American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise

The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.     

Screening, staffing, and emergency preparedness at worksite wellness facilities

PURPOSE: The purpose of this survey was to examine compliance of worksite health and fitness facilities with the American Heart Association/American College of Sports Medicine (AHA/ACSM) recommendations for cardiovascular screening, staffing, and emergency policies for health and fitness facilities. METHODS: A survey was developed and sent to 529 worksite health and fitness facilities. RESULTS: A total of 221 surveys were returned (42% response rate). Twelve percent of facilities had no staff supervision. Among facilities with staff, 12% were not certified in basic life support, and 6% had no national professional certification. Ninety-two percent of facilities followed a health history screening policy although 13% of these facilities administered it irregularly or not at all. Of a total 187 responding facilities, 122 (65%) defined "at risk" as two or more risk factors for heart disease. Of these, 97% either required or recommended new members obtain physician clearance before participation. Four (3%) responding facilities did not require physician clearance. Twenty-five percent of facilities experienced at least one emergency that required ambulance support in the previous year. CONCLUSION: Although this was a low response rate, most responding worksite health and fitness facilities appear to be in compliance with the AHA/ACSM recommendations yet have inconsistencies in some specific practices. There appears to be a need for further consistent implementation of these recommendations into worksite settings.     

Physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The purpose of this paper is to identify key practices for promoting physical activity in older adults, with a focus on older adults with chronic disease or low fitness and those with low levels of physical activity. Key practices identified in promotion activity in older adults include: 1) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; 2) Principles of behavior change, including: social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; 3) Management of risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk-to-benefit ratio and should be the goal for older adults; 4) An emergency procedure plan is prudent for community based programs; and 5) Monitoring aerobic intensity is important for progression and for motivation. Selected content review of physical activity programming from major organizations and institutions are provided. Regular participation in physical activity is one of the most effective ways for older adults, including those with disabilities, to help prevent chronic disease, promote independence, and increase quality of life in old age.     

Variables related to meeting the CDC/ACSM physical activity guidelines

PURPOSE: The purpose of this study was to investigate the relation between perceived importance of physical activity and demographic variables and current physical activity level with specific reference to the CDC/ACSM guidelines for sufficient physical activity for a health benefit. METHODS: Physical activity levels were assessed by a telephone survey of 2002 households throughout the continental United States and the District of Columbia to determine whether the individuals met the CDC/ACSM physical activity guidelines. RESULTS: Results indicate that 68% of the respondents are physically active below the CDC/ACSM criterion. Chi-square analysis revealed significant relationships between meeting the CDC/ACSM physical activity guidelines and 1) perceived importance of physical inactivity as a health risk (P < 0.0001), and 2) gender (P < 0.0001). Logistic regression analysis revealed that having a greater awareness of the health risks of physical inactivity improved the odds ratio (OR = 1.40, 95% CI = 1.21-1.62) of being sufficiently physically active for a health benefit by 40% (P < 0.0001) and being a male improved the odds ratio (OR = 1.45, 95% CI = 1.17-1.79) of being sufficiently physically active for a health benefit by 45% (P < 0.0006). CONCLUSIONS: Implications for health and physical fitness researchers and practitioners are that they need to improve awareness of life span fitness benefits and develop intervention programs based on individuals' current physical activity levels.     

Initiating and maintaining resistance training in older adults: a social cognitive theory-based approach

Numerous research studies performed in "lab-gyms" with supervised training have demonstrated that simple, brief (20-30 min) resistance training protocols performed 2-3/week following the American College of Sports Medicine's guidelines positively affect risk factors associated with heart disease, cancers, diabetes, sarcopenia and other disabilities. For more than a decade, resistance training has been recommended for adults, particularly older adults, as a prime preventive intervention, and increasing the prevalence of resistance training is an objective of Healthy People 2010. However, the prevalence rate for resistance training is only estimated at 10-15% for older adults, despite the leisure time of older adults and access to facilities in developed countries. The reasons that the prevalence rate remains low include public health policy not emphasising resistance training, misinformation, and the lack of theoretically driven approaches demonstrating effective transfer and maintenance of training to minimally supervised settings once initial, generally successful, supervised training is completed. Social cognitive theory (SCT) has been applied to physical activity and aerobic training with some success, but there are aspects of resistance training that are unique including its intensity, progression, precision, and time and place specificity. Social cognitive theory, particularly with a focus on self-regulation and response expectancy and affect within an ecological context, can be directly applied to these unique aspects of resistance training for long-term maintenance.     

Physical activity among adults >or=50 yr with and without disabilities, BRFSS 2001

PURPOSE: Before 2001, the Behavioral Risk Factor Surveillance System (BRFSS), a national survey of health behaviors, assessed only leisure-time physical activity. In 2001, the BRFSS used newly developed physical activity items to evaluate combined leisure-time, household, and transportation activities. Using BRFSS 2001 data, this cross-sectional study describes the prevalence of inactivity and insufficient and recommended physical activity for older adults (i.e., aged >or=50 yr). METHODS: BRFSS 2001 data were analyzed using prevalence estimates and logistic regression to assess physical activity patterns among older adults (N=74,960) stratified by disability status, and select sociodemographic and health status characteristics. RESULTS: A total of 43.4, 39.1, and 17.5% of respondents without disabilities were active at a recommended level, insufficiently active, and inactive, respectively, taking into account nonoccupational physical activities. A total of 28.8% of older adults with disabilities were active at a recommended level, 35.7% insufficiently active, and 35.5% inactive. Among persons with and without disabilities, groups with the highest odds of inactivity and insufficient activity were women, persons aged >or=75 yr, blacks, persons with lower education levels and low incomes, and those who were obese. CONCLUSIONS: Not all persons with disabilities can be active at recommended levels, but it is possible for the vast majority to do some types of physical activity, even if at insufficient levels. Thus, it may be possible for the prevalence of inactivity among persons with and without disabilities to be similar. This was not found. At the start of the new millennium, almost 60% of older adults without disabilities and 70% with disabilities were not obtaining a recommended amount of combined leisure-time, transportation, and household physical activity.     

