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  • GSSI Presented Webinar Q&A | Follow Your Gut

    by Greg Margason | Feb 27, 2023

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    GSSI Presented Webinar Q&A | Follow Your GutQ: Angiogenesis function? This is new to me. Are there are references you can point me/us to? 

    Franks I. Gut microbes might promote intestinal angiogenesis. Nat Rev Gastroenterol Hepatol. 2013;10(3). doi: 

    Hassan M, Moghadamrad S, Sorribas M et al. Paneth cells promote angiogenesis and regulate portal hypertension in response to microbial signals. J Hepatol. 2020;73(3):628-39. 

    Q: Is there a recommended test for to assessing dysbiosis?  

    The most direct measurement for now would be to have a GI map done on a stool sample.    

    Q: Does wine (red/white/rosé) count as a fermented food/beverage?  

    It’s more likely that the polyphenols in red wine contribute to the growth of beneficial bacteria as the benefits are seen in alcohol-free wine as well. Excessive alcohol consumption has also been found to break down the tight junctions and damage the intestinal epithelium.    

    Q: Dr Osterberg discussed the negative effects of strenuous exercise and overtraining on the gut. What amount of overexercising could cause this effect?  

    This is likely very dependent upon the individual’s fitness and training environment, diet, lifestyle, etc.  Some studies say that “overexercising” is anything over 60 minutes of moderate exercise, but the athletes in many of the studies I mentioned did much more than that, as do most elite athletes.  

    Q: Thank you for your presentation! Can you please comment on “leaky gut” and lectin-containing foods? Many athletes are leaning on a plant-based intake and they are getting protein and fiber from lentils and legumes, but Internet info raises concerns about leaky gut.  

    There may be some genetically susceptible people for whom lectins can cause an inflammatory reaction. I believe this is an autoimmune response, and I don’t have statistics on the prevalence of this, but if it’s like other autoimmune conditions, it would only affect a small number of people.  

    Q: what would you say should be our one to two takeaways to teach our clients?  

    Eat a wide variety of plant foods. Exercise regularly. Find ways to reduce psychological stress. 

    Q: Are you providing a rationale for carbs? What does this mean for the keto people? 

    Carbohydrate from plants is very important for health and supported by many epidemiological studies. A ketogenic diet reduces microbial diversity. For some people, especially those with seizure disorders, a ketogenic diet can improve symptoms, but it still reduces microbial diversity. 

    Q: Can you recommend a reliable fiber-screener tool to use with clients?  

    I don’t know of one, sorry. 

    Q: Would you please explain the difference between prebiotics and probiotics?  

    Prebiotics are fibers from plants that support the growth of beneficial bacteria in the gut. Probiotics are live bacteria that are ingested. 

    Q: Are you aware of any literature addressing how long it takes to “change” or “shift” a person’s microbiota after changing their diet? Curious as to length of that process within the gut. 

    Populations can shift very quickly — in as little as 24 hours. Most studies are short term, but the changes should last for as long as the dietary change is in effect.   

    Q: Realistically, how easy/effective is the process of adding to/getting your micro biome and gut health back to normative levels after years of bad diet and overusing antibiotics?  

    It’s a great question. A dietary change (from say Western to plant-based) would probably change microbial communities very quickly. The antibiotic piece is difficult to predict as it probably requires more than a “shift” but rather a repopulation.   

    Q: Meditation and gut health — could you please provide sources?  

    I didn’t have one when I made the comment — just a suggestion for reducing stress. But see below: 

    Jia W, Zhen J, Liu A et al. Long-term vegan meditation improved human gut microbiota. Evid Based Complement Alternat Med. 2020. doi: 10.1155/2020/9517897. 

    Q: With so much research proving a plant-based diet’s benefits for the gut, why would you say in your talk today that you’re not promoting the diet?  

    I fully support and would recommend a plant-based diet. I think my comment was that I wasn’t necessarily promoting a vegetarian or vegan diet. An omnivorous diet can also be healthy as the study I cited showed poultry, fish and low-fat cheese were also strongly associated with a healthy gut microbiota.  

    Q: How do you see the role of fermented food helping gut health?  

    Eating fermented food is essentially eating food that contains probiotics. When food is fermented under the right conditions, an acidic environment is created, allowing for the growth of beneficial bacteria (many Lactobacillus species) and the inhibition of pathogenic bacteria. 

