In This Section:

  • Could All Those Zoom Meetings be Bad for Your Health?

    by Caitlin Kinser | Jan 08, 2021

    woman sitting in front of her computer, participating in a virtual meetingPre-COVID-19 data estimates adults spend more than eight hours/day sitting. Some report sedentary behavior has increased upwards of three hours since that time. As individuals are less active, they are at increased risk of developing cardiovascular disease, type 2 diabetes and several cancers. With the recent rise in virtual learning, teleworking and health-mandated quarantines/ isolations, we can be confident that adverse health outcomes will eventually emerge among those who now find themselves classified as physically inactive (PI) or insufficiently active (IA).

    Early preliminary research shared on Cambridge Open Engage reported previously active Americans reduced their physical activity (PA) and increased their screen time (ST) by an average of 32% and 38%, respectively. Surprisingly, individuals classified as PI became even more sedentary, increasing their time sitting and ST an average of 16% and 25%, respectively. Since virtual and remote tasks may not disappear any time soon, we must embrace new ways to engage students, employees and colleagues in a manner that contributes to enhanced health.

    The COVID-19 pandemic has facilitated an environment that promotes increased physical inactivity and sedentary behavior due to self-isolation and mandatory quarantine requirements. Constant physical inactivity and sedentary behavior are associated with poor physical and mental health. Accumulating any physical activity mediates PI and sedentary behavior, which are separate constructs that together introduce health risks. Thus, safeguarding psycho-physical health during the pandemic is paramount and warrants special attention to promoting health, wellness and physical activity during virtual meetings.

    Realizing health gains can begin by implementing small, incremental bouts of physical activity. Reaching recommended daily physical activity targets is not required to see initial benefits. The Physical Activity Guidelines for Americans, 2nd Edition recommends PA accumulation can begin with five-minute increments. Health benefits are irrespective of age, gender, race, ethnicity and health status.

    Tips for scheduling meetings in the new year.

    How can we break up the sedentary time and begin to improve our health? Consider the following for your next virtual meeting:

    • Reduce the meeting duration to less than one hour.
    • Consider start/end times that allow adequate transition between virtual meeting rooms (e.g., 9:15–9:45 a.m. or 10–10:50 a.m.).
    • Implement five-minute standing activity breaks for every 25 minutes of meeting time or work performed.
    • Facilitate hip, hamstring and lower-back stretches at the desk or work area.
    • Model and promote physical activity during virtual meetings.

    Lifestyle modifications begin with small behavior changes. Those small, consistent behavior changes can provide drastic improvements in overall health. Changes in general health can be as simple as what happens during your next virtual meeting. If you need more guidance in selecting activities appropriate for your organization or group, ACSM, Exercise is Medicine and the CDC offer free resources.


    Alicia T. Bryan, Ph.D., FACSM, serves as the chair of ACSM’s Strategic Health Initiative: Women, Sport & Physical Activity. She is an associate professor and interim associate provost of Faculty Affairs and Academic Innovation at Columbus State University. She also is an ACE-Certified Medical Exercise Specialist and serves as the CEO of Evolutions, Inc. in Phenix City, Alabama.

    Raymond Jones, Ph.D., is a Postdoctoral Fellow at the University of Alabama at Birmingham in the Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care and the Center for Exercise Medicine.

  • Exercise and Sport Sciences Reviews: Reader Favorites in 2020

    by Caitlin Kinser | Jan 04, 2021

    ESSR 2020 CoversThe mission of Exercise and Sport Sciences Reviews (ESSR) is to provide forward-thinking reviews on contemporary issues that are of interest to members of ACSM. The journal publishes four issues each year: available by January, April, July and October. The charge to feature forward-thinking content is accomplished by inviting authors to provide either the rationale for a novel hypothesis or to summarize work on a contemporary issue and identify the key gaps in knowledge that need to be addressed to move the field forward. 

    The extent to which we achieve our mission can be assessed with two metrics: one related to the number of times the content is either read (viewed) or mentioned and one that reports the relative citation count of the published articles. Our articles can be accessed and read either through an institutional subscription to the journal (Ovid) or through the ACSM website. Typically, the read count (Ovid + ACSM) is greater for articles that were published in the years preceding a current year.  This year, however, an article published in 2020 (January issue) achieved the highest read count for the year: A Time to Eat and a Time to Exercise. The article with the second greatest read count was published in 2019 on the topic of exercise and the gut microbiome. The topics of other articles (year of publication) with high read counts in 2020 were the biomechanics of breast support for active women (2020), physical activity for cancer patients (2020), protective effects of exercise in older adults (2018), syncing exercise with meals and circadian clocks (2019), sedentary behaviors and depression (2020), altitude training for exercise performance (2018), vascular and muscular benefits of exercise training in older adults (2020) and exercise intolerance in heart failure (2020). 

