In This Section:

  • Active Voice | Visceral Fatness and ‘BrainAge’

    by Greg Margason | Apr 09, 2024

    There is little doubt that our brain changes as we age, with changes in structure that contribute to cognitive decline over time. However, the degree of change is highly variable across individuals in terms of its onset, rate and magnitude. How should we behave, and what should we change to ensure that our brains stay healthy longer? This question of what keeps our brains functioning well is one that should have clear meaning and personal implications for all of us. 

    In our recent study of 485 cognitively normal older adults, we explored this question in detail through machine-learning analyses that use MRI to look at hundreds of structural features across the brain to compute a “BrainAge.” This is then compared to the number of years the individual has been alive to determine if the brain is younger than expected based on the chronological age. We found that, compared to a control, a six-month exercise intervention was effective at improving cardiovascular fitness and elicited beneficial changes in body composition, mostly in the form of increased lean tissue. But surprisingly, changes in BrainAge over the course of the study were minimal and not related to increased fitness, higher levels of physical activity or changes in sleep. Our findings suggest you cannot exercise your way to a younger brain. 

    It is worth noting that across our entire cohort, there were individuals who had substantial weight loss, including large amounts of visceral fat. Perhaps individuals who enrolled in our study were motivated to change their lives, or maybe our active control group specifically contributed meaningful lifestyle changes. When we evaluated changes in BrainAge independent of group assignment, we found that changes in fatness, particularly visceral fatness, led to meaningful changes in BrainAge. Individuals who lost visceral fat had brains that were aging more slowly — both compared to others with more visceral fat and in terms of the number of months that had passed. Eureka! We have found the solution to the aging brain: Try to get rid of excess weight and keep it off! 

    This is of course overly simplistic, as there is no single answer to the challenges of maintaining health over our lifetimes, particularly as we examine something as complex as the brain. However, when our findings are combined with other evidence linking central obesity (in the form of waist circumference) to declines across multiple biological systems, it is clear that being overfat is particularly harmful to health, in both the short and long term. 

    Given the many important positive changes that occur with improved fitness and increased physical activity, it is tempting to view these as a “fix-everything” solution. This may be particularly true for those of us promoting Exercise Is Medicine®. Encouraging exercise and physical activity to promote health is critical, but there should also be a strong focus on maintaining a healthy body composition, particularly for successful aging and long-term health, including the health of the brain. As such, it is worthwhile to consider and promote the role of “Exercise and Food as Medicine” as we seek to better understand health across multiple complex and interconnected systems. 

    David Wing

    David Wing, M.S., is the senior manager of the Exercise and Physical Activity Resource Center at the University of California San Diego, where he oversees all aspects of its day-to-day operation. He is also instrumental in design, delivery and dissemination of multiple research studies and educational initiatives. Mr. Wing is completing his Ph.D. at Vrije University Brussels with a focus on the role of fitness, physical activity and body composition on brain health and aging. He is passionate about Exercise Is Medicine® and works with both public health and medical professionals to ensure that physical activity is included as a vital sign and every “patient” is recognized as an athlete. 


    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. 
  • “Sex Differences in Athletic Performance: Perspectives on Transgender Athletes”: ESSR 2023 Paper of the Year in the University Classroom

    by Caitlin Kinser | Apr 02, 2024
    2023 Journal Paper of the Year ESSR 1200x628

    The American College of Sports Medicine (ACSM)’s journal, Exercise and Sport Sciences Reviews (ESSR), awarded the “2023 Paper of the Year” designation to Sex Differences in Athletic Performance: Perspectives on Transgender Athletes (Volume 51, July 2023), collaborated on by authors Natalie J. Nokoff, Jonathan Senefeld, Csilla Krausz, Sandra Hunter, and Michael Joyner.  

    The manuscript provides an overview of sex-based differences in individual sports performance that arise at the onset of puberty, primarily because of the hormone testosterone. The authors consider perspectives related to transgender athletes, including facets of medical transition and hormone therapies, and conclude that there is demand for broadened research related to the implications of testosterone on sports performance among cis- and trans-gender individuals. Confused about the terminology? This Perspectives for Progress provides a table of terminologies and their definitions (adapted from the Endocrine Society Guidelines, 2017). The inclusion of Table 1 makes the paper a fair starting place on the topic of sex differences in the context of physiology and motor performance. 

