In This Section:

  • ACSM Hot Topic | Exercise Improves Liver Health

    by Greg Margason | Apr 28, 2023
    Exercise and the Treatment of NAFLD

    The liver plays a crucial role in numerous metabolic processes necessary to leading a healthy life, including those essential to metabolism, such as storing energy and regulating blood sugar. Exercise has been shown to improve liver health by reducing fat in the liver, improving insulin sensitivity, reducing inflammation, boosting the immune system and improving mental health. The great news here is that it doesn’t matter what type of exercise you choose to perform — any exercise is beneficial for the liver, and exercise prescription can be tailored to meet individual needs and preferences. That means that as an exercise professional, you can incorporate aerobic training, resistance training, high-intensity interval training (HIIT), low-impact HIIT and more. Several studies have even looked at the impact of yoga and Pilates on liver health, and although the results are mixed, in the right setting these may also provide benefit. 

    Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease and, in parallel with the obesity pandemic, now affects one out of three adults worldwide. NAFLD occurs when there is abnormal accumulation of fat in the liver not caused by alcohol consumption. NAFLD has been linked to obesity, insulin resistance and physical inactivity, and it can progress to a more severe form of liver disease called nonalcoholic steatohepatitis (NASH). Over time, NASH can lead to cirrhosis or liver cancer, which in some cases may require a lifesaving liver transplantation. 

    While many factors lead to the development of NAFLD, physical inactivity plays a major role. In light of this, the American College of Sports Medicine® (ACSM) held a roundtable discussion on NAFLD and physical activity in summer 2022. The roundtable brought together experts in the fields of hepatology, exercise physiology and behavioral health. The roundtable discussion highlighted the importance of physical activity in the prevention and treatment of NAFLD, finding that patients with NAFLD who exercise regularly can expect a number of benefits to liver health, including a reduction in liver fat accumulation, improved histologic disease activity, favorably changing body composition, improved glycemic control and lowered cardiovascular risk. Importantly, many of these findings can be expected without significant weight loss. 

    The roundtable group reached a consensus, recommending that individuals with NAFLD should engage in regular physical activity, ideally for at least 150 minutes per week of moderate-intensity aerobic exercise, such as brisk walking, or 75 minutes of vigorous-intensity aerobic exercise, such as jogging or cycling. Resistance training can be considered two days a week in order to improve muscle mass and strength. The experts also discussed the potential benefits of HIIT in individuals with NAFLD, and preliminary data suggests HIIT is as effective as either moderate- or vigorous-intensity aerobic exercise training. The roundtable faculty also acknowledged that individuals with NAFLD face many barriers to completing regular physical activity, including fatigue, joint pain and a lack of time. Exercise prescriptions that include a gradual progression of exercise, starting with low-impact activities and incorporating rest periods, may be beneficial to help remove these barriers and improve adherence. 

    Exercise is a great way to address NAFLD and its associated metabolic conditions, including obesity, diabetes, hypertension and more. By reducing liver fat and improving overall health, exercise may help prevent complications of liver disease and can improve quality of life. All patients with NAFLD should be encouraged to be as physically active as they can be! 

    Jonathan StineDr. Jonathan Stine is an Associate Professor of Medicine and Public Health Science at Penn State. As an internationally recognized liver expert with a research and clinical focus on nonalcoholic fatty liver disease (NAFLD) and exercise, he has authored more than 90 peer-reviewed papers, including multinational consensus guidelines. Stine is the recipient of multiple research grants and awards from the American Association for the Study of Liver Diseases, American Cancer Society and National Institutes of Health. Dr. Stine is the NAFLD consultant to the American College of Sports Medicine’s Exercise is Medicine initiative and recently co-chaired the International Roundtable on NAFLD and Physical Activity for ACSM. Dr. Stine serves as the Fatty Liver Program Director as well as the Liver Center Research Director for Penn State.  

  • 2023 ACSM Annual Meeting Highlighted Sessions in Biomechanics and Neural Control of Movement

    by Caitlin Kinser | Apr 21, 2023

    765x370 23 annual meeting_BiomechanicsThe 2023 ACSM Annual Meeting is packed with more Biomechanics and Neural Control of Movement content than ever before. This year, the Biomechanics and Neural Control of Movement topical area has seven special sessions (i.e., symposia and tutorial lectures), additional content being offered exclusively online, and an exciting group of interdisciplinary topics being presented through the free communication sessions.  

