Dr. Yasuo Kimura’s* journey to the 2023 ACSM Annual Meeting in Denver was far more involved than a mere international flight. At 80 years old, Kimura has long since retired from official duties, but he continues to pursue his work independently. The physical activity researcher is an old-school scientist, relying chiefly on measuring tape and a stopwatch to collect much of his data; thus, the perplexities of a post-pandemic online world — not to mention the added complication of operating in a second language — made it difficult for him to successfully submit his abstract to ACSM.

Of course, this wasn’t Kimura’s first rodeo. He has been a member of ACSM for more than thirty years — he still has the poster he presented at the 1986 ACSM Annual Meeting: “Simulated Swimming: A Useful Tool for Assessing the VO2 Max of Swimmers in the Laboratory” — and scrolling through ACSM’s available online records (from 2005 onward), one sees that he’d submitted no less than 17 abstracts, most of which related to physical activity in the aging population. (Before retiring at 65, Kimura had spent the previous decade working in a community services program for older adults.) And many of these abstracts were accepted. But as more and more ACSM operations migrated online, it became increasingly difficult for him to properly submit abstracts and register for events.  

To keep up with the times, Kimura sought assistance from colleagues, particularly Dr. Mieko Shimada, with whom he coauthored a number of studies. By 2018, he was also working with ACSM fellow Dr. Nobuko (Kay) Hongu, of Osaka Metropolitan University. Hongu had retired from a professorship at the University of Arizona roughly four years prior, and she was able to help Kimura better bridge the cultural and language gap between Japan and the U.S.  

In fact, Kimura and Hongu had first met in person at the 2016 ACSM meeting in Orlando, Florida.  

“He was presenting a poster,” Hongu says. “I asked, ‘Are you from Japan?’” — she was still teaching at Arizona at this point, and running into a fellow Japanese researcher was a pleasant surprise — “and we started chatting. ACSM really connects people.”  

With Kimura as lead author and Shimada and Hongu among the studies’ coauthors, Kimura had EIM posters and ePosters accepted in 2018 and 2019. In 2021 he submitted “Functional Characteristics of Musculoskeletal Ambulation Disability Symptom Complex (MADS) In Community-dwelling Older Women” as sole author but with Hongu’s sponsorship as an ACSM fellow. It was in 2022 that he ran into some issues.  

Kimura was once again working with Shimada and Hongu as coauthors, but he encountered a snag submitting the abstract. Enter Beth Reed, ACSM’s senior manager for meeting education. Reed got in contact with Hongu, and between the two of them they managed to iron out Kimura’s submission; ACSM accepted “Effects of Marching in Place and Chair Rise Exercises on Functioning in Community-dwelling Older Adults.” Kimura had intended to present his work in person in San Diego but was ultimately unable to do so because of the confusion and lingering red tape tangled around post-pandemic international travel. With a little more back-and-forth communication, Reed helped Kimura upload his work as an ePoster slide instead. The in-person presentation would have to wait.  

The next opportunity, of course, would be Denver. For 2023, Kimura submitted “Relationship Between Walking Frequency and Physical, Motor, Cognitive Functions in Older Japanese Women.” Shimada and Hongu were once again coauthors, along with Mamoru Hisatomi, Toshinobu Ikegami, and Kazuko Ohki, but Kimura had trouble inputting their names in the online form.  

Hongu, in light of her status as an ACSM fellow, had sponsored this paper as well. Consequently, she received a notification email when Kimura submitted the abstract. Noting the absence of the coauthors, she reached out to Reed, who was able to quickly address the error and ensure Kimura’s abstract was correct.  

At the time, Reed didn’t understand just how important her contribution was, either for 2023 or for Kimura’s previous ePoster in 2022. What had been a relatively routine task for her turned out to be a major gesture for Kimura. At long last, he was able to present his work in person at another ACSM meeting.   

It wasn’t until Hongu reached out to Reed at the Denver meeting that Reed really understood the impact her efforts had had.  

“Really it was normal, day-to-day job things,” Reed says. “We were all in tears when we met in Denver. They brought me gifts from Japan! This is why I love what I do because sometimes you forget how truly important this is to other people. Here I sit at this computer day to day and I do my job, send an email — but this was seriously like a highlight of their year. And when I saw that and got to meet them in person, it was just very eye-opening and thrilling and emotional.”