    In addition to recognizing that the taxonomy of these topics may not be known or consistent among readers, the authors provide a short overview on the history of policies regulating sex verification in elite sports, cumulating with the International Olympic Committee (IOC)’s most recent recommendations (2021), which are broad and defer regulatory power to the governing bodies of individual sports. No doubt, the policies that are adopted within individual sports may vary and will likely be interpreted differently, which is something I consider as a university educator who may come across a paper like this in my classroom. 

    The incorporation of journal club questions can help guide conversations in classrooms, no matter the format in which they are conducted, if at all. Often, they can help guide discussion on a piece of literature as relevant to the basic science the course is likely focused on (e.g., applied human physiology or exercise science). Guiding the thought process through questions like those that can be provided through a journal club is a reasonable solution to not imposing personal beliefs and letting the science direct the conversation, whether internally or aloud. Perhaps needless to state, it is important to provide students with the option to keep their perspectives private (a.k.a., not mandate they share their opinions). Beyond journal club questions, ESSR provides other free supplemental material for certain manuscripts, such as video abstracts and visual abstracts. This year’s honored paper does include journal club questions, which educators can download from the ESSR page to integrate into their classrooms. Integrating research articles, especially review papers, is an excellent mode to teach students curriculum content while developing their professional research skills. 

    Again, a big congratulations to the authors for the selection of their article as the ESSR 2023 Paper of the Year! ESSR’s paper of the year will be honored at ACSM’s Annual Meeting held May 28-31, 2024 in Boston, Massachusetts, USA in a session on May 31, 2024 3:45-5:45 PM local time welcoming the organization’s journals and authors of each journal’s featured paper.   

    Diba ManiDiba Mani, Ph.D., is an Instructional Associate Professor in the Department of Applied Physiology & Kinesiology at the University of Florida. She serves as the Digital Editor for Exercise and Sport Sciences Reviews. She earned her degrees under the mentorship of Dr. Roger Enoka in the Neurophysiology of Movement Laboratory at the University of Colorado. Her doctoral dissertation focused on evaluating the effects of electrical nerve stimulation on motor unit discharge properties and mobility in young and older adults. Dr. Mani most enjoys the human component of any work she is engaging in, be it research in the field of geriatrics or teaching college students in the classroom. Dr. Mani is an international judo referee and coach, and a regular vinyasa yoga practitioner. She is passionate about internationalization in the STEM courses, as implemented through experiences such as virtual exchange and study abroad. 

  • Hot Topic | Exercise Oncology: Ready for Prime Time

    by Greg Margason | Mar 26, 2024

    The field of exercise and cancer (exercise oncology) has a long history. In 1911, findings were published documenting that being more physically active was associated with lower risk of colon cancer. Throughout the 20th century, animal model experiments repeatedly showed that exercise slowed tumor growth. In the late 1980s, Winningham and MacVicar carried out the first human clinical trials of exercise and cancer, documenting benefits on body composition and quality of life. In 1996, the first review in the field of exercise oncology was conducted by Friedenreich and Courneya, and in 2005, the first meta-analysis was published, by Schmitz et al., that identified 22 high quality randomized controlled trials. The American College of Sports Medicine® (ACSM) published the first roundtable guidelines for exercise in cancer survivors in 2010, initiating 14 years of exponential growth in the field of exercise oncology. By the time the second roundtable guidelines for exercise in cancer survivors were published in 2019, there had been a 281% increase in the number of published randomized controlled trials in this area. A current search of PubMed indicates there are over 2,600 exercise oncology randomized controlled trials in humans and over 15,000 peer-reviewed scientific publications (including animal model research and observational studies). The American Cancer Society and the American Society of Clinical Oncology both published guidelines in 2022 echoing the advice from ACSM that exercise mitigates common cancer symptoms and treatment side effects, as well as helps to prevent the development and recurrence of cancer. More research is certainly needed to better understand the mechanisms by which exercise may improve cancer-related outcomes. But how should exercise be implemented in oncology settings? 