    Two articles published in 2020 were among the top 20 in the mention count (Altmetric score): A Time to Eat and a Time to Exercise (#8; January) and Consistent Morning Exercise May Be Beneficial for Individuals With Obesity (#16; October). The most-mentioned paper was on exercise and the gut microbiome (2019), followed by too much sitting (2010). These two papers had twice as many mentions as the third-ranked paper.

    The other metric that indicates the relative influence of our articles is the impact factor, which provides a normalized citation count by calculating the ratio between the number of times articles were cited in a two-year period relative to the number of articles published by a journal in that period. As a measure of our recent performance, we typically count the number of citations for the articles we published in 2018-2019. As these data are not available until the summer, I have used the number of mentions (Altmetric score) to identify that most impactful articles. The article with the most mentions (676) was on the topic of exercise and the gut microbiome with the second highest count (262) being for an article on the protective effects of exercise on cognition and brain health in older adults. These top two articles were followed by a cluster of three articles with a similar mention count (104-165); the topics of these articles (in order) were the panacea of human aging, modeling overuse injuries in sport as a mechanical fatigue phenomenon and raising an active and healthy generation

    Each year, ESSR publishes ~27 articles. So far for 2021, we have published seven articles in the January issue and have another 32 articles in various stages of development for the three remaining issues for 2021 and into 2022. The topics of these articles being prepared for publication are distributed across nine of the historical 11 topic areas for the annual ACSM meeting. The topic areas with the greatest numbers of prospective articles are (1) Skeletal Muscle, Bone and Connective Tissue; (2) Biomechanics and Neural Control; and (3) Physical Activity/Health Promotion. Among these articles to be published in 2021 are 11 Perspectives for Progress, which are written by senior investigators and include the following topics:

    • Strength training: in search of optimal strategies to maximize neuromuscular performance
    • The interaction between mobility status and exercise specificity in older adults
    • Physical activity and male reproductive function: a new role for gamete mitochondria
    • Exercise is muscle mitochondria medicine
    • Importance of cardiac functional remodeling to physical activity for optimization of orthostatic intolerance
    • Exercise as medicine during the course of hip osteoarthritis
    • The impact of insulin in cardiovascular control during exercise in diabetes
    • Exercise with a challenge improves your brain
    • Stepping back to minimal footwear: applications across the lifespan
    • Ballistic motor learning as a unique form of motor skill learning
    • Skeletal muscle nitrate as a regulator of systemic nitric oxide homeostasis and muscle function

    Other articles that are likely to generate notable interest are on the topics of massage as mechanotherapy, strategies to optimize physical activity interventions, skeletal muscle capillarization to optimize satellite cell responses, sarcopenia related to HIV, negative effects of a high fat diet, exercise rehabilitation in multiple sclerosis, motor unit remodeling in older adults and master athletes, breast cancer and skeletal muscle quality, neuromodulation as a restorative approach for rehabilitation, exercising the sleeping brain, pain relief does not ensure recovery after Achilles tendinopathy and the influence of cardiorespiratory fitness and exercise intensity on exercise blood pressure. 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.

    roger enoka 2019Roger 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).

  • ACSM's Exercise Physiologist Certification Prep Course

    by David Barr | Dec 23, 2020

    ACSM EP Certification Exam PrepEarn 7.0 CECs with the ACSM Exercise Physiologist Certification Preparation Course

    About the course:

    Prepare for the ACSM-EP exam with this convenient, online course. Learn and study at your own pace with audio and PowerPoint presentations. The course includes access to 5 modules that cover:

    • Module 1 – Pre-Activity Screening
    • Module 2 – Fitness Assessments and Exercise Prescription
      • 2a, Cardiorespiratory Fitness Assessments and Programming
      • 2b, Muscular Strength and Endurance Assessments and Programming
      • 2c, Body Composition and Weight Management
      • 2d, Flexibility Assessments and Programming
    • Module 3 – Exercise for Special Populations
    • Module 4 – Behavior Change and Stress Management
    • Module 5 – Leadership, Management, Marketing, and Legal Issues

    This ACSM-EP exam prep course includes audio and PowerPoints, a corresponding online quiz, and a course evaluation. Course costs do not include the cost of the exam or study materials. Additional study will be required for achieving ACSM certification.

