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  • Technogym Q&A | Physical Activity as Pillar of Healthy Longevity

    by Greg Margason | May 21, 2024

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    In the pursuit of a longer and healthier life, it's essential to focus on both the quantity and quality of the years we live. Healthy longevity—free from chronic diseases—requires attention to both morbidity and mortality. This approach offers valuable insights for health professionals, the public, and policymakers alike, shifting the focus from merely treating illnesses to preventing them.

    Physical activity plays a pivotal role in this shift, particularly as our population ages. Active adults not only live longer but also enjoy more years in good health. Meeting the recommended 150 to 300 minutes of moderate intensity of 75 to 150 minutes of vigorous intensity physical activity per week provides substantial benefits. Doubling this amount may yield even greater rewards. For the best results, combine aerobic exercises with 2 days of resistance training to maximize health benefits.

    The advantages of higher physical activity levels extend well into older age, helping to prolong life and increase the years spent free of chronic diseases. It's important to encourage those who are inactive to start incorporating physical activity into their routines. Significant health benefits can be achieved without needing to reach the highest activity levels. Moreover, adults already engaging in high levels of activity should continue, as they may gain additional modest benefits beyond the recommended amounts.

    Q: Is there a difference between strength training and cardiovascular training on life expectancy/longevity?

    Studies show that both aerobic and strength training individually lower mortality risk compared to no exercise. However, combining both types of exercise offers the greatest longevity benefits. Aerobic and strength training provide distinct and complementary health benefits, making the combination of the two optimal for overall health.

    Q: From your data it appears that the years with cardiovascular disease (CVD) are similar (6-7 years) regardless of physical activity level. Can you comment on this?

    Research indicates that more active individuals tend to have a longer total life expectancy and a longer healthy life expectancy. And for an active person who develops cardiovascular disease their higher levels of fitness can result in a stronger, more resilient body that can help them live longer even with the disease. Therefore, the number of years with disease may be similar between active and inactive individuals. Importantly, those who are more active often experience less severe disease and fewer recurrent events once they are diagnosed with a disease. Thus, even if the duration of illness is comparable in active vs inactive adults, the overall burden and severity of the disease are generally lower in active individuals.

    Q: Health is related to income, education, etc. How have these been excluded in your data?

    Physical activity is just one factor in living a healthier, longer life. Variables such as income, education, genetics, age, sex, and lifestyle factors (e.g., smoking, sleep) also play significant roles. In observational studies on physical activity and longevity, we account for these variables in our analyses. However, it's impossible to fully control for every factor. Thus, while physical activity is crucial, it is only one component of overall health.

    Q: Can engaging in light to moderate everyday activities suffice for being deemed physically healthy without fitness exercises?

    For optimal health, it's recommended that healthy young to middle-aged adults engage in moderate to vigorous intensity physical activities. While light intensity activities are better than a sedentary lifestyle, incorporating moderate to vigorous intensity exercise provides greater benefits. For older adults or those with chronic conditions, moderate intensity activities, or the highest intensity they can manage, are advised. Particularly for older adults, research has shown that light intensity activities can still offer longevity benefits.

    Q: How does physical activity before puberty influence longevity?

    Most longevity research focuses on cohorts starting from young adulthood (18+ years old), so there's limited data on the impact of childhood physical activity. Importantly, one of the major determinants of being active as an adult, is your history of physical activity, including whether you were active as a child. Developing a joy and commitment to being active early can lead to lifelong activity as an adult and contribute to a healthier, longer life.

    Q: What is the threshold of excessive resistance training for adults?

    The association between resistance training and mortality risk follows a J-shaped curve, with maximum risk reduction at about 30–60 minutes per week of muscle-strengthening activities. Benefits extend up to approximately 130–140 minutes per week. There are no well-established physiological mechanisms explaining why higher doses of resistance exercise may not provide additional benefits for mortality. However, two possible mechanisms could be increased arterial stiffness and chronic inflammation. Due to the small number of individuals engaging in very high levels of resistance training, research has not been able to definitively conclude whether there are risks of excessive training and at what volume should be consider too high.

