American College Of Sports Medicine Research Articles

Competitive Golf: How Longer Courses Are Changing Athletes and Their Approach to the Game.

Nutritional guidance for competitive golfers to improve performance is limited. Recommendations and study conclusions from older research used smaller golf courses compared to today and require a reevaluation of energy expenditure. This review identifies aerobic fitness, in addition to strength, as a key determinant of success. A novel nutritional approach that incorporates carbohydrate supplementation to support aerobic fitness without sacrificing the ability to build strength is presented since longer courses require more stamina. Strategies for training, competition, and recovery are outlined based on different skill levels. American College of Sports Medicine (ACSM) guidelines for carbohydrates, protein, and hydration intake are tailored specifically for competitive golf based on this approach. Putting requires precise movement and can be affected by fatigue. Nutritional studies in golf and similar sports that require focused movements are presented, exhibiting an improvement with adequate hydration and carbohydrate status and caffeine use. Competitive golf poses unique challenges to an athlete and commonly used ergogenic supplements that can improve performance in a variety of circumstances during training, competition, and while traveling are reviewed.

Cultural differences in hydration practices among physically active individuals: a narrative review.

ABSTRACTIt is well-established that appropriate hydration practices are essential in promoting health and optimizing performance and recovery. However, evidence-based hydration guidelines may not be adopted due to cultural differences across countries, such as religious beliefs, traditions, preferences, and beverage availability. Examples of hydration practices influenced by culture include beer consumption after sports in Western countries, consumption of sugarcane juice in India and Ramadan fasting among Muslims. For most cultural hydration practices, there is limited scientific evidence on their effects on rehydration, exercise performance, and recovery. Despite possible benefits of various hydration practices on exercise performance and recovery, they are inconsistent with current evidence-based hydration recommendations. More research on the impacts of cultural hydration differences on physiology, performance, and recovery is warranted to allow evidence-based guidelines and advisories.Abbreviations: ABV: alcohol by volume, ACSM: American College of Sports Medicine, NATA: National Athletic Trainers’ Association, ROS: reactive oxygen species, TCM: Traditional Chinese Medicine

Description and Functional Benefits of Meeting Frequency, Intensity, and Time of Resistance and Cardiovascular Exercises: A Study of Older Adults in a Community-Based, Slow-Stream Rehabilitation, Hospital-to-Home Transition Program.

This prospective cohort study described cardiovascular and resistance exercises completed by older adults in a community-based, slow-stream rehabilitation, hospital-to-home transition program; compared exercises completed to the American College of Sports Medicine (ACSM) exercise guidelines; and, assessed differences in Late Life Function and Disability Index (LLFDI)-Function Component (FC) between older adults who met and did not meet the ACSM guidelines. Descriptive statistics and Factorial ANCOVA were conducted. For cardiovascular exercise 59.3% of participants met frequency, 73.4% met intensity, and 35.9% met time. For resistance exercise, 67.2% of participants met frequency, 42.2% met intensity, and 76.6% number of repetitions. Participants who met both frequency and time for cardiovascular exercise had higher LLFDI-FC scores, as did those who met intensity and/or number of repetitions for resistance exercise. The findings provide support that older adults engaged in a slow-stream rehabilitation program can meet the ACSM exercise guidelines for community-dwelling older adults, and that meeting the guidelines improves function.

Exercise Is Medicine for Underserved and Vulnerable Populations: Factors Influencing Implementation

