can be added to the diet post-exercise to improve recovery. The recommended amount of protein consumed after exercise increases as the duration of exercise increases. For exercise lasting 90-120 minutes, add 0.275 g/kg post-activity. For exercise lasting 120-240+, add 0.3 g/kg post-activity. On average, this equates to approximately 25-40 grams of protein post-workout, depending on body weight and duration of activity. Refer to the Active Nutrition Guide for additional recommendations.

As more people aspire to lead a more active lifestyle, the role of protein in your meal pattern is becoming increasingly important. Refer to the Active Nutrition Guide and webinar for more evidence-based facts on protein and personalized nutrition recommendations.

References:

1. Hoffman, J. R. & Falvo, M. J. (2004). Protein – which is best? J Sports Sci Med 3: 118-130.
2. Babault, N. et al (2015). Pea proteins oral supplementation promotes muscle thickness gains during resistance training: a double-blind, randomized, placebo-controlled clinical trail vs. whey protein. J Int Soc Sports Nutr 12:3.
3. Cao, J. J. et al. (2014). Calcium homeostasis and bone metabolic responses to high-protein diets during energy deficit in healthy young adults: a randomized controlled trial. Am J Clin Nutr 99: 400-407.
4. Shams-White, M.M. et al. (2017). Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation. Am J Clin Nutr 105(6): 1528-1543.
5. Antonio, J. et al. (2016). A high protein diet has no harmful effects: A one-year crossover study in resistance-trained males. J Nutr Metab 2016: 9104792.
6. Devries, M.C. et al. (2018). Changes in kidney function do not differ between health adults consuming higher- compared to lower- or normal-protein diets: a systematic review and meta-analysis. J Nutr 148: 1760-1775.
   
   

About the Author: 
Mike Ormsbee, PhD, FACSM, FISSN, CSCS*D is the Associate Director of the Institute of Sports Sciences and Medicine and an associate professor in the Department of Nutrition, Food and Exercise Sciences at Florida State University. From his days as an NCAA collegiate ice hockey player, to competing in 70.3 Ironman races, to helping others achieve their performance goals, he has always used evidence-focused training and nutrition strategies to optimize performance and body composition. As a member of the Clif Bar & Company Nutrition Advisory Council, he uses his nutrition and sport science expertise to support Clif’s commitment to providing sustainable, nutritious food for athletes and active people.

 

About Clif Bar & Company: Clif Bar & Company crafts nutritious and organic food to feed and inspire adventure, including CLIF BAR® energy bars; CLIF Kid® energy snacks and LUNA® nutrition bars. Family and employee-owned, the company is committed to sustaining its people, brands, business, community and the planet.

HOW TO BENEFIT FROM CADENCE, CRITICAL POWER AND OTHER RUNNING METRICS

Running is one of those things that we take for granted, something that we have been doing for so long that we don’t really ever think about it. However, do we really know how to run? Are we really sure we do not need to learn how to run?

Running is an extremely complicated task that requires the conglomeration of different capacities: cardiovascular, neurological, psychological, physiological, anatomical, muscular and biomechanical. In this post, we will focus on the last three, trying to explain them in the clearest possible way.

Having the possibility of quantifying the effectiveness of the gesture performed and the accuracy of the workload through easily detectable metrics means training with quality and, if implemented with your workout routine, will surely bring enormous improvement to your running performance.

Simplifying the mechanics of running, we could describe it as a ball that bounces on the ground. The body’s bouncing motion on the feet allows us to store elastic energy and to use it in the following step (with considerable energy savings). It is therefore very similar to what happens in a spring; a biological spring!  

However, how does this biological spring really work? It depends on the task:

1. Are we looking for metabolic economy and energy saving (like when running or walking on flat ground)?
2. Are we trying to amplify our power output (for example, when jumping, accelerating, incline running, etc.)?
3. Or do we need to absorb forces (such as when landing, decelerating or decline running)?

If we are in the first scenario (energy saving), the body transmits its forces and momentum to the tendons, which return most of that energy to the body itself in a cycle and repetitive motion. This means that our muscles need to do very little in order to keep the body moving.

This is not the case for the second scenario (power amplification), when higher power production is required. In fact, when accelerating, the muscles start the movement by transmitting the generated power to the tendons, which amplify it and transfer it in a greater fashion to the body.

The exact opposite is true for energy absorption: the body transfers all its energy to the tendons, which promptly carry it to the muscles capable of efficiently absorbing most of that energy¹.

