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  • Why Checking the Box to Exercise isn’t Sufficient for Your Health

    by Greg Margason | Dec 19, 2023
    Why Checking the Box to Exercise isn’t Sufficient for Your Health

    Scenario: The sound of an alarm wakes you up at 6:30 a.m. to start your day. Upon waking up, you decide to go for a jog at the local park, but you are restricted to 30 minutes because of a work meeting scheduled for 8:30 at the office. After exercising, you sit down to pour your favorite cereal and eat breakfast, before driving to work for 20 minutes. You arrive in time for your meeting, which lasts longer than expected, ending around 10. Once the meeting is over, you return to your office to catch up on emails and tasks before going to lunch meeting with a few co-workers. While at lunch, you and your co-workers share personal stories and work-related updates for about an hour before returning to the office to finish up tasks and additional meetings prior to leaving work at 4:30 p.m. After leaving work, you drive back home to cook dinner leftovers before watching television until bedtime around 10 p.m. A similar but different routine repeats the following day - but why is this important even though you exercised?! 

    The 24-hour day entails four distinct behaviors called the 24-hour activity cycle. These behaviors are sleep, sedentary behavior, light physical activity, and moderate to vigorous physical activity. Current physical activity guidelines recommend that adults engage in at least 150 minutes per week of moderate physical activity, at least 75 minutes per week of vigorous physical activity or some combination of both. Sedentary behavior recommendations suggest adults “sit less and move more” due to a paucity of evidence during the development of the 2018 Physical Activity Guidelines for Americans. Finally, the National Sleep Foundation recommends that adults sleep at least seven hours a day. Thus, accurately measuring all these behaviors and meeting their recommendations pose a challenge. 

    All of behaviors of the 24-hour activity cycle are individually and independently associated with health. Ample evidence suggests that more time spent in moderate to vigorous physical activity and less time in sedentary behavior reduces the risk of a wide range of negative health outcomes such as hypertension, diabetes, cancer, cardiovascular disease, stroke, and a shorter mortality. By contrast, more time spent in sedentary behavior and less time in moderate to vigorous physical activity increases the risk of these negative health outcomes. Finally, current evidence also suggests a short sleep duration (less than seven hours per day) also poses similar negative health consequences as sedentary behavior. As such, growing evidence has now suggested that the combined effects of all these behaviors may be greater than their individual effects.  

    Time spent in one of these complex behaviors will offset time spent in the remaining behaviors. Meeting the aerobic physical activity recommendations or exercising for an hour each day, constitutes only about two percent of a 24-hour day. The remaining 98% of our day and behaviors (sleep, sedentary behavior and light physical activity) should be considered. Meta-analytical evidence suggests even if an individual meets the aerobic physical activity recommendations and engages in high levels of sedentary time throughout the day, the risk of mortality remains high. Previous research has also shown that even physical activity-focused programs do not yield meaningful reductions in sedentary time as an individual can be physically active (e.g. exercise 30 min/day) and yet spend the rest of the day sedentary. Thus, focusing efforts on a single behavior limits efficacy and may lead to spurious conclusions for our health. 

    To help inform a paradigm shift in this area future progress should be established in different areas. Research investigation should consider examining efforts to determine appropriate levels of sleep, sedentary behavior, light physical activity, and moderate to vigorous physical activity (or in certain combinations) to establish optimal 24-hour day recommendations. The fitness and medical community may also benefit in this area by exploring innovative tactics to understand time spent beyond their client’s exercise session to design a healthy 24-hour day.  

    More information about the 24-hour activity cycle can be found in three distinct continuing education courses. 

    Benjamin BoudreauxBenjamin D. Boudreaux, Ph.D. is a postdoctoral fellow at Columbia University Irving Medical Center. His research area of emphasis lies at the intersection of exercise science and physical activity epidemiology. His primary research interests includes examining the relationship between the 24-Hour Activity Cycle in the prevention or treatment of cardiovascular disease and other human health outcomes. He has extensive experience with consumer wearable devices in different populations for validation purposes or as a tool to alter physical activity and sedentary behaviors. Beyond research, Dr. Boudreaux devotes his service efforts towards the disability and Type 1 Diabetes communities such as running the 2023 TCS NYC Marathon for Type 1 Diabetes awareness and presenting or publishing about the importance of physical activity and exercise in the autism community.


