American College Of Sports Medicine Research Articles

Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta-Analysis.

We wanted to determine if higher compliance with American College of Sports Medicine (ACSM) exercise prescription guidelines influences exercise outcomes in knee osteoarthritis (OA). We conducted a systematic review. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to January 4, 2024, for randomized controlled trials evaluating resistance and/or aerobic exercise for knee OA. Interventions were classified as higher compliance (meeting ≥60% of ACSM guideline recommendations for frequency, intensity, and duration) or lower compliance (meeting <60% of recommendations). Effects on pain and function were evaluated via meta-analysis, stratified by compliance. Twenty-five trials (3,290 participants) evaluated combined resistance and aerobic programs, with no differences in outcomes between those with higher and lower compliance (standardized mean difference [SMD] pain: -0.38 [95% confidence interval (CI) -0.59 to -0.17] vs -0.31 [95% CI -0.45 to -0.16], respectively; SMD function: -0.43 [95% CI -0.64 to -0.21] vs -0.36 [95% CI -0.58 to -0.14]). Sixty-six trials (5,231 participants) evaluated resistance exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.60 [95% CI -0.81 to -0.39] vs -0.93 [95% CI -1.27 to -0.59]; SMD function: -0.64 [95% CI -0.83 to -0.44] vs -0.85 [95% CI -1.20 to -0.49]). Twelve trials (958 participants) evaluated aerobic exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.79 [95% CI -1.20 to -0.38] vs -1.00 [95% CI -2.52 to 0.53]; SMD function: -0.83 [95% CI -1.27 to -0.38] vs -0.76 [95% CI -2.02 to 0.50]). Higher or lower compliance with ACSM exercise prescription guidelines did not influence exercise outcomes. Given there was substantial heterogeneity and many publications were at risk of bias, our results should be interpreted with caution.

Physical activity and exercise intensity terminology: a joint American College of Sports Medicine (ACSM) expert statement and exercise and sport science Australia (ESSA) consensus statement

Physical activity and exercise intensity terminology: a joint American College of Sports Medicine (ACSM) expert statement and exercise and sport science Australia (ESSA) consensus statement

Effects of Supervised Exercise Therapy on Muscle Function During Walking in Patients with Peripheral Artery Disease

Background: Although supervised exercise therapy (SET) is a primary treatment for peripheral artery disease (PAD), the current literature is limited regarding the mechanisms contributing to increased walking distances, including how lower extremity muscle function is altered after SET. This study aimed to investigate the effects of SET on lower extremity muscle function during walking in patients with PAD. Methods: Twelve patients with PAD participated in a 6-month SET program consisting of three weekly exercise sessions (a total of 72 sessions) and adhered to the American College of Sports Medicine’s (ACSM) recommendations. Each session started with a 5 min warm-up of mild walking and static stretching of upper and lower body muscles, followed by 50 min of intermitted exercise on a treadmill, and then finished with 5 min of cool-down activities similar to the warm-up. Each patient walked across a 10 m pathway with reflective markers on their lower limbs twice: before (baseline) and after six months of participation in SET (post-exercise). Marker coordinates and ground reaction forces were recorded and imported to OpenSim software (version 4.0) for gait simulations. Muscle force, muscle power, and metabolic rate were estimated from OpenSim and compared between the baseline and post-exercise. Results: The mean plantar flexor force was not altered after SET. However, individuals’ plantar flexor muscles demonstrated improvements in force production (lateral gastrocnemius: 75–80% of stance, Cohen’s d = 0.20–0.43; medial gastrocnemius: 65–85% of stance, Cohen’s d = 0.20–0.71; soleus: 90–95% of stance, Cohen’s d = 0.20–0.26). Furthermore, plantar flexor power increased (80–95% of stance, Cohen’s d = 0.20–0.39) and this was attributed to increased power in the lateral gastrocnemius (80–85% of stance, Cohen’s d = 0.20–0.47), medial gastrocnemius (80–90% of stance, Cohen’s d = 0.22–0.60), and soleus muscles (85–95% of stance, Cohen’s d = 0.20–0.49). Similarly, other muscle groups (knee extensors, knee flexors, hip abductors, hip adductors, hip extensors, and hip flexors) also exhibited force and power increases after SET. Additionally, force and power variances were significantly decreased in several muscle groups (plantar flexors, knee extensors, hip abductors, hip external rotators, hip extensors, and hip flexors). Total metabolic rate also increased during the stance period where muscle force and power were elevated after SET (early stance: 5–25%, Cohen’s d = 0.20–0.82; mid stance: 35–45%, Cohen’s d = 0.20–0.47; late stance: 75–80%, Cohen’s d = 0.20–0.36). Conclusions: Our results suggest that from a biomechanics perspective, muscle functions during walking are improved in patients with PAD after SET; however, the improvements were generally small and were not reflected by all muscle groups.