    Q: Do high volumes of aerobic activity increase the risk of overuse injuries while aiming to increase lifespan?

    The majority of longevity benefits do not require very high volumes of activity. Most of the benefits are achieved by meeting the physical activity guidelines of 150-300 minutes of moderate or 75-150 minutes of vigorous activity per week. Participation in exercise and physical activity increases the risk of musculoskeletal injuries, particularly during the activity itself. The intensity and type of exercise are important factors related to the incidence of injury. Walking and moderate-intensity physical activities are associated with a very low risk of injury, whereas jogging and competitive sports carry a higher risk of injury. Common methods to reduce injury can be helpful - such as stretching, warm-up, cool-down, and gradually increasing exercise intensity and volume.

    Overall, being physically active across the lifespan may lower the risk of injury during daily living. For example, active older adults are less likely to experience serious falls, which are a leading cause of injury and disability in this age group.

    Q: What are your guidelines for defining moderate and vigorous activity? Do you use heart rate, RPE, etc.?

    One simple method is the talk test: for moderate activity, you can hold a conversation but not sing; for vigorous activity, you can only speak a few words at a time. Using heart monitors like wrist worn devices or chest straps, moderate intensity is 65-75% of maximal heart rate (%HRmax) and vigorous intensity is 76-96% HRmax. Rate of perceived exertion (RPE) is another method where on a scale of 0 to 10, moderate intensity targets an RPE of 3-4, while vigorous exercise targets an RPE of 5-7.

    Q: One of the major issues in society is that in the age of convenience, activities of daily living have become more sedentary. Examples include online shopping, Amazon orders, and DoorDash, which contribute to a spoiled lifestyle. Technology has deterred people from being more active. As a personal trainer, what is the best approach to advise clients to avoid using convenience as a deterrent to being active?

    With the rapid growth of technology, various conveniences can limit our daily physical activity. Setting a step goal is an effective strategy to encourage more movement and less sitting. We have shown that taking more steps per day is associated with a lower risk of death. Instead of using delivery services, clients can be encouraged that by walking through the grocery store, there is an opportunity to take 1,000 more steps toward a step goal. Similarly, opting for manual tasks like vacuuming instead of using a robot can help increase daily steps and overall activity. These small changes toward making your everyday life more active and less sedentary can be meaningful for health and longevity.

    In summary, embracing an active lifestyle is not an all-or-nothing proposition. By making consistent efforts to stay active, we can all enjoy the benefits of a healthier, longer life.

  • Fighting, Faith and Asynchronous Cardiac Rehab: Get to Know Alexis Bhagat, ACSM-CEP

    by Greg Margason | May 21, 2024

    Alexis Bhagat fought her way into sports medicine.

    The 32-year-old clinical exercise physiologist is a true Millennial: like many of us, she went to the mat, so to speak, on an extracurricular activity. Specifically karate, which blossomed into an impressive athletic career. And it was no surprise: Both of her older brothers were also fiercely competitive karate athletes, the elder of whom owns his own dojo in Chicago, where Bhagat (née Ocampo) originally hails from.

    But Bhagat is a long way from Chicago now. Based in Denver, she provides telehealth cardiac rehabilitation services for Kaiser Permanente’s Colorado system. Consequently, our mid-March Zoom interview has echoes of the scene in The Shining when Chef Halloran gets the phone call to go check on the Torrances: where I’m sitting, the temperature is hovering between the high 50s and low 60s, but when I ask her about the weather in her neck of the woods, she says, “We’re getting plowed with a ton of snow here in Denver. Thankfully, I work from home, so I don’t have to try to trek through it all.”

    Without harping too much on these strange sorts of environmental disjuncts, or the “revolutionary nature” or “newness” of remote work — telephones, faxes and email kept the world in much closer contact while physically apart than we seem to remember — the opportunity to offer telehealth care to patients and clients has been a distinct and important shift for physicians and certified exercise professionals alike. It’s not so much the newness of the technology but the newness of its widespread acceptance.