  • Navigating the Impact of New Weight Loss Medications

    by Greg Margason | Dec 18, 2023
    Navigating new weight loss medications

    Ozempic™, Wegovy™, Mounjaro™, and now, Zepbound™ - everywhere you turn, you hear about these new medications that have changed the weight loss world and are making a major impact on chronic diseases. The reality is that while 2023 has been flooded with media and excitement, it will likely continue - these effective medications promote, on average, 15-20+ percent weight loss.  

    Now that these new medications are here, can we forget about diet and exercise when it comes to weight loss? 

    If you asked me 20 years ago if I would be talking to you about using medications as a strategy for weight loss – I would have said, “No.”  

    However, after working with thousands of people seeking to lose weight in both research and real-world settings, I now understand the complexity of obesity as a disease. Sometimes the path to weight loss using the traditional “eat less and exercise more” method is not enough, and additional support with medical management (like taking a medication) is needed.  

    I get how confusing this can be, especially with all the media attention these new medications are getting and all the mixed messages out there. To simplify, let’s breakdown some common misconceptions that I hear a lot. Spoiler alert: being physically active is still important! 

    #1 – Ozempic™ is the Magic Bullet for Weight Loss 

    Ozempic™ is approved for the treatment of type 2 diabetes, not weight loss. The two popular medications that are FDA (Food and Drug Administration) approved for weight loss are semaglutide (Wegovy™) and tirzepatide (Zepbound™). These medications were originally approved for type 2 diabetes and later approved for weight loss, which explains why there are different trade names.

    So, are Wegovy™ and Zepbound™ the magic bullets for weight loss?  

    These medications are called nutrient-stimulated hormone therapies, and the name gives a clue to how they work in our bodies. Here is your quick and basic physiology lesson:  

    Nutrient-stimulated hormones signal our brain in ways that impact how much food we eat – this can be anything from how hungry you feel to whether or not you have food cravings. These new medications mimic those hormones in the body to reduce hunger levels and help people feel fuller longer. With that, people that respond to these medications, typically eat less which can lead to weight loss. 

    While these new weight loss medications are an effective tool, in general they are only impacting how much you eat, not how well. They also are not helping you move more. This is why these medications need to be a part of a broader plan that includes a physical activity and healthy eating strategy, and possible behavioral counseling to help you learn about underlying feelings and strategies to support weight loss.  

    Your healthcare provider is the best person to help you understand: 

    • If, when, and which weight loss medication might be right for you;  

    • The appropriate way it should be taken, whether you qualify; and, 

    • The best comprehensive treatment approach that includes eating better and moving more. 

    #2 – Weight Loss = Willpower 

    Sure, eating healthier and exercising more takes some self-discipline. Unfortunately, life and real barriers can get in the way. In fact, there are many other factors that can impact your weight – everything from your genetics, to how you sleep, where you live, and other dynamics that may increase your drive to eat, such as emotions, hormones, or other medical treatments – to just name a few. All of this can make “eating less and moving more,” MORE difficult over time.  

    To blame weight loss failures on willpower is assuming everything mentioned above is under your control, which it’s not.  

    People taking weight loss medications report that they have better control over their hunger and no longer have intrusive thoughts related to food. That removes some of the willpower challenges (yay!). 

    But let’s get back to the healthy lifestyle strategy. Let’s face it, figuring out how to build a healthy lifestyle is not always easy, with or without a weight loss medication. This is where I encourage you to get support from a professional.  

    Rule No. 1 – if someone tells you they have “the perfect” weight loss method or program, do not engage! Whether you are seeking dietary or physical activity support, only work with professionals who spend time determining what is best FOR you, not just overlaying their method ON you. Seek out support from registered dietitians and certified exercise professionals with experience in weight management and behavior change strategies.  

    #3 You Can Use a Medication to Quickly Lose Weight and Skip Diet and Exercise  

    I hear this constantly in my work, and sadly it is promoted a lot by influencers and celebrities. It sounds like the perfect solution, especially if you have previously struggled to lose weight with diet and exercise alone. Unfortunately, talking about using the medications in this manner is not recommended for several reasons:  

    First, all these medications were tested and approved for use alongside a lifestyle program that includes healthy eating and physical activity. Using a medication without modifying diet and moving more is against what is recommended!  

