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  • Active Voice | Progressive Resistance Training: A Way to Combat Persistent Pain after Breast Cancer Treatment

    by Greg Margason | Feb 07, 2023
    Active Voice | Progressive Resistance Training: A Way to Combat Persistent Pain after Breast Cancer Treatment

    Persistent pain is among the most common adverse effects to breast cancer and its treatments. It affects 25-60% of patients and can linger for several years as a source of considerable physical and psychological distress. Among other things, pain after breast cancer is a primary source of upper limb dysfunction and has been associated with greater levels of depression. These and other persistent pain-related issues collectively reduce the quality of life and perceived physical function of the patient, which is associated with increased breast cancer-related mortality. Unfortunately, there is currently a lack of knowledge on optimal management of persistent pain after breast cancer treatment. Consequently, the development of new and effective treatment strategies is of major clinical importance. 

    In our study conducted at Aalborg University, published in the February 2023 issue of Medicine & Science in Sports & Exercise®, we performed a randomized controlled trial to investigate the effect of a 12-week supervised resistance training program using free weights on persistent pain after treatment for breast cancer. We randomly allocated 20 survivors of breast cancer with self-reported pain into either a control group or an experimental group. The time frame for this study was six months (three-month intervention and three-month follow up). We assessed muscular strength, pain intensity during everyday life and mechanical pain sensitivity at baseline, three and six months. Participants allocated to the experimental group trained twice a week, in groups of two to four individuals, supervised by a certified strength and conditioning coach. They performed five multi-joint free weight exercises in sequential order, each for 2-4 sets separated by 3-5 minutes of rest. The number of repetitions decreased from 10-12 down to 2-4 over the course of the 12 weeks, while load started at 60% of 1RM and increased according to the individual training response. 

    The most important observations in this study were that our 12-week supervised resistance training program resulted in a 48% increase in 1RM, along with a 35% decrease in pain sensitivity. In addition, half the participants reported a decrease in everyday pain intensity of 20% or more. We found the gains in maximum strength largely remained following three months of detraining; however, the positive effects on pain had disappeared. Most notably, this suggests that resistance training can provide a clinically relevant improvement in persistent pain after breast cancer treatment. However, these benefits also appear to require consistent exposure and emphasize that resistance training for pain management is most likely a long-term commitment. 

    In short, resistance training is a valuable tool in the arsenal of clinical professionals to combat persistent pain after breast cancer. As previously highlighted by the American College of Sports Medicine, it is a safe and well tolerated exercise modality for this population, with an ever-growing base of evidence for its potential. For all these reasons, investigators at Aalborg University and elsewhere will continue to pursue this work in other clinical populations. 

    Gorm Henrik Fogh Rasmussen
    Gorm Henrik Fogh Rasmussen, Ph.D.
    , is originally trained as a sports scientist with emphasis on biomechanics and neuroscience at Aalborg University, Denmark. His research area focuses on the clinical application of resistance exercise for managing adverse effects of cancer and its treatments, with a special emphasis on resistance training and pain. Dr. Rasmussen utilizes both qualitative and quantitative research methods in his work and completed his Ph.D. with supervision from Professor Pascal Madeleine (Dr. Scient, Ph.D.) and Associate Professor Mathias Kristiansen (Ph.D.). 

  • How to Reduce Intimidation for New Clients in Group Exercise Classes or Group Training Sessions

    by Greg Margason | Jan 27, 2023
    How to Reduce Intimidation for New Clients in Group Exercise Classes  or Group Training Sessions

    For new students walking into a group exercise class or group training session, intimidation can be brought on for a number of reasons. Feeling uncomfortable in the exercise setting, for any reason, can reduce the student’s enjoyment of the exercise, decrease the benefits of the exercise and can cause the student to become upset and even decide to leave the class or not return to the next class. It’s important for instructors and coaches to know why this intimidation may occur and be prepared with proactive strategies to combat it.  

    Intimidation and Behavior Change 

    Certified fitness professionals should be familiar with the transtheoretical model of behavior change and its phases of action. When a new client enters your class, they are likely in the action phase, where they are actively making behavior changes (for less than 6 months)*, and intimidation can be closely tied to the newness of, or the return to, the exercise environment. 