ABSTRACT Purpose Communities of underserved and vulnerable populations (UVP) are particularly at risk for the negative health consequences related to inadequate physical activity. UVP include individuals from the following groups: racial and ethnic minorities, individuals with disability, those from rural and inner-city areas, elderly and pediatric populations, undocumented immigrants and political refugees, the uninsured/underinsured, those with low income, individuals with chronic medical conditions, non-English-speaking populations, and those with limited health literacy. Exercise Is Medicine (EIM®), launched in 2007 by the American College of Sports Medicine (ACSM) and the American Medical Association®, is a population health initiative aimed at assessing and promoting physical activity among all populations in the United States. The rationale for this commentary is to describe challenges in implementing EIM® in UVP, discuss potential solutions to these challenges, and share lessons learned from a decade of work in this area to maximize the impact of EIM® in UVP and thereby increase physical activity levels in UVP. Methods The ACSM Underserved and Community Health Committee developed a series of symposia presented at the ACSM Annual Meetings in 2012, 2014, 2016, and 2018 to address EIM® in UVP in terms of barriers, opportunities, health policy, dissemination, and implementation. These symposia included both committee members and other national experts in relevant fields of health disparities, health policy, implementation science, and health care delivery. Symposia highlights and relevant updates were collated by a writing group of committee members for this commentary and organized by applying the Socioecological Model (i.e., individual, relationship, community, societal levels). Results Recommendations regarding best practices for EIM® dissemination and implementation among UVP are presented for healthcare providers, exercise professionals, and patients. Key findings include the importance of tailoring EIM® interventions to improve service to UVP and increase their access to EIM® resources. Conclusion For EIM® to achieve its aim of moving the needle on population health by increasing activity, it will need continued focus on EIM® implementation among UVP communities with the highest rates of chronic disease and the lowest rates of physical activity.

IDF21-0581 IDF-MENA region guidelines for management of hyperglycemia in pregnancy

Background: Hyperglycaemia in pregnancy (HIP) is the most common medical disorder complicating pregnancy. In the Middle East and North Africa region, the prevalence of DM in women of reproductive age group is high and it varies widely between different regions due to variation in screening and diagnostic criteria for the identification of GDM. Universal blood glucose screening at first antenatal booking visit helps in identifying women with HIP. To reduce the future burden of complications of diabetes in adolescents and later age it is necessary to screen and diagnose pregnant women during pregnancy for the appropriate management and control of high levels of blood glucose during pregnancy to reduce the inter generational transmission and to reduce the future number of people with diabetes. The children exposed to diabetes inutero are likely to develop diabetes as early as 12–22 years of age. The longer the duration of diabetes more are the chances of early development of diabetes related complications. Regional guidelines if modified, developed and also implemented may address the issues of screening, diagnosis according to available evidence based protocols. Aim: The aim of the guidelines proposed here is to create a standardized pragmatic approach for the screening, diagnosis, and management of HIP that is effective, simple, and accessible to all HCPs. This will eventually assist in improving clinical practice and preventing long-term health complications in the region. Method: These recommendations are made after reviewing various existing guidelines including American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and American College of Sports Medicine. A literature search was done using PubMed, Cochrane Database, Google Scholar, EMBASE, various systematic reviews, and original articles. Search was done using key words “Hyperglycemia in pregnancy,” “gestational diabetes mellitus,” and “diabetes in pregnancy.” Results: The results will be available after the implementation of this published regional guideline and it will be monitored by regional and local diabetes in pregnancy Registries. Data will be analysed which will be obtained from these registries. The usefulness of the guidelines as a measure of health care practices regarding screening and diagnosis and maternal and perinatal complications data will be used to implement corrective strategy in screening and management of Hyperglycaemia in Pregnancy. The benefits of these guideline will be analyzed and the indicators will be the reduction in Maternal-prenatal complication rates. Discussion: Due to similarities in genetics and pathogenesis, the prevalence of GDM correlates and parallels with T2DM. In MENA region, the prevalence of T2DM varies from 3.9% (Yemen) to 18.3% (Saudi Arabia) and the prevalence of GDM varies from 5.1% (Yemen) to 37.7% (United Arab Emirates). The vast variation among MENA countries is because of dissimilar screening strategies, nonuniform diagnostic criteria for GDM, and economic differences among the countries. This makes accurate assessment and comparison of burden of HIP among the countries very challenging. Regional guidelines if modified, developed and also implemented may address the issues of screening, diagnosis according to available evidence based protocols. The timely diagnosis may reduce the complications of diabetes in maternal perinatal and adult life.