Modulators of Energy Expenditure Accuracy in Adults with Overweight or Obesity: E-MECHANIC Secondary Analyses.

American College of Sports Medicine (ACSM) metabolic equations are used to estimate energy expenditure (EE) of physical activity and prescribe aerobic exercise to meet EE requirements. Limited evidence supports their accuracy in sedentary adults with overweight or obesity during controlled exercise interventions. The purpose of this study was to compare EE estimated by the ACSM walking equation versus EE measured by indirect calorimetry during a 24-week aerobic exercise intervention, and identify potential modulators for their accuracy. Data from the exercising groups (8 or 20 kcal·kg body weight-1·week-1) of the E-MECHANIC study were utilized in this ancillary analysis (N = 103). Every 2 weeks for the initial 8 weeks and monthly thereafter, EE was measured via indirect calorimetry during absolute (2 mph, 0% grade) and relative (65-85% VO2peak) workload exercise. Resting metabolic rate, VO2peak, and body composition were assessed at baseline and follow-up. An EE offset factor (EOF) was calculated to express measured EE as a percentage of the estimated EE at each workload (EOF < 100% represents an overestimation of ACSM estimated EE). The accuracy of the equation decreased with increasing exercise workload (0.44%, 9.2%, and 20.3% overestimation at absolute, relative, and maximal workloads, respectively, at baseline) and overestimation of EE was greater after the exercise intervention. Furthermore, race, sex, age, fat mass, and VO2peak were identified as modulators for equation accuracy. Greater overestimation of EE was observed in Black compared to white females, particularly at lower exercise workloads. These findings support future efforts to improve the accuracy of metabolic equations, especially in diverse populations. Researchers should account for exercise efficiency adaptations when using metabolic equations to prescribe exercise precisely.

Automotive workers: the role of coordinative and conditional abilities as effectiveness wellness indicator.

Noncommunicable diseases are on the rise due to sedentary and unhealthy lifestyles. The World Health Organization (WHO) and the American College of Sports Medicine (ACSM) recommend maintaining a healthy diet and engaging in regular physical activity, particularly in the workplace. Prolonged and repetitive work tasks can result in extended sick leave and decreased productivity while at work. Therefore, it is important to identify predictive factors that can act as indicators of the health status of employees. Utilizing motor abilities assessment tests can help to identify health issues at an early stage. Promoting preventive health measures is crucial for addressing chronic diseases and enhancing overall occupational well-being. The purpose of the study was to characterize workers' motor abilities and fitness levels and identify potential indicators. A total of 605 workers participated in this study, including 529 male participants with a height of 176 ± 0.09 cm and a body mass of 75.9 ± 14.1 kg and 77 female participants with a height of 162 ± 0.11 cm and an average body mass of 58.9 ± 11.1 kg. These individuals were enrolled during an Italian automotive corporation's mandatory annual medical check-up. The participants were categorized into three groups based on their occupational roles: blue-collar, manager, and white-collar groups. The participants underwent motor abilities assessment tests for upper-limb strength, trunk flexibility, and reaction time. The blue-collar group reported the best results in upper-limb strength (93.3 kgf ± 18.60), but had the worst results in flexibility (21.7 cm ± 7.90), total reaction time (58.8 s ± 4.74); and average intermedium (0.68 ms ± 0.11). The white-collar group reported the best result in flexibility (23.7 cm ± 8.94) and reaction time (48.5 s ± 4.38; 0.64 ms ± 0.09). Despite being frequently used to assess health status, handgrip measurements may not provide accurate differentiations because of the common use of blue-collar workers for tasks that require upper-limb strength. In contrast, reaction time metrics appear more reliable and discriminative in evaluating a worker's physical fitness.

Exaggerated Blood Pressure Response to Exercise Is a Risk of Future Hypertension Even in Healthy, Normotensive Young Individuals—Potential Preventive Strategies for This Phenomenon?