    For her part, Bhagat is able to provide quality care to an extraordinary number of patients via the remote platform Kaiser has set up for her and her nurse practitioner colleague.

    But back to karate for the moment. How’d that happen?

    Bhagat: “I have two older brothers, and they were doing it at that time. And I sat in a karate class, and I just looked at my dad, and I was like, ‘Hey, I wanna do this too.’ And so he signed me up for karate class. Immediately it just became a family thing.”

    By the time she was six years old, Bhagat was putting in two-a-day training sessions. At 11 or 12, she was competing internationally with the U.S. team, primarily via AAU Karate. (Its philosophy of “Sports For All, Forever” dovetails nicely with ACSM’s mission to “extend and enrich lives through the power of movement.”)

    Bhagat trained with coaches all over the globe, competed in world championships, learned how to attack an exercise program with tenacity and gusto — learned, too, how to deal with and recover from injuries. It was an education about getting in touch with her own body in the way only a high-level athlete can.

    Here’s her resume and trophy room, translated into text:

    • 3x Ozawa Cup International Champion
    • 3x Most Outstanding Female Competitor of the Year
    • 3x US Open Champion
    • 10x NKF National Champion
    • 16x AAU National Champion
    • 2x Hawaii International Champion
    • 2x JKA Champion
    • 1x Jr. Pan American Games Champion
    • 2x WKC Jr World Champion
    • 1x WKC Sr World Champion
    • WUKF European Champion
    • WUKF World Champion
    • Former AAU-USA Assistant Coach

    Karate was the reason she pursued a pre-physical therapy degree at Benedictine University in Lisle, Illinois, before moving on to a master’s in clinical exercise physiology from the same school in the fall of 2016. It drove almost everything in her life.

    Then came the COVD-19 pandemic.

    The COVID-19 disjunct, as much we all desperately want to get past it, shows up as a crucial turning point in the lives of many I interview for ACSM. For Bhagat, the pause in her training and competition schedule hit just as she was beginning to feel like karate was something her “old self” had done. It seems the pause allowed her to take stock of who she’d become while she wasn’t looking. Her last competition was the 2019 European championships in Romania.

    “When the pandemic hit, that kind of took a toll,” she says. “And that’s when my priorities shifted. I got older. And of course, I really wanted to focus on my career and start a family.”

    At the time of our interview, Bhagat is 17 weeks pregnant.

    * * *

    By the time COVID-19 reared its head, Bhagat was immersed not only in karate but in a career as an exercise physiologist at Northwestern Memorial Hospital in Chicago.

    But she felt she was stagnating. She and her husband, Kevin, a UX designer, were itching for a fresh start somewhere outside the Windy City. The couple decided they wanted to move West.

    Initially, the goal was California, but it wasn’t to be. Instead, Colorado beckoned. And though she had plenty of work experience and a master’s degree, most of the jobs Bhagat applied to required a certification as well, which she hadn’t yet earned. Fortunately, she found her current role at Kaiser Permanente, and Kaiser provided a six-month grace period in which she could work to get certified. She chose ACSM.

    “When I got hired in April (2021), I studied immediately,” she says. “I studied really hard for three months, like even during work and after work. And then I took the test in July and passed on the first try, thank God, because I’m not a good test-taker.”

    Two years later, ACSM held its 2023 annual meeting in Denver. She took the opportunity to attend, finding herself particularly interested in sessions about cardiac arrest.

    An interesting anecdote bubbles up.

    “Actually, my oldest brother cardiac arrested while fighting in the dojo,” Bhagat recalls. “He got kicked really hard in the ribs and arrested in front of me — I was only 10 or 11 — and someone did CPR. They said that if she’d stopped, he would have died.”

    We chat about impact-related cardiac arrest (aka commotio cordis) and the sports in which it seems most likely to occur — football, baseball, etc. Then the connection:

    “It’s crazy that my experience of that when I was little is now my field.”

