Women are increasingly filling work roles that were previously dominated by men. While a larger proportion of military service members, law enforcement officers, health care workers and aviators continue to be men, women in these trades experience occupational hazards differently than their male counterparts. 

As a profession, we have already seen similar findings within athletics. Female athletes are more prone to bony stress injuries, knee injuries and other musculoskeletal injuries than male athletes competing in the same sports. By understanding these injury patterns, we, as sports medicine professionals, have been able to utilize education, training and equipment to mitigate injury risk. 

Given female representation in previously male-dominated careers is increasing, we can apply these lessons learned to the occupational work environment. But first, we need to be asking similar questions. Are women in previously male-dominated and/or manually intensive professions at increased risk for specific musculoskeletal injuries? Are these women experiencing different environmental exposures, work hazards and/or occupational challenges than men in the same work settings? The short answer is “yes.” 

Our article, published in the April 2023 issue of Current Sports Medicine Reports, sought to answer these questions. We identified and collated available information regarding occupational injury and environmental exposure risk data for women working in stereotypically male-dominated fields. Although there is limited available data in some cases specific to these populations, what has been published presents a compelling argument that sex differences in occupational risk exist. Women in these historically male-dominated fields experience different musculoskeletal injury risks, environmental exposures, equipment-related issues, reproductive and urogynecologic challenges, and operational stressors than men. A similar literature review, published in Medicine & Science in Sports & Exercise® in April 2022, discussed how physiologic differences between sexes led to different physical and physiologic work-related stress and injury patterns among female servicemembers compared to male servicemembers. Despite these differences noted in this and our review, women demonstrate increasing levels of success in these demanding environments with appropriate health promotion strategies. 

Given the unique perspective of sports medicine as a profession, answering these questions also allows us opportunities to develop and implement work-related injury prevention, rehabilitation and performance-optimization strategies specific to women working in these nontraditional professions. We intend for this article to highlight the need for increased sex-specific research into occupational and environmental risks for women in nontraditional work settings. We also hope this serves to introduce and broaden a necessary conversation on how we, as a profession, can influence the safe advancement of women in the workforce. 

Disclaimer: The views expressed herein are those of the author(s) and do not necessarily reflect the official policy of the Department of the Army, Department of Defense or the U.S. Government.  

Briana Lindberg, M.D., CAQSM, is a primary care sports medicine physician and member of ACSM. She recently graduated from the National Capital Consortium’s Military Primary Care Sports Medicine fellowship program and currently serves as core teaching faculty within the Womack Army Medical Center Family Medicine Residency Program in Fort Bragg, North Carolina. Her current position allows her unique opportunities to follow her passion of utilizing preventive sports medicine education and training to mitigate injury risk and promote rapid return to duty in military warfighters, with a particular emphasis on the female warrior athlete. 

Caitlyn Rerucha, M.D., MSEd, FAAFP, CAQSM, is a primary care sports medicine physician and member of ACSM. She is an assistant professor in the Department of Family Medicine at the Uniformed Services University in Bethesda, Maryland. She is a graduate of the National Capital Consortium’s Military Primary Care Sports Medicine fellowship program and currently serves as the first female active-duty military physician with 1st Special Forces Group (Airborne) with a focus on optimization of human performance and wellness for special operators. 

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

As a society, we are facing ballooning rates of obesity, Type 2 diabetes, heart disease and high blood pressure, conditions that drive up health costs, decrease productivity and erode quality of life. Exercise can have a positive impact on all of these conditions, yet many people don’t have access to informed, competent professionals who can guide them in addressing these problems.

At the same time, many potential fitness professionals are questioning the wisdom of pursuing a degree in exercise science or a related field of study. Is it worth incurring the debt that so often comes with a college degree? 

Within the last decade, the American College of Sports Medicine® (ACSM) amended its requirements for certification as a group exercise instructor or personal trainer to include those with a high school diploma or equivalent. Now women and men of all ages and backgrounds who already enjoy being physically active and working out for personal reasons can make an indelible mark on the health status of all segments of the population by becoming certified through ACSM. 