Physical activity and regular exercise are well known to reduce the risks of cerebrovascular and cardiovascular diseases, leading the American College of Sports Medicine to endorse the concept that “exercise is medicine”. However, a single bout of exercise temporarily raises arterial blood pressure (BP) to meet the metabolic demands of working muscle, and this BP response is particularly exaggerated in older adults and patients with cardiovascular conditions, such as hypertension, resulting in an exaggerated BP response during exercise. This presents a paradox: while regular exercise is crucial for preventing these diseases, excessively high BP responses during exercise could increase the risk of vascular damage. The mechanisms underlying this exaggerated BP response during exercise remain unclear, and effective exercise regimens for these populations have yet to be established. Currently, low-intensity exercise is recommended; however, its efficacy in disease prevention is uncertain. Notably, even among healthy individuals, there is significant variation in the BP response to exercise. Some healthy individuals, despite having normal resting BP, exhibit an exaggerated BP response during physical activity. Importantly, these individuals are often unaware that their BP becomes excessively elevated during physical activity. Repeated exposure to these heightened BP responses through regular physical activity may increase their long-term risk of cardiovascular disease. How can we prevent disease development in these individuals while still ensuring the effectiveness of exercise? Some studies have shown that individuals with a family history of hypertension may experience this phenomenon even in children and adolescents. Additionally, left ventricular hypertrophy contributes to an exaggerated BP response to exercise, suggesting a possible genetic influence. Conversely, other reports indicate that factors such as arterial stiffness, obesity, and low exercise capacity also contribute to this exaggerated response. Our recent preliminary data suggest that the cognitive benefits of exercise may be diminished in individuals who exhibit an exaggerated BP response during exercise. This implies that individuals with an exaggerated BP response, despite having normal resting BP, may not fully benefit from exercise. In this perspective paper, we review the physiological aspects of this phenomenon and explore strategies to address it. Additionally, we discuss BP responses in athletes within this content. Our goal is to prevent disease while maximizing the benefits of exercise for healthy individuals with an exaggerated BP response, as well as for elderly and cardiovascular patients.

The impact of aerobic exercise dose based on ACSM recommendations on patients with Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.

To explore the effects of different dose of aerobic exercise on motor function, balance, mobility, and quality of life in Parkinson's disease patients, aiming to provide insights into determining the optimal aerobic exercise dose for treating PD. Searching was conducted in four databases: PubMed, Embase, Web of Science, and Cochrane. The dose of aerobic exercise intervention was evaluated based on the recommendations of the American College of Sports Medicine regarding the development and maintenance of cardiorespiratory health, muscle strength, and functional mobility in patients with PD. The exercise intervention dose of the included studies were first classified into high ACSM compliance and low ACSM compliance based on meeting 4/6 of the ACSM recommendations. The reliability of the results was then validated using the criterion of meeting 5/6 of the ACSM recommendations. Comparisons of the effects of aerobic exercise dose on Motor function, Balance, Mobility, and QOL in PD patients using standardized mean difference with 95% confidence intervals. When using the 4/6 ACSM compliance criterion, 17 studies were categorized as high ACSM compliance and 12 as low ACSM compliance. The SMD ratios for high versus low ACSM compliance were: UPDRS-III (-0.79: -0.18), BBS (0.60: 0.05), TUG (-0.60: -0.60), and QOL (-1.05: -0.15). When using the 5/6 ACSM compliance criterion, 11 studies were categorized as high ACSM compliance and 19 as low ACSM compliance. The SMD ratios for high versus low ACSM compliance were: UPDRS-III (-0.95: -0.38), BBS (0.48: 0.37), TUG (-0.71: -0.55), and QOL (-0.7: 0.04). This study provides preliminary support for the potential of aerobic exercise to improve certain clinical symptoms in patients with PD. Furthermore, the results indicate that compliance to higher doses of aerobic exercise, as per ACSM standards, may contribute to improvements in motor function, balance, mobility, and quality of life for patients with PD. However, due to the heterogeneity in the studies and the influence of factors that have not yet been fully explored, these conclusions should be interpreted with caution. More high-quality randomized controlled trials are needed in the future to further verify and clarify the effects of aerobic exercise. https://www.crd.york.ac.uk/prospero, identifier PROSPERO: CRD42024517548.

Physical Activity and Excess Body Weight and Adiposity for Adults. American College of Sports Medicine Consensus Statement.

Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk-1 of moderate-intensity physical activity, and these benefits occur in a dose-response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.

Physical Activity and Excess Body Weight and Adiposity for Adults. American College of Sports Medicine Consensus Statement

ABSTRACT Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk−1 of moderate-intensity physical activity, and these benefits occur in a dose–response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.

“When hearing hoof beats from behind, expect horses, not zebras” – What flexibility research should adopt from scientific philosophy. A critical perspective on available evidence

The American College of Sports Medicine classifies flexibility as one out of 5 important health-related parameters that should be addressed in preventive and therapeutic training programs (Garber et al., 2011). Due to its importance in health and athletic performance development, there is an increasing number of studies to figure out flexibility training interventions as well as underlying mechanisms. While several exercise modalities are available, stretching and foam rolling (FR) are the most common training routines to improve range of motion (ROM). Interestingly, acute and chronic effects are mainly attributed to very similar mechanisms, more specifically, improved stretch tolerance and/or structural adaptations such as stiffness reductions in the muscle, the tendon, or the muscle-tendon complex (Takeuchi et al., 2023). Since stretching and FR seem to induce similar effect sizes in acute flexibility, authors suggested the replacement of static stretching to FR in movement preparation routines to avoid the stretch-induced force deficit, thus, impairments of subsequent strength related performance. Similarly, when discussing chronic flexibility routine effects, literature suggests task specificity. Therefore, increased ROM was attributed to specific stretch/foam rolling induced stiffness and passive peak torque changes. Unfortunately, statements developed from used research designs are incomprehensive. When referring to acute stretching of foam rolling effects that can be extracted from numerous systematic reviews, conclusions were drawn from comparisons to passive controls. This, however, does exclusively allow statements that stretching/FR was effective compared to doing nothing, however, does not exclude general warm-up effects, induced by muscle activity. Referring to William of Ockham (1287 – 1347), one popular philosopher from the United Kingdom, the most obvious explanatory approach would be the most likely one. In medicine diagnostics, this statement is metaphorically described as “when hearing hoof beats from behind, expect horses, not zebras”. Therefore, since both routines enhance temperature, the most likely explanation suggest acute ROM increases could rely on general warm-up effects instead of task-specific adaptations. Similarly, for chronic effects, literature suggests that ROM can be increased by several alternative interventions, e.g. full ROM resistance training, indicating shared mechanisms. Both interventions share underlying physiological mechanisms, such as inducing mechanical tension in high muscle lengths. Consequently, we extensively discussed available evidence in our published research. Key findings will be presented to challenge current paradigms (Warneke et al., 2024). References Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I.-M., Nieman, D. C., &amp; Swain, D. P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults. Medicine &amp; Science in Sports &amp; Exercise, 43(7), 1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefb Takeuchi, K., Nakamura, M., Fukaya, T., Konrad, A., &amp; Mizuno, T. (2023). Acute and long-term effects of static stretching on muscle-tendon unit stiffness: A systematic review and meta-analysis. Journal of Sports Science and Medicine, 22, 465–475. https://doi.org/10.52082/jssm.2023.465 Warneke, K., Behm, D. G., Alizadeh, S., Hillebrecht, M., Konrad, A., &amp; Wirth, K. (2024). Discussing conflicting explanatory approaches in flexibility training under consideration of physiology - A narrative review. Sports Medicine, 54, 1785-1799. https://doi.org/10.1007/s40279-024-02043-y

The Role of Exercise Blood Pressure in Hypertension: Measurement, Mechanisms and Management.

Hypertension affects one in three adults globally and is the leading modifiable risk factor for cardiovascular disease. While blood pressure measurements at rest are fundamental to the detection and management of hypertension, abnormal blood pressure responses to exercise, namely an exaggerated exercise blood pressure (EEBP), can provide additional independent information about current and future hypertension risk. This paper summarizes a symposium entitled: "The Role of Exercise BP in Hypertension: Measurement, Mechanisms and Management" included at the 2023 American College of Sports Medicine annual meeting, which presented a timely discussion about the clinical utility of EEBP. Here we will summarize the evidence presented by the speakers including considerations for blood pressure measurement during exercise, an overview of EEBP thresholds and discussion about the value of EEBP during submaximal exercise for the identification and management of hypertension, a summary of the potential physiological mechanisms underpinning an EEBP, and a review of exercise prescription guidelines based on new and emerging evidence as they relate to the American College of Sports Medicine's exercise recommendations for hypertension. We conclude by highlighting areas for future research with the overarching goal of improving the measurement and management of hypertension.

