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Welcome to ACSM's Blog An international resource fueled by the science of sports medicine The ACSM blog brings you up-to-date commentary from top ACSM experts around the world. Opinions expressed in the Sports Performance Blog are the authors’. They do not necessarily reflect positions of ACSM. Join the conversation on (http://http://www.facebook.com/pages/American-College-of-Sports-Medicine/64402266263? sk=messages_inbox&action=read&tid=id.208573645937254#%21/pages/American-College-of-Sports-Medicine/64402266263)Facebook (https://www.facebook.com/#%21/pages/American-College-of-Sports-Medicine/64402266263) and Twitter. (http://twitter.com/acsmnews) What’s Changed: New High Blood Pressure Guidelines (acsm-blog/acsm-blog/2017/12/01/new-high-blood-pressure-guidelines) by Guest Blogger | Dec 01, 2017 by Linda Pescatello, Ph.D., FACSM and Dr. Paul Thompson, M.D., FACSM High blood pressure (hypertension) is redefined for the first time in 14 years by the American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines (). The new threshold for high blood pressure is 130or 80 mmHg versus the old standard of 140 or 90 mmHg, as was defined by the Joint National Committee Seven on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)1 (). The change means 46 percent of adults in the United States now have hypertension, compared with 32 percent according to the old JNC 7 definition. Furthermore, the JNC 7 term prehypertension, defined as a resting systolic blood pressure from 120 to 139 mmHg or diastolic blood pressure from 80 to 89 mmHg, has been eliminated, and the new term elevated blood pressure, defined as resting systolic blood pressure from 120 to 129 mmHg and diastolic blood pressure < 80 mmHg, has been added. See the figure below for the new blood pressure classification scheme and other Highlights (C:\Users\Linda Pescatello\Documents\ACSMEXHTNPSREV\ACSM Blog New HTN Guidelines\public\@wcm\@sop\@smd\documents\downloadable\ucm_497445.pdf) from the new 2017 Guideline for the Prevention, Treatment, Evaluation and Management of High Blood Pressure in Adults2. What do the new guidelines mean for your patients and clients with high blood pressure? According to Dr. Paul Thompson, Chief of Cardiology at Hartford Hospital, and 42nd President of the American College of Sports Medicine, If you had come into my office in the past in that 130-to-140 mmHg range, I might have left you alone, maybe told you to keep an eye on it, improve your diet or exercise more. Even though the new guidelines recommend not prescribing medications for most patients ()* until they reach 140/90 mmHg, I think many doctors will. Keep in mind these are guidelines, not rules, so it will be up to the doctor to decide. This is also a lifestyle alert. The lower hypertension definition gives people a better chance to address their high blood pressure with exercise, weight loss, better diet, less sodium, and moderate alcohol use. What do the new guidelines mean for you, the exercise professional? The good news, as Dr. Thompson indicates, is the new guidelines are a lifestyle alert. Indeed, they state, “Even though more people will be classified as having hypertension . . . nearly all of these new patients can treat their hypertension with lifestyle changes instead of medications . . . with the biggest impacts being changes to diet and exercise.” In the report (http://hyper.ahajournals.org/content/early/2017/11/10/HYP.0000000000000065), physical activity was rated among the best nonpharmacologic interventions for the prevention and treatment of hypertension as it lowers blood pressure 5 to 8 mmHg among adults with hypertension3. The blood pressure lowering effects of exercise occur from lower to higher intensity, when exercise is continuous or accumulated in shorter bouts, and after both aerobic and resistance exercise. Dr. Thompson also likes to emphasize to his patients that you do not have to “get in shape” to get the blood pressure benefits from exercise since blood pressure is lowered immediately following a single session of exercise for up to 24 hours. In other words, 30 minutes a day of exercise, might help keep the medicines away. Nonetheless, the immediate blood pressure lowering effects of exercise, termed postexercise hypotension, were not addressed in the report (http://hyper.ahajournals.org/content/early/2017/11/10/HYP.0000000000000065). The new guidelines recommend 90 to 150 minutes per week of moderate-to-vigorous intensity, aerobic and resistance exercise training which is a bit of a departure from the American College of Sports Medicine (ACSM) recommendations regarding intensity and modality4,5. However, since the publication of the ACSM position stand on exercise and hypertension over a decade ago, accumulating evidence indicates the importance of higher exercise intensity6, and dynamic resistance7 and concurrent (i.e., aerobic and resistance combined)8 exercise in addition to aerobic exercise to lower blood pressure among adults with hypertension. The ACSM is in the process of revising its 2004 position stand on exercise and hypertension as a systematic review and meta-analysis of this newer evidence. Stay tuned! *Those with known cardiovascular disease, diabetes melllitus, or chronic kidney disease or an atherosclerotic cardiovascular disease risk score >10%, the new guideline recommends both lifestyle and pharmacological treatment for those with a systolic blood pressure >130 mmHg or diastolic blood pressure >80 mmHg. If the atherosclerotic cardiovascular risk score is 140 mmHg or diastolic blood pressure >90 mmHg, lifestyle and pharmacological treatment are recommended. Learn more here. (file:///C:/Users/ckinser/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/LEKFDYO3/Greenland_2017.pdf) References 1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL,Jr, Jones DW, Materson BJ, Oparil S, Wright JT,Jr, Roccella EJ, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung,and Blood Institute, National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42(6):1206-52. 2. The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines released the 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults [Hypertension, 2017]. 3. Cornelissen, VA, Smart, NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013b. 2(1):e004473 4. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA, et al. American College of Sports Medicine position stand: Exercise and hypertension. Med Sci Sports Exerc. 2004;36:533-53. 5. ACSMs Guidelines for Exercise Testing and Prescription 10th Edition. Riebe, D (senior ed.) and Ehrman, JK, Liguori, G, and Magal, M (assoc. eds.). Philadelphia, PA: Wolters Kluwer Health, 2018. 6. Pescatello LS, MacDonald HV, Ash GI, Lamberti LM, Farquhar WB, Arena R, Johnson BT. Assessing the existing professional exercise recommendations for hypertension: A review and recommendations for future research priorities. Mayo Clin Proc [Internet]. 2015 Jun;90(6):801-12. 7. MacDonald, HV, Johnson, BT, Huedo-Medina, TB, et al. Dynamic Resistance Training as Stand-Alone Antihypertensive Lifestyle Therapy: A Meta-Analysis. J Am Heart Assoc. 2016. 5(10):#pages# 8. Corso, LM, Macdonald, HV, Johnson, BT, et al. Is Concurrent Training Efficacious Antihypertensive Therapy? A Meta-analysis. Med Sci Sports Exerc. 2016. 48(12):23982406 Linda Pescatello, PhD, FACSM, is a Distinguished Professor of Kinesiology at the University of Connecticut. Her research on topics including exercise and hypertension, physical activity interventions and exercise genomics (among other topics) has been widely published. She was the recipient of an ACSM Citation Award in 2011, and served as the Senior Editor for ACSM's Guidelines for Exercise Prescription and Testing, 9th edition. Dr. Paul Thompson, M.D., FACSM is the Chief of Cardiology at Hartford HealthCare Heart and Vascular Institute in Hartford, CT. His research in the area of heart disease and cardiac function have been widely published. He served as the 42nd President of the American College of Sports Medicine 1998-1999.

Sales of activity trackers booming, but more research is needed on their benefits (acsm-blog/acsm-blog/2017/11/27/activity-trackers-booming-despite-lack-scientific-proof) by Guest Blogger | Nov 27, 2017 by Carol Kennedy-Armbruster, Ph.D., FACSM Activity trackers (ATs) are once again at the top of the ACSM fitness trends (clocking in at #3 on the 2018 list (http://journals.lww.com/acsmhealthfitness/Fulltext/2017/11000/WORLDWIDE_SURVEY_OF_FITNESS_TRENDS_FOR_2018__The.6.aspx)). Why is this? With 80 percent of the US population failing to meet the recommended cardiorespiratory and resistance training guidelines, maybe people are looking for a different and/or more convenient way to motivate themselves toward a healthy lifestyle. It is hard to research ATs in this world of changing technology. We do not know if wearing ATs changes behavior over time (the research is mixed and not very robust) but we know the business of ATs is booming. It is expected that ATs will generate $53 billion in sales by 2019, and an estimated 75 million people will use an AT by 2021! Has technology invaded the fitness world much the same way it has invaded many other aspects of our lives? The real question is: IS THIS HEALTHY AND DO THEY WORK TO SUSTAIN A LIFESTYLE CHANGE? Currently we do not have enough research to say one way or the other. Two past HFJ articles on ATs by Segar (1) and Kiessling et al. (2) shed some insights on this dilemma. Segar, a motivation scientist at the University of Michigan, suggested ATs, although valuable tools, are only tools, and that something additional must be included to provide motivation (1). Segar believes ATs do not address behavior change sustainability. She suggests you must realize WHY you want to move BEFORE you start counting steps. Kiessling et al. (2) initiated a Ready to Move (RTM) program combining activity tracker usage with health coaching (2). The health coaches were students enrolled in a course that taught motivational interviewing and behavioral intervention strategies. The students were encouraged to address clients’ core motivations for movement. Participants in this program did experience success in learning about the devices, and they stated that they enjoyed the freedom the device allowed for fitting movement into their day. A research focus that includes behavioral components of the impact of ATs might help us to understand their effects. Technology continues to challenge us to look at new and different ways to accomplish goals. What we do know is that ATs (whether accurate or not) have intrigued us to count steps, self-motivate, and participate in social challenges with others to move more and sit less. If this top ACSM trend is going to continue, our hope is that researchers focus on a behavioral/social perspective and research the impact of ATs on sustainable behavior change. For now, let us appreciate that ATs are here to stay whether we like them or not (and whether they are accurate or not). One thing is for sure; they cost less and are much easier to transport and move than weights and treadmills. In addition, they remind us that there is more to health and wellness than movement/exercise alone since they also track sleep, getting up regularly, and other health parameters. 1. Segar M. Activity trackers and motivational science. ACSMs Health Fit J. 2017; 21(4): 8-17. (http://journals.lww.com/acsmhealthfitness/Fulltext/2017/07000/ACTIVITY_TRACKING___MOTIVATION_SCIENCE__Allies_to.6.aspx) 2. Kiessling B, Kennedy-Armbruster C. Move more, sit less, be well. Behavioral aspect of activity trackers. ACSMs Health Fit J. 2016; 20(6): 26-31. (http://journals.lww.com/acsm-healthfitness/Fulltext/2016/11000/MOVE_MORE,_SIT_LESS,_AND_BE_WELL__Behavioral.8.aspx) Carol Kennedy-Armbruster, Ph.D., FACSM, is a Senior Lecturer within the Department of Kinesiology at Indiana University, Bloomington. She has worked in both the private and university setting during her 30 years in the fitness/wellness industry as an educator and supervisor of fitness staff. She has taught/created academic courses on group leadership, personal training, and fitness management and produced books and DVD’s on group exercise, water exercise and functional exercise progressions. Shehas served on multiple editorial/review committees and advisory boards during hertenure as a member of ACSM. She has presented both nationally and internationally on various fitness/wellness topics and is certified as a Group Exercise Instructor & Health Fitness Specialist. Moving Health: Celebrating the 10th Anniversary of Exercise is Medicine® — Much Accomplished, Much More to Do! (acsm-blog/acsm-blog/2017/11/21/10thanniversary-exercise-is-medicine) by Guest Blogger | Nov 21, 2017 by Robert Sallis, M.D., FACSM It is hard to believe that this month (November) marks 10 years since the Exercise is Medicine® (EIM) initiative was created during my tenure as president of the American College of Sports Medicine. It is exciting to look back and reflect on how far this initiative has come and where it can go in the future. As a family medicine physician, I have observed firsthand the harmful effect that a sedentary lifestyle can have on my patients. And, as an ACSM member, I became keenly aware of the vast scientific evidence base being assembled that has clearly demonstrated the health benefits of being physically active. It was obvious to me that, if such compelling evidence had been developed around a pill or surgical procedure, every doctor around the world would want to prescribe it to their patients — in fact, it would be malpractice not to do so! To me, it made perfect sense back in 2007 to use my pulpit as ACSM president to work toward making physical activity assessment and exercise prescription a standard part of the disease prevention and treatment paradigm for all patients. Along with that, I felt we needed to work toward merging the fitness industry with the health care industry so that physicians could refer inactive patients to a fitness professional and perhaps avoid increasingly costly pills and procedures. The first five years of EIM mainly involved getting the word out, building infrastructure and establishing collaborations (see SMB, May 17, 2011 (http://www.multibriefs.com/briefs/acsm/qa5-17.htm)). During the last several years, there have been a variety of efforts to move EIM forward in an increasingly complex and changing health care landscape, including education, partnerships, outreach and policy work. Some key highlights include: 1. Building an EIM global health network, including seven regional centers that coordinate EIM partnerships in some 43 countries around the world. These are linked by a robust website (http://www.exerciseismedicine.org/support_page.php/about/) designed to enhance communication and collaboration across this network; 2. Establishment of the World Congress on Exercise is Medicine as a central component of the ACSM annual meeting. The congress provides an annual dynamic forum for scientists, clinicians, health policy specialists and others to share the latest information on research and build collaborations across the country and around the world; 3. Growth of a vibrant EIM on Campus network that now includes 164 college and university campuses around the world and is still growing; 4. Development of a global EIM CME course to teach health care providers how to assess, counsel and refer patients for physical activity prescription to treat and prevent chronic disease; 5. Creation of an EIM Credential to qualify all NCCA (http://www.credentialingexcellence.org/ncca)-certified fitness professionals to receive and work with patients referred from health care providers; 6. Successful piloting of the EIM Solution model — linking clinical care/Physical Activity Vital Sign (PAVS) to community networks — at the Greenville Health System and the Greenville YMCA; 7. EIM partnerships with various health care associations and fitness organizations that have helped drive important programs to improve physical activity; specific partnerships include the Surgeon General’s Call to Action on Walking, the Every Body Walk! Collaborative and the Prescription for Activity Task Force. On this 10th anniversary of EIM, the ACSM Board of Trustees has begun a process entitled “EIM Re-imagined,” the goal of which is to redefine EIM priorities to help guide its program efforts in the coming years. Key areas for advancement will include further establishing the use of the PAVS as a standard of care around the world. That standard encompasses identification of all inactive patients, counseling them and, perhaps, referring them to a qualified fitness professional as part of the EIM Solution. Working to establish collaborations with the health club and fitness industries is the third component of the EIM Solution. It requires redefining the role of fitness professionals and the clubs where they deliver exercise services — enabling them to provide patients with therapeutic exercise to prevent and/or treat chronic disease. Along with this should come reimbursement for services and recognition of the vital role the fitness industry can play in improving global health. We also want to expand the reach of EIM On Campus so that no student will leave a college campus less fit than when they entered and without a lifetime plan for their personal fitness. Further, there are plans for advocacy initiatives to increase funding support available for physical activity research; this initiative should emphasize funding for interventional studies to compare use of physical activity interventions in place of pills and procedures, as well as studies focused on clinically relevant behavior change and on sustaining lifelong physical activity habits. Finally, the ACSM Board of Trustees has established an EIM governance board to guide and work closely with our new vice president of EIM, Robyn Stuhr, M.A., ACSM-RCEP. Robyn is a longtime member of ACSM who brings more than 30 years of clinical and leadership experience in health care, including sports medicine, health promotion, business and occupational health, and cardiac rehabilitation. She is positioned to be the perfect addition to the EIM team that will help achieve the lofty goals set for the next 10 years. We hope that all ACSM members will look for their niche in the EIM program and contribute to its advancement at your local, state, national and international levels. For more information and to get involved with Exercise is Medicine, contact us at [email protected] (mailto:[email protected]). Robert E. Sallis, M.D., FACSM, served as the 51st President of ACSM and chairs the Exercise is Medicine® Advisory Board. He originated the EIM concept and has been its leading advocate from the beginning. Dr. Sallis earned an M.D. from Texas A&M University and completed his residency in family medicine at Kaiser Permanente Medical Center in Fontana, California. He has continued his medical career with Kaiser and now co-directs their sports medicine fellowship training program. Dr. Sallis is the founding editor-inchief of ACSM's Current Sports Medicine Reports journal. Exercise Is Medicine® was launched in partnership with the American Medical Association and continues to grow as a global health initiative. The life of a manuscript: The peer review process (acsm-blog/acsm-blog/2017/10/30/life-of-a-manuscript-peer-review-process) by Guest Blogger | Oct 30, 2017 By L. Bruce Gladden, PhD, FACSM Many people may wonder why an article from a scientific journal should be considered more credible than one from a magazine on the grocery shelf. The most basic reason is peer review. But what is peer review? When a scientist performs a research study, analyzes his/her data, and writes a manuscript, he/she will submit the work to a journal in hopes of having it published. Any respected scientific journal will subject these manuscripts to a rigorous review by scientific experts (the author's peers) prior to publishing. Here is the typical series of events in the life of a manuscript: 1. The journal receives a submission. The first step is to check to see if it has followed the journal’s guidelines for formatting. 2. The Editor-in-Chief of the journal looks at the manuscript to see if it is worthy of further consideration. A few manuscripts are rejected at this stage for a variety of reasons: it’s not a good fit for the journal’s audience, poor methods, lack of new information. 3. If the manuscript passes this first simple test, the Editor-in-Chief will assign it to an Associate Editor who has expertise in the area of the manuscript. This Associate Editor will make his/her own additional assessment regarding whether the information in the manuscript is sufficiently new or important enough to warrant a full peer review. 4. If the manuscript passes this assessment, it is usually assigned to 2-3 reviewers (peers) who are experts in the area of research reported in the manuscript. These reviewers then perform a very detailed critique of the manuscript, including consideration of: the subject population, methods employed, appropriate analysis of the results (both statistics and interpretation) and novelty and uniqueness of the study. The reviewers especially consider if the study increases our knowledge about the topic being investigated. They then rank the manuscript in terms of overall quality. 5. The critiques of the expert reviewers are then returned to the Associate Editor who carefully considers this feedback and decides whether to reject the manuscript, or to allow the authors an opportunity to revise it. By far, most rejections occur at this stage. 6. If the Associate Editor allows revision, the revised manuscript will undergo the same rigorous scientific review that the original manuscript received, and most likely will ultimately be accepted. For many high-quality journals, no more than 25% of the submitted manuscripts make their way to acceptance and publication in the journal. The rigor of this process leads some scientists to say that a career in science is a lifetime career of negative reinforcement. Scientists are constantly receiving critiques of their work. Rarely would the first response to a submitted manuscript be, “Wow, this is really great!” However, these critiques are what make peer reviewed articles so reliable, and they protect the integrity of the scientific community.

ACSM published five scholarly journals. You can learn more about those publications and read articles here (http://www.acsm.org/public-information/acsm-journals). L. Bruce Gladden, Ph.D., FACSM, is a professor at Auburn University’s School of Kinesiology. His work is focused on the role of lactate in skeletal muscle and whole-body metabolism. He is the author or co-author of more than 75 refereed research articles and reviews, and his investigative work has attracted research funding from the National Institutes of Health, National Science Foundation, NATO and private research foundations. Dr. Gladden has served as president of the southeast chapter of ACSM, a member of the ACSM Board of Trustees and he is currently the editor-in-chief of Medicine & Science in Sports & Exercise®. He was the recipient of an ACSM Citation Award in 2015 in recognition of his significant contributions to sports medicine and the exercise sciences.

Interval-based exercise: So many names, so many possibilities (acsm-blog/acsm-blog/2017/10/26/interval-based-exercise-many-names-possibilities) by Guest Blogger | Oct 26, 2017 By Marcus Kilpatrick

Though the idea of interval-type exercise has been around for more than a half a century and has helped countless athletes achieve record performance, the last decade has witnessed an explosion of interest by researchers and excitement for individuals aiming to get in better shape. The recent enthusiasm for interval-based exercise can be traced to research from Canada and Europe in the early 2000s. The research in Canada started with exercise protocols that required participants to pedal at an all-out intensity for 30 seconds before recovering for a few minutes and then doing it again and again several more times. In contrast, the European research utilized relatively long but less intense intervals in cardiac patients. Findings from these studies demonstrated that interval-based exercise is a powerful tool for improving exercise performance and health. The workout by any other name would still be effective This form of training is so flexible that it has produced an endless number of training options and several different names to describe it. High-intensity interval training (or HIIT or HIT) is likely the most common name but several other labels exist as well, including sprint interval training (or SIT) or high-intensity interval exercise (or HIIE). One other aspect of flexibility around HIIT relates to the style of exercise. Most of the original HIIT workouts focused on what many call “cardio HIIT” in that it utilizes traditional cardio-based exercise options such as running and cycling. However, much of the contemporary use of HIIT is perhaps best described as “body weight HIIT” and includes some combination of resistance exercise and calisthenics. Most of the research to date is based on cardio types of HIIT but all signs point towards both forms of HIIT being highly beneficial. Get your motor running The important idea behind all forms of HIIT is providing an intense phase of exercise followed by a period of recovery. Each phase can range from a few seconds to a few minutes and are conducted across a range of intensities. The number of ways that HIIT can be configured is almost too numerous to count and perhaps this multitude of options is one of the reasons that so many people across a wide range of age, fitness and exercise experience seem to prefer this form of exercise over continuous exercise. Though planning and implementing HIIT is somewhat more complex than continuous exercise, its flexibility makes it a very attractive option for both new exercisers and the hardcore fitness junkie. One important consideration around HIIT is that it provides the exerciser the opportunity to experience the extra benefits of intense exercise without creating an experience that is negative or unpleasant. While there is no magic recipe for creating the perfect HIIT experience, research suggests that a good approach is to avoid the combination of work intervals that are both long and extremely intense. Longer intervals should be paired with high intensities, while shorter intervals can be paired with very high intensities. Exercisers should seek to create a HIIT experience that provides a great workout while simultaneously building confidence and producing positive attitudes and emotions. HIIT is an approach to exercise that provides a great opportunity to boost health and fitness in a variety of populations. All that is needed is a bit of patience in finding the right style and approach to HIIT and a willingness to try new versions and variations to keep things fresh and interesting. HIIT has been named the #1 Fitness Trend for 2018 via ACSM's Worldwide Survey. To learn about the other trends, check out this article (http://journals.lww.com/acsmhealthfitness/Fulltext/2017/11000/WORLDWIDE_SURVEY_OF_FITNESS_TRENDS_FOR_2018__The.6.aspx) in ACSM's Health & Fitness Journal.

Dr. Marcus Kilpatrick earned his bachelor’s degree from Florida State University in 1994, his master’s and doctoral degrees from the University of Texas at Austin in 1996 and 1999. He joined the faculty at USF in 2004 after spending five years at Southeastern Louisiana University in Hammond, Louisiana. Dr. Kilpatrick’s teaching efforts are linked to the undergraduate and graduate Exercise Science programs. His teaching experiences and responsibilities are varied but primarily focus on sport and exercise psychology, exercise testing and prescription, and research methods. Better sleep for breast cancer survivors starts with physical activity (acsm-blog/acsm-blog/2017/10/17/better-sleep-breast-cancer-survivors-physical-activity) by Guest Blogger | Oct 17, 2017 By Laura Rogers, M.D., M.P.H., FACSM Ah, a good night’s sleep is so sweet. Don’t you just wish you could save some of that feeling for when you haven’t slept well? This, of course, isn’t possible so experts recommend planning ahead so that what you do during the day will help you sleep better at night. Getting enough physical activity earlier in the day may be one of those things. But, what if you have had cancer and haven’t slept as well since your diagnosis and treatment? Can physical activity help, even then? The answer is yes, based on a recent scientific study published in Medicine and Science in Sports and Exercise (http://journals.lww.com/acsm-msse/Fulltext/2017/10000/Physical_Activity_and_Sleep_Quality_in_Breast.6.aspx). In this study, breast cancer survivors receiving a three-month physical activity intervention reported better overall sleep quality at the end of the intervention and three months later. How important is sleeping well for cancer survivors? Many cancer survivors have trouble sleeping well after their cancer diagnosis and treatment. Although this may improve over time, some cancer survivors struggle with trouble sleeping for months, or even years, after their diagnosis. This reduces their quality of life, worsens fatigue and depression, and increases risk of health problems. We don’t know for sure if sleeping well improves a cancer survivor’s chance of long term survival, but we do know that sleeping better is associated with living longer when measured in the general population. What is physical activity? Physical activity can be any movement that increases the number of calories your body burns. Although most people typically think of physical activity as walking on a treadmill, swimming laps, or going for a run, physical activity can include other activities such as gardening, walking your dog, parking further from the door, taking the stairs, etc. Our recent study focused on walking, because it is the form of physical activity most commonly preferred by cancer survivors. However, other studies have demonstrated yoga as another type of physical activity scientifically proven to help cancer survivors sleep better. What will be your next step? The intervention reported in the study also involved support from research staff and other cancer survivors—so choosing activities that connect you socially and help you feel less alone may help, too. The bottom line is that your good night’s sleep starts earlier in the day, so find a friend or family member and get moving! Dr. Laura Rogers is a Professor in the Department of Nutrition Sciences at the University of Alabama at Birmingham (UAB) and a Senior Scientist in the UAB Nutrition Obesity Research Center (NORC), Center for Exercise Medicine, and Cancer Control and Population Science Program of the UAB Comprehensive Cancer Center. She is a board certified internal medicine and obesity medicine physician in the UAB Weight Loss Medicine clinic. Her research focuses on exercise promotion and benefits in chronic disease populations, especially cancer survivors. Physical activity as possible depression prevention method (acsm-blog/acsm-blog/2017/10/10/physical-activity-depression-prevention) by Guest Blogger | Oct 10, 2017 By Chad D. Rethorst, Ph.D. Depression often results in significant economic and health burdens on society. One factor that contributes to this burden is the challenge in successful treatment of depression. Research indicates that nearly half of patients do not respond to initial treatment and one-third remain depressed even after multiple treatment attempts. While this indicates a need for more effective ways to treat people with depression, many researchers are also examining strategies to prevent depression. In my research, I’ve observed patients with depression whose conditions have improved by following an exercise program as a part of treatment. Now, a recent study published in the American Journal of Psychiatry (https://www.ncbi.nlm.nih.gov/pubmed/28969440)indicates that exercise may also be one way to prevent depression. The researchers who conducted this study found that 1-2 hours of exercise per week is enough to significantly reduce the risk of depression. People who reported no exercise were 44 percent more likely to be depressed in the future compared to those who exercised for 1-2 hours per week. While 1-2 hours per week may sound like a daunting goal for someone who doesn’t exercise, so it is even more encouraging that the results suggest that as little as 30 minutes of exercise per week may be beneficial. Also, the researchers found that the intensity of the exercise did not impact the preventive effect. So, one 30-minute walk per week may be enough to help prevent depression. While the results of this study are encouraging, more research in this area is needed. We need to develop effective interventions to increase exercise among persons at risk for depression and we need to understand the biology of how exercise prevents depression. With a greater understanding of these issues, we can hopefully reduce the burden caused by depression.

Chad D. Rethorst, Ph.D. Associate Professor Center for Depression Research and Clinical Care Department of Psychiatry University of Texas Southwestern Medical Center

Can my insurance pay for “the gym?”: An update on PHIT legislation (acsm-blog/acsm-blog/2017/09/18/insurance-phit-legislation) by Guest Blogger | Sep 18, 2017 By Monte Ward, ACSM Vice President of Government Relations Personal Health Investment Today, better known as PHIT is a campaign that was launched in January of 2013 by organizations like ACSM committed to healthy lifestyles. The mission of PHIT is to “dramatically improve the health of Americans, especially children, by implementing pro-activity programs.” The PHIT campaign also includes a legislative component: The PHIT Act (H.R. 1267/S. 482). This legislation is currently pending in Congress and would allow for reimbursement of physical activity expenses using pre-tax dollars in Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). The PHIT Act would expand the definition of a medical expense to include qualified physical activities as a form of disease and illness prevention.What does the proposed legislation mean for you and what will its impact be? The American College of Sports Medicine supports the PHIT Act because it will help American families to overcome financial barriers to active lifestyles. This legislation supports coverage of youth and adult sports league fees, youth sports camps, gym and health club memberships, pay-to-play school sports fees, exercise and yoga classes, required physical education uniforms, personal trainer fees, fitness tracking devices, sports and fitness equipment, bike rentals, and more. One of the top causes of death in The United States is physical inactivity, with 5.5 percent of all deaths in the United States caused by physical inactivity. Additionally, 80 percent of children are at risk for disease due to physical inactivity, and two-thirds of the youth population is not active at a standard level for health. If this dangerous trend is to improve, there must be a cultural change that starts with the young. The United States currently has the least physically active generation of children ever, and it is time to take a stand against sedentary behavior. The passing of the PHIT Act would be a strong show of support for the development of healthy lifestyles for American children and families.

Congress is expected to consider the PHIT Act as part of a broader tax reform package and we need your help. Contact your members of Congress and urge them to cosponsor the PHIT Act. (http://cqrcengage.com/acsm/app/onestep-write-a-letter?0&engagementId=397653) By showing our support, Congress will understand the importance of this critical legislation that encourages all Americans to lead active, healthy lives. ACSM advocacy efforts support evidence-based public policy that encourages healthy lifestyles and the safe enjoyment of sports and other physical activities. ACSM members serve as expert resources for federal, state and local policy makers, ensuring that decisions are founded on the latest research. For more information regarding ACSM Advocacy, click here (http://cqrcengage.com/acsm/?3). For the latest information, follow @ACSMadvocacy on Twitter! (https://twitter.com/ACSMAdvocacy) Stem cell treatments for youth sports injuries: Ready for prime time? (acsm-blog/acsm-blog/2017/08/25/regenerative-medicine-stem-cell-treatments-youth-sports-injuries) by Guest Blogger | Aug 25, 2017 By Clifton L. Page, M.D. If your child is an athlete and participates in sports, they may sustain an injury at some point. What do you tell your son or daughter after they have an injury that keeps them out of the sport they love? Thoughts of how long until they can return to play are filling their heads. How did their favorite sports heroes return to play so quickly? Today with rapid dissemination of information through social media and 140 characters, kids and parents have instant access to the latest and greatest trends in sports medicine injury treatment. Parents, coaches and young athletes ask sports medicine physicians which treatment allows the quickest return to sport. Over the last few years, we have seen an exponential increase in the interest of regenerative medicine, especially the use of mesenchymal stem cells (MSC) to assist athletes with returning to their sport quickly and safely after injury. Many parents or caregivers struggle to make an informed decision about the use of stem cells in injury recovery as these are newer, and less understood treatments. What is MSC? Mesenchymal stem cells are thought to accelerate the healing process for various musculoskeletal injuries such as torn ACLs. Studies have shown these cells have the capacity to form into specific types of cells, including bone, cartilage, muscle and ligament tissues. This specialization allows them to perform particular functions that may assist healing and repair at the precise site of injury. MSC cells are usually harvested from bone marrow or fat cells. Recent research suggests that MSC may provide a nonsurgical treatment option for conditions that affect muscle, tendons, ligaments and cartilage. This evidence, however, is limited in young athletes and based on a few, small, randomized clinical trials in adults. There have been reported benefits such as reduced pain and increased function in patients with osteoarthritis, especially after specific knee surgeries; however, it remains unclear whether these results would be similar in children or teens with sports injuries. Caution is needed when considering regenerative medicine in children and teens There has been an increase in the number of unregulated clinics advertising rapid recovery with use of stem cell therapies. These therapies may be marketed under names such as regenerative cells, healing cells or master cells. [Platelet Rich Plasma (PRP) injections are a separate form of therapy, but the concepts are often confused.] The American College of Sports Medicine urges patients and their families to exercise caution when considering these treatments. The hype surrounding stem cells makes them an exciting treatment option for many sports injuries. However, young athletes and their caregivers should be cautious in pursuing this as a first option for treatment. Despite the enormous potential, more studies are needed to determine their effectiveness in treating injuries and long-term safety among the pediatric athletic population. It is also important to note that often this treatment is not covered by insurance and can be very expensive. If more than one treatment is needed, the cost could skyrocket into thousands of dollars. For a more in-depth look at regenerative medicine therapies in youth and teen sports injuries, we recommend this article from the May/June 2017 issue of Current Sports Medicine Reports. (http://journals.lww.com/acsm-csmr/Fulltext/2017/05000/Not_Missing_the_Future___A_Call_to_Action_for.19.aspx) Clifton L Page, M.D., CAQSM, is a Primary Care Sports Medicine specialist at the University of Miami Miller School of Medicine in the Department of Orthopaedics and Family Medicine, Division of Sports Medicine. Dr. Page is in his eleventh year working with the University of Miami athletic teams as their team physician. Board certified in family medicine and sports medicine, Dr. Page's clinical interests include the non-operative care of sports-related injuries, especially tendinopathies, concussions, general medical conditions in the athlete, and sports injury prevention. Dr. Page received his undergraduate degree from the University of Notre Dame in 1998, and earned his medical degree from The Ohio State University. Increased instances of arthritic knees maybe not due to just “wear and tear” (acsm-blog/acsm-blog/2017/08/18/cause-increased-instances-arthritic-knees) by Guest Blogger | Aug 18, 2017 By: Lynn Millar, PT, PhD, FACSM We certainly know that knee pain is not a new phenomenon, but are people today living lifestyles that make it more common? Recently a study was published (http://www.pnas.org/content/early/2017/08/08/1703856114) suggesting that the incidence of arthritis has doubled since before the 1950s. In followup, another researcher examined bones from museums and medical schools (http://www.npr.org/sections/health-shots/2017/08/15/543402095/creaky-knees), and the findings also suggested an increase. While these stats may appear shocking, I think it is important to point out a few important factors: The population has expanded tremendously since prior to the 1950s The average age has increased Obesity has become a national epidemic The researchers said that even when correcting for body mass and age, there was still a large increase. This led the researchers to consider lifestyle factors. I have several thoughts related to this: Could it be that some of the changes are simply diagnosis – perhaps fewer individuals went to the doctor for knee pain prior to 1950, as they did not think there was anything abnormal about an increase in joint pain with aging? Knee replacement was not the go-to option in the early part of the 1900s, and medication options (and pain tolerance levels) have changed significantly since then. My grandmother told me knee and hip pain was a part of life! I agree with Drs. Richard Loeser and Lieberman that lack of activity may be a culprit of increased instances of arthritis. There has been a shift away from active careers toward sedentary desk jobs. Our bodies were not made to sit all of the time. As research has demonstrated time after time, exercise reduces arthritis pain and decreases the inflammation associated with arthritis. This seems to reinforce the need for motion and activity across the lifespan. It is true that injury is very predictive of the development of arthritis. However, I believe the benefits of regular exercise far outweigh the risk. One of the first components of therapy for someone with arthritis is exercise – a focus on strengthening muscles around the joint and increasing activity. Thus, I suggest that the focus should be on getting up and moving!

Lynn Millar has taught in Physical Therapy since 1987. Lynn has been active conducting and supervising research in diverse areas of physical therapy. While specialized in Exercise Physiology, she has expanded her expertise into Cardiopulmonary Rehabilitation and arthritis throughout the years. She has published numerous articles and presented regularly at the state, regional and national level. In addition to research articles, Lynn has authored several chapters related to arthritis, and one book, Action Plan for Arthritis. Lynn has been active in the American College of Sports Medicine, serving on regional and national committees. ACSM President's Vision (acsm-blog/acsm-blog/2017/08/08/acsm-president's-vision) by Guest Blogger | Aug 08, 2017 By Walter R. Thompson, Ph.D., FACSM In 1981, my mentor and friend Henry Miller, M.D., FACSM, became ACSM’s 25th president. Early on, Henry urged me to become involved in ACSM and, at the 1983 ACSM Annual Meeting induction reception, personally introduced me as one of the new Fellows. From that time on, one of my professional goals was to follow in his footsteps. It took more than 35 years, but now I am especially honored to be able to serve as your president for 2017-18. I have the good fortune to follow two great ACSM leaders, former President (2015-2016) Larry Armstrong, Ph.D., FACSM, and my leadership mentor, Liz Joy, M.D., FACSM, immediate ACSM past-president. ACSM presidents are often asked about their legacy programs, i.e., a unique initiative that they personally conceived, advocated and launched during their leadership year to advance the college’s mission. Exercise is Medicine® (http://exerciseismedicine.org/)(EIM) and ActivEarth (http://activearth.org/) are just two examples of these presidential legacies. Some have had immediate impact, while others take longer to gather momentum. All have had a major positive impact on ACSM. ACSM presidents need to be very careful and highly selective when announcing these legacy programs because not all members will agree. Some will be skeptical, others will be opposed and still others will be very happy to see them (finally) emerge as ACSM priorities. It will come as no surprise to anyone who knows me that my presidential priorities will be: Achieving greater inclusivity for engagement in physical activity for people with physical impairments; and Enhancing effectiveness of the EIM Solution (http://www.exerciseismedicine.org/support_page.php/the-eim-solution5/) in the Exercise is Medicine® initiative, focusing resources on innovative networking strategies that link community physicians to well-qualified fitness professionals who live and work in nearby cities and neighborhoods. As with any ACSM presidential priority, foundational work precedes an announcement and establishes the further development of ideas and programs. Let me briefly overview how each of these initiatives were developed and how we can, together, enrich them. Greater Inclusivity for People with Physical Impairments (This is one of those slowly developing legacy initiatives, just now gaining greater momentum.): After having served as the local research coordinator for the International Paralympic Committee (IPC) and for the Atlanta Paralympic Organizing Committee in 1996, I was asked to serve on the IPC Sports Science Committee. This latter committee was responsible for reviewing and coordinating research being conducted during IPC sanctioned events. The 1996 Paralympic Games was my first introduction to sports programs for athletes with a physical impairment; in more recent years, this has been extended to include athletes with an intellectual impairment, as well. I have had the very good fortune of attending every Winter and Summer Paralympic Games since 1996 and have worked with the most elite of athletes. More recently, ACSM has accomplished the following: In 2008, ACSM and the IPC signed a memorandum of understanding with the promise to work closely together; part of this agreement called for adding science and practice content on related topics to the ACSM Annual Meeting program; The 2017 Joseph B. Wolffe Lecture was delivered by IPC Sports Science Committee Chairperson, Yves Vanlandewijck, Ph.D., with the title “Crossroads and Conflicts: Olympics, Paralympics or Cyborg Olympics;” At the 2017 ACSM Annual Meeting in Denver, Cheri Blauwet, M.D. and Paralympic Champion became a member of the ACSM Board of Trustees; And, on May 10th of this year at the National Press Club in Washington, D.C., ACSM and the Inclusive Fitness Coalition (which was formed 10 years ago) announced a continuing partnership (http://acsm.org/about-acsm/media-room/news-releases/2017/05/10/inclusive-fitness-coalition-launches-new-partnership-for-inclusive-health) with the National Center on Health, Physical Activity and Disability (NCHPAD). The NCHPAD is housed at Lakeshore Foundation in Birmingham, promoting the Partnership for Inclusive Health. This Partnership is a strategic alliance between many organizations including the American Heart Association, the International Health, Racquet & Sportsclub Association (IHRSA), the National Association of Chronic Disease Directors (NACDD) and others. For this year and beyond, ACSM will continue to find ways to be more inclusive and discover new partners that we can work with to find solutions for the health issues and sports opportunities for people with disabilities. Enhancing the EIM Solution: The EIM program has received a lot of attention from ACSM over the past 10 years. However, a significant gap has been identified that has slowed broad implementation in communities. Routinely, doctors now ask their patients about physical activity and exercise. Some, of course, do provide basic exercise information. But, when a patient asks the doctor about community resources, there is a significant knowledge gap. One strategy ACSM has developed to close this gap is to create and deploy an EIM credential for certified fitness professionals. ACSM is also a founding member of the Coalition for the Registration of Exercise Professionals (CREP), which developed the U.S. Registry of Exercise Professionals (USREPS). USREPS provides local doctors with a significant resource to locate qualified fitness professionals right in their own communities, ensuring that their patients will get the very best (and safest) exercise program. This searchable database (www.usreps.org (http://www.usreps.org/)) is not yet well known, but could be one of the first steps for physicians looking to refer patients to well-qualified fitness professionals. My second presidential priority is to create a seamless referral network from physicians to these community resources. This network will enable physicians to answer the patient question, “Okay doc, I get it. I need to get more exercise, but where do I go and whom do I see?” These two presidential priorities are ambitious, but both are desperately needed in our communities. With the help of ACSM members who are basic and applied scientists, physicians and educators, as well as our affiliate members, we can get more people all over the world to become more physically active. ACSM’s new president is Walter R. Thompson, Ph.D., FACSM. He is a regents’ professor and associate dean for graduate studies and research in the College of Education & Human Development at Georgia State University in Atlanta. Walt, a member of ACSM since 1978, has served on and chaired several committees, including the Committee on Certification and Registry Boards and the International Relations Committee. In addition, he has served as chair of the American Fitness Index Advisory Board for 10 years. Active Voice: Protein Supplementation to Enhance Adaptations to Resistance Exercise Training - Not Supported by Scientific Evidence (acsm-blog/acsmblog/2017/07/25/active-voice-protein-supplementation-to-enhance-adaptations-to-resistance-exercise-training---not-supported-by-scientific-evidence) by Guest Blogger | Jul 25, 2017 By Paul T. Reidy, Ph.D., and Blake B. Rasmussen, Ph.D. Despite an abundance of conflicting evidence, the belief persists that protein supplementation during resistance exercise training will enhance muscle mass and strength. As such, protein supplementation is a several billion-dollar industry supported by strong dogma. This conception is heavily promoted in the lay population and is a solidified notion for the recreational and even the professional athlete. Unfortunately, this paradigm is perpetuated at times by researchers in the field - despite the impressive collection of scientific findings indicating otherwise! One important aspect of the ACSM mission is dissemination of accurate information derived from evidence-based research. In general, much emphasis in this ongoing activity of ACSM is given to advancing our understandings of the health and performance implications of participation in sport, exercise, and physical activity. The ACSM Position Stands and Joint Position Statements represent one venue to this end. The Nutrition and Athletic Performance Joint Position Statement (http://journals.lww.com/acsmmsse/Fulltext/2016/03000/Nutrition_and_Athletic_Performance.25.aspx) dedicates significant attention to the potential of protein supplementation to enhance adaptations to exercise training and metabolism. We suggest that more skepticism should be given to the promotion of protein supplementation during resistance exercise training to eliminate the current dogma. We have conducted a considerable amount of work examining whether protein supplementation enhances resistance exercise adaptations in young men. The first of these studies was the most extensive literature review to date of all clinical studies examining this question in both single exercise and longitudinal exercise training studies. The second was a series of publications on our clinical trials that further examined this question. After more than 6 years of work, this comprehensive and critical review was published in the Journal of Nutrition (http://jn.nutrition.org/content/146/2/155.long). We concluded that “although a plethora of single exercise supplement studies show a potent anabolic/metabolic effect with added protein supplementation …. a diminishing supplement effect occurs over a prolonged exposure to the stimulus after exercise training. Furthermore, we found that protein/amino acid supplements, combined with resistance exercise training, produced a positive, albeit minor, effect on the promotion of lean mass growth; a negligible effect on muscle mass; and a negligible to no additional effect on strength.” We also published findings* in MSSE (http://journals.lww.com/acsm-msse/Abstract/publishahead/Protein_Supplementation_Does_Not_Affect_Myogenic.97280.aspx) (see the June 2017 issue (http://journals.lww.com/acsm-msse/Abstract/2017/06000/Protein_Supplementation_Does_Not_Affect_Myogenic.17.aspx)) from a large clinical trial, recapitulating these findings. Alongside several other recent reports, these findings demonstrated that although whole body lean mass may be enhanced following resistance exercise training with protein supplementation, there are negligible to minimal effects on muscle mass and strength. Health professionals should be fully aware of the abundance of evidence demonstrating that, if a well-balanced diet is consumed, the adaptations of resistance exercise training will not be enhanced by protein/amino acid supplementation. Apart from sharing these findings and interpretations with our professional colleagues in this commentary, we believe that it is most important that it be clearly delivered to the lay population. *The MSSE paper mentioned in the above Active Voice commentary was supported in part by DuPont Nutrition & Health. Paul Reidy completed his Ph.D. dissertation in Dr. Rasmussen’s muscle biology lab at the University of Texas Medical Branch (UTMB), Galveston, Texas. He is currently a postdoctoral fellow at the University of Utah, Salt Lake City, Utah. Blake B. Rasmussen, Ph.D., is the Chair of the Department of Nutrition & Metabolism and the Associate Director of the Center for Recovery, Physical Activity & Nutrition at UTMB in Galveston. Dr. Rasmussen is an active ACSM member. This commentary presents Dr. Reidy’s and Dr. Rasmussen’s views on the topic of a research article that they had published with their colleagues in the June 2017 issue of Medicine & Science in Sports & Exercise® (MSSE). Viewpoints presented on the ACSM Blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Active Voice: Staying Independent in Later Life - The Role of Midlife Physical Activity (acsm-blog/acsm-blog/2017/06/23/active-voice-staying-independent-in-later-life--the-role-of-midlife-physical-activity) by Guest Blogger | Jun 23, 2017 By Barbara Sternfeld, Ph.D., FACSM

More than three decades ago, James Fries published a seminal paper in the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJM198007173030304) that predicted an expansion of the years of healthy, active life as a result of a delay in the onset of chronic disease and disability that would be greater than increases in overall life expectancy. He labeled this demographic shift the compression of morbidity. To those of us following in the steps of Drs. Jeremy Morris and Ralph Paffenbarger, Jr. in the thenemerging field of physical activity epidemiology, the compression of morbidity was a compelling hypothesis. Accumulating evidence for the role of physical activity in protecting against the major causes of morbidity and disability, such as coronary heart disease, hypertension, diabetes and some cancers, suggested that the lifetime burden of illness in the population could, indeed, be shortened by widespread adoption of regular physical activity. Since then, much demographic analysis and debate has focused on trends in morbidity and mortality and whether there is evidence for compression of morbidity. In 2011, Crimmins and Beltran-Sanchez examined age-specific disease prevalence and mobility-related functional status from 1998 to 2006 (https://academic.oup.com/psychsocgerontology/article/66B/1/75/583170/Mortality-and-Morbidity-Trends-Is-There). They based their analyses on data from the National Health Interview Survey, along with age-specific mortality rates from official U.S. life tables for the same years. The data showed a slight increase in overall life expectancy over this interval, but also a decrease in life expectancy free of disease or functional impairment. This result was due, perhaps in large part, to the increase in obesity in recent years. Those authors concluded that there had been an expansion, rather than a compression, of morbidity. Despite other analyses, with evidence supporting the compression of morbidity, Crimmins and Beltrans-Sanchez argued that this finding is largely because others have focused on severe disability, such as inability to perform activities of daily living, rather than functional impairment, such as ability to walk across the street before a traffic signal changes. Medical advances, they argued, have made chronic diseases both less lethal and less disabling, yet those conditions continue to impact higher-level functioning, often at younger ages. Our study, published in MSSE (http://journals.lww.com/acsm-msse/abstract/2017/02000/The_Effect_of_a_Healthy_Lifestyle_on_Future.7.aspx), has direct relevance for this discussion. Using 14 years of data from SWAN (Study of Women's Health Across the Nation), a population-based, multi-racial/ethnic cohort of midlife women, we showed that a healthy lifestyle score, consisting of regular physical activity, a healthy diet and abstention from tobacco, measured over as many as nine years during midlife, was positively associated with better physical performance, measured at least four years later in older midlife. The domains of physical performance that were associated with a healthy lifestyle were walking speed and repeated chair stands (a measure of lower body strength and endurance). Most striking, these associations were due entirely to physical activity. Although a healthy diet and abstention from smoking clearly have obvious health benefits, regular physical activity in midlife appears to be the key determinant of better mobility-related physical function in late midlife, at least for women. These findings strongly imply that physical activity can contribute to the expansion of life expectancy without functional impairment and, effectively, bring about the achievement of the compression of morbidity that Fries envisioned several decades ago. The challenge, of course, remains the relatively modest proportion of the population that regularly engages in physical activity. Although ACSM has been a leader in the efforts to promote physical activity, much more work in this area is still needed — particularly now, at a time when public health resources are expected to be stretched even further than they have been. It is imperative that we in ACSM do what we can to ensure that all segments of the population lead healthier, active lives. Barbara Sternfeld, Ph.D., FACSM, is an emeritus research scientist at the Kaiser Permanente Northern California Division of Research in Oakland, California, where she began her career in 1985. Dr. Sternfeld’s training is in epidemiology and exercise science. She has extensive experience with large, prospective cohort studies, most notably, the CARDIA study (Coronary Artery Risk Development in Young Adults), and SWAN (Study of Women’s Health Across the Nation). Her research interests, largely focused on women’s health issues, include longitudinal analyses of physical activity and health outcomes, methods for assessment of physical activity and intervention trials. This commentary presents Dr. Sternfeld’s views on the topic of a research article that she and her colleagues authored. That article appeared in the February 2017 issue of Medicine & Science in Sports & Exercise® (MSSE). Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. The Science of Exercise (acsm-blog/acsm-blog/2017/05/16/the-science-of-exercise) by Guest Blogger | May 16, 2017 By Jordan Metzl, M.D.