What’s new for the clinician– summaries of recently published papers

Type 2 diabetes mellitus (T2DM) is the most common chronic disease in the Western world and developing countries have also shown an explosion in the incidence and prevalence of this disease. Exercise therapy is essential for the management of diabetes. The American College of Sports Medicine and the American Diabetes Association have recommended at least 150 min/week of moderate (50%-70% of an individual’s maximum heart rate) to vigorous (> 70% of an individual’s maximum heart rate) physical activity for patients with type 2 diabetes (T2DM). Studies including lifestyle and health interventions have shown that they have a positive health effect on patients with T2DM. For example, physical activity has been shown to improve the metabolic condition of T2DM patients, reduce HbA1c levels and cardiovascular mortality, and improve the quality of life, lipid levels, and blood pressure. Diabetes has been identified as an important risk factor for periodontitis. The risk of developing periodontitis and peri-implantitis is significantly increased in patients with diabetes compared to healthy control groups. Wernicke and colleagues (2021)1 reported on a trial that sought to test the hypothesis that physical activity is a health-promoting measure with significant positive effects on periodontal health and HbA1c concentrations.

Muscle-strengthening via resistance exercise with intensity progression adjusted through free-weights in individuals with chronic low back pain: A gap in the literature

Aim: To describe Randomized Controlled Trials (RCTs) that tested progressive muscle strength exercises in adult patients with chronic low back pain, and confirm the guidelines that guide the progression system of variables used in exercise programs for muscle strength.Methods: We searched RTCs in Medline and Cochrane with controlled descriptors for low back pain and exercise. Two reviewers independently assessed the quality of the studies using the PEDro scale score. Studies that developed the muscle strength exercise program according to the guidelines of the American College of Sports Medicine were included.Results: Twenty-eight articles were recruited, 22 RTCs retrieved from Medline and 6 from Cochrane, after the analysis, only one study partially met the eligibility criteria.Conclusion: It has a gap RTCs on progressive resistance exercises for muscle strength in patients with chronic non-specific low back pain, also, literature does not have guidelines to guide the progression system of variables used in exercise programs for muscle strength in this population.

The Female Athlete Triad-the impact of running and type of diet on the regularity of the menstrual cycle assessed for recreational runners.

BackgroundThe Female Athlete Triad (FAT) included three interrelated conditions including disordered eating, amenorrhea, and osteoporosis. The American College of Sports Medicine updated the definition of FAT to reflect the interdependence of low energy availability with or without eating disorders. The main aim of the study was to assess the impact of recreational running on potential disturbances in the regularity of women’s menstrual cycles. Additionally, this work compared differences in the menstrual cycle between women runners and women who did not regularly practice sports. The respondents were also asked about the type of diet they consumed.MethodsA total of 360 women took part in the research. This group included 217 runners and 143 control. The authors’ questionnaire was used in the research.ResultsWhen compared to the control group, the runners had an increased frequency of menstrual cycles of <24 days (10.14% vs. 3.50%), fewer typical cycles of 25–31 days (75.58% vs. 86.71%), had fewer regular cycles per year (9.62 vs. 11.22), shorter duration of bleeding (4.79 vs. 5.27 days), and an increased frequency of painless menstruation (23.96% vs. 7.69%). A positive predictor of menstrual cycle disorders was the use of a ‘special diet’ (R:1.67; 95% C:0.47–2.87).ConclusionsThe runners had shorter and less regular monthly cycles and shorter and more often painless menstrual bleeding when compared to the control group. The frequency of menstrual disorders in runners was increased by following a ‘special diet’. The frequency of menstrual cycle disorders in runners, however, did not differ significantly from the control group.

