Childhood obesity is an epidemic affecting over 340 million youth worldwide, with rates continuing to increase each year. Importantly, childhood obesity does not occur in isolation, as rates of physical inactivity are also increasing, with children and teens being less physically active now than in the past. These areas of public health are incredibly interrelated, because children with obesity commonly become adults with obesity, and inactive children also tend to become inactive adults. As of 2018, four out of five adolescents, and three out of four adults, did not meet the recommended levels of regular physical activity in the U.S., with $117 billion in annual health care costs related to physical inactivity.

Childhood obesity, which can result from physical inactivity as well as many other lifestyle factors, has been associated with cognitive decline, neurological disorders and mental health issues. However, participation in physical activity can prevent obesity and consequently promote cardiorespiratory fitness, physical health and cognitive and brain function.

In our study published in Medicine & Science in Sports & Exercise_®, we investigated the brain-fitness-adiposity relationship in children aged 8-11 years. Using a data-driven approach, we aimed to identify differences among obesity and cardiorespiratory fitness measures on resting state functional brain networks as acquired with functional magnetic resonance imaging (fMRI). The amount of adipose tissue in the body was derived by dual-energy-X-ray absorptiometry (DXA). Cardiorespiratory fitness was derived from VO_2max testing. Relative VO_2max measures were adjusted for lean body mass.

Our study was novel for two reasons. First, it utilized a data-driven approach to identify which physiological measures were associated with functional regions of the preadolescent brain, from the whole sample of 121 children. Second, our results identified evidence for a brain-fitness-adiposity relationship such that overall, a negative effect of adiposity-related brain patterns and a positive effect of fitness-related brain patterns were observed using a functional network parcellation of the brain. These networks, which have been associated with cognitive functions, have previously been established in association with either fitness or adiposity paradigms. However, the key takeaway from our study is that functional brain networks were found to be differentially associated with positive (e.g., cardiorespiratory fitness) and negative (e.g., obesity) health factors during childhood. Further, mediation analyses revealed that that cardiorespiratory fitness did not mediate the relationship between adiposity and functional brain networks. Additionally, adiposity did not mediate the relationship between cardiorespiratory fitness and functional brain networks. These findings suggest the negative effects of the brain-adiposity relationship and the positive effects of the brain-fitness relationship were independent of each other.

Our study provides novel findings that advance our understanding of the underlying functional brain networks associated with physiological health factors in preadolescent children, which is important for optimal brain health. As childhood obesity is a global health concern, considerable efforts should be taken to reduce the negative health outcomes, such as the negative associations with brain function, associated with childhood obesity. Notably, there are many environmental and health factors associated with the development of childhood obesity. However, targeting the issue of global physical inactivity with the promotion of exercise during childhood is one avenue whereby physiological health, such as cardiorespiratory fitness, can be improved and consequently promote brain health.

Nicole Logan, Ph.D., is an assistant professor of kinesiology in the University of Rhode Island College of Health Sciences. She has a background in psychology, neuroscience and exercise science, and earned her doctoral degree in psychology from Northeastern University. Dr. Logan’s research investigates how a variety of health factors, such as exercise, cardiorespiratory fitness, childhood obesity, mental health and developmental adversity, influence our cognition and brain function across the lifespan. Originally from New Zealand, she has been an elite international and NCAA water polo coach.

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

Automobile racing is one of the largest spectator sports in the world, with a viewing audience equal to that of soccer, and most people, regardless of their interest in the sport, can name famous race events like the Daytona 500 or Indy 500 and drivers like Jeff Gordon, Mario Andretti or Lewis Hamilton. The popularity of automobile racing has also grown in recent years thanks to the Netflix documentary series Drive to Survive and the feature film Ford vs Ferrari. Yet if you were to ask, “Are race car drivers athletes?” most responses would be “no.” Many people think drivers just sit in the car while the vehicle does the work. However, racing drivers routinely compete at heart rates of 160-180 beats per minute, can lose up to seven pounds sweat  during a race and are exposed to gravitational forces that rival those experienced by fighter pilots and astronauts.