In today’s news, much of the information we read about exercise is driven by the latest craze or fad in fitness and weight loss. These often confusing circumstances can be frustrating for individuals looking to make true lifestyle changes that improve their health. As a physician, I have witnessed many clients struggle to sort through the “noise,” so I was honored when approached to write the introduction for a special edition of TIME Magazine (http://amzn.to/2pZfOoh) titled “The Science of Exercise.” (http://amzn.to/2pZfOoh) TIME engaged a variety of subject matter experts to bring its readers science-backed fitness and exercise information that will help them make informed choices about their physical activity. As a nod to ACSM’s position as the global authority in this space, several of my ACSM colleagues also contributed to this issue, including Jack Berryman, FACSM, Steven Blair, 40th President of the American College of Sports Medicine (1996-97), Anthony Hackney, FACSM, and Pamela Peeke, FACSM. The issue also references ACSM’s exercise recommendations and cites ACSM’s journal Medicine & Science in Sports & Exercise. I have seen numerous patients meet and exceed their health goals through exercise, and I am a true supporter of Exercise Is Medicine® (http://www.exerciseismedicine.org/), a global health initiative managed by ACSM. The benefits of physical activity on health have been proven time and time again, both in the research lab and the gym. I’d encourage each of you to pick up an issue of this outstanding TIME Magazine publication about exercise, the miracle drug. Here’s a preview of my article: Thankfully, you don’t need to take mega-doses of this drug [exercise] to get the benefits. A little bit goes a long way. The American College of Sports Medicine recommends 150 minutes of exercise per week— just about 30 minutes, five days a week. More is better, but this seems to be the sweet spot. Anything from brisk walking to jogging to hightailing it up the stairs counts. And the harder you’re willing to push yourself, the less time you’ll have to commit to enduring it. If I had my way, medicine’s four core vital signs — temperature, pulse, blood pressure and respiration rate — would be joined by a fifth: step count, with a goal of 10,000 per day. It should be part of every standard medical chart, right alongside height and weight. Don’t forget that May is Exercise is Medicine (http://www.exerciseismedicine.org/) Month- download the toolkit today (http://www.exerciseismedicine.org/assets/page_documents/EIM%20month%202017%20toolkit%20(1).pdf) and help make a difference in your community. I hope to see you all in Denver at the ACSM Annual Meeting, where I will be presenting on a physician-led fitness community called the IronStrength Community Fitness Program that I lead in New York. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Jordan Metzl, M.D. (http://drjordanmetzl.com/), is a 19-year member of ACSM and a sports medicine physician at the Hospital for Special Surgery in New York City. He is pioneering a bridge between the medical and fitness communities by leading the first physician-led fitness program that he calls the IronStrength Community program. In addition to his medical practices in New York City and Stamford, Connecticut, Dr. Metzl is the author of six books, including the bestselling titles Running Strong, The Exercise Cure and Athlete’s Book of Home Remedies. Dr. Metzl is also the medical columnist for Triathlete Magazine. Active Voice: Dry Needling - An Option to Improve Muscle Strength and Flexibility and Prevent Muscular Injuries? (acsm-blog/acsm-blog/2017/05/09/active-voice-dryneedling---an-option-to-improve-muscle-strength-and-flexibility-and-prevent-muscular-injuries-) by Guest Blogger | May 09, 2017 By Florian Pfab, M.D. Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Florian Pfab, M.D., is a board-certified specialist in dermatology, sports medicine and acupuncture and holds the rank of professor at the Technische Universität in Munich, Germany. He is the medical director of the German Bundesliga soccer team FC Ingolstadt, which currently leads the German Bundesliga in statistics for least time-loss due to injuries (see www.fussballverletzungen.com (http://www.fussballverletzungen.com/)). He also is a consulting physician for several other professional German and international sports teams. This commentary presents Dr. Pfab’s views on the topic of a research article which he and other colleagues had published in the February 2017 issue of Medicine and Science in Sports and Exercise®. Although muscle injuries are the most common reason for presentation to a sports medical specialist and the most common time-loss injury in professional sports, scientific evidence for prevention or treatment of muscle injuries is still scarce. Some of the risk factors for muscle injuries — tightness of muscles, previous muscle injury, strength imbalances and reduced flexibility — are linked to myofascial trigger points (TrPs). TrPs are hyperirritable points located within a taut band of skeletal muscle or fascia. A method for targeting myofascial trigger points, which has been effective in managing myofascial pain syndromes, is called dry needling. Dry needling is an intervention that involves the insertion of an acupuncture needle into a myofascial trigger point which elicits a local twitch response (more on TrPs (https://link.springer.com/article/10.1007%2Fs11916-012-0279-6)). In our randomized controlled trial involving 30 elite youth soccer players (http://journals.lww.com/acsmmsse/Abstract/2017/02000/Effect_of_Dry_Needling_on_Thigh_Muscle_Strength.20.aspx), as published in the February 2017 issue of MSSE, we investigated the effects of four weekly sessions of dry needling plus water/pressure/massage on thigh muscle force and range of motion for hip flexion. The experimental group receiving placebo-LASER plus water/pressure/massage, a second group received placebo laser with water/pressure/massage and the third group had no intervention. Data was collected at baseline, treatment end and at a four-week follow-up. A five-month muscle injury follow-up also was performed. The dry needling group showed a significant improvement in muscular endurance and hip flexion range-of-motion that persisted at the four-week follow-up. Also, compared to placebo, the experimental group showed significant improvement in hip flexion that persisted at four weeks post-treatment. Finally, compared to non-intervention control, the dry needling treatment group showed significantly higher maximum knee extensor forces when tested at four weeks post-treatment. Thus, dry needling can be an interesting and promising option for professional athletes who are aiming to improve muscular flexibility and muscular force. Evidence-based strategies for preventing muscle injuries include injury prevention exercise programs, especially if these include the Nordic hamstring exercise (http://www.stretching-exercises-guide.com/hamstring-injury-prevention.html#The_Nordic_Hamstring_Exercise). In addition to our study’s findings, further options aimed at addressing injury risk factors include ice baths and wearing compression garments. Active Voice: Physiological Profiling of a Tour de France Champion (acsm-blog/acsm-blog/2017/04/18/active-voice-physiological-profiling-of-a-tour-de-france-champion) by Guest Blogger | Apr 18, 2017 By Phillip G. Bell, Ph.D. In recent times, several professional and elite-level sports have undergone intense scrutiny by their governing bodies and the public media for the wrong reasons. For example, questions about use of performance enhancing drugs (PED’s) have frequently been directed toward numerous individual athletes. In addition, we have seen recently how evidence of state-sponsored doping programs can result in broadly barring all the athletes and teams of a nation from international competition. One sport that has an acknowledged legacy of PED abuse is elite road cycling. Given this history and the current PED climate, there is a public uproar for cyclists to be fully transparent regarding their routines, medicines and physiological make-up. A reluctance on the part of these athletes to divulge their training and nutritional routines is understandable. Further, it would be unethical to expect them to release personal medical information in many instances. Yet, publishing the details of their personal physiological capacity is, perhaps, a step in the right direction for cyclists who compete at the most elite level of the sport. Little data exists within the public domain detailing the physiology of elite cyclists and even less for a Tour de France champion. Of course, vast speculation persists about what it takes (physiologically speaking) to win such an event. Indeed, these thoughts are what led to our case study that was published in the January 2017 issue of MSSE (http://journals.lww.com/acsm-msse/Abstract/2017/01000/The_Physiological_Profile_of_a_Multiple_Tour_de.14.aspx). In this case study of a two-time Tour de France champion, we reported the responses for numerous physiological variables collected during cycling tests that were administered in an environmental chamber under both ambient and hot/humid conditions. More specifically, we assessed and analyzed the following: body composition (dual x-ray absorptiometry); submaximal and maximal aerobic profiling (cycle ergometry and online gas analysis); gross cycling efficiency (i.e. amount of work completed per unit of energy cost); thermoregulation responses (skin and core temperature); and sweat rates and electrolyte content. Several interesting findings were identified, including: a higher than anticipated body fat percentage; some of the highest aerobic values on record for a cyclist; a combination of high VO2 peak and high gross cycling efficiency (uncommon to be high on both measures); and an ability to maintain high gross cycling efficiencies in hot and humid conditions. Collectively, the data demonstrated what may be the prerequisite physiological characteristics to be a Tour de France champion. While this athlete we studied fully acknowledged that the results from our case study neither confirm nor deny the use of PEDs, they do provide an insightful and unique perspective into the physiology of one of the greatest endurance athletes on the planet. Moreover, the athlete should be commended for having the foresight to publicly share an in-depth analysis of his physiological performance characteristics. To do so is not a requirement by any cycling governing body and is far more than most elite cyclists have been prepared to divulge in the past. Thus, positioning themselves on a pedestal to be targeted by media, skeptics and rivals.1 1Author’s Footnote: Given the unique nature of this paper and the interest it has created within the cycling community, it is important to give some background context. First, the athlete drove the initiation of this case study, independently of his employers. Second, our laboratory was approached for the study given our own expertise, independence (i.e., not affiliated with any sports governing bodies) and ability to conduct thorough, robust and timely testing. Thirdly, it was made clear to the athlete that, although the final peer-reviewed article would be anonymized, his unique characteristics and achievements would likely increase the risk of public identifiability.

Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Phillip is a principal scientist at the GlaxoSmithKline Human Performance Lab (Brentford, UK). He earned his Ph.D. at Northumbria University (Newcastle, UK). Phillip is an active researcher with primary interests in modalities to accelerate recovery following participation in sports performance by high-level athletes and the impact on subsequent adaptation. From an applied perspective, Phill has provided physiological support to multiple Olympic and World Championship medalists in a range of sports. This commentary relates to a research paper authored by Dr. Bell and colleagues that was published in the January 2017 issue of Medicine & Science in Sports & Exercise® (MSSE).

Active Voice: Too Little Exercise, Too Much Sitting and Expanding Waistlines! (acsm-blog/acsm-blog/2017/03/22/active-voice-too-little-exercise-too-much-sitting-andexpanding-waistlines!) by Guest Blogger | Mar 22, 2017 By Ai Shibata, Ph.D., Neville Owen, Ph.D.

Sedentary behaviors, put simply, mean too much sitting, as distinct from too little exercise. We now understand such behavior to constitute a risk to health, beyond that attributable to lack of physical activity. While research on sedentary behavior puts a novel slant on ways to think about physical inactivity, it should not be taken to negate or downplay the importance of public health and clinical recommendations on improving health outcomes through regular exercising and taking every opportunity to include bouts of moderate-vigorous activity in your daily life. Neville Owen, Ph.D. Rather, this new focus helps to expand our perspective, providing further ways to think about the determinants of poor health within Ai Shibata, Ph.D. the overall texture of people’s everyday lives. A great many of us are deskbound in the workplace, through time spent sitting in cars and spending long periods of time in front of computer screens at the office and TV screens in the domestic environment. Against this background, we set out to examine – concurrently – the roles of moderate-vigorous physical activity and TV viewing time in determining the extent of increases in adults’ waist circumference. The national AusDiab study (https://www.bakeridi.edu.au/ausdiab/) provided us with a unique opportunity to do so, using unique prospective epidemiological data. AusDiab originally examined more than 11,000 adults in 1999-2000 and, subsequently, conducted five-year and 12-year follow-ups. This landmark Australian study conducted a comprehensive assessment of risk factors for obesity and diabetes, with clinical assessments that included directly-measured waist circumference. We were fortunate, also, to be able to include from the very start of AusDiab not only the standard Active Australia questionnaire for characterizing moderate-vigorous physical activity, but also a simple self-report measure of daily TV viewing time. In our study, as reported in the April 2016 issue of MSSE (http://journals.lww.com/acsm-msse/Abstract/2016/04000/Physical_Activity,_Television_Viewing_Time,_and.7.aspx), we use data from the three observation points of the AusDiab prospective cohort to identify the extent of 12-year changes in waist circumference. We examined those changes in relation to the changes in moderate-vigorous physical activity and TV viewing time that took place over the five years between the first and second AusDiab observations. With the multiple clinical and behavioral measures that were available, we were able to control for several potential confounding factors (including total energy and alcohol intakes) in our analyses. The logic of the comparisons described above gave our study some strong, but also challenging, scientific traction. Most previous studies on this topic have identified cross-sectional associations, or have used exposure measures taken at only one preceding time point. Our approach in our Australia-Japan collaboration resulted in us being able to identify stronger relationships of waist circumference change with the moderate-vigorous activity changes – and then to examine how these compared to what we saw for changes in TV viewing time. Of some interest in the context of the “either-or” debates that have emerged about physical activity and sedentary behavior, there were compelling (and as we see things, expected) combined effects – that is, we observed a 6.7 cm average increase in waist circumference for those who reduced their moderate-vigorous activity and increased their TV time. These findings add support to the case for addressing the two interrelated problems of too little exercise and too much sitting. Several countries – including Australia – have already adopted (or are considering) new sedentary behavior elements to be integrated into their physical activity guidelines. In practice, this can provide a commonsense and straightforward basis for advising patients and the public – we need to be emphasizing the importance of being physically active each day and, at the same time, taking every opportunity to reduce and break up sitting time. Too little exercise and too much sitting characterize the daily lives of far too many adults in developed countries. This pattern also is now highly prevalent in the rapidly-urbanizing populations of low- and middle-income countries. Both elements of the activity equation – moving more and sitting less – are keys that can contribute to a healthier population. Together with those two behavior changes is the need for a healthy, less energy-dense and energy-replete diet. With these changes, we can more effectively address the “epidemic” of obesity, as well as type 2 diabetes, cardiovascular disease and other serious adverse metabolic health outcomes. The simple bottom line is: Sit Less, Move More and More Often! Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Ai Shibata, Ph.D., is an exercise and behavioral scientist at the University of Tsukuba in Ibaraki, Japan. Her research addresses how best to increase physical activity and reduce sedentary behavior in clinical groups, the general population and among older adults through observational and intervention studies that employ objective measurement tools, such as accelerometers. Neville Owen, Ph.D., is head of the behavioral epidemiology laboratory at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia. His current research is focused on understanding and influencing sedentary behaviors. His research spans experimental studies in the laboratory, observational epidemiological studies, real-world intervention trials and large-scale international work to identify the environmental determinants of physical activity and sedentary behavior. This commentary presents the authors’ views on the topic related to a research article which they and their colleagues from Australia and Japan have authored. Their research article appears in the April 2016 issue ofMedicine & Science in Sports & Exercise® (MSSE). Active Voice: Position Stand Development at ACSM (acsm-blog/acsm-blog/2017/02/01/active-voice-position-stand-development-at-acsm) by Guest Blogger | Feb 01, 2017 By Lynette L. Craft, Ph.D., FACSM ACSM has a long history of publishing position stand documents. The position stand is the most authoritative, evidence based statement issued by ACSM. The topics covered by these documents represent those deemed to be among the most important and contemporary for ACSM to address in sports medicine and exercise science. ACSM Position Stands are designed to: Answer specific scientific and/or clinical question(s); Provide overall summaries of the literature and strength of the cumulative evidence, as of the date that the document has been issued; Provide evidence based recommendations to support decision-making; and Identify gaps in knowledge that can serve the purpose of stimulating and advancing further scientific activity that may advance the knowledge base. Over the past few years, ACSM has devoted significant resources to the creation of a protocol for the development of position stands (http://www.acsm.org/docs/defaultsource/translated-position-stands/evidence-based-position-stand-development.jpg?sfvrsn=2) that will ensure that the contents reflect the best available science, and that the process is systematic, transparent and efficient. To that end, position stands are written per processes outlined in ACSM’s Evidence Based Protocol for Position Stand Development. This protocol statement includes identification and approval of PICO questions, a systematic review of the literature, evaluation of individual studies for freedom from risk of bias and grading the strength of the overall body of evidence. PICO refers to a paradigm for extracting answers from the health sciences literature, e.g. Population, Intervention, Control, Outcome. The position stand also undergoes multiple rounds of external peer review and internal organizational review prior to being approved by the board of trustees as an official pronouncement of ACSM and published in Medicine & Science in Sports & Exercise®. In 2013, the college approved and adopted this new protocol and, in 2016, two position stands were published using this new methodology. These include: 1. Physical Activity, Fitness, Cognitive Function, and Academic Achievement in Children: A Systematic Review and; 2. Nutrition and Athletic Performance (this is a joint position stand with the Academy for Nutrition and Dietetics (http://www.eatright.org/) and the Dietitians of Canada (http://www.dietitians.ca/)). Currently, one other is underway, i.e. an update to the 2004 Exercise and Hypertension Position Stand. Following completion and approval of that document, the 2007 Position Stand on Exertional Heat Illness during Training and Competition will be updated. In addition to the new protocol, the college has created the MOSAIC Resource Center and Evidence Library (http://mosaic.info/default.php). MOSAIC is envisioned as both a repository for a variety of resources that members can use in their teaching, research and clinical work, as well as a repository for the work done by ACSM Credentialed Evidence Analysts, as they contribute to the creation of position stands. Credentialed evidence analysts are volunteer ACSM members who have completed the evidence analyst training webinar and credentialing exercises. The credentialed evidence analysts assist with the development of ACSM position stands by reviewing, summarizing and grading the research included in position stands. The work of each analyst is documented and maintained in MOSAIC for transparency, efficiency and for use by the position stand writing group. In the future, readers of the position stand will be able to access MOSAIC to see how the individual studies used to develop the position stand were summarized and graded. Longer term, the position stand becomes a living document, with periodic updates scheduled at appropriate points that will include previous work housed in MOSAIC, as well as results of analyses completed on new scientific literature accumulated since the position stand was last published. Click here (http://www.acsm.org/docs/default-source/translated-position-stands/evidence-based-position-stand-development.jpg?sfvrsn=2) to view a flow chart that outlines the key steps in the development of position stands. Lynette L. Craft, Ph.D., FACSM, is the vice president for evidence based practice and scientific affairs at ACSM. Dr. Craft earned her Ph.D. in kinesiology and is an adjunct faculty member in the Department of Preventive Medicine at Northwestern University, Feinberg School of Medicine in Chicago, Illinois where her research focused on the relationship between exercise and mental health. In her role as VP at ACSM, she provides expertise and oversight to ensure that evidence based practice protocols and processes are followed when developing and disseminating ACSM’s official pronouncements. In this capacity, she works with expert panels in all phases of developing ACSM Position Stands, which are systematic evidence based reviews that lead to major findings. In addition, she is leading the development of MOSAIC, an online resource center and evidence library for sports medicine and the exercise sciences. Active Voice: Appetite Responses to Exercise in Females: Implications for Weight Control (acsm-blog/acsm-blog/2017/01/27/active-voice-appetite-responses-to-exercise-infemales-implications-for-weight-control) by Guest Blogger | Jan 27, 2017 By David Stensel, Ph.D. and Kevin Deighton, Ph.D.

The effects of exercise on appetite have been a topic of intense debate over many decades. Interest in this area has increased since the turn of the century, with the discovery in 1999 of the appetite-stimulating (“hunger hormone”) ghrelin. This area has obvious implications for David Stensel, Ph.D. the role of exercise in maintaining a healthy weight and for inducing weight loss in those who are overweight and want to lose weight. Unfortunately, there is widespread misunderstanding about how exercise affects appetite. One such misconception is that exercise enhances appetite and food intake and thus undermines attempts to lose weight. This view is often propagated by the popular press (e.g., TIME (http://content.time.com/time/magazine/article/0,9171,1914974,00.html), 9 August 2009, “Why exercise won’t make you thin”).

Kevin Deighton, Ph.D.

In contrast to this widespread view that exercise increases appetite, most research suggests that vigorous exercise transiently suppresses appetite. Subsequently, appetite will return but this is usually not sufficient to fully compensate for the energy expended during exercise. However, most of the published research related to this idea has been conducted in males, and an area of existing uncertainty is whether males and females differ in their appetite responses to exercise. Indeed, the ACSM 2009 Position Stand (http://journals.lww.com/acsmmsse/Fulltext/2009/02000/Appropriate_Physical_Activity_Intervention.26.aspx) highlights that there is a potential gender difference in the weight loss responses to exercise and calls for further research to clarify this issue. Our research, as reported in the March 2016 issue of MSSE (http://journals.lww.com/acsm-msse/abstract/2016/03000/Appetite_and_Energy_Intake_Responses_to_Acute.10.aspx), actually consisted of two studies. One of these examined appetite responses to energy deficits created through diet or exercise. The results showed that appetite perceptions increase robustly when food intake is reduced - but not when energy expenditure is increased via exercise! In concert with appetite perceptions, we found that concentrations of ghrelin were higher during the food restriction trial than during the exercise trial. Furthermore, while concentrations of peptide YY (an appetite suppressing hormone) remained high throughout the exercise trial, these levels were low during the food restriction trial. Taken together, these hormonal responses suggest that food intake is likely to be greater when an energy deficit is created via food restriction than via physical activity. This tended to be reinforced when we observed the participants, as they consumed a buffet meal at the end of the trial days. These findings are consistent with our previous work in men. In the second of those two studies, we directly compared appetite perception, appetite hormone and food intake responses to exercise in men and women – finding no gender difference in the responses. Appetite perceptions and ghrelin concentrations were reduced during a one-hour run and recovered shortly after the cessation of exercise. Food intake at a subsequent buffet meal did not differ between resting and exercise trials (i.e., exercise did not increase food intake) in either the women or the men. The findings from our experiments indicate that females do not respond differently to males in terms of appetite, appetite hormone or food intake responses, in response to energy deficits. This provides new insight into the relationship between exercise and appetite in women and supports the role of exercise in weight management for both genders. This also substantiates findings published in the February 2013 issue of MSSE (http://journals.lww.com/acsm-msse/Fulltext/2013/02000/No_Sex_Difference_in_Body_Fat_in_Response_to.19.aspx) by other investigators, which demonstrated that exercise is a successful approach to weight loss in both men and women. Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. David Stensel, Ph.D., is an exercise physiologist working at Loughborough University, Leicestershire, United Kingdom. He has been a member of ACSM since 1993. Kevin Deighton, Ph.D., is a senior lecturer in sport and exercise nutrition at Leeds Beckett University, Leeds, United Kingdom. This commentary presents the authors’ views on the topic of a research article which they and their colleagues authored. The article appeared in the March 2016 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Muscle gets better with age - enhanced oxidative capacity in lifelong endurance athletes! (acsm-blog/acsm-blog/2017/01/04/active-voice-muscle-gets-better-withage---enhanced-oxidative-capacity-in-lifelong-endurance-athletes!) by Guest Blogger | Jan 04, 2017 By F. Amati, M.D., Ph.D., FACSM, J.J. Dubé, Ph.D. and B.H. Goodpaster, Ph.D.

According to the United States Census Bureau, the population of Americans aged 65 years and older is expected to grow to 83.7 million by the year 2050. This has the potential to place an enormous burden on the health care system, as well as individuals, given the association between aging, declines in physical activity and increased rates of morbidity and mortality. While a significant body of literature has clearly demonstrated the capacity of older adults to respond to exercise interventions, less is known about effects of lifetime fitness on skeletal muscle.

F. Amati, M.D., B.H. Goodpaster, Ph.D., J.J. Dubé, Ph.D. Chronic aerobic exercise results in several positive adaptations within skeletal muscle, including a maintenance of oxidative Ph.D. FACSM fibers and overall fiber size, as well as enhanced mitochondrial function. These aspects of muscle physiology likely contribute to an improved quality of life and reduction in the risk for falls. Yet, there are gaps in our understanding of the effects of lifetime fitness, skeletal muscle metabolism and wholebody substrate oxidation. In our recently published MSSE article (http://journals.lww.com/acsm-msse/abstract/2016/03000/Muscle_Characteristics_and_Substrate_Energetics_in.17.aspx), we examined several aspects of skeletal muscle physiology, substrate oxidation and insulin sensitivity in 14 young (age 18-39 years) and 13 older (age 60-75 years) endurance-trained athletes. There were several strengths to our study design and analytic approach, including subjects who were matched for mode and frequency of exercise and that we directly assessed skeletal muscle characteristics from biopsy samples. Also, using indirect calorimetry, we assessed whole-body carbohydrate and fat oxidation under different physiological conditions - including fasting, insulin-stimulation (mimicking what happens after a meal) and aerobic exercise. Finally, we measured insulin sensitivity using the hyperinsulinemic euglycemic clamp, known as the gold standard method to assess how the body responds to insulin, which is an important marker of metabolism. The results of our study indicated that older endurance-trained athletes had greater intramyocellular lipid compared to the younger athletes - this was true of both the oxidative and glycolytic fiber types that we analyzed. Conversely, muscle from younger athletes contained more glycogen. In addition to greater lipid storage, we demonstrated that older athletes had a higher relative proportion of oxidative fibers. Importantly, we demonstrated that older endurance trained athletes have enhanced metabolic efficiency during exercise (i.e. the proportion of energy derived from fat oxidation). We could not detect any differences in metabolic flexibility (i.e. the capacity to switch from fat to carbohydrate after insulin stimulation) or insulin sensitivity between the older and younger athletes. The results from our study suggest that lifetime aerobic exercise training results in key skeletal muscle adaptations that promote enhanced lipid storage and utilization at moderate exercise intensities. These data emphasize the importance of physical activity as a method to attenuate the age-related declines in skeletal muscle oxidative capacity. Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Francesca Amati, M.D., Ph.D., FACSM, is an associate professor in the Department of Physiology and Institute of Sports Sciences at the University of Lausanne, Switzerland. Her research focuses on metabolic adaptations to exercise in aging and chronic diseases. Her clinical duties combine activities in sports metabolism and diabetes clinics. John J. Dubé, Ph.D., is an assistant professor of Biology at Chatham University in Pittsburgh, Pennsylvania. His research focuses on skeletal muscle substrate regulation, particularly intramyocellular lipids, as it relates to muscle function and metabolic disease. Bret H. Goodpaster, Ph.D., is a senior investigator and professor at the Florida Hospital Sanford Burnham Prebys Translational Research Institute for Metabolism and Diabetes. His research and scholarship have made a broad impact across the disciplines of exercise physiology, metabolism, obesity, diabetes and aging. This commentary presents the views of these three investigators on the topic of a research article which they had published with their colleagues in the March 2016 issue of Medicine & Science in Sports & Exercise®(MSSE). Active Voice: The Use of Microbiopsies for Study of Muscle (acsm-blog/acsm-blog/2016/12/19/active-voice-the-use-of-microbiopsies-for-study-of-muscle) by Guest Blogger | Dec 19, 2016 By Jeremy R. Townsend, M.S., and Jay R. Hoffman, Ph.D., FACSM

Since 1962, the Bergstrom needle muscle biopsy technique has long been perceived as the gold standard in muscle tissue sampling due to its ability to provide morphological, biochemical and pathological analysis of human muscle tissue. Though widely implemented, this technique is moderately invasive, requiring an incision through the skin and fascia of the muscle. More recently, the microbiopsy (or fine needle aspiration) has been implemented as a minimally invasive technique using a small gauge needle for tissue sampling without the need for an incision. The fine needle aspiration technique has been validated in histochemical and pathological analyses. However, due to perceived inconsistencies with sample weight and questionable morphological integrity, it is not Jeremy R. Townsend, Jay R. Hoffman, Ph.D., commonly used for immunohistological staining and analysis. M.S. FACSM In our article, recently published in MSSE (http://journals.lww.com/acsm-msse/Abstract/2016/02000/A_Microbiopsy_Method_for_Immunohistological_and.19.aspx), we examined whether skeletal muscle tissue obtained using this microbiopsy technique was sufficient for use in immunohistological analysis. Four healthy young males reported to our lab on two separate occasions for muscle biopsies of the vastus lateralis via a 14-gauge microbiopsy needle device (Argon Medical, Athens, Texas). The needle was passed through an insertion cannula placed in the thigh and muscle samples weighing between 14-22 mg per biopsy were obtained. We then used a sterile needle to carefully remove the tissue from the biopsy needle and orient the sample in a small cryomold. Tissue-Tek® was then applied over the sample and the entire sample was frozen in pre-cooled isopentane and stored for later sectioning and analysis. Since skeletal muscle tissue has the potential to provide an abundance of data for researchers and clinicians, the purpose of this study was to determine if a less invasive technique, providing less tissue than the more traditional biopsy sample, had the capacity for meaningful histological analysis. Using this technique, we were able to demonstrate that muscle sections were obtained with adequate fiber number, morphology and with good reliability between time points. With remaining samples, we were able to successfully stain for laminin, myosin heavy chain I, II and Pax 7 satellite cells in the muscle. Although we were successful in obtaining sufficient fiber to stain and analyze muscle sections, there did appear to be limitations in regard to fiber number obtained. Thus, the Bergstrom technique may still be preferred for analyses that require a large amount of fibers. Our findings provide novel evidence for the use of skeletal muscle microbiopsies for both morphological and immunohistological research. With its less invasive nature, this technique may provide investigators with the ability to enhance their study design by allowing for repeated measures designs and potentially for adding additional muscle groups that can be sampled. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Jeremy R. Townsend, M.S., is an assistant professor in exercise and nutrition science at Lipscomb University in Nashville, Tenn. His primary research interests include nutritional interventions for optimizing sport performance, exercise immunology and understanding the physiological mechanisms involved in regulating skeletal muscle remodeling. Jay R. Hoffman, Ph.D., FACSM, holds a dual appointment as a professor in sport and exercise science in the College of Education and Human Performance and in the Burnett School of Biomedical Science at the University of Central Florida in Orlando, Florida. He also serves as the chair of the Department of Education and Human Sciences and as director of the Institute of Exercise Physiology and Wellness at the same institution. His research program focuses on the physiological adaptations resulting from nutritional and exercise intervention. This commentary presents Mr. Townsend’s and Dr. Hoffman’s views on the topic of a research article which they and their colleagues published in the February 2016 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Measuring Children’s Physical Activity with Accelerometers: Apples and Pears (acsm-blog/acsm-blog/2016/11/29/active-voice-measuring-children-s-physicalactivity-with-accelerometers-apples-and-pears) by Guest Blogger | Nov 29, 2016 By Stuart J. Fairclough, Ph.D.

Children are the most active segment of the population, but concerns exist about their declining levels of physical activity – a problem that becomes progressively more pronounced as children advance through adolescence. Accurate measurement of children’s physical activity (PA) is challenging because their activity behaviors typically include high tempo bouts of moderate and vigorous PA, interspersed with periods of light PA and rest. Accelerometers are the instruments of choice to measure children’s free-living PA. However, variation in accelerometer brands, location that the device is worn on the body, output metrics and data processing procedures all combine to limit the degree to which children’s PA data are comparable between studies. Most previous studies have used hip-mounted Actigraph accelerometers to record children’s PA, based on conversion of the manufacturer’s proprietary ‘counts’ to time spent in PA at different intensities. Recently, PA intensity thresholds derived from raw accelerations have been developed for the ActiGraph GT3X+ and GENEActiv accelerometers. Basing PA data on raw accelerations provides an opportunity to improve comparability between studies using different devices, and promote transparency and consistency of post-data collection analytical processes. In our study, recently reported in MSSE (http://journals.lww.com/acsm-msse/Abstract/2016/02000/Wear_Compliance_and_Activity_in_Children_Wearing.9.aspx), we examined children’s compliance to wearing hip and wrist-worn accelerometers, compared children’s PA derived from raw acceleration signals from these devices. Using these data, we investigated differences in PA estimated from raw data with that from counts data. For seven consecutive days during waking hours, 129 healthy children (9-10 years old) wore an Actigraph GT3X+ accelerometer (AGhip) on the right hip and a GENEActiv accelerometer (GAwrist) on the non-dominant wrist. Data were downloaded and analysed based on raw acceleration data (AGhip and GAwrist) and counts data (AGhip only). We found that children wore the GAwrist for longer each day and for more days over the week than the AGhip. Children recorded more time being physically active based on GAwrist raw accelerations compared to those from the AGhip. In fact, 86.9 percent of children achieved current PA guidelines based on their GAwrist data, compared to 19 percent according to raw AGhip data. Comparison of PA from AGhip raw and counts data revealed a seven min/d difference in the category of moderate PA (raw data greater than counts data) and a 30 min/d difference in vigorous PA (counts data greater than raw). In children, it would appear that accelerometer wrist placement promotes superior compliance compared to the hip. This reflects the more recent NHANES accelerometer data collection cycles that have employed wrist-worn accelerometry (see: Freedson & John, MSSE 2013 (http://journals.lww.com/acsmmsse/Fulltext/2013/05000/Comment_on__Estimating_Activity_and_Sedentary.20.aspx), for related comment). Using raw accelerations would seem to offer greater potential for comparability of PA outcomes between devices than previous counts-based approaches based on manufacturers’ proprietary algorithms. However, we found substantial differences in PA that were possibly due to accelerometer placement location and technical differences between devices. From a health promotion perspective, current PA guidelines are based mainly on selfreport questionnaires and, to a lesser extent, on data from hip-worn accelerometer counts. As the use of raw acceleration data increases, examination of activity-health relationships using raw data from wrist-worn devices is warranted. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Stuart J. Fairclough, Ph.D., is a professor of physical activity education at Edge Hill University in the United Kingdom. His research focuses on youth physical activity and health, with an emphasis on physical activity correlates, school-based interventions and physical activity measurement. This commentary presents Professor Fairclough’s views on the topic of a research article which he and his colleagues published in the February 2016 issue of Medicine & Science in Sports & Exercise® (MSSE). New Physical Activity Report Card Reveals Much Work Needs to be Done (acsm-blog/acsm-blog/2016/11/17/new-physical-activity-report-card-reveals-much-work-needs-tobe-done) by Guest Blogger | Nov 17, 2016 By Paul Branks, Vice President of Communications and Media Advocacy American College of Sports Medicine The National Physical Activity Plan Alliance released its updated “United States Report Card on Physical Activity for Children and Youth” (http://physicalactivityplan.org/projects/reportcard.html) on Wednesday, and the results were disappointing. The report says three quarters of children in the United States are currently not meeting physical activity recommendations, putting them at increased risk for future obesity, diabetes and related chronic illness. The report only confirms what ACSM already knew: As a society, profession and organization, much more needs to be done. ACSM recognized these challenges years ago, and is doing its part to address them. Our Strategic Health Initiatives on Obesity and Youth Sports and Health, Health Policy and Science Committee, and partnerships with organizations such as the National Youth Sports Health and Safety Institute and Aspen Institute’s Project Play are just a few examples of how ACSM is actively promoting physical activity and its benefits among youth. Still, challenges remain. According to the report, only 21.6 percent of children ages 6-19 meet U.S. physical activity guidelines. Nearly 63 percent of children are exceeding sedentary behavior guidelines, which suggest no more than two hours of screen time per day. Less than 13 percent of children walk or ride their bike to school, a habit that has been associated with lower odds of obesity among children. The report does show an improvement in the number of youth who are participating on at least one sports team, but shows a significant gender disparity with more boys participating than girls. ACSM knows that physical activity plays a major role in promoting children’s health. Further, it helps ensure that our children become active, fit and healthy adults as well. As an organizational partner of the alliance, we support the National Physical Activity Plan because it lays out a strategy for increasing the physical activity level of all segments of our population, children and youth included. Based on the findings, four key recommendations to increase physical activity among youth were included in the report, and we encourage you to be an advocate for change in these areas: Schools should work to increase physical activity opportunities among youth and should be a key part of a national strategy to increase physical activity. Preschool and childcare centers should enhance physical activity. To advance efforts to increase physical activity among youth, key research gaps should be addressed. Changes involving the built environment (such as safe outdoor and indoor recreation spaces) and similar sectors are promising, but need additional work. You can download the US Report Card from the National Physical Activity Plan Alliance website (http://physicalactivityplan.org/projects/ reportcard.html (http://physicalactivityplan.org/projects/%20reportcard.html)). ACSM Research in Action: Foundation Research Grants (acsm-blog/acsm-blog/2016/11/16/acsm-research-in-action-foundation-research-grants) by Guest Blogger | Nov 16, 2016 By Wesley Lefferts, Ph.D. Candidate, Syracuse University I received a Foundation Research Grant from ACSM to compare the effects of acute aerobic exercise on arterial stiffness, cerebral perfusion and cognitive function in middle-aged hypertensive and normotensive adults. Increases in artery stiffness have been strongly linked to detrimental changes in cerebral blood flow and cognitive function with aging and disease, and aerobic exercise is recognized as a potent means to improve artery stiffness, blood pressure and slow cognitive decline. Hypertensive adults, however, may not experience reductions in artery stiffness following exercise, which may alter the typically beneficial effects of exercise on the brain and cognition. Receiving this grant from ACSM has allowed me to pursue my own line of research while directly supporting my dissertation. Additionally, the ACSM-FRG will strengthen my ability to get further funding in pursuit of a post-doctoral research position in the next step of my career. My appreciation for the ACSM Foundation in supporting my research cannot go understated as it will likely serve as a springboard for the rest of my research and academic career. I would advise applicants to apply for the funding at any opportunity they get. ACSM has a long legacy of supporting student research and if your research questions align with the mission of ACSM it is well worth pursuing despite the acute stress of applying for funding! Even if you do not receive funding on the first submission, ACSM grant reviewers provide helpful comments that strengthen your study and further develop you as a scientist. More information is available on the ACSM website (http://www.acsm.org/find-continuing-education/awardsgrants/research-grants/research-endowment) if you’re interested in learning more. CNN features ACSM members, promotes principals behind Exercise is Medicine® (acsm-blog/acsm-blog/2016/11/15/cnn-features-acsm-members-promotes-principalsbehind-exercise-is-medicine-) by Guest Blogger | Nov 15, 2016 ACSM members Dr. Jordan Metzl and Dr. Jennifer Trilk were quoted in a feature article published on CNN.com last week. Metzl discusses the benefits of exercise for health, while Trilk talks about incorporating education about exercise into medical school training. Trilk works for the University of South Carolina School of Medicine Greenville, which is one of the first institutions in the nation to lead that charge; clinical exercise physiology is already required teaching in all four years of the Greenville med school’s curriculum as a way to educate future physicians on the health benefits of exercise. Read the full article, “Exercise, it’s what the doctor ordered (http://www.cnn.com/2016/11/08/health/prescribing-exercise-asmedicine/index.html).” To address the rapid progression of chronic diseases and skyrocketing health care costs, the USC School of Medicine, the Greenville Health System and the Y joined Exercise is Medicine®(EIM) (http://www.exerciseismedicine.org/), a global health initiative managed by the American College of Sports Medicine (ACSM), along with the American Council on Exercise (ACE) (https://www.acefitness.org/) and the Medical Fitness Association (MFA) (http://www.medicalfitness.org/) to announce a new collaboration called the Exercise is Medicine Solution (https://www.youtube.com/watch?time_continue=1&v=AhvchRSofA4). The partnership and the EIM Solution bring together health care systems, clinicians, fitness professionals and community resources to affect positive health outcomes and reduce health care costs. The announcement was made at the National Press Club in February in Washington D.C. and included a keynote by 18th U.S. Surgeon General Regina Benjamin, M.D. View video from that event here (https://www.youtube.com/watch?v=u_GkwT0bFpw). Active Voice: The Sex Disparity in ACL Injury Risk - Adolescent Girls Demonstrate a Machine-Motor Mismatch (acsm-blog/acsm-blog/2016/11/07/active-voice-the-sexdisparity-in-acl-injury-risk---adolescent-girls-demonstrate-a-machine-motor-mismatch) by Guest Blogger | Nov 07, 2016 By Timothy E. Hewett, Ph.D., FACSM

Living as an “Ohi-Tuckian” both in the city of Cincinnati and in the country near Boone County, Kentucky, I’ve had three enduring loves… science, motors and sports. I grew up with six sisters; half of whom were better athletes than me. My sister Jenny ruptured her ACL playing basketball, had a hamstring graft that stretched out and now lives with an unstable, swollen osteoarthritic knee. The genesis of this study was a dream I had that included, believe it or not, science, motors and sports! We previously understood the four-to-six fold greater risk of an ACL tear in women was coincident with adolescent growth, and we could reduce these risks by 62 percent with neuromuscular training targeted for specific imbalances (ligament, quadriceps, leg and trunk dominance). The development of imbalances was coincident with adolescent growth in girls. What we didn’t know yet were the how and why of this critical problem, hence the repeated puzzling that led to my dream and the basis of a five year, $3.9 Million NIH grant we secured – aimed at “Identifying Females at High Risk for ACL Injury.” Our recent paper, published in the December 2015 issue of MSSE (http://journals.lww.com/acsm-msse/Abstract/2015/12000/Longitudinal_Increases_in_Knee_Abduction_Moments.12.aspx), is the culmination of five years of work, in which we longitudinally studied the basketball, soccer and volleyball players in Boone County. What we observed was a machine-motor mismatch that developed as girls matured. Loads on the knee joint, as measured by knee abduction moments and angles, increased initially with rapid increases in femur and tibia lever length in both boys and girls. But these joint loads increased with peak height velocity in girls, not boys. The how and why of this increase in knee forces and torques in girls and not boys is the development of a machine-motor mismatch in girls with growth. Let’s use a car engine analogy. Consider that both pre-adolescent girls and boys have an engine that is matched to the size of their body chassis, let’s say a Chevy Geo with a Geo motor. With rapid boney growth, girls and boys get a bigger chassis, let’s say girls get an Impala and boys get a Cadillac Chassis. However, soon after the longest body bone/lever growth, boys have a great increase in muscle motor power, while girls do not. For our analogy, boys get a super-sharged Corvette Stingray motor to power their Cadillac, while girls have an Impala chassis with somewhere between a Geo and an Impala motor; Hence, a machine-motor mismatch. We’ve corroborated this difference in machine-motor mismatch in multiple cross-sectional and longitudinal studies. For example, we’ve repeatedly shown that, as boys get more massive, they can displace their centers of mass at a greater relative vertical distance (due to their Corvette Stingray motor!), while girls stay the same, due to their Geo-Impala sized motor. This highly repeatable measure of body power shows us strong evidence for this machine-motor mismatch in these young, vulnerable athletes. The good news is there are now 14 high-level studies published in the literature that show we can reduce ACL injury risk by 62 percent. We’ve demonstrated repeatedly that neuromuscular training can induce a power spurt in these high risk athletes that both reduces their neuromuscular imbalances and their risk of an ACL injury. We now have the ability to screen athletes to identify those at high risk, and do so with high sensitivity and specificity of approximately 80 percent! Further, we now can target our neuromuscular training interventions to focus on the imbalances that place them at greater risk. And, finally, we can reduce their relative risk by 50-67 percent. In sum, dreams really can come true!

Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Timothy E. Hewett, Ph.D., FACSM, is director of biomechanics and a professor and consultant in the Departments of Orthopedic Surgery, Physiology and Biomedical Engineering and Physical Medicine at Mayo Clinic. He has published more than 300 peer-reviewed articles with more than 25,000 citations. He has authored a book on this topic. He is chair of the National Institutes of Health MRS Study Section and is an international expert in the field of injury prevention. This commentary presents Dr. Hewett’s views on the topic of a research article which he and his colleagues published in the December 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). ACSM Research in Action: The ACSM NASA Space Physiology Grant (acsm-blog/acsm-blog/2016/11/04/acsm-research-in-action-the-acsm-nasa-space-physiology-grant) by Guest Blogger | Nov 04, 2016 By Amanda Zaleski I am a third year doctoral student from the Department of Kinesiology at the University of Connecticut. I was the recipient of the 2015 American College of Sports Medicine NASA Space Physiology Grant for my project entitled "The Effect of Compression Socks on Blood Clot Risk During Travel in Oral Contraceptive Using Women." This research study sought to examine the influence of estrogen-based oral contraceptives on blood clot risk in active women at flight. Estrogen-based oral contraceptives increase the risk of a venous thrombosis (blood clot) fivefold, while the combination of travel more than hours and endurance activity increases the risk 2.5 times. Given the growing popularity of marathon running, this has serious implications for the increasing numbers of athletes who travel long distances to and from competitive events. In addition to athletes, active individuals who travel frequently, but do not run marathons (i.e., military personnel, NASA flight crew and aviation personnel) may also be at high risk for blood clots. Common-sense recommendations call for the use of compression socks to mitigate travel-induced increased blood clot risk in active women using contraception; however, the efficacy of this intervention had yet to be examined prior to our study. The ACSM NASA Space Physiology Grant afforded me the opportunity to formulate, execute and coordinate my own research question within an academic environment that solely exists to support and mentor junior investigators such as myself. Specifically, the results of this specific project resulted in two abstracts, a manuscript (in preparation), seven presentations at the regional and national level, and an award from the University of Connecticut Graduate Student Research Forum; all experiences and honors that will undoubtedly serve to strengthen future grant and employment applications upon graduation. The biggest piece of advice that I can give to other students that are considering applying for the ACSM NASA Space Physiology grant is to consider how your project can ultimately contribute to the bigger picture. I would encourage students to explore the major priority areas set forth by the NASA Human Research Program as well as the mission statement of the ACSM Foundation. How can the results of your research question uniquely serve both the advancement of sports medicine as well as our understanding of human physiology during flight? We are so close in our technological advancements to be able to offer commercial space flight, yet research that isolates the physiological adaptations to the unique stressors of space flight is still in its infancy. If you really stop and think about it, the fact that this particular grant mechanism even exists symbolizes such an exciting time for us as scientists and humans! ACSM Research in Action: Oded Bar-Or International Scholar Award (acsm-blog/acsm-blog/2016/10/31/acsm-research-in-action-oded-bar-or-international-scholar-award) by Guest Blogger | Oct 31, 2016 By Dr. Paolo Emilio Adami, M.D. I received the Oded Bar-Or International Scholar Award (http://www.acsm.org/find-continuing-education/awards-grants/international-awards) in 2015. The aim of my project was to investigate the appropriate indications and efficacy of sub-cutaneous Implantable Cardioverter-Defibrillators (ICDs) in athletes and physically active people, assessing the occurrence of those complications and side effects that are more frequently seen with “usual” ICDs. The Oded Bar-Or grant has given me the opportunity to further specialize and start a new field of research within my sports cardiology interests. Thanks to the Oded Bar-Or Scholarship I had the chance to attend the New England Cardiac Arrhythmia Center at Tufts Medical Center, in Boston, Massachusetts, led by Professor NA Mark Estes III. This facility is one of the world leading centers in electrophysiology and sports cardiology with a unique expertise in safety of athletes with ICDs and, more in particular, in patients with S-ICDs. I could work closely with Prof. Estes, Prof. Mark Link and the amazing team at the New England Cardiac Arrhythmia Center. I would highly recommend qualified individuals to apply for the grant. It has given me opportunities I wouldn't have had otherwise and it represented a turning point in my clinical and scientific career, while at the same time being an incredible life experience. If I could, I would apply again! Active Voice: Inhaled Beta2-agonist – A Performance-Enhancing Agent? (acsm-blog/acsm-blog/2016/10/24/active-voice-inhaled-beta2-agonist-a-performance-enhancingagent-) by Guest Blogger | Oct 24, 2016 By Morten Hostrup, Ph.D., and Jens Bangsbo, Ph.D.

Beta2-agonists are a cornerstone in treatment of bronchoconstriction associated with asthma and exercise-induced bronchoconstriction. Given the high prevalence of these two conditions among athletes, use of beta2-agonists is higher among athletes than non-athletes. While athletes formerly were required to apply for a therapeutic use exemption to use inhaled beta2-agonists while in and out of competition, the World Anti-doping Agency (WADA) loosened the restrictions toward beta2-agonists in 2010 and 2012. The commonly prescribed beta2agonists - salbutamol, salmeterol and formoterol - are now allowed within defined therapeutic thresholds and without a therapeutic use exemption. Morten Hostrup, Ph.D.

Jens Bangsbo, Ph.D. For the past decades, researchers have debated whether beta2-agonists are performance-enhancing. Despite limited evidence to support enhancing effects of therapeutic inhalation of beta2-agonists, asthmatic athletes have outperformed their non-asthmatic peers at every Olympic Game since 2000. The reason behind this is unknown and various theories have been suggested, including genetic factors, training modality or that athletes who train the most are more likely to develop asthma. Another reason is that beta2-agonists, even when inhaled, provide performance-enhancing effects. Indeed, oral ingestion of beta2-agonist, salbutamol, may enhance muscle strength, sprint ability and endurance. The discrepancy between enhancing effects observed for oral beta2-agonists compared with inhaled appears related to the marked difference in dose administered, usually being more than 10 fold higher when orally ingested compared to inhalation. Indeed, in our study reported in the January 2016MSSE (http://journals.lww.com/acsm-msse/Abstract/2016/01000/Inhaled_Beta2_Agonist_Increases_Power_Output_and.7.aspx), we observed that high dose inhalation of beta2-agonists, terbutaline, enhances power output during 10-s of maximal cycling in well-trained subjects. Likewise, we have observed that high dose inhalation increases muscle strength and sprint performance in highly-trained subjects with and without airway hyper-responsiveness on par with that observed for oral salbutamol. On the other hand, there is no indication that high dose inhalation enhances endurance performance. So what mechanisms are causing the enhancing effects of beta2-agonists on sprint ability and muscle strength? Even when inhaled, a large proportion of the administered dose reaches the systemic circulation. Skeletal muscle contains a large concentration of beta2-adrenoceptors. Thus, beta2-agonists exert several muscular effects that affect force production, metabolism and fatigue development. In recent years, we have focused on such effects by collecting muscle biopsies from vastus lateralis. In the aforementioned study in the MSSE January 2016 issue (http://journals.lww.com/acsm-msse/Abstract/2016/01000/Inhaled_Beta2_Agonist_Increases_Power_Output_and.7.aspx), we observed that the higher power output induced by beta2agonist was associated with increased breakdown of glycogen and production of lactate in muscle during the 10-s sprint. Notably, we also observed that reduction in muscle ATP stores was lower for beta2-agonist than placebo conditions at the end of the 10-s sprint, in spite of the higher work performed during the sprint. Thus, beta2-agonists increase anaerobic energy production and may counteract muscle fatigue caused by critically low ATP during sprinting. Aside from these effects, we have observed in one of our other studies (http://onlinelibrary.wiley.com/doi/10.1113/jphysiol.2014.277095/abstract) that high dose inhaled beta2-agonist enhances muscle Ca2+ handling. Given that muscle force production and relaxation are related to Ca2+ release and uptake, this finding may explain the enhancing effect of beta2-agonist on maximal cycling power output and muscle strength. Lastly, we have observed (http://onlinelibrary.wiley.com/doi/10.1113/jphysiol.2014.277095/abstract)that beta2-agonists counteract exercise-induced reductions in muscle Na+/K +-pump function. Such an effect may delay contraction-induced accumulation of K + and fatigue as exercise progresses. Evidently, beta2-agonist exert several muscular effects in trained subjects that may enhance performance and strength. The recent observations that high dose inhalation of beta2-agonist may enhance performance are a challenging anti-doping issue. Urinary thresholds are essential to detect prohibited misuse of beta2-agonist in doping control. Currently, no urinary threshold exists for terbutaline and salmeterol on WADA’s 2016 list of prohibited substances. Hopefully, thresholds will be introduced for these substances in near future.

Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Morten Hostrup, Ph.D., holds a postdoctoral position in the Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen and the Department of Respiratory Research at Bispebjerg Hospital in Copenhagen, Denmark. During his Ph.D. training, he investigated performance-enhancing effects of beta2-agonists with emphasis on their effects in skeletal muscle. Jens Bangsbo, Ph.D., is professor and vice head of research at NEXS, University of Copenhagen, Denmark. He is the leader of the Integrative Physiology Group at NEXS. His research focuses on optimizing exercise performance, including how development of muscle fatigue is affected by high-intensity training. This commentary presents Dr. Morten Hostrup’s and Professor Jens Bangsbo’s views on the topic of a research article which they and their colleagues published in the January 2016 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: High Intensity Interval Exercise — More "Bang for Your Buck" at Improving Blood Vessel Health in Youth (acsm-blog/acsm-blog/2016/10/19/active-voicehigh-intensity-interval-exercise-more-bang-for-your-buck-at-improving-blood-vessel-health-in-youth) by Guest Blogger | Oct 19, 2016 By Bert Bond, Ph.D., and Alan Barker, Ph.D. Cardiovascular diseases (CVD) are the leading cause of death worldwide. While the clinical relevance of CVD is not apparent until later life, the underlying atherosclerotic progression is understood to have its origins in youth. Accordingly, efforts to reduce future CVD should start in the early years. Physical activity is understood to lower CVD risk, however very few children and adolescents achieve the recommended daily minimum of 60 minutes of moderate to vigorous physical activity. Furthermore, a recent meta-analysis concluded (http://www.bmj.com/content/345/bmj.e5888) that interventions designed to increase physical activity in youth have limited success. This highlights the importance of considering how small volumes of exercise can be optimized for the prevention of future CVD in youth. We have read with interest recent observational studies from Canada (http://www.nature.com/ijo/journal/v38/n1/full/ijo2013135a.html) showing that only time spent performing vigorous intensity physical Bert Bond, Ph.D. Alan Barker, Ph.D. activity is favorably related to CVD risk factors in adolescents. That work identified that the amount of daily vigorous physical activity required to provide this health benefit in adolescents is actually quite small, i.e. only approximately four to eight minutes. Interestingly, this is consistent with other data from UK investigators, which highlight that only time spent performing vigorous physical activity is related to endothelial function in children. This outcome is conceptually important as an impairment in endothelial function may be a prerequisite for fatty streak development in arterial vessels. Thus, the intensity of habitual physical activity appears to be a key consideration regarding future CVD risk. It is thought that the benefits of habitual physical activity are related to the repeated cardiometabolic responses to a single bout of exercise. Therefore, our article in the December 2015 issue of MSSE (http://journals.lww.com/acsm-msse/Abstract/2015/12000/The_Acute_Effect_of_Exercise_Intensity_on_Vascular.18.aspx), was designed to assess the effect of exercise intensity on vascular function in adolescents. Twenty participants (10 boys, 10 girls) were ask to complete three conditions on separate days: 1) rest in the laboratory (control); 2) eight one-minute bouts of high intensity interval exercise, interspersed with 75 seconds of light exercise; or 3) continuous moderate intensity exercise, the duration of which was adjusted so that the total work (joules) performed by each subject was the same in both exercise conditions; this, in effect, enabled us to isolate the effect of exercise intensity. Our results demonstrated that endothelial function was attenuated immediately after high, but not moderate intensity exercise – which has previously been observed before in children and adults. However, our investigation was the first to track the time course of the vascular response following exercise. We found that endothelial function was augmented for two hours after a single bout of high intensity interval exercise, yet remain unaltered following moderate intensity exercise. In addition, the intensity of exercise was favorably related to microvascular function, which is important as the earliest detectable manifestation of the metabolic syndrome may be present in the capillary and arteriole beds, rather than conduit arteries. Although our MSSE paper demonstrated that exercise intensity is important to augment vascular function adolescents, further work is needed to establish how long these benefits last after a single bout of exercise and to explain the underlying mechanisms, e.g. shear stress. Encouragingly, we also observed that the high intensity interval exercise was more enjoyable than the moderate intensity exercise bout. These findings highlight the need for randomized control trials to determine the efficacy of low volume, high intensity training compared to moderate intensity interventions to alter blood vessel structure and function and traditional CVD outcomes (e.g. blood lipids.) However, our recent work adds to a growing body of evidence which demonstrates that the intensity of exercise is an important consideration for promoting maintenance and/or improvements in cardiometabolic health in adolescents. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Bert Bond, Ph.D., currently is an associate research and teaching fellow at the University of Exeter. He finished his Ph.D. in 2015 on the topic of exercise intensity and health outcomes in adolescents. Alan Barker, Ph.D., is a senior lecturer in pediatric exercise and health at the University of Exeter. His research focuses on how exercise intensity can improve health outcomes in children and adolescents. This commentary presents Dr. Bond’s and Dr. Barker’s views on the topic of a research article they published in the December 2015 issue of Medicine & Science in Sports & Exercise® (MSSE.) Walk to Build a Strong Community in October (acsm-blog/acsm-blog/2016/10/10/walk-to-build-a-strong-community-in-october) by Guest Blogger | Oct 10, 2016 Walking is a chance to get engaged with your town. This month, use your walks to note areas where improvements are needed, connect with local businesses and other neighbors and take action to make your community a great place to walk. Take time this month to say that you will use your walks as a way to improve your community and find new opportunities to engage with local businesses and neighbors. Share what you’re doing locally with #Walk4MyTown. If you’re participating in the #StepItUpUSA challenge (https://www.stepitupusa.org/), make your steps count toward improving your community. ACSM to Host Surgeon General Murthy, Olympic Legends at Sport & Health Summit October 5; Watch Live (acsm-blog/acsmblog/2016/10/03/acsm-to-host-surgeon-general-murthy-olympic-legends-at-sport-health-summit-october-5-watch-live) by Guest Blogger | Oct 03, 2016 ACSM, the Aspen Institute Sports & Society Program, the Global Obesity Prevention Center (GOPC) at Johns Hopkins and the Laureus Sport for Good Foundation USA are convening a dynamic one-day conference on October 5 that will include interactive panel presentations with influential Olympic athletes, national experts, lunch-time ideation workgroups and a fireside chat with 19th U.S. Surgeon General Vivek H. Murthy concluding the day. The Innovation Summit, titled “Moving American Health Across the Spectrum of Physical Activity (http://www.globalobesity.org/events/GOPC_Summit_Handout_FINAL.pdf),” will feature a number of interactive agenda topics including: next steps in getting more kids moving through sports; compelling and emerging scientific evidence on physical activity and health; and the role of industry and technology for scale featuring companies like Fitbit and SportsEngine. The goal of the summit is to generate powerful insights, new ideas and innovative, actionable opportunities that will improve health and prevent chronic conditions across the lifespan. Some of the speakers include: Missy Franklin, five-time Olympic gold medalist; Edwin Moses, two-time Olympic gold medalist; Woody Scal, chief business officer of Fitbit; Tom Farrey, ESPN reporter and director of the Aspen Institute Sports & Society Program; and Surgeon General Murthy. Watch the live stream here (https://webcast.jhu.edu/Mediasite/Play/b93dbf04c36a4782be1e79835ee327671d) beginning at 9 a.m. EDT. A Coach’s Take on Becoming One of America’s Healthiest Schools (acsm-blog/acsm-blog/2016/09/26/a-coach-s-take-on-becoming-one-of-america-s-healthiest-schools) by Guest Blogger | Sep 26, 2016 A Coach’s Take on Becoming One of America’s Healthiest Schools By Matt Majors, Boys & Girls Swimming Coach, Raymore-Peculiar High School, Peculiar, Missouri As a high school swimming coach, I often tell my athletes about the importance of fueling their bodies with healthy foods in order to do their best in the pool. These foods not only provide the body with the nutrients it needs to perform, but they also give the brain the energy it needs stay focused. The same holds true in the classroom. Research shows that healthy students perform better academically – they get higher grades, attend school more often and have fewer behavioral problems. These are the kinds of results we experienced at Raymore-Peculiar High School when we become one of America’s Healthiest Schools (https://www.healthiergeneration.org/healthiestschools/). Since enrolling in the Alliance for a Healthier Generation’s Healthy Schools Program, we’ve transformed our campus into a healthier one that encourages everyone to fuel for optimal achievement – whether that’s in the pool, in the classroom or even at home. In the cafeteria, our lunch line features more healthy options from which students can choose. Our school stores now sell fresh fruits. We’re also providing students and staff with fresh produce to take home. To keep all students and staff moving, we purchased new equipment for our fitness center and opened it up to everyone – not just athletes. Teachers utilize physical activity breaks (https://www.healthiergeneration.org/_asset/4rljn7/Activity-Breaks.pdf) during class to get the blood flowing and we now offer classes on active, healthy living. In order for Raymore-Peculiar to reach its peak performance and earn (https://www.healthiergeneration.org/_asset/6kptdz/AHS_Raymore_MO_Silver_082416.pdf) the Alliance’s National Healthy Schools Silver Award, we had to work together and commit to setting a healthier example for our students, families and the entire community. Coaches can play a central role in these efforts at any school. Set an example for your team by joining your school’s wellness committee (https://www.healthiergeneration.org/take_action/schools/wellness_committees__policies/convene_your_committee/) or promoting healthy fundraisers (https://www.healthiergeneration.org/_asset/1p0l6s/Healthy-Fundraising-for-Schools.pdf) to raise money for your next season. Ready to dive in and become one of America’s Healthiest Schools? Get started today (https://schools.healthiergeneration.org/)! Matt Majors is the boys & girls swimming coach at Raymore-Peculiar High School in Peculiar, MO. The school was recently named to the 2016 list of America’s Healthiest Schools by the Alliance for a Healthier Generation. Physical Activity Beyond Sport (acsm-blog/acsm-blog/2016/09/19/physical-activity-beyond-sport) by Guest Blogger | Sep 19, 2016 By: Justin B. Moore, Ph.D., MS, FACSM From September 8 through September 19, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of para-athletes participating in this month’s international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. With the close of the Rio 2016 Olympic and Paralympic Games (https://www.rio2016.com/en) now behind us, we celebrate the best athletes the world has to offer. Their stories of dedication, personal sacrifice, overcoming hardship, professional camaraderie and victory (or valiance in defeat) inspire us. For many, it has been the spark that ignites a desire to dust off our road bike, goggles, running shoes or golf clubs. It may also inspire youth around the globe to take up a sport that may provide much-needed physical activity (http://journals.lww.com/acsm-msse/pages/articleviewer.aspx?year=2015&issue=10000&article=00007&type=abstract). However, it also gives us a chance to reflect on the unique nature of the Olympic Games as a celebration of sport, the implication for physical activity and sport promotion, and the necessary supports to promote lifelong physical activity in our communities. The Olympics are partially comprised of commercially popular sports (eg, basketball, soccer, and tennis) that, along with sports such as American football, tend to dominate youth sports, particularly in America. However, research suggests (http://bjsm.bmj.com/content/42/11/901.long), and anecdotal evidence would support, that most adults who participate in sport will participate in those that resemble traditional Olympic sports such as badminton, swimming, running or weightlifting. As such, it may make more sense to promote these sports, which can be engaged in over a lifetime, than those which rarely survive the transition to adulthood (eg, football). However, if we are to support these lifelong physical activities, what are the barriers that need to be overcome? An article in Medicine & Science in Sports & Exercise (http://journals.lww.com/acsm-msse/Fulltext/2008/01000/Socioeconomic_Status,_Environmental_and_Individual.11.aspx) by Kamphuis and colleagues (2008) suggests targets for intervention. For example, they found that neighborhood characteristics (eg, safety concerns), household factors (eg, lack of material resources), and characteristics of participants (eg, low self-efficacy) were associated with socioeconomic inequalities in sports participation. In short, those in resource poor communities were less likely to participate in sport. However, if you look at these results, you see modifiable targets for community action. Safe places for children and adults to play can be built and maintained. Equipment and transportation programs can be developed and supported. Youth can be given developmentally appropriate lessons to build their self-efficacy for sport. As such, supporting organizations related to the Olympic Games and the athletes who train there, such as the National Cycling Center (http://usncc.org/) in Winston-Salem, NC, can provide the skills, resources, and opportunities for lifelong sport in our communities. Justin Moore is an associate professor in the Department of Family & Community Medicine in the Wake Forest School of Medicine in Winston-Salem, NC. Preparing to Be a Champion (acsm-blog/acsm-blog/2016/09/16/preparing-to-be-a-champion) by Guest Blogger | Sep 16, 2016 By: Thayne Munce, Ph.D. From September 8 through September 19, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of para-athletes participating in this month’s international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. Millions of people participate in athletics worldwide. While not everyone can be a medalist, all individuals can set personal goals and work hard to achieve their full potential. Sports provide young athletes, in particular, with wonderful opportunities to dream big and have fun while engaging in physical activities they enjoy. For those who are driven to perform at a high level in competitive sports, it is important they understand that athletic success is often a long, difficult process that requires commitment, perseverance and a burning desire to get better. The best athletes in the world embrace the concept of athletic development and focus on the things they can control: their effort, their attitude and their preparation. Being prepared to meet the immediate demands of training and competition in a sustainable manner is the centerpiece of appropriate athletic development. This preparation is defined as athletic readiness and is determined by both natural ability and the degree to which someone can optimize their potential. Athletic readiness is comprehensive and encompasses all attributes that contribute to success in sports, including: Athleticism Movement Quality Mental Toughness Athletic IQ Sport-Specific Skill Game Day Preparation All aspects of athletic readiness are necessary for optimal performance in sports. Many gifted athletes get by on their athleticism alone until they compete against other individuals who are just as strong, fast and powerful as they are. At that point, athletes who are more highly skilled or who have taken better care of their bodies are at a distinct advantage. Regardless of ability, everyone is capable of improving their performance over time by focusing on overall athletic readiness. Less athletic and talented individuals have often overcome their deficiencies by being smarter, better-prepared athletes. There is no guarantee that anyone will ever become a champion, but striving to reach your potential and becoming a better athlete in a sport you love is a victory in itself. Dr. Munce is the Associate Director of the Sanford Sports Science Institute and an Associate Scientist in the Children’s Health Research Center at Sanford Research. Assessing Energy Requirements for Para-Athletes (acsm-blog/acsm-blog/2016/09/15/assessing-energy-requirements-for-para-athletes) by Guest Blogger | Sep 15, 2016 By: Laura Newsome, Ph.D. From September 8 through September 18, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in this month’s international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. The competition this month in Rio DeJaneiro is a chance for athletes to showcase the strength of will and the power of the human spirit, no matter their level of physical ability. We can see the tremendous growth in the support for these athletes in a variety of settings, including increased funding, increase scientific research, improved training programs and more effective rehabilitation. Since para-athletes have such a wide variety of impairments and classifications within each impairment, there has been a greater push to understand the physiological responses to exercises and how to train within these unique parameters. Assessing the energy requirement for athletes with tetraplegia or quadrplegia has been relatively underinvestigated in the research arena but, like with all aspects of disability sport, it is slowly starting to gain ground. Understanding the energy requirements needed to train for and compete in the games is essential for ensuring the athlete’s peak performance and ample recovery between events. Not unlike their able-bodied competitors, these athletes take a great interest in preparing their bodies to perform at the highest level, but unlike able-bodied athletes, athletes with tetraplegia or quadrplegia have varied heart rate responses (accelerated or blunted) that make exercise intensities an unreliable way to estimate energy expenditure. Within each sport, the energy expenditure will vary with the level of the athlete’s impairment type and involvement. Energy expenditure can range from as low as 1.5 METS in archery to the upper level of ~8 METS in wheelchair basketball. Using these numbers to attempt to make a blanketed statement regarding the needs of these athletes is erroneous. With the limited research performed in this area, there is a lack of normal values and outcomes for comparisons, which increases the challenge to develop an exercise program with appropriate periodization to meet the functional needs of the athletes. As more information becomes available, better training regimens will be developed based on the specific sport and classification. The basic training principles used with able-bodied athletes does not always hold true for para-athletes. With the increasing awareness and accessibility to adaptive sports, higher levels of research are being perfomed to assist these elite athletes in better understanding their bodies and how to train, eat and perform at the highest level. Para-athlete competition is a great opportunity to observe how incredible these athletes are by highlighting the obstacles they have had to overcome to train and compete at the elite level. Laura J. Newsome, Ph.D., ACSM-CEP, EIM-3, is an assistant professor in the Department of Health and Human Performance at Radford University. Dealing with Disappointment: An Athlete’s Perspective (acsm-blog/acsm-blog/2016/09/14/dealing-with-disappointment-an-athlete-s-perspective) by Guest Blogger | Sep 14, 2016 By: Lauren Paquette From September 8 through September 18, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in this month’s international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. My name is Lauren Paquette, and I am NOT an Olympian. And that is okay- NOW. It didn’t seem to be okay in the weeks following the recent trials, when it looked like my competitors (and friends) had achieved their goals and were moving forward, while I felt as if I were stuck, stagnant. I had to shake myself off a bit to get out of the funk that comes after having a chance to make a national team and falling short. Those close to me had the patience and compassion to remind me of how much I had accomplished this year, and assure me that my running career is far from over. There will be more opportunities and more goals to chase. As hard as it can be, there is beauty and lessons learned in disappointment. You get a chance to improve. I had to remind myself of something I always tell the athletes that I coach after they have a bad race, “Take the time to be upset, figure out what you could have done better and move on. You can never move forward in life if you are constantly looking in the rearview mirror.” When falling short of a goal, competitors pick themselves up and make new ones. Whatever your goals are, don’t be afraid to realistically adapt them or establish new ones when things don’t go perfectly in athletics or in life. Watch out for the “greenies;” jealousy is a friend of disappointment. Be happy for those (yes, even your competitors) who achieved their goals and may have even gotten what YOU wanted; next time around, it could be your time to shine. Lastly, don’t forget to be proud of yourself – you’re as good as your best performance. Lauren Paquette is a professional distance runner sponsored by Brooks Running and Breakaway Running who competed in the 5000 meters at the 2016 U.S. Olympic Trials. She has an undergraduate degree in Exercise Physiology and Masters in Science in Sport Psychology & Motor Behavior. Mental Skills for Elite Performance (acsm-blog/acsm-blog/2016/09/13/mental-skills-for-elite-performance) by Guest Blogger | Sep 13, 2016 By Aaron Moffett, Ph.D. From September 8 through September 18, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in this month’s international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. We just witnessed some of the greatest athletes ever in Rio de Janeiro. There are several psychological skills that help an athlete reach their peak performance at the elite level. Gould, Dieffenback and Moffett (2002) studied 10 Olympians and found that these athletes had high ability to cope with and control anxiety, confidence, mental toughness, ability to focus, ability to set and achieve goals. Similarly, coaches and para-athletes view confidence, motivation and focus as vitally important for peak performance at their competitions (Moffett, Dieffenbach, & Statler, 2009). Now, how do they develop these skills so that they can peak at their important event? Here are just a few strategies to help improve confidence, motivation and focus and, thus, performance when preparing for an event. Set goals and celebrate successes: When we reach an important goal, it increases our confidence. Set both short-term and long-term goals for both practice and competition and celebrate reaching each goal. Athletes want to get better and setting short-term practice goals lets them know if they are improving. Structure the environment to provide for early success: Establish tasks or small goals for the beginning of the competition or event that are challenging, but the likelihood of succeeding is high. Athletes will recognize that they had to work hard and overcome some challenges and this will be most rewarding to them and help build their confidence. Recognize and become comfortable with your preferred level of arousal: People perform better under different conditions; some people prefer low feelings of arousal and others think they need pressure or high arousal to perform at their best. Practice with various levels of arousal so that you can learn how you perform under each level. Then, when it’s game time, develop techniques that help increase or decrease your arousal levels to your peak level. If you need to reduce your arousal level, try slow, deep breathing, focus on the basics or use a positive statement about how you’ve succeeded in a similar environment or task. If you need to increase your arousal level, than psych yourself up with music, by doing something active or focusing on positive thoughts. Develop and repeat a mantra: During practice, recognize the successes you have had and the basic skills that you need for peak performance. Then, develop a positive statement of what you KNOW you can do, and an action statement of what you need to do for peak performance. Use this mantra or positive statement when you are the most nervous or need focus. This will help you reflect on your positive skills and successes and build confidence while also improving focus on the task at hand. Elite para-athletes use many psychological skills to help with peak performance. These same skills can help you improve performance when you need it most. Confidence, motivation and focus are vitally important for peak performance and you can improve each of these skills by practicing the above techniques in your daily routines and practices. Dr. Moffett is the Adaptive Sports Program Coordinator with the Air Force Wounded Warrior Program. Evolution and Assessment of Elastic Taping- Part 2 (acsm-blog/acsm-blog/2016/09/12/evolution-and-assessment-of-elastic-taping--part-2) by Guest Blogger | Sep 12, 2016 By: John Balletto, LMT, CKTP® From September 8 through September 18, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in this month’s international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. The literature is inconclusive as to the actual, or statistically significant, benefits and mechanisms of therapeutic taping. While the amount of investigation into the claims and purported benefits and outcomes is steadily increasing, many studies are small in sample size, contain questionable methodology and populations, and yield very conflicting results—both supporting and disclaiming therapeutic benefit. Nonetheless, anecdotal support from both clinicians and patients alike is evident both in its wide-spread use throughout the world, with claims of effective rehabilitation, enhanced functional movements in activities of daily living, athletic performance and even in the prevention of injury. Interestingly, taping applications provide both a tactile and visible stimulus to the user, reminding them that they are actively working to ameliorate pain or dysfunctional movement patterns. Emotionally, this both acknowledges an individual condition and exhibits active support and participation in a rehabilitation process, and as a reminder to modify behaviors and movement patterns that may exacerbate symptoms. Taping, therefore, may even be operating at more than a physical or physiological basis as well. Clearly, more rigorous study into the mechanisms behind and therapeutic values of elastic taping are needed. Today, taping is an integral part of my day-to-day practice both in the athletic training room and in my private practice. Results are still a bit mixed, but definitely I’m getting more positive outcomes than not. And most importantly, my clients—professional, collegiate and amateur athletes; those in rehabilitation or recovery from injury or surgery; those in pain, and those who are increasing their daily activity level as part of their commitment to bettering their health through the ACSM’s “Exercise is Medicine” initiative—are repeatedly asking for taping applications because they are effective. Elastic tapes can be purchased in a variety of venues and are also readily available online. There are countless pictures and videos posted in social media and on websites available to the general public, some even demonstrating self-applications. While this promotes common usage, it is always best to see a health care provider who is trained to make accurate assessment of your situations and health concerns and will select a taping application that will yield the best possible results for you. They will give appropriate instructions and directions for the care of, removal of and possible self-application of your tape. So, splash on some color. Sport some crazy, tattoo-like patterns of tape. Get noticed at the pool, at the gym, or on your daily walking or running path. Give elastic taping a try. You might be pleasantly surprised with the results. John Balletto, LMT, CKTP® is a Licensed Massage Therapist and Certified Kinesio Taping® Practitioner in Pawtucket, RI. Evolution and Assessment of Elastic Taping- Part 1 (acsm-blog/acsm-blog/2016/09/09/evolution-and-assessment-of-elastic-taping--part-1) by Guest Blogger | Sep 09, 2016 By: John Balletto, LMT, CKTP® From September 8 through September 18, the ACSM Sports Performance Blog isfeaturing a special content series in celebration of the achievements of elite athletes participating in this month’s international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. I remember my first introduction to elastic taping. It was in the early 2000s at a conference of athletic trainers. I took a three-hour workshop on what then was considered a new and innovative approach to working with athletes—Kinesio Taping®. The instructor applied various strips of colored tape around muscles, over joints and was touting its benefits. While I was hearing some anecdotal success stories, I was skeptical but, nonetheless, I bought a couple of roles of tape and when I returned home, I tried it out on some of my amateur and professional athlete clients. Well, the results and comments were mixed—“it felt good;” “I think it kind of did something, but I’m not sure;” “Whoa, my calves felt awesome.” I really wasn’t convinced there were any benefits from taping. During the Beijing Olympics in 2008, I was watching Women’s Beach Volleyball players. One of their shoulders was covered with this colorful tape in some rather interesting and complicated patterns. The announcer made several comments about it—raising the interest of other athletes, sports therapists and the general public. I wondered what I was missing. So, along with my newly piqued curiosity came the explosion of Kinesio Tape® and its presence in the world of American athletics. I decided to invest in formal training to really see what this was all about. Here’s what I learned. More than 30 years ago, Dr. Kenzo Kase, a Japanese chiropractor and acupuncturist, worked to lengthen the duration affect of his manual and needling interventions. His experimenting resulted in the development of an elastic tape with a heat-activated adhesive that had a texture and elasticity closely resembling living, human skin that could safely remain on the body for three to five days. The outcomes of his tapings facilitated the body’s natural healing processes without restricting the natural movements of the body. He registered the terms Kinesio Tape® and Kinesio Taping®and began teaching his methods by training health care professionals on its myriad uses and benefits. Today, and despite registered trade branding, the terms Kinesio Tape® and Kinesio Taping® have become common terms in our vocabularies, now referring to many different elastic tapes and taping applications used therapeutically. Other terminology used includes Kinesiology taping, K-taping, Functional taping, and KT tape, etc. Elastic taping applications are used today in a wide range of clinical settings including physicians’ offices, athletic training rooms, rehabilitation clinics, and in the practices of chiropractic, physical therapy, occupational therapy and massage therapy. It is a safe, non-invasive therapeutic intervention used for all populations—from pediatric to geriatric, from sedentary to athletic—providing pain relief, swelling reduction, improved joint functioning and range of motion, and as some athletes will attest, improved performance. John Balletto, LMT, CKTP® is a Licensed Massage Therapist and Certified Kinesio Taping® Practitioner in Pawtucket, RI. Fueling like an Elite Athlete (acsm-blog/acsm-blog/2016/09/08/fueling-like-an-elite-athlete) by Guest Blogger | Sep 08, 2016 By: Felicia D. Stoler, DCN, MS, RDN, FACSM, FAND From September 8 through September 18, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in this month’s international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. The calls have begun to come in over the past few weeks with requests to explain how athletes need to eat for what many consider to be the ultimate athletic competition beginning today in Rio. Let me start by saying, this is a loaded question, even for someone like me. You probably don’t want to hear me say, “Well, it depends.” Truth be told, it does depend on so many factors. Consider that the age range of those representing the US is from 16 to 52. I note this because food choices are based upon preferences… most teens do not like the same foods as an older adult (I say this as a mother of two teens). Religion, culture, food beliefs (vegan, lacto-ovo, paleo) and even food allergies and intolerances will impact what an athlete needs to eat in order to fuel their competition. Trust me, one thing athletes of this caliber have mastered by the time they qualify is their fueling strategy. Game day versus training may change for some athletes, whereas for others, it may be exactly the same. Here are the essentials of what keeps an athlete fueled for victory: Carbohydrates – my favorite macronutrient that gets a bad rap… it is the master fuel for exercise. We can only store about six hours’ worth of carbohydrates (in the form of glycogen) in our bodies… so just like the gas you put in your car (or electricity)… it needs to be replenished. This includes all fruits, vegetables, whole grains and even dairy foods that contain carbohydrates. This should make up 50 percent of an athlete’s daily caloric intake. Protein – while not necessarily used for fuel, it is important for muscle recovery. Amino acids – which are the building blocks of protein – can be found in just about every food “group” except fruits. Foods of animal origin, beans, nuts, legumes, grains and vegetables have amino acids. This should make up around 20-25 percent of an athlete’s dietary intake. Fat – helps many foods taste better, transports fat soluble vitamins into the body, and is an important way to add calories for athletes who require more than 5000 calories per day. Michael Phelps reported he consumed almost 12,000 calories per day during the 2008 competition in Beijing. Trust me, it is difficult to get all of those calories in. It is important to note that the one thing athletes do not want is to have any food in their stomach pouch while competing or even training, because it causes cramping. Mixed macronutrient foods are consumed hours before the real workout begins. Liquid calories that do not have a lot of fat or fiber, prior to physical activity are generally well tolerated. After training or competition, it is time to load up on calories and macronutrients for recovery… carbohydrates and protein. Practice makes perfect. Just as an athlete keeps track of their training, their fueling strategy needs to be perfected during training! Dr. Felicia Stoler, DCN, MS, RDN, FACSM, FAND is a Registered dietitian nutritionist, exercise physiologist and expert consultant in wellness and healthful living. Travel Nutrition for the Paralympic Athlete: Preparing for the 2016 Paralympic Games in Rio (acsm-blog/acsm-blog/2016/09/01/travel-nutrition-for-the-paralympic-athletepreparing-for-the-2016-paralympic-games-in-rio) by Guest Blogger | Sep 01, 2016 By Kelly Pritchett and Jacque Scaramella In anticipation of the upcoming Paralympics, we’re running this special blog on the importance of nutrition for traveling Paralympians. From September 8 through September 18, the ACSM Sports Performance Blog will be featuring a special content series in conjunction with the Paralympics and in celebration of the achievements of these elite athletes. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. As we gear up for the 2016 Paralympic Games in Rio de Janeiro, Brazil, special considerations need to be assessed and planned ahead of time to ensure the smoothest transition into the competition environment to limit additional stress. Traveling for competition often disrupts normal patterns and routines, several of which are amplified for Paralympic athletes. To understand the possible travel issues for Paralympic athletes, it is important to understand the range of impairments, including spinal cord injuries, amputees, cerebral palsy and acquired brain injuries, visual and hearing impaired, les autres, and intellectual impairments. The following are issues that may arise for Paralympic athletes while traveling to Rio: Total travel time is quite lengthy and wheelchair athletes can expect longer travel times, as they are often the first to board the plane and the last to exit. They need to plan for extra time, especially between connections. Air travel can be dehydrating. Additionally, it is often challenging for Paralympic athletes to use bathroom facilities during travel. Many athletes purposely limit their fluid consumption in order to minimize the need to use the bathroom on flights. This often leads to significant dehydration. To prevent dehydration during travel, athletes should bring a water bottle and aim to increase the frequency of ingestion while decreasing the volume of fluid over time. This strategy along with the use of electrolytes will help improve fluid retention while decreasing the need to urinate. In-flight food availability may not meet special needs or be adequate to support an athlete’s nutritional needs. Athletes pack appropriate snacks to help supplement travel meals. There is also an increased risk of illness and infection during travel due to increased exposure to bacteria and viruses. Paralympic athletes, in particular, have a higher incidence of urinary, skin and gastrointestinal (GI) infection and illness. High levels of training and stress going into a major competition, such as the Paralympic Games, take a toll on an athlete’s immune system and increase their susceptibility of acquiring upper respiratory tract infections and the common cold. Strategies to help prevent acquiring an illness or infection include frequently washing your hands, carrying hand sanitizer, drinking safe sources of water and avoiding the sharing of beverages or food with others. Taking probiotics two weeks prior to travel and throughout the duration may help increase immunity and may help prevent and fight infection and illness. Food safety precautions to help decrease the risk of illness include: Washing your hands before eating Drinking bottled water and avoiding ice in developing countries Skipping fresh fruits and vegetables that are rinsed with local water sources (while in developing countries) Choosing fruits and vegetables you can peel Avoiding food from local street vendors When traveling for competition, athletes should try to stick with similar foods and avoid large variations in their food choices. Packing familiar foods on trips is a great way to try and maintain some routine while traveling. These might include nut butters, nuts or seeds, cereals, protein powders and portable sports bars. Eating in unfamiliar dining areas may be quite overwhelming at first, especially ones as large as at the Games. Coaches and staff are recommended to give their athletes extra time surrounding meals to allow for extra time to navigate the dining options. The location of living quarters in relation to dining should be minimized to limit fatigue, especially for amputees, and wheelchair athletes. Tables in the dining hall may also need to be lowered to accommodate wheelchair athletes. Additionally, timing of meals and training or competition should allow for an athlete to achieve personal bowel management routines. Athletes with intellectual impairments should be accompanied by support staff to assist with meal choices at buffets, food safety awareness and personal hygiene around meal times. High temperatures and humidity may pose concerns and lead to decreased performance for some athletes competing outdoors in the heat, or those competing for extended periods of time. In particular, athletes with spinal cord injuries are often at highest risk due to the decreased number of active sweat glands below the level of a spinal cord lesion, leading to compromised thermoregulation, or the ability to dissipate heat and keep core temperature down. Cooling and hydration strategies should be trialed to maximize thermoregulation and hydration. Cooling vests and ice cold towels around the wrists or neck are some strategies to help with thermoregulation. Ensure the athlete understands their hydration needs in hotter environments, including extra fluid consumption, salting foods and electrolyte use. Before an Olympic or Paralympic Games, the sports dietitians supporting these athletes prepare the athletes by helping them develop plans surrounding training and competition times to support adequate fueling and recovery. Additionally, they communicate how to prepare for environmental differences, the location of their accommodations in the village in relation to their training and competition venues, as well as dining hall logistics (food availability, meal times, catering style and location). It is important to remember that each athlete’s nutrition needs are unique and performance nutrition plans should be developed well ahead of a the Games to ensure comfort while competing and enhanced performance. Kelly Pritchett, PhD, RDN, CSSD is assistant professor of nutrition and exercise science at Central Washington University. Jacque Scaramella, MS, RD, CSSD is a sport dietetic consultant for the United States Olympic Committee. Get Active with #0to60 (acsm-blog/acsm-blog/2016/08/31/get-active-with-0to60) by Guest Blogger | Aug 31, 2016 The fastest way to living healthy starts right now! The President’s Council on Fitness, Sports & Nutrition and the National Foundation on Fitness, Sports & Nutrition have officially launched the #0to60 Campaign. In honor of the Council’s 60th Anniversary, the goal of this national campaign is to show all Americans the “how” of getting active, leading a healthy lifestyle and enjoying the journey. The Council has been dedicated to helping the nation find ways to lead a healthy lifestyle for 60 years and this year they are revving everything up a notch. In partnership with the Foundation, the Council has developed an innovative new #0to60 App (https://itunes.apple.com/us/app/0to60-fastestway-to-living/id1142310436?mt=8) and mobile-ready website (http://www.0to60fitness.org/) full of tips and information on how all Americans can integrate regular physical activity and good nutrition into their everyday lives. #0to60 is a national effort that is much bigger than the Council. To bring the most engaging, helpful and innovative content, the Council has partnered with the nation’s leaders in physical activity and nutrition. The app features a variety of content, including quick tips to jump start healthy habits; resources for families, communities, and schools; and, programs designed to support individuals on their journey to living healthy. Additionally, all of the content available on the app will also be made available at 0to60fitness.org (a mobile-ready website). Whether you use the app or check for updates on the website, keep an eye out for tips on physical activity and nutrition to jump start healthy habits for a journey from zero to sixty. Other resources provide key articles, information, programs, and challenges for families, communities, and schools. The app is designed to support individuals on their journey to accelerate their healthiest life! To top it off, the Council and Foundation have teamed up with First Lady Michelle Obama and Funny Or Die to unveil a new video! Inspired by the Council’s history and many faces of fitness through the years, Funny Or Die produced the “History of Exercise (http://www.funnyordie.com/videos/32216dbb77/history-of-exercise-with-nick-offerman-and-first-lady-michelleobama?_cc=__d___&_ccid=d803c334-1db8-413a-8e2b-75b7dbf8048d),” featuring the First Lady and Nick Offerman. The video underscores the fact that while fitness routines may have changed over the years, the importance of adopting a healthy lifestyle has remained the same. If this seems exciting, stay tuned for more. This is just the launch; #0to60 will continue to work with all Americans to inspire the country to go from zero to sixty every day! Overtraining Syndrome: When “Pushing Through It” Just Isn’t Possible (acsm-blog/acsm-blog/2016/08/22/overtraining-syndrome-when-pushing-through-it-just-isn-tpossible) by Guest Blogger | Aug 22, 2016 By: Matt Tenan, Ph.D. ATC From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. With closing ceremonies now behind us, one question to ask is “Did some athletes over-train?” Elite athletes are skilled individuals, but they weren’t born that way. It takes months and years of hard work and training. Any of these athletes will tell you that their training regimen is critical, but they may not mention that their recovery and rest days are the secret sauce to their training regimen. In the short term, rest enables your muscles and bones to recover and adapt, increasing strength and decreasing injuries, such as stress fractures. If an athlete trains heavily for a long time (think many months) and doesn’t allow enough time for recovery, they may develop Overtraining Syndrome (http://journals.lww.com/acsmmsse/Fulltext/2013/01000/Prevention,_Diagnosis,_and_Treatment_of_the.27.aspx). Unlike a stress fracture, which is generally located on a specific body part and can be seen on an MRI, Overtraining Syndrome is a whole body condition and doesn’t have a clear diagnostic test. The athlete may notice that their performance has dropped off, they’ll often feel lethargic, have trouble sleeping and may feel depressed or anxious. In short, they can’t perform well and they simply feel awful. Scientists have shown that Overtraining Syndrome results in a decreased ability to use oxygen in aerobic exercise and that the balance of hormones is disturbed, but we still don’t know why Overtraining Syndrome occurs. I’ve spoken to a number of physicians who work with elite athletes like those competing the last two weeks, and they actually say that their best diagnosis criteria is to check for depression along with decreases in athletic performance. The only treatment for Overtraining Syndrome is long-term rest, and we aren’t talking just a couple of days! Overtraining Syndrome can occur in recreational or collegiate athletes, so if you’re training hard, performance has dropped off and you’ve had other associated symptoms, it may be time to see a sports medicine physician. Matt Tenan, Ph.D. ATC is a Certified Athletic Trainer and Research Scientist with the U.S. Army Research Laboratory. Watch Cycling Today for Inspiration to Ride Your Own Bike! (acsm-blog/acsm-blog/2016/08/19/watch-cycling-today-for-inspiration-to-ride-your-own-bike!) by Guest Blogger | Aug 19, 2016 By: Melissa W. Roti, PhD, FACSM, ACSM-EPC, ACSM-GEI From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. How can I enjoy my bicycle? Let me count the ways. Bicycles are wonderful inventions that allow for invigorating, wind-on-your-skin movement for transportation, exercise and play. It is also wondrous to see in action, as this week’s competition provides a wonderful opportunity to watch the various cycling events with different types of bikes and riding. Cycling events include road, mountain, BMX and track. Most are familiar with road and mountain biking, as they are popular activities for many. BMX and track racing are held on a dirt track or wooden/cement track, respectively, and are very fast-paced races. BMX is a form of off-road racing similar to motocross. Track cycling for both men and women has been around since the late 1800s. Cycling is also part of the triathlon. You do not need to be a racer to enjoy the benefits and joys of cycling, and there are many kinds of bikes from which to choose. You can learn to ride a bike at any age or ability. In 1895, 53-year-old Frances Willard learned to ride her bicycle, Gladys, calling it her “harbinger of health and happiness.” Cycling is good for your physical health as well as the health of your wallet and the environment, especially when used as transportation for commuting or local errands. One less car means fewer carbon emissions; you are burning calories and saving money on gas and health care expenses, too. ACSM’s global health initiative, ActivEarth (http://activearth.org/), promotes active transportation to address the dual health issues of physical inactivity and climate change. There is a cultural shift beginning here in the US with many major cities creating more cycling friendly infrastructures with protected bike lanes and bike share programs. Take advantage of these opportunities. I challenge you to take one trip by bike this month (wearing a helmet, of course). Tune in to the cycling events today for inspiration and remember the benefits for your personal, financial and environmental health for added motivation (“Carbon, Calories & Cash”). Most of us aren’t as fast or strong as elite cyclists, but we can all contribute to a healthier and happier world. To learn more about ACSM’s healthy environment initiative, go to www.ActivEarth.org (http://www.activearth.org/) Melissa W. Roti, PhD, FACSM, ACSM-EPC, ACSM-GEI is a professor and director of the Exercise Science Program in the department of movement science at Westfield State University, Westfield, Mass. Measuring Head Impact Exposure (acsm-blog/acsm-blog/2016/08/18/measuring-head-impact-exposure) by Guest Blogger | Aug 18, 2016 By: Kasee Hildenbrand From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. With all the media attention on concussion, a common term that is referenced is “head impact exposure.” Concussions are notoriously hard to research since signs and symptoms can be very individualized and researchers often must “wait” for patients to suffer a concussion before research can begin specific to what a patient is experiencing. As researchers are working to understand how and why a concussion occurs in some instances and not in others, many are now looking at head impact exposure. Impacts that do not result in a concussion get labeled as “sub-concussive” impacts, meaning they did not result in a concussion, but did register movement to the head. Using devices developed to measure both linear and rotation acceleration, researchers can examine the magnitude of impacts as well as the number of impacts during a sporting event. Using sensors either embedded into helmeted sports, or sensors that can be embedded in mouth guards or worn affixed to the head by adhesive patches or head bands, researchers can monitor when a patient’s head moves and attempt to measure the magnitude of movement. Using this information, researchers can track the number of impacts and use this information to compare levels of play (youth, high school, college and professional), sex and type of sport. The take-home message is that head impact exposure provides information about the magnitude and number of impacts a head might receive, but we don’t yet know how this translates into concussion risk, both immediately and long-term. But it does provide useful comparisons between sports, sex and level of play. Kasee Hildenbrand is associate director of athletic training at Washington State University Pullman. R4 - A Simple Way To Ensure Appropriate Recovery From Exercise (acsm-blog/acsm-blog/2016/08/17/r4---a-simple-way-to-ensure-appropriate-recovery-from-exercise) by Guest Blogger | Aug 17, 2016 By: Mark Kovacs, PhD, FACSM, CSCS*D From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. Training for sport and health requires hours of appropriate training. However, athletes at every level – including the elite athletes competing this month – usually do not optimize their recovery from training or competition. When discussing Recovery, R4 is a concept that I use with athletes at all levels, and it is also backed with good quality evidence from the scientific literature. R4 stands for Rehydrate, Refuel, Rest and Repair. Rehydrate – After exercise, it is important to rehydrate with appropriate fluids. For light exercise (usually less than 60 minutes), it may be appropriate to rehydrate with water. For longer exercise, most athletes will need a beverage that has some carbohydrates and electrolytes to replenish what has been lost during exercise. The specifics are related to the type of sport or physical activity, the individual exercise intensity and duration of exercise. Link to ACSM position on hydration/rehydration. Refuel - After exercise, the body needs appropriate fuels to replenish what was lost during exercise as well as enough nutrients to help the body recover from the stress imposed on the body by the physical activity. The need exists for a combination of carbohydrates, fats and proteins. Although many types of foods may work to help refuel, it is important to ensure that enough protein is consumed in the post-workout meal to aid in the recovery. The most recent research suggests somewhere between 15-25 grams of high quality protein during the post activity shake or meal. The protein needs may be higher for older adults. Link to Position Stand on Nutrition and Athletic Performance that was a joint position statement authored by the Academy of Nutrition and Dietetics (AND), Dietitians of Canada (DC), and American College of Sports Medicine (ACSM). http://journals.lww.com/acsm-msse/Fulltext/2016/03000/Nutrition_and_Athletic_Performance.25.aspx (http://journals.lww.com/acsmmsse/Fulltext/2016/03000/Nutrition_and_Athletic_Performance.25.aspx) Rest – After exercise, the body has experienced a stress that causes a multitude of physiological reactions. For the body to be able to fully recover, appropriate rest is required. Rest for athletes takes on many forms. Sleep is one of the most important aspects of effective recovery. The data on the benefits of quality sleep and appropriate duration of sleep continues to be highlighted in the scientific literature. Another important aspect of rest is relaxation while awake. Athletes are busy people. It is important to provide time throughout the day to rest and recharge. Repair – The repair process of recovery can take on many forms. Manual therapies like soft tissue work, massage, joint mobilization, myofascial release techniques among others are used extensively by athletes. Electronic/technology based recovery devices are increasing in use, including various types of electronic muscle stimulation, laser therapies and electronic-based compression. Also popular are various types of temperature based-techniques, including both heat and cold treatments. Heat is aimed at increasing blood flow to specific areas, whereas cold is aimed at reducing blood flow and short-term inflammation. Recovery is a multifaceted process, and utilizing a simple structured approach like the R4 will ensure that an athlete does not miss a major aspect of recovery. Mark Kovacs, PhD, FACSM, CSCS*D is a performance physiologist, researcher, author, speaker and coach. Gymnastics Helps Develop Bone and Muscle (acsm-blog/acsm-blog/2016/08/16/gymnastics-helps-develop-bone-and-muscle) by Guest Blogger | Aug 16, 2016 By Janet R. Wojcik, Ph.D., FACSM From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. Gymnastics is one of the most popular sports among viewers, and it always gets prime-time television coverage. These athletes are amazing from an exercise science standpoint because they are strong, they are fearless, they have amazing balance and they appear to fly like superheroes. People often wonder if all the exercise the gymnasts do contributes to their short stature. The available research has not supported that exercise, particularly resistance exercise, affects height or injury to growth plates. Overall, resistance training and weight-bearing exercises that include jumping and running can be encouraged for youths to help them develop peak bone mass as well as muscle, and gymnasts are a great example of this adaptation. ACSM recommends at least three days per week of muscle and bone strengthening exercise for youths as part of the recommended 60 minutes per day of enjoyable, age-appropriate physical activity. The gymnasts are small as a result of a natural self-selection for their sport. Smaller bodies are needed to “fly” and are better able to develop the flips and twists they need in their routines. Some interesting data comes from bone density research. Gymnasts have much higher bone densities compared to other youths of the same age and size, particularly in their arms and spine. It is the repetitive mechanical stress of their training that leads to both bone and muscle development. Building peak bone mass in youth may be important when looking down the road at aging-related bone loss and osteoporosis. Gymnasts’ bone density remains high against others in their age group as they go into their 20s when peak bone mass occurs. Gymnasts, like any other athlete who competes at a reduced body weight, should be monitored for signs of stress fractures and/or Female Athlete Triad 5(osteoporosis, disordered eating, and amenorrhea or lack of menstrual cycles if they have gone through menarche). Their training and competition can lead to injuries just like any other athlete, which would then require appropriate care by medical staff. Janet R. Wojcik, Ph.D., FACSM is associate professor and program director of exercise science at Winthrop University. She is an ACSM Certified Exercise Physiologist and Certified Cancer Exercise Trainer. My thoughts on Athletes and Sports Massage (acsm-blog/acsm-blog/2016/08/15/my-thoughts-on-athletes-and-sports-massage) by Guest Blogger | Aug 15, 2016 By: John Balletto, LMT, CKTP From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta lang=en) and Instagram (acsm1954) and share using #ScienceofSport. Lasse Virén, the “Flying Finn,” attributed his success in winning the 1972 and 1976 5K and 10K events to his regular massage regimen. Ever since, sports massage has become a household term in training rooms, health clubs, in conversations with other athletes and at the location of competitions – from scholastic and recreational events and to elite competition venues. So, what is sports massage all about? Well, simply stated, sports massage uses the principles and theories of massage that are applied specifically with the desired outcome to help an individual athlete obtain maximum performance levels. It is far more than a reward at the end of a workout or competition. It is recognized as a critical component of an athlete’s training regimen, helping them recover from exertion (DOMS) or injury, maintain healthy range of motion and functional movement patterns, as well as helping the athlete remain both physically and psychologically healthy. Today’s sports massage therapist is an integrated member of an athlete’s care and coaching team. At the events this month and next, sports massage therapists will be an integrated part of the medical team, assigned to provide pre-event and post-event massage at select competition venues and at the medical clinic for athletes. I have had the great fortune to serve as a massage therapist at several of these venues as well as in the training rooms of collegiate and professional teams. My experiences are deeply etched in memories now, as I concentrate on serving my local athletic community. With my clients, I have enjoyed the thrill of victory and the disappointment of just missing out on a qualifications similar to what is happening to athletes this week; the joys of winning an NCAA national championship; the agony of breaking an oar at the finals of a rowing championship; cheering a client on at their first 5K or marathon event; helping to give an athlete some peace of mind and reassurance by applying an elastic taping to a “stiff shoulder” prior to competing in an individual medley, carrying their oars to the dock while giving them a little pep talk prior to their rowing sprint event, and countless other moments that support athletes at all levels of competition. More importantly, though, I provide sports massage services to a much wider public trying to improve their health and wellbeing—in support of Exercise is Medicine® (http://exerciseismedicine.org/), a global health initiative managed by the American College of Sports Medicine. While in my jurisdiction it is outside of the legal scope of practice to include recommendations for physical activity and exercise while working with my clients, I regularly speak at local running clubs, senior centers, cardiac rehabilitation support groups to encourage physical activity—and to let these very special athletes know that their local sports massage therapist is there to help them. Sports massage is effective in relieving the pain of shin splints in the overweight factory worker trying to achieve his fitness tracker goal of 10,000 steps per day; or to help a 59 year-old female, 10-hour “marathoner” finisher to maintain the 88-pound weight loss she achieved five years ago. And, with the help of clients reporting their satisfaction and results, more and more physicians, physical therapists and ACSM certified personal trainers are encouraging their patients and clients to use sports massage therapists to help keep them physically healthy and on track to meet their health care goals. So, I encourage athletes at all levels, health care providers of every specialty, wellness coaches and all supporters of Exercise is Medicine to remember the sports massage therapist and include them as part of the team. Let us help make America (and the rest of the world) healthy again. John Balletto, LMT, CKTP, is a licensed massage therapist and certified kinesio taping practitioner. Does your DNA Hold the Secret to Your Optimal Diet? (acsm-blog/acsm-blog/2016/08/12/does-your-dna-hold-the-secret-to-your-optimal-diet-) by Guest Blogger | Aug 12, 2016 By:Nanci S. Guest, MSc, RD, CSCS From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targeti lang=en) and Instagram (acsm1954) and share using #ScienceofSport. While it has long been suspected that genetics play a critical role in determining how we respond to foods and nutrients, only recently has research in the emerging field of nutrigenomics been able to demonstrate this scientifically. As a result, there has been an interest in using genetic testing to gain a better understanding of how we can feed our body exactly what it needs. Nutrigenomics uses the results of DNA analysis from a simple saliva test to uncover the relationship between genes, nutrition and human health and performance. Research in this field has shown how our unique genetic makeup affects the way we absorb, metabolize, and use nutrients, and how that influences our health and performance. We are all unique: We all know someone who can hit the gym for two weeks and lose five pounds or follow a specific diet for a month and drop a dress size. But others may spend months sweating through daily workouts and adhering to a strict diet with less than impressive results. Maybe we aren’t doing what’s right for our body? Recent research has shown that DNA-based dietary advice results in improved motivation and better outcomes. Individuals can now receive, at a reasonable cost, a personalized dietary report based on their genetics to improve their health and optimize their performance. This type of information is being used by athletes to help them gain a competitive edge. Individuals can order a genetic test either direct-to-consumer or through a health care provider. Using a health care provider that has received training in genetic testing and nutrition offers the benefit of ensuring that the results are interpreted correctly. A trained health care provider can also answer any questions regarding the genetic test results. What will a genetic test tell you: Caffeine has been shown to increase the risk of heart attack or high blood pressure in people with a specific version of a gene called CYP1A2. Below is an example of a test result for an individual’s response to caffeine. We know some people should limit caffeine intake because they have an elevated risk based on their CYP1A2 gene, which determines the rate at which caffeine is broken down and eliminated from the body. Recent research involving this same gene has also shown that athletes may have improved or worsened sport performance when they consume caffeine. Gene

Variant

Risk

Recommendation

CYP1A2

GA or AA

Elevated

Limit caffeine consumption to 200 mg/day.

GG

Typical

Limit caffeine intake to 400 mg per day



What to look for when choosing a genetic test Many consumer genetic tests assess a wide variety of health factors beyond nutrition, so hone in on those that focus on diet and exercise. Look for a genetic test from a reputable company. Some companies offer tests that misinterpret the science, so a little research can go a long way here.In addition, look for companies that have a scientific advisory board consisting of experts and credentialed professionals in nutrition and genetics. Be careful not to choose quantity over quality. Companies may offer testing for a large number of genes, but further investigation can reveal poor evidence supporting their science. Choose tests that include only genes that have the highest level of evidence to ensure reliable results. This might not be obvious to someone with little scientific training, which is why it’s best to go with a company that uses trained or certified providers. For more information: 1. Diet by DNA: http://training-conditioning.com/content/diet-dna (http://training-conditioning.com/content/diet-dna) 2. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0112665 (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0112665) 3. http://www.independent.co.uk/life-style/health-and-families/features/dna-diet-the-genetic-test-that-alerts-you-to-potentially-deadly-effects-of-salt-caffeine-or-9973704.html (http://www.independent.co.uk/life-style/health-and-families/features/dna-diet-the-genetic-test-that-alerts-you-to-potentially-deadly-effects-of-salt-caffeine-or-9973704.html) Nanci S. Guest, MSc, RD, CSCS served as the head dietitian for the 2010 Winter Olympics and 2015 Pan Am Games. Preventing Heat Injury (acsm-blog/acsm-blog/2016/08/11/preventing-heat-injury) by Guest Blogger | Aug 11, 2016 By: Jason Zaremski From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targetid=&fl=&extra=MultivariateId=&&&2035&&&https://www.fa College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&targetid=&fl=&extra=MultivariateId=&&&2036&&&https://twitter.c lang=en) and Instagram (acsm1954) and share using #ScienceofSport. With international competition now underway and fall sports beginning, concerns of heat injury and illness are rising. It is imperative that all athletes, coaches, volunteers and parents are trained to identify and respond to a potential Exertional Heat Injury (EHI). Simple tips can help detect, treat and prevent bad outcomes associated with this injury. There are many reasons why our core temperature begins to rise. Some reasons include: wearing darker clothes and equipment, being dehydrated or not prehydrated before practice or training, a history of sickle cell trait or disease, increased air temperature, humidity, wind speed, direct sunlight, not being prepared for the start of training; being sick and/or with a fever, and use of any diuretics, stimulants (such as caffeinated drinks) or alcohol. Recognizing EHI is important to prevent progression. If caught early, muscle cramping may be treated with cessation of exercise, stretching affected muscles and drinking cold liquids such as water or an electrolyte replacement drink. If not recognized early, EHI may develop into heat stroke (which is defined as core body temperature greater than 104 degrees Fahrenheit). Symptoms of heat stroke include syncope, exhaustion, weakness, fatigue and mental status changes. Treatment for heat stroke includes immediate ice-water tub immersion. If one is not available, place ice packs around the armpits and groin. A rectal temperature must be obtained and EMS should be called as well. Here are some pearls to keep in mind: PEARL #1: A high school or youth league may purchase a rubberized large bath tub (100-150 gallon) for a minimal amount of money by going to a local hardware store or through online websites. Money should not be an excuse as cost is nominal. PEARL #2: A rectal temperature is the only way to accurately assess for core temperature. If one is not taken, then you cannot determine if the core temperature has risen to a dangerous level. PEARL #3: If a patient is suffering a heat stroke, do not have EMS or another individual remove the athlete from the cold water tub immersion until core temperature has decreased below 102degrees Fahrenheit or until s/he is shivering. There is a 100 percent chance of survival if core temperature is decreased to less than 102 degrees Fahrenheit in less than 30 minutes. Follow the mantra of “Cool first, transport second.” PREVENTION There are many ways to reduce your risk for heat injury. 1. Allow for frequent rest and hydration during practice or competition. Also remember to pre-hydrate. Drink 24 ounces of noncaffeinated fluid two hours before exercise as well as an additional eight ounces of water or electrolyte replacement 15 minutes prior to exercise. While you are exercising, break for eight ounces of cool fluids every 20 minutes. 2. Wear light weight and colored clothing as well as sunscreen 3. Check the color of your urine (yes, you read that correctly). Clear or light yellow means you are in the appropriately hydrated zone, but dark means you are dehydrated. 4. Practice and train in cooler times of day (early morning, sundown or at night, if possible) 5. Increasing the intensity and duration of exercise or practice should occur gradually over a one-to-two week period. Longer practices lead to more rates of EHI. Jason Zaremski is a sports medicine physician at the University of Florida.