    Some key points of intimidation can be: 

    • Being at a low level of physical fitness due to not exercising in the past or from taking a long pause from exercising 

    • Recovering from an illness or injury that has left them feeling unsure about their physical capabilities 

    • Not knowing how to exercise, or not knowing how to specifically perform the type of exercise featured in the class or group session 

    • General anxiety: They are new to the facility/class, they don’t know anyone else, or are generally shy 

    Any of these reasons or a combination of them could be enough to make your new student look at the “regulars” around them and feel that they don’t measure up. Your job as an instructor or coach is to ease these fears and reinforce this positive action that they have taken. In other words, make them feel as if they are a part of the community. This can significantly improve your student retention and will help your students effectively move toward their fitness goals. Check out these tips and ask yourself: How many of these tactics am I currently using, and how can I improve on my use of these tactics? 

    Start before the class/session 

    Depending on the type of facility in with you teach/coach, you may or may not have access to a completed pre-participation screening form for your students ahead of the scheduled start time. Especially if you do not, making the time to seek out new students and have a brief conversation with them prior to hitting your “go” button will go a LONG way.  

    Say hello to new students when you see them enter the class, and thank them for joining you. Introduce yourself, ask them their name and ask what brought them to class today. Apply your active listening skills* to interpret and anticipate their needs. This can help you to gauge where this person may be on their fitness journey and what, if any, experience they have with the format you are teaching. 

    If you have not been able to review a pre-participation screening form, ask the student if they have any injuries or restrictions of which you should be aware before getting started. If they do mention anything, do a mental check of your class plan: Are there exercises or movements that will need to be modified for them? Depending on their response, you may need to follow up by asking for confirmation that they have received medical clearance to participate. (Moving forward from here, we will assume that they have been cleared to participate.) If they will require significant modifications or will need to use the assistance of equipment, let them know ahead of time when in the class to expect to look to you for modifications or assistance. You may even want to demonstrate those modifications for them ahead of the start of the class. Whether or not they mention any restrictions, assure them that they can look to you at any time during the class for modifications or assistance. Finally, direct them to collect any equipment they may need and where they can get set up for the start of the class. 

    Check out part two, Cueing for Confidence: How to Keep New and/or Struggling Students on Pace for a Successful Class for tips on cueing throughout a class or group sessions in a way that help new students feel comfortable and engaged. COMING SOON!

    *You can learn more about behavior change and active listening skills in the ACSM premium resources found here and in ACSM’s Resources for the Personal Trainer, 6th edition, chapters 7 and 9. 

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    Caitlin Kinser
    Caitlin Kinser, M.S.
    , has been teaching group exercise classes since 2010. She’s taught in a variety of settings including fitness studios, large gyms, college campuses, youth/community centers and virtually. She has taught multiple formats, but her heart belongs to dance fitness. Caitlin owned and operated a boutique fitness studio for two years prior to joining the professional staff at the American College of Sports Medicine®, where she serves as the director of digital strategy. 
  • ACSM Hot Topic | Working with Older Adults? Don’t Skimp on Strength Training

    by Greg Margason | Jan 24, 2023
    Hot topic Working with Older Adults? Don’t Skimp on Strength Training

    “Garrett, I’m too old to strength train.”

    If I had a penny for every time I heard this statement, I’d be a rich man! Really, I would. More recently:

    “Dr. Kellar, aren’t some people too old to do strength training?”

    What? No! A person is never — yes, never — too old to strength train!

    As one ages, one loses muscle. As muscle is lost, strength is lost. As strength is lost, the ability to carry out activity is lost. Need I go on?

    Of course I do!

    Strength training has the ability to stop, or at the very least slow down — or as I liked to say, “punch these changes in the nose!” — the impacts of aging, such as muscle weakness, risk of falls, decreased quality of life and ability to do activities of daily living. And that’s just a couple impacts we can see!

    Strength training also “punches changes in the nose” that we can’t see, like the ability to use glucose (or sugar), cholesterol and fat accumulation, and the ability to create and utilize energy.