    The free communication portion of the Biomechanics and Neural Control of Movement content will begin with a podium session on “Parkinson's Disease” (Wednesday May 31, 9:30 – 11:30 a.m.) and poster sessions on “Baseball & Softball Biomechanics” and “Methods & Alternative Measurement Techniques” Wednesday May 31, 9:30 a.m. – 12:30 p.m.). Other free communication sessions include: a thematic poster session titled, “Arthritis” (Friday, June 2, 3:45 – 5:45 p.m.) which will include research on arthritis and osteoarthritis;  a thematic poster session titled, “Biomechanical Considerations for ACL Injury & Rehabilitation” (Thursday June 1, 9:30 – 11:30 a.m.); a rapid-fire podium session titled, “Special Topics in Gait Biomechanics” (Thursday June 1, 3:45 – 5:45 p.m.); a thematic poster session on “Running Injury” (Friday June 2, 1:30 – 3:30 p.m.); and poster sessions dedicated to running mechanics, concussions, military health biomechanics, aging, ankle instability, jumping & landing biomechanics, among other great topics. 

    Our showcase highlighted symposium this year is “Moving & Shaking: Biomechanical and Motor Considerations for Cancer Treatment and Rehab” (Thursday June 1, 1:30 – 3:30 p.m). Presenters include David Lipps, Ph.D. (University of Michigan), Srikant Vallabhajosula, Ph.D. (Elon University), Shane Murphy, Ph.D. (University of Wisconsin, Lacrosse), and Lise Worthen-Chaudhari, PhD, MFA, CMES (Ohio State University) and chaired by Ajit Chaudhari, PhD, FACSM (Ohio State University). This symposium will present the biomechanical and motor effects of cancer and cancer treatment including the effects on neuromuscular tissues and human functional performance. Preliminary data from exercise interventions to improve biomechanical function in cancer patients will be presented and considerations for designing therapeutic interventions that consider movement capabilities of cancer patients and reduce the risk of falls will be discussed. An additional goal of this symposium is to highlight the importance of small, pragmatic trials as critical steppingstones to increase our understanding of the biomechanical challenges facing cancer survivors and our ability to improve exercise and mobility-focused interventions for them. 

    The two symposia for the Biomechanics and Neural Control of Movement topical area include:

    Wednesday May 31, 1:30 – 3:30 p.m. “Can a Causal Framework Improve the Science and Rehabilitation of the Injured Runner?” presented by Chris Napier, PT, Ph.D. (Simon Fraser University), Rich Willy, PT, Ph.D. (University of Montana, Missoula), Emily Kraus, MD (Stanford University), Shalaya Kipp, MS (University of British Columbia), as well as distance runner and author, Lauren Fleshman. The historical focus on a single factor (e.g., biomechanics, strengthening) has not been effective in the prevention of running-related injuries. This symposium will discuss a causal framework that considers the complexity of injury within the context of the runner and the complex interaction between runner’s biomechanics, applied training loads, energy availability, nutrition, physiology, and psychology. Examining running injuries from this framework may be more insightful in the prevention and treatment of running related injuries than historical approaches. Overall, this proposal aims to present a multi-disciplinary approach, including discussion from the athlete’s perspective, to challenge and improve upon current approaches to the research and care of the injured runner. 

    Friday June 2, 3:45 – 5:45 p.m. “Data-Driven Biomechanics to Optimize Performance and Prevent Injuries” presented by Michael Hahn, Ph.D. (University of Oregon), Jennifer Hicks, Ph.D. (Stanford University), Michael Fredericson, M.D., FACSM (Stanford University), Swithin Razu, Ph.D. (University of California, San Diego), and chaired by Scott Delp, Ph.D. (Stanford University). Artificial intelligence (AI) has transformed fields including natural language processing and computer vision. With growing data available about human performance from wearable sensors and video, AI is poised to have a similar transformative effect on the study of human movement biomechanics. Researchers are now examining cohorts that are orders of magnitude larger than the typical biomechanics study. Findings from these studies could provide athletes of all types and abilities with personalized, data-driven insights to customize their training and recovery. This symposium will feature research that uses large-scale datasets, such as those provided by wearable and mobile sensors, to uncover underlying biomechanical mechanisms of injury and performance, and provide meaningful insights to improve training, screening, rehabilitation, and return-to-play. Speakers will discuss both the challenges associated with analyzing datasets that may be “messier” than typical experiments, as well as the transformative opportunities of AI for movement biomechanics and human performance. 

    Tutorial lectures include: 

    • “Knee Hyperextension, the Underappreciated Knee Pathology” (Wednesday May 31, 10:40 – 11:30 a.m.) presented by Patricia Teran-Wodzinski, PT, Ph.D, Irene Davis, Ph.D., P.T., FACSM, and Mackenzie Garreth, PT, DPT, OCS all from the University of South Florida. 