Using Elite Athletes to Create a Healthy Body Image in Youth... Tips for Parents and Coaches (acsm-blog/acsm-blog/2016/08/10/using-elite-athletes-to-create-a-healthy-bodyimage-in-youth...-tips-for-parents-and-coaches) by Guest Blogger | Aug 10, 2016 By: Christy Greenleaf, Ph.D., and Caitlyn Hauff University of Wisconsin Milwaukee Department of Kinesiology

From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta lang=en) and Instagram (acsm1954) and share using #ScienceofSport. Bodies come in all shapes and sizes and nothing highlights and celebrates body diversity more than international competition among elite athletes. Athletes of varying heights, weights, muscularity, leanness and physical mobility demonstrate their expertise and skill during their events. Whether an athlete is lacing up a pair of baseball cleats, diving head first into the water, securing a prosthetic leg before a race, or taking a seat in a wheel chair and rolling onto the court, audiences become captivated not by the type of body that athlete has, but by how these athletes are able to use their bodies during competition. The display of all types of bodies (and body movements) becomes a great opportunity for parents and coaches to use highly visible athletic competition to promote healthy body image and support body appreciation. Helping young people focus on what an individual’s body can do (rather than what they weigh or how they look) is a great place to start while watching athletic events. By emphasizing ability, skill, and function, parents and coaches can combat the unhealthy societal message that everyone’s body should look a certain way in order to be healthy or attractive. Physical activity and sport provides a wonderful setting in which to help young people focus on physical function rather than physical appearance by developing fitness, learning new skills, and improving personal performance. The determination, tenacity and spirit displayed by elite athletes over the next several weeks are a prime examples of how an individual with any type of body can strive for greatness and persevere through adversity. Parents and coaches can also help young people identify healthy role models and can serve as role models themselves. By avoiding negative body talk and engaging in health promoting physical activity and eating behaviors, adults provide powerful examples of positive body image for kids. Likewise, using highly visible athletes as examples, parents and coaches can help all types of aspiring athletes focus on developing strength, endurance, and power as a means to succeed. By watching competition in person or on television, audiences are able to admire athletes for their physical abilities, recognizing that aesthetics have little bearing on performance outcomes and adopt positive role models that empower individuals to believe hard work, sweat and mental toughness are what lead to success. As elite athletes continue to push limits and challenge the status quo in the coming days, they act as a positive reminder of the amazing things the body can do. Regardless of one's weight, height and physical appearance, these athletes prove that dedication, determination and discipline are what lead to success, not numbers on a scale or size charts. For more information about eating and exercise practices that support healthy bodies, please visit www.acsm.org (http://www.acsm.org/). Christy Greenleaf is a professor specializing in psychosocial aspects of body and physical activity. Caitlyn Hauff is a doctoral student studying social media, body image, and physical activity. The Making of an Elite Soccer Player (acsm-blog/acsm-blog/2016/08/09/the-making-of-an-elite-soccer-player) by Guest Blogger | Aug 09, 2016 By: Jesse Fudge, M.D. From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta lang=en) and Instagram (acsm1954) and share using #ScienceofSport. After four years, it’s finally here! Having grown up playing soccer, with Mia Hamm as my idol, I watched those athletes every game. I wanted to be them, and still do! I was never close to reaching an elite level of soccer, but I enjoyed playing the sport through college, medical school and residency. While I had a few broken bones and ankle sprains, I never had a major soccer knee injury. I credit this mostly to being a multisport athlete. Not specializing early in life encourages development of a broader range of skills and develops different muscles. Ultimately, being a multisport athlete decreases injuries and “burnout” which is critical for making a career of your favorite sport later in life. It seems that the US Women soccer players agree. After interviewing the Women’s National Team during the 2015 World Cup, a USA Today (http://www.usatoday.com/story/sports/soccer/2015/07/03/abby-wambach-morgan-brian-laurenholiday/29665797/)reporter noted that most players were multisport athletes before specializing in soccer and they credited those other sports to their soccer success. Some important quotes from this article (http://www.usatoday.com/story/sports/soccer/2015/07/03/abby-wambach-morgan-brian-lauren-holiday/29665797/): Lauren Holiday: “Having that variety is an awesome thing and I would encourage any young athlete or parent not to restrict themselves.” Doing different things develops different parts of your body. It can help prevent injuries and definitely help prevent burnout. Whitney Engen: “You might not realize that what you’re doing in volleyball is improving your spatial awareness and communication, but in reality maybe it is.” Abby Wambach (Retired): “Having the ability to play basketball for a bit throughout the year gave me the chance to crave soccer, to miss it.” Playing basketball had a significant impact on the way I play the game of soccer. In basketball, I was a power forward and I would go up and rebound the ball. So learning the timing of your jump, learning the trajectory of the ball coming off the rim, all those things play a massive role.” One injury that can end an elite athlete’s dream is an ACL tear. The hip and core strength I developed through nordic skiing, likely helped me prevent ACL tears and other significant knee injuries. Unfortunately, cross training and participating in multiple sports does not always prevent injury. Some who had hoped to recover from ACL tears before competing this summer, but didn’t, were disappointed. Studies suggest that the most important aspect in ACL injury prevention is good neuromuscular control. The good news is that this can be trained and ACL injuries can be prevented! The most recent American College of Sports Medicine (ACSM) Team Physician Consensus Statement (http://journals.lww.com/acsmmsse/Fulltext/2016/01000/Selected_Issues_in_Injury_and_Illness_Prevention.21.aspx) identifies multiple areas to focus on for ACL prevention and recommends implementing a sportspecific conditioning program. This should include: 1. Motor control (including core and lower extremity strength, balance, and flexibility 2. Technique training to include landing and sport-specific athletic skills program 3. Risk awareness education Good programs to start your young soccer (or other sport) star with include: Knee Injury Prevention Program (KIPP) For Coaches (http://kipp.instituteforsportsmedicine.org/) PEP Program (http://smsmf.org/smsf-programs/pep-program) FIFA 11+ Injury Prevention Program (http://f-marc.com/11plus/home/) So, how do you become an elite Soccer Player? Have fun and maintain a good variety of other activities to prevent burnout and improve your chances of staying injury free. Treat Your Knees to Elite-Level Tennis (acsm-blog/acsm-blog/2016/08/08/treat-your-knees-to-elite-level-tennis) by Guest Blogger | Aug 08, 2016 By: Angela Smith, M.D., FACSM From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta lang=en) and Instagram (acsm1954) and share using #ScienceofSport (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta i=579f8fafb3cb0). Torn anterior cruciate ligament. Kneecap pain. Dislocated kneecap. Can you avoid them? Maybe – if you move like one of the elite tennis players competing this week! Torn anterior cruciate ligament (ACL) ends far too many sports careers. But tennis players almost never tear their ACL's, according to Dr. Alexis Colvin, chief medical officer of the United States Tennis Association. In my experience as a pediatric orthopedic sports medicine specialist, it’s almost unheard of for a young player to suffer a torn ACL or dislocated kneecap from tennis. When you stand on both feet, feet hip width apart, and bend your knees, are your knees as far apart from each other as your feet are? Bending your knees may push them a bit forward of your toes, but the middle of the kneecap should be in line with the second or third toe. As you step sideways in your partially squatting position, do the knees stay aligned over the toes, or do they turn inward? Your knees should stay just as far apart as your feet – knees over toes! The best tennis players, like the ones competing this week, learn great strategies for getting from corner to corner on the court, to manage to return a ball that looks almost impossible! At the net, waiting for a ball in the ready position, the athlete has knees over toes, balancing on the front of the feet, often on the balls of the feet. He is ready to move quickly, at the last moment if needed, to reach a ball on the other side of the court. By the time he lands, his body weight is usually over the landing foot, with the knee well aligned between the body and the foot, not rotated inward. The elite tennis player runs, turns, pivots and cuts with her weight squarely over the foot, on the ball of the foot rather than flat-footed. She avoids landing with the flat-footed, heavy, offbalance, straight or hyperextended knee pattern that causes so many ACL tears. She lands firmly but with great shock absorption, well aligned. Land with toes and ball of the foot first, shock-absorbing knee bend, knees over toes. Whether your sport keeps you moving around a court, field, rink, or mat, move like an elite tennis player. Your knees may thank you! Angela Smith, M.D., is a Past President of the American College of Sports Medicine, specializing in pediatric orthopedics and sports medicine at Nemours/AI DuPont Hospital for Children in Wilmington, and practicing in Bryn Mawr, Pennsylvania. Recovery, Injury Prevention and Stress Reduction: Massage Therapy for Elite Athletes (acsm-blog/acsm-blog/2016/08/05/recovery-injury-prevention-and-stress-reductionmassage-therapy-for-elite-athletes) by Guest Blogger | Aug 05, 2016 By: Ann Blair Kennedy From August 5 through August 22, the ACSM Sports Performance Blog is featuring a special content series in celebration of the achievements of elite athletes participating in international competition. Be sure to follow the blog as well as Facebook (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta College-of-Sports-Medicine-64402266263/?fref=ts), Twitter (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2179037&messageid=2179037&databaseid=Mailing.DS179037.2179037.162293&serial=17602728&emailid=pbranks@acsm.org&userid=64330698&ta lang=en) and Instagram (acsm1954) and share using #ScienceofSport. Another four years have passed, and it is time again to enjoy the pinnacle of elite, international competition. One complex issue is how to keep athletes in peak athletic performance in order to potentially achieve victory and glory for themselves and their nations. Health care at high-profile sporting events requires an integrative team, from physicians to dentists to massage therapists, which can keep athletes in their peak performance zones. While surveillance of types of illness and injuries has been reported for large-scale international athletic events, rarely is the type of treatment discussed. In a new study of the Pan American Games in 2011, statistical modeling indicates that massage therapy was the most sought treatment by the US athletes. World renowned athletes competing this month are reporting that massage therapy is one of the key interventions that have helped them on their journey to success. Elite athletes often rely on massage therapy to help with their recovery and treating injuries. Also, massage appears to help not just with the physical injuries; it may also help with mental stresses that athletes are coping with during competition. While massage therapy does appear to help improve health and wellness for athletes, it is important to note that a study in Medicine and Science in Sports and Exercise (http://journals.lww.com/acsm-msse/Fulltext/2007/01000/Therapist_Education_Impacts_the_Massage_Effect_on.7.aspx) found the effectiveness of post-athletic event massage therapy was impacted by the level of experience and education of the therapist giving the treatment. In short, more education on the part of the therapist led to less soreness for the athlete at 24- and 48-hours post event. Remember, athletes at all levels can benefit from treatment. Massage therapy can be a valuable part of anyone’s wellness and health care plan. If you are in need of finding a professional massage therapist for yourself or a patient, the Find a Massage Therapist Locator Service (https://www.amtamassage.org/findamassage) from the American Massage Therapy Associationthe most respected association in massage therapy- can link you with a qualified therapist in your area. The locator service allows therapists to indicate techniques (e.g. sports massage) and years of experience along with their location and contact information; therefore, searching for a sports massage therapist with a significant amount of training should help narrow down the field to find the therapist that is just right. Sports medicine teams supporting athletes this month will have the benefit of having qualified massage therapists nearby to help athletes recover from and prepare for intense competition. Swimmers, cyclists, gymnasts and all manner of athletes have reported using massage therapy during training, competition and recovery but as an observer, it is unlikely that you will ever catch a glimpse of these important sports medicine team members. They will be behind the scenes, assessing injuries, creating plans of care and treating athlete after athlete. Ann Blair Kennedy, LMT, BCTMB, DrPH is a SC licensed massage therapist and the first Postdoctoral Fellow at the University of South Carolina School of Medicine Greenville where she is interested in using health behavior theories in interventions and clinical practice to assist people in starting and maintaining positive lifestyle behavior change. You can find her on Twitter at ABKlmt. Q&A: 2015-2020 Dietary Guidelines for Americans (acsm-blog/acsm-blog/2016/08/01/q-a-2015-2020-dietary-guidelines-for-americans) by Guest Blogger | Aug 01, 2016 By: Katrina L. Piercy, Ph.D., R.D., ACSM-CEP

The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) recently released the 2015-2020 Dietary Guidelines for Americans (http://health.gov/dietaryguidelines/2015/), the nation’s trusted resource for evidence-based nutrition recommendations. The Dietary Guidelines encourage Americans to adopt a series of science-based recommendations to help reduce obesity and prevent chronic diseases like type 2 diabetes, hypertension and heart disease. This commentary is a Q&A interview with Dr. Piercy and also reflects information provided to her through consultation with her colleagues in the Division of Prevention Science in the Office of Disease Prevention and Health Promotion, HHS. Q: How can health care providers and fitness professionals use the Dietary Guidelines? What recommendations should they give to their patients/clients? A: We know that regular physical activity and a healthy diet are among the most powerful tools we have to prevent or slow development of disease, and reduce the money we spend on health care. Professionals can help communicate healthy lifestyle messages based on the needs of their patients and clients. The new Dietary Guidelines recommendations focus on making small, manageable changes while working toward a healthier eating pattern. This includes eating fruits and vegetables, grains, lean meats and other protein foods, low-fat and fat-free dairy, oils and limited amounts of saturated fats, trans fats, added sugars and sodium. Q: Previous editions of the Dietary Guidelines included information on physical activity’s impact on health. In this latest edition, are there also new recommendations on how much physical activity we need? A: Although the primary focus of the Dietary Guidelines is on nutrition recommendations, physical activity is mentioned throughout this edition because of its critical and complementary role in promoting good health and preventing disease. As in the previous edition, Americans are encouraged to meet the current Physical Activity Guidelines for Americans (http://health.gov/paguidelines/) (PAG.) Also included are strategies for all sectors of society to support Americans in making healthy eating choices and providing opportunities for regular physical activity. HHS recently announced its intent to update the PAG in 2018, and nominations are being accepted for the PAG Advisory Committee (https://www.federalregister.gov/articles/2015/12/18/2015-31837/announcement-of-intent-to-establish-the-2018-physical-activity-guidelines-advisory-committee-and) through February 5, 2016. Q: This edition of the Dietary Guidelines includes caffeine for the first time. Is there guidance on caffeine and exercise performance? A: More science is emerging on caffeine and health, specifically related to coffee intake. Although the Dietary Guidelines do not include specific guidance on caffeine and exercise, there is guidance that moderate coffee consumption (three to five 8 oz. cups/day or up to 400 mg/day of caffeine) can be incorporated into healthy eating patterns. However, people who do not usually consume caffeine are not encouraged to add it to their diet. There is not enough evidence to support a recommendation on energy drinks. Q: There has been a lot of controversy in the media about new recommendations on meat in these latest Dietary Guidelines. Should we be eating more or less protein foods? A: It is important to clarify that there was no change to recommendations for meat (or overall protein) consumption in the 2015-2020 Dietary Guidelines. Three healthy eating patterns, which include a variety of protein foods (1 - Healthy U.S. Style; 2 - Healthy Mediterranean Style; and 3 - Healthy Vegetarian Style), are provided; the first two of these patterns include recommendations for meat intake. Data shows that some population groups, particularly teen boys and adult men, consume greater amounts of meat, poultry, and eggs than the Dietary Guidelines recommends. All Americans – and these two male groups, especially – would benefit from consuming a greater variety of protein foods, like seafood, legumes and nuts. Q: What was the evolution of cholesterol recommendations included in the Dietary Guidelines and why were these changed in this latest edition? A: The change in the cholesterol recommendations is a result of the increasing scientific rigor that is used to inform the Dietary Guidelines – this is a good example of why it is important for the guidelines to be updated every five years based on the total body of scientific evidence. The current data showed that there was not adequate evidence demonstrating a direct relationship between dietary cholesterol intake and LDL cholesterol levels. In contrast, the evidence does show that a clear relationship exists between foods that are high in saturated fats and LDL cholesterol levels. Many foods that are high in saturated fats also are high in cholesterol. Therefore, if you are following a healthy eating pattern that is low in saturated fats, the amount of dietary cholesterol you consume will also be low. Health care providers and fitness professionals are critical partners in implementing the strategies in this edition of the Dietary Guidelines. We plan to release a toolkit on health.gov during National Nutrition Month in March that will help health and fitness professionals share the messages in the Dietary Guidelines with their clients and patients. Sign up for email updates to receive information about these resources at www.dietaryguidelines.gov (http://www.dietaryguidelines.gov/). Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Katrina L. Piercy, Ph.D., R.D., ACSM-CEP is a physical activity and nutrition advisor in the U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion. She also is a lieutenant dietitian officer in the United States Public Health Service Commissioned Corps. She served as a policy writer for the 2015-2020 Dietary Guidelines for Americans and is the federal coordinator for the 2018 Physical Activity Guidelines for Americans. Dr. Piercy is an ACSM member and previously served on the Clinical Exercise Physiology Association (CEPA) Board. Active Voice: Statins and Physical Activity - Friends or Foes? (acsm-blog/acsm-blog/2016/07/18/active-voice-statins-and-physical-activity---friends-or-foes-) by Guest Blogger | Jul 18, 2016

Statins are the most widely prescribed medications in the world and are used to treat hyperlipidemia and reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Statins are well tolerated, but approximately 10 percent of statin users report myalgia or “muscle pain,” cramps and weakness. These symptoms appear to be more frequent following physical activity and in physically active individuals. This is a concern because statin side effects could reduce physical activity in those who would benefit most, i.e., those with an increased ASCVD risk. We examined the relationship between maximal dose statin treatment and physical activity levels in 418 healthy, statin naïve adults in our six month, double blinded, randomized controlled trial: The Effect of Statins on Skeletal Muscle Function and Linda S. Pescatello, Performance or the STOMP study. In a STOMP sub-study, published in the January 2016 issue of MSSE Gregory A. Panza, Paul D. Thompson, Ph.D., FACSM, (http://journals.lww.com/acsm-msse/Abstract/2016/01000/The_Effect_of_Atorvastatin_on_Habitual_Physical.1.aspx), we M.S. M.D., FACSM FAHA measured physical activity using accelerometers before and after six months of either atorvastatin 80 mg daily or placebo treatment. Accelerometers objectively measure activity counts, time spent in sedentary behavior, and time spent in light, moderate and vigorous physical activity. Surprisingly, we found that both the statin and placebo groups increased their sedentary behavior time and decreased their total physical activity! Why might this be the case? There are several possible explanations why both the placebo and statin groups decreased their physical activity. First, STOMP was conducted in New England where a seasonal effect might be suspected to modify the results. But, statistically controlling for season did not change the result. Another possibility might be an “alerting reaction,” which could have prompted the subjects to be more active when they first wore the accelerometers at baseline. However, this explanation is unlikely given that high test-retest reliability of repeated accelerometer assessments has been well established in the literature. Yet, another possibility is that subjects could have decreased their physical activity levels to avoid side effects of statin that occur more frequently during or following physical activity. This explanation also is unlikely, since both groups decreased their activity levels similarly and still exceeded the ACSM's recommendations of at least 30 minutes of moderate intensity physical activity per day during six months of either placebo or statin treatment. Finally, regression to the mean could have accounted for our findings. According to this statistical phenomenon, higher than average physical activity levels at baseline should decrease over time and be closer to the mean, or “average out” at the second measurement. However, subjects were not recruited for high baseline activity, thus making this explanation unlikely. We concluded that statin use does not reduce habitual physical activity levels of healthy adults? at least, not during the six months of our study. Physical activity should be encouraged as lifestyle therapy in conjunction with statins for the treatment of hyperlipidemia and the prevention of heart disease. Our findings support ACSM’s Exercise is Medicine® campaign that encourages health care providers to prescribe exercise along with the patient’s other medicines. Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Gregory A. Panza, M.S., is an exercise physiologist researcher in the Division of Cardiology at Hartford Hospital, Hartford, Conn. He currently is pursuing a doctoral degree in Kinesiology at the University of Connecticut in Storrs, Conn. His research focuses on the effects of statins on muscle strength, cognitive function, and physical activity habits. He also has research interests in the implications of exercise for individuals at risk for or diagnosed with Alzheimer's dementia. Linda S. Pescatello, Ph.D., FACSM, FAHA, is a distinguished professor within the Department of Kinesiology at the University of Connecticut in Storrs, Conn. She was senior editor for the 9th Edition of ACSM's Guidelines for Exercise Testing and Prescription and a member of the expert panel and writing team that recently updated ACSM's recommendations for exercise preparticipation health screening. Her research focuses on the clinical and genetic determinants of the response of health/fitness phenotypes to acute and chronic exercise. Paul D. Thompson, M.D., FACSM, is chief of cardiology at Hartford Hospital in Hartford, Conn. He has authored more than 400 scientific articles on such topics as the effects of exercise in preventing and treating heart disease, the cardiovascular risks of vigorous exercise, the effects of exercise on lipid metabolism and the effects of statins on skeletal muscle. Dr. Thompson has held numerous leadership roles in ACSM, including serving as ACSM president in 1998-99. He also was the principal investigator of the STOMP study (see commentary text for details). This commentary presents the viewpoints of Mr. Panza and Drs. Pescatello and Thompson on the topic of a research article that they and other colleagues published in the January 2016 issue of Medicine & Science in Sports & Exercise® (MSSE). ACSM President’s Vision for the Coming Year — A Focus on Sports and Physical Activity for Women and Girls (acsm-blog/acsm-blog/2016/07/11/acsm-president-s-visionfor-the-coming-year-a-focus-on-sports-and-physical-activity-for-women-and-girls) by Guest Blogger | Jul 11, 2016 By Elizabeth Joy, MD, MPH, FACSM

A major strength of the American College of Sports Medicine is its multidisciplinary membership. It’s a place where clinicians, scientists and educators come together with a goal of promoting safe, enjoyable, health-promoting physical activity and sport for all people. A focus on women and girls will leverage ACSM’s special strengths and leadership in clinical medicine, research, education and advocacy. Drawing upon our membership strengths in clinical medicine and, in close partnership with Exercise Is Medicine® and the National Physical Activity Plan, we will continue to pursue the goal of universal integration of a physical activity vital sign (PAVS) in electronic health records for both adults and children/adolescents. In addition, we will develop and submit for consideration a HEDIS (Healthcare Effectiveness Data Information Set) clinical quality measure for physical activity assessment and promotion for adults. HEDIS measures reside in the National Committee on Quality Assurance and are used by more than 90 percent of health plans to measure performance on multiple dimensions of health care delivery. This is a key strategy to achieve changes in policy and reimbursement for the clinical resources necessary to support physical activity promotion in health care settings – in hopes of improving upon current assessment rates which, according to the Healthy People 2020 report, hover around 8 percent of all child and adult outpatient medical visits. Worth noting, there is a significant cost associated with the development and submission of HEDIS measures - ACSM will seek strategic partnerships to help achieve this objective. An additional area of focus this year will be to address physical activity assessment and promotion during pregnancy and the postpartum period. Joining the ACSM Board of Trustees is Michelle Mottola, Ph.D., FACSM. Michelle is one of the world’s foremost researchers in the area of exercise during pregnancy. We will work closely with her and others to promote regular assessment and physical activity during pregnancy – the goal being to improve the health and outcomes for moms and babies. Moving on to research, we will work closely with ACSM’s Office of Evidence Based Practice, as well as key ACSM interest groups, to identify gaps in the research available from translational, clinical and implementation sciences on critical issues in sport and physical activity for women and girls. The information from this gap analysis will guide the development of ACSM research RFPs, in addition to ACSM publications aimed at summarizing existing evidence and prioritizing areas in need of future investigation. A similar gap analysis will concentrate on ACSM educational initiatives, ensuring that our educational content includes essential differences between genders, i.e., injury risks and prevention strategies, metabolic consequences of exercise and physical activity promotion strategies. This work will examine ACSM courses such as the ACSM Team Physician Course, EIM Certification Course for health & fitness professionals, the ACSM Team Physician Consensus Conference and others. Results of this gap analysis will inform changes to curricula to ensure that we are addressing the unique needs of women and girls in sport and physical activity participation. Finally, ACSM will leverage its substantial influence nationally and internationally to advance issues supporting sport and physical activity participation for women and girls. We already have strong relationships with organizations that are focused on women and girls, including WomenSport International, Women’s Sports Foundation and the Female Athlete Triad Coalition. Other organizations, including Project Play, Let’s Move, the President’s Council on Fitness, Sports & Nutrition to name only a few, will be key partners. We will also engage other partners to advance an agenda focused on sports and physical activity participation for women and girls. ACSM is the largest sports medicine and exercise science organization in the world. We have a tremendous opportunity to focus our considerable resources to vigorously and effectively promote sports and physical activity for women and girls. These segments of our population are at particular risk of inactivity and inactivity-related illness and injury. An ACSM Presidential Task Force will take the lead in prioritizing the aforementioned activities; however, I encourage each and every ACSM member to consider how we can individually and collectively impact physical activity for women and girls in our homes, schools, communities, the nation and other countries across the globe. I look forward to sharing the results of our collective efforts, and defining a sustaining legacy at ACSM.

Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. ACSM President Elizabeth (Liz) Joy, MD, MPH, FACSM, is the medical director of community health and clinical nutrition at Intermountain Healthcare. She also is adjunct professor of family & preventive medicine at the University of Utah School of Medicine in Salt Lake City, Utah. Dr. Joy was installed as president at the ACSM Annual Meeting in Boston earlier this month. Active Voice: The Age-Related Decline of Maximal Heart Rate is Delayed in High Fit Individuals (acsm-blog/acsm-blog/2016/06/20/active-voice-the-age-related-decline-ofmaximal-heart-rate-is-delayed-in-high-fit-individuals) by Guest Blogger | Jun 20, 2016 By Cemal Ozemek, Ph.D. and Leonard A. Kaminsky, Ph.D., FACSM

Cardiopulmonary exercise tests (CPX) are readily applied in both performance and clinical settings to assess an individual’s fitness, the risks of underlying cardiac disease, and to generate exercise prescriptions. Numerous studies have fortified the utility of CPX-derived measures for forecasting mortality risk. Examples of such predictors include (but certainly are not limited to) cardiorespiratory fitness (CRF, or maximal oxygen consumption) and maximal heart rate (HRmax) across healthy and diseased populations. Maintaining a high level of CRF with advancing age can delay functional reductions across numerous physiological systems. Although there is consensus that HRmax declines with age, there has been little to no agreement on the rate at which HRmax declines and whether CRF affects its trajectory. There are uncertainties in the scientific literature with respect to quantifying the rate of HRmax decline with age. This may be due to study Leonard A. Kaminsky, Cemal Ozemek, Ph.D. design limitations. A number of large cross-sectional studies have performed symptom-limited tests which do not collect expired gases, Ph.D., FACSM which would allow for objective determination of maximal or near maximal endpoints. Therefore, an inadequate exercise exertion could result in underestimating the true HRmax for a given age. Such an effect may also bias regression models reported in study results in a way that suggests a steeper decline of HRmax decline with increasing age. The few longitudinal studies that have examined HRmax decline with age have been limited by small sample sizes. To date, there has only been one crosssectional study (from the Cooper Clinic in 1977) that compared the rate of HRmax decline with age across predicted CRF tertiles. In an effort to objectively evaluate the effects of CRF on HRmax decline with age, we conducted a retrospective cross-sectional and longitudinal analysis on CPX data from the Ball State University Adult Physical Fitness Program cohort (see the January 2016 issue of MSSE (http://journals.lww.com/acsmmsse/Fulltext/2016/01000/High_Cardiorespiratory_Fitness_Levels_Slow_the.11.aspx)). Data were available from over 6,000 CPX records of 3,647 men and women, tested between the years 1971 and 2014. Only CPXs that were performed on a treadmill by individuals not taking HR altering medications, who achieved a respiratory exchange ratio >1.0, and were free of heart disease were included for analysis. These subject records then were categorized into high, moderate, and low CRF categories relative to age- and sex-matched peers. Both cross-sectional and longitudinal analyses of our data revealed an inverse relationship between CRF and rate of HRmax decline with age (high fit= roughly -0.6 beats per min [bpm]/year, moderate fit= roughly -0.8 bpm/year, and low fit= roughly -1 bpm/year). In addition to demonstrating support for a preserving effect of CRF on HRmax with age, these findings have particularly meaningful implications for clinical testing facilities. Many CPX facilities generally base an adequate test as one in which subjects can achieve 85 percent of predicted HRmax (220-age). We found, in our study, that the HRmax prediction equations generated for low fit individuals were similar to the widely used 220-age formula. Uniformly applying the 85 percent of 220-age criteria for determining a CPX endpoint in high or moderate fit cases, therefore, may result in those individuals failing to attain an effort close to their peak CRF level. This could reduce the effectiveness of the CPX for detecting cardiac abnormalities (if they exist) and also lead to the generation of an insufficient exercise prescription. The present study demonstrates that HRmax declines at a faster rate in lower fit individuals. Thereby, these findings underscore the importance of considering an individual’s CRF relative to normative age and sex values (estimated CRF using the Cooper Clinic standards or measured CRF using the recently published CPX registry (http://www.mayoclinicproceedings.org/article/S0025-6196(15)00642-4/pdf)) when interpreting HRmax. Additionally, the findings suggest another important benefit of fitness, i.e. a slowing of the decline in HRmax with age. Viewpoints presented on the ACSM Blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Cemal Ozemek, Ph.D., received his doctoral degree from the Human Performance Laboratory at Ball State University. He is currently a cardiovascular research fellow at the University of Colorado Anschutz Medical Campus. His research interests focus on studying the effects of sex hormones on cardiac and vascular aging, as well as studying the effects of physical activity and regular exercise on attenuating age-related cardiovascular declines. Leonard A. Kaminsky, Ph.D., FACSM, completed his doctoral studies in exercise physiology at Southern Illinois University. He is the John and Janice Fisher Distinguished Professor of Wellness at Ball State University, where he formerly directed the Clinical Exercise Physiology Laboratory. Currently, he is the director of the Fisher Institute for Health and Well-being. His research has focused on relationships among physical activity, physical fitness and health. He presently chairs the advisory board for an initiative to establish a national registry of cardiorespiratory fitness. This commentary presents Drs. Ozemek’s and Kaminsky’s views on the topic of a research article that they and their colleagues had published in the January 2016 issue of Medicine & Science in Sports & Exercise® (MSSE). Weight and Protein: Hot Topics at the ACSM Annual Meeting (acsm-blog/acsm-blog/2016/06/10/weight-and-protein-hot-topics-at-the-acsm-annual-meeting) by Guest Blogger | Jun 10, 2016 By Nancy Clark MS RD CSSD The American College of Sports Medicine (http://www.acsm.org) is the world's largest organization of sports medicine and exercise science professionals. At ACSM's annual meeting in Boston in May, over 6,800 exercise scientists, sports dietitians, physicians and health professionals gathered to share their research. Here are a few highlights related to the hot topics of weight management and dietary protein. Weight management •Do we really know what drives the obesity epidemic: Is food intake too high? Or does body fatness reduce the desire to exercise? We have much to learn about this delicate balance. • Hunger, that irritating feeling that motivates you to eat, is related to muscularity (but not to body fatness). Muscular athletes have more hunger than their less-muscular peers and they need more fuel. Hence, if you love to eat (and be lean), lifting weights could be a helpful addition to your exercise program! • We each have hundreds of types of microbes in our gut that help with digestion. The microbe profile of people with obesity differs from that of lean people. In mice, we know that obese mice absorb more calories from their food than do their lean counterparts. When the gut microbes of obese mice are transplanted into lean mice, the lean mice start to gain weight. The bottom line: eat a diet that makes for a healthy and slimming gut microbiome: fiber-rich fruits, vegetables, legumes and whole grain foods. • Body fatness is strongly linked to sleep deprivation. In a weight reduction study with 123 overfat adults, those who slept the most lost more weight than those who were sleep deprived. In another study with 77 overfat men, a third of them had undiagnosed sleep apnea. They lost less weight than those who slept well. Clearly, sleep is an essential part of a weight management program. If you sleep poorly and struggle to lose weight, you might want to find out if undiagnosed sleep apnea is part of the problem. • Eating the majority of your calories in the earlier part of the day helps to maintain leanness. In a 20-week study with 420 people, the subjects who ate a late lunch lost less weight than those who ate an earlier lunch. Why does meal timing matter if you eat the same amount of calories, only at different times? Diet-induced thermogenesis (the amount of energy needed to digest and assimilate a meal, generally 7-10 percent of calories consumed) is lower at night. Circadian rhythms that drive hunger are also stronger at night compared to morning. Try to frontload your calories? • Should people in treatment for eating disorders be allowed to exercise? Traditionally, the answer has been no. Current research indicates no adverse effects, as long as the person is medically stable. Yoga, lifting weights and aerobic exercise (30 minute limit) have been shown to be beneficial in terms of greater muscle mass and weight gain, with fewer disordered eating symptoms. Yes, exercise can be helpful for people with eating disorders—as long as exercise is moderate and accompanied by adequate fuel. Protein • Protein is a positive addition to a weight management program. One reason, it is satiating (helps keep you feeling fed). Another reason, it helps to curb loss of muscle. (When deprived of fuel, the body breaks down muscles for energy.) The less muscle you have, the fewer calories you burn. •Despite popular belief, high protein diets are unlikely to harm your health (if you are healthy). Extra protein does not cause kidney failure, nor does it cause bone loss. Yet, diets high in animal protein can be filled with unhealthy fats, as well as be harmful to the environment. Moderation… • Eating extra protein is NOT the key to building muscle. The key is to lift heavier and heavier weights (progressive resistance exercise). Surprisingly, endurance and strength athletes have similar protein needs per pound of body weight. • Athletes should pay attention to not only how much protein they eat but also to when they eat it. Research with 20 grams of protein taken 4 times a day (80 g/day) shows better muscle protein synthesis than 10 grams taken eight times a day, or 40 grams taken twice a day. Hence athletes want to target about 20 grams of protein every three to four hours at breakfast, lunch, afternoon snack and dinner. • Protein needs are based on body weight (not percent of calories). While the total daily need is about 0.5 to 0.75 grams protein per pound (1.2-1.7 g pro/kg), a suggested distribution is 0.12-0.14 grams of protein per pound of body weight per meal (0.25-0.3 g pro/kg). For a 150-pound (68 kg) athlete, this comes to about 20 grams protein per meal. For a 120-pound (55 kg) athlete, the dose is about 15 g protein/meal. A 200-pound athlete (90 kg) needs about 25 g protein/meal. Most athletes eat more than this; the extra protein does not build bigger muscles. • Dieters, serious athletes and masters athletes (who want to reduce muscle loss associated with aging) can benefit from another 40 grams of protein before bed. Extra bedtime protein reduces overnight muscle breakdown and enhances overnight muscle growth. Cottage cheese, anyone? • The “anabolic window of opportunity” (optimal time to eat protein after a workout to build muscle) is longer than initially thought. After a weight-lifting session, the muscles are in building-mode for the next two days. In comparison, the best time for refueling depleted muscle glycogen is within the first hour or two after exercise. Your best recovery bet is to enjoy a post-exercise carb-protein combination that both builds and refuels muscles. Eggs and toast? Chicken and rice? Chocolate milk? Sports nutritionist Nancy Clark MS RD CSSD has a private practice in the Boston area where she helps both fitness exercisers and competitive athletes create winning food plans. Learn more at www.nancyclarkrd.com. Active Voice: Running Biomechanics from Ages 20 to 60: What’s Going On at the Ankle? (acsm-blog/acsm-blog/2016/05/16/active-voice-running-biomechanics-from-ages-20to-60-what-s-going-on-at-the-ankle-) by Guest Blogger | May 16, 2016 By Paul DeVita, Ph.D., FACSM The Runners Injury and Longitudinal Study, or TRAILS, is a multi-organization study investigating the hypothesis that a discrete set of biomechanical, behavioral and physiological risk factors distinguish runners who sustain an overuse running injury from those who remain injury-free. Wake Forest University, the U.S. Army and East Carolina University are collaborating to define factors that differentiate injury-free from injured runners over one year. The long-term goal of this research is to reduce the number of injuries sustained by military recruits during their training. As described in our January 2016 MSSE (http://journals.lww.com/acsm-msse/Abstract/2016/01000/The_Relationships_between_Age_and_Running.14.aspx) paper, we used the baseline data from 110 male and female runners to address this issue and produce relevant data on the changes in running biomechanics for subjects aged 20 to 60 years. The primary results of this cross-sectional study were: 1) stride length and running velocity decreased 15 percent over the 40 years, but stride rate did not change; 2) hip and knee muscle function also were unchanged over the four decades, but ankle calf muscle function decreased precipitously. I need to mention that nonbiomechanical factors possibly may have contributed to these observed changes with age. For example, reduced overall fitness may have led the older runners to decide to run slower and they did so by reducing calf muscle function to take shorter steps and run slower. The focused decline in ankle muscle function is still a unique observation, no matter the causal factors, and suggests either strength or power training focusing on the calf muscles may be a viable mechanism for attenuating the reduction in running biomechanics with age. Training these muscles is typically performed less frequently by runners. Instead, runners tend to train with squats, the leg press and knee extension exercises - with the result being improved strength or power in the quadriceps. Certainly, fewer people perform ankle squats, ankle presses and ankle extension exercises — but, we now are suggesting that they should try to incorporate ankle training into their overall regimen. Reduced ankle power also may be related to the observed increase in Achilles and calf muscle injuries that occur in older vs. younger runners. This may be due to the fact that these tissues may not be able to handle the stresses of running as we reach our 40s and 50s. We also find it interesting that the focused decline in ankle muscle function agrees with data showing that older adults (i.e. 70 years and older) lose a relatively greater degree of muscle function at the ankle than at the hip. Perhaps we have identified a functional decline prompted by the aging process, as far as locomotion is concerned — loss of calf muscle function. This idea suggests that training our calf muscles also may benefit older adults during more routine activities of daily living. Beyond what I have just described, we also were able to calculate a yearly rate of decline for these variables. This calculation was a novel contribution of the study and may serve to help other investigators by providing reference values for these measures. The regression equations may be used to accurately estimate stride length and running velocity at various adult ages. Furthermore, these predictions can be used to assess an individual’s current performance level and provide target goals for coaches, medical personnel or runners themselves. Finally, these data support the idea that long-term running behavior ameliorates the increase in body weight and BMI evident in sedentary, middle aged adults. In support of this impression is the fact that the 30 to 59 year olds in our study had nearly identical body mass and BMI values, and their values were only slightly higher than those in the 20 to 29 year olds. Hey - wherever you are on this age continuum, keep running! Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Paul DeVita, Ph.D., is the director of the Biomechanics Laboratory in the Department of Kinesiology at East Carolina University in Greenville, North Carolina. He currently is president of the American Society of Biomechanics and an ACSM Fellow. Dr. DeVita is a locomotion biomechanist and has investigated walking and running gaits in healthy, young and old adults, obese individuals and people with knee osteoarthritis. The work he discusses in this commentary is part of a larger research project on running injuries that has been funded by the U.S. Army, with Stephen P. Messier, Ph.D., FACSM, as the principal investigator. This commentary presents Dr. DeVita’s views on the topic of a research article that he and his colleagues had published in the January 2016 issue of Medicine & Science in Sports & Exercise® (MSSE). May 4 is Project ACES Day — All Children Exercise Simultaneously! (acsm-blog/acsm-blog/2016/05/03/may-4-is-project-aces-day-all-children-exercise-simultaneously!) by Guest Blogger | May 03, 2016 In conjunction with May's Exercise is Medicine® Month, tomorrow is the day that "The World's Largest Exercise Class" will come to children and schools around the world. Millions of participants across the globe will be celebrating the annual Project ACES® Day beginning at 10 a.m. This Youth Fitness Coalition (YFC) signature program, in partnership with the American College of Sports Medicine’s Exercise is Medicine® initiative, promotes physical activity to children in order to decrease the prevalence of childhood obesity. Project ACES, an acronym for All Children Exercise Simultaneously, also coincides with National Physical Fitness and Sports Month and National Physical Education Week. To learn more, please visit www.projectaces.com (http://www.projectaces.com). Active Voice: Increasing Motor Skill Performance, Not Physical Activity, In Preschool Children is Possible with Joyful Activities (acsmblog/acsm-blog/2016/05/02/active-voice-increasing-motor-skill-performance-not-physical-activity-in-preschool-children-is-possible-withjoyful-activities) by Guest Blogger | May 02, 2016 By Kristina Roth, Ph.D.

Reduced physical activity and motor skills in children remain a major public health concern, as these issues are associated with several cardiovascular risk factors and overweight status. However, we also know that motor skill acquisition and physical activity play key roles in child development and promotion of health. In particular, the preschool period seems to be a key phase for prevention and numerous intervention studies have been implemented and evaluated all over the world. Some intervention strategies focusing on preschool settings show great promise for prevention. However, the answers to some questions are still lacking: can a child-appropriate preschool intervention program with individualized components led by the preschool teachers be effective, especially in the long run? Also, are there some persisting positive effects? A randomized controlled trial with an intervention phase lasting one academic preschool year gave us the opportunity to provide answers to these questions. Our research report (http://journals.lww.com/acsm-msse/Abstract/2015/12000/Effects_of_a_Physical_Activity_Intervention_in.7.aspx) on this study, the Prevention through Activity in Kindergarten Trial (PAKT) was published in the December 2015 issue of MSSE. We investigated how a multi-component, childappropriate preschool intervention program lasting 11 months with a daily 30 minute physical activity intervention can enhance physical activity, motor skill performance and other health-related outcomes in four- and five-year-old children. We consider motor development and physical activity motivation of children to be individualized and complex. Thus, we developed an intervention program based on a holistic pedagogic approach. This offered a huge scope for individualizing components and focusing the joy and fun that could be incorporated into motor tasks in children. Furthermore, our intention was that intervention lessons can be led easily by the preschool teachers ? irrespective of the equipment, personnel and space of the preschool. Our results showed that children in the intervention group gained significant benefits in motor skill performance compared to children in the control group. Much to our pleasant surprise, this positive effect still persisted three months after the end of intervention. Regarding physical activity behavior, we found a slight increase in the children who participated in the intervention group. But, this effect was at borderline significance and was not sustained after the intervention ended. Furthermore, we could not detect any positive intervention effects on body mass index, skinfold thickness, blood pressure, rates of accidents in everyday life, or infections for the entire intervention group over the controls. But, what seemed more important, our findings in a subsample of overweight children suggested that the intervention may clearly reduce increases in subcutaneous fat. The findings from our study are relevant to the many institutions and personnel involved in providing care to preschool children. We demonstrated that a child-appropriate physical activity intervention can be easily implemented in preschools by the preschool teachers. Successful implementation is feasible, regardless of whether personnel and special resources are available or not. This type of intervention can have positive implications on motor skill performance and, at least among overweight preschool children, may counter tendencies to increase body fat. Finally, regular and obligatory physical activity in preschool settings could be a key factor in public health strategies in young children. However, a change of health-related behavior such as physical activity seems to be a greater challenge. Further research is needed to gain knowledge about the possibility to change children’s physical activity habits in the long-term. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Kristina Roth, Ph.D., is a physical education scientist, physical education teacher and a researcher at the University Children’s Hospital Würzburg, Germany. Her research focuses on the cross-sectional association and the longitudinal effects of physical activity intervention on motor skill performance, physical activity and health in children. This commentary presents Dr. Roth’s views on the topic of a research article which she and her colleagues published in the December 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). May is Exercise is Medicine® Month; Toolkit Available (acsm-blog/acsm-blog/2016/04/20/may-is-exercise-is-medicine-month-toolkit-available) by Guest Blogger | Apr 20, 2016 Exercise is Medicine® (EIM) Month begins in less than two weeks! During May, communities throughout the U.S. will hold activities that recognize the positive impact of physical activity

and exercise in helping to prevent and treat more than 40 chronic diseases. Individuals and organizations of all kinds, from youth groups to universities, churches, fitness centers, corporations and hospitals, will hold events aimed at keeping people active and healthy, and encourage them to make exercise a part of everyone’s health care plan.. To learn more about EIM Month 2016 and how to get your local college or university campus involved, visit the EIM website (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2169047&messageid=2169047&databaseid=Mailing.DS169047.2169047.152304&serial=17554574&emailid=aspencer@acsm.org&userid=64318119&target p=108) or download the EIM Month toolkit (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2169047&messageid=2169047&databaseid=Mailing.DS169047.2169047.152304&serial=17554574&emailid=aspencer@acsm.org&userid=64318119&target p=117). April 24 Marks the First National Park Rx Day (acsm-blog/acsm-blog/2016/04/13/april-24-marks-the-first-national-park-rx-day) by Guest Blogger | Apr 13, 2016 By Thomas P. Martin, Ph.D., FACSM

Sunday, April 24, 2016 will be the first-ever National Park Rx Day (https://www.nps.gov/planyourvisit/healthy-events.htm), and it’s an opportunity for members to spread the Exercise is Medicine® (http://www.exerciseismedicine.org/) message. This day will be celebrated across the United States to promote the growing movement of prescribing parks and nature to patients as a means for improving human health. VADM Vivek H. Murthy, US Surgeon General, will present a keynote address at this event when it is celebrated in Washington, DC. National Park Rx Day encourages everyone to see recreational visits to parks and public lands as very important parts of their health. According to the National Parks Service, there are eight reasons to get outdoors and enjoy a walk in the park on Park Rx Day! 1. 2. 3. 4. 5. 6. 7. 8.

Being in nature can improve your mood. Having access to parks can increase physical activity and combat obesity. Parks and their health benefits can be enjoyed by anyone, regardless of who you are or from where you come. Contact with nature through parks improves all people's physical, mental and spiritual health. Parks foster social connections which are vital to community cohesion and contribute to social well-being. For children, parks foster active play, which is associated with physical, cognitive and social benefits. For adolescents, parks improve mental and social health during what is often a challenging time of life. Park use is linked to physical and mental health benefits among adults, especially older adults.

National Park Rx Day is a promotion of the National Park’s “Healthy Parks Healthy People” initiative. It is a global movement that harnesses the power of parks and public lands in contributing to a healthy civil society. The idea originated with Parks Victoria, Australia, and was brought to global prominence at the 1st Healthy Parks Healthy People Congress in April, 2010. The National Park Service’s Healthy Parks Healthy People US program was established in 2011 to reframe the role of parks and public lands as an emerging, powerful health promotion strategy. See the NPS Healthy Parks Healthy People website (http://www.nps.gov/public_health/hp/hphp.htm) for further information. Moving, in all its forms, is advantageous to healthy body function. Outdoor physical activity/play can and should be interesting, enjoyable and satisfying. In that way, it will provide both reinforcement and motivation for continued participation. This is the goal of National Park Rx Day. Participation also may confirm and/or instill the realization that a reasonable level of physical fitness is beneficial for both outdoor activities and everyday life! For those with higher goals, preparation (e.g., training) for challenging outdoor “adventures” becomes an additional reason to maintain or improve physical fitness. So, get out there and wheel chair, walk, run, hike, backpack, climb, swim, canoe, kayak, raft, snorkel, cycle, etc. And, encourage others to do the same — not only on April 24 but every day! Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Thomas P. Martin, Ph.D., FACSM, is professor emeritus in the Health, Fitness, and Sport Department at Wittenberg University in Springfield, Ohio. He is an ACSM Registered Clinical Exercise Physiologist and Exercise is Medicine® credential holder (Level 3). He is a member of the National Park Foundation and has been promoting healthy “physical activity” on our protected land/water for several years. His avocation is “Outdoor Pursuits.” He has been physically active in all 59 of the U.S. National Parks and continues to pursue a goal of experiencing all National Park Areas (>400). In addition, he has completed 49.8 of the U.S. State Highpoints (http://www.summitpost.org/u-s-state-highpoints/171191) and created the “Martin Classification of Difficulty for U.S. State Highpoints.” The Martin scale is based, in large part, on the total energy expenditure to reach each highpoint – click here to access the Martin scale. (http://www4.wittenberg.edu/academics/hfs/tmartin/highpointing/hparticle.html) Active Voice: Sedentary Behavior and Regional Fat Distribution: Are You Sitting Too Comfortably? (acsm-blog/acsm-blog/2016/04/11/active-voice-sedentary-behavior-andregional-fat-distribution-are-you-sitting-too-comfortably-) by Guest Blogger | Apr 11, 2016 By Joseph Henson, Ph.D.