The Front Squat Exercise

Peter Ronai, M.S., FACSM, ACSM-CEP, ACSM-EP, EIM-III, CSCS,is a clinical professor of exercise science in the Department of Physical Therapy and Human Movement Sciences at Sacred Heart University in Fairfield, Connecticut. He is a fellow of the American College of Sports Medicine (ACSM) and an associate editor of ACSM's Health & Fitness Journal®. He writes articles regarding exercise programs for persons with chronic diseases and disorders and also about online tips and tools that exercise professionals can access to better serve their clients. Disclosure: The author declares no conflict of interest and does not have any financial disclosures. The author would like to thank Matt Carter for serving in the videos and several of the photos.

From the Editor

I recently reviewed a report performed for the American College of Cardiology (ACC) titled Survey Report: Cardiac Rehab Industry Insights and Best Practices (1). Only a fraction of the cardiac rehabilitation (CR) programs in the United States were assessed (N = 72 of 800+ programs). The survey provided information on a wide array of topics including eligible patient participation, intensive versus traditional CR use (10% and 90%, respectively), the number sessions attended, maintenance program charges, “virtual” CR services (only 13% offering), other offerings (e.g., pulmonary, PAD, oncology), American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) program certification (75% certified), program revenues (50% reported positive net revenue), and barriers to growth.Another area of focus was on staffing. Two items related to the reporting of staffing caught my attention. First, and I have mentioned this previously, is the disappointment I had in the listing of “Exercise Physiologist” (EP) and not “Clinical Exercise Physiologist” (CEP). A goal of those individuals who belong to the organizations that allow access to this journal (CEPA, ESSA, and CSEP) should be to promote the specialty of clinical exercise physiology. The American College of Sports Medicine recognizes CEPs and EPs as distinctly separate professionals (2). The CEP is an allied healthcare professional with specific education and practical skills to guide those with existing chronic disease (many who are newly diagnosed and with complex comorbidities) through an exercise and lifestyle modification program. I urge anyone reading this article to recognize the differences between CEPs and EPs, and when the term EP is used when CEP should have been use, please notify the author or organization of this mistake. For example, I recently asked the current president of the AACVPR to change from EP to CEP on their registration to the annual meeting and provided rationale. It was met with acceptance, and he stated they will be making this change.The other area in the staffing section of the ACC CR survey had to do with use of various disciplines for program staffing. It was heartening to read that 95% of programs surveyed employed exercise professionals (stated as EPs in the survey—see above). CR remains the primary location of employment of the CEP, particularly in the United States. Additionally, 89% of the programs reported using a registered nurse. Nursing involvement in CR has been traditional since its inception. However, our program at Henry Ford Hospital has not used nurses for the past 20 years. We have relied solely on appropriately trained and experienced CEPs, with physician support, to implement programming and deal with the variety of medical situations that occur (blood glucose issues, chest pain, hypotensive responses, the need for CPR and/or defibrillation). We have been able to provide safe and effective CR programming in the settings of hospital and standalone clinic while serving an extremely sick and frail population. And this has also included the implementation of several important National Institutes of Health trials (HF-ACTION, CLEVER, iATTEND) (3). Importantly, staffing with only CEPs meets the 2006 Medicare and Medicaid definition for staffing of CR programs (4). I urge you to read the point:counterpoint from the 2015 issue of the Journal of Clinical Exercise Physiology (only 1 issue per year at that time and any article older than 18 months is freely available) in which I debate that the CEP is the best and logical choice for the majority of staffing in CR programs (5). My goal is to continue to promote the primary use of CEPs in all exercise settings catering to those with chronic disease.