    Q: Any caution regarding alcohol intake on gut health?  

    Excessive alcohol intake can increase gut permeability and damage epithelial cells.  

    Q: Do you have a theory for why the marathoners had that strain of microbiota spike so greatly after the marathon vs. during training? Was the exertion that much greater on race day, perhaps?  

    It’s a great question! It may have been related to exertion or maybe fueling … or lack thereof?   

    Q: Has there been any study comparing gut health and performance of athletes with plant-based diets (vegan & vegetarian) vs. those who consume meat?  

    There are many studies comparing plant-based to omnivores in humans, but nothing that measured performance (that I know of). 

    Q: Are there any good studies with recommendations for fermented food intake? Including frequency and amount? 

    I don’t know of any specific recommendations.   

    Cold weather training doesn’t place the same thermal stress on the gut. Blood flow to the gut is more easily maintained because it doesn’t have to be diverted to the skin for cooling. 

    Q: Do supplemental probiotics need to be taken indefinitely, or do they eventually colonize in the body?  

    It’s a great question. I’m not sure if it’s ever a case that they colonize, but I do think they help balance total communities in favor of beneficial bacteria. I think the amount of time you would need to take them would depend on the reason they’re being taken (diarrhea, food intolerance, immune function, etc.). 

    Q: Does sodium bicarbonate supplementation impact gut microbiota?  

    Great question! My guess is that most sodium bicarbonate is absorbed in the small intestine, so it would not impact microbiota to a large extent. 

    Q: You discussed the Veillonella rat study, increasing run time in rats. There are now some probiotics that include this bacteria. Could taking these pre race improve performance? 

    Interesting! I didn’t know this, but I can’t wait to see if supplementation helps!   

    Q: You mentioned that high cardiorespiratory fitness and more intense exercise increases bacterial diversity. How is intense exercise different than exhaustive exercise? And how do we determine helpful vs. harmful levels of exercise?  

    Intense exercise is exercise that is done at a high percentage of VO2 max. Exhaustive exercise is generally defined as exercise that continues until a certain minimum % VO2 max or max wattage can no longer be maintained. Intense exercise doesn’t have to be exhaustive. As for your second question, I don’t have a good answer in the context of gut microbiota. It’s likely multifactorial and based on many other factors in any individual athlete’s life, including diet, fitness, lifestyle, etc. 

    Q: Toward the end you mentioned avoiding cutting blood flow to the gut? How would one be cutting circulation? 

    Intense exercise, especially exercise in the heat, diverts blood flow away from the gut and to muscles (for fuel and oxygen) and skin (for cooling). This decreases blood flow to the gut and can damage the epithelium and increase the likelihood of gut permeability. 

    Q: How would you compare “themed” diets like keto, paleo, etc. with their effect on gut health? 

    Studies would suggest that the more plants and fiber the diet contains, more microbial diversity would be present in the gut. 

    Q: What is a good way to determine if the gut is irritated by consumption of certain food? Should that food be cut out for good?  

    There are certainly conditions that call for cutting out the food for good (celiac disease, for example). For some people, eliminating foods that contain certain components (FODMAPs) can help ameliorate symptoms of GI distress. When a person is in dysbiosis, they may respond to food components differently than they would if their gut is healthy. In general, I would recommend keeping as many plants in the diet as possible.  

    Q: Comments on fecal transplants?  

    Definitely works for certain conditions (C. diff)

    Q: From a sports medicine standpoint, do you think objective measures of gut health could realistically be something incorporated into a preparticipation exam? Or should it be more athlete specific during the season?  

    Really good question! My guess is that it would be athlete specific simply because you’d have to have an athlete that was motivated and willing to make changes if you found dysbiosis. In my experience with athletes, if they don’t have a good reason to change their dietary habits (e.g., they feel bad), they won’t.       

    Q: Do you have any information as to how bariatric surgery would affect the microbiome?  

    It seems to have a large impact. Here is a study that outlines some of the effects: 

    Ulker İ, Yildiran H. The effects of bariatric surgery on gut microbiota in patients with obesity: a review of the literature. Biosci Microbiota Food Health. 2019;38(1):3-9. doi: 10.12938/bmfh.18-018. 

    Q: I know whole foods are best, but what do all of the additives and preservatives in various foods do to the gut?  