    Secondly, once a person comes off the medication, those hunger signals will come back, and this can be followed by weight regain.  

    Third, any time you lose weight, you don’t just lose fat mass, but also lean mass. This is typical, but there is concern that higher levels of lean mass loss might be occurring with these newer weight loss medications.  

    A big question is whether the lean mass that is lost is actually your muscle mass.  

    Most people don’t realize this, but the terms “lean mass” and “muscle mass” are not the same. Muscle mass is only one aspect of your body’s lean mass. Researchers are currently studying the effect these medications have on lean mass loss that includes not only muscle but also bone, water, organs, and other body tissues.  

    Why does this matter to you? Some people taking these medications report feeling weaker and taking care of your muscular health may help.  

    This is where exercise may play an important role. 

    Will resistance training completely preserve lean mass or muscle mass loss? The verdict is still out, and the answer is likely no. But we do know that resistance training is still beneficial for you during weight loss, and of course can improve feelings of weakness, and your overall strength and physical function.  

    Some people taking these medications also report feeling fatigued or tired even though they have lost weight.  

    Overtime, participating in a regular exercise program can improve feelings of fatigue. Moderate-intensity physical activity, as simple as brisk walking, can be a great place to start to increase stamina.  

    Have I convinced you yet that these medications are not quick fix for weight loss?!?!  

    Bottom line – a foundation in healthy eating patterns and a physical activity plan are critically important to support your weight loss journey to have you feeling your very best! They may help you keep the weight off and provide health benefits beyond what happens on the scale.  

    ReneeJRogers Headshot
    Dr. Renee J. Rogers, Ph.D., FACSM,
     is a senior scientist at the University of Kansas Medical Center and also works as an independent healthy lifestyle consultant and strategist. She chairs ACSM’s Strategic Health Initiative on Behavioral Strategies and Summit Program Committees. Dr. Rogers is an expert in bio-behavioral intervention design with a focus on relevant engagement approaches that blends her 20+ years of experience working in exercise physiology, behavior change, and weight management. 

  • Q&A with ACSM’s Chief Medical Officer

    by Greg Margason | Dec 12, 2023
    Roberts qa

    Past President Bill Roberts, M.D., FACSM was named ACSM’s first chief medical officer earlier this year. As 2023 comes to a close, we caught up with Bill to talk about his vision, priorities, progress and opportunities for 2024. 

    What is your vision for the CMO role at ACSM? 

    I would like to advance and align our clinical sports medicine strategy to encourage physicians and others with clinical doctorates to join and stay in ACSM as their home organization for continuing education and leadership opportunities. I hope to expand our content and advocacy efforts in support of sports medicine clinicians and integrate important cross-disciplinary issues for all ACSM members, both clinical and non-clinical. Part of this will be an effort to expand the medical category to include all clinicians with doctorate degrees who care for athletes, with a goal to unify clinical programs and solidify our sports and activity related clinical care teams. This will involve exploring the clinical universe for potential members with a focus on non-fellowship trained clinicians who can become Fellows of ACSM. 

    What were your initial priorities when you started as ACSM’s CMO? 

    My initial priorities as the inaugural CMO were to re-learn the administrative and leadership functions of the college. In the two decades since my time in the leadership of the college, much has changed. I have focused on meeting the staff and learning their priorities, and understanding the updated strategic plan that will drive the mission of the college over the coming years. 

    How would you like to support ACSM’s physicians/clinicians in this role? 

    Getting ACSM’s physicians and clinicians more involved in the committee and leadership structure of the college will help drive recruitment and retention. When I accepted the gavel as president of ACSM, I quoted an unknown source with “people go where they are invited and stay where they feel welcome.” I hope that we can amplify this philosophy across all parts of the college because, as someone else said, “we all do better, when we all do better.” 

    What do you feel are the best opportunities for ACSM in 2024? 

    I am eternally grateful to my early sports science mentors, Bob Serfass and Jack Kelly, for steering me to ACSM. I hope we can all steer our younger clinical colleagues toward ACSM as their future home in sports medicine. Our best opportunities to advance ACSM involve carrying forward- in all our college and professional activities- the work that so many have done to integrate medicine and science in sports and exercise. 