*This story follows Western name order, as used in the abstracts Dr. Kimura and colleagues submitted.  

If you’re on the fence about attending the 2024 ACSM Annual Meeting in Boston, consider the story of two ACSM fellows, Drs. Li Li and Jeffrey A. Ross. 

Li, a research professor in Georgia Southern University’s Department of Health Sciences and Kinesiology, and Ross, an associate professor at the Baylor College of Medicine’s Department of Surgery, Section of Vascular Surgery (as well as chief of podiatry in the Department of Surgery), met at last year’s ACSM Annual Meeting in Denver. Both attended the Biomechanics Interest Group meeting, at which Li was receiving his Career Achievement Award. 

According to Ross, “After hearing Dr. Li present on diabetic peripheral neuropathy and core body strength, I felt we had a common interest. I approached Dr. Li after the presentation and discussed my work with diabetics, peripheral neuropathy, and both surgical intervention (amputations) and gait, as well as topics of mutual interest.” 

These shared interests were so closely aligned that the pair soon decided to pursue a research collaboration, which has thus far culminated in a tutorial session titled “Postural and Gait Impairment among People with Diabetic Neuropathy and Potential Exercise as Intervention,” which was accepted for presentation at the 2024 ACSM Annual Meeting in Boston. 

In the following Q&A, the researchers discuss their partnership and work, the unique value of ACSM membership, and reasons why more M.D.s and Ph.D.s should consider teaming up. 

How did you get involved with ACSM? 

Li: I presented for the first time at ACSM’s 1996 annual meeting in Cincinnati as a doctoral student. 

Ross: I was president of the American Academy of Podiatric Sports Medicine and attended a meeting of various sports medicine associations. The executive director of ACSM, Jim Whitehead, introduced me to ACSM. I then presented at some early meetings, one along with Dr. Peter Gerbino on adolescent overuse sports injuries. I then became an ACSM fellow and served on my first committee, the Credentialing Committee. I have presented at meetings almost every year and now serve on the Medical Education Committee and Public Relations Committee. 

Why did you decide to collaborate? 

Li: We discovered that our research projects are complementary. Dr. Ross and his team have investigated the effects of clinical interventions for people suffering from neuropathy, whereas our studies focus on the consequences of physical activity interventions. We are both interested in exploring the mechanisms that lead to the relevant impairments in postural and gait stability among this population and the pathways for the most effective rehabilitation protocols. 

Ross: I have been working with Dr. Bijan Najafi (our director of research) and our research team here at Baylor, investigating the effects of clinical interventions for patients (diabetics and frail patients suffering from peripheral neuropathy), whereas Dr. Li’s team has been focusing on the consequences of physical activity interventions. After the Denver meeting, we had a Zoom conference with myself, Dr. Najafi and our team, and we both expressed an interest in exploring the mechanisms that lead to the relevant impairments in postural and gait stability among this population and the pathways for the most effective rehabilitation protocols. I even went further and discussed this possible study with the kinesiology department at the University of Rhode Island, where possible multi-site research could be conducted. 

What are you researching? 

Li: Our current focus is the adaptive interactions between the central and peripheral nervous systems with the progress of neuropathy. As the development of peripheral neuropathy, people’s foot sole tactile sensation deteriorates. The progress of foot sole insensitivity leads to debilitating postural and gait impairments. To compensate for this degenerative process, the central nervous system could potentially adjust the modulation of the proprioceptive sensation and use it to enhance our feedback system for postural control. 

Ross: Our research is looking at the effects of diabetic peripheral neuropathy and frailty in this population and the use of remote monitoring sensors to detect and predict pressure areas that might result in the formation of diabetic ulceration. With this data, we can use insoles, orthotic or shoe intervention to improve gait and to mitigate these potential pressure areas to prevent diabetic ulceration formation, particularly in patients who have undergone partial amputation of the foot. 

What has been your most interesting finding? 

Li: The textbook statement for losing tactile sensation due to peripheral neuropathy in humans is “irreversible” — we have evidence that proper interventions can reverse the loss of foot sole sensation, at least at the early stage of the disease.