    Zhou X, Qiao K, Wu H, Zhang Y. The impact of food additives on the abundance and composition of gut microbiota. Molecules. 2023;28(2):631. doi: 10.3390/molecules28020631. 

  • Cueing for Confidence: How to Keep New and/or Struggling Students on Pace for a Successful Class

    by Greg Margason | Feb 22, 2023
    Cueing for Confidence: How to Keep New and/or Struggling Students on Pace for a Successful Class

    Making sure that a new student is comfortable and feels included and welcomed throughout the class is key to reducing any intimidation they may have felt when they walked in the room, and enhancing their overall experience in your class.

    New students should be monitored particularly closely during their first few classes. Look for signs that they might be intimidated by the class to help guide the tactics that you use throughout the class to keep them focused on the progress that they are making.

    Signs of intimidation:**

    • Constantly watching other students
    • Facial expressions of frustration or fear
    • Withdrawn body language, such as moving to the back of the space, looking at the ground and moving hesitantly
    • Giving up — doing exercises with little to no energy or not doing them at all

    If you see a student displaying these behaviors, it’s important to note that any action on your part that makes them feel “singled out” from the rest of the students is likely going to have a negative effect. There are two approaches I have found to be successful: the verbal approach, and the nonverbal approach. (And, spoiler alert, they often work best when used together!)

    Caveat: The cueing tips below may seem old hat to seasoned instructors — you’re likely doing many of these things without even realizing it. For new instructors, I know there is already so much going through your head just trying to remember the exercises/movements for your class, let alone think about all of these cueing tips at the same time! I recommend practicing these just as you would practice other cueing. Rehearse your class at home: Imagine different scenarios and practice how you would cue in response. As you get more and more classes under your belt, you will become very comfortable and confident in interacting with your students, both new and “regulars,” this way.

    Speak up: The verbal approach

    The verbal approach is focused on using your words effectively to communicate to the group in a way that provides needed direction without calling out individual students and telling them to correct their behavior. This should flow seamlessly into your verbal cueing for the class as a whole and not give any indication that you’re giving direct instructions to a specific student. You can also provide verbal encouragement to help manage any internal dialogue your students may be having about their ability to do exercises or judging themselves against others in the class.

    You may not know the specific reason a student is responding to a movement or exercise while the class is going on, so your verbal cues should cover the spectrum of potential points of intimidation. Offer students modifications and motivation while still giving them “permission” to take the space they need to rest.

    An example of the verbal approach: The class is instructed to hold a high plank, and you notice a new student immediately dropped down from the plank and is now sitting or lying on the ground with a defeated look on their face. You don’t know in that exact moment why they have given up, so you verbal cues should cover the spectrum noted above:

    “Remember that planks can be performed with your forearms and elbows on the ground to take pressure off of your wrists. You can also lower your knees to ground, or you can even do both. It’s normal to feel a little shaky in a plank, but you’re pushing those muscles! Hold if you can, but rest if you need to; you’re all doing a great job!”

    This example offers multiple modifications, motivation/normalizing of the physical challenge of the exercise and also acknowledges that the student may simply need to rest, and if so they should not feel badly about taking that time.

    You can also use the verbal approach to focus students’ attention. Example: You see a new student looking around and anxiously watching other students for cues during an exercise with which they are not familiar. This can cause confusion and also introduce unnecessary comparison between their performance and that of other students. Call out, “Be sure to look at my feet! See how they are pointing forward? Check that your feet are pointing in the same direction as mine.” You’ve now redirected their attention back to your cueing and their own body placement.

    Eyes on me: The nonverbal approach

    Depending on the format of the class you are teaching, verbal cueing may not be the most effective way to support an intimidated student. Physical cues and nonverbal communication can help a struggling student to feel more comfortable and confident during the class.

    A straightforward way of giving physical cues is to position yourself to directly face or move near the new student. Make sure that they can very clearly see you demonstrating movements and modifications without other students or equipment obstructing their line of view. This is a version of a psychology technique called mirroring. If you’re teaching a class where you regularly move around the room (such as yoga or barre) you can spend time directly next to the student as you are cueing, giving additional physical cues to the student while you are giving verbal cues to the “regulars” in your class who are comfortable with following along.