Our modern day society now encompasses an ecological niche in which sedentary behavior (best conceptualized as sitting during waking hours with low energy expenditure) and labor-saving devices have become the new reference of living. Despite this shift being considered by many as an improvement in living conditions, the insidious nature of sedentary behavior has undoubtedly created a mismatch between our evolutionary history and the environment for which humans adapted. Within modern society, many adults now spend the majority of their waking hours sedentary (up to 70 percent), a figure that far surpasses the hunting, gathering and migratory patterns of our ancestors. Recently, multiple observational studies have demonstrated a positive association between objectively measured sedentary time and markers of diabetes risk, independent of the amount of moderate-to-vigorous physical activity (MVPA) undertaken. These findings, alongside its ubiquitous nature, suggest that sedentary behavior is likely to be a distinct risk factor for type 2 diabetes mellitus (T2DM) and, thus, a potential target for lifestyle intervention. In this observational study, published in the August issue of MSSE (http://journals.lww.com/acsm-msse/Abstract/2015/08000/Associations_of_Sedentary_Time_with_Fat.22.aspx), we examined the association between objectively measured sedentary time and heart, liver, visceral and total body fat, independent of MVPA and whole body fat in a population at high risk of T2DM. These are important markers of health, particularly as regional fat deposits have been postulated to be of greater importance than overall adiposity in provoking metabolic disturbance. We examined magnetic resonance images (MRI) and accelerometer data from 66 participants, who were recruited from diabetes prevention programs. Each 30 minutes of sedentary time was associated with a 15.7cm3 increase in heart fat (p=0.008), 1.2 percent increase in liver fat (p=0.026) and a 183.7cm3 increase in visceral fat (p=0.039) after adjustment for several covariates, including glycemia, whole body fat and MVPA. The findings from this study suggest that objectively measured sedentary behavior has a deleterious impact upon heart, liver and visceral fat in individuals at a high risk of T2DM. Interestingly, since the associations remained after adjustment for whole body fat and MVPA, it may suggest that sedentary behavior is linked to selective depositions of fat which cannot be fully explained by an increase in overall adiposity and may act via an independent mechanism. These observations need further examination in carefully controlled experimental research studies. The results from this study, coupled with the mounting evidence promulgating the importance of reducing sedentary behavior as a therapeutic target (particularly in the promotion of metabolic health), mean there is an ongoing need to establish causation while also considering how this evidence can be incorporated into diabetes prevention and treatment pathways. In particular, care is needed regarding how interventions aimed at reducing sedentary behavior are integrated alongside the well-recognized benefits of participation in regular MVPA. It is plausible that highly sedentary and inactive individuals may benefit from a stepped interventional approach whereby the first step is aimed at reducing sitting time through increasing standing or light ambulation before more purposeful MVPA is introduced. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Joseph Henson, Ph.D., is a research associate in sedentary behavior, physical activity and health at the Leicester Diabetes Centre, University of Leicester, UK. The Leicester Diabetes Centre is an international center of excellence in research, education and innovation, which is a partnership between the University Hospitals of Leicester NHS Trust and the University of Leicester and is led by Professors Kamlesh Khunti and Melanie Davies. His research, which is funded by the National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, focuses on the independent association of sedentary behavior and the impact of interruptions upon chronic disease markers, particularly those affiliated with Type 2 diabetes (T2DM). This commentary presents Dr. Henson’s views on the topic of a research article that he and his colleagues had published in the August 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Successful 2016 ACSM Summit on the Books; See You in San Diego in 2017 (acsm-blog/acsm-blog/2016/04/05/successful-2016-acsm-summit-on-the-books-see-you-in-sandiego-in-2017) by Guest Blogger | Apr 05, 2016 The 20th Annual ACSM Health & Fitness Summit & Expo wrapped up last Friday in Orlando, Florida. Participants enjoyed outstanding presentations, workouts and more. See all the highlights on the ACSM certification blog (http://certification.acsm.org/blog) and ACSM’s social media accounts: American College of Sports Medicine (https://www.facebook.com/pages/American-College-of-Sports-Medicine/64402266263?fref=ts) on Facebook, @ACSMNews (https://twitter.com/ACSMNews) on Twitter and acsm1954 (https://instagram.com/acsm1954) on Instagram. Mark your calendars for next year's ACSM Summit: April 6-9 in San Diego, California! Proposals for the 2017 summit are due May 15. Click here (http://acsmsummit.org/programming/2017-proposals/) for more information about 2017 proposals. A Landmark Accomplishment for ACSM & Exercise is Medicine® (EIM) – Implementing the EIM Solution (acsm-blog/acsm-blog/2016/03/23/a-landmark-accomplishmentfor-acsm-exercise-is-medicine-(eim)-implementing-the-eim-solution) by Guest Blogger | Mar 23, 2016 By Adrian Hutber, Ph.D. & Phillip Trotter

A Brief Synopsis of EIM. EIM’s most fundamental mission has been to establish physical activity as an issue to be addressed in every physician-patient office visit and, by virtue of that interaction, engage physicians in writing individual scripts for each patient. The philosophy, concepts and implementation models of EIM are based on scientifically sound and persuasive evidence as to the health values of regular physical activity. Such a system, if implemented in communities across the U.S. and worldwide, holds great promise for disease prevention and controlling ever-rising health care costs. In the early going, tireless efforts by many EIM volunteer and staff leaders advanced understanding and enthusiasm for these concepts. As a result, EIM is supported by a global network of collaborating centers – a network that is still growing. Now, Adrian Hutber, Ph.D. Phillip Trotter moving forward, EIM has developed methods and protocols capable of demonstrating effectiveness and practicality when implemented in health care settings. The next stage, and the subject of this commentary, is the plan for full-scale implementation in a large health system. Two critical components required for this phase include carefully coordinated involvement of community stakeholders and simultaneous integration of a rigorous system to evaluate the real-life effectiveness of EIM program. EIM, as an entity, is complex and has many working parts. A Health Care System in Transformation. Today in the U.S., chronic diseases are responsible for 80 percent of health care costs. One major consequence is that payers (employers, insurers, Medicaid and Medicare) are demanding that health systems share fiscal responsibility for interventions that successfully decrease both the prevalence and economic burden of these chronic diseases. A key strategy to bring this about is a transformation of the health care system – from one that is focused on volume to a system focusing on value-based care. So, instead of the longstanding “fee for service” model, there is great momentum building for replacement it with a model that rewards achievement of successful patients’ health outcomes. With this new model has come remarkable opportunities for exercise professionals and facilities, providing them with the opportunity to play a significant role in the prevention and intervention of chronic diseases. The National Press Club Announcement of February 23rd. The American College of Sports Medicine (ACSM), American Council on Exercise (ACE) and the Medical Fitness Association (MFA) came together at the National Press Club in Washington, DC to announce that they were uniting under the Exercise is Medicine® (EIM) platform. The purpose of this collaboration is to support the building of what EIM identifies as Community Care Teams – these include trained personnel who can deliver chronic disease prevention and intervention programs. A health care-relevant analogy is that this EIM model builds into each community an “exercise pharmacy,” i.e. referring to personnel, facilities and places where the health care provider, with confidence, sends their patient on a trusted pathway to fill a given prescription for disease prevention. Clinicians have long acknowledged that physical activity, at the very least, is an important factor for both the prevention and management of chronic diseases. With health care systems now widely adopting the Population Health Management (https://www.healthcatalyst.com/population-health/) (PHM) care model, regular physical activity and exercise is now a must-have lifestyle behavior priority. This PHM care model helps to describe the evolution underway that is designed to improve health across the continuum of care. The capacity-building needed to make possible these community-level connections between the PMH model and the “exercise pharmacies” has been underway for several years – through planning and guidance provided by EIM’s Global Center (http://exerciseismedicine.org/support_page.php?p=68) (EIM-GC)and its Global Research and Collaboration Center (EIM-GRCC (http://exerciseismedicine.org/support_page.php? p=348)). The challenge is where to refer these population groups for participation in accessible, safe and uniformly effective prevention and intervention programs. In simple terms, many health systems are reluctant to refer patients to a community resource that cannot demonstrate quality assurance of service equivalent to what patients receive within that same community’s clinical settings. This quality assurance is exactly what the EIM Solution (http://www.exerciseismedicine.org/support_page.php?p=116) provides. EIM’s programs and credentialed professionals provide the engagement methodology needed for advancing patients toward a physically activity lifestyle – including attention to the duration, frequency and intensity of activity necessary to develop behavior-change outcomes that lead to self-management and a return on investment for health systems. Editorial Note: Part II of this commentary will focus on how the EIM Solution will be applied and the role of EIM-GRCC in evaluating and validating a system of metrics to demonstrate effectiveness of implementation. Adrian Hutber, Ph.D., has served as vice president of Exercise is Medicine® at ACSM since 2008, after previously serving as vice president of a major fitness corporation and as the director of the distance education division at Human Kinetics. During his time at ACSM, Dr. Hutber has helped to establish seven EIM Regional Centers and 43 EIM National Centers, all with the goal of making physical activity assessment, prescription and referral part of health care systems globally. Phil Trotter, B.S., leads the EIM Solution “on the ground.” The EIM Solution is the key component of EIM that brings about implementation of community networks that include local health systems, health providers and resources necessary to make physical activity and exercise a standard element in the delivery of health care to all patients. This commentary summarizes perhaps the most exciting news about Exercise is Medicine® since its inception in 2007. For reasons of scope and complexity, the presentation is divided into Parts I and II. Part I presents a short overview of EIM and key details from a special press conference held late last month at the National Press Club in Washington, D.C. (see: https://youtu.be/u_GkwT0bFpw (https://youtu.be/u_GkwT0bFpw)). This part also identifies the roles of the EIM Solution, the EIM Global Center and the EIM Global Research and Collaborative Center, all of which are key components needed to implement EIM in large U.S. health systems. Part II will follow soon in a future issue of SMB. Active Voice: Placebo Doping to Enhance Endurance Performance (acsm-blog/acsm-blog/2016/03/21/active-voice-placebo-doping-to-enhance-endurance-performance) by Guest Blogger | Mar 21, 2016 By Ramzy Ross, Ph.D., Cindy M. Gray, Ph.D. and Jason M.R. Gill, Ph.D. In competitive sport, athletes are constantly seeking novel methods to improve performance and gain an edge on the opposition. The line between what constitutes a legal or illegal ergogenic aid may not be a sharp one, and the prohibited list of substances and methods from the World Anti-Doping Agency (WADA) continues to evolve and be updated. For example, taking human recombinant erythropoietin (r-HuEPO) to improve the oxygen-carrying capacity of the blood is currently banned. However, sleeping in an altitude tent which elicits a similar physiological effect is not banned. Many athletes delve into the ethically grey area of taking supplements which, although not on the prohibited list, claim to produce similar effects to those substances which are banned. Many of these supplements have no clear evidence supporting an ergogenic effect: however, despite such substances potentially being biologically inert, it is possible that the belief of the athlete that such substances are beneficial may improve physiological performance via a placebo effect. The placebo effect is real and measurable. It is because of this that the placebo controlled trial is the gold standard for medical research. This raises the possibility that some of the benefits of illegal performance enhancing drugs, such as r-HuEPO, may be mediated by a placebo effect. In our research, reported in the August 2015 issue of MSSE (http://journals.lww.com/acsm-msse/Fulltext/2015/08000/Effects_of_an_Injected_Placebo_on_Endurance.15.aspx), we sought to quantify the effect of a placebo on running performance, by providing participants with daily injections of saline but fictitiously informing them that they were receiving a drug with similar effects to r-HuEPO. Our randomized crossover study in 15 club-level runners assessed running performance over 3000m in a “‘real world,”’ field-based, head-to-head competition setting on a 200m indoor track. We found a statistically significant 1.2 percent improvement in performance following one week of daily placebo administration. Qualitative analysis of interviews with participants suggests that the placebo improved performance in two ways. First, by reducing the perception of effort and, second, by increasing potential motivation – in other words, the highest amount of effort that the athlete was prepared to exert during the race. We also found a role for cognitive beliefs and expectations in mediating the placebo effect – those who anticipated the greatest positive change from taking the placebo and perceived decreased physical effort during training, had the greatest improvements in performance. Thus, like lucky horseshoes, you need to believe in the effect for it to work. This magnitude of improvement with placebo, at 1.2 percent, was smaller than the reported effect of r-HuEPO on performance in similar competitive events (~5-6 percent). However, this effect is nevertheless of clear sporting relevance. In the 2012 Olympics, the difference between the gold medal and fourth place was less than one percent in all track events from 1500m to 10000m for both men and women. Thus, this real ergogenic effect of placebo perhaps raises an interesting philosophical and ethical issue. Is a coach who provides his/her athlete with “‘supplements”’ to improve performance facilitating a placebo effect by instilling the belief that ergogenic effects will occur? Moreover, if they do this in the absence of objective evidence that the supplement is beneficial, are they engaging in a morally questionable and deceptive practice or simply following their duty, as coaches, to use all (legal) means possible to get the best out their athlete? Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Ramzy Ross, Ph.D.

Cindy M. Gray, Ph.D. Jason M.R. Gill, Ph.D.

Ramzy Ross, Ph.D., is an exercise physiology and physical performance specialist currently working with governmental entities of the United Arab Emirates. In addition to physical performance-based research, his roles within the Ministries of Defence, Health and Education involve the health and physical development of youth, enhancement of occupational and military performance, as well as the development of public health initiatives. Cindy M. Gray, Ph.D., is a Lord Kelvin Adam Smith Fellow in Health Behaviour Change at the University of Glasgow in Scotland. She is a psychologist with a main research focus on using social innovation to engage hard-to-reach groups in physical activity and dietary behaviour change, employing both qualitative and quantitative methods. An example of this is the award-winning Football Fans in Training (FFIT) project, and its follow-up, European Fans in Training (EuroFIT). Jason M.R. Gill, Ph.D., is a reader (associate professor) in exercise and metabolic health in the Institute of Cardiovascular and Medical Sciences at the University of Glasgow in Scotland. While the majority of his research relates to the effects of exercise and diet in the prevention and management of vascular and metabolic diseases, he also has an interest in sports performance. He has been a member of ACSM for nearly 20 years. This commentary presents the views of these authors in a research article published in the August 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).

Ten Ways to Start an Exercise Program (acsm-blog/acsm-blog/2016/03/14/ten-ways-to-start-an-exercise-program) by Guest Blogger | Mar 14, 2016 By Greg Chertok, M.Ed., CC-AASP The beginning of the new year is a popular time to start an exercise program, after months of holiday indulgences. Are you ready to start a healthier lifestyle? Here’s 10 recommendations to help you stick to your resolution this year: 1. Get to Know Your Body Every exerciser must have a basic understanding of the human body. This includes: • proper identification of the major muscle groups • knowledge about the effects of activity vs. inactivity • distinction between stretching and strengthening a muscle • distinction between “good pain” (muscle burn and fatigue) and “bad pain” (joint pain, lower back pain/impingement). If you know nothing about the workings of the body, you may be putting yourself in a dangerous position. I once worked with an older man who, in response to experiencing soreness from exercise the day prior, decided to address the issue by doing more of what got him sore in the first place. Rather than stretching or resting the muscle, he assumed that working more would do the trick. He was forced to take even more time off to relieve the resulting soreness. This man, a senior vice president for a successful financial firm, was not uneducated. He was simply uninformed. 2. Understand Why You Are Exercising Pose questions to yourself such as, “Why did I decide to start exercising?” It is suggested that exercisers who are intrinsically motivated experience more positive effects and better adherence than those who are extrinsically motivated. Intrinsically motivated exercisers do so for the satisfaction gained from engaging in the activity itself; in other words, they exercise for the challenge, to gain or learn skills, or to have fun. Extrinsically motivated exercisers do so as a means to an end; they exercise simply to improve their fitness or appearance. The proper reason behind exercising can act as powerful and long-lasting fuel. To read the full article, please visit the Fit Society Page (http://http://www.acsm.org/docs/default-source/fit-society-page/acsm-fsp-16-5.pdf?sfvrsn=0) archives. Active Voice: Aerobic Exercise Targets Specific Higher-order Brain Functions (acsm-blog/acsm-blog/2016/03/09/active-voice-aerobic-exercise-targets-specific-higher-orderbrain-functions) by Guest Blogger | Mar 09, 2016 By Timothy B. Weng, B.S., and Michelle W. Voss, Ph.D. The benefits of physical activity and habitual aerobic exercise on cognitive function and brain health are becoming increasingly appreciated both by the scientific community and the general public. These findings stem from a growing body of epidemiological, crosssectional and long-term intervention studies. Despite the abundance of encouraging scientific evidence, guidelines for establishing public health recommendations remain unclear due to a lack of knowledge regarding the exact mechanisms through which exercise benefits brain function. Furthermore, a concern arising from these studies is the difficulty of discerning the unique brain benefits of physical exercise, as distinguished from those associated with changes in other lifestyle factors, such as dietary and sleep habits. In our study, reported in the July 2015 issue of MSSE (http://journals.lww.com/acsmmsse/abstract/2015/07000/Differential_Effects_of_Acute_Exercise_on_Distinct.17.aspx), we sought to contribute to knowledge on these issues by investigating the acute effects of aerobic exercise on cognitive performance. We reasoned that such acute effects might reflect transient changes that, over time, contribute to more stable adaptations that result from long-term exercise training. Previous research Timothy B. Weng, B.S. Michelle W. Voss, Ph.D. indicates that executive functions are more sensitive to acute moderate-intensity aerobic exercise than are other cognitive processes. However, executive functions are comprised of multiple processes, and advancing mechanistic knowledge requires clarifying whether these are differentially affected by an aerobic exercise bout. Therefore, we tested the specificity of the acute effects of moderate intensity aerobic exercise on two tasks that engage theoretically distinct components of executive function. In our sample of healthy young adults, we found that 30 minutes of stationary aerobic cycling improved their ability to mentally store and update multiple features of information (i.e., working memory). Although we found that their working memory accuracy improved by ~6.4 percent, there were no significant changes in their ability to exert control over irrelevant information (i.e., inhibitory control). Furthermore, no changes in either task occurred when the same participants completed a passive exercise control condition in which their legs were moved by motorized pedals on the same bike and at the same cadence as in the aerobic condition. We interpret these findings as evidence that, in healthy young adults, moderate-intensity aerobic exercise affects some specific brain systems more than others. Based on our findings, we suggest that actively engaging the musculoskeletal and cardiovascular systems at a moderate intensity, rather than moving passively, affects brain systems involved in working memory processes. In our study, we observed this specificity in the acute phase after one exercise session. Future investigations that combine acute and chronic exercise paradigms within the same individuals may provide insight into how the specificity of acute effects contributes to long-term adaptations that accumulate with subsequent training. We hope that our findings also encourage others to consider a within-subjects acute exercise paradigm that controls for muscle movement as a method to systematically evaluate which exercise parameters maximize outcomes on a variety of brain and cognitive measures. Ultimately, we anticipate that advancing such knowledge will accelerate the establishment of evidence-based exercise recommendations for improving cognitive and brain health. Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Timothy B. Weng, B.S., is a Ph.D. student in the Department of Psychological and Brain Sciences at the University of Iowa. His research investigates acute changes in brain and cognitive function following a single session of exercise. He applies this methodology to gain mechanistic insight into the beneficial effects of physical activity and aerobic exercise on brain health. Michelle W. Voss, Ph.D., is an assistant professor in the Department of Psychological and Brain Sciences at the University of Iowa. Her research focuses on maximizing the plasticity of the aging mind and brain through interventions such as cognitive training and physical exercise training. This commentary presents Mr. Weng’s and Dr. Voss’ views on the topic of a research project that they and their colleagues recently completed. Their research report appears in the July 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Exercise and the Brain: More Reasons to Keep Moving (acsm-blog/acsm-blog/2016/02/29/exercise-and-the-brain-more-reasons-to-keep-moving) by Guest Blogger | Feb 29, 2016 by Brad A. Roy, Ph.D., FACSM The benefits of physical activity in preventing chronic health conditions and as a therapeutic approach for people diagnosed with them are well recognized. There is a plethora of medical and scientific evidence documenting how regular physical activity can help prevent and/or treat hypertension, type 2 diabetes, abnormal blood lipids, coronary artery disease, stroke, osteoporosis, arthritis, certain cancers and other conditions. The strength of this evidence has resulted in the American College of Sports Medicine and U.S. Department of Health and Human Services recommending that all Americans undertake a minimum of 150 minutes per week of moderate-intensity aerobic exercise and that children and adolescents participate in 60 minutes or more of daily physical activity. Unfortunately, most Americans do not achieve these recommended minimum levels. To read the full article, please visit the Fit Society Page (http://www.acsm.org/docs/default-source/fit-society-page/acsm-fsp-16-4.pdf?sfvrsn=0) archives. Active Voice: Precisely, What Do We Mean— Force, Work & Power? (acsm-blog/acsm-blog/2016/02/15/active-voice-precisely-what-do-we-mean-force-work-power-) by Guest Blogger | Feb 15, 2016 By Howard G. Knuttgen, Ph.D., FACSM

Having participated in ACSM’s 2015 annual meeting in San Diego, I was highly impressed with the quality of the science being reported. At the same time, however, I was greatly disappointed with the frequent inappropriate use of the term “work.” While “work” in everyday language can refer to anything from a vocation to a composition of music, for science and medicine it is defined in the international system of measurement as, “the product of a force component by the magnitude of displacement (distance)” and quantified in joules (J). A quantity of work can be performed over any period of time and, if quantified in terms of a unit of time, it must be reported as “power” for which the international system unit is the watt (W). Having lived and worked in the Scandinavian countries for over three years where research into exercise has been carried out vigorously for almost 100 years, I believe that I can trace the problem of the inappropriate use of the term “work” to the fact that there is no equivalent term in any of the Scandinavian languages for “exercise”. Investigators from these countries employ a term for muscular activity that is the same one used in these languages for any vocation (Norwegian - arbeid, Swedish - arbete, and Danish - arbejde). It is, therefore, not surprising that the Scandinavian investigators such as Erling Asmussen, P.-O. Åstrand, Bengt Saltin, and Björn Ekblom have used the term “work” instead of “exercise” when publishing in English. However, it is incorrect. Further support to my objection regarding what I heard at ACSM’s annual meeting is my observation that, in every instance where the presenter inappropriately identified the physical activity as “work” he/she then quantified the performance in watts, the international unit for Power. If an investigator does, indeed, wish to present the total work involved in a physical activity, the international unit must be the joule (J) which is independent of time. Work performed per unit of time is Power, the measure of the exercise intensity. Editorial Note: While serving as editor-in-chief of MSS, Dr. Knuttgen first addressed this topic in an editorial statement. The statement may be accessed by members through the ACSM website. Go to “My Journals” and locate the article “Force, Work, Power, and Exercise (http://journals.lww.com/acsmmsse/Abstract/1978/10030/Force,_Work,_Power,_and_Exercise_.17.aspx)”, in the fall 1978 issue. A reminder about this also is presented in ACSM’s online Call for Abstracts each year, as follows: To ensure consistency and clarity, it is directed that authors use the terms as defined by MSSE “Information for Authors,” while utilizing the units of measurement of the Systeme International de’Unite (SI). Additional guidance on terminology and units of measurement for describing exercise and sports performance (http://fecna.com/wpcontent/uploads/2011/08/Strength-and-Power-in-Sport-Koomi.pdf), as compiled by the Sub-committee on Publications in the Sports Sciences, IOC (International Olympic Committee) Medical Commission, is available online (at the source, see pages xiii-xiv). Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Howard G. (Skip) Knuttgen, Ph.D., FACSM, is senior lecturer in physical medicine and rehabilitation at the Harvard University Medical School in Boston, Massachusetts. His research expertise is in skeletal muscle physiology and the related implications for human physical performance and clinical care in sports medicine. He completed his doctoral degree at the Ohio State University in 1959 and was a Fulbright Scholar in Human Physiology at the University of Copenhagen, 1959-1961. Skip has a stellar record of leadership in ACSM, serving as ACSM’s 17th president during an important transformational period for our association. He was editor-in-chief of ACSM’s flagship journal, Medicine and Science in Sports (formerly MSS, now Medicine & Science in Sports & Exercise® or MSSE), from 1974-79. In 1983, Dr. Knuttgen, was responsible for spearheading ACSM’s International Scholars Program, which since has fostered collaborations between young clinicians and scientists from other countries with ACSM members in the United States. The ACSM blog is pleased to present this commentary by Dr. Knuttgen, relating to his impressions and recommendations regarding the importance of precision in scientific communication. Fitting in Fitness: Active Workstations (acsm-blog/acsm-blog/2016/02/09/fitting-in-fitness-active-workstations) by Guest Blogger | Feb 09, 2016 Decreasing levels of physical activity increases the risk for obesity and various chronic health problems. Dramatic changes in occupational physical activity may be a major contributor to the declining rates of overall physical activity in the United States. For example, there has been a decrease in labor-intensive occupations and a large growth in seated “9-to-5” computerized jobs in a modern office. Health problems due to declining physical activity may be compounded by recent suggestions that prolonged sitting may exert an independent harmful effect on health. Thus, the World Health Organization has now recognized the workplace as a “priority-setting” for health promotion. To read the full article, click here (http://www.acsm.org/docs/default-source/fit-society-page/acsm-fsp-17-1.pdf?sfvrsn=0) to open the March 2015 issue of the Fit Society Page Newsletter. Active Voice: ACSM's New Translational Journal — A First Look from the Editor-in-Chief (acsm-blog/acsm-blog/2016/02/02/active-voice-acsm's-newtranslational-journal-a-first-look-from-the-editor-in-chief) by Guest Blogger | Feb 02, 2016 By Joseph E. Donnelly, Ed.D., FACSM Translational and policy science is now a priority of major governmental agencies, such as The National Institutes of Health and Patient-Centered Outcomes Research Institute (PICORI (http://www.pcori.org/)). The Translational Journal of The American College of Sports Medicine (TJACSM) will place ACSM in the forefront for translational and policy science related to exercise. TJACSM is designed to close the gap between laboratory and clinical sciences and the application of research findings to the general community. The National Institutes of Health defines translational research as “the movement of discoveries in basic research to application at the clinical level.” It is the attempt to find ways to take established science into everyday practice. A common theme for translational science includes the concept “it works in the laboratory, but does it work in the real world?” In a similar fashion, translational research often seeks to determine how to make established science work effectively in the general population or community. Therefore, this type of research often includes an analysis of comparative effectiveness of approaches and cost analysis. Frequently, attempts to translate science to community involve community participatory methods; however, translational research does not rely solely on this methodology. An example of translational research would be an investigation to determine how to install an established and effective health risk management program in the workplace by comparing a face-to-face wellness program to a similar program delivered remotely using technology. Another example would be an investigation to determine the effectiveness of translating new findings in basic science for exercise and blood pressure to effective programs for seniors with hypertension in care facilities. One more example would be an investigation to compare two or more effective strategies used to alter public school policy to establish new policies aimed at increasing physical activity in public schools. In these examples, the objective is to find ways to translate known science into effective applications in everyday practice or communities. Many ACSM members are actively engaged in translational research, and TJACSM will provide an outlet for the best scientific findings. Likewise, members involved with direct services to clientele would benefit from an authoritative source of information to guide their approach with individuals and communities. TJACSM will publish research investigations and evidencebased systematic reviews that determine how to put science into practice. We welcome submission of research articles from scientists who investigate the translation of exercise science to practice, including the study of policy that often impacts or determines how translation takes place. Note: Submission of papers will begin with editor-invited papers in this month. The first issue of the journal is scheduled for April 1, 2016. As TJACSM develops, articles will progress to open submission. We will alert members when open submission begins and provide specifics on submitting papers via the TJACSM website. The production of TJACSM will take a slightly different format from other ACSM journals. Content will be updated to the journal site regularly, with articles appearing as they are accepted on a biweekly basis. In addition, we plan to capitalize on the digital nature of this journal by also including ancillary digital content with each manuscript. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Joseph E. Donnelly, Ed.D., FACSM, has been an ACSM member since 1978. He is currently professor, internal medicine and director of the Energy Balance Laboratory and Center for Physical Activity and Weight Management, Cardiovascular Research Institute at The University of Kansas Medical Center in Kansas City, Kansas. He is a past president of the Central States Chapter of ACSM, past member of the Board of Trustees, a current member of the ACSM Strategic Health Initiative for Obesity and the first Editor-In-Chief of ACSM’s new Translational Journal. His research has focused on the translation of energy balance science to community settings to impact obesity, diabetes and cardiovascular diseases in children and adults. Creating Walkable Communities (acsm-blog/acsm-blog/2016/01/25/creating-walkable-communities) by Guest Blogger | Jan 25, 2016 By Heidi Simon, America Walks Walkable communities create strong, healthy and livable communities. Infrastructure that facilitates walking, such as sidewalks, safe street crossings and low auto speeds, coupled with access to everyday destinations enables people of all ages, abilities, incomes and ethnicities to walk for everyday transportation. Walking provides access to necessary goods and services, such as grocery stores and parks, and doing so helps address disparities found far too often in cities and towns across America. Walking is also an excellent source of everyday physical activity. Walking provides the base level of activity needed for adults and eliminates the disparity gap for Americans that lack the time and ability to dedicate time to workouts. People were made to walk, and in doing so, can take back control of their physical, mental and cognitive health. To read the full article, click here (http://www.acsm.org/docs/default-source/fit-society-page/acsm-fsp-18-1.pdf?sfvrsn=0) to view the January 2016 issue of the ACSM Fit Society Page. Active Voice: Battle of the Sexes: Are Females More Resistant to Extreme Neuromuscular Fatigue? (acsm-blog/acsm-blog/2016/01/19/active-voicebattle-of-the-sexes-are-females-more-resistant-to-extreme-neuromuscular-fatigue-) by Guest Blogger | Jan 19, 2016 By John Temesi, Ph.D., and Guillaume Millet, Ph.D.

Ultra-endurance sports such as running, cycling and adventure racing are rapidly increasing in popularity. The great distances and extreme conditions in these events are uniquely capable of being used to understand the limits of human performance. With the rapid growth of ultra-endurance sports there has also been a huge uptick in female participation. To date, ultra-endurance research has focused exclusively on male participants, resulting in a large knowledge gap pertaining to the physiology and performance of females in such demanding conditions. Our recent study, published in MSSE (http://journals.lww.com/acsmmsse/Abstract/2015/07000/Are_Females_More_Resistant_to_Extreme.7.aspx), is the first to directly compare neuromuscular fatigue in the knee extensors and plantar flexors, both functionally important muscle groups for locomotion, in males and females. There are reports that Guillaume Millet, Ph.D. females may be as good or even better performers than males at extremely long distances. In fact, women have won or placed in the top John Temesi, Ph.D. three overall in such extreme events as the Badwater ultramarathon and Western States Endurance Run. One possibility that has been suggested is that females demonstrate less fatigue than males, and thus can perform better. In this study, the neuromuscular function of 10 male and 10 female ultra-trail runners, were evaluated before and after they completed a 110-km ultra-trail running race with almost 6000 m in positive elevation change. The subjects were matched by finishing time calculated as a percentage of the winning time of their sex. The major neuromuscular parameters that were assessed were the changes in maximal voluntary torque (i.e. indicating the amount of overall fatigue), torques evoked by nerve stimulation in the relaxed muscle state (i.e. indicating fatigue within the muscle) and maximal voluntary activation assessed by nerve and transcranial magnetic stimulations. We also assessed electromyography, including the excitability and inhibition of the corticospinal tract to the knee extensors. After the trail running race, all subjects demonstrated substantial general neuromuscular fatigue in both the knee extensors and plantar flexors (i.e. decrease in maximal voluntary torque). Although overall fatigue in the knee extensors was greater in males than females, the source of this greater fatigue could not be clearly isolated. In the plantar flexors, males also demonstrated greater muscle fatigue than females. In both muscle groups, the magnitude of fatigue within the central nervous system and brain was similar for both sexes. Moreover, similar changes occurred after the event in males and females with regard to corticospinal excitability and inhibition of the knee extensors. The greater general neuromuscular fatigue in the knee extensors and greater muscle fatigue in the plantar flexors for males suggests that differential fatigue between the sexes occurs solely at the muscle level. These differences may partly explain the reports of better performance by females in extremely long duration running races, particularly as the race distance increases. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. John Temesi, Ph.D., is a postdoctoral fellow in the faculty of kinesiology at the University of Calgary. His research focuses on neuromuscular fatigue, especially central and supraspinal fatigue, related to locomotor exercise in both athletic and clinical populations. Guillaume Millet, Ph.D., is professor in the faculty of kinesiology at the University of Calgary. His general research area investigates the physiological, neurophysiological and biomechanical factors associated with fatigue, both in extreme exercise (ultra-endurance, hypoxia) and patients (neuromuscular diseases, cancer). Guillaume is also an ultra-marathon runner. This commentary presents Dr. Temesi’s and Dr. Millet’s views on the topic of a research article which they and other colleagues had published in the July 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Measuring Results from Exercise – How Do You Know It’s Working? (acsm-blog/acsm-blog/2016/01/11/measuring-results-from-exercise-how-do-you-know-it-s-working-) by Guest Blogger | Jan 11, 2016 by Clinton A. Brawner, MS, ACSM-RCEP, FACSM Two important components to fitness are aerobic endurance and muscular strength/endurance. Laboratory-based tests are available to evaluate these and have been used in research studies to measure the body’s response to various types of exercise training programs. Although these assessments can provide useful information, they are neither appropriate for all individuals nor necessary to document improvements in fitness. The purpose of this article is to review easy ways that individuals can track their own progress or recognize changes in response to having increased their physical activity. Priority #1- Sticking With It According to the 2008 Physical Activity Guidelines for Americans from U.S. Department of Health and Human Services, adults should participate in at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity, or an equivalent combination of both types. In addition, adults should also perform exercises to enhance muscular strength at least 2 days per week. Unfortunately, only about 25% of adults meet these goals; 50% engage in physical activity irregularly; and 25% of adults do not engage in any physical activity. To read the full article, please click here (http://www.acsm.org/docs/other-documents/acsmfsp15-2.pdf? sfvrsn=0) to visit the Fit Society Page archives. Active Voice: Battle of the Sexes: Are Females More Resistant to Extreme Neuromuscular Fatigue? (acsm-blog/acsm-blog/2015/12/30/active-voice-battle-of-the-sexes-arefemales-more-resistant-to-extreme-neuromuscular-fatigue-) by Guest Blogger | Dec 30, 2015 By John Temesi, Ph.D., and Guillaume Millet, Ph.D. Ultra-endurance sports such as running, cycling and adventure racing are rapidly increasing in popularity. The great distances and extreme conditions in these events are uniquely capable of being used to understand the limits of human performance. With the rapid growth of ultra-endurance sports there has also been a huge uptick in female participation. To date, ultra-endurance research has focused exclusively on male participants, resulting in a large knowledge gap pertaining to the physiology and performance of females in such demanding conditions. Our recent study, published in MSSE (http://journals.lww.com/acsmmsse/Abstract/2015/07000/Are_Females_More_Resistant_to_Extreme.7.aspx), is the first to directly compare neuromuscular fatigue in the knee extensors and plantar flexors, both functionally important muscle groups for locomotion, in males and females. There are reports that females may be as good or even better performers than males at extremely long distances. In fact, women have won or placed in the top John Temesi, Ph.D. three overall in such extreme events as the Badwater ultramarathon and Western States Endurance Run. One possibility that has been suggested is that females demonstrate less fatigue than males, and thus can perform better.

Guillaume Millet, Ph.D.

In this study, the neuromuscular function of 10 male and 10 female ultra-trail runners, were evaluated before and after they completed a 110-km ultra-trail running race with almost 6000 m in positive elevation change. The subjects were matched by finishing time calculated as a percentage of the winning time of their sex. The major neuromuscular parameters that were assessed were the changes in maximal voluntary torque (i.e. indicating the amount of overall fatigue), torques evoked by nerve stimulation in the relaxed muscle state (i.e. indicating fatigue within the muscle) and maximal voluntary activation assessed by nerve and transcranial magnetic stimulations. We also assessed electromyography, including the excitability and inhibition of the corticospinal tract to the knee extensors. After the trail running race, all subjects demonstrated substantial general neuromuscular fatigue in both the knee extensors and plantar flexors (i.e. decrease in maximal voluntary torque). Although overall fatigue in the knee extensors was greater in males than females, the source of this greater fatigue could not be clearly isolated. In the plantar flexors, males also demonstrated greater muscle fatigue than females. In both muscle groups, the magnitude of fatigue within the central nervous system and brain was similar for both sexes. Moreover, similar changes occurred after the event in males and females with regard to corticospinal excitability and inhibition of the knee extensors. The greater general neuromuscular fatigue in the knee extensors and greater muscle fatigue in the plantar flexors for males suggests that differential fatigue between the sexes occurs solely at the muscle level. These differences may partly explain the reports of better performance by females in extremely long duration running races, particularly as the race distance increases. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. John Temesi, Ph.D., is a postdoctoral fellow in the faculty of kinesiology at the University of Calgary. His research focuses on neuromuscular fatigue, especially central and supraspinal fatigue, related to locomotor exercise in both athletic and clinical populations. Guillaume Millet, Ph.D., is professor in the faculty of kinesiology at the University of Calgary. His general research area investigates the physiological, neurophysiological and biomechanical factors associated with fatigue, both in extreme exercise (ultra-endurance, hypoxia) and patients (neuromuscular diseases, cancer). Guillaume is also an ultra-marathon runner. This commentary presents Dr. Temesi’s and Dr. Millet’s views on the topic of a research article which they and other colleagues had published in the July 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Moving Through the Cure: How Exercise Benefits Cancer Survivors (acsm-blog/acsm-blog/2015/12/21/moving-through-the-cure-how-exercise-benefits-cancer-survivors) by Guest Blogger | Dec 21, 2015 Exercise isn’t a cure for cancer, but for more than 14 million Americans diagnosed with cancer, daily life often improves when the body is engaged in regular physical activity. What’s more: recurrence of certain cancers may be lowered significantly for those who exercise. The medical community recognizes that, for many people, cancer is a chronic disease, and people often continue the treatment or management of their cancer for many years, even decades. A recent shift in perspective means that now a person is considered a “survivor” from the time of diagnosis. The seismic shift from passive recipient to active participant has come of age. To read the full article, please view the ACSM Fit Society Page archives (http://www.acsm.org/docs/default-source/fit-society-page/acsm-fsp-17-2-1.pdf?sfvrsn=0). Active Voice: Does Drink Temperature Matter? (acsm-blog/acsm-blog/2015/12/14/active-voice-does-drink-temperature-matter-) by Guest Blogger | Dec 14, 2015 By Dallon Lamarche, B.SC., and Glen P. Kenny, Ph.D. Hydration is of particular importance for everyone participating in exercise and/or work-related tasks. This is especially relevant in hot environments when the body will store excess heat. Recently, researchers have considered whether the temperature of ingested water could play a factor in regulating the amount of heat stored and thereby alter core body temperature. Prior to our publication in the June 2015 issue of MSSE (http://journals.lww.com/acsmmsse/Abstract/2015/06000/Temperature_of_Ingested_Water_during_Exercise_Does.22.aspx), the media has outlined that consuming hot water resulted in a lower amount of heat stored in the body compared to cold water (http://www.theglobeandmail.com/life/health-andfitness/fitness/a-hot-drink-cools-you-faster-than-a-cold-one-myth-or-reality/article4474567/)due to an over-compensatory increase in sweating. This counterintuitive notion was based on a recent study which suggested that hot water may help cool the body. However, our recent findings show that ingesting hot or cold water does not influence body heat storage, and thus core temperature regulation during exercise. Dallon Lamarche, B.SC. Glen P. Kenny, Ph.D. In our study, 10 males (19-32 years) cycled for 75 minutes at normal room temperature (25°C) at 50 percent of their maximal oxygen uptake. The exercise was performed in the Snellen whole-body direct calorimeter, which is a device that precisely measures the amount of heat lost over time (through sweat evaporation and dry heat exchange). During exercise, participants consumed either hot (50°C) or cold (1.5°C) water every 15 minutes. We observed a continuous separation in whole-body sweating such that sweating was higher with hot relative to cold water ingestion. However, this difference in sweating was proportionate to the difference in heat content of the ingested water between the temperature conditions, resulting in similar changes in body heat storage. Therefore, we showed that, during moderate prolonged exercise, the human body adjusts the sweating response to compensate for the heat content of the ingested water—no less and no more—such that heat balance is maintained. Our findings indicate that the temperature of ingested water does not have a direct influence on body temperature during exercise. However, one cannot ignore the different behavioral and psychological effects that water of different temperatures may have on maintaining adequate hydration. For instance, the palatability of cold water is shown to clearly be more favorable during prolonged exercise in comparison to hot water. When provided the option to drink cold water at will in one session and hot water in another, a group of investigators demonstrated several years ago that individuals will ingest much more cold water (by about 37 percent) (http://www.sciencedirect.com/science/article/pii/0031938489900851). This has important implications for the athlete and the worker because individuals are more inclined to drink cold water during physical activity which leads to a better maintenance of hydration and core body temperature regulation. In addition, cold water ingestion has been shown to improve performance, as evidenced by extended time to exhaustion and lower perceived exertion in performance based events when compared to ingesting hot water. On the other hand, drinking hot water during exercise is not pleasant as anecdotally reported by the participants in our study and, consequently, may hinder performance through behavioral and psychological modifications. Ultimately, our message is clear: athletes and workers should consume water at cooler (or “more comfortable”) temperatures during physical tasks as opportunities allow. In the end, the consumption of water itself is the most important consideration for hydration status. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Dallon Lamarche is a recent bachelor of science graduate with specialization in human kinetics at the University of Ottawa, Canada. He completed the study highlighted in this commentary at the Human and Environmental Physiology Research Unit as part of his senior year research project requirements under the supervision of Dr. Glen P. Kenny. Glen P. Kenny is a professor of exercise physiology at the University of Ottawa, holds a university research chair in environmental physiology and is a member of ACSM. His research has been directed at characterizing the physiological control mechanisms governing human temperature regulation during heat stress. An area of special focus in his work is the investigation of the physiological effects of heat stress in subpopulations with conditions rendering them particularly vulnerable to heat injury, such as aging, obesity and diabetes. This commentary presents Mr. Lamarche’s and Dr. Kenny’s views on the topic related to a study which they and colleagues recently completed. Their research report appears in the June 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). From seed to forest, EIM is positively impacting lives (acsm-blog/acsm-blog/2015/12/14/from-seed-to-forest-eim-is-positively-impacting-lives) by Guest Blogger | Dec 14, 2015 By Adrian Hutber, PhD, Vice President of Exercise is Medicine Exercise is Medicine (EIM) began as a seed of an idea just over eight years ago. As part of a presidential legacy program, ACSM leadership, together with incoming President Ron Davis of the American Medical Association, developed a vision for a global health initiative that would facilitate physical activity as a chronic disease health intervention through physician-patient interactions. Further, EIM would work with the medical community, health systems and exercise professionals to expand the breadth of these interventions by incorporating physical activity into treatment plans. The seed took root in December 2007 at the National Press Club when EIM was formally announced, and the initiative has been growing ever since. Consider: EIM is now in more than 40 countries More than 6,000 physicians have been trained 9,000 exercise professionals have been trained to receive patient referrals EIM has been promoted in the Wall Street Journal The EIM Global Research Center has been established in partnership with Emory University to track progress and gain insights for continuous improvement Early in 2016, the first major health system will launch using all the major components of the EIM Solution How has so much been done so fast? It took a solid vision that aligns with ACSM’s mission, a passionate advisory board and support staff, and a number of corporate partners who understood the value of promoting physical activity as a means for combatting chronic disease. Soon after the announcement at the National Press Club, ACSM began the process of identifying sponsors who could help fund the implementation of the EIM plan. Over the last eight years, several organizations have provided their support to EIM, including companies representing the fitness, health care, medical equipment, food and beverage, and personal hygiene industries. As is our practice, all of these relationships are transparent and allow total independence in the expansion of physical activity and health worldwide. We’re grateful for this cross-industry collaboration that fertilized that initial seed and helped it grow into a forest of healthy interventions all around the world. At the end of the day, it’s about impacting lives. Here are some quotes from real people whose lives were changed through the principals of EIM: “The EIM program has helped motivate me to start exercising regularly.” -Samantha, age 31 “I just had a call from my doctor after last Friday’s physical. My weight is down, I have been declared free of pre-diabetes and for the first time in 10 years all my cholesterol numbers are as they should be. My blood pressure is 107/71 and I’m coming off the medication, whoo hoo!” -Richard, age 60 “EIM has completely changed my life. You know what to do to improve your health because a trained professional is now in your corner helping you every step of the way. -Lynn, age 62 “The program has been a great resource for my patients. The guidance the program provides gives my patients the confidence to exercise. They have improved their exercise tolerance, feeling of well-being, weight and blood pressure.” -Joseph H. M.D. If you’re not familiar with EIM or would like an update, please visit the EIM website (http://mail.acsm.org/owa/redir.aspx? C=49fb2961ee95491a9de7c76b23bcc0e4&URL=http%3a%2f%2fexerciseismedicine.org%2fsupport_page.php%3fp%3d113) and learn more about this great program. Or read this article about exercise prescription and EIM from The Pharmaceutical Journal (http://www.pharmaceutical-journal.com/news-and-analysis/features/tracking-down-the-optimum-dose-ofexercise/20068939.article). For more about ACSM’s Approach to Partnerships, go here (http://www.acsm.org/about-acsm/partners-sponsors/partner-development). Many reasons to be excited about our upcoming world congress (acsm-blog/acsm-blog/2015/12/11/many-reasons-to-be-excited-about-our-upcoming-world-congress) by Guest Blogger | Dec 11, 2015 By Liz Joy, MD, FACSM, ACSM President-elect As chair of the 2016 ACSM Annual Meeting Program Committee, I’m looking forward to The World Congress on the Basic Science of Energy Balance: A Global Perspective on the Combined Importance of Diet and Physical activity that will be happening in conjunction with the annual meeting. According to The National Institutes of Health (http://www.nhlbi.nih.gov/health/educational/wecan/healthy-weight-basics/balance.htm) website, energy balance is “the balance of calories consumed through eating and drinking compared to calories burned after physical activity.” Read More (http://). So why am I excited about a World Congress on energy balance? There are several reasons: Energy balance is a hot topic today, timely and relevant to our profession and a variety of health-related issues. As leaders in facilitating open dialogue about subjects important to our industry and public health, the congress will bring the brightest minds together to discuss how both a healthy diet and adequate physical activity are needed for effective weight management. As experts on the health benefits of physical activity, ACSM members have a great deal to bring to this discussion. We’re excited about collaborating with others on the essential relationship between dietary intake and physical activity to achieve healthy energy balance and healthy weight. Hosting the congress aligns with our (http://)long-held position stand on energy balance (http://journals.lww.com/acsmmsse/Fulltext/2009/02000/Appropriate_Physical_Activity_Intervention.26.aspx). First published in 2001, our position stand is based on scientific evidence and concludes that, for successful long-term weight loss, both physical activity and dietary change are important. This position was endorsed by the Academy of Nutrition and Dietetics. Finally, our congress will help re-focus the conversation as it relates to the vital topic of energy balance. Recent negative news coverage regarding an organization called the Global Energy Balance Network- which had no affiliation with ACSM – may have detracted from the fact that energy balance is, indeed, a basic science that acknowledges the dual importance of diet and physical activity. I hope you’ll join me for this great congress on May 31, 2016 in Boston, Massachusetts. See you there! For more about the 2016 ACSM Annual Meeting and World Congresses, please visit the website. (http://www.acsm.org/attend-a-meeting/annual-meeting) Physical Activity for Men with Osteoarthritis (acsm-blog/acsm-blog/2015/12/07/physical-activity-for-men-with-osteoarthritis) by Guest Blogger | Dec 07, 2015 by A. Lynn Millar, PT, Ph.D., FACSM The most common form of arthritis is osteoarthritis (OA) — joint-specific degeneration which causes pain and stiffness. Approximately 27 million adults in the U.S. have OA. While men have lower rates of OA as compared to women, it is still one of the leading causes of disability and movement limitation. The most common symptomatic joints for men include the knee, hip, and hands, with the knee being the most common (13.5% in men 45 years or older). Guidelines for management of OA include physical activity, weight control and joint protection. This article originally appeared in the 2014 issue of the Fit Society Page newsletter. To read the full article, please visit the web archive (http://www.acsm.org/docs/other-documents/acsmfsp15-4.pdf?sfvrsn=0). Active Voice: Strength Fitness, Body Weight and Cardiometabolic Health (acsm-blog/acsm-blog/2015/11/30/active-voice-strength-fitness-body-weightand-cardiometabolic-health) by Guest Blogger | Nov 30, 2015 By Christian K. Roberts, Ph.D., FACSM Obesity is associated with increased risk of type 2 diabetes, cardiovascular disease, metabolic syndrome, fatty liver disease and certain forms of cancer, as well as reduced quality of life and increased mortality. However, many of these same conditions also are linked to decreased fitness. Consequently, there is much debate about the relative roles of body weight and fitness indicators in determining the risk of the aforementioned cardiometabolic diseases. This debate was fueled with the U.S. Centers for Disease Control-published meta-analysis in 2013, which suggests that individuals with a body mass index (BMI) 27 kg/m2. Thus, two groups exhibited similar strength training frequency and two similar body weights. Using this design, we set out to shed light on two aspects related to the fitness and body weight conundrum. The first was whether the strength-trained groups, NT and OT, would display better metabolic and cardiovascular phenotypes compared to the OU group. The second was if the strength-trained groups with similar strength fitness levels, would exhibit similar metabolic and cardiovascular phenotypes, despite higher weight and fat mass in the OT group. As young individuals are at low risk of mortality, we used a variety of phenotypes associated with disease risk, including central and brachial blood pressures, indices of arterial stiffness, serum lipids, inflammatory and metabolic markers, and steroid hormones. Our findings indicated that overweight/class I obese and normal weight individuals who are both strength-trained exhibit remarkably similar cardiovascular and metabolic phenotypes and both better than overweight/obese untrained individuals. Interestingly, the similar phenotypes in the OT and NT groups were present despite the elevated body fat mass in the OT group. This new evidence challenges the existing view of the importance of body weight classification per se and suggests that strength fitness may have more influence on metabolic and cardiovascular health than previously appreciated. Furthermore, strength fitness may be an alternate therapeutic target, especially in those unable to normalize body weight. Ultimately, it may be time for a paradigm shift in how we think about the relative roles of fitness and body weight in the context of health. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Christian K. Roberts, Ph.D., FACSM, is an integrative exercise physiologist, and his research investigates the efficacy and mechanisms by which exercise training and diet interventions prevent metabolic diseases, including cardiovascular diseases and type 2 diabetes, as well as the impact of metabolic health improvement independent of obesity reversal. He has been a member of ACSM for 20 years. This commentary presents Dr. Roberts’ views on the topic related to a study which he and his colleagues recently completed. Their research report appears in the June 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Caffeine and Endurance Time Trial Performance— Effects and Mechanisms of Action? (acsm-blog/acsm-blog/2015/11/24/active-voice-caffeine-and-endurancetime-trial-performance-effects-and-mechanisms-of-action-) by Guest Blogger | Nov 24, 2015 By Christopher D. Black, Ph.D. and Alexander R. Gonglach, M.S. Christopher D. Black, Ph.D., is an assistant professor of exercise science at the University of Oklahoma in Norman, Oklahoma. He is a member of ACSM, with research interests and training in the area of muscle physiology and the causes and performance/adherence consequences of exercise-related musculoskeletal pain. Alexander R. Gonglach, M.S., is an exercise physiology graduate student at the University of Oklahoma in Norman, Oklahoma. Caffeine improves endurance performance — on this expected response, most researchers, athletes and weekend warriors agree. For a small subset of the population, an ergogenic effect of this magnitude has large practical significance, since a two to four percent increase in performance could equate to a 40 to 80 second improvement in a 35-minute race. Such improvement Christopher D. Black, Ph.D. Alexander R. Gonglach, M.S. would easily represent the difference between medaling in a highly competitive race versus not even finishing among the upper tier of runners. Despite 30- plus years of research demonstrating that caffeine improves endurance performance, the mechanism(s) of action remain somewhat a mystery. Several hypotheses have been put forth, including: 1) alterations in fat metabolism leading to glycogen sparing; 2) direct actions on skeletal muscle leading to increased force production, perhaps through alterations in calcium release from the sarcoplasmic reticulum; 3) central and/or peripheral nervous system actions leading to increased skeletal muscle force production; and 4) reductions in perceptions of muscle pain and sense of effort. While there is growing scientific support for certain hypotheses, scientific evidence supporting each of these hypotheses may be found in the recent literature. The results of our most recent study were published in the June 2015 issue of Medicine & Science in Sports & Exercise® (http://journals.lww.com/acsmmsse/Abstract/2015/06000/Caffeine_s_Ergogenic_Effects_on_Cycling__.7.aspx). We wanted to explore the role of improved strength and reductions in muscle pain, as possible mechanisms by which caffeine might act to improve performance. We used a novel approach by having participants perform leg and arm crank cycling on separate days and, in a different set of experiments, by assessing strength, motor-unit recruitment, ratings of muscle pain and endurance performance (See the abstract (http://journals.lww.com/acsmmsse/Abstract/2015/06000/Caffeine_s_Ergogenic_Effects_on_Cycling__.7.aspx)for details of methodology). This was done because previous research has indicated that caffeine improves motor-unit recruitment and strength to a greater and more consistent extent in large leg muscle groups, such as the quadriceps, compared to smaller muscle groups in the arms. Using this approach, we successfully manipulated strength and motor-unit recruitment at 60 minutes following caffeine ingestion (5mg·kg-1 body weight) with the quadriceps, but not the biceps, showing an increase. Our participants then performed 30 minutes of moderate-intensity (60 percent of V?O2 peak) leg or arm crank cycling, followed by a 10-minute maximal effort time trial. Consistent with other studies, ratings of muscle pain were reduced during moderate intensity cycling, regardless of muscle group used following caffeine ingestion. Interestingly, this effect was lost during the time trial. Work performed during the time trial increased following caffeine ingestion with leg cycling, but not during arm crank cycling. Our findings point toward caffeine-induced changes in strength being more important for explaining the increased performance than were reductions in muscle pain. The mechanism of caffeine’s action is likely of little interest to an athlete or a person who simply wants to perform/train at a higher level on a given day. The “how” and “why” it might induce improvements does not concern them. Their concern is simply “does it work?” Based upon a wealth of research, including our own, the answer to that question is clearly “yes,” especially for events such as running and cycling which use the large muscles of the legs. So that cup of coffee isn’t helpful just for getting you going in the morning, but perhaps it also should become part of your pre-workout and pre-race routine. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Exercise During Pregnancy and Post-Partum (acsm-blog/acsm-blog/2015/11/20/exercise-during-pregnancy-and-post-partum) by Guest Blogger | Nov 20, 2015 The American College of Sports Medicine (ACSM) and American Congress of Obstetrics and Gynecology (ACOG) have similar guidelines that encourage pregnant women to engage in health-related physical activity during pregnancy. Before beginning an exercise program, pregnant women should complete a screening questionnaire (e.g., PARmed-X; www.csep.ca/forms.asp) and discuss exercise options with their obstetric provider to ensure it is safe for her (and her baby) to exercise. During pregnancy, the goals are to maintain/ increase fitness and avoid exertion that could be harmful to mother or fetus. The intensity of exercise that is safe and appropriate varies among individuals and changes across the length of the pregnancy. To read the full article, click here (http://www.acsm.org/docs/default-source/fit-society-page/acsm-fsp16-3.pdf?sfvrsn=0) to revisit the October 2014 issue of the ACSM Fit Society Page newsletter. Breaking News Member Editorial: New Report Suggests Doping by Russian Sports Teams (acsm-blog/acsm-blog/2015/11/12/breaking-news-membereditorial-new-report-suggests-doping-by-russian-sports-teams) by Guest Blogger | Nov 12, 2015 The World Anti-Doping Agency released a concerning report (http://strongmail1.multiview.com/track?