    It’s always possible to assign too much or too little significance to the events in our lives, but the striking moment Bhagat describes, in which her brother is roundhouse kicked in the chest, then walks to the side of the dojo before simply and suddenly collapsing, his life left entirely in the hands of a CPR-capable bystander, begs our attention.

    Here we must remember that we’re viewing the scene through the eyes of a little girl who may or may not know that her brother is on a knife edge, for whom the concept of death might not yet be concrete but who feels the enormity and strangeness of life events far more than we as adults allow ourselves to. The poetic logic that Bhagat was destined to work in cardiac rehab seems inescapable.

    Now, Bhagat is one of three clinical exercise physiologists in the Kaiser system. She provides remote supervision to cardiac rehabilitation patients who perform prescribed exercise while wearing Fitbits to track their vital signs.

    In fact, Bhagat and her chief co-worker, a nurse, had no small part in building the remote program they now run. It’s asynchronous, meaning that Bhagat doesn’t lead exercise classes per se but rather works on exercise prescriptions for patients and monitors their vital signs from afar.

    There are guardrails, of course.

    “These patients are exercising independently,” she says. “So we have stricter criteria. A patient should be able to walk a hundred feet unassisted.”

    Naturally, Bhagat’s role is to make sure they aren’t getting into dangerous territory during their routines, and she also meets with them for 30 minutes each week to see if they’re experiencing any concerning symptoms. And if someone shows a dangerously abnormal vital sign, she’ll receive an alert in real time. She provides care to roughly 100 patients at any on juncture; each month, about 28 enroll as others cycle out.

    Crucially, Bhagat worked with her supervisors to ensure her CPT coding was at the same level as her nurse colleague’s, since she was providing the same level of care. (Promoting proper coding for certified professionals is an ACSM priority.)

    * * *

    What many ACSM members and cert pros might know Bhagat for, though, is her social media presence.

    “It all started during pandemic,” she says. “I started posting exercise physiology study guides. I was gearing towards students needing help because I was at that stage. Like, I needed help.”

    Having always been compelled to take meticulous notes — and to organize them in a visually appealing manner — Bhagat was unintentionally preparing herself to help other up-and-coming physiologists in their studies. During the pandemic, she saw nurses posting to TikTok but noticed that there was a dearth of clinical exercise physiology content. She decided to fill the niche.

    At first, it was just for fun. But the momentum grew. Eventually, she added day-in-the-life content, providing needed visibility to the field of clinical exercise physiology — especially important for students wondering what they might be able to do with such a degree.

    Her reach grew, as well as her impact.

    “I’ve had, I would say, almost 15 or 20 interviews already from 2020 till now, just with different students,” she says. “I would have people messaging me like, ‘Hey, I’m in the field. Can I do an interview with you from my school, just so I can learn more from someone who’s actually in the field?’ and I’m like, yes, please let’s do it.”

    Later, she says: “Our role is so diverse, but it’s also very specific as well. And so I wanted to shed light on that.”

    You can check out her posts (@alexisobhagat) on Instagram and TikTok.

    * * *

    I ask what she does in her spare time.

    “I love hiking,” she says. “That’s always fun. I haven’t tried it yet since getting pregnant, so I’ll have to try that, but hiking for sure.” She continues: “I love hanging out with my friends. I’m very faith based as well. So I’ve been with my small groups here in my church just hanging out with them and getting to know them.”

    This leads to a discussion about the role of faith in her life and work. She outlines how athletes often harbor a powerful desire for control — diet, training, and overall routine being a mere handful of examples. She and her husband really wanted to end up in California, for one thing, but it just didn’t happen. The pandemic tested their faith as well. Yet, the solution was to loosen rather than tighten their grip.

    “I had to surrender all of my control and just let God take the reins. And it actually led me to Colorado — still a really nice place. Friendly people and a job I love doing, although I am away form family. It just opened up so many doors for me, and I feel like I wouldn’t have done that if I didn’t surrender control of what, you know, I think should be done.”

    What about the future?