This topic is dear to me; my path to ACSM certification was not traditional. I spent nearly two decades as a steelworker at a Pittsburgh area mill but always loved working out. While I had already been certified as a personal trainer, I really wanted to earn the industry’s “gold-standard” ACSM certification. Without a bachelor’s degree, that path was closed to me. 

My opportunity came at a meeting at my church for members who had any background in health and wellness. In attendance was the associate director of the University of Pittsburgh Center for Minority Health. The university was starting a community wellness program to help people attenuate the effects of high blood pressure and diabetes. My participation in the program as a health coach would eventually lead me to earning both a bachelor’s and master’s degree, starting a personal training and wellness practice, and creating the Community Wellness Initiative, a nonprofit organization that aims, among other goals, to provide similar and even greater professional opportunities than those afforded to me.

Today, those who aspire to ACSM certification face fewer hurdles. While a college degree offers clear advantages, with intense study and preparation, a meaningful career as a health professional is open to them. I urge current health and wellness professionals to encourage those just starting out by mentoring promising individuals of any age and work experience to follow their dreams. We need them if we are to make an impact on the health issues undermining the lives of so many today.

Additional Resources: 
Blog | 5 Skills of High Performers in the Fitness Industry
Download | ACSM Career Guide
Jobs | ACSM Career Center

Christopher E. Howard, M.S., ACSM-EP, is the founder and executive director of the newly launched nonprofit organization the Community Wellness Initiative of Pittsburgh. After a career as a steelworker, Chris earned a Bachelor of Science in exercise science at the University of Pittsburgh and a Master of Science in exercise science with a concentration in health promotion, wellness and fitness at California University of Pennsylvania. He is an ACSM Certified Exercise Physiologist® and established the personal training and wellness practice C. Howard Fitness in 2012. 

I just found out that Thursday the 30th of March is “Take a Walk in the Park Day” here in the U.S., and although it sort of sounds like a “Go jump in a lake day,” I have to admit — on reflection — that the founders of this holiday are on to something good. After all, as I type this blog, I’m sitting in a climate-controlled office in front of a laptop computer screen completely separated from nature, with the possible exception of the wood my desk might actually be made from. 

And yet, even here in Los Angeles, I’m spoiled for choice on park opportunities. From beach walks to mountain canyon trails, I have nearly 39,000 acres of park land right here in the city, with an additional 27,000 acres spread throughout the county. And that’s just Los Angeles. You folks in places like Washington, D.C., or the Twin Cities or Houston or Seattle fare even better per capita according to data from the Trust for Public Land. As a matter of fact, even the U.S. National Park Foundation reports that we have 424 national park sites that cover 84 million acres throughout the country with opportunities to engage in physical activity beyond that of walking. 

If “Take a Walk in the Park Day” is all about getting us to recognize and utilize the parks available to us, I say it’s high time we do. Spring is on the way in many parts of the country, so a walk in the park is a good way to break that hibernation groove following a long, cold winter. This is good not only for our physical health but for our mental well-being too. Study results referenced from a 2020 American Psychological Association blog similar to this one justify our need to connect with nature. The APA reports that cognitive development in children improves from having parks near schools and mood states improve across all age groups when we connect with nature. I was surprised to learn from a 2019 study cited by the APA that even the sounds of nature (e.g., ocean waves, crickets) improve subject performance on cognitive tests when compared to subjects who listen to city sounds. 

We need nature. Experiencing nature directly, by getting out there to take a walk in the park, also connects us to our communities and helps us to understand how much that we and our built environment influence our surroundings and how, ultimately, our natural world governs the quality of our lives. Among the most enduring images in my mind during the COVID-19 pandemic are those of wild animals tentatively roaming the streets of our cities as we retreated indoors during lockdown. I doubt they missed us much, but I know I missed them. 