    ACSM started a new disease-specific initiative in 2019 under the umbrella of Exercise Is Medicine® called Moving Through Cancer. This initiative has a bold goal of making exercise the standard of care in oncology settings by 2029. Activities to this point include policy proposals (including the submission of a National Coverage Determination application in March 2024), stakeholder awareness resources (including brochure and movie), workforce development resources (including development of the revised ACSM-ACS Cancer Exercise Specialist Course), program development (including registry of exercise oncology programs across the United States and beyond) and research and evaluation activities (including a Medicare pilot study). 

    One observation from many in the field of exercise oncology is that there is not an overarching organizational home for those who work in this field. A review of recent sports medicine annual meetings reveals less than 20 hours of exercise oncology-focused programming to be the norm. The small amount of exercise oncology content at such meetings does not reflect the progress in the field, the volume of work ongoing scientifically or the rise in the clinical practice of exercise oncology. There is real concern that this may constrain development of the field. Might it be time for a new scientific organization focused exclusively on exercise oncology? 

    A critical preconference planning meeting has been set for May 28, 2024, in advance of the ACSM annual meeting in Boston, to discuss the formation of the International Society of Exercise Oncology. The purpose of this society would be to create a central hub for the growing exercise oncology community, including exercise oncology researchers, clinicians, exercise professionals with specialty training in cancer, trainees, people living with and beyond cancer and potential sponsors. The meeting will feature panel discussions on multidisciplinary and international perspectives regarding the future of exercise oncology and audience insights and opinions will be encouraged. We welcome all to attend and be part of this critical movement in exercise oncology. ACSM annual meeting attendees can register as a supplement to the annual meeting registration

    Kathryn Schmitz, Ph.D., MPH, FACSM
    , is a professor of medicine at the University of Pittsburgh School of Medicine. She serves as associate director of population science and co-leader of the Biobehavioral Cancer Control Program for the UPMC Hillman Cancer Center. Dr. Schmitz is the founder of ACSM’s Moving Through Cancer initiative, which has a bold goal of making exercise a standard of care in the setting of oncology by 2029. She is a past president of ACSM and the recipient of the prestigious Citation Award from ACSM, the Distinguished Scientist Award from the Society of Behavioral Medicine, an honorary fellowship from the Faculty of Sport and Exercise Medicine U.K., and the American Cancer Society’s Clinical Research Professorship. 

    Allison Betof Warner, M.D., Ph.D.
    , is an assistant professor of medicine (oncology), director of the Melanoma Program, director of Solid Tumor Cellular Therapy, and Mark & Mary Stevens Endowed Scholar in Melanoma at Stanford Cancer Institute. Dr. Betof’s laboratory focuses on modulating tumor microenvironment to overcome resistance to immunotherapy. A large focus of her work is on immunomodulatory effects of exercise, and her lab utilizes preclinical models to study how exercise may enhance anti-tumor immunity. She is the principal investigator of clinical trials exploring novel treatments for immunotherapy-refractory melanoma and is internationally recognized for her expertise in brain/CNS metastasis and the use of novel cellular therapies. 

    Karen Wonders, Ph.D., FACSM
    , is the founder and CEO of Maple Tree Cancer Alliance and professor/program director of exercise physiology at Wright State University. Her passion is to advocate for exercise as part of the national standard of care for cancer. Her nonprofit organization (Maple Tree) provides free exercise training to thousands of cancer survivors every month at 65 clinical locations across the United States. An avid researcher, Dr. Wonders is committed to evidence-based practice in her facilities and leads a robust research program on exercise and cancer recovery. Dr. Wonders has given numerous professional presentations, including a talk at TEDxDayton on Exercising through Cancer Care. 

    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. 
  • Bold Goals and New Roles: The ACSM Committee on Certification and Registry Boards

    by Greg Margason | Mar 20, 2024

    Leadership transitions give organizations the opportunity to reflect on their achievements and determine how said achievements make for lasting and impactful change. The American College of Sports Medicine® (ACSM) recently adopted a new and exciting vision, to “extend and enrich lives through the power of movement,” and mission, to “educate and empower professionals to advance the science and practice of health and human performance.” The ACSM Committee on Certification and Registry Boards (CCRB) is committed to supporting the vision and mission of the college by ensuring that ACSM certified exercise professionals have the knowledge, skills and abilities to safely and effectively help people live longer, healthier lives. As a result of their connection to the college, ACSM certified professionals have access to the latest research and the newest developments in the field. Moving science into practice is the hallmark of the ACSM certified professional.