Toward a Symbolic AI Approach to the WHO/ACSM Physical Activity &amp; Sedentary Behavior Guidelines

The World Health Organization and the American College of Sports Medicine have released guidelines on physical activity and sedentary behavior, as part of an effort to reduce inactivity worldwide. However, to date, there is no computational model that can facilitate the integration of these recommendations into health solutions (e.g., digital coaches). In this paper, we present an operational and machine-readable model that represents and is able to reason about these guidelines. To this end, we adopted a symbolic AI approach that combines two paradigms of research in knowledge representation and reasoning: ontology and rules. Thus, we first present HeLiFit, a domain ontology implemented in OWL, which models the main entities that characterize the definition of physical activity, as defined per guidance. Then, we describe HeLiFit-Rule, a set of rules implemented in the RDFox Rule language, which can be used to represent and reason with these recommendations in concrete real-world applications. Furthermore, to ensure a high level of syntactic/semantic interoperability across different systems, our framework is also compliant with the FHIR standard. Through motivating scenarios that highlight the need for such an implementation, we finally present an evaluation of our model that provides results that are both encouraging in terms of the value of our solution and also provide a basis for future work.

Effectiveness of Whole-Body Vibration Combined with Multicomponent Training on the Risk of Falls and Quality of Life in Elderly Women with Osteoporosis: Study Protocol for a Randomized Controlled Clinical Trial.

Simple SummaryRisk of falls secondary to osteoporosis consists an important problem that affects society and there is no defined treatment to ameliorate both the symptoms and quality of life of elderly women with osteoporosis and reduce the risk of falls. We aim to evaluate the effectiveness of whole-body vibration protocol combined with various exercises specifically in this population, therefore, our results might identify a defined protocol to reduce their risk of falls as strength, balance, and functional capacity improves.Osteoporosis and the risk of falls increase the risk of fractures and events of falls. Prescriptions and programs for different forms of exercise have different impacts on the risk of falls, and exercises from multiple categories of whole-body vibration can be effective. This study aims to evaluate the effectiveness of whole-body vibration (WBV) protocol combined with multicomponent training (MCT) in elderly women with osteoporosis and their history of falls. Our proposal is a protocol for a randomized clinical trial, divided into two stages: First, development of a protocol for WVB combined with MCT for elderly women with osteoporosis and a history of falls, under the Guidelines of the American College of Sports Medicine, and following the recommendations of the Standard Protocol Items Recommendations for Interventional Trials (SPIRIT), and second, a randomized controlled clinical trial following the Consolidated Standards of Reporting Trials (CONSORT). This trial will have implications for the effectiveness of a vibration protocol combined with multicomponent exercise on the risk of falls and quality of life for older women with osteoporosis. We expect that adding full-body vibration to an exercise protocol will decrease the risk of falls and improve participants’ quality of life, as well as their strength, balance, and functional capacity.

Exercise response on dose curve among class I obese young adult population.

To identify exercise regimes having a short duration and yet incorporating the effects of both aerobic and resistance exercises. The randomised study was conducted from December 1, 2019, to April 31, 2020, at Ziauddin Hospital, Karachi, and comprised individuals of either gender aged 20-40 years with class-I obesity. All participants were initially screened using a physical activity and readiness questionnaire to determine if they were fit to perform the exercises. Subsequently, dynamic exercises were introduced based on the guidelines of the American College of Sports Medicine. The subjects were randomised into aerobic group A, resistance group B and dynamic resistance group C. The intervention lasted 12 weeks. The quantification of exercises was done using the frequency, intensity, time, and type protocol. The results were analysed on MedCalc statistical software. Out of the 102 participants, 51(50%) each were males and females. Each of the three groups had 34(33.3%) subjects; 17(50%) males and as many females. The impact was significant in all the three groups (p<0.05). The effect was significantly better in group C than groups A and B. Body mass index and body fat percentage values improved through aerobic, resistance and dynamic resistance exercises.