type=click&eas=1&mailingid=2153258&messageid=2153258&databaseid=Mailing.DS153258.2153258.136688&serial=17478068&emailid=jwhitehead@acsm.org&userid=11237959&targ main-prod.s3.amazonaws.com/resources/files/wada_independent_commission_report_1_en.pdf) earlier this week, outlining findings that suggest the Russian government is running a staterun doping program. The report details serious allegations including bribery and intimidation of doping testers, destruction of laboratory materials and police intervention in laboratory work. The report suggests disciplinary measures including banning Russia from participating in next year’s Olympic Games in Rio de Janerio. Russia will also face scrutiny as the host of the 2018 FIFA World Cup after reports of misconduct at the Sochi Olympics. For more information, see this recent news article from the New York Times (http://strongmail1.multiview.com/track? type=click&eas=1&mailingid=2153258&messageid=2153258&databaseid=Mailing.DS153258.2153258.136688&serial=17478068&emailid=jwhitehead@acsm.org&userid=11237959&targ athletes-part-of-state-sponsored-doping-program-report-finds.html?_r=0). In response to this news, and based on his expertise and experience with the World Anti-Doping Agency, Gary Wadler, M.D., FACSM shares his opinion in the following blog post. This viewpoint reflects the opinion of the author and does not necessarily reflect positions or policies of ACSM: "Once again, the world of sport has been wracked by the scourge of institutionalized and state sponsored/supported doping. This time it is neither the East Germans nor FIFA. This time it is Russia and it is International Track and Field- and who knows what doping practices and violations lie beneath the surface of the field of play? We are now faced with another crisis of confidence in sport with the potential to destroy sport as we know it. What is particularly disconcerting is the depth and the pervasiveness of the allegations and the fact that all this has been occurring in the context of worldwide comprehensive antidoping programs and practices. The independent WADA commission amongst other violations confirmed allegations that some Russian doctors and/or laboratory personnel acted as enablers for systematic cheating along with athletics coaches. The commission identified the intentional and malicious destruction of more than 1,400 doping samples by Moscow laboratory officials after receiving written notification from WADA to preserve target samples. This multipronged doping scandal once again threatens the very existence of sport." Dr. Wadler practices internal medicine and sports medicine in Manhasset, New York. He is also a clinical associate professor of medicine at the Hofstra North Shore-LIJ School of Medicine. He has served as medical advisor to the White House Office of National Drug Control Policy and recently served as chairman of the World Anti-Doping Agency (WADA) Prohibited List and Methods Committee. Dr. Wadler is an expert on sport and substance abuse and has provided medical leadership and served as a policy advisor on these matters at the highest levels nationally and internationally for many years. ACSM Reveals 2016 Fitness Trends, New #1 (acsm-blog/acsm-blog/2015/10/26/acsm-reveals-2016-fitness-trends-new-1) by Guest Blogger | Oct 26, 2015 ACSM Reveals 2016 Fitness Trends, New #1 Are you tracking your running mileage, calories burned or average heart rate using a wearable device? The American College of Sports Medicine (ACSM) has announced its annual fitness trend forecast and, for the first time, exercise pros say wearable technology will be the top trend in fitness. The results were released in the article “Worldwide Survey of Fitness Trends for 2016: 10th Anniversary Edition (http://journals.lww.com/acsm-healthfitness/Fulltext/2015/11000/WORLDWIDE_SURVEY_OF_FITNESS_TRENDS_FOR_2016__10th.5.aspx)” published yesterday in the November/December issue of ACSM’s Health & Fitness Journal®. Now in its tenth year, the survey was completed by more than 2,800 health and fitness professionals worldwide, many certified by ACSM, and was designed to reveal trends in various fitness environments. Forty potential trends were given as choices, and the top 20 were ranked and published by ACSM, including a few new additions to last year’s list. The full list of top 20 trends is available in the article (http://journals.lww.com/acsm-healthfitness/Fulltext/2015/11000/WORLDWIDE_SURVEY_OF_FITNESS_TRENDS_FOR_2016__10th.5.aspx). The ACSM Foundation in Action (acsm-blog/acsm-blog/2015/10/21/the-acsm-foundation-in-action) by User Not Found | Oct 21, 2015 By James M. Pivarnik, Ph.D., FACSM

The American College of Sports Medicine Foundation (http://www.acsm.org/about-acsm/foundation) was formed to pursue resources needed to advance the work of the College. One of our goals has been to involve individuals, foundations and those in the corporate world who share ACSM’s interests in furthering exercise physiology, sports medicine, policy and public health issues to support our mission to advance health through science, education and medicine. Individual members of ACSM have made a difference for the College and the programs it supports. In 2014, nearly $61,400 was received in individual gifts thanks to ACSM member donors. As you reflect on what ACSM means to you personally and professionally, I encourage you to consider joining me in making a gift to the ACSM Foundation anytime throughout the year. One outcome of these donations is the creation of additional endowments to fund research grants, scholarships and awards (http://www.acsm.org/find-continuing-education/awards-grants). I’d like to recognize 2015’s foundation scholarship and travel awards winners: The 2015 Michael L. Pollock Student Scholarship -- (Jaquelyn Holt and Ryan Pettit-Mee) The Steven M. Horvath Travel Award (Riana Pryor and Scott Crawford) The Gail E. Butterfield Nutrition Travel Award (Jessica Knurick and Paddy Dempsey) The Lisa Stroud Krivickas Clinician-Scholar Travel Award (Dina Christina Janse van Rensburg) The Priscilla M. Clarkson Undergraduate Travel Award (Mateus da Silva Bezerra) The GSSI-ACSM Sport Nutrition Award (Louise Turner) The GSSI-ACSM Young Investigator Award (David Clayton) And finally, the GSSI-ACSM Young Scholar Travel Award (Benjamin Ryan and Jenna Gillen) The Foundation has a strong commitment to funding research and disseminating the findings. We are very pleased to honor the researchers who competed successfully for the 2015 Foundation Research Grant Program: ACSM Foundation Research Grants: PAFFENBARGER-BLAIR FUND FOR EPIDEMIOLOGICAL RESEARCH ON PHYSICAL ACTIVITY Youngdeok Kim ACSM RESEARCH ENDOWMENT Marcia J. Abbott Daniel Gagnon Nathan T. Jenkins Anna E. Stanhewicz CLINICAL SPORTS MEDICINE ENDOWMENT Robert C. Lynall CARL V. GISOLFI MEMORIAL FUND Matthew T. Wittbrodt NASA SPACE PHYSIOLOGY RESEARCH GRANT Anita V. Mantri Amanda L. Zaleski DOCTORAL STUDENT RESEARCH GRANTS Jacob M. Allen Daniel H. Craighead Aaron J. Done John J. Guers Justin Perry Hardee Jin Hee Jeong Hawley E. Kunz Sanghee Park Meghan G. Ramick Lindsay A. Tanskey Heather L. Vellers Zachary M. Zenko DR. RAYMOND A. WEISS RESEARCH ENDOWMENT Elena L. Ivanova During the 2015 ACSM Annual Meeting we awarded $135,504 to these talented young investigators, a total of 23 grants. Two years ago, ACSM entered into a multi-faceted partnership with the American Medical Society for Sports Medicine (AMSSM), in part to fund a joint research venture. The 2015 recipient of the ACSM- AMSSM Clinical Research Grant was Dr. M. Kyle Smoot. As we look to the future, I challenge each of you to participate by giving of your time, talent and resources to the Annual Fund (https://www.formstack.com/forms/?1837743txVADiGeQk) and other programs of the ACSM Foundation. I encourage those researchers and young investigators to apply for any of these opportunities provided by the ACSM Foundation (http://www.acsm.org/find-continuing-education/awardsgrants) today!

Active Voice: Leisure Time Sitting and Cancer Risk (acsm-blog/acsm-blog/2015/10/13/active-voice-leisure-time-sitting-and-cancer-risk) by Guest Blogger | Oct 13, 2015 By Alpa V. Patel, Ph.D. and Lynette L. Craft, Ph.D, FACSM Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Alpa V. Patel, Ph.D., is a cancer epidemiologist and principal investigator of the Cancer Prevention Study-3 at the American Cancer Society in Atlanta, Georgia. Her research broadly focuses on physical activity, sedentary behavior, obesity and disease risk. More specifically, she is interested in understanding these factors in relation to cancer risk and survival, as well as better quantification of the amount and type of activity needed for optimal health. Lynette L. Craft, Ph.D., FACSM, is the vice president for evidence-based practice and scientific affairs at ACSM. Her Ph.D. is in kinesiology and she is an adjunct faculty member in the Department of Preventive Medicine at Northwestern University, Feinberg School of Medicine in Chicago, Illinois. Her research focuses on the mental and physical benefits of exercise. Specifically, she examines how intervening on lifestyle factors, such as physical activity and sedentary behavior, are related to Alpa V. Patel, Ph.D. chronic disease risk and quality of life in breast cancer survivors.

Lynette L. Craft, Ph.D., FACSM

This commentary presents the views of Drs. Patel and Craft on the topic of a research article which they and their colleagues recently published in the journal Cancer Epidemiology, Biomarkers & Prevention (http://cebp.aacrjournals.org/content/early/2015/06/30/1055-9965.EPI-15-0237.abstract?sid=e826f3b3-d28c-4cb2-b1ec-d70cc483b79d), which has received extensive attention in the public media over the last two weeks. In recent decades, there has been a dramatic increase in leisure time where people sit while using technology advancements such as computer use, television viewing, transportation and other factors. Many individuals who meet physical activity guidelines are sedentary for the majority of their remaining awake time (they often are referred to as “active couch potatoes”). Thus, in recent years, sitting time has been examined in relation to health outcomes as a distinctly different behavior than physical inactivity. In fact, numerous epidemiologic studies have shown that sitting time is independently associated with higher risk of premature death from any cause and risk of various chronic diseases such as cardiovascular disease, type II diabetes and some types of cancer. While the benefits of physical activity in relation to cancer prevention are well documented, the evidence to support an association between sitting time and cancer risk is in its infancy. Using data from the American Cancer Society’s Cancer Prevention Study-II (CPS-II) Nutrition Cohort, we conducted a detailed analysis of leisure time spent sitting in relation to total and site-specific cancer risk. This study builds upon previously published work (see: Patel et al., 2010 (http://aje.oxfordjournals.org/content/172/4/419.long)) where we documented an association between sitting time and total mortality in men and women. However, in that study, excess risk of cancer-specific mortality associated with sitting time was observed only in women. The analysis in this, our current study, is comprised of 69,260 men and 77,462 women on the CPS-II Nutrition Cohort who were cancer free at enrollment in 1992 and have been followed for cancer incidence (the current analysis is with follow-up complete through 2009). During that time, 18,555 men and 12,236 women were diagnosed with cancer. Overall, we observed a 10 percent higher risk of total cancer among women who sat six or more hours versus less than three hours in their leisure time (95 percent CI 1.04-1.17). We further examined risk in 17 individual cancer sites in women and found positive associations between sitting time and multiple myeloma, invasive breast cancer and ovarian cancer. We found no overall association between sitting time and total cancer nor with any of the 15 individual cancer sites examined in men. The lack of any observed associations in men may be a real biologic difference or may be due to some limitation in the data available for this analysis. For example, we lacked occupational sitting time data, but this was likely to have a minimal effect on associations in women, since the vast majority of the women in our study were either retired or never worked outside of the home. The majority of men were retired at study entry, but their sitting patterns at enrollment may not reflect their usual sitting patterns during most of their adult years. Given the potentially long latency period of most cancers, it is possible that we did not capture the relevant sitting time exposure. Thus, as we stated in the conclusions of this recent paper, further research is needed to understand the gender difference in the relationship between sitting time and cancer. Some physical activity guidelines, including those set forth by ACSM and the American Cancer Society, recommend limiting time spent sitting whenever possible. Nonetheless, there is a need to better understand the benefits of reducing sitting time along with meeting recommended levels of physical activity in relation to optimal health. With the widespread interest in the general public and media to understand the health effects of too much sitting, there may be an opportunity to improve population health via messaging about sitting time, especially among the large proportion that is otherwise physically inactive. Active Voice: From San Diego 2015 to Boston 2016 – ACSM Soars! (acsm-blog/acsm-blog/2015/09/28/active-voice-from-san-diego-2015-to-boston-2016-acsm-soars!) by Guest Blogger | Sep 28, 2015 By ACSM President-elect Elizabeth A. Joy, M.D., M.P.H., FACSM Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Elizabeth A. Joy, M.D., M.P.H., FACSM, is medical director for Community Health at Intermountain Healthcare in Salt Lake City and practices family medicine and sports medicine at the Salt Lake Clinic LiVe Well Center. She is an adjunct professor at the University of Utah in the Department of Family and Preventive Medicine. As ACSM’s current president-elect, Dr. Joy chairs the Program Committee – leading thematic focus and planning for the 2016 ACSM Annual Meeting. She has had extensive leadership experience with ACSM, including as a board of trustees member, vice president and, currently, as an associate editor for Current Sports Medicine Reports and chair of the Exercise is Medicine® Clinical Practice Committee. Dr. Joy is widely published in several areas related to her expertise, including physical activity assessment and promotion, the Female Athlete Triad, sports injury prevention and diabetes prevention. The 2015 ACSM Annual Meeting in San Diego was the largest meeting in ACSM’s history in regard to total attendance. Thanks to the outstanding program, under the leadership of Larry Armstrong, Ph.D., FACSM, and the ACSM Program Committee, more than 82 percent of attendees rated the annual meeting very good or exceptional. More than 70 percent of basic and applied science attendees applauded program content in their specialties, and 85 percent of physician attendees reported very good or exceptional chances to have their questions answered. The opportunities to learn and network with colleagues are key drivers for attendance at the annual meeting — and San Diego was no exception. The multidisciplinary environment at the annual meeting creates an unprecedented opportunity for scientists, clinicians and students to engage and learn from another. 2015 saw an increase in student participation at the annual meeting, representing one-third of all attendees. The Exercise is Medicine® (EIM) World Congress and the Basic Science World Congress on Fatigue were centerpieces of the meeting. Physician attendees noted that they would “adopt new exercise participation guidelines” as a part of their clinical practice and would “encourage more EIM treatments.” Feedback on the Basic Science World Congress was equally positive, extolling the quality of the speakers and content. Submissions for the 2016 ACSM Annual Meeting in Boston are outstanding. The Program Committee met in Indianapolis earlier this month to sift through these submissions. Annual meeting submissions are reviewed by the 12 topical representatives who reflect the broad categorical interests of our members (e.g., biomechanics and neural control of movement, epidemiology and biostatistics, metabolism and nutrition), in addition to Program Committee members representing clinical medicine and EIM. We repeatedly heard from reviewers regarding the high quality proposals and the difficult task of deciding what to include. The EIM World Congress will kick off the Boston meeting on Tuesday, May 31, 2016 including the first Morris/Paffenbarger EIM Keynote lecture by Mike Pratt, MD, MPH, FACSM, who will talk about the economic costs of physical inactivity. John M. Jakicic, PhD, FACSM, is leading the Basic Science World Congress, which will be focused on energy balance. He shared a sneak peek of the sessions that will be included, and the congress will be nothing short of cutting-edge science in this critically important area. The 2016 meeting, which will be held May 31-June 4, is ACSM’s first ever trip to Boston for the annual meeting. Held at the Hynes Convention Center, attendees and their family members will have access to three attached hotels and two shopping destinations for an all-inclusive convention experience. Attendees will be thrilled to learn that the Hynes Convention Center offers free Wi-Fi access and boasts complete cell phone coverage throughout the building. As chair of the Program Committee for 2016, I can assure you that Boston will be an outstanding meeting. I encourage you to submit your abstracts and case presentations by the November 2 deadline — you will receive advance information in future issues of SMB, the September issue of Medicine & Science in Sports & Exercise® and in timely e-blast notices as the deadline approaches. The meeting also will include wonderful social and networking opportunities throughout the week in Boston, including the annual meeting banquet on Friday evening, where attendees have the opportunity to rub shoulders with ACSM leaders and enjoy a wonderful evening hearing from our award winners. I hope to see you in Boston in 2016. Please feel free to email me directly with thoughts on how we can make Boston the best meeting ever – [email protected] (mailto:[email protected]). In the words of Boston native, John Adams, “Let us dare to read, think, speak and write.” I look forward to hearing from many of you in Boston 2016. Input Needed on Proposed Revisions in Federal Policies on Human Subjects Protections (acsm-blog/acsm-blog/2015/09/23/input-needed-on-proposed-revisions-in-federalpolicies-on-human-subjects-protections) by Guest Blogger | Sep 23, 2015 By: Kevin Heffernan, Ph.D. While the scientific method has remained largely the same for hundreds of years, the dissemination of science has changed drastically. The digital era now provides unbridled access to information at the click of a button. Complete literature reviews and even advanced statistical analyses can be done on powerful hand-held devices from any place and at any time. Research is on the go and like so many aspects of our day-to-day lives, it can be hard to detach. Pressures mount to secure funding to keep research agendas afloat. Age-old mantras like “publish or perish” are stuck in our psyche. Grant submission deadlines are on our calendars alongside holidays, birthdays and anniversaries. Papers need to be published to help secure the next grant. Progress reports need to be generated to appease funders. Write, write, write… submit, submit, submit… Sometimes researchers may forget why we do what we do. Whether to prevent/treat disease, augment athletic performance, enhance recovery from injury or improve overall health, wellness and quality of life, our scholarship seeks to help others. Our undertaking is one of service and at the very foundation of our research lies (sometimes literally) the participant. We are indebted to those individuals that graciously give of their time and effort to participate in our research projects so that we may hopefully use our findings to help others. Earlier this month, the Department of Health and Human Services (DHHS) released its most recent Notice of Proposed Rulemaking (NPRM) regarding Federal Policy for the Protection of Human Subjects (https://www.federalregister.gov/articles/2015/09/08/2015-21756/federal-policy-for-the-protection-of-human-subjects). This expansive document seeks to maintain research ethical standards at the highest level while improving the overall research experience for participants and researchers alike. Members of ACSM are highly encouraged to explore this document, as guidelines put forth will directly impact how ACSM navigates its scholarship. Opportunities will be made available to share our views and concerns with DHHS. Comments will be accepted until December 1, and we invite and encourage your input. ACSM is the largest sports medicine and exercise science organization in the world and our mission is to advance and integrate scientific research to provide educational and practical applications of exercise science and sports medicine. We believe in the power of exercise as medicine and we entrust that our medicine heals; and our vessel to share this message is research. It is our duty as scientists and our responsibility as citizens of inquiry and exploration to protect our research participants’ rights and ensure their safety. Without research participants, research itself comes to a screeching halt. Kevin Heffernan, Ph.D. Syracuse University, Department of Exercise Science Director of the Human Performance Laboratory and member of the SU Institutional Review Board Surgeon General Announces Call to Action to Promote Walking; Resources Now Available (acsm-blog/acsm-blog/2015/09/17/surgeon-general-announces-call-to-action-topromote-walking-resources-now-available) by Guest Blogger | Sep 17, 2015 In a landmark announcement on September 9, U.S. Surgeon General VADM Vivek H. Murthy, M.D., unveiled his Step It Up! Call to Action to Promote Walking and Walkable Communities (http://www.informz.net/z/cjUucD9taT0xOTcxNTMyJnA9MSZ1PTMzMjI2NDY1MyZsaT05OTI1NTU5/index.html). As a leader in the promotion of physical activity, ACSM was pleased to play an integral role in both the conceptual development of the call to action and the official announcement. Former ACSM Presidents Robert E. Sallis, M.D., FACSM and Russell R. Pate, Ph.D., FACSM; ACSM Fellows Brian W. Hainline, M.D., FACSM and Jack L. Groppel, Ph.D., FACSM, as well as CEO Jim Whitehead all had prominent roles in the event. This announcement is a huge step forward for the cause of physical activity and health and we invite you to join ACSM in enthusiastically supporting this call to action. To assist in this effort, a number of resources are now available for you and your organization. Visit our ACSM Call to Action web page (http://www.informz.net/z/cjUucD9taT0xOTcxNTMyJnA9MSZ1PTMzMjI2NDY1MyZsaT05OTI1NTYy/index.html) and find a partner's guide, videos, social media messages, web banners, customizable press release to announce your organization’s support, and more. America Walks and the Every Body Walk! have also launched an exciting new collaborative micro grant program (http://americawalks.org/call-to-action-every-body-walk-collaborative-micro-grants/) designed to assist local walking advocates to build on the momentum of the newly released Surgeon General's Call to Action. Applications are due by 5 p.m. EDT on October 15th. Active Voice: Features of Prolonged Sitting Behavior Correlate with Cardiometabolic Disease Risk Markers (acsm-blog/acsm-blog/2015/09/14/active-voice-features-ofprolonged-sitting-behavior-correlate-with-cardiometabolic-disease-risk-markers) by Guest Blogger | Sep 14, 2015 By Kate Lyden, Ph.D. and Sarah Kozey Keadle, Ph.D., M.P.H.

This commentary presents Drs. Lyden’s and Kozey Keadle’s views on the topic related to a research article they authored with their colleagues and which appears in the May 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Based largely on epidemiologic evidence that sedentary behavior increases risk of chronic disease and premature mortality, some have suggested that physical activity guidelines, which currently focus on moderate-to-vigorous physical activity (MVPA), should also include recommendations to reduce sitting. While a basic message of “sit less” may be possible given the current evidence, we believe there are important research questions that need to be answered before specific evidence-based recommendations are warranted. First, what “dose” (or amount) of sedentary behavior is bad for health? Certainly, it is unrealistic to recommend that people never sit, but what is the threshold at which sedentary behaviors begin to negatively influence health? Is this threshold different for specific groups (e.g., young vs. old, exercisers vs. non-exercisers?) Second, does reducing and/or changing patterns of sedentary behavior impact relevant health outcomes? If we recommend to individuals that they reduce their sedentary time, how Kate Lyden, Ph.D. much should they reduce it, and does it matter what type (e.g., standing vs. walking) and intensity of activity they perform instead?

Sarah Kozey Keadle, Ph.D.

To answer these questions, experimental trials that manipulate sedentary time are needed. However, previous experimental studies have primarily relied on bed rest or other extreme sedentary conditions (e.g., 24 hours confined to a wheel chair) in part due to the challenge of measuring sedentary behavior. While these studies provide evidence of the possible mechanisms linking sedentary behavior to poor health, they are not representative of “real-world” sedentary behavior. Even the most sedentary, but otherwise healthy individuals, take breaks from sitting to perform activities of daily living. The frequency, type and intensity of these breaks are potentially important factors impacting health. Technological advances that improved the precision of body worn activity monitors now make such studies of habitual patterns of sedentary behavior feasible. These devices enable researchers to link specific behaviors with health-related outcomes, which was the purpose of our article published in the May 2015 issue of MSSE (http://journals.lww.com/acsmmsse/Abstract/2015/05000/Discrete_Features_of_Sedentary_Behavior_Impact.24.aspx). Our study was designed to reflect “real-world” sedentary behavior patterns where people are constrained by their job, mode of transportation or other factors that promote sitting. We enrolled 10 participants who were recreationally active and measured their baseline levels of sedentary behavior and physical activity for seven consecutive days using a well-validated activity monitor. During a second seven day period, they were instructed to sit as much as possible, to limit standing and walking, and to refrain from structured exercise. At the end of each week, we conducted an oral glucose tolerance test to assess blood glucose and insulin in response to a glucose load. In the sedentary condition, insulin levels 10 hours post-glucose load, the area under the insulin curve and a composite insulin sensitivity index were all significantly elevated. Because we included data from the activity monitor, we were able to assess whether these changes were linked to specific behaviors. We found that change in the 2-hour insulin was negatively associated with change in light-intensity physical activity (r = -0.62) and positively associated with change in time for sitting bouts that were longer than 30 min (r = 0.82) and 60 min (r = 0.83). We think our study is an important first step. However, there is much more work needed in this area. We included a small sample of healthy young adults who changed both their exercise and sedentary behaviors. It is plausible that the effect of changing sitting time may differ for people who are not active at baseline or for older adults. Activity monitoring allows researchers to measure relevant behavioral patterns and answer research questions that we believe have important public health implications. We anticipate, and hope, that these tools will be widely used in the future to identify novel behaviors that are important in disease initiation and development.

Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Kate Lyden, Ph.D., is a research scientist at the University of Colorado, Denver. Her research is funded by the NIH and examines the effects of interrupting sedentary time with short and continuous bouts of moderate intensity walking on metabolic outcomes in overweight adults. She has developed methodologies to quantify physical activity, sedentary behavior and sleep using wearable sensors and uses these techniques to understand the dose-response relationship between physical activity, sedentary behavior and chronic disease. Sarah Kozey Keadle, Ph.D., M.P.H., is a cancer prevention fellow in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute in Bethesda, Maryland. Her research broadly focuses on the relationship between physical activity, sedentary behavior and disease prevention, with a specific interest in improving measures of active and sedentary behaviors and applying novel methods to further our understanding of the associations between these behaviors and health risk. Active Voice: Barefoot Running, Hip Movements and Knee Injuries (acsm-blog/acsm-blog/2015/09/03/active-voice-barefoot-running-hip-movements-and-knee-injuries) by Guest Blogger | Sep 03, 2015 By Colm McCarthy, MRCPI, MICGP, FRACGP, MSc.

Barefoot running, or running in minimalist shoes, is a somewhat controversial topic— often polarizing both researchers and clinicians. Debate continues about the role of footwear in running performance and injury. Two of the most common running injuries are patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS), both causing pain around the knee. There is growing evidence for the role of hip movements in both the causation and successful treatment of PFPS and ITBS (http://journals.lww.com/acsmmsse/Abstract/2013/06000/Prospective_Evidence_for_a_Hip_Etiology_in.14.aspx). A greater degree of hip adduction and/or hip internal rotation during running has the effect of the distal femur moving “inwards” toward the midline during the stance phase of running, when the leg is supporting the body’s weight. When excessive, this movement may increase strain on the ITB and affect the movement of the patella over the femur, leading to pain. Strengthening the hip muscles (especially the gluteals) or teaching the runner to control the “moving in” of the knee during running and other activities have proved effective in studies aimed at treating both PFPS and ITBS. “Gait retraining” has gained in popularity both in research and clinical practice. Here, instructions or “cues” often focus on encouraging the runner to run with reduced hip adduction/internal rotation. Changes to foot strike pattern and stride length/cadence are also sometimes advocated. For our recent study reported in MSSE (http://journals.lww.com/acsm-msse/Fulltext/2015/05000/Barefoot_Running_and_Hip_Kinematics___Good_News.16.aspx), we examined if something very simple— running without shoes— would bring about changes in kinematics (how a joint moves) at the hip; and thus potentially modify a risk factor for knee injury. Twenty-three healthy female runners with no experience with barefoot running were tested in a gait laboratory, running first in regular running shoes and then barefoot. No instructions, cues or other information were provided. When running barefoot, our participants took shorter strides and landed more toward the forefoot, with less flexion at the knee than they did in shoes. This agrees with the findings of other researchers. Most interestingly for us, hip adduction and hip internal rotation, along with contralateral pelvic drop, were significantly reduced at foot strike and at 10 percent of stance (corresponding to the vertical impact peak) when running barefoot compared to shod. Our study is the first to report on 3-D hip kinematics during barefoot running in recreational female athletes— the group most affected by PFPS and ITBS. We postulate that bringing about a reduction in hip internal rotation and adduction using barefoot running could help runners with PFPS or ITBS return to running or prevent the injuries in the first place. Full-time barefoot running is not always practical and carries risks for runners used to running with shoes. However, from our own previous research (https://www.thiemeconnect.com/DOI/DOI?10.1055/s-0033-1353215), we know that runners who trained in very minimalist shoes for 12 weeks “carried over” some of the new gait characteristics when they returned to their regular footwear. We suggest that barefoot running could be incorporated as a training tool to encourage good form that prevents knee injuries or as a treatment and rehab tool for runners recovering from PFPS or ITBS. It also may serve as an adjunct to gait retraining programs, where reducing hip adduction and internal rotation are treatment goals. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Colm McCarthy is a general practitioner and sports doctor. He trained in Ireland and currently works in Perth, Western Australia. He completed a MSc. in sports and exercise medicine at Trinity College Dublin. He has worked with teams in the codes of soccer, Australian rules and Gaelic football. His clinical and research interests focus on running; in particular, knee injuries and rehabilitation and the effect of footwear and gait on performance and injury. This commentary presents Dr. McCarthy’s views on the topic related to a research article he authored with his colleagues and which appears in the May 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).

Active Voice: Does Exercise Protect Against Sleep Complaints During Middle Age? (acsm-blog/acsm-blog/2015/08/14/active-voice-does-exercise-protect-against-sleepcomplaints-during-middle-age-) by Guest Blogger | Aug 14, 2015 By Rod K. Dishman, Ph.D., FACSM, and Shawn D. Youngstedt, Ph.D.

Poor sleep is a burden on public health. It is associated with medical conditions such as coronary heart disease, hypertension, obesity, diabetes and metabolic syndrome. Poor sleep also contributes to emotional distress and impairment of daytime function. Nearly one in four middle-aged adults in the U.S. say they recently had trouble falling or staying asleep, or sleeping too much. About half the people who seek treatment for sleep problems will be prescribed a drug that will have poor efficacy and adverse risks with long-term use. Many people who don’t seek treatment will purchase over-the-counter sleep aids or use alcohol to get to sleep at night. Neither is effective or healthy in the long run. Rod K. Dishman, Ph.D., Shawn D. Youngstedt, Trials of exercise training have shown improved reports of sleep quality and objective measures of better sleep in middle-aged adults who FACSM Ph.D. already complained of sleep problems. However, whether regular exercise protects against the onset of sleep problems hasn’t been studied much. The scientific advisory committee for the federal 2008 Physical Activity Guidelines (http://www.health.gov/paguidelines/guidelines/chapter2.aspx) for Americans concluded there was moderate evidence to support that physical activity improves sleep. However, the committee recommended that physical activity exposures and outcomes need to be measured frequently to properly examine change. None of the epidemiological studies included in their review had concurrently assessed objectively measured change in physical activity exposure and sequential measures of sleep outcome, or accounted for other risk factors that can vary across time to confound the association between physical inactivity and the odds of sleep disturbance. Change in cardiorespiratory fitness during middle age provides a proxy measure of cumulative physical activity exposure. Our collaboration with Steven N. Blair, P.E.D., FACSM, now at the University of South Carolina, let us follow 7368 men and 1155 women from the Aerobics Center Longitudinal Study that had not complained of sleep problems, depression or anxiety at their first visit to the Dallas clinic. Cardiorespiratory fitness (minutes of graded treadmill endurance) was assessed then and at three subsequent clinic visits, each separated by an average of two to three years. There were 784 incident cases of sleep complaints in men (11 percent) and 207 cases in women (18 percent). After adjustment for initial fitness, age, time between visits and other risk factors for poor sleep assessed at each visit, each minute decline in treadmill endurance between ages 51 to 56 (about one-half MET) increased the odds of incident sleep complaints by 2 percent in men and 1 percent in women. Odds were approximately 8 percent higher per minute decline in fitness among people with sleep complaints at two or three visits. Said another way, the decline in fitness was less for those who never reported sleep complaints – for men, only about 6 percent and only about 4 percent for women. It was about 8 percent in incident cases of sleep complaints, i.e., an additional loss of about one-half minute of maximal treadmill time. That smaller decline observed for those without sleep complaints is an amount easily retained in most people by regular, moderate-to-vigorous physical activity consistent with ACSM recommendations for healthy physical activity. Although a large randomized trial is needed to determine how many cases of sleep complaints might be prevented by mitigating this decline in fitness, our results suggest that maintenance of cardiorespiratory fitness during middle age, when decline in fitness typically accelerates and risk of sleep problems is elevated, helps protect against the onset of sleep complaints made to a physician in both men and women.

Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Professor Rod Dishman, Ph.D., FACSM, is an exercise scientist and is co-director of the Exercise Psychology Laboratory at the University of Georgia in Athens. One of his research lines has examined mental health outcomes associated with physical activity, focusing on neurobiological mechanisms. He chaired the mental health section of the scientific advisory committee for the federal 2008 Physical Activity Guidelines for Americans. He has been a member of ACSM since 1978. Professor Shawn Youngstedt, Ph.D., is a sleep scientist in the College of Nursing and Health Innovation and with the program in Exercise Science and Health Promotion, Arizona State University in Phoenix. His research has focused on morbidities and mortality associated with sleep problems and non-pharmacologic means of improving sleep and mental health. His group has conducted research on the effects of exercise and bright light on insomnia, sleep apnea and Posttraumatic Stress Disorder. He has been a member of ACSM since 1989. This commentary presents the views of Drs. Dishman and Youngstedt on the topic of a research article (http://journals.lww.com/acsmmsse/Fulltext/2015/05000/Decline_in_Cardiorespiratory_Fitness_and_Odds_of.10.aspx) which they and their colleagues published in the May 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Fitness is Fiscal (acsm-blog/acsm-blog/2015/08/05/fitness-is-fiscal) by Guest Blogger | Aug 05, 2015 Dear 2016 Presidential Candidates: We believe there is an issue in this campaign that so far has received only limited attention. We hope to change that by urging you include a strategy to promote increased physical activity for Americans as a central component of your health care policy platform. The Centers for Disease Control and Prevention (CDC) indicate that poor diet and physical inactivity cause over 400,000 deaths each year, yet still 68% of adults and 16.9% of children in the United States are obese or overweight. The link between the rise in obesity and ballooning increases in health care spending could not be more apparent. According to Department of Health and Human Services data, physical inactivity is responsible for between 20 and 30% of most major diseases and conditions. For example, 25-35% of coronary heart disease and cardiovascular diseases are attributed to this root cause. Similarly, 30-40% of type-2 diabetes; 30% of colon cancer; 20% of breast cancer; 20-30% of depression; 30% of falls; and 36-58% of hip fractures link back to a lack of exercise.1 The economic price of inadequate levels of inactivity is estimated at $131 billion per year2 – costs borne by federal and state governments as well as individual citizens. In effect, physical fitness IS fiscal responsibility, and improving fitness by regular physical activity dramatically reduces the risk of morbidity and mortality in normal weight, overweight, and obese individuals. Empowering Americans to increase their level of physical activity is part of the solution to both our health care and budgetary challenges. To this end, we urge you to include the following principals in your national health strategy: • Ensure that exercise is front and center in public discussions on disease prevention, health, and wellness and that health care providers assess and review every patient’s physical activity level at every visit. • Expand research programs at the National Institutes of Health and other federal science agencies directed at sports science and physical activity matters. • Promote walkability in public spaces and in the design of America’s infrastructure. • Establish a regular requirement for periodically updating Physical Activity Recommendations for Americans. In far too many cases, preventable conditions are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition that keep people healthy and out of the hospital. We urge you to use your voice in this presidential campaign to raise these critical issues for the future of our nation. Sincerely,

Jim Whitehead CEO, American College of Sports Medicine 1 2012 Advisory Committee Report, U.S. Secretary of the Department of Health and Human Services for the National Physical Activity Guidelines , pages E5-E17 2 S. Carlson et al., Progress in Cardiovascular Diseases 57:315-323, 2015

Active Voice: Television Viewing Time Predicts Usual Walking Speed — But Is It the Sitting That’s Important? (acsm-blog/acsm-blog/2015/08/03/active-voice-televisionviewing-time-predicts-usual-walking-speed-but-is-it-the-sitting-that-s-important-) by Guest Blogger | Aug 03, 2015 By Victoria L. Keevil, BMBCh and Katrien Wijndaele, Ph.D.

Sedentary behavior, i.e., time spent sitting or lying when energy expenditure is low, has been proposed as an independent risk factor for poor health and is acknowledged in a recent ACSM Position Stand on physical activity recommendations (http://journals.lww.com/acsm-msse/Fulltext/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26.aspx). In particular, both total sitting time and specific sedentary behaviors, such as watching television (TV), have been associated with type 2 diabetes, cardiovascular disease, specific cancers and premature mortality. However, little is known about the potential impact of prolonged sitting on physical function. This is somewhat surprising given the established link between prolonged bed rest and muscle atrophy, the importance of maintaining optimal physical function later in life and the high volumes of sitting time observed among older adults. Therefore, sedentary behavior is potentially an attractive target for public health intervention. In our research article published in April 2015 issue of MSSE (http://journals.lww.com/acsmVictoria L. Keevil, BMBCh Katrien Wijndaele, Ph.D. msse/Fulltext/2015/04000/Television_Viewing,_Walking_Speed,_and_Grip.8.aspx), we utilized the infrastructure of a large prospective cohort study, the European Prospective Investigation of Cancer (EPIC)-Norfolk study, to investigate associations between television viewing time and objective measures of physical capability in community-based adults aged 48-92 years old. Television viewing time, the most common leisure time sedentary behavior in Western cultures, was measured in more than 6000 participants at two time periods: in 1998-2000 and again in 2006-2007. Usual walking speed, grip strength and timed chair stands speed also were measured at a central research clinic between 2006 and 2011. These objective measures of physical function have been extensively validated in clinical and epidemiological cohorts and usual walking speed and grip strength also are featured in the motor domain of the National Institutes for Health toolbox (http://www.nihtoolbox.org/WhatAndWhy/Motor/Pages/default.aspx). We found that men and women who watched TV for less than two hours per day, either in 1998-2000 or 2006-2007, had faster usual walking speeds compared to those who watched TV for four or more hours per day. In analyses combining men and women and using the average of both TV viewing time measurements, a clear dose-response association was evident across TV viewing time categories. Those who watched less than two hours per day walked 2.4 m/min faster than those who watched four or more hours/day, a difference in usual walking speed equivalent to around four years difference in age. TV viewing time was not consistently or strongly associated with either grip strength or timed chair stands speed, the latter being a proxy measure for lower body strength. Usual walking speed has been proposed as the “sixth vital sign” of health in older people. It is associated with a range of health parameters, including cognition and premature mortality. Therefore, the observed association of less TV viewing time with faster usual walking speed, which persisted when TV viewing time was measured nearly a decade before, is of great public health interest. These findings add valuable evidence to the existing literature in this area, which is mainly cross-sectional and often based on self-reported measures of physical function, which come with substantially more measurement error. We do, of course, have to carefully consider the interpretation of our findings before recommending change in public health policy. TV viewing time is not a measure of overall sitting and it is associated with a complex range of socioeconomic and behavioral factors. Although we aimed to account for these variables in our analyses, we cannot be certain that it is the “sitting” per se, while watching TV that is solely contributing to the association we observed. Future studies with objective measures of overall sitting time should explore prospective associations with physical function. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Victoria L. Keevil, BMBCh, is a clinician specializing in medicine for older people and was awarded a Wellcome Trust clinical training fellowship to undertake a Ph.D. under the supervision of Prof Kay-Tee Khaw, at the Department of Public Health and Primary Care, University of Cambridge (UK). She is interested in the heterogeneity of physical functional health in later life and in establishing links with modifiable risk factors, including sedentary behavior. Her research was inspired by the need for evidence-based public health policy to promote good health in older age. Katrien Wijndaele, Ph.D., is a British Heart Foundation (BHF) intermediate basic science research fellow at the Medical Research Council Epidemiology Unit, University of Cambridge (UK). Her primary research interest lies in the potential health consequences of prolonged sitting in adults and children, with an additional focus on sedentary behavior measurement and development of intervention strategies to decrease prolonged sitting. This commentary presents Drs. Keevil’s and Wijndaele’s views on the topic of a research article which they and other colleagues had published in the April 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).

Special Olympics: A Sports Medicine Perspective (acsm-blog/acsm-blog/2015/07/28/special-olympics-a-sports-medicine-perspective) by Guest Blogger | Jul 28, 2015 Aaron Rubin, M.D., FACSM, FAAFP, Medical Director Special Olympics World Games Los Angeles 2015 The mission of Special Olympics is to provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities. Doing so gives them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community. In the 1950s and 60s, Eunice Kennedy Shriver noted how unjustly people with intellectual disabilities were treated and started a summer day camp in her backyard. The first Special Olympics Summer Games were held in 1968 at Soldier Field in Chicago for one thousand people with intellectual disabilities. Participants came from 26 states and Canada and competed in track and field and swimming. In summer 2015, 7000 athletes and 3000 delegates from 177 countries will be in Los Angeles for the World Games. More than 30,000 volunteers and 500,000 spectators will be attending the largest sports and humanitarian event in the world to cheer on these amazing athletes who will compete in 25 events. Although this large event creates attention, the Special Olympics movement is much more. In 2013, more than four million athletes participated in 81,000 competitions around the world. This works out to 222 games per day, or nine games per hour. Some 1.4 million free health examinations have been provided in more than 120 countries through the Special Olympics Healthy Athletes program. Screenings are done in seven disciplines: 1. Fit Feet provides podiatric screenings, including checking shoe size (many athletes compete with ill-fitting shoes) and a variety of foot problems. 2. FUNfitness provides physical therapy evaluation for balance and flexibility, with recommendations for improvements and preventing injuries. 3. Health Promotion teaches better health and well-being, including hand washing, sun protection, diet and hydration. 4. Opening Eyes provides vision screening and eyeglasses when needed. 5. Healthy Hearing screens for audiology problems and provides evaluation for hearing aids as needed. 6. Special Smiles provides dental screenings and recommendations. 7. MedFest performs sports physical exams. As medical director of the 2015 Games, I’ve experienced many challenges in putting together a medical plan for such a large multi-day event spread over a large geographic area. The medical team has to consider providing medical care for athletes at events, but with a higher number of medical conditions including diabetes, heart disease, and seizure disorders. We also had to give special attention to communicating with athletes with intellectual disabilities. The Special Olympics World Games partnered with medical groups and hospitals to provide medical expertise and oversight for the athletes and delegations during the entire course of the games. Teams are working on the medical care for athletes arriving at the Los Angeles Airport, with a welcome center medical station set up to assure that the athletes are doing well after their trips and have all medications and other needs met. The delegations spend several days at local communities called Host Towns to acclimate to and enjoy Southern California. They will then come to the Olympic Villages at UCLA and USC and have medical care available as needed in the dorms and during non-competition times. Medical teams will be available at each venue to care for minor medical issues that may arise, with sports medicine consultants available to come to the field as needed. Any condition requiring further lab or x-ray testing can be referred to a local “poly clinic” on the campuses or a local hospital clinic or emergency department. The goal of the medical staff at this event, as at all sporting events, is not to limit or restrict participation, but to allow and encourage safe participation. This is especially true for this population which is often looked at for their disabilities instead of their abilities. As with any such event, the hope is that the medical staff is able to take away more than they put into providing culturally appropriate, current and empathetic medical care with an increased awareness of the medical needs for this underserved population. Active Voice: Football and FIFA – It’s Still a Game, Right? (acsm-blog/acsm-blog/2015/07/28/active-voice-football-and-fifa-it-s-still-a-game-right-) by Guest Blogger | Jul 28, 2015 By Michael F. Bergeron, Ph.D., FACSM

Here we go again. Another sports scandal. The soccer world (international football) has been shocked over the past several days by numerous reports of bribery and corruption in the sport’s premier governing body, The Fédération Internationale de Football Association (FIFA (http://www.fifa.com/about-fifa/who-weare/index.html)). FIFA is an old and venerated institution, established in 1904 with a global mission of protecting the integrity, growth and financial stability of football. FIFA has become a powerful empire, reportedly worth some $2.8 billion. Ironically, and despite its self-declared responsibility to “tackle current challenges to football, such as illegal betting and bribery,” officials at the highest levels of the organization now have been accused of agreeing to accept bribes in connection with selection of the host countries for the 1998 and 2010 World Cup. For more on the latest news, see: http://www.cnn.com/2015/06/05/football/fifa-corruption-scandal/index.html (http://www.cnn.com/2015/06/05/football/fifa-corruption-scandal/index.html). No question, sport is big business, which makes it and those in charge vulnerable to the temptations and misguided choices that too often are characteristic in business whenever big money and individual or national prestige are involved. Even youth sports has become inappropriately and exceedingly adult- and mediacentered. But youth sports is still really about the kids who play sports, with football having recognized worldwide appeal. Adult football heroes are followed and admired by the boys and girls who find it simply thrilling and fun to run up and down the field while dribbling a ball in the imagined footsteps of these great players. But an important concern that perhaps is lost in all the media is the impact of this disappointing conduct on the many youth athletes who are heavily invested in football and have probably viewed FIFA as a high-minded leadership group. What does a scandal like this do to the children and adolescents who see football as the game they love? What is the unintended message and resulting consequence? Sadly, this demonstrated “leadership” distracts from, even deprecates, the core purpose of sport which is to promote healthy play, enjoyment, development, fitness, socialization and the dignity of ethical conduct. So we’ll do what responsible adults – parents, coaches, teachers and others who care about our children and the sports they love – always do. We’ll use this scandal as a lesson and a timely opportunity to emphasize that football (like all sports) is still a great game where commitment, hard work, character and respect are the tenants of success at any level of play. The IOC has made a commitment to re-emphasize healthy youth athlete development by critically evaluating the current state of youth sports and providing specific recommendations for developing healthy, resilient and capable youth athletes. This international consensus (available next month) comprises an emphasis on the whole athlete in developing character. This encompasses commitment and respect to self, other athletes, the community and the game, while providing opportunities for all levels of sport participation and success. The IOC further challenges all youth and other sport governing bodies to embrace and implement these guiding principles. The National Youth Sports Health & Safety Institute (http://nyshsi.org/) and the newly formed Youth Sports of the Americas (http://www.youthsportsoftheamericas.org/) enthusiastically support the IOC’s commitment to the positive values of sports and healthy youth athlete development. We have the obligation to, once again, save a sport, at least in the minds of those who matter the most: our children. They are watching, and counting on us.

Viewpoints presented on the Active Voice blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Michael F. Bergeron, Ph.D., FACSM, is president and CEO of Youth Sports of the Americas, Birmingham, Ala., as well as executive director of the National Youth Sports Health & Safety Institute. He is a past trustee of ACSM and currently a member of the Medical Advisory Committee for Pop Warner Little Scholars, Inc. that provides youth football and cheer and dance programs with an emphasis on maintaining academic standards. Dr. Bergeron also serves on the academic advisory board for the International Olympic Committee’s postgraduate diploma program in sports medicine, and he recently co-chaired the IOC Consensus Meeting on youth athletic development which will be highlighted in a special edition of the British Journal of Sports Medicine in July 2015. Active Voice: Does Return to Activity after Concussion Impact Recovery of Gait Stability? (acsm-blog/acsm-blog/2015/07/20/active-voice-does-return-to-activity-afterconcussion-impact-recovery-of-gait-stability-) by Guest Blogger | Jul 20, 2015 By Li-Shan Chou, Ph.D.

