Pregnancy is one of the most complex periods in human life, and every year more research is published detailing how events experienced during gestation affect the future growth and development of the child. Epigenetic factors are particularly impactful during this time, and maternal lifestyle during pregnancy is of enormous importance. 

Thus, the current worldwide rates of sedentary behavior during pregnancy are acutely worrying: Globally, barely 20% of pregnant women are sufficiently active to meet the current physical activity guidelines for health during pregnancy. We believe one way to address this issue is to create obstetric care teams that support and encourage pregnant women to engage in physical activity. 

Regular appointments with obstetric health care providers are a standard component of clinical care, allowing specialists to monitor how a pregnancy is progressing. Alarmingly, during these follow-ups we are seeing an increase in gestational diabetes, hypertension, obesity and mental illnesses — all conditions in which physical activity has been shown be an important part of the management approach. 

The COVID-19 pandemic further increased rates of sedentary behavior and associated health issues. It likewise constituted a period of increased anxiety globally, from a pre-pandemic baseline of 38,249 cases per 100,000 people to 48,024 cases per 100,000 people. More to the point, roughly 57% of pregnant women exhibited symptoms of anxiety during the pandemic. 

Anxiety is associated with a number of other pathologies, from heart disease to cancer and stroke, as well as the hypertension and gestational diabetes observed in the follow-ups discussed above. Physical activity has been shown to prevent and reduce prenatal anxiety and anxiety symptoms, so why are so few pregnant women active? 

The question becomes more confounding when we realize the period of the COVID-19 pandemic saw an enormous increase in the amount of health information available, particularly on social media, about the benefits of physical activity. Despite growing access to this information, sedentary behavior has continued to increase. 

The specific reasons why the population generally, and pregnant women in particular, remain sedentary despite ready access to health information demonstrating the benefits of physical activity are still unclear. However, our research indicates that adding physical activity professionals to the already established multidisciplinary pregnancy care team (e.g., gynecologists, obstetricians and midwives) improves pregnant women’s adherence to supervised exercise programs — particularly since the regularity of these appointments provides us with the opportunity to consistently reinforce to patients the necessity of physical activity and to support them with appropriate exercise prescriptions. Our research group, which works with public medical centers and exercise professionals at Spanish public universities, has seen significant rates of exercise adherence in these programs. Ideally, such teams would proliferate not only throughout Spain but in other countries as well. 

Physical activity during pregnancy has a profound effect on the life of both the mother and child. Further, children who grow up in an environment that values physical activity may be more likely to stay active themselves, making the value of the multidisciplinary approach our team has developed even more apparent. 

Miguel Sánchez-Polán, Ph.D., is a researcher focused on physical activity during pregnancy at the Universidad Politécnica de Madrid in Spain. 

Taniya Nagpal, Ph.D., is an assistant professor at the University of Alberta within the faculty of kinesiology, sport and recreation researching adherence to health behaviors and the psychosocial barriers to them, such as weight stigma, pre conception, during pregnancy and postpartum. 

Ruben Barakat, Ph.D., is a full professor at the Universidad Politécnica de Madrid and a leading researcher studying the effects of physical activity during pregnancy on the mother, fetus and newborn. 

HHS releases midcourse report on ‘Physical Activity Guidelines for Americans.’ 

Health and Human Services (HHS) of the Office of Disease Prevention and Health Promotion (ODPHP) released its Physical Guidelines for Americans Midcourse Report: Implementation Strategies for Older Adults (Midcourse Report) highlighting strategies to increase physical activity in key settings among adults ages 65 years and older from the Physical Activity Guidelines for Americans.

The Guidelines emphasize why individuals need to engage in physical activity and what dose of physical activity is needed for health benefits. The Midcourse Report focuses on how and where to incorporate physical activity and reinforces the amounts and types of physical activity older Americans need. The report includes strategies that professionals, as well as others working with older adults, can implement wherever older adults spend their time — including in community, health care, and home settings.

These strategies include policy, systems, and environmental approaches; behavior change; and physical activity programs. View the Executive Summary and additional resources such as Top 10 Things to Know about the Midcourse Report and this FAQ. 

Thank you to the ACSM members who played critical roles as writers, literature reviewers and peer-reviewers for the Physical Activity Guidelines for Americans Midcourse Report:

• Katrina L. Piercy, Ph.D., R.D., ACSM-CEP, FACSM
• David R. Brown, Ph.D., FACSM
• Geoffrey P. Whitfield, Ph.D., M.Ed.
• Graycie Soto, MPH
• Dana L. Wolff-Hughes, Ph.D.
• Barbara J. Nicklas, Ph.D., FACSM
• David E. Conroy, Ph.D., FACSM
• Loretta Di Pietro, Ph.D., MPH, FACSM
• NiCole R. Keith, Ph.D., FACSM
• David X. Marquez, Ph.D., FACSM
• David M. Buchner, M.D., MPH, FACSM 

American Fitness Index results to be announced next week

ACSM's American Fitness Index will reveal its fitness rankings of America's largest 100 cities on a composite of health behaviors, health outcomes, community infrastructure, and local policies that support a physically active lifestyle.