For the past fifteen years, my laboratory, Spartan Motorsport Performance Laboratory,  worked to dispel the notion that race car drivers are not athletes by documenting the stressors they are exposed to, their physiological responses to these stressors and the overall fitness requirements for driving race cars. In the short term, we seek to identify evidence-based training and nutrition practices that will optimize driver health and performance—efforts that have contributed to drivers winning the Daytona 500, 24 hours of Le Mans, Baja 1000, and Monaco Grand Prix, as well as several NASCAR, Formula 1 and IMSA championships. In the long term, we want racing drivers universally recognized as the athletes they actually are, increasing their access to the sports medicine practices enjoyed by their peers in more traditional sports.

If you were to tour a traditional professional sport’s team training facility, you would encounter a state-of-the-art sports medicine clinic with modern equipment and certified professionals (e.g., physician, athletic trainer, sport psychologist, exercise physiologist, strength and conditioning coach, dietician) dedicated to optimizing athlete performance and rehabilitating injuries. However, if you were to tour a professional race team facility, you would discover a venue equal in cost and personnel expertise focused on the performance of the race car, yet lacking sports medicine support. Certainly, there are highly skilled medical personnel (e.g., the IndyCar Safety Team) present at the racetrack who respond to and treat drivers during a crash, but establishing a day-to-day health and training regime is often the sole responsibility of the driver. In many racing contracts, it is up to the driver to source their own physical training/nutrition advice and sports medicine care, often at their own cost.

To document how drivers manage their sports medicine care, I worked with Drs. Abigail C. Bretzin and Julia N.D. Hines to evaluate racing driver knowledge, attitudes and reporting behaviors regarding concussion (published in The Translational Journal of the American College of Sports Medicine in 2022). Like most contact sports, concussion is a concern in motorsports and a serious injury if not properly treated. We used validated surveys to assess knowledge, attitudes and reporting behaviors in 59 professional race car drivers and determined that most drivers were aware of concussion symptoms and the dangers of improper management of concussion. Alarmingly, though, we learned that only half the drivers reported a concussion to their team, the reason being that they did not want to let their race team down by being unable to drive the car. Placing the responsibility on the driver to direct their own health care and training cultivates a culture of drivers choosing between their health and their career.

Auto racing has seen substantial improvements in driver health and safety in recent years, and the next step is to increase the presence of sports medicine health care teams within motorsports. Drivers and race teams should be taught about the physical stressors of and physiological responses to driving, along with how a sports medicine team can mitigate these issues. Sponsors should be taught that, in addition to funding the race car and driver salary, they should consider funding health care professionals within the race team. For their part, sanctioning bodies should be taught about the importance of sports medicine and encouraged to consider regulations that would increase drivers’ access to such critical resources. Lastly, sports medicine physicians, athletic trainers, physical therapists, exercise physiologists, nutritionists, strength and conditioning coaches and sport psychologists should turn an eye toward motorsports and consider whether their expertise could benefit this underserved population.

David P. Ferguson, Ph.D., FACSM, is an Associate Professor of Kinesiology at Michigan State University. With over 15 years of research experience in professional auto racing, Dr. Ferguson focuses on helping racing drivers improve their performance while staying safe. He began his journey by earning a B.S. in Kinesiology from the University of Nevada, Las Vegas. Following this, he earned an M.S. in Clinical Exercise Physiology from the University of North Carolina at Charlotte. He went on to earn a Ph.D. in exercise physiology from Texas A&M University and completed a Postdoctoral Fellowship in Nutrition and Cardiovascular Physiology at Baylor College of Medicine. He has published multiple scientific papers on racing driver physiology and served as author and editor for a book, “The Science of Motorsport” on the topic. His expertise supported drivers in the winning of three NASCAR Cup series Championships, an IMSA Sportscar Championship and two Formula 1 World Championships. He has also helped drivers win notable races such as the Daytona 500, 24 Hours of Le Mans, 24 Hours of Daytona, and the Baja 1000.

Cardiometabolic risk describes a collection of factors known to increase the likelihood of cardiovascular disease. It includes lipid and glucose metabolism as well as adiposity and hypertension.