  • Active Voice | Racial Disparities in Concussion Recovery among Collegiate Athletes in the United States

    by Greg Margason | Dec 12, 2023
    Racial Disparities in Concussion Recovery among Collegiate Athletes in the United States

    The National Collegiate Athletic Association (NCAA) is the premier landscape for amateur athletics in the United States. Contrary to the notion that sport participation in the United States is equitable, it has been observed that college sport participation is more prevalent among individuals with specific geographic, social, and financial advantages. This disparity in participation may disproportionately influence injury management and associated recovery trajectories, particularly among those from a lower socioeconomic status who have a serious head injury. A recent epidemiological study demonstrated that sport-related concussions, a mild traumatic brain injury, are prevalent in NCAA sport. Moreover, several studies have reported that sport-related concussion outcomes are influenced by biopsychosocial factors and social determinants of health. Accordingly, we sought to examine the intersection of the race of the NCAA student-athlete across household income and sport participation. We also examined the association between the race of the NCAA student-athlete and sport-related concussion recovery characterized as time to normal academic performance and return to play. 

    Our study, published in the December 2023 issue of Medicine & Science in Sports & Exercise®, leveraged data collected as part of the Concussion Assessment, Research, and Education (CARE) Consortium. The CARE Consortium is a 30-site, prospective cohort study aimed at characterizing the short- and long-term effects of sport-related concussions in NCAA student-athletes and military service academy members. Participants were administered routinely used clinical concussion assessments prior to the competitive season and at discrete clinically relevant timepoints (within 48 hours, at the initiation and completion of the return to play protocol) following sport-related concussions. 

    We found that across NCAA men’s and women’s sports, white-identifying athletes disproportionately participated (~75%) in all sports except for men’s and women’s basketball, and men’s football. Student-athletes in these same sports more often reported having come from households with a median income less than $60,000. This distribution is in stark contrast to NCAA sports such as men’s and women’s lacrosse and ice hockey, where student athletes came from households with a median income that was greater than $150,000. 

    Across sport-related concussion recovery trajectories, we found that the race of student-athletes was not associated with time to normal academic performance or initiation of the return to play protocol. However, it appears that non-Black/white student-athletes (compared to white student-athletes) may be at a lower risk of completing the return-to-play protocol, suggesting a slower recovery or more cautious management. Additionally, Black student-athletes (compared to white student-athletes) were associated with an increased risk of being cleared for unrestricted return to play, which might indicate a quicker recovery or accelerated management. These findings highlight the need for further investigation into the underlying factors that contribute to these disparities. Regardless of the underpinnings of these findings, implementing return-to-learn and play protocols that consider individual recovery rates is the clinical gold standard

    Despite a relatively homogenous NCAA student-athlete composition, our study suggests that self-identified race of the student-athlete appears to have marginal, and likely non-clinically impactful, associations with sport-related concussion recovery. It may then be reasoned that within the 30 schools sampled across the nearly 1,100 NCAA schools/universities that equitable sport-related concussion management is being performed. Despite this observation, we still acknowledge there will be NCAA student-athletes who suffer from implicit biases and further work is needed to elucidate those patterns to establish mechanisms for student-athletes to utilize when they feel their care is being mismanaged. 

    Adrian Boltz
    Adrian J. Boltz, MSH
    , is a Ph.D. student in the Michigan Concussion Center at the University of Michigan in Ann Arbor, Michigan, and the research associate for the National Collegiate Athletic Association Injury Surveillance Program at the Datalys Center for Sports Injury Research and Prevention. His research encompasses both sports injury epidemiology and sport-related concussion. Specifically, he is interested in understanding factors associated with sleep disturbance following sport-related concussion leveraging clinical measure, neuroimaging, and fluid biomarker data. He also serves as member of ACSM’s Exhibits Advisory Committee. 

    Conflict of Interest Disclosure: Adrian J. Boltz is currently working (or has worked) on projects funded by the National Collegiate Athletic Association, Department of Defense, National Athletic Trainer’s Association, and National Operating Committee on Standards for Athletic Equipment. 