    Over the past three years, the CCRB has actively listened to our stakeholders, including prospective certification candidates, currently certified professionals, faculty members, employers and industry leaders. The invaluable information they’ve shared includes their collective challenges, which has provided us with the opportunity to prioritize our strategies, tactics and actions to ensure that we are best serving those who have invested in ACSM certification.

    When ACSM revisited its mission and vision in 2023, it prompted us to likewise engage in strategic planning to ensure our goals for the committee’s future both align with those of our parent organization and support the unique needs of ACSM certified professionals. This engaging and exciting process resulted in the formulation of one goal unique to the CCRB: “Make ACSM the home for prospective and current certified professionals.” We are committed to supporting the development of preparation materials, certification exams and continuing education experiences that enhance the experiences of ACSM certified professionals across their careers.

    Our committee found that three other goals adopted by the college also reflected our values. These include efforts to create a compelling customer experience, deliver an ongoing commitment to technology and build a fiscally sustainable organization.

    Therefore, the CCRB’s four bold goals provide the roadmap for our future work. The initiatives described below will help us get closer to achieving our newly stated mission: “Advance the credibility and integrity of ACSM certified professionals through career-long development with evidence-based practices to benefit all.”

    In 2023, the CCRB created the Employer Advisory Council (EAC), which brought employers together to provide feedback on how ACSM can be a key resource for their employees. Through these meetings, we learned what challenges employers have in hiring exercise professionals, what employees are looking for in certifications and continuing education, barriers that prevent them from obtaining needed continuing education credits, and topics that are relevant to their growth and development. ACSM’s commitment to better serving its professionals through the EAC has helped us identify potential opportunities for collaboration with employers. Similarly, we are working to establish a Faculty Advisory Council that will help us better understand how we can support exercise science faculty and their students, particularly as the latter transition from students to exercise professionals.

    Meanwhile, the CCRB’s Continuing Professional Education (CPE) subcommittee has been working diligently to set the policy for recertification and continuing education programs. The subcommittee has developed a new framework for evaluating the applications of new and renewing education providers to better determine if their content is acceptable for the certification program they are applying for. The CCRB acknowledges that our industry is everchanging and that continuing education programs must meet the competencies of our four certification programs; by providing relevant continuing education opportunities, we aim to support our members and certified professionals throughout all levels of their careers.

    Crucially, in 2023, ACSM and the CCRB partnered with the IDEA® Health & Fitness Association to produce the 2023 Fitness Industry Compensation Trends Report, which explores compensation benchmarks, regional disparities and the overall importance of certifications and specializations on certified professionals’ compensation, among other insights. Information like this is essential for certified professionals and other members of the industry who want to understand how the certification and continuing education choices they make impact their future financial and career success. ACSM members can view the report for free.

    The CCRB will also continue to work on other initiatives, including an investment in our website to create a more user-friendly experience, using our association management system to collect valuable data that will be used to further advance our mission and working with our partners on all areas of our strategic plan.

    We look forward to the work ahead of us as we support and advance the efforts of our members and certified professionals.


    Christie L. Ward-Ritacco, Ph.D., FACSM, ACSM-EP, EIM, is an associate professor and graduate program director in the Department of Kinesiology at the University of Rhode Island. Dr. Ward-Ritacco is the immediate past chair of the ACSM Committee on Certification and Registry Boards (CCRB) and is actively working with an ACSM task force pursuing recognition and reimbursement for exercise professionals as qualified health care providers.



    Lauren Korzan, M.A., ACSM-EP, ACSM-GEI is the Southeast Regional Program Manager for Aquila, overseeing a large multi-site fitness program in Atlanta, as well as providing remote management and support for additional fitness programs in the Southeast region. With over 20 years of fitness management experience, she is responsible for all aspects of fitness center operations, staff development, and fitness and wellness programming. Lauren is the chair of ACSM’s Committee on Certification and Registry Boards and serves on a variety of ACSM committees, including the International Health and Fitness Summit Planning Committee and the Strategic Planning Committee. In her free time, she enjoys reading, teaching group fitness classes, and spending time with her husband and daughter.