Ross: Our research has shown that the use of remote monitoring sensors can monitor patients who suffer from diabetic peripheral neuropathy. We can also utilize computerized gait and pressure analysis to also help to predict pressure areas that might result in the formation of diabetic ulceration. We can use orthotic and shoe therapy to reduce pressure areas, improve gait, and allow these patients to be more active, ambulate, exercise and stay healthy — improve their quality of life. 

How has ACSM contributed to your career and work? 

Li: In addition to the rich academic exchange, ACSM is very important in my work and career development. I have participated in every ACSM annual meeting since 1996 as a member of the college. I was awarded ACSM fellowship in 2003, served as the chair of the Biomechanics Interest Group in 2008-9, and was the recipient of the 2023 Career Achievement Award from ACSM Biomechanics Interest Group. 

Ross: I have been a sports medicine podiatrist for over 40 years, and ACSM has allowed me to work with various sports teams; marathon runners; and amateur, collegiate, and professional athletes. Attending and presenting at the annual conferences, and serving on various committees, I have been able to share academic and clinic experiences that have benefited my patients. 

More recently, about three years ago the president and another representative of my alma mater, the University of Rhode Island, introduced me to the dean of the College of Health Sciences, Dr. Gary Liguori (now provost at the University of West Florida), and we realized we were both ACSM fellows. Dr. Ligouri invited me to volunteer and serve on the advisory committee for Rhode Island’s College of Health Sciences. In addition, he invited me to lecture the students in the Department of Kinesiology and to advise the Pre-Med Society. I likewise invited Dr. Ligouri and the Rhode Island faculty to meet with Dr. Bijan Najafi here at Baylor to collaborate on mutual research studies. 

Further, Rhode Island’s interim dean, Dr. Deborah Riebe, FACSM, and I met in Denver and discussed the meeting with Dr. Li and possible research on diabetic peripheral neuropathy and improving gait that could be conducted with her students. Dr. Riebe has continued to invite me to present to the students in the Department of Kinesiology, where I combine clinical experiences with scientific biomechanics. It was that relationship with ACSM that lead to these introductions and these future relationships. That was another reason for wanting to meet with Dr. Li and create a new relationship. 

What advice do you have for M.D.s and Ph.D.s interested in interdisciplinary collaboration? 

Li: Get involved. ACSM provides excellent opportunities for learning about the most up-to-date scientific discoveries, exploring potential research ideas, and networking with scientists from diverse disciplines for future collaborations. Get involved beyond presentations and passive learning — actively involved in the organization — and get the most out of what the college can offer. 

Ross: At a recent ACSM Medical Education Committee Zoom meeting with my colleagues, I discussed the importance of collaboration between clinical M.D.s and Ph.D.s. I elaborated on the meeting with Dr. Li and our research study, an upcoming presentation at the ACSM Annual Meeting in Boston. I feel that combining the clinical experiences of our patients with scientific research studies is a natural fit, and that we should foster these relationships to forge ahead with new findings. This can benefit both our patients and the academic institutions. I encourage my colleagues to become involved with ACSM and all that it offers. You never know who you might meet! 

If you’re interested in attending Dr. Li and Dr. Ross’s presentation, make sure to register for the 2024 ACSM Annual Meeting in Boston, May 28-31.  

Making the leap to start, grow or relocate your fitness business should be an exciting time. But don’t let the allure of being a business owner distract you from the very real challenges that can come from poor planning at the outset. The ceiling leak and its eventual outcome is just one example of a scenario I hadn’t planned ahead for when I owned a boutique fitness studio. I never shy away from using my hard-learned lessons to help others avoid my mistakes— so here are the things that I wish someone had told me before I signed a lease for my fitness business.* 

Who is responsible for what? 

One of the most important—and most expensive—contracts that you will sign during this process is a lease or rental agreement for the space. It is pivotal to delineate who is responsible for what and in what circumstances when it comes to the space. Keep in mind that space includes not only the physical rooms, but the walls, plumbing, roofing, sidewalks, parking spots and everything in between! You want to be sure that you and your business are protected, and that you’re fully aware of any risks that you are assuming.  