Executive functions in male and female older adults with aligned levels of VO2max.

Studies have shown a positive relationship between cardiorespiratory fitness (CRF) and executive functioning in older adults. Although this relationship has been well established, there seems to be a gap in the literature on the role of sex differences concerning CRF and executive functions. The current study aimed to assess the effect of sex in the relationship between CRF and cognition in older adults by stratifying the results to examine effects in males and females. Ninety-six older adults (61 females) gave their written, informed consent to participate in this cross-sectional study. All participants underwent a maximal continuous graded exercise test on a cycle ergometer to assess their maximal oxygen uptake (VO<inf>2max</inf>) and a computerized Stroop task (naming, inhibition, and switching) to assess their executive functions. According to VO<inf>2max</inf> test results and the American College of Sports Medicine's guidelines, females and males were classified into higher-fit and lower-fit groups. A general linear model and estimated marginal means analyses were applied. Results showed no significant differences in the naming, inhibition and switching performance tests between male and female older adults (P>0.05). Based on the observed positive relationship between CRF and executive functioning, the data of the current study supports the idea that aerobic exercise, which typically increases CRF, is well-situated to improve executive functioning in older adults, irrespective of sex.

Recent Findings on Exercise Therapy for Blood Glucose Management in Patients with Gestational Diabetes.

Inadequate management of blood glucose levels in gestational diabetes mellitus (GDM) poses risks for both pregnant women and the developing fetus. Attaining appropriate blood glucose control is crucial to mitigate potential adverse outcomes. This study aimed to consolidate the latest guidelines from representative professional societies, providing insights into exercise therapy for GDM patients and suggesting potential avenues for future research. The review was conducted with up-to-date exercise guidelines from prominent societies, such as the American College of Obstetricians and Gynecologists (ACOG), the Society of Obstetricians and Gynecologists of Canada (SOGC), the Canadian Society for Exercise Physiology (CSEP), the American College of Sports Medicine, the American Diabetes Association (ADA), and the Korean Diabetes Association. The ACOG and SOGC/CSEP recommend 150 min of low to moderate intensity exercise, 3-4 times a week, combining aerobic and resistance exercises. All guidelines advise against activities involving sudden directional changes, physical contact, a risk of falling, and exercises performed lying down. Despite cautions from the ADA and ACOG on blood glucose fluctuations during physical activity, the lack of specific methods and recommendations from other societies reveals a notable gap in evidence-based guidelines for GDM. For effective and safe blood glucose management in GDM patients, further research should be conducted on the exercise-related precautions outlined for GDM patients. Establishing ample evidence would facilitate the development of customized exercise guidelines for GDM patients.

Knowledge, Attitude, and Preventive Practices Regarding Exercise-related Acute Cardiovascular Events in Gym Trainers

Abstract Exercise is a powerful tool in preventing and reducing the occurrence of lifestyle diseases. However, engaging in intense physical activity, especially activities that are unfamiliar, can increase the risk of heart complications, particularly in individuals who are not very physically active. The number of health clubs is growing, leading to a significant increase in the number of fitness trainers who provide guidance and motivation during workout sessions. As a result, it is crucial for fitness center trainers to minimize complications by prescribing personalized workout regimens and promptly addressing any incidents. A cross-sectional study was conducted on gym trainers who had a basic level certification lasting 6 months or more and at least 1 year of experience, using convenience sampling. Trainers with medical or paramedical qualifications were excluded. A questionnaire designed by the researchers was distributed among the gym trainers. Descriptive data analysis was performed using Microsoft Excel to calculate the percentages. The study found that 51% (120) of the participants were knowledgeable about chest pain, while only 14% (32) were aware that light-headedness and tiredness were symptoms indicating possible cardiovascular events. This implies that the trainers surveyed had limited knowledge. In terms of attitude, when asked about their confidence in recognizing symptoms of a heart attack, only 2% were very confident, 38% were neutral, and 8% were not confident at all. Only 38% of trainers practiced risk stratification/pre-exercise screening, and only 44% followed the guidelines set by the American College of Sports Medicine (ACSM). The study suggests that certified gym trainers lack sufficient knowledge, possess a neutral attitude, and do not frequently implement preventive measures related to exercise-related acute cardiovascular arrest.