Design and implementation of a clinic-to-community, physical activity health promotion model for healthcare providers

Due to the worldwide burden of noncommunicable disease, the American College of Sports Medicine (ACSM) launched a global health awareness initiative in 2007 called Exercise is Medicine® (EIM®) to create awareness in healthcare providers in promoting physical activity to their patients. To transition awareness into action, Exercise is Medicine Greenville® (EIMG®) launched in 2016 through a first-of-its-kind partnership between a medical school, large healthcare system, and community organization to comprehensively integrate physical activity as a primary prevention strategy into their health system. The EIMG® model connects patients referred by their healthcare provider due to diagnosis of a physical inactivity and/or noncommunicable disease to community partners who provide evidence-based physical activity programs as a population health management strategy. The EIMG® program is inclusive of all patients referred and provides an “open door policy” through the YMCA scholarship fund. Through 2019, 210 patients completed the program (>60% graduation rate). Patients receiving usual care by their healthcare provider decreased body weight (p < 0.001) and systolic blood pressure (p = 0.042). Patients receiving usual care by their healthcare provider who were referred with hypertension decreased body weight (p = 0.001), and both systolic and diastolic blood pressure (p < 0.001). Graduating patients were highly satisfied with the program and program personnel (>4 on a 5-point Likert scale). Aligning healthcare and community partners to implement a clinic-to-community model for patients with noncommunicable disease may be a beneficial population health promotion strategy. Future efforts will be to refine the referral process, scale the model, and continue to inform national health promotion strategies.

Pre-bout hypertension in the combat sports athlete: clearance recommendations

ABSTRACT Hypertension is one of the most prevalent medical disorders in the world and is associated with significant cerebrovascular and cardiovascular morbidity. Pre-bout blood pressure (BP) elevation is extremely common, and ringside physicians must accurately assess the accompanying risk of adverse cerebrovascular and cardiovascular events in the decision to allow participation in combat sports. It is strongly recommended that a ringside physician consider disqualifying a combat sports athlete with severe pre-bout hypertension (systolic BP ≥160 mm Hg and/or diastolic BP ≥100 mm Hg, or stage 2 hypertension in children when indexed by gender, age, and height) from that bout, if it persists despite rest and repeated measurement with accurate equipment. This recommendation is congruent with that of the American College of Sports Medicine, the American College of Cardiology, and the American Heart Association, which recommend non-clearance for sports or exercise testing when BP exceeds those thresholds. Severely elevated BP, as defined above, confers markedly increased risk of morbidity and mortality. Exercise further raises BP markedly. The combination of severely elevated blood pressure and cranial trauma during combat sports is a risk factor for intracranial hemorrhage with a direct impact on the morbidity and mortality associated with ringside combat sports events. Combat sports athletes with SBP ≥130 or DBP ≥90 – and their coaches and families, if available and the athlete consents – should be educated on the causes of hypertension, its acute and chronic risks, and the possible future implications for bout clearance, and the athletes should be referred for evaluation and management.

Four weeks of electrical stimulation improves glucose tolerance in a sedentary overweight or obese Hispanic population.

Introduction/purposeMost US adults (54%) do not meet the minimum exercise recommendations by the American College of Sports Medicine. Neuromuscular electrical stimulation (NMES) is a novel alternate strategy to induce muscle contraction. However, the effectiveness of NMES to improve insulin sensitivity and energy expenditure is unclear. The purpose of this study was to investigate the effects of 4 weeks of NMES on glucose tolerance in a sedentary overweight or obese population.MethodsParticipants (n  = 10; age: 36.8 ± 3.8 years; BMI = 32 ± 1.3 kg/m2) were randomized into either control or NMES group. All participants received bilateral quadriceps stimulation (12 sessions; 30 min/session; three times/week at 50 Hz and 300 µs pulse width) altering pulse amplitude to either provide low-intensity sensory level (control; tingling sensation) or at high-intensity neuromuscular level (NMES; maximum tolerable levels with visible muscle contraction). Glucose tolerance was assessed by a 3-h oral glucose tolerance test (OGTT), and substrate utilization was measured by indirect calorimetry and body composition via dual X-ray absorptiometry at baseline and after 4 weeks of NMES intervention.ResultsControl and NMES groups had comparable fasting blood glucose, glucose tolerance, substrate utilization, and muscle mass at baseline. Four weeks of NMES resulted in a significant improvement in glucose tolerance measured by OGTT, whereas no change was observed in the control group. There was no change in substrate utilization and muscle mass in both control and NMES groups.ConclusionNMES is a novel and effective strategy to improve glucose tolerance in an at-risk overweight or obese sedentary population.