    Available ACSM CECs 7.0

    Learning Objectives for the ACSM Exercise Physiologist (ACSM-EP) Certification Preparation Course:

    • Health and fitness assessments of healthy individuals and individuals with stable chronic health conditions.
    • Exercise prescription and implementation for individuals and individuals with stable chronic health conditions.
    • Exercise counseling and behavioral strategies as related to positive health and wellness outcomes.
    • Risk management and professional responsibilities of an exercise physiologist.

    Purchase and earn CECs

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  • The Peer Review Process

    by Caitlin Kinser | Dec 21, 2020

    You’ve done the research, written the manuscript and submitted to the journal. What happens next?

    A scientific journal will enter your manuscript into a rigorous review by subject matter experts (your peers) prior to accepting the manuscript for publication.

    Why is this peer review important? L. Bruce Gladden, PhD, FACSM — Editor-in-Chief of Medicine & Science in Sports & Exercise® and ACSM President-Elect — states that peer review “protects the integrity of what we do.” Hear more of what Dr. Gladden has to say:


    ACSM MSSE peer review infographic 


    For more details, read The life of a manuscript: The peer review process.

  • Recovery Ratios and Intermittent Fasting | Nutrition FAQs

    by David Barr | Dec 17, 2020

    Recovery Ratios Intermittent Fasting Nutrition ACSM
    3 Nutrition FAQs from the webinar - Nutrition and Physical Activity: The Science Works

    This part of the FAQ series covers: recovery ratios, and intermittent fasting and older adults.


    Watch the Webinar on the Professional Resources Page

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    Q4: I have heard before of a 3g:1g carbs: protein ratio for recovery. You are talking more about a 25g carbs for 20g protein. Why is this ratio better for recovery?


    The key point to consider is that there is evidence that both carbohydrate and protein consumption post exercise are important. The general recommendation is that more carbohydrate (g/kg) should be consumed post exercise than protein, but the data on the specific ratio are, as yet, categorized as only ‘fair’ or ‘limited’ (see reference below: Thomas et al., 2016).

    It has been summarized from these studies that consuming about 20 to 30 g protein, or ~10g of essential amino acids post-exercise results in increased whole body and muscle protein synthesis as well as improved nitrogen balance. Please note the large range in the recommendation (i.e., 20 to 30 g). It has also been found that co-ingestion of carbohydrate with protein found no significant improvement on muscle glycogen synthesis, as this is primarily a carbohydrate only factor.


    ACSM Nutrition for Exercise Science

    Download Sample Now 



    It has been determined that the highest rate of muscle glycogen synthesis occurs when large amounts of carbohydrate (1.0–1.85 g/kg/h) are consumed immediately post-exercise and at 15-minute intervals thereafter, for up to 5 hours post-exercise. (Please note the range in carbohydrate recommendation.)  The total daily recommended protein intake is approximately the same (1.2 to 2.0 g/kg/d) as the post-exercise hourly intake of carbohydrate, suggesting that post-exercise carbohydrate needs are significantly higher post exercise.

    To put this into relative perspective, the recommendation for 30 g of protein post exercise for a 150 lb (68 kg) athlete represents about 0.44 g/kg protein, with the recommendation for carbohydrate significantly higher. These data also suggest differential effects, with protein consumption focusing primarily on muscle soreness and recovery, with carbohydrate consumption focusing primarily on glycogen recovery.

    Sports Nutrition FAQ
    View Nutrition FAQs on fasting, adaptation timing and glycogen.

    Clearly, athletes need carbohydrate, protein, and fluids post exercise, and the judgement on the relative amount provided should be based on the degree to which glycogen depletion and muscle soreness have occurred, which are factors likely related to exercise duration and intensity, and fluid volume/quality consumed during exercise.

    As a side note, since energy balance is likely to be low post exercise, a relatively high protein and low carbohydrate intake post-exercise is likely to result in at least a portion of the protein being used to satisfy energy recovery needs. As this can only occur when protein is denitrogenated, the resultant higher blood urea nitrogen is likely to result in higher urine production and inhibit a speedier return to a well-hydrated state.

    • Thomas DT, Erdman KA, Burke LM. American College of Sports Medicine Joint Position Statement: nutrition and athletic performance. Med Sci Sports Exerc. 2016;48(3):543–68.


    Q5: You mentioned skipping meals increases risk for cardiometabolic diseases. What about intermittent fasting protocols?