We know that being more physically active is associated with lower cardiometabolic risk. However, it is not clear whether more specific or tailored physical activity guidance can be given in relation to cardiometabolic risk. Further, given the increasing prevalence of chronic disease, there is need to focus research on those with chronic disease. Indeed, this was highlighted in the most recent World Health Organization physical activity guidelines. Thus, our study included two groups — people with and people without chronic disease. We explored whether overall physical activity or the intensity of activity was more strongly associated with lower cardiometabolic risk in both these groups.

Our study, published in Medicine & Science in Sports & Exercise_®, used data from existing trial datasets from the Leicester Diabetes Centre in the U.K. We used data from wrist-worn physical activity monitors, taken from a sample of over 1,500 adults with and without a chronic disease. From these data, we generated metrics that describe overall physical activity and the distribution of activity intensity across the day. These metrics can be used to gain insight into whether the intensity or overall level of physical activity is more important for health, or whether they are both important.

In addition to the physical activity data, we generated a clustered cardiometabolic risk score incorporating waist circumference, mean arterial pressure, haemoglobin A1c, triglycerides, and HDL cholesterol. We determined whether associations between cardiometabolic risk and physical activity differed between those with and without a chronic disease.

We found that in people without a chronic disease, both more overall and more intense physical activity were associated with cardiometabolic risk. However, in those with a chronic disease, only more overall physical activity was associated with cardiometabolic risk. This implies that for those with a chronic disease, the focus should be on being more physically active even at low intensities, supporting “every minute counts” messaging. However, those who are healthy may gain extra benefit from incorporating higher intensity physical activity in their daily routines.

As with most guidance, contextualizing the information is important to improve uptake, (e.g., presenting this message in the form of walking). In those with a chronic disease, cardiometabolic risk was lower in those who walked for 60 minutes across the day, regardless of walking speed. For the healthy adults, risk was lower in those who were more physically active overall, but also accumulated at least 10 minutes of brisk walking.

Our results further support the importance of physical activity in relation to cardiometabolic risk. They also suggest that it may be appropriate to tailor the emphasis on intensity of physical activity according to health status. However, it should be noted that our results are cross-sectional. Thus, we cannot be sure whether the physical activity led to better health markers or vice versa. If confirmed, our results suggest that physical activity prescriptions could be tailored to specific populations and/or to intensity preferences.

Nathan Dawkins, Ph.D., is a lecturer in sport and exercise science at Leeds Trinity University and completed his Ph.D. at the Diabetes Research Centre, University of Leicester. His research focuses on developing methods for assessing physical activity using wearable accelerometer devices and understanding the role of physical activity in the prevention of chronic disease.

Alex Rowlands, Ph.D., is an associate professor at the Diabetes Research Centre, University of Leicester. His research focuses on the use of accelerometry-based wearable monitors to quantify human movement patterns and their associations with health. He is associate editor for the Journal for the Measurement of Physical Behaviours and Pediatric Exercise Science. He has been a member of ACSM since 2014.

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

Early in 2022, the American College of Sports Medicine (ACSM), in conjunction with publishing partner Wolters Kluwer, announced the launch of a new research journal, Exercise, Sport, and Movement (ESM). ESM represents ACSM’s first-ever open access journal, thereby making its content free to anyone interested in the subject matter. As the person selected to be ESM’s Inaugural Editor-in-Chief, I have since fielded many questions about open access, particularly, “why should I publish in an open access journal?” Fast-forward to August 25, 2022, when the White House released a significant announcement dictating that all future taxpayer funded research, and the resulting dissemination of such research, shall be freely available to U.S. taxpayers without further delay.

Practically speaking, what this means is that all current and future federally funded research results must be published in an open access journal, like ESM. Part of the argument for this change is that U.S. taxpayers fund literally billions of dollars of important research, especially in the broad area of health, yet most of it sits behind paywalls for extended periods of time and is therefore not available to those same taxpayers who provide the funding. This will no longer be the case, and ESM, thanks to the foresight of ACSM and Wolters Kluwer, is perfectly positioned to begin publishing federally funded research, along with all other research, that fits the scope of the journal.

To be clear, publishing in general does not come without costs, as there are production processes necessary before the information becomes available. Open access journals move those costs from the reader to the researcher. Therefore, ESM, like all other open access journals, does have an article processing charge, or APC, however, ESM’s fees are lower than most and vary by submission type.