The Effects of FIT Taijipao on Heart Rate

As an American College of Sports Medicine (ACSM) initiative known as Exercise Is Medicine (EIM) is becoming more and more popular globally, FIT Taijipao has been proposed as a new approach to exercise. FIT Taijipao has been introduced as an individualized and dynamic exercise. The purpose of this study was to examine the effects of FIT Taijipao on Heart Rate (HR) at different speeds including peak (YANG) and minimum (YIN) points every three months across 15 months of continuous FIT Taijipao exercise, concluding with a follow-up retention test to examine the effects of an 18-month detraining. The participant of the case study was recruited in a college-wide mind &amp; health program. A 48-year-old sedentary Asian female volunteered for this pilot longitudinal study. The participant performed FIT Taijipao on a treadmill two to three times per week in the exercise lab. A Polar HR Monitor (M400 + H10 chest unit) was used to record HR data. According to FIT Taijipao guidelines, HR Average per 200m was used for data analysis. The Borg Rating of Perceived Exertion (RPE) scale was used to monitor the participant’s subjective effort and controlled to be no higher than 15. YANG Speed (peak) is attained as RPE reaches 15 or less when HR reaches 145 bpm. The running speed was adjusted according to FIT Taijipao established speed profile. Weekly HR average of YANG (peak) speed decreased by 25.3 bpm (146.3 to 121.0 bpm) after first 3 months of FIT Taijipao; Weekly HR average at the same speed continuously decreased to 117.3, 120.0, 116.0, and 116.3 bpm at 4.5 mph speed. YANG (peak) speed increased gradually from 4.5 mph, to 5.7, 6.0, 6.1, 6.3, and 6.3 mph every three months. After 18 months of detraining, a retention FIT Taijipao test was done to examine the HR change. Weekly HR average at 6.3 mph was 160.6 bpm, and the lap average speed was 5.7 mph when HR was around 145 bpm. The RPE reported was 13. This case study illustrates that regular FIT Taijipao leads to a decreased HR, a useful index for exercise intensity and cardio-respiratory fitness. The participant enjoyed FIT Taijipao, a 40-45 minutes run. FIT Taijipao has a great potential to help general population to gain the benefits of exercise and physical activity without being over stressed.

Obesity and Brain Health: The Impact of Metabolic Syndrome and Cardiorespiratory Fitness on Cognitive Performances in Middle-Aged Obese Women.

Mid-life obesity has been reported to be a significant risk factor for later-life dementia and Alzheimer's disease. Metabolic syndrome (MetS) has been suggested to have an adverse effect while cardiorespiratory fitness (CRF) has been suggested to have a protective effect on cognitive function of older adults. However, studies investigating such effects in middle-aged obese women are limited. To compare cognitive performances between obese and normal weight middle-aged women and examine the effects of MetS and CRF on cognitive performances when combined with obesity. Cross-sectional study with the data of 87 middle-aged women (58 obese and 29 normal weight, with age and education matched). The non-invasive screening method for metabolic syndrome (NIM-MetS) was used to detect MetS. CRF was determined by using maximal oxygen consumption (VO2 max) and was classified as high or low (VO2 max higher or lower than 50th percentile) based on the American College of Sports Medicine's guidelines. Neurocognitive tests including Montreal Cognitive Assessment (MoCA), digit span (DS), trail making test (TMT), hand reaction time (HRT), logical memory (LM), and semantic verbal fluency test (SVFT) were administered to all participants. The obese group demonstrated significantly lower score in MoCA, DS, TMT, HRT, and LM than the normal weight group (p < 0.05). The obese with MetS subgroup (n = 28) showed significantly lower score in LM than the obese non-MetS subgroup (n = 30) (p = 0.002). Normal weight with high CRF participants (NW-high CRF; n = 28) demonstrated significantly higher score in MoCA and HRT than obese with high CRF participants (OB-high CRF; n = 24) (p < 0.05), and demonstrated better score in MoCA, DS, TMT, HRT, and LM than obese with low CRF participants (OB-low CRF; n = 24) (p < 0.05). OB-high CRF showed significantly greater score in DS, TMT and LM than OB-low CRF (p < 0.05). Obesity shows negative impact on several cognitive functions, which memory appears to be further affected when combined with MetS in middle-aged women, whereas CRF is suggested to have benefit on certain aspects of cognitive domains. Maintaining a healthy body weight and improving CRF are beneficial for cognitive function of middle-aged women.