    “In my role right now, I love what I do. I love my co-worker; she’s awesome too. And then just working with Kaiser, it’s just been awesome. So I’m not sure right now, but I definitely want to stay in this virtual realm of exercise physiology.”

    Like many of us, the name of the game right now is to soldier on. Comfortably situated in a rewarding role, and with a growing family to look forward to, Bhagat continues to share her story with up-and-coming physiologists on her social media platforms.

    So, when the next big change does occur, we’re sure to hear about it.

  • Hot Topic | This May, Actively Transport Yourself to Work and Play

    by Greg Margason | May 21, 2024
    Hot Topic 5-23

    May is Active Transportation Month, a time to get outside — an experience enhanced by walking, riding or rolling rather than driving a vehicle. The health benefits of incorporating physical activity into one’s daily routines, whether during our commute, running errands or simply for leisure, have been extensively reported. These benefits span across cardiovascular, metabolic, psychological and social realms, quantified through various metrics such as blood lipids, blood glucose, heart rate, steps per day, body composition and energy expenditure. Moreover, the psychological boost and social connections fostered by such activities contribute to enhanced confidence, overall well-being and happiness. 

    Venturing outdoors adds another layer of richness to the physical activity experience. We invigorate our bodies (e.g., increased DNA repair, reduced arterial stiffness) and rejuvenate our minds (e.g., increased expression of beta endorphins) and spirits (e.g., suppressed melatonin production and reduced symptoms of seasonal affective disorder). Sun exposure can also help regulate circadian rhythms, thereby improving sleep quality and energy levels.  

    However, active transportation is about more than just personal well-being: it is an act of reciprocity towards our planet. By opting for walking, biking or rolling, we actively reduce the accumulation of harmful greenhouse gasses and air pollutants emitted when traveling in gas-fueled vehicles. Transportation is a major contributor to greenhouse gas emissions, with many pollutants being released into the atmosphere. One study followed 2,000 urban residents who switched from driving a car to riding a bicycle for just one trip per day, a small lifestyle change that reduced their annual greenhouse gas emissions from 1.8 to 1.3 tons of CO2. The authors also suggested that if just 10% of the population made this small change in their travel behavior and reduced personal vehicle usage, greenhouse gas emissions from commuting and recreational trips would be reduced by 4% each year. While this alone will not stem the effects of humans on global climate, this alongside other efforts can have real and measurable positive effects at reducing our carbon footprint. 

    The good news is that the United States is following the lead of many European countries and embracing the shift towards a more walkable and bike-friendly infrastructure. With over 101 cities officially recognized for their walkable communities, 18,000 miles of bike trails and over 1,300 National Recreation Trails to hike, opportunities for active transportation abound. All of us should become familiar with our local infrastructure to make the most of walking, biking and hiking trails for commuting and leisure. The emerging popularity of electric bikes has added a novel element of fun and function as individuals of all fitness levels enjoy the possibility of exploring new places regardless of distance or hills with as little or as much effort as they desire. 

    As stakeholders in our communities, we have the power to effect positive change. If you identify areas for improvement in your community’s infrastructure, be proactive and contact your local city officials, particularly city planners. Your input could not only enhance active transportation options but also benefit local businesses and overall public health. Walkable communities tend to have higher housing values, boost local businesses, attract tourists and contribute to residents’ overall sense of well-being

    With May being a celebrated month for active transportation/commuting, let’s seize this opportunity to embrace active transportation, not just for our own well-being and happiness but also for the health of our communities and planet. Alongside local partners and global health organizations, we can create more vibrant, sustainable and connected neighborhoods, one step, pedal or roll at a time. 

    Helaine Alessio


    Helaine Alessio, Ph.D., FACSM, is professor and chair of the Department of Kinesiology, Nutrition, and Health at Miami University and past president of the ACSM Midwest Regional Chapter. She has received university commendations for teaching, research and service; has over 80 journal articles, book chapters, national and international peer reviewed blogs, infographics and NPR broadcasts; and has been funded by the National Institutes of Health (NIH), private foundations and corporations.  