In every condition, there is always a seamless, finely coordinated mechanism between body, tendons and muscles.

 

The mechanics of proper running

In order for this mechanism to work efficiently, its components need to be perfectly aligned. It is exactly here that a proper running form becomes fundamental. From several biomechanical studies, it is known that a proper technique requires:

• compact arms
• balanced forward posture with the feet always falling under (or almost) the body’s center of mass
• good load distribution (symmetry)
• high cadence
• low ground contact times
• proper foot strike

So, next time you are out there running and struggling to maintain your pace at the 6th mile (~10th kilometer) of your run, you just need to make sure that all the aforementioned requirements are under control. Easy, right?! Well, not really; however, here’s where technology comes in handy.

Training indoors, on a device that can monitor all these parameters for you, returning a few clear, instant feedbacks, can no longer be seen as an alternative, but as an implementation that could actually improve the quality of your training and, ultimately, of your runs.

 

An insight into the ideal 5 parameters

At this point you might still be wondering why the aforementioned requirements are correlated with a good running form and how you can benefit from monitoring them. To clear these doubts, let’s analyze 5 metrics that should be taken into greater consideration and try to understand how to “play” with them.

1. Contact Time. Experienced runners have low contact times² (time that the foot spends on the ground), with sprinters averaging values between 110 and 150 milliseconds and distance runners between 170 and 350 milliseconds. The relationship between flight and contact time is called flight ratio and is greater in more efficient runners (with values ranging between 0, when walking, and about 50 percent).

    

2. Stride and Cadence. Equally as important is monitoring your stride length and cadence. Runners with a short stride and high cadence have minor impact forces and consequently a lower incidence of injuries³. Moreover, a higher level of frequency “unlocks” those elastic properties mentioned earlier, allowing you to reduce oxygen consumption by about 20 percent and to increase running efficiency up to 50 percent⁴.

    

   Be careful, though. There is no ideal stride or cadence, since these parameters can vary in relation to speed, acceleration and body type. That is why the best way to raise awareness of your cadence and turn it into a fatigue control system is to choose a speed, check your natural cadence at that given speed and train with cadence variations in a defined range between +5 percent and -5 percent.

    

3. Symmetry is another value that is worth checking. Better load distribution between the right and left foot brings many advantages to both performance and preventive aspects, and it represents a parameter that can be monitored easily. Just remember that a range of variability of less than 5 percent is perfectly normal for healthy subjects and requires no intervention.

    

4. Running power. We can describe running power output as how much force and speed a runner is exerting at any given moment. The power of our human engine should be equal to the sum of the power required to overcome running resistance, air resistance and climbing resistance (if present).

Therefore, speed (and consequently contact time), cadence (and so stride), body weight and its distribution (and therefore symmetry) all fall into the equation. Varying any of these will consequently vary our power output, making this parameter a sort of immediate and qualitative measure of our running form for a given task. For example, if your goal is endurance at a fixed constant speed, you want to keep lower values of power (which correlate with a better efficiency) while, if your aim is to accelerate and sprint, you want to produce the highest values of power possible.

Having the possibility of quantifying the effectiveness of the gesture performed and the accuracy of the workload through easily detectable metrics means training with quality and, if implemented with your workout routine, will surely bring enormous improvement to your running performance.  

 

REFERENCES

1. Roberts TJ, Azizi E. Flexible mechanisms: the diverse roles of biological springs in vertebrate movement.  J Exp Biol. 2011 Feb 1;214(Pt 3):353-61.

2. Hayes PR, Caplan N. Leg stiffness decreases during a run to exhaustion at speed at VO2max. Eur J Sport Sci. 2014; 14(6):556-62.

3. Lyght M, Nockerts M, Kernozek TW, Ragan R. Effects of foot strike and step frequency on Achilles tendon stress during running.  J Appl Biomech. 2016; 32:365-72.

4. Cavagna GA, Saibene FP, Margaria RJ. Mechanical work in running. Appl. Physiol. 1964; 19:249-56.

Author:
Roberto Nicoletta works in the Medical-Scientific Research & Innovation department of Technogym and holds the role of Head of Sport Science for the Italian Rugby League National Team. He also collaborated with the NBA as a Strength and Conditioning Coach during the NBA Global Camp 2018.

Roberto Nicoletta holds an international Master of Science in Sport Science, Health and Physical Activity obtained studying across 4 different European universities (the University of Foro Italico of Rome, the University of Southern Denmark in Odense, the German Sport University of Cologne and the University of Vienna).