    This is an important issue, so I appreciate your question.  In the references provided below, it was found that subjects who skipped breakfast as adults had significantly higher WC and BMI, and that subjects who skipped breakfast as children and as adults had even higher WC and BMI, and more cardiometabolic risk factors. (Smith et al., American Journal of Clinical Nutrition. 2010.; Isacco et al., Child Care Health and Development. 2010.)

    The result of intermittent fasting that you describe is to create a state of relative energy deficiency, so it is important for you to carefully review the International Olympic Committee consensus statements on the health and performance issues created with Relative Energy Deficiency in Sport (RED-S). These references, as IOC consensus statements, are publicly available (suggest doing a Google Scholar search for ‘Mountjoy RED-S’) to download and review.  Here are some references related to RED-S:

  • Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC Consensus Statement on Relative Energy Deficiency in Sport (RED-S) Br J Sports Med. doi:10.1136/ bjsports-2018-099193
  • Torstveit MK, Fahrenholtz I, Stenqvist TB, Sylta O, and Melin A. Within-Day Energy Deficiency and Metabolic Perturbation in Male Endurance Athletes. Int J Sport Nutr Exerc Metab. 2018; 28: 419-427
  • Fahrenholtz IL, Sjödin A, Benardot D, et al. Within-Day Energy Deficiency and Reproductive Function in Female Endurance Athletes. Scand J Med Sci Sports 2018; 1-8: DOI: 10.111/sms.13030.
  • Delk-Licata A, Behrens CE, Benardot D, et al. The Association Between Dietary Protein Intake Frequency, Amount, and State of Energy Balance on Body Composition in a Women’s Collegiate Soccer Team. Int J Sports Exerc Med 2019; 5(3):123. DOI:

    These papers and the book (ACSM’s Nutrition for Exercise Science) clearly describe the health and performance issues created when there is insufficient energy available to perform the physical task at hand. While there may be a temporary ‘weight’ loss, the elevation in cortisol suggests that far too much of the weight is coming from lean tissue, which compromises the very tissue the athlete is trying to improve through exercise.

    In addition, cortisol is highly catabolic to bone tissue, placing the athlete at higher risk of skeletal injury (stress fracture, etc.). It is important to consider that blood sugar maintenance during the day with normal daytime activity is approximately 3 hours, and at night while asleep approximately 7 hours. Exercising when in a low blood sugar state, as these papers clearly describe, creates precisely the opposite outcomes to what the athlete is wishing to achieve.

    Thank you for asking this important question.


    Q6: I'm glad we're talking about sex-related differences in youth. But what about sex-related difference in adulthood? And what about sex-related changes as we reach older-adults? Particularly when it comes to menopause? The research in these areas are limited but we need to start having these conversations more and recognize that these do require different things.


    Thank you for your question. I couldn’t agree with you more that this is a critically important area, and that we have much more to learn. Recent studies indicating that older people can increase lean tissue just as quickly as younger people, but that they can lose lean/skeletal tissue much more quickly than younger people absent appropriate physical activity and nutritional strategies has huge implications for matching appropriate nutrition and physical activity strategies.

    There are also issues related to sustaining a reasonable energy balance through a dynamic matching of energy intake and expenditure.  While the health and performance sequellae of Relative Energy Deficiency in Sport (RED-S) have been reviewed for competitive athletes, there is scant information for how RED-S may differentially impact older active individuals of different sexes. Chapter 10 of “ACSM’s Nutrition for Exercise Science” is devoted to reviewing what we know about optimizing nutrition strategies for different ages and sex. The focus on older athletes are the following health-related issues:

    • Age-related changes in body composition and the impact this has on REE;
    • Lowered capacity to quickly recover from intensive or long bouts of exercise;
    • Gradually diminishing bone mass;
    • Subtle changes in GI tract function that could influence nutrient absorption;
    • Progressively lower heat tolerance;
    • Progressive decreases in the glomerular filtration rate and renal blood flow;
    • Reduced capacity to concentrating urine, increasing urinary frequency, and, potentially, lowering fluid consumption.

    I appreciate you bringing this to my attention. Be assured that future talks I give will give appropriate attention to this important issue.

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    ACSM Fellow Dan Benardot, Ph.D., DHC, R.D., L.D., is Professor Emeritus at Georgia State University, and Professor of Practice in the Center for the Study of Human Health at Emory University. He is the author of the popular book ACSM’s Nutrition for Exercise Science.