Types of physical exercise based on the side effects of each oncological patient

Cancer treatments like surgery, radiotherapy, chemotherapy, and target therapies can have various side effects on patients, affecting their health and quality of life. Exercise has been shown to be effective in reducing these side effects by regulating hormone levels, improving immune function, and reducing inflammation. The American College of Sports Medicine recommends a specific exercise regimen for cancer patients, including cardiovascular exercise and strength training. It is important to tailor exercise programs to each patient's needs and adapt the intensity based on their condition and disease stage. Understanding the physiological effects of cancer treatments is crucial for developing effective exercise programs that benefit patients. Motivating patients to stay active and adhere to exercise routines long term is also essential for their overall well-being.

Translational Journal of the American College of Sports Medicine: 2023 Paper of the Year

Translational Journal of the American College of Sports Medicine: 2023 Paper of the Year

Feasibility of a Recumbent Stepper for Short-Interval, Low-Volume High-Intensity Interval Exercise in Stroke.

Studies investigating high-intensity interval exercise (HIIE) in stroke typically emphasize treadmill training. However, a literature review suggested that seated devices such as a recumbent stepper or cycle offer a promising alternative for HIIE since exercise can be prescribed using peak power output (PPO). Therefore, this would give health care professionals the ability to monitor and adapt power output for the target heart rate range. The purpose of this secondary analysis was to examine the feasibility of prescribing short-interval, low-volume HIIE using PPO in chronic stroke. We used several methods to test feasibility: (1)Acceptability: Measured by the percentage of participants who completed the entire HIIE protocol; (2) Implementation was assessed by the number of reported cardiac or serious adverse events during submaximal exercise testing and HIIE and the average percentage of participants reaching vigorous intensity, defined by the American College of Sports Medicine as at least 77% of age-predicted maximal heart rate (HRmax). Data were available for 28 participants who were 32.2 (17.2) months post-stroke and 61.4 (11.9) years of age. Twenty-eight participants completed HIIE per protocol. No cardiac or serious adverse events occurred during the submaximal exercise test or during HIIE. The rapid switching between HIIE and recovery showed no evidence of blood pressure reaching unsafe thresholds. Average intensity during HIIE reached 76.8% HRmax, which is slightly below the target of 77.0%. A single bout of short-interval, low-volume HIIE, prescribed using PPO, was feasible in chronic stroke.

Barriers to and enablers of physical activity participation in lung cancer survivors.

Although physical activity physical activity has been shown to have significant benefits for individuals living with cancer, engaging lung cancer survivors (LCS) in increasing routine physical activity participation has been particularly challenging. To describe enablers of, barriers to, and patterns of physical activity among LCS and to characterize interest in a physical activity program as a first step to improving physical activity engagement. The study consisted of a cross-sectional survey (n = 100) of adult LCS recruited from a thoracic oncology clinic assessing multiple domains of physical activity (engagement, perceived barriers, benefits, physical function, psychosocial factors, self-efficacy, and programmatic preferences). Only 12% of LCS in our cohort (average age 67 years, 54% male, 81% with stage III or IV disease) met American College of Sports Medicine (ACSM) physical activity guidelines. Participants engaged in moderate-to-vigorous physical activity, with an average (SD) of 48.4 (91.8) minutes per week. The most commonly reported barriers to physical activity were fatigue (49%), dyspnea (39%), and difficulty with daily activities (34%). Regression analysis demonstrated a positive association between moderate-to-vigorous physical activity and higher income (r = 0.241, p = .016), physical function (r = 0.281, p = .005), and physical activity self-efficacy (r = 0.270, p = .007). Qualitative results demonstrated a strong interest in physical activity programming that is lung-cancer specific with a high level of support and guidance. This study identified that LCS had low levels of physical activity with fatigue, dyspnea, socioeconomic, and functional limitations contributing. The majority of LCS are interested in an exercise program and believe that exercise engagement will produce functional benefits. The present study presents a framework to guide development of community-based interventions to increase LCS physical activity participation among LCS.