    • “What we Know and What we Don't Know Regarding Gait Biomechanics in Aging” (Thursday June 1, 8:25 – 9:15 a.m.) presented by Jaimie Roper, Ph.D., Patrick Monaghan, MS, and Brandon Peoples from Auburn University.  

    • “Footwear Debate” (Friday June 2, 10:40 – 11:30 a.m.) led by Irene Davis, Ph.D., P.T., FACSM (University of Southern Florida) 

    • “Instrumented Mouthguards: Best Practices and Lessons Learned for Compliance in Sports” (Friday June 2, 1:30 – 2:20 p.m.) presented by Nicholas Murray, Ph.D. (University of Nevada, Reno) and Enora Le Flao, Ph.D. (Stanford University) 

    • Online Exclusive – “Searching for “Optimal” Loading in Groups at High Risk for Knee Osteoarthritis” presented by Derek Pamukoff, Ph.D. (Western University) and Brian Pietrosimone, Ph.D., FACSM (University of North Carolina, Chapel Hill) 

    • Online Exclusive – “Emerging Technologies for Evaluating Human Motion in Sports & Exercise Medicine” presented by Cindy Lin, M.D., FACSM (University of Washington, Seattle), Cayce Onks, DO, MS, ATC (Pennsylvania State University, Hershey), and Matthew Silvis, M.D. (Pennsylvania State University, Hershey) 

    There are several other sessions that will be of interest to biomechanists and motor controlists that are being presented throughout the Annual Meeting and World Congresses, such as the symposium titled, “The Age-Related Changes in Gait Biomechanics and the Energy Cost of Walking in Old Age: Where Are We and What Do We Need to Know?” (Thursday June 1, 3:45 – 5:45 p.m.) presented by Jane Kent, Ph.D., FACSM (University of Massachusetts, Amherst), Katherine Boyer, Ph.D. (University of Massachusetts, Amherst), Brian Umberger, Ph.D. (University of Michigan), and James Finley, Ph.D. (University of Southern California). This session is included within the program for The World Congress on the Basic Science of Physical Activity and Aging Biology. 

    The Biomechanics Interest Group (BIG) will be hosting their meeting on site. Stay tuned to their website and Twitter for details about the event as they become available. The BIG meeting will include a social event, awards ceremony, and a talk by the 2023 ACSM-BIG Career Achievement Award Winner.

    Join Us at the ACSM Annual Meeting

    Allison GruberAllison H. Gruber, Ph.D., FACSM, is an Associate Professor of Kinesiology in the Indiana University School of Public Health – Bloomington. She is the Topical Representative for Biomechanics and Neural Control of Movement and a previous chairperson of the ACSM Biomechanics Interest Group. Her research interests include the mechanisms of running-related musculoskeletal injuries, wearable technology, and using advanced analysis techniques to better understand biomechanical signals for gait analysis. Symposia summaries were compiled based on information provided by the submitter. 

  • The Benefits of High-Intensity Training for People with Parkinson’s Disease

    by Greg Margason | Apr 19, 2023
    The Benefits of High-Intensity Training for People with Parkinson’s Disease

    What is Parkinson’s disease?

    Parkinson’s disease (PD) is a progressive neurodegenerative condition associated with low levels of the neurotransmitter dopamine, due to damage that occurs in a part of the midbrain known as the substantia nigra. People living with PD will have a combination of motor and nonmotor symptoms that can adversely affect activities of daily living, functional capacity and/or physical functional. Common motor symptoms include slowed movement (known as bradykinesia), postural rigidity (resulting in balance decrement) and tremor at rest. Nonmotor symptoms can include fatigue, cognitive deficit/dementia and autonomic/enteric nervous system dysfunction. The primary methods of management for PD include a variety of medications and exercise.

    Exercise has been shown to be one of the most effective methods for managing PD and can result in slowed progression of the disease, improvement in motor and nonmotor control, and improved quality of life. Common exercise programs for PD include aerobic activity, resistance training, flexibility, and neuromotor exercise such as boxing, dance, tai chi or yoga. Recently, high-intensity interval training (HIIT) has been shown to have equal or greater improvements compared to moderate-intensity exercise for persons with PD and should be considered as a programming option for exercise professionals.

    What is HIIT training?

    HIIT is a time-efficient training method that uses a combination of short-duration, higher-intensity intervals followed by recovery intervals at longer duration and lower intensity at repeat frequencies. Typical intensities for HIIT include 85-95% age-predicted heart rate maximum (APHRM). Intensity of programming is relative to each person and does not always have to be “high skill” activities such as sprinting. For instance, a person with PD may be able to achieve APHRM within HIIT ranges by increasing treadmill walking speeds by 20% (referred to as forced intensity) and returning to a lower workload for recovery. People with earlier-onset PD or less severe cases will be able to perform higher skill activities such as treadmill running. HIIT can also be performed on a stationary cycle or seated rower if balance decrements exist.