With the help of the Fitness Index, local officials, community groups, health organizations, and individual citizens can assess factors contributing to their city’s fitness, health, and quality of life.

Sign up for AFI's newsletter to receive the rankings once they release. 

Muscle weakness is difficult to treat after a traumatic joint injury as it stems from a multifaceted interplay of neurological and morphological processes that disrupt the muscle's communication and regulation. Data from a large clinical database showed that four out of five patients who engage in anterior cruciate ligament rehabilitation (one of the most common therapeutic programs) leave with strength levels well below clinical recommendations. To improve this situation, rehabilitation specialists need to think beyond conventional forms of exercise prescription, as it is clear that the current treatment approaches fail to adequately restore muscle strength. In our review paper, published in Exercise and Sport Sciences Reviews (ESSR), we propose a novel framework for an exercise prescription in muscle recovery that is often overlooked. 

Eccentric contractions (also known as lengthening contractions) offer a potent solution for muscle recovery by uniquely stimulating the nervous system and cellular signaling pathways that promote tissue health and growth. Our research, along with others, has demonstrated the power of an exercise prescription emphasizing eccentric contractions to effectively enhance neural drive and cellular signaling, which are responsive to muscle stretch and repetitive lengthening. 

Despite its potential, there is still reluctance in the clinical community to adopt eccentric exercise due to its association with injury. This dogma is due, in large part, to misinterpreted benchtop models that often involve extreme conditions that do not accurately represent the clinical scenario (e.g., the removal of the distal point of long-tendon from the bone for experimental purposes or animals that are exercised with the intent to cause injury). We previously reported that experiments that use clinically translational doses of eccentric exercise (e.g., 15 minutes) have shown its safety and effectiveness. 

Insufficient strength recovery is associated with various negative outcomes, including increased risk of re-injury, early joint degeneration, and reduced physical activity levels. To counteract this situation, clinicians must prioritize exercises that target the underlying causes of muscle weakness. Eccentric exercise achieves this by maintaining muscle communication through neural pathways less affected by the initial injury. It also engages essential stretch-sensing properties of the muscle, which convert mechanical stress into responses that promote muscle growth. To this point, we and others have found that training with eccentric contractions improves the magnitude and firing rate of alpha-motoneurons, resulting in greater strength recovery and knee movement profiles in those with a significant history of joint injury relative to concentrically treated patients. 

Exploring alternative rehabilitation approaches that treat the underlying causes of muscle weakness is key to promoting more effective outcomes. Through our review paper, we aim to stimulate dialogue and reflection regarding current practices and the safe use of eccentric contractions to enhance muscle recovery. We encourage clinicians to responsibly consider the inclusion of isolated lengthening exercises to address the various factors that degrade muscle health. The review provides a series of original clinical articles that offer protocols as guidelines for development. 

Lindsey Lepley, Ph.D., is an associate professor of athletic training, director of the Comparative Orthopaedic Rehabilitation Laboratory (CORL), and co-director of the Orthopedic Rehabilitation & Biomechanics Laboratory (ORB) at the University of Michigan School of Kinesiology. Her research focuses on elucidating the mechanisms that regulate skeletal muscle strength, activation, and structure after traumatic joint injury to establish interventions that optimize muscle recovery. To advance clinical practice, her research group utilizes noninvasive animal injury models and human subject research to design, test, and translate new sports medicine strategies from conception to practice. 

Viewpoints presented in ACSM Bulletin commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for the ACSM Bulletin. 

In this space last year, I provided some explanation of the Journal Impact Factor (JIF), the journal metric released annually by Clarivate Analytics as part of the Journal Citation Reports (JCR). This year provides an opportunity to address the changes that Clarivate have imposed over the past three years and how macrotrends in scientific publishing have affected journal metrics. 

From 1975 to 2019, the JIF was calculated using the same data definitions and formula. The great advantage of this consistency was that it enabled every journal to make relatively accurate year-to-year comparisons, and easily identify the variables that may have driven the JIF up or down. Consequently, editorial strategies were easier to develop and assess. 

2020 Journal Impact Factor: Introducing “Early Access” 

This all came to a somewhat crashing halt with the release of the 2020 JIFs. As communicated by Clarivate, the 2020 JIF would see the introduction of “Early Access” content to the JIF formula, though 2020 would be a transition year. “Early Access” content, a finalized version of an article not yet published in an issue, could now be indexed in Web of Science and contribute to the JIF formula. Complicating this was that a small subset of journals and publishers had participated in a two-year trial prior to 2020. Clarivate had to come up with a way to accommodate the citations that had been generated by “Early Access” content without giving journals that had participated in the pilot an unprecedented advantage. 