    Eye contact is a very important part of nonverbal communication and mirroring during a fitness class. You can give a student a correction by making eye contact with them, and then point to or move the area of your own body where they should be making a correction with theirs. This is best described with an example: You see the student pulling their shoulders up to their ears during an overhead dumbbell press. Make eye contact, and either tap your shoulders (if you’re not also holding the dumbbells) or do a little lift of your own shoulders (if you are also holding dumbbells), and then overexaggerate a lowering of the shoulders. If you make this exaggerated movement while making eye contact, it very clearly signals to them to relax their shoulders.

    You can also use eye contact to congratulate or “cheer on” the student. Make eye contact and give them a big smile and/or a positive head nod. This clearly signals to them that they are doing a move correctly. This can be particularly effective if their face says “I don’t know if I’m doing this right” while, in fact, they are doing the movement correctly.

    All together now

    As noted before, these techniques can often work together to increase effectiveness. You may use one or the other at various times throughout a class, and you may find yourself using both at the same time. Not all approaches work the same way for every student or every format. You may need to try both or a combination to get a positive reaction from a student.

    Follow up with an invitation

    After the class finishes, check in with your new students. Ask them how they felt about the class and answer any questions that they may have. Finally, thank them again for coming and invite them to join you in the next class. “We have this class every Thursday at 6 p.m.; I would love to have you join us again next week!” You may be surprised at how a very simple invitation can make them feel much more at ease, and confirm to the student that they belong in your class.

    Some final tips that I’ve collected over the years:

    • Humanize yourself. All of your students will feel less intimidated by you as an instructor if you acknowledge the parts of the class that are challenging you too. “Wow, my legs are really shaking as we hold this position! What about you all?”
    • Use inclusive language. Avoid using any kind of gendered language, or language that assumes the gender identity of your students. Phrases like “great job, guys,” or “come on, ladies” are frequently heard in fitness classes; instead, focus on using inclusive terms like “everyone/everybody,” “you all,” “friends,” “folks” and “ya’ll” (if you’re so inclined).
    • Allow students to set their own bar. Avoid using subjective terms like “hard” or “easy” to describe exercises. This can set a bar, especially for new students, that may not be realistic. What feels relatively easy to one student may feel impossibly hard to another.

    **An important reminder: it is CRUCIAL for you as a fitness professional to be able to discern frustration or situational discomfort from physical pain and/or overexertion. If there is any indication that a student is in distress, immediately pause the class to attend to the situation based on your facility’s protocols.

    Related Content: 
    Blog | How to Reduce Intimidation for New Clients in Group Exercise Classes or Group Training Sessions
    Blog | Music that Moves: Building a Playlist that Hits
    Certification | Become an ACSM Certified Group Exercise Instructor®

    Caitlin Kinser
    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. 
  • February is Heart Health Month: How Are You Monitoring Your or Your Clients’ Hearts?

    by Greg Margason | Feb 21, 2023
    How Are You Monitoring Your or Your Clients’ Hearts?

    Cardiovascular health is, if you’ll excuse the pun, at the heart of physical fitness. Appropriate, then, during American Heart Month to have a look at the ways we can monitor our hearts as well as those of our clients. 

    For clients, getting ahold of an at-home blood pressure monitor can be a good start, as well as considering a smartwatch or similar wearable that charts heartrate and related data. This may seem like an unnecessary step for the healthy gymgoer, but keeping track of baseline cardiac data can be quite helpful in the long term, from something as simple as charting how persistent exercise improves pulse rate over time to giving you a good point of comparison to fall back on for when you suspect something might be wrong. It’s hard to know if you’ve suddenly developed unusual symptoms if you don’t have a history of data points. Plus, many of our clients are dealing with ongoing medical issues. Particularly since older adults comprise one of the fastest-growing groups of gymgoers. (Note that ACSM follows the American Heart Association’s blood pressure guidelines, as do ACSM’s certification exams. They are a great reference point for you and your clients.) 

    Different monitoring devices serve different purposes, of course. Wearable tech in particular has seen a steady increase in popularity in recent years, according to ACSM’s Worldwide Survey of Fitness Trends, in fact ranking No. 1 on the survey for 2022. Think Apple Watches, Fitbits, Google Pixel Watches, Garmins and the like.  

    Is this the right choice for you? It depends. Some of these offerings require you to pay a fee to pair them with various apps. And your mileage may vary in terms of how useful you find the device’s software: People’s tastes differ, and the interface that works well for one may not work for another. And how you and/or your client feel about an app will necessarily have a big impact in the gym. Some people have a favorite workout shirt, leggings or even pair of socks that gives them an extra psychological boost during their routine. You better believe that your fitness tracker needs to be engaging rather than off putting. If it seems like the device and app you or a client has chosen is bogging things down, and it’s financially feasible to switch, make sure to do so. 