    Is HIIT beneficial for people with PD?

    Recent research indicates that HIIT may contribute to greater neurogenesis in people with PD at a higher magnitude when compared to moderate- or low-intensity exercise. HIIT may increase hippocampal activity of the brain, which is associated with improved mood, memory and cognition; these in turn are linked to slowed progression of dementia. When activated, the hippocampus may also secrete greater amounts of brain-derived neurotropic factor (BDNF). BDNF may be associated with growth of new neurons and improved neural function in the aforementioned areas of the brain. Additionally, HIIT training can result in greater dopamine production and receptor sensitivity, which has been shown to improve motor control both during exercise and a few hours following the exercise session. This carryover effect can be neuroprotective in nature for people with PD and contributes to greater motor control and improved physical function following a HIIT session. Other benefits associated with HIIT in PD include improvements in aerobic and muscular fitness that is similar to gains made in people without PD.

    Programming HIIT for people with PD

    When considering HIIT training for clients with PD, the exercise professional must consider the following:

    • Disease variability Motor and nonmotor symptoms may fluctuate daily or session by session. Be sure to be flexible with HIIT programming based on how a person is feeling that day.
    • Medications — Different medications can cause adverse effects or complicate tolerance and adherence to exercise. PD medications can have on-off fluctuations with motor control and may cause dyskinesia (uncontrolled and involuntary movements) when taken long term.
    • Cognitive function — Many people with PD may experience cognitive deficit. The exercise professional needs to keep instructions simple and allot time to repeat instructions throughout the session, if necessary.
    • Fitness level — People with PD who have earlier onset of disease or have greater initial fitness can typically participate in more aggressive HIIT programs. In the case of lower fitness or more severe PD, HIIT programming will start more conservatively and progress as tolerated.
    • Session timing — Exercise professionals need to ask the client how they are feeling prior to the exercise session. It is recommended that HIIT training be performed at a time of day when the client “feels best” or typically experiences the fewest motor symptoms.

    Exercise professionals must educate the client on the benefits of HIIT and never force a mode of exercise on a person that they may not be interested in participating in. If complications arise, the exercise professionals must communicate efficiently with physicians, care team members and caregivers. HIIT training should not replace other modes or intensities of exercise but needs to be considered when working with people who are managing PD through exercise.

    Additional Resources:
    Blog | Practical Strategies to Implement Parkinson’s Exercise Guidelines
    Infographic | Exercise Recommendations for Parkinson’s Disease
    EIM Handout | Being Active When You Have Parkinson’s Disease

    Paul Gallo
    Paul M. Gallo, Ed.D., FACSM, ACSM-EP, ACSM-CEP, ACSM-GEI
    , is the director of exercise science and wellness at Norwalk Community College in Norwalk, Connecticut; adjunct faculty at Teachers College Columbia University, in New York City; and a past president of ACSM’s New England Chapter. Dr. Gallo is the chair of ACSM’s CCRB-Continuing Professional Education Subcommittee, associate editor-in-chief of ACSM’s Health & Fitness Journal® and associate editor for the Journal of Clinical Exercise Physiology. He strongly believes in the importance of translating science to evidence-based practice within the health-fitness and exercise science fields.

  • 2023 ACSM Annual Meeting Highlighted Sessions in Clinical Exercise Physiology

    by Caitlin Kinser | Apr 19, 2023

    765x370 2023 annual meeting_CEPAs the topical representative for Clinical Exercise Physiology, it is my pleasure to highlight some of the exciting sessions at the 2023 Annual Meeting that will be held in Denver, CO.  

    Our Highlighted Symposium this year is titled “Lactate in Health and Disease: The Renaissance Metabolite” and is Friday, June 2nd at 9:30AM (All times listed in Mountain Daylight Time). Lactate has historically been a popular topic and in recent years has reemerged for its clinical implications role in regulating metabolism as it relates to health and disease. This session includes a great lineup of speakers and is being organized by Joe Houmard, Ph.D., FACSM, and Nick Broskey, Ph.D. from East Carolina University. The session will include talks by Bruce Gladden, Ph.D., FACSM, Auburn University (Evolution of Blood Lactate as a Predictor of Health), Nick Broskey, Ph.D., East Carolina University (Lactate as a Predictor of Metabolic Disease), George Brooks, Ph.D., FACSM, University of California-Berkeley (Role of the Postdrianial and other Lactate Shuttles in Metabolic Regulation), and Inigo San Millan, Ph.D., University of Colorado Anschutz Medical Campus (Lactate and Health: Lessons Learned from Elite Athletes to Apply to Clinical Populations). We look forward to an informative session on this important and relevant topic.   