Effect of Brisk Walking and Moderate Resistive Exercises on Physical Fitness Level in Middle-aged Women: A Randomised Clinical Tria

Introduction: Insufficient physical activity is considered as one of the leading risk factors for global mortality and morbidity. American College of Sports Medicine recommended an engagement of minimum 150 minutes per week of moderate physical activity. Physical fitness gradually declines with aging. Low muscle strength and decline in the ability to produce force quickly (power) are associated with low walking speed and, further, with mobility limitations. In India, women are more physically inactive than men. Women shows more rapid decline in physical activity than men in middle age. This sex difference may be due to the hormonal changes and barriers such as lack of time, lack of motivation, lack of energy, self awareness and health problems. Aim: To evaluate the effect of brisk walking and moderate resistive exercises on body weight, body fat percentage (Skinfold Caliper), six minute walk distance covered and Physical Fitness Index (PFI) in middle-aged women. Materials and Methods: A randomised clinical study was conducted in Outpatient Department at Dr. D.Y. Patil college of Physiotherapy, India, from November 2021 to January 2022. Total 40 subjects, between age group of 40-60 years with low physical activity, assessed by International Physical Activity Questionnaire, were included in the study. Subjects were divided into two groups with simple random sampling using lottery method. Group A (experimental group; n=20) brisk walking with moderate resistive exercises were given. Group B (conventional group; n=20) includes only brisk walking. The protocol was given for four days a week for four weeks. The outcome measures taken were body weight, body fat percentage, physical fitness index and six minute walk distance. The statistical analysis was done using Medcalc software 18.2.1. Results: The mean age was 45.55±5.73 for group A and 43.30±4.62 for group B. The mean difference of Body weight (BW), Body Fat percentage (BF%), 6 minute walk distance (6MWD) and Physical Fitness Index (PFI) was 1.56, 1.98, -18.82, and -182.34 respectively for group A and 0.23, 1.22, -8.23, -126.16 for group B. On intergroup comparison, the mean difference of BW, BF%, 6MWD and PFI was 1.33, 0.76, -10.59 and -56.18. This shows significant difference between the groups. Conclusion: Brisk walking and moderate resistive exercise can be used as effective treatment in weight management to improve physical fitness level in middle-aged women.

Reproductive health of the fem ale athletes

Physicians, including gynecologists, who deal with sportswomen, do not always consider in their everyday practice the changes in female reproductive function caused by severe physical exercises. A t the same time, this problem is so important, that in 1992 American College of Sports Medicine introduced the term Female Athlete Triad, describing interrelationships between eating disorders, amenorrhea and osteoporosis. It is well known that menarche in athletes occur later than in sedentary women, 5-50% o f athletes are amenorrheic, anovulation takes place in 16%, luteal phase deficiency -in 4 2 % of female athletes. The high rate of ovarian insufficiency among athletes and theirprobable unfavorable sequelae require the problems in treatment andprevention of reproductive disorders in female athletes to be solved. This must be done within the modem standards of reproductive medicine.