    If wearables aren’t you or your client’s thing, consider a blood pressure monitor or a pulse oximeter, depending on the circumstances. Wrist-worn and upper-arm blood pressure monitors, as well as finger-worn pulse oximeters, are often available at your local pharmacy, and though not exactly inexpensive (my local drug store lists various types and models between $60 and $100 at the time of writing), they’re much more affordable than most wearables. Some clients may also be able to purchase blood pressure monitors or pulse oximeters using their health flexible spending account (FSA) from work.  

    Depending on the model, digital wrist-worn and upper arm blood pressure monitors generally track diastolic and systolic blood pressure as well as pulse and can sometimes detect potential arrhythmias. Fingertip pulse oximeters measure pulse — heartbeat — and the amount of oxygen in the blood. 

    If you or your client opts for a blood pressure monitor, there are a few things to bear in mind: According to the Mayo Clinic, you’ll want to have the device checked against those of a medical professional before using it. No sense in taking readings with a poorly calibrated diagnostic tool. You’ll also want to take multiple readings at a time to ensure that you’re not recording an outlier. And best not to take a reading right when you wake up. Instead, wait a little while. Don’t eat or drink — especially not caffeinated beverages — before you take your readings, and if you have to pee, make sure you take care of that beforehand. Needing to go can raise your blood pressure a bit. Also, taking your readings at two different and consistent times of day are probably best: in the morning and in the evening. Finally, and obviously, make sure you’re using the device as recommended. For wrist-worn blood pressure monitors, this often includes resting the arm you’re using to measure on a table or other surface so that the monitor is at the same level as your heart. 

    If opting for a pulse oximeter, a device you generally clip on the end of your finger and that uses light to take its readings, the FDA recommends sitting still, making sure the hand you’re using is warm and resting below your heart, and interestingly and importantly, that you make sure to remove any nail polish on the finger you’re measuring since this might interfere with the device’s readings. 

    Remember of course that at-home technology, which is subject both to its own potential defects as well as human error, is no substitute for medical expertise, and no one should be making medical decisions outside the care of a certified medical professional. These tools should be used to track a general baseline or progression over time and serve as potential indicators that someone should seek proper medical attention and care. 

    This American Heart Month, consider incorporating heart monitoring into you and your clients’ programming. With benefits ranging from something as simple as tracking improvements in pulse and blood pressure over the course of an exercise prescription to potentially catching a problem early and allowing your client to seek appropriate medical attention, why not add it to your repertoire? 

    Related Resources:
    Trending Topic | Heart Health
    Blog | Tips to Help Start a Heart-Healthy Lifestyle
    Handout | Being Active When You Have Heart Valve Disease

  • ACSM Hot Topic | Harnessing the Expertise of Exercise Professionals to Move the Needle on Blood Pressure Control

    by Greg Margason | Feb 20, 2023
    Harnessing the Expertise of Exercise Professionals to Move the Needle on Blood Pressure Control

    High blood pressure (BP) or hypertension is the most common costly but modifiable major risk factor for the development of cardiovascular disease and premature mortality, affecting nearly half (47%) of the U.S. adult population. A recent scientific statement from the American Heart Association (AHA) reinforces physical activity as a critical component of first-line treatment for individuals with mild- to moderate-risk BP. In addition, individuals with elevated BP are encouraged to self-measure BP in the home to (a) confirm a diagnosis of hypertension, (b) rule out white-coat hypertension and (c) evaluate the treatment response of interventions such as exercise. Just the act of BP self-monitoring is associated with improved BP control, but when performed in conjunction with co-interventions (e.g., education, clinician involvement, lifestyle modification) translates to superior BP reductions than self-monitoring alone. 

    This all sounds great on paper, but putting these guidelines into practice can be challenging. The default care model offers few resources or tools to support patients who are going from 0 to 1. In addition, providers have diminishing bandwidth and incentive to provide initial and/or ongoing behavioral counseling for interventions like exercise or BP self-monitoring. The result is often a very overwhelmed patient who has just been told they have 12 weeks to lower their BP on their own but with no clue where to begin. How much exercise is enough? What BP monitor should I buy? How often should I take my BP? Should I be recording all this data somewhere? 