    All these things we can and can’t see contribute to our ability to remain independent as we age.

    I know what you’re thinking: “That all sounds great, but I’m worried about my health too!”

    What if I told you that there are many studies that show the distance a person can walk in six minutes; how fast a person walks; how many times they can stand from a chair; how hard they can grip; and how fast one can get up from a chair, walk around a cone, and sit down, all can predict not only sickness and death, but hospitalizations?

    Don’t all those benefits of strength training sound glorious for older adults? Of course they do! The problem is, a very small amount of older adults participate in strength training (8.7% of adults >75).

    But the barriers for older adults to do strength training are really the reasons they should do strength training (health, pain, fatigue, fear, safety). We, as exercise professionals, need to educate our patients, clients, family, friends, neighbors, even health care professionals, on not only the safety of strength training but the massive amount of benefits! And not just to look better, but to feel better, move better and have a better quality of life!

    Well, how do we help people achieve all these awesome benefits?

    Let’s shoot for at least two days per week. It’s ok to go heavier (60-80% 1-RM), or we can go lighter to focus more on power (30-60% 1-RM) because this is important too! Let’s try 1-3 sets and anywhere from 6-15 repetitions. Whatever gets our older adults interested in strength training, that’s what we should do. Let’s not be afraid to mix it up and add some balance and functional exercises into those strength training exercises also (two or three birds, one stone)!

    So, again, when is one too old to strength train? Let’s say it together: NEVER! Let’s also remember to make strength training a priority for our older adults.

    Garrett Kellar
    Garrett Kellar, Ed.D., ACSM-CEP, ACSM-EP, EIM3 is an assistant professor and program director of exercise science at Youngstown State University. He is a graduate of Indiana University of Pennsylvania (where he recently won the Young Alumni Achievement Award) and the University of Pittsburgh. Dr. Kellar has over 15 years of clinical experience in cardiac and pulmonary rehab, and exercise testing and prescription for older adults. Dr. Kellar currently serves on ACSM’s Exercise is Medicine Older Adult Committee as well as multiple American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) committees.

  • Congressional Changes and NIH News

    by Greg Margason | Jan 24, 2023

    Policy Corner Congressional Changes and NIH NewsCongress 

    On Jan. 3, the U.S. House of Representatives convened with 434 representatives-elect. The House has 74 new members, with a split of 222 Republicans to 212 Democrats. The U.S. Senate also welcomed seven new senators and has a current split of 51 Democrats to 49 Republicans.  

    Vying for the House Speaker position, Kevin McCarthy (R-CA) sought the 218 votes that he would need to win the position. After 15 rounds of voting taking place over four days, Congressman McCarthy negotiated terms with conservative Republicans that gave him a sufficient number of 215 votes to win the speakership. Present votes lowered the threshold for him to win without the 218 majority usually required. 

    If McCarthy had not received the required number of votes to win the speakership, the business of the House would have temporarily stalled, including the swearing in of all House members and approval of the House Rules for the 118th Congress.  

    Accompanying McCarthy’s win of the speakership are new negotiated House Rules, which eliminate proxy voting; offset mandatory spending increases with a corresponding cut in mandatory spending; and charge the Select Subcommittee on the Coronavirus Pandemic with investigating the origin of the virus, gain-of-function research, and the economic and societal impacts of forced COVID shutdowns. 

    Other big legislative items that will take attention this year are raising the debt ceiling, annual appropriations, immigration, tech privacy and the Farm Bill. 

    NIH 

    National Institutes of Health’s (NIH) Advisory Committee to the Director (ACD) convened its 125th meeting. Responsible for providing advice on matters related to NIH’s support of biomedical research, the meeting involved discussions on a broad range of science policy topics, including peer review, animal research and the biomedical workforce. 

    Larry Tabak, DDS, Ph.D., performing the duties of NIH director, shared high-level updates on NIH’s current initiatives, including the agency’s efforts to fund early-stage investigators (ESIs). Tabak noted that each year, NIH strives to fund 1,100 ESIs on their first R01 or equivalent grant. In 2022, NIH surpassed this goal, funding a record 1,589 ESI applicants. 