Rating of Perceived Exertion: A Large Cross-Sectional Study Defining Intensity Levels for Individual Physical Activity Recommendations

BackgroundPhysical inactivity is a growing risk factor worldwide, therefore getting people into sports is necessary. When prescribing physical activity, it is essential to recommend the correct training intensities. Cardiopulmonary exercise testing (CPX) enables precise determination of individuals’ training intensities but is unavailable for a broad population. Therefore, the Borg scale allows individuals to assess perceived exertion and set their intensity easily and cost-efficiently. In order to transfer CPX to rating of perceived exertion (RPE), previous studies investigated RPE on specific physiological anchors, e.g. blood lactate (bLa) concentrations, but representativeness for a broad population is questionable. Some contradictory findings regarding individual factors influencing RPE occur, whereas univariable analysis has been performed so far. Moreover, a multivariable understanding of individual factors influencing RPE is missing. This study aims to determine RPE values at the individual anaerobic threshold (LT2) and defined bLa concentrations in a large cohort and to evaluate individual factors influencing RPE with multivariable analysis.MethodsCPX with bicycle or treadmill ergometer of 6311 participants were analyzed in this cross-sectional study. RPE values at bLa concentrations 2 mmol/l, 3 mmol/l, 4 mmol/l, and LT2 (first rise in bLa over baseline + 1.5 mmol/l) were estimated by spline interpolation. Multivariable cumulative ordinal regression models were performed to assess the influence of sex, age, type of ergometry, VO2max, and duration of exercise testing on RPE.ResultsMedian values [interquartile range (IQR)] of the total population were RPE 13 [11; 14] at 2 mmol/l, RPE 15 [13; 16] at 3 mmol/l, RPE 16 [15; 17] at 4 mmol/l, and RPE 15 [14; 16] at LT2. Main influence of individual factors on RPE were seen especially at 2 mmol/l: male sex (odds ratio (OR) [95%-CI]: 0.65 [0.587; 0.719]), treadmill ergometry (OR 0.754 [0.641; 0.886]), number of stages (OR 1.345 [1.300; 1.394]), age (OR 1.015 [1.012; 1.018]), and VO2max (OR 1.023 [1.015; 1.030]). Number of stages was the only identified influencing factor on RPE at all lactate concentrations/LT2 (3 mmol/l: OR 1.290 [1.244; 1.336]; 4 mmol/l: OR 1.229 [1.187; 1.274]; LT2: OR 1.155 [1.115; 1.197]).ConclusionOur results suggest RPE ≤ 11 for light intensity, RPE 12–14 for moderate intensity, and RPE 15–17 for vigorous intensity, which slightly differs from the current American College of Sports Medicine (ACSM) recommendations. Additionally, we propose an RPE of 15 delineating heavy and severe intensity domain. Age, sex, type of ergometry, duration of exercise, and cardiopulmonary fitness should be considered when recommending individualized intensities with RPE, primarily at lower intensities. Therefore, this study can be used as a new guideline for prescribing individual RPE values in the clinical practice, predominantly for endurance type exercise.

Effects of exercise dose based on the ACSM recommendations on patients with post-stroke cognitive impairment: a systematic review and meta-analyses.

This review aimed to assess the impact of different exercise dosages on cognitive function in individuals with post-stroke cognitive impairment (PSCI). Four electronic databases-Embase, PubMed, Web of Science, and Cochrane Library-were systematically searched from inception to 01 January 2024, focusing on the impact of exercise therapy on cognitive function in individuals with PSCI. Only randomized controlled trials meeting the criteria were included. The exercise therapy dose and adherence were evaluated following the American College of Sports Medicine (ACSM) guidelines, categorized into a high compliance group with ACSM recommendations and a low or uncertain compliance group. A random-effects model compared the effect of ACSM compliance on cognitive function in individuals with PSCI, with the effect size represented by the standardized mean difference (SMD) and a 95% confidence interval (CI). In total, 18 studies meeting the criteria were included, with data from 1,742 participants. The findings suggested a beneficial effect of exercise on cognitive function in individuals with PSCI [SMD = 0.42, 95% CI (0.20, 0.65)]. Ten studies were categorized as the "high adherence group" and eight in the "low or uncertain adherence group" based on the ACSM recommendations. The subgroup analysis revealed that the SMD of the high compliance group was 0.46 (95% CI: 0.10, 0.82) (p = 0.01), while the SMD of the low or uncertain compliance group was 0.38 (95% CI: 0.07, 0.70) (p = 0.02). Our study indicates the beneficial impact of exercise for patients with PSCI over no exercise. Furthermore, high adherence to the exercise dose recommended by ACSM guidelines demonstrated a more substantial improvement in cognitive function than low or uncertain adherence in patients with PSCI. Systematic Review Registration: https:// www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023487915.