Insurance and liability

The safety of your space for staff and customers needs to be a top priority. Here are some questions to ask and scenarios to consider when it comes to your lease: 

• What kind of insurance does the property owner hold and what does it cover and not cover about your physical space, and are there special circumstances? In the case of my leaking ceiling, the property owner’s insurance covered the cost of repairing the building itself, but it did not cover my costs to replace any custom buildouts, like the specialty dance floor, which had water damage. Make sure you have a clear understanding of what is covered and what is not. I had assumed their insurance would cover scenarios like this, and ended up paying out of my pocket for repairs since I didn’t have the right coverage.
  
  It’s also important to note that it is very unlikely that the property owner’s insurance would cover your items in the space such as fitness equipment, computers or sound systems. Consider the following scenarios, which could all have different levels/types of coverage when it comes to insurance:
  • Natural disaster or act of god (e.g. flood, tornado, earthquake) 
  • Criminal act (e.g. vandalism, arson, robbery) 
  • Negligence (e.g. lack of maintenance leads to an electrical fire, another tenant in the building leaves the water on and multiple units flood) 

• What kind of insurance does the property owner hold and what does it cover and not cover regarding use of the space, and any shared spaces? Now we’re talking about humans and injuries or other losses. In nearly every scenario, if a customer is injured using the leased space as intended, for example, they trip over a piece of equipment or injure themselves during an exercise, that will need to be covered by your own liability insurance. But consider the following scenarios:
  • A customer in your space is injured as a result of a natural disaster, act of god or other building/facility-wide crisis (e.g. a customer is injured by shattered glass during a tornado) 
  • Your customer is injured when passing through shared space to reach or exit your space (e.g. they slip and fall on ice on the sidewalk) 
  • Incidents that occur after a customer leaves your space or the shared space (e.g. a customer consumes alcohol in your space at an event and gets into an accident on the way home)
  These scenarios can become very nuanced and will likely be very dependent on the type of space and shared space that exists. Additional considerations may need to be made. Get it all in writing!
• What insurance will you need to hold? Some property owners or management companies will require you to hold a certain type of insurance or have a minimum amount of coverage. Find out if there is a requirement, and then use the above considerations to determine what kind of insurance you will need to fill the gaps between the owner’s coverage and what you will need to be protected (in addition to your own personal liability insurance). This includes what insurance you will require any additional employees and/or independent contractors to secure for themselves. 
• Security cameras. Are there cameras in place in the facility, and if so, where? Is all footage recorded, and how long are those recordings kept? Can you install your own cameras within your space? All of this can be important should something occur in or around your space where liability is disputed or the circumstances are questioned. 

When reviewing the contract do not be shy about asking questions and seeking clarification, and certainly don’t make assumptions—if it’s not specifically outlined in the contract or an appendix, ask. 

Do not be afraid to ask for changes or to negotiate price, fees, or any other part of the contract. The worst they can say is no, and then you know for sure exactly what you’re committing yourself to. Additionally, do not assume requested changes have been made without reviewing the revised contract. 

It may seem like an added expense, but the fee you may pay to have a legal professional review a lease, or any contract related to your fitness business, before you sign it, can end up saving you thousands of dollars in the long-term. If you have partners in your business, it's also beneficial to consult a legal professional on how all parties should be attributed in the lease agreement so not one person is solely responsible for the risk. 

I hope that the lessons learned from my mistakes can help to save you both stress and money as you embark on your new business. I wish you the very best! 


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.  


*Disclaimer: This blog is not legal advice. It is the sharing of one individual’s experience, and it is not meant to be an exhaustive list of all the things to consider when signing a lease or rental contract. To ensure that you’re fully protected and understand your risks before signing a lease or any contract relating to your business, consult with a legal professional.  

The Physical Activity Alliance (PAA), of which ACSM is a member organization, has published a list of current procedural terminology (CPT) codes related to physical activity. 

Physicians and other qualified health professionals use CPT codes to report and bill for the services they provide their patients and clients; the American Medical Association (AMA) maintains the CPT system. 

ACSM, along with the PAA, advocates for the expansion of CPT codes so that qualified exercise professionals can more easily bill for the important health interventions they provide. 

Prior to Jan. 1, 2020, there were no dedicated CPT codes for health coaching services. On that date, however, the AMA released new category III codes for such services. 

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