The 2020 JIF formula would include citations from “Early Access” content in the numerators of any journals whose content has been cited during the pilot, but would not include “Early Access” content in the denominator of journals that published “Early Access” until the articles had appeared in an issue. There was an enormous amount of debate at the time over how this would skew JIF rankings, and to what extent this was to the advantage of journals that published both “Early Access” content and exhibited a relatively high rate of self-citation. Most publishers anticipated that that 2020 JIFs would experience some level of inflation, solely due to the introduction of “Early Access” content into the pipeline of citations. 

Instead, any affect the “Early Access” content had on JIFs was completely overwhelmed by the far more extensive impact of a boom in published research that was driven directly and indirectly by COVID-19. Scientific output increased across all specialties in 2020, and the more articles being published, the more citations are being entered into the scientific literature. For editors, it was a rollercoaster ride of excitement when the journals’ 2020 JIF was 20% higher than 2019, and then the realization that this same growth had occurred for all competing journals as well. For most journals, regardless of the improvement in JIF, their rankings remained largely the same. 

2021 Journal Impact Factor: Outliers Abound 

The 2021 JIF ended the “Early Access” transition period, and “Early Access” content was now fully incorporated into the JIF formula. Again, there was an expectation from publishers that the JIFs would now largely normalize; however, COVID-19 was still having a tremendous impact on the publishing landscape. Although overall output had begun to slow by the end of 2021, citation activity remained high, and on average we saw JIF remain static. However, in some subjects, citation outliers drove some journal JIFs into a second wave of growth. Analysis revealed that COVID-related review articles with straightforward titles, such as “COVID and Pregnancy” or “Coronavirus and Hypertension” received citations far above average. In some cases, one of these articles alone could drive the Impact Factor 15%-20% higher. 

2022 Journal Impact Factors: The End of the COVID Bump and Welcome ESCI Journals 

If 2020 and 2021 JIFs had been inflated by the unusually high publication outputs in those years, the 2022 JIF represented a reset of sorts. JIFs returned to their 2019 numbers driven down by two primary factors: First, as scientific output decreased, the number of citations in the pipeline decreased and numerators dropped, and second, the increased output of both 2020 and 2021 were now being reflected for the first time in the denominator. Across the Wolters Kluwer (ACSM's publishing partner) portfolio, JIFs fell by an average of 7.3% (0.43 lower) than 2021 JIFs. If there was any concern that this was limited to Wolters Kluwer, it’s important to note that average rankings rose slightly by 0.1 place. We can assume that this means that the JIF deflation affected almost every publisher across every category. 

Confusing comparison to JIFs of years past, the 2022 JIFs also were displayed to only one decimal place (as opposed to the three previously displayed). Since JIFs were rounded to the nearest tenth, it means that the differences in JIF from 2021 to 2022 could have a margin of error of 0.054. Also, this new change in JIF precision almost certainly will result in the introduction of ties moving forward – changing the methodology by which Clarivate will determine category rankings. 

Significantly, Clarivate also awarded journals that had been indexed in the Emerging Sources Citation Index (ESCI) JIFs for the first time. In total, this means that almost 9,000 journals will be receiving a JIF for the first time (8% more open access journals, and 5% more journals from south of the equator). However, ESCI journals will not receive category rankings in the 2022 JCR.  

2023 Journal Impact Factors: About Those Rankings 

In next year’s JCR, all the different database rankings (ESCI, SCIE, and SSCI) will be combined into unified categories. In the past, for example, a nursing journal might be in both SCIE and SSCI, receiving a single JIF, but two distinct rankings for each database. Another nursing journal may have been in ESCI, receiving a JIF, but no ranking. In 2023, there will be a single set of rankings for each category, regardless of the database(s) in which the journal is indexed. The addition of ESCI journals may have a significant impact on which quartile SCIE-indexed journals may find themselves. It also begs the question of why ESCI continues to exist as a separate database. 

Optimistically, I hope that the 2023 JCR reflects the last changes we will see to how JIF is both calculated and displayed for the near future – but I suspect that Clarivate may have opened a Pandora’s box of complications, which will be marked by a series of adjustments and overcorrections. In Clarivate’s own words, they have made some of these changes to de-emphasize the JIF, and force journals to consider other metrics, such as the Journal Citation Indicator (JCI). It remains to be seen if journals themselves will become so exasperated by Clarivate’s changes to the JIF that we will finally begin to discuss a journal’s Eigenfactor Score – in my opinion, the best journal metric ever devised! 

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Duncan MacRae is the director, Editorial Strategy and Publishing Policy for Wolters Kluwer, one of the world’s foremost publishers of medical, nursing and allied health journals. In this role, Duncan oversees the development and implementation of editorial policies followed by journals in the Lippincott and Medknow imprints. In addition, he works with a portfolio of editorial service providers to assist our society partners in achieving their strategic goals.