The relative re-injury risk for individuals who have sustained a concussion has been reported to be almost six times greater than those with no history of concussion. However, the factors, which contribute to this increased risk, are not clearly understood. Hence, the clinical decision of when to allow individuals to return to pre-injury levels of activity remains among the most difficult decisions in sports medicine. Previous research has reported that student athletes with concussion may experience a worsening of symptoms if they return to sports or school prematurely. Therefore, proper timing of activity resumption after a concussion is of critical importance to reduce the risk of prolonging the course of recovery. As deficits in physiologic functions have been documented to persist beyond patient-reported recovery of symptoms, additional objective measurements may be assistive in determining full recovery of the brain after injury. The ability to effectively execute motor tasks under conditions of divided attention (dual-task) is an important element for successful sport performance. Of particular interest to our research, this ability has been shown to be particularly sensitive to a concussion and remains impaired for several weeks after injury. In our April 2015 MSSE article (http://journals.lww.com/acsm-msse/Abstract/2015/04000/Return_to_Activity_after_Concussion_Affects.1.aspx), we addressed the questions of how return-to-activity (RTA) affects the recovery of single and dual-task gait balance control as well as recovery of cognitive functions and clinical symptoms. We employed a dual-task gait paradigm, which involved a recorded voice played over speakers. The voice expressed the words “high” or “low,” at pitches that were occasionally inconsistent with the meaning of the word (e.g., a low-pitched voice might say the word “high”). The subject, while walking, was required to identify the correct pitch, regardless of the word that was heard. In a prospective-longitudinal study, we followed 19 concussed high school students over a period of two months post-injury and measured these variables in the acute post-injury period (within 72 hours of injury) and at systematic intervals thereafter (one week, two weeks, one month, two months post-injury) against 19 uninjured matched controls. To test the effect of activity resumption within this two-month testing period, we examined the recovery trajectory of the variables immediately prior to and immediately after RTA clearance for each concussed subject. The results revealed improvement in dual-task gait medial-lateral balance control during the period immediately prior to RTA, but a worsening immediately after RTA. All other variables showed improvement in the pre-RTA period, and these continued to improve or remain stable post-RTA. This study concurs with findings from our group (http://journals.lww.com/acsmmsse/abstract/2006/06000/Gait_Stability_following_Concussion.2.aspx) reported previously in MSSE, which showed a recovery reversal in side-to-side stability when walking with a divided attention following RTA in concussed college-age students. The finding that regression of recovery was only observed in dual-task gait balance control immediately following the clearance for activity resumption, but not in cognitive, symptom or single-task walking variables suggests that dual-task medial-lateral sway is particularly sensitive to a concussion and its recovery may be influenced by premature RTA. This study also suggests that examination of dual-task gait stability may be able to detect important residual concussion-related impairments after cognitive and symptom resolution. Moreover, these findings reinforce the need for a multifaceted approach to concussion management. Viewpoints presented on the Active Voice blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Li-Shan Chou, Ph.D., is a professor and department head in the Department of Human Physiology at the University of Oregon. He directs the Motion Analysis Laboratory, and his research falls under general areas related to biomechanics and motor control of human movement, with focuses on the investigation of mobility impairments associated with ageing, musculoskeletal diseases or injuries and traumatic brain injury. This commentary presents Dr. Chou’s views on the topic of a research article which he and his colleagues published in the April 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). The Historic NIH Common Fund Announcement: Door to Physical Activity Research and Opportunities Swings Open (acsm-blog/acsm-blog/2015/07/13/the-historic-nihcommon-fund-announcement-door-to-physical-activity-research-and-opportunities-swings-open) by Guest Blogger | Jul 13, 2015 By Lawrence E. Armstrong, Ph.D., FACSM Game-changer. Watershed moment. Key milestone. Turning point. Whatever you may call it, the positive ramifications of the decision cannot be overstated. I’m talking, of course, about last Thursday’s announcement by the National Institutes of Health (NIH) that physical activity research is being added to the NIH Common Fund. For those unfamiliar with the fund, it encourages collaboration and supports a number of high-impact, trans-NIH programs. These programs are designed to pursue major opportunities and gaps in biomedical research that no single NIH Institute could tackle alone, but that the agency as a whole can address to make the biggest impact possible on the progress of medical research. The NIH Common Fund was enacted by Congress in 2008 to support high priority and the most promising research areas in NIH. The inclusion of physical activity research in the Common Fund is important not only to the science and health communities, but to the elected U.S. leadership as well. It’s extraordinary in its significance for the future of the field. Adding physical activity to the Common Fund will have a profound effect and create numerous opportunities for ACSM members. And while the decision to include physical activity research is exciting, the NIH’s long-term commitment is stunning. Over the next five years, NIH will invest $170 million in the physical activity research program - the largest targeted NIH investment of funds into the ways that physical activity improves health and prevents disease. ACSM is committed to keeping members informed about the new physical activity research program and the opportunities it will provide for research funding. At this time, request for applications (RFAs) are expected to be released next month. Decisions and financial investments like these don’t happen randomly. Foremost, this reflects the decades of research and scientific discovery to which so many of you have been powerfully and continuously contributing. We also are indebted to our colleagues at the NIH who have worked tirelessly over the past several years to promote this initiative. I am proud that ACSM, the leading sports medicine and exercise science organization in the world, also helped lead the way. Our esteemed researchers provided important scientific input to the proposal, and ACSM rallied support among more than 500 individuals and organizations that joined us in signing a letter of support. There were a series of meetings with NIH leaders, demonstrating that ACSM is no stranger to the NIH. Our organization is highly credible and influential, and the acceptance of physical activity into the Common Fund is due, again, to the incredible reputation and trail-blazing efforts of ACSM researchers. Broadly speaking, this new initiative will change the landscape in which we work and ACSM members can be excited about the contribution our organization has made, and will continue to make, moving forward. So why this, and why now? ACSM is all about integrating scientific discovery into practice and driving positive outcomes. Because the NIH Common Fund is a gateway for helping our members achieve this mission, pursuing opportunities through the fund is strategically reasonable. Using federal resources to support high-impact research in areas of emerging scientific opportunity such as the biomedical sciences is critical for moving society forward and improving public health. The knowledge that physical activity induces biological responses that are critical to the prevention and treatment of numerous diseases is a fundamental aspect of ACSM’s mission. However, the molecular and cellular mechanisms underlying those health benefits are largely unknown. That’s what makes this achievement thrilling. The biomedical discovery potential of a focused effort like this is clear. With the NIH announcement behind us, ACSM is already building on this momentum and will continue to play a leadership role to ensure the success of the Common Fund physical activity program. We are looking to make this a uniquely integrated and enduring effort that will sustain the growth and acceleration of physical activity research on a continuous basis, long past the Common Fund designation. This will involve, for instance: the NIH Strategic Plan that will be developed for submission to Congress at the end of this year; and the bipartisan 21st Century Cures Congressional bill that will greatly enhance funding for targeted areas of research. Next on-going steps for our organization include: Continued collaboration with NIH leadership Producing an informational webinar about program goals and benefits Facilitating a network of basic and clinical scientists that will allow ACSM researchers to collaborate on Common Fund physical activity research Developing a grant writing series to provide training and visibility for new investigators Making members aware of Common Fund updates, opportunities to serve as NIH grant reviewers, RFAs and important deadlines An on-going commitment to ensure that the NIH Common Fund priorities are reflected in a collaborative research roadmap, which ACSM will be coordinating The future of physical activity research, as well as the health of individuals and communities and nations, is now considerably brighter. Let’s seize this opportunity as leaders in scientific discovery. Carpe diem… and then some! You can learn more about the Common Fund announcement by reading the NIH news release (http://www.nih.gov/news/health/jun2015/nih-11.htm). Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. ACSM President Lawrence E. Armstrong, Ph.D., FACSM, is a professor and director of the Human Performance Laboratory in the Department of Kinesiology, University of Connecticut in Storrs, Conn. Much of his research has focused on human fluid-electrolyte balance and effects of dehydration and fluid consumption on physiological responses and physical performance in athletic, firefighting and military contexts. In recent years, he has completed research studies that focused on effects of mild dehydration on cognitive performance and mood in men and women and on hydration status of women across the term of pregnancy and during breastfeeding. Active Voice: Does Return to Activity after Concussion Impact Recovery of Gait Stability? (acsm-blog/acsm-blog/2015/07/06/active-voice-does-return-to-activity-afterconcussion-impact-recovery-of-gait-stability-) by Guest Blogger | Jul 06, 2015 By Li-Shan Chou, Ph.D. The relative re-injury risk for individuals who have sustained a concussion has been reported to be almost six times greater than those with no history of concussion. However, the factors, which contribute to this increased risk, are not clearly understood. Hence, the clinical decision of when to allow individuals to return to pre-injury levels of activity remains among the most difficult decisions in sports medicine. Previous research has reported that student athletes with concussion may experience a worsening of symptoms if they return to sports or school prematurely. Therefore, proper timing of activity resumption after a concussion is of critical importance to reduce the risk of prolonging the course of recovery. As deficits in physiologic functions have been documented to persist beyond patient-reported recovery of symptoms, additional objective measurements may be assistive in determining full recovery of the brain after injury. The ability to effectively execute motor tasks under conditions of divided attention (dual-task) is an important element for successful sport performance. Of particular interest to our research, this ability has been shown to be particularly sensitive to a concussion and remains impaired for several weeks after injury. In our April 2015 MSSEarticle (http://journals.lww.com/acsm-msse/Abstract/2015/04000/Return_to_Activity_after_Concussion_Affects.1.aspx), we addressed the questions of how return-toactivity (RTA) affects the recovery of single and dual-task gait balance control as well as recovery of cognitive functions and clinical symptoms. We employed a dual-task gait paradigm, which involved a recorded voice played over speakers. The voice expressed the words “high” or “low,” at pitches that were occasionally inconsistent with the meaning of the word (e.g., a low-pitched voice might say the word “high”). The subject, while walking, was required to identify the correct pitch, regardless of the word that was heard. In a prospective-longitudinal study, we followed 19 concussed high school students over a period of two months post-injury and measured these variables in the acute post-injury period (within 72 hours of injury) and at systematic intervals thereafter (one week, two weeks, one month, two months post-injury) against 19 uninjured matched controls. To test the effect of activity resumption within this twomonth testing period, we examined the recovery trajectory of the variables immediately prior to and immediately after RTA clearance for each concussed subject. The results revealed improvement in dual-task gait medial-lateral balance control during the period immediately prior to RTA, but a worsening immediately after RTA. All other variables showed improvement in the pre-RTA period, and these continued to improve or remain stable post-RTA. This study concurs with findings from our group (http://journals.lww.com/acsmmsse/abstract/2006/06000/Gait_Stability_following_Concussion.2.aspx) reported previously in MSSE, which showed a recovery reversal in side-to-side stability when walking with a divided attention following RTA in concussed college-age students. The finding that regression of recovery was only observed in dual-task gait balance control immediately following the clearance for activity resumption, but not in cognitive, symptom or single-task walking variables suggests that dual-task medial-lateral sway is particularly sensitive to a concussion and its recovery may be influenced by premature RTA. This study also suggests that examination of dual-task gait stability may be able to detect important residual concussion-related impairments after cognitive and symptom resolution. Moreover, these findings reinforce the need for a multifaceted approach to concussion management. Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Li-Shan Chou, Ph.D., is a professor and department head in the Department of Human Physiology at the University of Oregon. He directs the Motion Analysis Laboratory, and his research falls under general areas related to biomechanics and motor control of human movement, with focuses on the investigation of mobility impairments associated with ageing, musculoskeletal diseases or injuries and traumatic brain injury. This commentary presents Dr. Chou’s views on the topic of a research article which he and his colleagues published in the April 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: AHA Frames Guideline for Non-Physician Supervisors of Clinical Exercise Tests (acsm-blog/acsm-blog/2015/06/29/active-voice-aha-frames-guideline-for-nonphysician-supervisors-of-clinical-exercise-tests) by Guest Blogger | Jun 29, 2015 By Jonathan N. Myers, Ph.D., FACSM, and William G. Herbert, Ph.D., FACSM

The exercise test continues to have an important place in clinical medicine. Not only does the test help guide decisions regarding diagnosis and/or medical interventions, it remains valuable for evaluating the effects of therapies and setting exercise recommendations for patients. The knowledge and training required to properly conduct an exercise test are of central relevance to the clinical exercise physiologist. However, previously published guidelines on clinical competency for performing exercise testing have been directed toward physicians. If and when a non-physician should independently supervise a clinical exercise test and among which types of patients has remained uncertain. Early versions of exercise testing guidelines, beginning in the 1970s, recommended that a physician be available at all times to directly supervise an exercise test. This was due to the perceived risk associated with the test, particularly among patients with known disease. Since that time, surveys of event rates during exercise testing have consistently indicated that attendant serious events are extremely rare. In addition, significant changes in clinical practice patterns with exercise testing have continued to evolve over time. In contemporary exercise laboratories, physicians often provide supervision or oversight, but are less frequently present in the testing room. In fact, the majority of such tests today are administered by non-physicians (exercise physiologists, nurses, physical therapists or technicians)?including those tests performed among high-risk patients. As these changes have evolved, ambiguity has arisen regarding the physician's role relative to the non-physician. While ACSM has provided the standard for certification programs for clinical exercise physiologists, there remains uncertainty regarding the cognitive and procedural skills necessary from both a practical and legal standpoint regarding who should supervise an exercise test in clinical settings. In September 2014, the American Heart Association (AHA) published a Scientific Statement entitled, "Supervision of Exercise Testing by Non-physicians." (http://circ.ahajournals.org/content/130/12/1014.full) This document provides guidance for the clinical performance and supervision of exercise testing by non-physicians in the current era, while extending prior recommendations from the ACSM, AHA and American College of Cardiology directed toward physicians. Importantly, the document also provided specific guidance in terms of the type of physician supervision required. Three categories of supervision were defined, depending on the type of patient being tested: (1) personal supervision, requiring a physician's presence in the room; (2) direct supervision, requiring a physician to be in the immediate vicinity or on the premises or the floor and rapidly available should emergencies arise; and (3) indirect supervision, requiring physician availability by phone or pager. The statement responds to the need to specify the appropriate education, training, experience and cognitive and procedural skills necessary for non-physicians to conduct exercise testing and to delineate standards that maintain patient safety. The statement also responded to the need to provide physicians with guidance in terms of cognitive and procedural skills that strengthen their ability to supervise non-physician health professionals who perform exercise testing. One of the key consensus recommendations from the document was that, in most cases, clinical exercise tests can be supervised safely by properly trained non-physician health professionals. This recommendation, however, is predicated on the individual non-physician meeting competency requirements for exercise test supervision, being fully trained in cardiopulmonary resuscitation, and supported by a physician skilled in exercise testing or emergency medicine. Other key features in this document include: (1) the expectation that the supervising physician will maintain competency standards for exercise testing; and (2) the requirement that the non-physician supervisor is competent and able to effectively screen for highrisk patients and alert the physician supervisor, when appropriate. For further important features, see the full-text article online. The statement provides support for practices that have been routine in clinical settings for nearly two decades, wherein the non-physician often has been the supervisor who is present in the exercise lab and conducts the test. Importantly, however, it also confirms the physician's paramount role as final authority for the safety and quality of testing and interpretation. Thus, the statement acknowledges the non-physician's value, not merely as a less expensive physician surrogate, but also as a highly trained professional who brings skills that are complementary to those of the physician. This new scientific statement from the AHA brings some long-needed clarity to a procedure that remains a major part of many clinical practices. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Jonathan N. Myers, Ph.D., FACSM, completed his doctoral studies in exercise physiology at the University of Southern California. He is coordinator for the cardiology department's exercise laboratory at the Palo Alto VA Medical Center and is a clinical professor of medicine at Stanford University. Much of his work has focused on epidemiology studies that have demonstrated the importance of exercise tolerance and physical activity in modulating risk for cardiovascular events. Dr. Myers has authored or co-authored guidelines on exercise testing and related topics for numerous organizations, including ACSM, the American Heart Association and the American Thoracic Society. William G. Herbert, Ph.D., FACSM, is professor emeritus in the Department of Human Nutrition, Foods and Exercise at Virginia Tech in Blacksburg. Much of his research and writing relates to exercise testing and physical activity interventions in coronary heart disease and obstructive sleep apnea, but he also has contributed to the literature on standards of care, legal issues and safety in adult exercise programs. He has been a member of the writing teams for several ACSM publications, including ACSM's Guidelines for Exercise Testing and Prescription, and chaired the Committee for Certification and Education, ACSM Clinical Exercise Physiology Practice Board and chief editor of ACSM's Sports Medicine Bulletin. This commentary presents the authors' views on the above-titled American Heart Association Scientific Statement that was recently published in the journal Circulation. Dr. Myers chaired the multidisciplinary writing team and Dr. Herbert was a contributor.

Active Voice: The Tortoise and the Hare - A Sex Difference in Marathon Pacing (acsm-blog/acsm-blog/2015/06/22/active-voice-the-tortoise-and-the-hare---a-sex-difference-inmarathon-pacing) by Guest Blogger | Jun 22, 2015 By Robert O. Deaner, Ph.D. and Sandra K. Hunter, Ph.D., FACSM Distance running is one of the most popular forms of exercise in the U.S. and, for many recreational runners, participating in races is a major motivator. A key aspect of successful racing is selecting an appropriate initial pace, given one’s ability and training. An initial pace that is too slow may not allow a runner to achieve their time goals, but starting too fast may result in pronounced slowing and also great discomfort. Outstanding endurance performances involve almost even pacing (http://www.runnersworld.com/runningtips/what-world-records-teach-about-marathon-pacing). The current marathon world records for men (Dennis Kimetto, Berlin, 2014) and women (Paula Radcliffe, London, 2003), for example, were achieved by running the second half of the race just 30 to 40 seconds faster than the first half. Despite the importance of pacing to all runners, most pacing studies have only considered elite competitors. In the March 2015 issue of MSSE, we reported our findings (http://journals.lww.com/acsmmsse/Fulltext/2015/03000/Men_Are_More_Likely_than_Women_to_Slow_in_the.19.aspx) from a pacing study based on all finishers at 14 recent U.S. marathons. Collectively, those races included almost 92,000 performances. The strongest predictor of Robert O. Deaner, Ph.D. Sandra K. Hunter, Ph.D. even pacing was overall performance: slower runners were much more likely than faster runners to reduce their speed in the second half of the marathon. Another key predictor of pacing was sex: on average, men ran the second half of the marathon 15.6 percent slower than the first half, whereas women slowed by an average of 11.7 percent. The sex difference was especially clear when considering runners who slowed by 30 percent or more: men were about three times as likely as women to experience such dramatic slowing. Similar effects have been reported by others in one earlier study (http://journals.lww.com/nscajscr/Abstract/2011/02000/Age,_Sex,_and_Finish_Time_as_Determinants_of.14.aspx), which employed a smaller sample. We also investigated whether racing experience was related to pacing and whether it might contribute to this sex difference. For more than 2,900 runners, we acquired information on racing experience from the web source athlinks.com. We found that years of racing experience and number of previous marathons finished were both associated with more even pacing. However, these experience effects were similar for men and women, so that controlling for experience did not eliminate the observed sex difference in marathon pacing. In addition, we showed that, although older runners tended to pace more evenly, the sex difference in pacing held across age groups. Our results raise many questions, including why men tend to slow their pace more than women do. One possibility is that this reflects men being more likely than women to decide to undertake a risky, aggressive pace. A risky pace may pay off by allowing a runner to achieve a superb performance, but it also increases the risk of dramatic slowing. A second possibility is that physiological factors cause the sex difference in pacing. Women typically use more fat and less carbohydrates during endurance exercise of similar intensity. This should make them less likely to ‘bonk’ or ‘hit the wall’ because they are less likely to have their muscles depleted of glycogen. To better address the predictors of successful pacing in non-elite runners, we suggest that future studies obtain data on runners’ training, targeted pace, subjective feelings and measures of physiological status. Such studies might go a long way toward clarifying reasons for these sex- related pacing differences, helping runners achieve more even pacing and better performances, and enjoy their racing more. Viewpoints presented on the ACSM Blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Robert O. Deaner, Ph.D., is an associate professor in the Department of Psychology at Grand Valley State University in Allendale, Mich. His overarching goal is to contribute to a scientific understanding of human nature, especially by demonstrating the value of evolutionary theory. Most of his current projects involve sex differences and sports. Sandra K. Hunter, Ph.D., FACSM, is a professor in the exercise science program with the Department of Physical Therapy at Marquette University in Milwaukee, Wisc. Her research focus includes understanding the mechanisms for (1) sex and age differences in motor control, neuromuscular fatigability and human performance in healthy and clinical populations; and (2) the added effects of stress and exercise training on motor control and fatigability of old adults and clinical populations. This commentary presents Drs. Deaner’s and Hunter’s views on a topic related to the research report that they and their colleagues recently authored. The report of their original investigation appears in the March 2015 issue ofMedicine & Science in Sport & Exercise® (MSSE). Active Voice: Physical Activity, Metabolism and Brain Morphology in Twins (acsm-blog/acsm-blog/2015/05/06/active-voice-physical-activity-metabolism-and-brainmorphology-in-twins) by Guest Blogger | May 06, 2015 By Urho Kujala, M.D., Ph.D. In exercise science, long-term intervention studies are challenging to accomplish, and observational follow-up studies, even in a longitudinal setup, also present problems in establishing cause and effect relationships. A monozygotic (MZ) twin-pair co-twin control study design presents a highly effective means to establish controls for genetic predisposition and largely controls for childhood home environment. In our co-twin control study (part of the FITFATTWIN study), recently published in MSSE (http://journals.lww.com/acsmmsse/Abstract/publishahead/MOTOR_DEVELOPMENT_AND_PHYSICAL_ACTIVITY___A.97792.aspx), we investigated how physical activity level is associated with body composition, glucose homeostasis and brain morphology in young adult male MZ twin pairs – pairs that have been discordant for physical activity during the past three years. Identifying MZ co-twins who have long-term discordance in their physical activity habits is challenging because participation in physical activity has a rather high heritability. First, 10 adult male MZ twin pairs whose members were clearly discordant for their leisure time physical activity during the past three years were comprehensively identified from a population-based Finnish twin cohort. As expected, active twins had higher cardiorespiratory fitness, a lower body fat percent and better glucose homeostasis compared to inactive co-twins. Findings on body composition show that long-term physical activity may clearly reduce percent body fat without having a significant effect on body weight. The pairwise difference in insulin resistance/sensitivity also was seen, as measured by both a steady state (fasting/HOMA) index and a dynamic (Matsuda) index. Based on whole brain magnetic resonance imaging with voxel-based morphometry and use of preprocessing algorithms, we determined that physically active co-twins had larger striatal and prefrontal cortex gray matter volumes compared to their inactive co-twins. These regions are heavily involved in motor control networks. Other brain regions also may differ between active and inactive members of twin pairs, but the differences were not great enough to reach statistical significance in our “global” brain analysis. As MZ twins usually have a high-degree similarity in brain structure, our finding provides novel evidence for the structural region-specific effects of long term physical activity on the healthy adult brain. The findings pointing toward enlarged areas involved with controlling motor abilities may have health implications in the long-term, such as possibly reduced risk of falling and mobility limitations at older age. As the study also showed beneficial effects on cardio-metabolic risk factors, exercising seems to have multidimensional, site-specific and systemic effects on healthrelated factors. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Urho Kujala, M.D., Ph.D., is a specialist in sports and exercise medicine and professor at the Department of Health Sciences, University of Jyväskylä, Finland. His research focuses on different health benefits and adverse effects of sports and exercise. He has been a member of ACSM for 25 years. This commentary presents Dr. Kujala’s views on the topic of a research article which he and his colleagues published in the March 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). This research study also was covered in a recent article in The New York Times (http://well.blogs.nytimes.com/2015/03/04/one-twin-exercises-the-other-doesnt/? _r=0). Active Voice: Weight Loss and Obstructive Sleep Apnea - What Lies Ahead? (acsm-blog/acsm-blog/2015/04/27/active-voice-weight-loss-and-obstructive-sleep-apnea---whatlies-ahead-) by Guest Blogger | Apr 27, 2015 By Devon A. Dobrosielski, Ph.D. Weight loss is recommended by the American Academy of Sleep Medicine for all overweight adults with obstructive sleep apnea (OSA) (http://www.ncbi.nlm.nih.gov/pubmed/19960649), a disorder associated with obesity and characterized by repeated episodes of upper airway obstruction, recurrent arousals and episodic oxygen desaturations during sleep. This recommendation has been bolstered in recent years by several large clinical trials that have demonstrated improvements in OSA severity with intensive lifestyle modification (e.g., dietary change and increased physical activity). These improvements are dose-dependent and are sustained once an intervention has ended or even when weight regain occurs. Less well established is whether improvements in OSA severity, despite weight regain, translate into improved cardiovascular outcomes. OSA is linked to cardiovascular morbidity and mortality through a number of mechanisms that include endothelial dysfunction, inflammation and sympathetic activation. Moreover, abdominal obesity is an established risk factor for both OSA and cardiovascular disease. Our most recent report, published in MSSE (http://journals.lww.com/acsm-msse/abstract/2015/01000/Effects_of_Exercise_and_Weight_Loss_in_Older.4.aspx), is one of the first investigations to examine potential cardiovascular disease mechanisms in the context of an OSA intervention that reduces weight, alters body composition and increases fitness simultaneously. We found that after undergoing a 12-week intervention that included exercise and dietary-induced weight loss, older men and women with OSA had reduced disordered breathing events and showed improvements in nightly desaturations. These changes were accompanied by reductions in body fat and increased fitness. Uniquely, we also found that improved arterial distensibility (a marker of vessel wall damage) was related to improvement in the severity of nightly desaturations. These findings suggest that beneficial cardiovascular outcomes accrued through a lifestyle program may be influenced to a greater extent by OSA severity rather than body weight or composition. They also imply that vascular impairments existing in many patients with OSA may not be the cause or consequence of physical inactivity. We remain cautious in the interpretation of these data, but feel that testing the above hypotheses are important, especially since weight loss and increased physical activity are generally regarded as cornerstone therapies for reducing the burden of chronic diseases. Yet, clinicians and scientists also might want to consider the possible role that OSA may have in mediating the associations between reduced obesity and cardiovascular health. Indeed, there is evidence that OSA actually impairs weight loss (http://thorax.bmj.com/content/67/8/735.abstract). Moreover, while exercise is thought to confer cardioprotection through direct effects on endothelial function, this benefit may be lost, or at least attenuated, in the presence of undiagnosed OSA. Accordingly, screening for and treating OSA with continuous positive airway pressure might actually facilitate weight loss and allow for exercise to result in more beneficial cardioprotective outcomes. Clearly, there is much to be learned about long-term effects of lifestyle modification on cardiovascular health in OSA patients. The stage is set for continued research designed to explore the most effective treatment strategies for reducing OSA, with regard to weight loss and exercise programing. Addressing this would undoubtedly have major implications for reducing cardiovascular disease risk among obese patients with and without OSA. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Devon A. Dobrosielski, Ph.D., is an assistant professor of exercise science in the Department of Kinesiology at Towson University in Maryland. Dr. Dobrosielski is an ACSM member, focusing his research on examining the impact of exercise and sleep on the cardiovascular consequences of chronic disease. In particular, he is interested in determining whether exercise can serve as an effective countermeasure to vascular impairment commonly observed in the presence of sleep disorders. This commentary presents Dr. Dobrosielski’s views on the topic of the research article which he and his colleagues published in the January 2015 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Fitness and Academic Achievement in Children – Not Necessarily a Straightforward Association (acsm-blog/acsm-blog/2015/04/20/active-voice-fitness-andacademic-achievement-in-children-not-necessarily-a-straightforward-association) by Guest Blogger | Apr 20, 2015 By Stephen D. Herrmann, Ph.D. and David Hansen, Ph.D. Finding an association between academic achievement and physical activity (PA) or aerobic fitness (fitness) would surprise few these days. In general, the research literature indicates higher PA and fitness tend to correlate with higher academic achievement, and vice versa. That is, children who are more physically active and those who are more aerobically fit tend to have higher academic achievement. This positive, linear association adds to a growing list of PA/fitness benefits for children’s health. But is this association of PA/fitness with academic achievement as straightforward—linear—as it seems? Is the association basically the same across subject matter? Furthermore, who benefits most academically by increased PA/fitness? These questions were the impetus for our recent publication in MSSE (http://journals.lww.com/acsmmsse/abstract/2014/12000/Linear_Nonlinear_Relations_of_Activity_and_Fitness.11.aspx). Our analyses were derived from baseline data from a larger, three-year randomized trial titled “Academic Achievement and Physical Activity across the Curriculum” (A+PAAC). Seventeen schools enrolled in A+PAAC with 687 2nd and 3rd grade children included in baseline assessments. Briefly, the goal of A+PAAC is to improve students’ academic achievement and health by incorporating 100 minutes/week of moderate-to-vigorous physical activity into classroom lessons delivered by the A+PAAC trained teacher (click here for further details (http://www.biomedcentral.com/1471-2458/13/307)). Here are the highlights of what we found. First, only fitness, not PA, was significantly associated with academic achievement and only for mathematics and spelling (no association with reading achievement). Fitness was measured by number of laps completed from the 20 meter shuttle run (PACER) laps. Second, the pattern of association for mathematics and spelling was not a straight line. Instead, a positively sloping line was found up to a particular fitness level for math (22 laps) and spelling (28 laps), but the line plateaued beyond those fitness levels. In percentiles, these laps translate into the 50th-75th fitness percentiles. There are several implications of these findings worth noting. First, these findings are a cross-sectional snapshot of associations and do not indicate a cause-effect relationship. Further research is needed, in particular, to examine how changes in fitness may or may not influence this fitness/academic achievement relation. However, our findings do suggest that improving fitness for those children below the 50th fitness percentile could have substantial benefits for their achievement. The good news is that this level of fitness is achievable for most children. That said, we still understand very little about how fitness might produce such benefits. These findings do provide clear guidance on the next set of research questions we need to ask. Despite emerging evidence that PA and fitness are associated with higher academic achievement, there has been a trend in recent years toward reducing physical education opportunities in schools, sometimes with the intent of increasing classroom academic time. This strategy could backfire, however, if it contributes to increased sedentary patterns that, over time, can decrease or limit improvements in fitness. Thus, one pressing question is whether increasing students’ fitness levels through greater PA, especially among those in the lower fitness percentiles, can help improve academic achievement. Thus, we suggest schools may benefit from a proactive approach and aim to increase opportunities for students to be active and promote fitness that will improve health and may improve academic achievement. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Stephen D. Herrmann, Ph.D., is a researcher at Sanford Research in the Children’s Health Research Center and is the director of program development and training for profile by Sanford. His research is focused on understanding individual response to exercise and diet interventions— more specifically, why certain people respond positively to exercise and diet interventions and others do not. Dr. Herrmann is a member of ACSM. David Hansen, Ph.D., is associate professor at the University of Kansas School of Education. His expertise is on adolescent development and learning in a variety of in and out-of-school settings, including the full range of organized youth activities (e.g., extracurricular, community-based programs). This commentary presents the views of Herrmann and Hansen on the topic of their research article, which they and their colleagues published in the December 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: A Novel Strategy for Promoting Recovery of Muscular Strength after Strenuous Exercise in Competitive Athletes (acsm-blog/acsm-blog/2015/04/13/activevoice-a-novel-strategy-for-promoting-recovery-of-muscular-strength-after-strenuous-exercise-in-competitive-athletes) by Guest Blogger | Apr 13, 2015 By Kazushige Goto, Ph.D. As athletes commonly perform intensive physical training or compete on consecutive days, rapid recovery of exercise capacity is important to maximize competitive success and to prevent excessive fatigue. The wearing of compression garments (CG) after exercise promotes recovery of muscular strength and attenuates exercise-induced muscle damage. I established research projects with Takuma Morishima, M.Sc., to demonstrate the effects of CG during exercise or the post-exercise period. In our latest paper published in MSSE (http://journals.lww.com/acsm-msse/abstract/2014/12000/Compression_Garment_Promotes_Muscular_Strength.9.aspx), we explored the effects of wearing a CG for 24 hours on the detailed time course of changes in muscular strength, muscle damage and inflammatory responses after strenuous resistance exercise. Nine recreationally trained males completed two exercise trials, wearing either a CG or a normal garment (CON) for 24 hours after exercise. We clearly showed that wearing a CG after resistance exercise promoted recovery of upper body and lower limb muscular strength. In particular, upper body strength improved within 3 to 8 hours after exercise, while significantly greater recovery of lower limb muscular strength was evident within 24 hours after exercise. Muscle soreness also was reduced by wearing the CG during the post-exercise period. The good news is that it is very easy to simply wear a CG; this renders the popular recovery procedures (massage, active recovery and water immersion) unnecessary. In terms of the mechanism involved, the CG is hypothesized to attenuate exercise-induced muscle damage and swelling by applying pressure to the exercised muscles. As our experimental subjects wore CG during the post-exercise period only, it appears that the CG protected against secondary muscle damage, which causes delayed-onset muscle soreness. Although we did not detect marked between-group differences in biomarkers of exercise-induced muscle damage and inflammatory responses (e.g., myoglobin, interleukin-6), further examination of blood flow and/or intramuscular metabolism in future studies may allow us to elucidate the detailed mechanism behind the observed effect. From a practical viewpoint, two research questions arise. First, is wearing a CG between multiple training sessions over a single day helpful in terms of recovery? Second, is use of a CG beneficial during recovery from endurance exercise? In our latest experiments, two graduate students (Ayaka Mori, M.Sc., and Sahiro Mizuno) have explored these two questions, and original research articles are being developed that will report those answers. The idea of using a CG to aid recovery came from the observation that a CG is commonly employed in clinical settings to treat chronic inflammatory disorders or peripheral swelling in patients with vascular disease. Our novel research in sports science indicates that wearing a CG during post-exercise periods facilitates the recovery of athletes who engage in strenuous training several times a day, or on consecutive days. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Kazushige Goto, Ph.D., received his Ph.D. degree in 2004 from the University of Tsukuba, Ibaraki, Japan. He followed this with a four-year postdoctoral fellowship at the University of Tsukuba, Tokyo University (Japan), which included collaborations with the Bispebjerg Hospital in the Capital Region of Denmark. He began his academic career at the Waseda University in Saitama, moving to the Ritsumeikan University in Shiga in 2010, where he accepted his current appointment as an associate professor. His research interests include exercise-induced endocrine and metabolic changes, post-exercise recovery strategies and the effects of exercise training in hypoxia. This commentary presents Dr. Goto’s views on the topic of a research article which he and one of his colleagues published in the December 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Oral Citrulline to Circumvent Splanchnic Hypoperfusion and Gut Injury in Athletes (acsm-blog/acsm-blog/2015/03/30/active-voice-oral-citrulline-tocircumvent-splanchnic-hypoperfusion-and-gut-injury-in-athletes) by Guest Blogger | Mar 30, 2015 By Karolina A.P. Wijnands, M.D., and Kaatje Lenaerts, Ph.D. In that work, we studied athletes on two occasions in which they performed a one-hour cycling protocol at 70 percent of their maximal workload capacity. In one of these cycling bouts, they ingested L-citrulline 30 minutes prior to exercise and, in the other, they ingested L-alanine as a placebo 30 minutes in advance. Oral citrulline intake significantly increased plasma citrulline and arginine in healthy athletes, resulting in prolonged increased arginine availability for NO synthesis?without causing GI discomfort, as has been reported for arginine. To assess the effect on splanchnic perfusion, we used gastric air tonometry and side-stream dark field sublingual imaging procedures (for more on gastric air tonometry, see van Wijck et al., 2012 (http://ajpgi.physiology.org/content/303/2/G155)). Data revealed that citrulline intake prior to exercise resulted in preserved splanchnic perfusion and improved sublingual microcirculation. Importantly, these improvements were associated with significantly reduced enterocyte damage during exercise compared with placebo. These findings encourage further studies on the effects of citrulline in symptomatic athletes aimed at relieving ischemia-related Karolina A.P. Wijnands, M.D. Kaatje Lenaerts, Ph.D. abdominal complaints. Furthermore, our data may be of interest for asymptomatic athletes as well. Preserving enterocyte integrity during exercise by citrulline supplementation is expected to improve nutrient uptake during and after exercise, and in this way contribute to enhanced recovery. Furthermore, clinical studies are ongoing to determine whether citrulline supplementation exhibits similar beneficial effects in patients suffering from splanchnic-hypoperfusion, such as in sepsis. Viewpoints presented on the ACSM Blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Karolina A.P. Wijnands, M.D., is in the final phase of writing her Ph.D. thesis. Her research seeks to understand the effects of L-citrulline supplementation on arginine-NO metabolism and microcirculation, employing conditions that reduce splanchnic perfusion such as (experimental) sepsis and strenuous exercise in healthy athletes. Karolina currently is an orthopedic surgery resident with the Maastricht University Hospital in The Netherlands, where she will be continuing her research on arginine-NO metabolism in inflammatory conditions, bone healing and exercise. Kaatje Lenaerts, Ph.D., is an assistant professor in the Department of Surgery at Maastricht University, The Netherlands. Trained as a biomedical scientist, she studies several facets of gut wall integrity loss, from unraveling the molecular basis of intestinal ischemia to developing models and tools to assess the impact of stressors on the gastrointestinal tract. Her translational research focuses on the interplay between intestinal compromise, innate immunity and nutrition to enhance intestinal mucosal homeostasis. This commentary presents Drs. Wijnands’ and Lenaerts’ views on the topic related to a research article that they authored with colleagues. Their article appears in the November 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Up to 70 percent of endurance athletes suffer from abdominal complaints during or after performing strenuous exercise. Gastrointestinal (GI) symptoms include nausea, vomiting, flatulence, cramps, diarrhea and rectal bleeding. The incidence and type of GI symptoms depend on factors including exercise type, intensity, duration and food/fluid intake, and these symptoms can vary from mild to severe. Splanchnic blood flow reduction and concomitant intestinal ischemia are considered important factors in the development of exercise-induced GI discomfort. This decrease in intestinal perfusion is a result of blood flow redistribution, directing the blood toward the active muscles, heart and lungs, and away from the GI system. Formation of intestinal nitric oxide (NO), a potent vasodilator, is impaired during splanchnic hypoperfusion. NO is produced from amino acid L-arginine via NO synthase and has an important role in vasoregulation of the splanchnic bed. Hence, increasing the local availability of NO is a potential means to enhance the intestinal microcirculation. Logically, L-arginine was one of the first agents studied in this respect and, while its administration has been shown to increase plasma arginine availability, the results have not been unequivocally positive. In addition, arginine supplementation in man may induce adverse GI effects, such as nausea, vomiting and diarrhea, thus limiting its practical application. Another means to increase NO availability is by supplying L-citrulline, a precursor of L-arginine. Importantly, in a previous study (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0037439) we showed that, compared with arginine, citrulline is a more suitable substrate to enhance intestinal perfusion and microcirculation in endotoxemic mice. To translate these findings to humans, we applied our strenuous exercise model (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0022366), which is characterized by splanchnic hypoperfusion, intestinal injury and intestinal barrier loss in healthy athletes, to study the protective effects of citrulline in our current study, recently reported in MSSE (http://journals.lww.com/acsmmsse/Fulltext/2014/11000/L_Citrulline_Improves_Splanchnic_Perfusion_and.1.aspx). Active Voice: Can Exercise Capacity Predict Survival in Cystic Fibrosis? (acsm-blog/acsm-blog/2015/03/16/active-voice-can-exercise-capacity-predict-survival-in-cysticfibrosis-) by User Not Found | Mar 16, 2015 By Erik H. J. Hulzebos, P.T., M.Sc., Ph.D., and Tim Takken, M.Sc., Ph.D. Life expectancy in patients with cystic fibrosis (CF) is increasing. However, since the predicted median survival is still around 50 years for individuals with CF who were born in 2000, life expectancy remains an important, clinically-relevant outcome. A number of modifiable and nonmodifiable variables, including gender, lung function decline, number of pulmonary exacerbations, nutritional status/lower muscle mass, diabetes mellitus, a positive culture for Burkholderia cepacia colonization and lower peak oxygen uptake (VO2peak), have all been associated with mortality in patients with CF. Among these variables, several studies have identified percentage of predicted forced expired volume in one second (FEV1%predicted) as being one of the best predictors of mortality in adults, children and adolescents with CF. Other common predictors of mortality in patients with CF are derived from cardiopulmonary exercise testing (CPET) including peak minute ventilation (VEpeak), peak ventilatory equivalent ratio for oxygen (VE/VO2), a marker of ventilatory efficiency and perhaps the best known predictor from CPET - the VO2peak. Nevertheless, exercise capacity in patients with CF is limited, which seems to have a multifactorial cause. If there is a possible relationship between CF genotype and some measures of exercise capacity, the mechanisms remain to be determined. It seems that there is an interrelationship between lung function, muscle mass, energy expenditure, respiratory and/or skeletal muscle function and exercise capacity in patients with CF. The pathophysiology of reduced lung function and reduced muscle mass are known to be the most important factors leading to exercise limitation in CF. Nixon et al. (1992) (http://www.nejm.org/doi/full/10.1056/NEJM199212173272504) were the first to report a significant association between the aerobic exercise capacity of young patients with CF and survival over eight years. Patients with the highest levels of aerobic exercise capacity (VO2peak ≥ 82% of predicted) had a survival rate of 83% after eight years, as compared with rates of 51% and 28% for patients with middle (VO2peak, ranging between 59-81% of predicted) and lowest (VO2peak ≤ 58% of predicted) levels of aerobic exercise capacity respectively. Thus, higher levels of aerobic exercise capacity in patients with CF are associated with a significantly lower risk of dying. Although a better aerobic exercise capacity may simply be a marker for less severe illness, measurement of VO2peak appears to be clinical valuable for predicting prognosis. The debate with regards to the strongest predictor of mortality in CF is ongoing. To date, a strong focus has been on VO2peak as a biomarker for cardiorespiratory health status - for example, to assess how physical activity or exercise training might positively affect VO2peak. Yet, the question arises whether other parameters of exercise or a combination of both exercise and non-exercise parameters might yield even stronger biomarkers of health status. In our study, recently reported in MSSE (http://journals.lww.com/acsm-msse/Fulltext/2014/11000/Prediction_of_Mortality_in_Adolescents_with_Cystic.2.aspx), we found that a model consisting of BMI, FEV1%predicted and VE/VO2 is a strong predictor of mortality in adolescents with CF over a 7.5±2.7 year follow-up period. Further research is warranted to determine whether improving aerobic exercise capacity, through physical exercise programs or other interventions (e.g., nutritional supplementation) will result in a better prognosis. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Erik J. Hulzebos, P.T., M.Sc., Ph.D., is a clinical exercise physiologist, sports physical therapist, and assistant professor in clinical health sciences at the University Children’s Hospital of the University Medical Center Utrecht, the Netherlands. His main research and clinical interest is clinical pediatric exercise physiology. He has performed studies in many clinical populations including children with cardiorespiratory disease. Dr. Hulzebos published more than 35 peer-reviewed papers and authored five books. He is an ACSM Registered Clinical Exercise Physiologist, and member of the European Pediatric Work Physiology, European Cystic Fibrosis Society and ECFS working group “Exercise in patients with cystic fibrosis. Tim Takken, M.Sc., Ph.D., is a medical physiologist and associate professor in pediatrics at the Wilhemina Children’s Hospital of the University Medical Center Utrecht, the Netherlands. He has a special interest in clinical pediatric exercise physiology. He is currently director of the Clinical Exercise Testing Laboratory in Utrecht. Further, he is the chair of the Dutch chapter of CPX international. Dr. Takken has published more than 150 peer-reviewed papers and authored four books. This commentary presents Dr. Hulzebos’ and Takken’s views on the topic related to a research article that they authored with colleagues. Their article is published in the November 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Lie, Sit, Stand or Ambulate? The Measurement of Body Postures (acsm-blog/acsm-blog/2015/03/02/active-voice-lie-sit-stand-or-ambulate-the-measurement-ofbody-postures) by Guest Blogger | Mar 02, 2015 By David R. Bassett, Jr., Ph.D., FACSM There are many ways to group activities that people perform in everyday life in order to quantify and describe their physical activity so that it is easily reported and understood. For instance, activities are often grouped by intensity level (sedentary, light, moderate and vigorous). But another method is to group activities by the body postures people assume when performing them (lying down, sitting, standing and ambulating). “Postural allocation” refers to the amount of time people spend each day in different postures. Researchers are becoming convinced that the amount of time spent sitting may influence our health. The activPAL™ (PALtechnologies, Glasgow, Scotland) is a miniature device worn on the thigh. Roughly the size of a USB thumb drive, it has a miniature triaxial accelerometer that senses dynamic accelerations produced by human movements, as well as static acceleration due to gravity. The accelerometer in this device can detect the angle of incline of the thigh, allowing it to distinguish between lying/sitting, standing and ambulating. However, since the thigh is horizontal when sitting and lying down, it cannot differentiate these two body postures. One could ask why it is important to distinguish lying down from sitting. One reason is that lying down usually represents sleep, and sleep has health-enhancing, restorative powers. Prolonged sitting, on the other hand, is viewed as deleterious to health - this applies more to individuals who do not perform leisure time physical activity than to those who perform aerobic activity for hours on end. In our study, recently reported in MSSE (http://journals.lww.com/acsm-msse/Abstract/2014/10000/Detection_of_Lying_Down,_Sitting,_Standing,_and.19.aspx), we examined whether wearing two activPAL™ devices, one each on the thigh and torso, would allow four body postures (lying down, sitting, standing and ambulating) to be accurately classified. Fifteen healthy adults performed a routine consisting of lying down, sitting, standing, sweeping (floors), treadmill walking at 3 mph and treadmill running at 6 mph. We then used the data from both activPALs to predict a person’s body posture. When both activPALs were horizontal, that was taken to represent lying down. When the thigh device was horizontal and the activPAL™ on the torso was vertical, that was taken to represent sitting. When both activPAL™ devices were vertical, that was taken to indicate the upright position. This method of classifying body postures showed good agreement with direct observation. The notion that sedentary behavior is deleterious to health is not a new idea. Around 1700, Bernardino Ramazzini, the founder of occupational medicine, studied people in various jobs and noted that scurrying messengers were healthier than sedentary tailors and bookkeepers. He referred to the latter two classes of workers as “chair workers.” Ralph Paffenbarger, Jr., MD, DrPH, devised a questionnaire for the College Alumni Health Study, which began in 1960. His famous questionnaire is best known for its physical activity index (PAI), computed from distance walked, flights of stairs climbed, and sports and recreation. However, Paffenbarger also had the foresight to ask people how much time they spent during a usual 24-hour day, engaged in sleeping/reclining, sitting, light activity (e.g. office work, strolling, standing with little motion), moderate activity and vigorous activity. Some researchers are skeptical about people’s ability to accurately recall these behaviors, so they have turned to wearable activity monitors for more accurate answers. There is growing evidence that desk jockeys, long-distance commuters and television-viewing couch potatoes are at increased risk for metabolic syndrome and premature death. Interventions are needed to identify practical, low-cost and acceptable ways of reducing time spent in these sedentary pastimes, or converting them to more active ones. Measurement tools are needed to quantify the magnitude of behavior changes induced by these interventions. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Dr. David R. Bassett, Jr., is an exercise physiologist and researcher at the University of Tennessee in Knoxville, Tenn. His research focuses on the validity and reliability of objective measurements of physical activity, cross-sectional studies of the relationship between physical activity and health, and behavioral interventions. This commentary presents Dr. Bassett’s views on the topic related to a research article which he and colleagues authored. Their research article appears in the October 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: What Happens When an Active Couch Potato Ingests Added Sugar? (acsm-blog/acsm-blog/2015/02/24/active-voice-what-happens-when-an-active-couchpotato-ingests-added-sugar-) by Guest Blogger | Feb 24, 2015 By Amy Bidwell, Ph.D. A diet high in added sugar has already been established to be correlated with increased weight and metabolic disturbances. However, what happens when a person is ingesting moderate amounts of added sugar, either in the form of sucrose or high fructose corn syrup (HFCS) while also being physically inactive? Moreover, in this context, what constitutes being physically active? Although previous research has shown that a diet high in fructose can cause deleterious metabolic effects to the body, these studies tend to use an excessive amount of added sugar, which often results in weight gain. Moreover, high fructose corn syrup is now being replaced with sucrose (table sugar) in many foods, giving the indication that they are “natural” and hence, healthier; although from a metabolic standpoint, HFCS and sucrose are essentially the same. This change in labeling has resulted in an even larger influx of added sugar in our diet. We have recently published a series of papers investigating the effects of a diet high in a more moderate amount of added fructose (~17 percent calories from added fructose). We found through this work that, in as little as two weeks, a healthy young adult’s metabolic profile begins to be negatively altered. The observed consequences included increased postprandial triglyceride, very-low density lipoproteins levels and low grade inflammation when subjects were physically inactive. These results were found without subsequent changes in weight. So now the question is this: What if a person who is ingesting only a moderate amount of added fructose, while maintaining their weight, is also physically inactive? According to the most recent ACSM Position Statement on exercise for apparently healthy adults (http://journals.lww.com/acsmmsse/Fulltext/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26.aspx?WT.mc_id=HPxADx20100319xMP), 30-60 minutes of moderate-intensity exercise is recommended, five days per week. The problem is that a person can go to the gym for 30-45 minutes, five days per week and still only be getting ~4000-5000 steps per day because they may be sitting at a desk at work or school all day then on the couch at night. This creates the active couch potato conundrum. The person thinks they are being active because they do their structured recommended exercise for 45 minutes per day. But, the fact is that they are inactive the remaining 23 hours per day! If you compound that circumstance with having just one bowl of sugary cereal for breakfast and a “natural” sweetened ice tea for lunch or dinner, you now have a person whose metabolic profile is being unfavorably altered, even though they were trying to be healthy. Even if someone is diligently going to the gym daily and maintaining a proper weight, they are still doing their body harm if they are not being active throughout the day and eating a diet composed of low sugar, unprocessed, whole foods. We have done such an immense job at promoting regular, daily exercise, we need to now take it one step further and begin to educate people on the harms of being physically inactive the remaining 23 hours per day. Additionally, there needs to be more focus on educating people on the metabolic disadvantages of a diet including even a moderate amount of added sugar, regardless of whether it is from sucrose or high fructose corn syrup. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Dr. Amy Bidwell is an assistant professor in the Department of Health Promotion and Wellness at the State University of New York at Oswego where she teaches exercise physiology and nutrition. Her research focuses on the adverse effects of physical inactivity and its interaction with diet, obesity and obesity-related diseases. Specifically, Dr. Bidwell researches the adverse effects of a diet high in fructose and low in physical activity. She is a member of ACSM. This commentary presents Dr. Bidwell’s views on the topic related to her research specialization. See the November 2014 issue of Medicine & Science in Sport & Exercise® (MSSE) for a report that she and her colleagues authored (http://journals.lww.com/acsm-msse/Fulltext/2014/11000/Physical_Activity_Offsets_the_Negative_Effects_of.8.aspx) on findings from one of their recent investigations in this topic area. Active Voice: Size Matters when Treating Victims of Exertional Heat Stroke (acsm-blog/acsm-blog/2015/02/10/active-voice-size-matters-when-treating-victims-of-exertionalheat-stroke) by Guest Blogger | Feb 10, 2015 By Glen P. Kenny, Ph.D. The human body is quite inefficient at using the energy derived from metabolic processes to create external work, with approximately 70 to 95 percent of energy as heat— this does, of course, vary with the physical task. The human body has an amazing capacity to handle the large amount of heat released during physical activity. To offset the large increase in metabolic and environmental heat gain [high ambient air temperature, radiant heat sources (sun, fires, kiln, etc.), the human thermoregulatory system must adjust the rate of heat loss by increasing skin blood flow and sweating. Under circumstances where the body is unable to increase heat loss sufficiently to offset the increase in heat production/gain, core temperature continually rises. If left unchecked, core temperature can continue to increase to dangerously high levels— placing individuals at high risk of developing exertional heat stroke (EHS). The risk of EHS is always present when military personnel, laborers, athletes and others perform physical activity in the heat, especially when protective equipment is worn. Key to the survival of victims of EHS is the early recognition of the condition. Even if EHS is promptly recognized at the time of the incident, an individual can still succumb if extreme hyperthermia is not rapidly reduced. The severity and reversibility of multisystem organ failure associated with EHS is related to the duration of temperature elevation. Cold water immersion (2°C circulated ice-water bath, CWI) is the gold standard treatment for victims of EHS, as it has been shown to produce the highest core cooling rates to date (0.35°C/min). Recent work by DeMartini and colleagues (http://journals.lww.com/acsmmsse/Abstract/publishahead/Effectiveness_of_CWI_in_the_Treatment_of_EHS_at.97999.aspx) showed that the use of CWI resulted in a 100 percent survival rate for all 274 recorded cases of EHS at the Falmouth Road Race over the last 18 years. Yet, despite the obvious clinical advantages of CWI in the treatment of EHS, some experts advocate the use of temperate water immersion (26°C) on the basis that CWI may negatively impact the health of the EHS patient as a result of the potentially undesirable side effects, such as cold shock response, excessive shivering, etc. – see the Casa et al. perspectives column in MSSE (http://journals.lww.com/acsmmsse/Citation/2010/07000/Immersion_Treatment_for_Exertional_Hyperthermia_.3.aspx) for an expanded discussion. However, as our recent research report published in MSSE (http://journals.lww.com/acsm-msse/abstract/2014/09000/Water_Immersion_in_the_Treatment_of_Exertional.7.aspx) showed, the benefits of CWI far outweigh the short lived discomfort that the patient may experience. More importantly, CWI provided core cooling rates 2.7 faster than temperate water immersion. A critical oversight in many discussions pertaining to the treatment of EHS patients relates to the physical characteristics of the patient. We showed that when it comes to treating victims of EHS size matters. Individuals with a low body surface area-to-lean body mass ratio (AD/LBM) experience longer cooling times irrespective of the choice of water temperature (i.e., temperature, 26°C versus cold water immersion, 2°C) compared to those individuals with high AD/LBM. However, immersion in cold water dramatically reduced the differences between groups such that the effects of the physical differences on core cooling rates were minimized. Exertional heat-related illness is a risk to individuals of all sizes and shapes irrespective of the nature of activity performed. While the pathway to hyperthermia may be different for each EHS patient, our study clearly demonstrates that the path to recovery must always be immediate CWI treatment for all individuals. Viewpoints presented on the ACSM Blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Dr. Glen P. Kenny is a professor of exercise physiology at the University of Ottawa, holds a university research chair in environmental physiology, and is a member of ACSM. His research has been directed at characterizing the physiological control mechanisms governing human temperature regulation during heat stress. An area of special focus in his work is investigation of the physiological effects of heat stress in subpopulations with conditions rendering them particularly vulnerable to heat injury, such as aging, obesity and diabetes. This commentary presents Dr. Kenny’s views on the topic related to a study which he and colleagues recently completed. Their research report appears in the September 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Leg Pain in Athletes – Don’t Forget the Nerves (acsm-blog/acsm-blog/2015/02/02/active-voice-leg-pain-in-athletes-don-t-forget-the-nerves) by Guest Blogger | Feb 02, 2015 By Jonathan T. Finnoff, D.O., FACSM A 19-year-old soccer player goes to a physician’s office complaining of medial leg pain. The patient describes the pain as a deep, aching, burning pain with a severity of 0-8/10 that is exacerbated by running and relieved with rest. Occasionally, the pain radiates into the medial foot and can be associated with paresthesias (numbness or burning type sensations) in the same distribution. On physical examination, the athlete has no tenderness to palpation, benign findings on knee and ankle examinations and a normal lower extremity neurologic examination. Radiographs of the symptomatic region are normal. For the examining physician, what might be the differential diagnosis for this individual? What would the next step be in the physician’s evaluation process? This clinical scenario is not uncommon. Certainly the variety of entities that can produce these symptoms is broad, but one should keep in mind that peripheral nerve entrapments frequently present in this manner. In this particular case, the patient was diagnosed with a saphenous nerve entrapment at the level of the knee where the saphenous nerve passes between the sartorius and gracilis tendons. The patient responded to temporary avoidance of aggravating activities, stretching of the relevant musculotendinous structures, and an ultrasound-guided saphenous nerve block with a combination of local anesthetic and corticosteroid at the site of entrapment. In my opinion, there are a few key items that increase my suspicion that an athlete’s symptoms are being caused by a peripheral nerve entrapment. 1. History a. Neuropathic symptoms (e.g., paresthesias, weakness) in the distribution of a peripheral nerve b. Symptoms exacerbated by activity that are improved with rest 2. Physical examination a. Positive Tinel’s sign over the entrapment site (percussion elicits sensations of nerve irritation, e.g. ‘pins and needles’), which reproduces symptoms in the same distribution as the athlete’s pain While electrodiagnostic studies and standard imaging studies are frequently normal in athletes with peripheral nerve entrapments, I have found ultrasound to be very helpful when evaluating this patient population. First, diagnostic ultrasound can frequently identify the location of nerve entrapment, which presents as focal compression of the nerve at the site of entrapment and enlargement of the nerve proximal to the site of entrapment. Second, if the diagnostic ultrasound examination is unrevealing, but nerve entrapment is still suspected, an ultrasound-guided diagnostic nerve block at the probable site of entrapment can be performed. If the athlete’s symptoms are resolved by the nerve block for the duration of the local anesthetic, this is highly suggestive that nerve entrapment is the source of the athlete’s pain. If not, then an alternative pain generator should be sought. In our article, “ Lower Extremity Nerve Entrapments in Athletes (http://journals.lww.com/acsm-csmr/Fulltext/2014/09000/Lower_Extremity_Nerve_Entrapments_in_Athletes.8.aspx) ”, recently published in ACSM’s Current Sports Medicine Reports, the history, physical examination, diagnostic studies and treatment options for common lower extremity nerve entrapments in athletes are discussed. Hopefully, this information will add to the “tools in the physicians’ toolbox” and improve their ability to successfully identify and treat athletes with nerve entrapments. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Jonathan T. Finnoff, D.O., FACSM, is a senior associate consultant in the Department of Physical Medicine and Rehabilitation at Mayo Clinic School of Medicine, and a clinical professor in the Department of Physical Medicine and Rehabilitation at the University of California Davis School of Medicine. He is the medical director of the Mayo Clinic Sports Medicine Center in Minneapolis, Minn. and a faculty member for the University of California Davis School of Medicine and University of Nevada School of Medicine Sports Medicine fellowships. He specializes in non-operative sports medicine and diagnostic and interventional ultrasound. This commentary presents Dr. Finnoff’s views on the topic related to a clinical article which he authored with a colleague and which was published in the September/October 2014 issue of ACSM’s Current Sports Medicine Reports (CSMR). Active Voice: What the New Congress May Mean for ACSM; Member Advocacy Will Be Crucial (acsm-blog/acsm-blog/2015/01/20/active-voice-what-the-new-congress-maymean-for-acsm-member-advocacy-will-be-crucial) by Guest Blogger | Jan 20, 2015 By Robert Oppliger, Ph.D., FACSM The federal elections last fall seemed to indicate that the American voters wanted change. That change included Republicans taking control of the U.S. Senate while maintaining control of the U.S. House of Representatives. As the new 114th Congress convenes in January, it will be difficult to forecast what exactly will happen legislatively. World and national events— even the weather— can influence what transpires in Congress. The good news for ACSM is that there’s reason for optimism for our current key initiatives. Although their reasons for supporting physical activity (PA) may differ, members of Congress generally support legislation related to PA on a bipartisan basis. Like cities, states and businesses, Congress is catching on to the value PA provides for promoting health and the economic benefits for the individual, as well as for communities and the nation as a whole. In addition to its other policy priorities, ACSM supports three pieces of legislation. The requirement for periodic review of PA guidelines by the Secretary of Health & Human Services may come-up for vote in the lame duck session over the next month, and there’s good reason for optimism that it will pass. Likewise, legislation renewing the Carol M. White Physical Education Program (PEP) (http://www2.ed.gov/programs/whitephysed/index.html) has received bipartisan support. The PEP bill asks for level funding for competitive grants to promote PA in schools. A third bill, the Personal Health Investment Today (P.H.I.T.) Act, expands the definitions of medical expenses to include PA as an element of preventive medicine. This allows individuals to deduct expenses for selected items relating to PA in their medical savings accounts. Although the bill has yet to be introduced in the Senate, it too has significant bipartisan support in the House. I would be remiss if I did not encourage ACSM members to engage in advocacy at the local, state and national level. National office staff offer resources for promoting the mission of ACSM. Becoming a Key Contact offers a simple, but significant, way to become engaged. Periodically, ACSM staff will contact Key Contacts regarding federal legislation and encourage us to contact Congressional delegates in support of specific issues, e.g. the three bills mentioned above. Becoming a Key Contact merely requires clicking the button on ACSM’s website and providing the needed information. On March 3-4 2015, ACSM will host its 3rd annual Capitol Hill Day. No experience is necessary to participate, and we do on-the-job training. It’s not difficult, but it is a great opportunity to see how public advocacy works. I hope you’ll join us. Contact Monte Ward ([email protected] (mailto:[email protected])) for more details or to sign-up. In brief, there will be change. However ACSM’s mission to promote physical activity should continue to make progress. ACSM is planning a webinar in January that will provide more information about the new Congress and the implications for issues related to the promotion of physical activity. Look for more details in future issues of SMB. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Robert (Bob) A. Oppliger, Ph.D, is a Fellow in the American College of Sports Medicine and has served on a wide range of ACSM committees for more than 20 years. Currently, he is chair of ACSM’s Health Science Policy Committee and holds memberships on both the Strategic Planning Committee and ad-hoc ActivEarth committee. His academic vita includes more than 50 publications and well over a hundred presentation to scientific and lay audiences. He has chaired the authoring committee for an ACSM position statement and been a consultant to the NCAA, National Federation of High School Associations and several state high school sports associations. Bob is a League of American Bicyclist (LAB) Cycling Instructor and currently, a candidate for the LAB’s board of directors. When he’s not on a bike, he referees little league and high school soccer and tends his gardens Active Voice: “Sarcopenic Obesity” – The Plague of Aging Baby Boomers? (acsm-blog/acsm-blog/2015/01/12/active-voice-sarcopenic-obesity-the-plague-of-aging-babyboomers-) by Guest Blogger | Jan 12, 2015 By David M. Gundermann, Ph.D, and Todd M. Manini, Ph.D., FACSM Over the next 20 years, the aging of the population and obesity epidemic will collide. These two aircraft carriers of health burden are expected to lead to the nation’s growing health issues. First, aging is associated with a dramatic and progressive loss of muscle mass and quality, which partly leads to a diminished functional ability, increased susceptibility to disease and a declining physical quality of life leading to the possibility of physical dependence. Individuals who lose significant muscle mass are considered to be sarcopenic and, as a result, they typically have low appendicular lean mass relative to body height. Second, advancing age leads to their increased susceptibility to weight gain that contributes to development of obesity, along with a host of cardiovascular, metabolic and functional consequences. Accordingly, there has been a rising concern that older adults who possess both low amounts of appendicular muscle and high levels of adipose tissue are particularly vulnerable to physical disability and health consequences. Low levels of muscle relative to the total fat mass clearly predisposes to metabolic dysregulation and Todd M. Manini, Ph.D., FACSM David M. Gundermann, Ph.D biomechanical disadvantages in performing tasks of daily life against gravity (e.g., stair climbing, chair rising, etc…) Sarcopenic obesity (a phrase coined in 2000) is difficult to easily detect because many older adults maintain their body weight, but experience a body composition shift with losses in muscle mass and reciprocal gains in fat mass. Additionally, there are no clear criteria, nor are there well defined cutoffs for sarcopenic obesity. For example, there are at least five different published benchmarks, leading to different prevalence estimates ranging from 4 to 40 percent. More importantly, though, the debate about defining sarcopenic obesity is dwarfed by the debate about the actual health concerns it poses. One could assume that the combination of obesity and low muscle mass would lead to an additive effect on health risks, although that may be an unfair assessment. That is because those labeled with sarcopenic obesity still have significantly more muscle than those with frank sarcopenia (even by all the current definitions). Thus, in fact, they might not be expected to have the same health risks associated with sarcopenia. A more apt comparison tends to be between the obese and the sarcopenic obese. So far, there are mixed results in the research literature that the latter condition predicts higher health and disability risks. While it is a worthwhile endeavor to compartmentalize the older adult population into risk categories, sarcopenic obesity may simply be the natural progression from obesity, considering that high fatness, in fact, predicts accelerated loss of muscle. Therefore, even though sarcopenic obesity is a relatively new concept that is gaining traction, there remains much to be understood about whether additional risk is conferred by the condition, especially if you consider covariates such as changes in daily activity and diet. Regardless of the causes and consequences, sarcopenic obesity is a condition that can benefit from existing treatments of physical activity and appropriate dietary intake. Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Drs. David Gundermann and Todd Manini are geriatric exercise scientists in the Department of Aging and Geriatric Research at the University of Florida. Their research focuses on enhancing skeletal muscle for preventing physical disability in late life. Both are members of ACSM and are actively involved with research to treat obesity and sarcopenia. Dr. Manini serves on ACSM’s Strategic Health Initiative on Aging Committee and has received an award from the ACSM’s Paffenbarger-Blair Fund for epidemiological research on physical activity. Good Health Doesn’t Happen By Chance (acsm-blog/acsm-blog/2015/01/07/good-health-doesn-t-happen-by-chance) by Guest Blogger | Jan 07, 2015 By: Stephen Cherniak Stephen is a Health Management Consultant with the Marsh & McLennan Agency. He is an ACSM member and serves on the Board of Directors of the International Association for Worksite Health Promotion (IAWHP). Good health doesn't happen by chance. It's the result of the choices we make on a daily basis. Good choices = good health. In fact, the right choices are so simple, people tend to not believe their effectiveness in not only improving health, but also: reducing the risk of heart disease, diabetes, stroke and cancer; lowering blood pressure; reducing weight, providing more energy and an improved outlook on life, lifting depression and managing stress; keeping focus and an improved capacity to learn and be more effective; and living longer. A study* involving researchers at the Johns Hopkins' Center for the Prevention of Heart Disease revealed that individuals who adopted four basic habits were 80% less likely to die from all causes over the study's 8-year span than those who had none of the four habits. The researchers added, "there are risk factors that people can't control, such as their family history and age, but these four habits are things that can change and consequently make a BIG difference in their health." So what are these choices that result in the best medicine for our bodies and lifestyle? They center on four lifestyle habits: 1. 2. 3. 4.