    Noni Byrnes, Ph.D., director of the Center for Scientific Review (CSR), presented proposed changes to NIH peer review criteria for both research project grants (RPG) and Ruth L. Kirschstein National Research Service Award (NRSA) fellowships. The framework aims to relieve administrative burden on reviewers by refocusing the process on scientific merit. The changes also seek to lessen the effect of reputational bias associated with institutions and primary investigators. 

    Following the peer review discussion, ACD members discussed the new working group focused on novel alternative methods, “Catalyzing the Development and Use of Alternative Methods to Advance Biomedical Research.” The working group aims to identify nonanimal methods and technologies used in biomedical research, assess their strengths and weaknesses and determine which areas merit further NIH investment. Co-chairs of the working group emphasized the agency’s recognition that these methods serve to complement ongoing research with animals. The working group plans to issue draft recommendations in June. 

    The Re-envisioning NIH-Supported Postdoctoral Training Working Group co-chairs provided background on the impetus for the working group. Primarily, a perceived decline in Ph.D.s pursuing postdoctoral research positions, which is a multifaceted problem. ACD members engaged in data pertaining to overall postdoc numbers, international graduate students and postdocs, F32 applications and awards, and benchmarking academic stipends with salaries available elsewhere. An RFI to solicit stakeholder engagement is expected to be issued in early 2023. 

    The next ACD meeting is scheduled for June 2023, when members anticipate hearing updates and next steps for each of these topics. 

  • Why Getting Certified Should Be Your Next Step

    by Greg Margason | Jan 20, 2023
    Why Getting Certified Should Be Your Next StepSeven years ago I got my first job out of college as an exercise therapist at a local hospital, where I worked in the rehab department. I taught aquatic exercise classes and land-based classes for different types of people — older people, people with heart problems, those who had neurological conditions and so forth.  

    It was at that point in time in my career I found out that there was so much more that I wanted to learn and there was also so much that I didn’t know. I was faced with a client who had so many comorbidities that I was unsure of how to go about treating them, what exercises worked best for them, and how those exercises would help or hinder their progress. This prompted me to want to know as much as possible how exercise affects chronic diseases and what the potential outcomes were. Fast forward to today: I have worked in three hospital systems and seen thousands of patients, and I still feel there’s more to do and learn. Through the years I learned from watching others and asking questions, and then I decided that it was time to challenge myself and test everything I have learned through practical experience. 

    The ACSM-CEP® certification represents a gold standard for exercise science and fitness professionals and allows us the opportunity to grow in our careers, with chances for advancement and to work in other areas of allied health like cardiac or pulmonary units, oncology and other chronic conditions. I find cardiology fascinating, and having worked with many patients with different cardiac issues, I find this certification can help educate me in all there is to know about specific conditions like cardiovascular disease, post-MI rehabilitation and congestive heart failure. This certification will give me a sense of accomplishment and the knowledge and practical understanding of how to best go about training these populations. This certification will also allow potential employers and colleagues in other disciplines to take me seriously as a clinician and give me the ability to choose the environment I would like to work in and the type of patient or client I would like to work with.  

    I have always been a person who loves to learn, and I feel sitting for this exam gives me the best opportunity to do that and test my knowledge of this field that I have been in for the past seven years.  

    If you are on the fence about whether you should go for this certification, I would say that so many doors will open after you obtain it — you will practically be able to work in any setting you want, from hospital-based outpatient rehab to cardiopulmonary rehab to cardiology. Not to mention fitness-related areas like a fitness director or health and wellness coach. The options you will have are endless, and the sky is the limit. This is going to be the standard in the future, and if you want to have a career that pays you fairly based on your education — and to do what you love and what always challenges you — then I would highly recommend you branch out and learn the things that you don’t know and continue to grow as both a professional and student of this profession. 

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    Austin Cooper
    Austin Cooper is an exercise physiologist and master’s student at American Public University (’23) studying sports and health sciences. He is a certified strength and conditioning specialist, nutritionist and wellness coach experienced in spinal cord rehabilitation, weight management and the prevention of cardiovascular disease through lifestyle interventions.  
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