    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.  

  • Fighting For You on Capitol Hill

    by Caitlin Kinser | Dec 11, 2023

    ACSM's work at the national level has been robust in 2023, and we’ve experienced both victories and challenges while shepherding legislation through the House and Senate. In addition, our work with the Physical Activity Alliance (PAA) secured a major achievement in the publishing of the Physical Activity Implementation Guide (IG), which is a major step toward our goal of bringing physical activity assessment, prescription and referral to the US health care system. Here's a summary of what we're focusing on:

    Omnibus Physical Activity Legislation 

    ACSM, through its partnership with PAA, is working on legislation that will highlight the importance of physical activity.  The legislation would accomplish the following: 

    1. Create Physical Activity Guidelines for Americans report. 

    1. Create an Inter-Agency Committee on Physical Activity 

    1. Study and report on Exercise Prescription Reimbursement 

    1. Provide financial incentives for physical activity through HSAs and FSAs. 

    1. Small Business incentives for physical activity 

    1. Provide funding for physical activity education in medical schools. 

    1. Promote physical activity and PE in schools. 

    1. Invest in education and promotion for our nation’s military. 

    1. Provide infrastructure for physical activity for veterans. 

    1. Establish physical activity research grants within NIH and create a greater infrastructure within research agencies to promote physical activity. 

    1. Authorize the President’s Council on Sports, Fitness and Nutrition 

    1. Finance infrastructure in local communities to encourage physical activity.  

    The bill is expected to be introduced in January 2024 by the co-chairs of the Congressional Physical Activity Caucus.

    Legislation Highlight 

    Senators Sherrod Brown, Roger Wicker and Shelley Moore Capito recently introduced S. 397, the Promoting Physical Activity for Americans Act in the Senate. This bill would direct the Department of Health and Human Services (HHS) to prepare and promote physical activity recommendations based on the latest scientific evidence at least every ten years. 

    S. 397 would also direct HHS, five years after the release of each set of recommendations, to publish a midcourse report highlighting best practices and continuing issues relating to physical activity among Americans.  Given the strong base of science and medicine that shows the benefits of exercise, every American needs to know the current physical activity recommendations to promote health and combat obesity. 

    We need your help! Please take a moment and ask your Senators to co-sponsor physical activity legislation.  Click Here  

    Government Funding 

    • Congress passed the bipartisan Continuing Resolution (CR) shortly before Thanksgiving to keep the government running.   

    • Under the CR the Congress must pass all 12 spending bills to keep the government running.   

    • The CR has a two-tiered deadline of January 19th for four of the spending bills and a February 2nd deadline for the remaining 8 spending bills.   

    • Speaker Johnson doesn’t intend to enact any further short-term CRs to keep the government running so the bills must be passed or the government could shut down. 

    • However, there is discussion of a full-year stop gap bill to keep the government running.   

    • Both the CR and the full-year stop gap bill would be harmful to ACSM members that are involved in research funding from the federal government as it could lead to reduced funding or no funding at all in the coming fiscal year.   

    • ACSM is pushing the Congress to pass the spending bills in a timely manner so that ACSM members will be able to access research grants, etc.

    HL7

    The Physical Activity Implementation Guide (IG) is published. The IG standardizes the ability of computer systems or software to exchange information involved in measuring, reporting, and intervening to improve patient physical activity levels. 

    Publication signifies that the IG is ready to start being incorporated and used in stakeholder systems. These include, but are not limited to, healthcare systems, Electronic Health Record systems (EHR), physical activity professionals/organizations (including community-based organizations), and physical activity-oriented app developers. These early implementations will provide real-world testing of the IG and feedback for continued improvement and development. 

    The publication of the IG puts PAA’s work on the path to becoming a normative standard. It also represents the point at which we begin to bring physical activity assessment, prescription, and referral to the US health care system. The feedback from the early implementers will help the project group to refine the IG and ensure it is able to work for wide implementation throughout all stakeholder groups. This is version 1, or STU1, of the IG. Once we feel there has been enough testing and changes to the IG, PAA will submit for ballot approval and publication for version 2 (STU2). This may take about a year to accomplish, and the PAA will repeat the process until the IG meets HL7® criteria for a normative standard.

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