    As hypertension continues to have widespread public health impacts, Dr. Katharine Currie will lead a symposium on “The Role of Exercise Blood Pressure in Hypertension:  Measurement, Mechanisms, and Management” with talks by Dr. Martin Shultz, Dr. Phillip Millar, and Dr. Linda Pescatello, FACSM that will begin at 3:45PM on Thursday, June 1st. This session will not only overview current knowledge on exercise for hypertension but will also cover the use of exercise testing for identifying individuals at risk for hypertension.   

    In addition to these wonderful sessions there will be a session on the Professionalization of the Clinical Exercise Physiologist (Tuesday May 30th 2:10PM; sponsored by Exercise is Medicine) and a session on Implementing Exercise Testing and Physical Activity in Pediatric Clinics (Friday, June 2nd,4:55PM), along with several poster sessions spread throughout the week. A pre-recorded Colloquium on Employer and Colleague Expectations of the Exercise Professional will also be available following the meeting.  

    We look forward to a fabulous 2023 ACSM Annual Meeting and it is my hope that you will find these sessions informative, thought provoking and will foster opportunities for those interested in Clinical Exercise Physiology to connect and network.   

  • 2023 ACSM Annual Meeting Highlighted Sessions in Exercise is Medicine

    by Caitlin Kinser | Apr 17, 2023
    765x370 2023 annual meeting_EIM

    It is our pleasure to serve as the ACSM topical representatives for Exercise is Medicine (EIM), which focuses on work examining the integration of physical activity into health settings and the referral of physically inactive patients to community-based resources. The World Congress on EIM formally starts with the Morris/Paffenbarger EIM Keynote Lecture (Wednesday, May 31st from 10:40-11:55 a.m.) given by Janet Fulton, Ph.D., FACSM on “The Evolving Science of Step Counts: What is my Device Telling me about my Health?” This keynote presentation will be followed by an update on the successful implementation of physical activity into the healthcare sector under The National Physical Activity Plan (Thursday, June 1st from 8:25-9:15 a.m.). In addition to these presentations, we would like to highlight three other sessions that may be of particular interest to conference attendees.  

    The first is a highlighted symposium entitled, “Physical Activity & Age-Related Cognitive Function.” This translational symposium session, featuring experts in older adults and physical activity from the U.S., Europe, Australia, and Asia, is scheduled for Wednesday, May 31st from 3:45-5:45 p.m. The panel will discuss the latest research being conducted in the field of physical activity and aging, including the public health epidemiology of age-related cognitive decline and associations with physical activity, underlying biological mechanisms, and emerging evidence on the impact of both aerobic and strength/high intensity interventions on cognitive decline.  

    The second tutorial lecture we would like to highlight is entitled, “Exercise is Medicine for Children and Adolescents: Experience in a Healthcare System.” This session, led by  ACSM Past-President Elizabeth Joy, M.D., FACSM, is scheduled for Tuesday, May 30th from 3:15 -4:05 p.m. The self-reported nature of the Physical Activity Vital Sign (PAVS) makes collecting information on physical activity levels in younger children challenging. Intermountain Healthcare developed and integrated a pediatric PAVS into the EHR as a part of clinical practice in 2016. This presentation will provide an overview of how physical activity is assessed in children and adolescents in pediatric care at Intermountain Health and describe the physical activity behaviors of these patients with respect to their demographic characteristics. 

    The final tutorial lecture that we would like to highlight is entitled, “Collaborating from Clinics to Community: Advancing Health Equity through Physical Activity,” and features faculty from the Ohio State University Wexner Medical Center, as well as the Executive Director of the Eldon & Elsie Ward Family YMCA of Central Ohio. This session, scheduled for Thursday, June 1st (4:55 – 5:45 p.m.) will describe the process, outcomes, challenges, and successes of building out a physician referral platform in the electronic medical record and partnering directly with the YMCA to provide a community-based health education and exercise program in a community that has been underinvested in for many years due to structural racism. 

    Other key sessions to keep an eye for include a symposium on the implementation of EIM in four different international health settings (Tuesday, May 30th, 1:00 – 3:00 p.m.), symposiums describing the future role of exercise professionals working in coordination with physicians, multiple EIM On Campus sessions, and an EIM poster session (Wednesday, May 31st from 9:30 a.m. – 12:00 p.m.).

    Join Us at the ACSM Annual Meeting