  • ACSM and EIM: Developing a Network of Trusted Exercise Professionals

    by Greg Margason | Mar 20, 2024

    Individuals seeking expert guidance in becoming physically active face a marketplace full of exercise professionals with certifications from several reputable, and sometimes not-so-reputable, organizations. With so many exercise certifications available in the U.S. market, there is often widespread confusion as to who are trusted sources of expert guidance.

    The American College of Sports Medicine(ACSM) has long been the gold standard in certifying exercise professionals through multiple certification and continuing education programs. More recently, ACSM has been playing a major role in establishing national standards for exercise professionals under the United States Registry of Exercise Professionals® (USREPS), an effort to secure recognition of registered exercise professionals for their distinct roles in medical, health, fitness and sports performance fields.

    The EIM Credential

    ACSM originally launched the Exercise is Medicine® (EIM) Certification in 2012 to identify exercise professionals who were the most qualified to work with patients in health care settings. In 2021, the structure and requirements for the EIM Certification program were strategically reimaged as a specialty program (the EIM Credential), often referred to as an educational certificate. Educational certificates are advanced training programs used to expand a certified professional’s ability to practice in certain fields: (1) in emerging fields with limited information about and/or ongoing research into the efficacy of a particular service/program, (2) fields that require additional training knowledge or skills to safely and effectively work with clients/patients who have unique considerations, or (3) both.

    The EIM Credential includes information about working with patients with common chronic medical conditions (e.g., hypertension, dyslipidemia, obesity, metabolic syndrome, nonalcoholic fatty liver disease, prediabetes and type 2 diabetes, osteoarthritis, low back pain) in their community or referred to them by health systems and health care providers. In addition, the EIM Credential requirements were updated and simplified to make it easier for health care providers to understand and refer patients to credentialed professionals. The EIM Credential distinguishes exercise pros as skilled professionals trained to work as an extended part of a health care team and guide individuals of all age groups and with multiple co-morbidities to better health through physical activity.

    Learn more about how you can earn the EIM Credential.

    Launch of the new EIM Credential online course

    eim_course_email_thumbnailA main requirement for earning the EIM Credential is completing a newly released interactive online course that can be completed asynchronously (at your own pace). The latest version of the EIM Credential online training course was developed by senior course editors Robyn Stuhr, M.A., FACSM, and Cedric Bryant, Ph.D., FACSM, through a yearlong process leading to its official launch in June 2022. The course involved input from more than 35 ACSM subject matter experts, who provided their expertise in developing content and providing the most current information on physical activity in alignment with U.S. Physical Activity Guidelines and ACSM’s Guidelines for Exercise Testing and Prescription.

    The new, interactive EIM online course consists of 17 sections grouped into five modules:

    • Health Care Basics
    • Exercise Prescription for Common Chronic Medical Conditions
    • Exercise Prescription for Older Adults
    • Facilitating Behavior Change 
    • Exercise Prescription in Special Settings

    Learn more about the EIM Online course.

    Benefits of the EIM Credential training course

    The EIM Credential presents an opportunity for exercise professionals to gain additional training and offers a pathway to become an active part of the EIM movement. Whether you receive referrals from a health care provider or simply work with clients who have chronic diseases, the EIM online course will prepare you to safely guide individuals in becoming more physically active.

    Since its release, the latest version of the EIM Credential online course has been completed by more than 1,000 exercise and allied health professionals. You can register for the online course in its entirety or take individual modules of interest. Those who complete the online course have the option of following a simple process to obtain the EIM Credential.


    Mark Stoutenberg, Ph.D., MSPH, is a Professor in the Department of Sport and Exercise Science at Durham University in the United Kingdom. He has always worked as a consultant with Exercise is Medicine since 2013.



    Special thanks to Robyn Stuhr, MA, ACSM-CEP, FACSM, Shelby Mandla, and Francis Neric, MS, MBA for their contributions to this piece.