    After 12 weeks, the same patient returns for a follow-up visit clutching a crumpled piece of paper with a few BP values scribbled on it, with no corresponding date or documentation of physical activity, rendering this data difficult to make any sense of. Lifestyle intervention never stood a chance!  

    How can we do better to make sure our most vulnerable patients aren’t “left to their own devices”? Currently, there are few resources for the co-implementation of a structured BP self-monitoring and exercise program. However, exercise professionals are well positioned to serve as a trusted partner in care to unlock the value of patient-generated data into actionable insights that facilitate guideline-directed care. As such, it’s imperative that our field is prepared to support commonly experienced scenarios encountered when working with individuals with hypertension embarking on a behavior-change journey. Table 1 presents an overview of evidence-based best practices (when available) and common sense recommendations derived from clinical and research experience. Note that these guidelines are geared toward exercise professionals but may be useful for any qualified health care professional coordinating a multi-component, condition-specific lifestyle intervention for adults with hypertension.  

    Table 1. Key Clinical Levers to Support Individuals Initiating an Exercise-Based, Hypertension Self-Management Program 

    Key Touchpoints


    Quick Resources

    BP device selection
    Patients should be encouraged to select a validated, automated BP device (oscillometric method preferred) intended for home use and that measures BP from the upper arm (if possible).
    Patients can be referred to the U.S. Blood Pressure Validated Device Listing as a trusted and non-biased resource to support device selection.
    BP device training and education
    Recommendations for self-measured BP emphasize the importance of ensuring proper BP measurement technique.
    Target:BPTM, an AHA/AMA initiative, hosts a suite of educational and practical resources to support patient education, including a Patient Training Checklist tool.
    BP self-measurement protocol
    Guidelines recommend a self-measured BP monitoring of 2 measurements taken at least 1 min apart in the morning and evening (i.e., 4 readings per day) optimally for 7 days (i.e., 28 readings total) with a minimum of 3 days (i.e., 12 readings total). Encourage patients to record time of day, exercise, medication use and other factors that may be useful for interpretation.

    Target:BP™ tools such as the SMBP Recording Log can be used to support a standardized protocol to reference in the home.
    Establish baseline and target goal BP
    After baseline home BP is established, ensure all members of care team are aligned with goal BP and exercise intervention (e.g., intensity, the need for pre-participation screening, special considerations)
    Establish ExRx for hypertension
    Individuals with hypertension are encouraged to engage in ≥20 – 30 min of low, moderate, or vigorous intensity exercise on most, preferably all, days of the week to total ≥90 to 150+ min per week of continuous or accumulated exercise of any duration. Special emphasis should be placed on a) moderate intensity and b) aerobic or resistance exercise (alone or combined) in addition to neuromotor and flexibility depending on personal preference. 
    ACSM member resource provided by Pescatello LS summarizes new ExRx for individuals with hypertension. Note that emphasis is no longer placed on aerobic exercise alone and patients should be encouraged to engage in any multi-modal exercise that they enjoy. 
    Provide ongoing high-touch support
    In the initial phase of BP self-monitoring, patients may seek technical support. As task self-efficacy and comfort increase, patients will likely shift to require more clinical support (e.g., interpretating BP values).

    When possible, facilitating BP self-monitoring in a fitness or medical facility gives additional opportunities for training, feedback, education and habit formation.

    Integrate BP self-monitoring with exercise intervention
    In addition to daily BP assessment, patients can be encouraged to measure BP before and after an exercise session. Self-monitoring of BP before and after an exercise session has the potential to provide immediate feedback that BP is lower following exercise (and for some time after), allowing a patient to link their exercise behavior with the positive health outcome of lower BP as a result of exercise.
    Methods previously reported by Zaleski et al. PMID: 31058797
    Outcomes-based evaluation
    Support proper documentation of self-monitoring and exercise interventions, inclusive of daily/weekly averages for exercise characteristics (e.g., frequency, intensity, time, type); BP values; % exercise adherence; and other relevant patient-level measures.
    Methods previously reported by Zaleski et al. PMID: 31058797

    To Summarize

    Exercise professionals have an opportunity to contribute tremendous value to a patient-centered, multidisciplinary care team through the provision of (a) upfront education and counseling on the benefits of BP self-monitoring and exercise for prevention, treatment, and control of hypertension; (b) high-touch support in the initial phases of BP self-monitoring; (c) serving as a trusted resource to “quarterback” care, interpret and appraise the BP response to exercise, and escalate to the provider (when necessary); and (d) proper documentation of a structured lifestyle intervention that directly informs and enables guideline-directed care decisions. Whenever possible, an interdisciplinary, collaborative approach involving the patient, health care provider(s) and other members of the care team will largely improve lifestyle and pharmaceutical adherence, translating to greater BP control and overall health, which is the ultimate goal in the treatment of hypertension. 