Stop using tobacco - if you can only change one thing in your daily lifestyle this is it. Increase your daily physical activity Eat a diet high in fruits, vegetables, and LEAN meat Maintain a normal weight

So, think “No Excuses” - the idea that while each of us can come up with a variety of excuses why we can't exercise, lose weight, and eat healthier - there really is not one good one. Hundreds of times a day we're faced with moments that require choices regarding these four lifestyle habits. You can begin the change by making some of these choices the positive/good ones; and over time the right choices become good habits and lead to a healthier, longer and better quality of life. (*Multi-Ethnic Study of Atherosclerosis (MESA) reported in the American Journal of Epidemiology, June, 2013.) Active Voice: Sedentary Behavior in Old Age is Rooted in Midlife — Intervene Early! (acsm-blog/acsm-blog/2014/12/30/active-voice-sedentary-behavior-in-old-age-is-rootedin-midlife-intervene-early!) by Guest Blogger | Dec 30, 2014 By Julianne van der Berg, M.Sc., and Annemarie Koster, Ph.D. In 2011, ACSM published an online brochure titled “Reducing Sedentary Behaviors: Sitting Less and Moving More (http://www.multibriefs.com/briefs/acsm/sedentary.pdf)” that reported on the harmful effects of too much sitting. Sitting or other sedentary behaviors such as lying down, watching TV and using the computer have been studied extensively during the last several years. Studies suggest that even when you exercise regularly, prolonged periods of sedentary time are a risk factor for cardiovascular disease, type 2 diabetes and even mortality. What is not well-understood yet is what factors influence the amount of sedentary time. Our recent article in MSSE (http://journals.lww.com/acsmmsse/abstract/2014/07000/Midlife_Determinants_Associated_with_Sedentary.11.aspx) reports on an investigation where we examined factors present in midlife adulthood that were associated with subsequent sedentary behavior in old age. We used data Julianne van der Berg, M.Sc Annemarie Koster, Ph.D. of 565 adults participating in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study in Iceland. Measurements were obtained in all participants during midlife at the average age of 49 years and, again, in old age (average age of 80 years). During midlife, we measured factors in four domains: 1. 2. 3. 4.

demographic factors (e.g., sex, age, marital status); socioeconomic factors (e.g., level of education, housing type, occupation); lifestyle (e.g., smoking status, physical activity, active commuting, occupation activity); biomedical factors (e.g., body mass index (BMI), weight status, blood cholesterol levels, heart disease, type 2 diabetes).

Approximately 30 years later, we objectively measured the time people were sedentary over multiple days, using an accelerometer. We examined which of the factors measured during midlife were associated with sedentary time in old age, independent of the participants’ current health status and level of physical activity. Our results showed that lower educational level, poorer housing and not being married were associated with an average of 12, 13 and 15 more sedentary minutes per day. Also, being obese and having a heart disease during midlife resulted in considerably more sedentary time in old age. When these factors were present, subjects averaged 22 and 39 minutes more sedentary time per day, respectively! Given the large number of highly sedentary adults and the related risks for health, it is important to develop prevention programs that aim to reduce sedentary time. The results of our study indicate that risk factors for a sedentary lifestyle in old age can be identified years before this behavior manifests. This information can be used to identify groups in an early stage that are at risk of becoming highly sedentary. Our findings, therefore, provide essential information for developing effective prevention strategies to reduce sedentary time and its related adverse health effects. Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Julianne D. van der Berg, M.Sc., studied health sciences at VU University Amsterdam, The Netherlands. After graduation, she joined the Exercise, Nutrition and Health Sciences department at the University of Bristol (UK), where she worked on projects focusing on physical activity, physical environment and health. Since 2012, she has been working at the Maastricht University as a Ph.D. candidate, investigating effects of leading a sedentary lifestyle on type 2 diabetes and its complications. Annemarie Koster, Ph.D., is an assistant professor in the Department of Social Medicine at Maastricht University in the Netherlands. As an epidemiologist, her research focus centers on understanding the causes and consequences of physical (in)activity and obesity in old age. She has a strong background in physical activity assessment by accelerometry, with a particular interest in the health effects of sedentary behavior. This commentary presents Ms. van der Berg’s and Dr. Koster’s views on the topic of a research article which they and their colleagues had published in the July 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Overcoming Fear of Movement due to Back Pain in the Obese Older Adult (acsm-blog/acsm-blog/2014/12/19/active-voice-overcoming-fear-of-movement-due-toback-pain-in-the-obese-older-adult) by Guest Blogger | Dec 19, 2014 By Heather K. Vincent, Ph.D., FACSM Physical activity is recommended to obese individuals by their doctors for weight loss and overall joint heath. Activities that increase caloric expenditure are helpful for reducing weight and offloading the joints of the body. However, obese individuals commonly experience low back or knee pain during exercise, leading them to avoid exercise. Avoidance behavior initiates a cycle of continued weight gain, worsened joint pain, pain catastrophizing, fear of movement (termed kinesiophobia) and disability. The published literature has shown that people with chronic low back pain demonstrate fear avoidance behaviors and kinesiophobia. Separate research teams have identified different pain-related issues that contribute to exercise avoidance. First, pain catastrophizing triggers the negative pathway leading to physical disability. Second, obese and older populations have high prevalence of joint pain complaints that contribute to avoidance of physical activity. Third, obese individuals are more likely to catastrophize and ruminate about their pain issues than non-obese individuals. We are in the infancy of understanding the relationships between different exercise programs and the effectiveness on reducing fear behaviors, kinesiophobia and catastrophizing in the obese, older population with back pain. This is problematic, because clinicians do not yet have the information necessary to prescribe the appropriate exercise type or dosage needed to combat pain catastrophizing and kinesiophobia in this growing demographic. Evidence of exercise methods that can help clinicians empower patients to reduce pain, improve exercise tolerance, and achieve better musculoskeletal health is becoming increasingly important. We recently published a series of papers showing that lower lumbar muscle strength was related to higher pain scores during activities such as walking and stair climbing in obese older adults with chronic low back pain. Kinesiophobia predicted perceived disability. We also identified a direct positive relationship between muscle strength and walking endurance. Our most recent study, published in MSSE (http://journals.lww.com/acsm-msse/abstract/2014/09000/Resistance_Exercise,_Disability,_and_Pain.3.aspx), was a randomized, controlled single blind trial. The goal was to determine the efficacy of two different types of resistance exercise programs (total body exercise vs. lumbar extension only) compared to a non-exercise control condition on measures of pain symptoms, kinesiophobia, fear avoidance beliefs and catastrophizing and mobility. Walking endurance improved, especially when the lumbar strength gain was greater than 20 percent from baseline. We showed that even with no weight loss, total body resistance exercise reduces pain catastrophizing by as much as 64 percent. Total body exercise also reduced perception of disability due to pain and pain during physical activities more than lumbar extension. In our view, these results indicate that resistance exercise with a lumbar strengthening component can be used to counteract the psychological steps that initiate avoidance behaviors and physical disability in this population. Reducing pain catastrophizing is an appropriate treatment target because the measure is related to reductions in ambulatory pain severity and perceived disability. Decreasing pain catastrophizing levels may help obese older adults with back pain re-assess the harmfulness of the pain and develop confidence in performing physical activities. We believe that regular participation in resistance exercise should be encouraged to help these patients positively change their personal experience with exercise to achieve high quality mobility (low pain or pain-free movement). Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Dr. Heather Vincent is a research faculty member in the Department of Orthopaedics and Rehabilitation at the University of Florida (UF) College of Medicine in Gainesville, Fla. She is the director of the Human Dynamics Research Laboratories and UF Sports Performance Center. Her research is focused on developing appropriate exercise-based interventions for obesity to improve the physiological, mechanical and psychological disease risk factors and attenuate musculoskeletal disease progression. She is currently serving on the ACSM Consumer Information Committee. This commentary presents Dr. Vincent’s views related to a research article she and her colleagues had published in the September 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Active Voice: Finding a Cure for the Plague of the 21st Century (acsm-blog/acsm-blog/2014/12/15/active-voice-finding-a-cure-for-the-plague-of-the-21st-century) by Guest Blogger | Dec 15, 2014 By Robert Sallis, M.D., FACSM I recently represented Exercise is Medicine® and the Every Body Walk! Collaborative at Walk21, the 15th Annual Conference on Walking and Walkable Communities. The meeting was held on October 21-23 at the Luna Park Conference Facility (http://www.walk21sydney.com/) located alongside the beautiful harbor in Sydney, Australia. Walk21 2014 was a remarkable meeting that brought together a wide variety of stakeholders interested in the development of healthy and sustainable communities where people choose to walk. In addition to those from the fields of medicine and public health, the bulk of the attendees were involved in city planning, transportation, education, urban design and architecture. All of the attendees were passionate about the importance of walking for health and quality of life. In addition, the premier of New South Wales and the lord mayor of Sydney also attended and spoke, underscoring the importance of this meeting at the highest levels of government in Sydney and beyond. I came away from this meeting with an enhanced appreciation for the importance of walking and how we might best get citizens of the world to do it. My focus has primarily been from a medical perspective and on assessing and prescribing walking to patients, using physical activity as I would a medication. However, I came to realize that it does little good for me to prescribe exercise to my patients if they have nowhere to do it. On the contrary, if patients have inviting walking trails and green space nearby where they live and work, they are much more inclined to walk. Furthermore, if they live in a city that places an emphasis on public transportation, with safe sidewalks and crosswalks that make getting around easier, they are much more likely to walk than take a car. So it became clear to me that we, as health care providers, need to partner with urban planners to improve the health of our urban populations. I also realized there is a long history of city planners coming together with public health professionals to prevent and cure disease. The bubonic plague of 14th century Europe was cured when urban planners developed effective means of collecting and disposing of garbage in order to eliminate rats carrying fleas that transmitted the disease to humans. Cholera was also essentially eliminated when urban planners figured out how to keep sewage separated from water, food and the environment. These simple measures to improve sanitation in our cities, brought about by astute urban planners, saved more lives than any medicine or vaccine could. Today the major causes of death around the world are no longer infectious diseases, but non-communicable diseases (NCD’s) which are mainly related to inactivity and poor diet. Lately, the news has been filled with hysteria over Ebola, but almost nothing on the biggest global threat, which is a sedentary lifestyle. The plague, cholera and TB have been replaced by diseases closely linked to a sedentary lifestyle such as heart disease, diabetes and cancer. What we now understand is that this has occurred because we have engineered physical activity out of our daily lives. The consequences have been catastrophic, but really quite predictable. And, once again, we need to call on our urban planners to rescue us from the epidemic of NCD’s by making our communities more walkable so people are able to walk every day. Stamping out disease is a role that our urban planners have played before and must play again. We must design cities built for walking and physical activity so that everybody can gain the health benefits achieved through an active and fit way of life. While NCD’s are the plague of today, our response has been much more indolent than was the case for the bubonic plague of centuries past. Yet, these NCD’s are just as deadly and must be taken just as seriously. We all need to work together to ensure this happens. Editorial Note: Dr. Sallis spoke at this conference, representing ACSM, Exercise is Medicine®, and the Every Body Walk! Collaborative. His participation in Sydney was supported, in part, by a grant ACSM received from Kaiser Permanente -Improving health through clinician-to-patient conversation on benefits of walking. Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Robert E. Sallis, M.D., FACSM, is a past president of ACSM and currently is chair of the Exercise is Medicine® Task Force. He originated the EIM concept and has been its leading advocate from the beginning. Dr. Sallis earned an M.D. from Texas A&M University and completed his residency in family medicine at Kaiser Permanente Medical Center in Fontana, Calif. He has continued his medical career with Kaiser and now codirects their sports medicine fellowship training program. Dr. Sallis is the founding editor-in-chief of ACSM's Current Sports Medicine Reports journal. Rethinking the Role of the Human Heel Pad during Barefoot Locomotion (acsm-blog/acsm-blog/2014/12/08/rethinking-the-role-of-the-human-heel-pad-during-barefootlocomotion) by Guest Blogger | Dec 08, 2014 By Albrecht Dietze, M.D., and Scott C. Wearing, Ph.D. Textbooks on sports medicine typically report that the heel pad is a thick elastic-adipose tissue which plays a critical shock-absorbing role during human locomotion. The concept of the heel pad as a shock absorber owes much to the work of McNeil-Alexander, Radin, Aerts and colleagues who, in the 1970s and 80s, used mechanically-simulated impacts to hypothesize that deformation of the heel pad attenuated peak force at impact, dissipated mechanical energy during heel strike and, ultimately, protected the calcaneus by lowering local stress. In one of the few studies to investigate deformation of heel pad during locomotion, DeClercq, Aerts and co-workers demonstrated in the 90s that the heel pad actually offered minimal resistance to deformation at initial impact and ‘bottomed out’ during barefoot running. They hypothesised that deformation of the heel pad during barefoot running, therefore, mainly served to minimize local stress at the calcaneus. Given that shock absorption is related to energy dissipation over the entire load-deformation cycle, their study was unable to assess the shock absorbing capacity of the heel pad. So we decided to further examine the hypothesized function of the heel pad by undertaking an observational study which detailed the forcedeformation behavior of the healthy human heel pad over the entire load-deformation cycle and at a lower gait speed. Our most recent report (http://journals.lww.com/acsmmsse/abstract/2014/08000/Force_Deformation_Properties_of_the_Human_Heel_Pad.14.aspx), published in MSSE, is the first to assess the forcedeformation properties of the heel pad in healthy subjects while walking barefoot at preferred speed using a dynamic radiographic imaging technique coupled with a pressure measuring platform. We confirmed previous observations and showed the heel pad had a distinct nonlinear behavior during walking, in which increasing force was associated with progressively less deformation. Initial stiffness of the heel pad was a tenth of its final stiffness and only about one joule of energy was dissipated by the heel pad with each walking step. The energy dissipated by the heel pad in our carefully controlled laboratory–based experiment was 5 to 10 times less than that reportedly dissipated by other structures such as the Achilles tendon and the ligaments of the medial longitudinal arch. In our view, this finding warrants a critical reappraisal of the relative shock reduction and energy dissipating role of the heel pad during locomotion. In our experiment, we also found that the energy required to deform the heel pad during walking was only marginally less than that reported during barefoot running at moderate speed. Furthermore, we found that the peak deformation of the heel pad during walking was close to that predicted for the limit for pain tolerance. This finding has important clinical implications. For instance, to avoid potential pain and injury at higher barefoot gait speeds, movement of the rearfoot and soft tissues of the shank must increasingly contribute to energy dissipation during heel contact or gait adjustments must occur to ensure the contact energy during heel strike is comparable during barefoot walking. These findings also provide indirect support to the so–called ‘Robbins and Hanna’ hypothesis in which plantar foot sensation is proposed to moderate impact loading of the foot during gait. These findings also may, in part, account for the more plantar–grade foot strike pattern that occurs with barefoot gait at speeds faster than walking. With the advent of treadmills containing inbuilt pressure sensor technology, our next step is to address some limitations associated with use of a one-dimensional analysis and fluoroscopic imaging of the heel pad to evaluate heel pad mechanics over a wider range of gait speeds— and the potentially mitigating effects of footwear. Albrecht Dietze, M.D., is an orthopedic trauma surgeon with a special interest in foot and ankle surgery. His research focuses on clinical application of foot and ankle biomechanics. In particular, imaging techniques and pedobarographic analysis are the main methods applied to improve strategies and clinical outcome in the treatment of foot and ankle pathology. Scott C. Wearing, Ph.D., is an experimental soft tissue bioengineer and researcher at the Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia. His research focuses on the measurement of human soft tissue adaptation to exercise, pathology and disease and is targeted toward prevention, recovery and expedited rehabilitation of musculoskeletal injury. This commentary presents Drs. Dietze’s and Wearing’s views on the topic of their research article which they and their colleagues published in the August 2014 issue of Medicine & Science in Sports & Exercise® (MSSE). Viewpoints presented in Active Voice commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. Active Voice: Strengthening Muscle for Your Health (acsm-blog/acsm-blog/2014/12/02/active-voice-strengthening-muscle-for-your-health) by Guest Blogger | Dec 02, 2014 By: Martin Sénéchal, Ph.D., CEP Exercise is a cornerstone in the management and the prevention of obesity-related chronic conditions. National and international agencies are recommending a minimum of 150 minutes per week of endurance exercise at moderate intensity in conjunction with at least two days of strengthening activity. However, the public generally only remembers the endurance part of this recommendation. Based on some changes that occur through the lifespan, there is a rationale for emphasizing strength training in individuals. For example, between 20 to 70 years of age, a natural loss in about 40 percent of muscle mass, called “sarcopenia” occurs. In adults, strength training is a rational strategy to attenuate the effect of muscle mass loss. However, it is unknown if older adults can actually increase muscle mass with resistance exercise training. Nevertheless, besides “sarcopenia,” aging is also associated with a decline in muscle strength commonly called “dynapenia.” Interestingly, the rate of loss of muscle strength with aging is much steeper compared to that for muscle mass decline. In other words, individuals lose more muscle strength than muscle mass for a given time period. Therefore, strength exercises should be emphasized to prevent decreases in muscle strength rather than targeting the muscle mass. The good news is that when sedentary people begin strength training, they obtain fast improvements in muscle strength— within six weeks! In addition, gain in muscle strength can be as high as more than 100 percent, and this occurs in all age groups. Fast improvement in muscle strength is more likely to help people maintaining adherence to exercise training, which is a real challenge in the field of clinical exercise. Specifically with older adults, increasing overall muscle strength will help to achieve activities of daily living such as climbing stairs, and carrying objects (e.g., grocery bags), thereby helping them to be more independent. Finally, being stronger has been associated with a better quality of life and health outcomes. In this paper recently published in MSSE (http://journals.lww.com/acsm-msse/abstract/2014/08000/Cut_Points_of_Muscle_Strength_Associated_with.1.aspx), we investigated 7,226 men from the Aerobics Center Longitudinal Study first to determine whether low muscle strength was associated with an increased risk of having the metabolic syndrome (cluster of risk factors) and second, to quantify the level (threshold) of muscle strength associated with the metabolic syndrome. In our study, we found that low muscle strength, defined as < 20 percentile of combined 1RM (from bench and leg press) scaled to body weight (per kg body weight), was associated with having metabolic syndrome, especially in young men. Our result confirms previous work on the topic. However, limitations of previous research were the presence of confounding effects of fitness or adiposity, which were controlled in our study. In addition, our study adds to the literature by proposing thresholds of muscle strength associated with the metabolic syndrome. This point is a stepping-stone for professionals working in the field of exercise. First, the study gave thresholds of relative muscle strength based on two widely used exercises (bench and leg press). Second, these thresholds help them design exercise programs that aim to improve health outcomes. Third, as muscle strength is a modifiable risk factor, our result reinforces the message that people should perform strength training as a part of their exercise regimen to help enhancing metabolic risk factors. Therefore, this study provides evidence for exercise professionals in their day-to-day practice. The next steps are to investigate these thresholds with a prospective study and look at potential mechanisms (biological markers) that could explain why muscle strength is associated with metabolic syndrome.

Martin Sénéchal, Ph.D., CEP, is associate postdoctoral fellow at The Manitoba Institute of Child Health, University of Manitoba, faculty of medicine, department of pediatrics and child health in Winnipeg, Manitoba, Canada. His research focuses on cardiometabolic risk factors, chronic disease and exercise. More specifically, he is interested in the metabolic response to resistance training and the predictors associated with exercise-responders. This commentary presents Dr. Sénéchal’s views on the topic of a research article which he and his colleagues had published in the August 2014 issue of Medicine Science in Sports & Exercise® (MSSE). Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. High-Intensity Interval Training, It's a HIIT! (acsm-blog/acsm-blog/2014/10/09/high-intensity-interval-training-it's-a-hiit!) by User Not Found | Oct 09, 2014 The popularity of high-intensity interval training is on the rise. High-intensity interval training sessions are commonly called HIIT workouts. This type of training involves repeated bouts of high intensity effort followed by varied recovery times. What are the benefits of HIIT workouts? How often can you do them? How do you develop a HIIT program? The ACSM Consumer Information Committee has created a brochure to answer all of these questions and more: ACSM Information on High-Intensity Interval Training (http://www.acsm.org/docs/brochures/highintensity-interval-training.pdf?sfvrsn=4) Two athletes from different backgrounds both diagnosed with progressive conditions that have no cure. How can these athletes pursue their athletic endeavors? (acsmblog/acsm-blog/2014/02/21/two-athletes-from-different-backgrounds-both-diagnosed-with-progressive-conditions-that-have-no-cure.-how-can-these-athletes-pursue-theirathletic-endeavors-) by User Not Found | Feb 21, 2014 Written by Kristin Duquette, US Paralympic Swimmer For athletes like myself and Gary Hall, Jr. being physically active proved to be an important part of our lives. Not only are we both swimmers, but both of us learned how to manage and deal with our conditions through physical activity. As Hall was faced with Type 1 Diabetes and I was diagnosed with Muscular Dystrophy, we both learned how to properly train and ultimately succeed in our sport.

Much of our training came with lots of trial and error: mentally focusing and refocusing on what is possible. With Type 1 Diabetes, practices for Hall consisted of glucose monitoring and insulin treatments during his workout sets and competitions. During this process, Hall learned how to maintain a steady insulin level by matching carbohydrates consumed with the amount and level of physical activity. Training with Muscular Dystrophy brought its own challenges. With a body having the potential to constantly change, much of my training was finding what strokes should be modified for best water dynamics in addition to avoid fatiguing. Another challenge included how to isolate and engage a muscle without compensating from other parts of my body. And with an unconventional body, training and physical activity requires innovative thinking from the athlete, parents, coaches, trainers, and doctors.

Having a progressive condition is not only manageable, but one can benefit from physically activity. I realized this epiphany a few months after I did not make the 2012 US London Paralympic Team. Different doctors told me that training helped maintain my strength and mobility. Swimming was, and will always be one of the best things I can do for my condition. Even before I was diagnosed at age 9, swimming established the neural pathways and mental memory in my brain which became evident when I retaught a different body how to swim after a 6 year break. Regardless of competition, sport and physical activity provide more benefits than we may know. Physical activity can truly shatter our limitations on one’s potential and how far the human body can truly go. Coping with Sports Injuries & Rehab – Reframing Attitudes & Goals Pays Dividends (acsm-blog/acsm-blog/2014/02/18/coping-with-sports-injuries-rehab-reframingattitudes-goals-pays-dividends) by User Not Found | Feb 18, 2014 Written by Matt Cuccaro, Ed.M., and Greg Chertok, M.Ed., CC-AASP Under the illumination of the Olympic torch, many human stories are emerging in Sochi - from some extraordinary athletes. The unfortunate reality of training, competing and pushing human limits is that injury is a potential result. Lindsay Vonn’s recent departure from the US Ski Team is just one example of the many difficult decisions athletes are facing regarding injuries throughout the Olympic Games. Overcoming an injury is something most athletes will face at least once throughout a career. Here are a few brief ideas to assist any athlete who is managing the difficulty and uncertainty of injury recovery. Beginning: Much the same as an athlete cannot choose his or her opponent or win/loss record, an athlete cannot control the time, place or severity of an injury. One of the most important mental factors in effectively overcoming injury comes in the form of acceptance. It is natural to have an emotional reaction to injury, yet helplessness, anger, and denial are not emotions which will assist the individual to progress or adhere to a rehabilitation program. Once an athlete accepts the presence of an injury, he or she tends to become more recovery-focused and action-oriented (“How can I get better?”). Accepting something that may impede participation in an event for which one has trained for so many years is remarkably difficult. Yet, athletes who become more emotionally charged with embracing the challenge of recovery tend to adhere to medical advice and achieve better results in the end. Middle: Medical staff becomes the coach Because many athletes are accustomed to being healthy and functioning at a high level, spending time with a medical team – which, to most athletes, is synonymous with dysfunction and poor health – may be uncomfortable. Rightfully so, athletes have a closer and more trusting relationship with their athletic team than with their medical team. A coach is meant to assist an athlete in reaching his or her goals, while a doctor or physical therapist is often indication that a barrier has arisen that might hinder achievement of those goals. However, effective injury recovery revolves around the close work of the athlete and their medical staff. Those who recognize and embrace their new team will build stronger relationships, gain deeper trust and likely to increase adherence to expert advice along the road to recovery. Injury recovery becomes new sport Much the same as the medical staff becomes a new coach, injury recovery becomes the new sport. As much as an athlete yearns to resume play, physical and mental investment into the rehabilitation process will prove to create better use of time and energy. Some days may be filled with stretching and strengthening, while others might include ice and repeated rest. An athlete who stays committed and active with their rehab process, the same as they would their sport training, will find greater purpose and feel more fulfilled along the path back to the playing field. End: Beware of “ticking clock”…deadlines become distractions Having a specific date or game in mind to come back to the field may prove to be more of a distraction than a motivator throughout the recovery process, especially as that day approaches. Game time doesn’t make an athlete ready, recovery makes an athlete ready. Those who stay focused and committed to recovery will make a stronger and healthier return to the playing field, while those who allow certain games or dates to dictate their return might find themselves right back at the beginning of the injury recovery process. How an athlete views an injury is ultimately the choice of the athlete. Observe the behaviors of the athletes at the highest level and you will see a reaction to injury not unlike the one described above. From the beginning to end stages of an injury, an athlete has complete control over his or her physical and emotional response. Olympic athletes understand and adhere to a more facilitative response, one that will quicken the recovery process and leave them fully ready to return to their sport.

About Matt Cuccaro, Ed.M.: Matt Cuccaro is the Director of Mental Training at Ivan Lendl International Junior Tennis Academy in Hilton Head Island, SC. He has a Masters of Education in Counseling/Sport Psychology from Boston University and is an active member of the Association for Applied Sport Psychology. Matt has worked with athletes, coaches, and administrators in a number of sports from the junior to world-class professional level.

About Greg Chertok, Ed.M.: Greg Chertok is the Director of Mental Training at CourtSense, a high performance junior tennis academy in Bergen County, NJ. He has a Masters of Education in Counseling/Sport Psychology from Boston University and is a certified consultant with the Association for Applied Sport Psychology. Greg has worked with athletes from the junior to Olympic level. Note: The views expressed in ACSM Olympics Hot Topics are those of the contributors only, and should not be construed as official statements of the American College of Sports Medicine. Active Voice: Equipment & Technology Issues in the Paralympics (acsm-blog/acsm-blog/2014/02/17/active-voice-equipment-technology-issues-in-the-paralympics) by User Not Found | Feb 17, 2014 Written By Peter Van de Vliet, Ph.D. Dr. Peter Van de Vliet is the Medical & Scientific Director, International Paralympic Committee (IPC). He holds a PhD in Physiotherapy and Motor Rehabilitation from Leuven University (Belgium) and held a post-doctoral research position in Adapted Physical Activity at that university prior to moving to Bonn, Germany, for the actual position as IPC Medical & Scientific Director. The portfolio includes the coordination of anti-doping and medical services, classification, and sports science developments in the Paralympic Movement. Dr. Van de Vliet has (co-)authored several scientific publications and book chapters on the subject, and coordinates the relationships with internationally leading research bodies in the respective areas. Equipment rules are becoming more prominent in the Paralympic Movement. As a result, the International Paralympic Committee’s (IPC) Sports Science Committee recently held a scientific forum to exchange current information, research, and expertise that focused entirely on equipment and technology in Paralympic Sports. This conference, “VISTA 2013”, was held May 1-4 last year at the Gustav-Stresemann Institute in Bonn, Germany. The conference program (http://www.paralympic.org/Events/VISTA2013) describes the complex issues that the IPC must address in determining what equipment may or may not be approved for use by competing Paralympic athletes. What are the implications of a technology for competitive fairness? Is the device a necessity that enables the individual to participate or might it enhance performance in some manner? Does it represent a ‘grass roots’ approach that could be broadly applied by low-income countries or is it a high-tech, individualized application that only athletes from selected countries might be able to access? Equipment rules are a sport-specific subject. To effectively address those details in this brief commentary would require that experts from each sport present specific and detailed responses. Rather, it is better here to avoid such a case-by-case discussion, and instead draw your attention to the IPC Equipment Policy. This policy is part of the IPC Handbook (see Section 2, Chapter 3.10 (http://www.paralympic.org/sites/default/files/document/120203164107739_Sec_ii_Chapter_3.10_IPC_Sport_Equipment_Policy.pdf)), to which all members of the Paralympic Movement (sports and athletes) must to adhere. In brief, this policy states that all adaptive equipment used in a Paralympic sport must be in compliance with four main principles: 1. Safety: all equipment must be safe for the athlete, any opponent, and may not cause irreversible damage to the field of play; 2. Fairness: sport rules must detail the provisions of all equipment in terms of dimensions, weight, and use of material; 3. Universality: prototype equipment is not allowed, and costs must be 'under control' to avoid that access to equipment becomes a matter of exclusivity. For this reason, the IPC also actively engages in the development of low cost equipment (for examples, see the website motivation.uk); 4. Physical Prowess: equipment may not be steered by machine, computer or robot. For further information on this topic, I highly recommend the following journal article by Brendan Burkett, PhD, from the University of the Sunshine Coast (Australia): Paralympic Sports Medicine—Current Evidence in Winter Sport: Considerations in the Development of Equipment Standards for Paralympic Athletes (http://journals.lww.com/cjsportsmed/Abstract/2012/01000/Paralympic_Sports_Medicine_Current_Evidence_in.8.aspx). Professor Burkett is a member of the IPC Sports Science Committee. Performing at High Altitudes (acsm-blog/acsm-blog/2014/02/13/performing-at-high-altitudes) by User Not Found | Feb 13, 2014 Written By Jordan Guillot, ACSM Health Fitness Specialist Varying altitudes may propose a new challenge for athletes competing in the Winter Olympic Games. As the elevation above sea level increases, not only does the barometric pressure of the air decrease, but the pressure of oxygen in that air also decreases (Exercise Physiology, McArdle, Katch, and Katch, 6th ed., 2007). This decrease in pressure of oxygen becomes that new challenge. The diffusion of oxygen from inspired air in the lungs across a membrane and into the blood stream depends on a pressure gradient (from area of higher pressure to area of lower pressure). As blood flows through the body, muscles and other tissues utilize the oxygen, which decreases the pressure of oxygen in the blood stream before returning to the heart. Once this blood reaches the lungs from the heart, its pressure of oxygen is much less than that of the inspired air. This difference in pressure allows diffusion of oxygen from the greater pressure inside the lungs and into the area of lower pressure – the blood stream – to be delivered throughout the body. The blood leaving the lungs is what is commonly known as the oxygenated blood, and is vital to muscle and tissue function. At higher altitudes, as mentioned before, the pressure of oxygen is lower than at sea level, and that pressure continues to decrease with every increase in elevation. If the pressure of oxygen lowers in inspired air, the difference in pressures between the inspired air and the blood stream would decrease, also. This decrease in difference lowers the rate at which diffusion takes place. Thus, a decrease in oxygen saturation of the blood can be expected. Now the muscles have an inadequate supply of oxygen, which inevitably affects and decreases performance than what can be expected at sea level or at lower altitudes. Olympic Winter Games rules state that a downhill skiing course must have a vertical drop of 800-1100 meters (2600-3280 ft.) (FIS Ski Rules 2008, 79). This is more than enough vertical distance for the start and finish to differentiate in their pressures of oxygen. However, there is a question of how much oxygen pressure change effects might come into play. Given these events are relatively brief and as a consequence, is a substantial part of the needed energy generated by anaerobic pathways? Bioenergetics and the Olympic Athlete (acsm-blog/acsm-blog/2014/02/11/bioenergetics-and-the-olympic-athlete) by User Not Found | Feb 11, 2014 Leave a comment (acsm-blog/acsm-blog/2014/02/11/bioenergetics-and-the-olympic-athlete#commentsWidget) By Mark Deaton, Ph.D., CSCS, EIM We all desire to be bigger, faster, stronger – but how do we get there? Some people look to the $400 billion supplement industry, while others take a more natural approach. Bioenergetics is the term used for the interactive energy systems within the human body and how energy is expended through exercise. It is defined as the conversion of protein, carbohydrates and fats into biologically usable energy that can be used for muscular activity (Powers, S.K, Howley, E.T. 2009, p 23). Fueling a working body is as vital to training and performance as gasoline or electricity is for an automobile. Some may think understanding the biochemical components of each food isn’t necessary, as long as you “just eat it!” But we know food comes in various nutrient levels; therefore, it would be best to understand proper nutrition. It is critical for an athlete to have a better understanding of bioenergetics to increase the efficiency of their personal performance (Powers, S.K., Howley, E.T. 2009, p. 23-24). The three energy systems are: 1) Phosphagen (ATP-PC) – responsible for producing energy for the first few seconds of any athletic event; 2) Glycolysis – continues energy production from 30 seconds to three minutes into the athletic event via the breakdown of carbohydrates from blood glucose or muscle glycogen stores; and 3) Oxidative (aerobic) – produces energy after three minutes until the event ends or fatigue limits the performance. The primary source of energy produced by these three systems is adenosine triphosphate (ATP). Depending on the intensity and duration of the athletic event, these energy systems will interact with one another and even revert back and forth on a continuum of ATP production. An example would be a sprint at the end of an endurance event where a crossover effect to fast glycolysis will occur (Baechle, T.R., Earle, R.W., 2008, p. 22-36). Educating yourself on the effects of certain nutrients and their combinations will provide a potential natural advantage that your energy systems will utilize. So, what do you need to know? Educate yourself as an athlete and as a health professional who works with athletes regarding bioenergetics and proper nutrition for performance. Before recommending or taking supplements, reevaluate training principles (overload, progression, etc.), and supplement safety. Analyze current calorie-to-protein intake from natural sources (Hoffman, J. 2010, SSTC). Chances are you may find an area to manipulate slightly that could result in a more productive performance. POST YOUR COMMENTS: How does your food intake affect your performance? Knowing the sport-specific demands of your sport, how have you manipulated your training and nutrition? What are your thoughts on nutrient timing (pre-event, post-event) and what foods are ingested? References Baechle, T.R., Earle, R.W. (2008). Essentials of strength training and conditioning. National Strength and Conditioning Association. 3rd edition. Hoffman, J. (2010). Sport-specific training conference. National Strength and Conditioning Association. Powers, S.K., Howley, E.T. (2009). Exercise physiology: Theory and application to fitness and performance. 7th edition. McGraw-Hill, New York, NY. Olympic Figure Skating: What It Takes (acsm-blog/acsm-blog/2014/02/09/olympic-figure-skating-what-it-takes) by User Not Found | Feb 09, 2014 Leave a comment (acsm-blog/acsm-blog/2014/02/09/olympic-figure-skating-what-it-takes#commentsWidget) Written By Gemmie S. Devera, MD, MS, MP Olympic Figure Skating consists of women’s singles, men’s singles, pairs, and ice dancing. Elite competitors skate at the senior level. To reach this level, skaters must pass 16 rigorous tests in Moves in the Field and Free Skating. Moves in the Field showcase skating skills and transition elements such as spirals, a move that involves balancing on the skating leg and extending the free leg, or non-skating leg, into the air. Free Skating moves highlight jumps, spins, and transition elements in a choreographed program. Ice dancers complete a separate series of dance tests. Each Olympic year, the U.S. Figure Skating National Championships double as the Olympic Trials. The number of athletes a country can send to the Games depends on the country’s placements at the previous year’s World Figure Skating Championships. Winners from the last U.S. National Championships or World Championships automatically qualify for the U.S. Nationals. Other athletes qualify for the Nationals from a top placement at another major event or by advancing through both Regional and Sectional Championships. U.S. Figure Skating (USFS) then chooses the Olympic Team based on placements at Nationals and the skaters’ previous body of work through the years. At the Olympics, the women, men, and pairs have six minutes to complete short and long programs. The top men will attempt quadruple jumps that rotate four times before landing. The top women will attempt triple – triple combinations. Pairs will attempt dangerous twists, throws and lifts. Ice dancers will display their unison with intricate footwork sequences in three dance performances. A new team skating event will debut in Sochi, featuring top skaters in each discipline to determine which country reigns supreme. Reaching the Olympic podium takes strength, flexibility, endurance, musicality, charisma and strong mindsets. Skaters typically train at least 15 hours on the ice, five days per week, and also do off-ice training. Skaters need strong core muscles to pull the body in tightly and rotate. A triple axel, for example, uses a forward take-off from a quarter-of-an-inch skate blade and completes three-and-one-half revolutions in 0.7 seconds. Skaters acquire strength from skating, Pilates, or weight training. Yoga and ballet increase flexibility and awareness of body position in space. Run-throughs of skating programs build endurance. Music and the arts develop musicality and a point of view. Periodization of training helps skaters avoid injury. Elite skaters have achieved a certain level of athletic performance, and a positive mindset allows skaters to express figure skating’s unique blend of artistry and athleticism on the Olympic stage. Discussion question: What training aspects in the days before the Olympics, mental or physical, are most important for a peak performance? Diabetes and Physical Activity (acsm-blog/acsm-blog/2014/02/08/diabetes-and-physical-activity) by User Not Found | Feb 08, 2014

Written by Barbara Bushman, Ph.D., FACSM Diabetes is a disease characterized by high blood glucose (high sugar in the blood). Diabetes affects 346 million people worldwide. Type 1 diabetes is an autoimmune disease which causes the destruction of insulin-producing cells in the pancreas. Type 2 diabetes occurs when the body no longer uses the insulin produced, resulting in insulin resistance. In both types of diabetes blood glucose levels become elevated without the assistance of insulin to help move glucose into the body's cells. Athletes must have glucose (carbohydrate) available in the muscle cells for high intensity activity and so it would seem diabetes and athletic competition would be a poor match. On the contrary, former successful Olympians (swimmer Gary Hall Jr., volleyball player Kevin Hansen, cross country skier Kris Freeman) as well as many others (marathoner Missy Foy, football quarterback Jay Cutler) have been very successful athletes while managing their diabetes. Physical activity and a focus on diet are two important lifestyle factors for everyone, and are especially important for individuals with type 1 or type 2 diabetes. Monitoring blood glucose levels to ensure adequate glucose levels are maintained is an added challenge, but one worth the effort, not just for those pursuing Olympic glory, but for everyone. Read more from the ACSM Sports Performance Center Olympic Commentary from Gary Hall Jr: Arrival in London (/access-public-information/acsm's-sports-performance-center/olympic-commentary-from-gary-hall-jr-arrival-in-london) Snacking Tips for Olympic Viewing (/access-public-information/acsm's-sports-performance-center/snacking-during-the-olympics) Sports Nutrition Unplugged (/access-public-information/acsm's-sports-performance-center/sports-nutrition-un-plugged) Recommended Resources For more information on the benefits of physical activity for anyone with type 2 diabetes, see the ACSM position stand, Exercise and Type 2 Diabetes: American College of Sports Medicine and the American Diabetes Association: Joint Position Statement. (http://journals.lww.com/acsmmsse/Fulltext/2010/12000/Exercise_and_Type_2_Diabetes__American_College_of.18.aspx) For additional information on healthy approaches to managing type 1 or type 2 diabetes, ACSM’s Complete Guide to Fitness & Health (http://www.acsm.org/access-publicinformation/books-multimedia/books/lists/books-for-topics-pages/acsm%27s-complete-guide-to-fitness-health) includes an entire chapter explaining how to develop a safe and effective exercise program along with a complementary dietary focus.

Barbara Bushman, Ph.D., FACSM, is a professor at Missouri State University. Dr. Bushman has authored papers related to menopause, factors influencing exercise participation, and deep water run training. She authored ACSM’s Action Plan for Menopause (Human Kinetics, 2005), edited ACSM’s Complete Guide to Fitness & Health (Human Kinetics, 2011), and serves as an associate editor for ACSM’s Health & Fitness Journal Note: The views expressed in ACSM Olympics Hot Topics are those of the contributors only, and should not be construed as official statements of the American College of Sports Medicine. Sport-Related Concussion & the Olympics (acsm-blog/acsm-blog/2014/02/07/sport-related-concussion-the-olympics) by User Not Found | Feb 07, 2014 Written By Michael J. O’Brien, MD and William P. Meehan III, M.D. Sport-related concussion, sometimes referred to as mild traumatic brain injury, is a temporary, trauma-induced interruption of normal brain function. Concussions occur due to a rapid, rotational acceleration of the brain, often as a result of a blow to the head or face. It is a functional injury, as opposed to a structural injury. There is no detectable bleeding, swelling or bruising of the brain. Concussions occur in all sports. Although much of the medical literature on sport-related concussions focuses on American football players, higher incidence rates have been reported in one of the sports featured in the winter Olympics: ice hockey.1 (#_ENREF_1),2 (#_ENREF_2) Concussion has also been reported in skiing, snowboarding, luge, and speed skating.3-7 (#_ENREF_3) 8 (#_ENREF_8), Concussion is suspected if, after a rapid acceleration of the head, an athlete shows any of the signs of concussion or experiences any of the symptoms of concussion. Signs of concussion include vomiting, amnesia, imbalance, confusion, and less commonly loss of consciousness, among others. Symptoms of concussion include headaches, dizziness, nausea, sensitivity to light, and changes in sleep patterns, among others. On-site management of brain injury during the Olympics will start with assessment of the airway, breathing, and circulation of the injured athlete and proceed along established protocols. Once all other injuries are addressed, focus will turn to managing the athletes’ concussions. The mainstays of concussion management are physical and cognitive rest.10-12 (#_ENREF_10) The athlete will avoid strenuous activity and rigorous training during the recovery period. In order to achieve cognitive rest, intellectually challenging tasks, such as studying, reading, playing video games, and working online, will be minimized. Once the injured athlete’s symptoms subside, they will be started on a return-to-play regimen, beginning with some light aerobic activity, and advancing as tolerated by symptoms to more rigorous activities. Stages for the return-to-play progression have been outlined by the international conferences on concussion in sport. The stages from the 4th conference are shown below (table).11 (#_ENREF_11) Stage Level of Activity 1

No activity (symptom limited physical and cognitive rest)

2

Light aerobic exercise e.g., walking, swimming, stationary cycling;