    Alexander Montoye


    Alexander H.K. Montoye, Ph.D., FACSM, is a faculty member in Integrative Physiology and Health Science at Alma College in Michigan. Dr. Montoye’s research focus is on analysis and interpretation of accelerometer-based movement sensor data for outcomes including activity types and intensities. He also has keen personal interest in active transportation for personal and environmental health. 



    Kyle Timmermann


    Kyle Timmerman, Ph.D., FACSM, is an associate professor in the Department of Kinesiology, Nutrition, and Health at Miami University. He is currently the president-elect of the ACSM Midwest Regional Chapter. His scholarship has focused on interactions among physical activity, inflammation, aging and biomarkers of disease. His research has been funded by the NIH and private organizations, and his scholarly works have been cited over 5,000 times. 

  • Supporting Active Transportation, CDC Committee Nominations, NIH Grants Policy and More Updates

    by Caitlin Kinser | May 13, 2024

    Active Transportation Infrastructure Investment Program

    ACSM recently joined several other organizations in support of the Active Transportation Infrastructure Investment Program. Specifically, a letter was sent to the House and Senate Appropriations Committee to request their support for the Active Transportation Infrastructure Investment Program (ATIIP) in the Fiscal Year 2025 budget at the $200 million level as authorized in the Infrastructure Investment and Jobs Act (IIJA).  

    IIJA established policies and programs aimed at developing a transportation system that is safer, more sustainable and equitable, and provides broader access to economic opportunities. To realize these goals, a key piece of unfinished business for IIJA has been the failure to fully fund ATIIP.  

    ATIIP is a unique and essential new program designed to leverage existing infrastructure to connect people to the places they need to go by foot and bicycle. The novel approach maximizes return on investment and ensures that the mobility and economic needs of urban, suburban, and rural areas are each addressed by investing in facilities connecting within and between communities. 

    Click to read the letters sent to the House and Senate Appropriations Committee.

    CDC Advisory Committee to the Director 

    On May 7, the Centers for Disease Control and Prevention (CDC) released a notice entitled, Solicitation of Nominations for Appointment to CDC’s Advisory Committee to the Director (ACD). In accordance with the Federal Advisory Committee Act, the CDC is seeking nominations for membership on the ACD. The ACD consists of up to 15 experts knowledgeable in areas pertinent to the CDC mission, such as public health, global health, health disparities, biomedical research, and other fields as applicable. 

    Any interested ACSM members should click here and follow the directions to apply for nomination.   

    NIH Grants Policy

    NIH recently released a notice entitled, Notice to Announce the Significant Changes to the NIH Grants Policy Statement for Fiscal Year 2024. NIH is announcing a publication of the updated significant changes that have already been made to the NIH Grants Policy Statement (GPS) in FY 2023 that will be reflected in the GPS for FY 2024. The NIH GPS provides both up-to-date policy guidance that serves as NIH’s standard terms and conditions of award for all NIH grants and cooperative agreements and extensive guidance to those who are interested in pursuing NIH grants. This update incorporates significant changes for FY 2024, such as new and modified requirements, the clarification of certain policies, and the implementation changes in statutes, regulations, and policies that have been implemented through appropriate legal and/or policy processes (e.g., Federal Register Notices, where appropriate) since the previous version of the NIHGPS was last released in December 2022. 

    2024 Congressional Physical Activity Challenge 

    ACSM, through its membership in the Physical Activity Alliance (PAA), has been promoting the Congressional Physical Activity Challenge. The Congressional Physical Activity Challenge (sponsored by PAA and MyZone) is an annual competition involving the offices of the U.S. Congress in a bid to achieve the highest level of physical activity. The Challenge is held each May for the duration of National Physical Fitness and Sport Month and open to all members of Congress & their congressional staff and interns, committee staff and leadership staff. This year we've also inviting the President’s Council on Sport, Fitness, and Nutrition to participate. Stay tuned for the launch of the leaderboard! 