Take a walk in your local park on Thursday the 30th. Get away from the screen, get some fresh air, and don’t be surprised if your escape becomes a habit. In more ways than one, you’ll be better off for the effort.  

Christopher Berger, PhD, FACSM, ACSM-EP, CSCS is an Exercise Physiologist with Occidental College in Los Angeles where he never needs a national holiday to enjoy a walk in the park.

Cardiorespiratory fitness (CRF) is an important component of physical fitness and represents the ability of the heart and the lungs to deliver oxygen to the working muscles during maximal-effort exercise. Over the past decades, CRF has been shown to be inversely related to many common and prevalent chronic diseases, including but not limited to cardiovascular diseases, diabetes and several cancers. Also, CRF has been shown to be directly related to mental health. 

One of the most important roles of an exercise professional is to assess and evaluate CRF to develop an appropriate aerobic exercise prescription. Indeed, the American Heart Association issued a Scientific Statement that CRF be considered a vital sign. Submaximal exercise testing using a treadmill, a cycle ergometer or a stepping bench is commonly used to assess CRF in many health fitness settings. The utilization of these tests necessitates the exercise professional having the skill to assess heart rate accurately and to estimate maximal heart rate (HR_max).  

Measurement of heart rate is commonly done through either palpitation or the use of wearable technology. However, there are shortcomings to both approaches; thus, exercise professionals should be aware of the pros and cons of both methods. There are also some drawbacks associated with estimating of HR_max. Although several regression equations can be used to estimate HR_max, all of them are subject to interindividual variability (i.e., SEE= ± 3-12 bpm) which makes these estimations less reliable than direct measurement from a maximal exercise test. Both the inability to measure heart rate correctly and the inaccuracy of estimating HR_max, can lead to prescribing exercise at intensity levels that are higher or lower than intended. 

In our March/April 2023 article published in ACSM’s Health and Fitness Journal, we sought to provide exercise professionals with practical examples of submaximal exercise testing to illustrate potential shortcomings associated with these common practices. For example, we demonstrated how small heart rate measurement errors and miscalculations can lead to substantial under- and overestimation of CRF. We provided insight into steps that the exercise professional can take to develop a more accurate exercise prescription. These simple steps include regular calibration of testing equipment, choosing appropriate and population-specific HR_max equations, following testing instructions, selecting test protocols that suit the individual, meeting the submaximal exercise testing assumptions, measuring heart rate accurately and utilizing the rating of perceived exertion (RPE) scale as a supplementary tool. 

The accurate estimation of CRF using submaximal exercise testing helps exercise professionals prescribe an appropriate exercise intensity for their clients. Intensity is an integral part of the FITT (Frequency, Intensity, Time, and Time) principle of exercise prescription as described by ACSM. The knowledge, skill and ability to correctly conduct submaximal exercise testing and understand the limitations of these assessments is a critical skill for all exercise professionals. 

Meir Magal, Ph.D., FACSM, is the chair of the School of Mathematics and Sciences as well as program director and professor of exercise science at North Carolina Wesleyan University. Dr. Magal served on ACSM’s Committee for Certification and Registry Boards (CCRB) in several capacities, including as chair of the International Subcommittee and as the chair of CCRB. He also served as an associate editor of the 10th edition of ACSM’s Guidelines for Exercise Testing and Prescription and as a coeditor on the sixth edition of ACSM’s Fitness Assessment Manual. 

Deborah Riebe, Ph.D., FACSM, is the interim dean of the College of Health Sciences and professor in the Department of Kinesiology at the University of Rhode Island. Dr. Riebe served on ACSM’s Board of Trustees, as chair of the ACSM International Health & Fitness Summit and as chair of the CCRB. She is the senior editor of the 10th edition of ACSM’s Guidelines for Exercise Testing and Prescription and has authored more than 80 articles in refereed journals and book chapters.