    Amanda Zaleski
    Amanda Zaleski, Ph.D., ACSM-CEP
    , is a senior scientist in the Department of Preventive Cardiology at Hartford Hospital with clinical and research expertise in the blood pressure response to exercise, digital health interventions, statin-associated muscle symptoms and mechanisms underlying blood clot risk in athletes. Dr. Zaleski was a contributing author for ACSM’s Guidelines for Exercise Testing and Prescription, 11th Edition, and ACSM’s Exercise Testing and Prescription, Seventh Edition; an ACSM Credentialed Evidence Analyst; a project manager for the Hypertension Position Stand Update; and most recently, a proud member of the inaugural editorial group for ACSM’s newest journal, Exercise, Sport, and Movement

  • Inspiring ACSM Leaders: Antronette (Toni) Yancey, M.D.

    by Caitlin Kinser | Feb 15, 2023

    ACSM inspiring leaders series Toni YanceyAntronette (Toni) Yancey, M.D., was born in Kansas City, Kansas, in 1957. She studied biochemistry and molecular biology at Northwestern University before attending Duke University for her M.D. and going on to pursue a long and successful career in public health and public health education. Dr. Yancey received a posthumous ACSM Citation Award in 2014. 

    In her letter in support of Dr. Yancey’s nomination for the award, ACSM Past President NiCole Keith, wrote, “Dr. Yancey was certainly a luminary whose influence will continue to span decades. She was, to my knowledge, the only African American female physical activity researcher who also was a full professor at her academic institution. She mentored a core group of us to continue to strive for leadership opportunities that would put ourselves in positions to be decision makers to help make the world a better place — just as she did. Her creative inspiration spread through us and beyond us.” 

    While serving as the director of public health for the city of Richmond, Virginia, Dr. Yancey championed a campaign called Rock! Richmond to encourage physical activity throughout the city. Then as director of chronic disease prevention and health promotion for Los Angeles County, she initiated LA Liftoff, which encouraged overweight and sedentary workers to take a 10-minute exercise break based on low-impact dance. The program later evolved into the concept of “Instant Recess,” which Dr. Yancey ultimately outlined in her 2010 book Instant Recess: Building a Nation 10 Minutes at a Time, focused on the nation’s health and fitness, particularly obesity and sedentary behavior, and the policies she laid out in it have been adopted at least 37 cities. Instant Recess earned Dr. Yancey a number of awards, in particular the 2012 Pioneering Innovation Award from the Centers for Disease Control and Prevention. 

    Dr. Yancey, a professor in the UCLA Fielding School of Public Health, was a co-founder of the school’s UCLA Kaiser Permanente Center for Health Equity, which promotes social justice and whose mission “focuses on eliminating disparities in incidence, prevalence, mortality and burden of disease experienced by disadvantaged and underserved populations.” 

    Dr. Yancey’s passions extended far beyond her work, and she lived an interesting and multifaceted life: She was variously a D1 basketball player at Northwestern, a poet and a fashion model. And among other awards, she received a Lifetime Achievement Award from the Association of Black Women Physicians; the California State Assembly 47th District's Woman of the Year honor; an Award for Excellence from the American Public Health Association; a WNBA Los Angeles Sparks Lisa Leslie Inspiring Women Award; a Women Who Dared Award from the California Black Women’s Health Project; a Champions of Health Professions Diversity Award from the California Wellness Foundation; a Joint Health Promotion Award from the California Public Health Association; a Lifetime Achievement Award from the President’s Council on Fitness, Sports and Nutrition; and a Health Education Achievement and Leadership Award from the Henry Ford Health System. 

    Dr. Yancey passed away in 2013 at the age of 55 after a fight with lung cancer, but her legacy lives on in the communities she served and in the careers and achievements of those she mentored and inspired.