“When research is widely available to other researchers and the public, it can save lives, provide policymakers with the tools to make critical decisions, and drive more equitable outcomes across every sector of society,” said Dr. Alondra Nelson, head of White House Office of Science and Technology Policy (OSTP). “The American people fund tens of billions of dollars of cutting-edge research annually. There should be no delay or barrier between the American public and the returns on their investments in research.”

All federal agencies will be expected to have their respective policies updated and fully implemented by December 31, 2025. However, agencies will be expected to update their public access and data sharing plans right away, by mid-2023.

In the end, this is a monumental decision by the White House to give back to the taxpayers. At the same time, ACSM and Wolters Kluwer fully anticipated this, leading to the development and launch of ESM. Now that the OSTP has made open access the new standard, ACSM, Wolters Kluwer, and of course, ESM, are excited to be a key outlet for publishing federally funded research.

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Gary Liguori, Ph.D., FACSM, is the dean of the College of Health Sciences and a professor of kinesiology at the University of Rhode Island in Kingston, Rhode Island. He is the Senior Editor of the 11th edition of ACSM's Guidelines for Exercise Testing and Prescription (GETP11), and the Editor-in-Chief of Exercise, Sport, and Movement.

Engagement in physical exercise has shown widespread benefits on cardiovascular, physical, emotional and cognitive health in older adults. However, initiating and sustaining an exercise routine over the long term (e.g., six months or more) is incredibly challenging. Our historical understanding of the factors that determine engagement in physical exercise comes from psychological and psychosocial theories, of which there are many. Leveraging these theories to develop interventions to change behavior has led to both trivial and sometimes modest improvements in exercise behaviors.

Translating these theory-based interventions into practice lies in the realm of implementation science, which is the science of the systemic uptake of a given evidence-based intervention. Implementation science suggests that even the most effective intervention is not effective if it’s not implemented. The approach we took in our study in Medicine & Science in Sports & Exercise_® compliments implementation science by recognizing interindividual differences in the response to any given exercise intervention.

We believe that computational and cognitive neuroscience approaches to exercise behaviors can eventually allow one to match the right person with the behavioral intervention.

Given the brain drives many aspects of complex behavior, we hypothesized that its functioning may hold keys to both novel intervention development as well as personalized precision-medicine approaches. For example, we demonstrated that individual differences in specific neural network properties of the brain predicted adherence to our six-month exercise intervention in older adults. Given that knowledge, we could now target these mechanisms and test whether by modulating that neural target we can modulate future exercise behaviors. In the long term, the goal is to develop validated prediction models of several different intervention types, which can match an individual with the intervention they would benefit from.

A common critique of this type of approach is that clinical spaces and centers will not have the resources to apply expensive neuroimaging to simply “provide” a behavioral intervention to participants. We argue, however, that providing one-size-fits-all interventions to everybody limits the public health benefits of exercise as they can lead to high attrition rates. This is exacerbated when individuals present with noncommunicable diseases, where the timeframe for effectiveness of behavioral interventions is accelerated.

While the results in our current study are unlikely to impact clinical practice currently, the approach and premise paves the way for future research into precision-medicine applications to exercise behaviors. The intersection of computational neuroscience and movement sciences can offer novel approaches to increase adherence to physical exercise interventions and improve public health. 

Dr. Timothy P. Morris is an assistant professor of physical therapy, movement and rehabilitation sciences and a member of the faculty in the Center for Cognitive and Brain Health at Northeastern University. He has a master’s degree and Ph.D. in neuroscience from Spain’s Autonomous University of Barcelona and a bachelor’s degree in sport and exercise science from Aberystwyth University in Wales. His training and research experience puts his expertise at the intersection of exercise sciences and neuroscience. He is a current member of ACSM.

Dr. Arthur F. Kramer is professor of psychology and director of the Center for Cognitive & Brain Health at Northeastern University. He previously served as senior vice provost for research and graduate education at Northeastern University. He also previously served as director of the Beckman Institute for Advanced Science & Technology and the Swanlund Chair and Professor of Psychology and Neuroscience at the University of Illinois. Professor Kramer’s research projects include topics in aging, cognitive psychology, cognitive neuroscience and human factors.

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