    Physical Activity Alliance “It's Time to Move” Update 

    The PAA is currently working with a technical advisor to develop Reference Implementation Apps (for both the Provider and Patient) testing—significant progress has been made towards preparing the apps for the first round of testing, likely to start late May. After initial rounds of testing, both apps will launch for public use. In July, the PAA will participate in the CMS Connectathon and present updates on its work at the upcoming HL7 Work Group Meetings in Dallas, TX. 

    Lastly, the PAA is continuing conversations with the National Committee on Quality Assurance (NCQA) about developing quality and performance measures around physical activity assessment and referral, creating important incentives for health plans, clinicians and health systems. The hope is to develop a strategic road map for doing this work in summer 2024. 

  • Active Voice | Understanding the Energy Requirements of Paralympic Athletes

    by Greg Margason | May 07, 2024

    With the growing participation of athletes with disabilities in competitive sports, there is an increased need for specialized nutritional support tailored to their unique physiological differences. These athletes often exhibit distinct body compositions, metabolic rates, training loads and activity patterns compared to their peers without disabilities. Sports nutritionists, especially those working with Paralympic athletes, have underscored the urgent need for a more profound understanding of these athletes’ nutritional demands. A critical first step is elucidating the daily energy requirements of Paralympic athletes, as this knowledge is essential for setting initial targets for their daily energy intake. In our study, we employed the doubly labeled water method, which is widely recognized as the gold standard for measuring total daily energy expenditure under free-living conditions. This technique involves consuming water enriched with the stable isotopes deuterium (2H) and oxygen-18 (18O). After allowing the isotopes time to equilibrate within the body, their elimination is measured through urine samples. Deuterium is exclusively lost through water (H2O), whereas oxygen-18 is lost through both water and carbon dioxide (CO2). The differing rates of elimination for these isotopes provide a measure of carbon dioxide production and, consequently, reflect the energy expended by the individual. 

    Our study, published in the May 2024 issue of Medicine & Science in Sports & Exercise®, involved 48 Dutch and Norwegian Paralympic athletes from diverse sports, including Para cycling, wheelchair tennis, wheelchair basketball, Para Nordic skiing and alpine skiing. Over a 14-day period, the mean total daily energy expenditure across all participants was assessed at 2,908 ± 797 kcal per day. However, we observed a considerable variation among sports: wheelchair basketball players had an energy expenditure of 2,322 ± 340 kcal per day, whereas Para cyclists expended 3,607 ± 1,001 kcal per day. Notably, the energy expenditure for some athletes neared 5,000 kcal per day. Given that these measurements span a 14-day period, it is possible that energy expenditure could even surpass 6,000 kcal on days of intense training or competition. 

    Our analyses revealed that fat-free mass, exercise duration and the presence of a spinal cord disorder are primary factors influencing energy expenditure. Consequently, athletes with greater fat-free mass or longer training durations generally display higher energy expenditures. Conversely, those with spinal cord disorders typically exhibit lower energy expenditures. 

    Although the doubly labeled water method is the gold standard for assessing total daily energy expenditure, its high costs and logistical challenges make it impractical for routine use. To address these issues, we developed prediction equations based on readily obtainable factors. These equations enable accurate estimates of daily energy expenditure for Paralympic athletes, assisting nutritionists in establishing initial targets for their athletes’ daily energy intake. 

    Altogether, our study provides advanced insights into the daily energy requirements of Paralympic athletes and introduces practical tools for accurately estimating these needs. These developments aid sports nutritionists in aligning nutritional strategies with individual energy demands, ultimately enhancing both health and performance of Paralympic athletes. Furthermore, our research enhances the understanding of nutrition for athletes with disabilities and lays the groundwork for future studies and the development of targeted nutritional guidelines in this area.  


    Jan-Willem van Dijk, Ph.D., leads the Sport & Nutrition Expertise Team at HAN University of Applied Sciences in the Netherlands. In addition to research and educational tasks, his team offers specialized nutritional counselling to elite athletes, including those competing at the Olympic and Paralympic levels. The combination of daily practice and academic research not only generates relevant research questions but also aids in translating research findings into innovative nutritional strategies.