磁共振心脏成像平面的定位与解剖

目的:改进优化磁共振心脏成像层面的定位方法并阐释重要解剖结构.材料和方法:55名受检者,以显示美国心脏协会(AHA)推荐的标准心脏断层层面为目标,在现有定位方式上,增加两次重复使显示的四腔心层面个体之间差别最小;并在此基础上摸索显示瓣膜和心室流出道的标准层面.结果:经过改进的定位方式可以获得标准的、与AHA推荐的成像层面一致心脏水平长轴位、垂直长轴位和短轴位图像;重要结构如瓣膜和流出道等均可在标准化的层面显示.结论:经过改进的定位方法可以获得AHA推荐的标准心脏断层成像层面,为心脏的磁共振检查提供参考.     

Preparticipation cardiovascular screening

Regular aerobic exercise provides many health benefits regardless of age, and should be promoted by health care providers to all patients. In older athletes, coronary artery disease is the most common cause of sudden death. There is widespread consensus, however, that the overall health benefits derived from exercise outweigh the risks of participation. Screening should focus on identifying signs and symptoms of underlying cardiovascular disease by obtaining a personal and family history and performing a focused physical examination according to the recommendations of the AHA. Exercise testing is recommended in males older than 40 and females older than 50, and individuals with cardiac risk factors. Cardiovascular PPE screening in young athletes remains a challenge, because potentially fatal abnormalities are uncommon and in some cases are undetectable without sophisticated testing. Most sudden cardiac deaths in athletes are caused by anomalies that are clinically silent, are rare, or are difficult to detect by history and physical examination. Many athletes may not experience symptoms consistent with heart disease or may not report family histories of sudden cardiac death. Important clues to a cardiac abnormality include history of syncope, chest pain, and family history of sudden death. Any underlying condition suspected on the basis of history or physical examination requires further diagnostic evaluation before the athlete can be cleared for activity. Currently there is considerable variability and inconsistency among state requirements for PPEs. A national adoption of a more uniform PPE screening process should be encouraged. The screening process should include the AHA's cardiovascular screening recommendations, as this would assist in closing the gap between screening practices recommended by sports medicine experts and the reality of current screening practices. Although the extent of screening continues to be debated, clinical guidelines for performing PPEs and determining clearance have been established. Without a uniform implementation of the current guidelines, it will not be possible to assess the value of the current cardiovascular screening recommendations in detecting and preventing cardiovascular death in young athletes. Physicians should be aware of the emerging role of genetic testing for cardiovascular diseases in athletes with a family history of heart disease or sudden death. Advances in the diagnosis and understanding of cardiovascular disease may provide better tools for preventing sudden death of young athletes in the future [11].     

Menstrual disorders in athletes

Conclusions No one should interpret warnings to physically active women about the hazards of undernutrition as discouraging them from participating in vigorous physical activity. The 1997 ACSM position stand on the female athlete triad opens by stating that "the majority of girls and women derive significant health benefits from regular physical activity without incurring health risks. They should be encouraged to be physically active at all phases of their lives." Nevertheless, the ACSM has a long history of warning against exercising in an unhealthful manner. The ACSM position stand on the female athlete triad is in that responsible tradition.     

Prescription of resistance training for healthy populations.

Although there are well documented protective health benefits conferred by regular physical activity, most individuals of all ages are not physically active at a level for sufficient maintenance of health. Consequently, a major public health goal is to improve the collective health and fitness levels of all individuals. The American College of Sports Medicine (ACSM) and other international organisations have established guidelines for comprehensive exercise programmes composed of aerobic, flexibility and resistance-exercise training. Resistance training is the most effective method available for maintaining and increasing lean body mass and improving muscular strength and endurance. Furthermore, there is an increasing amount of evidence suggesting that resistance training may significantly improve many health factors associated with the prevention of chronic diseases. These health benefits can be safely obtained by most segments of the population when prescribed appropriate resistance-exercise programmes. Resistance-training programmes should be tailored to meet the needs and goals of the individual and should incorporate a variety of exercises performed at a sufficient intensity to enhance the development and maintenance of muscular strength and endurance, and lean body mass. A minimum of 1 set of 8 to 10 exercises (multi-joint and single joint) that involve the major muscle groups should be performed 2 to 3 times a week for healthy participants of all ages. More technical and advanced training including periodised multiple set regimens and/or advanced exercises may be more appropriate for individuals whose goals include maximum gains in strength and lean body mass. However, the existing literature supports the guidelines as outlined in this paper for children and adults of all ages seeking the health and fitness benefits associated with resistance training.     

Physical fitness profiles of young men: associations between physical fitness, obesity and health

Obesity in youth has increased during the last 10 years in Western countries. Several studies have investigated physical activity and its effects on obesity and health, showing that regular physical activity combined with improved physical fitness reduces the risk of obesity and several metabolic problems (e.g. diabetes mellitus, metabolic syndrome, heart disease) and also improves overall health. However, there is only limited scientific information available concerning the changes in the physical fitness profiles of youth. It is obvious that only slight changes observed in endurance-type physical activity can also be observed in aerobic capacity. Today and in the future, a major public health concern for teenage and young adults is the combination of increasing body fatness together with decreasing physical fitness. In order to evaluate overall fitness level, it is particularly essential to examine both aerobic and neuromuscular fitness. Therefore, in clinical practice work and health behaviour education, a person's physical fitness should be measured more frequently with various measures. Furthermore, population-based surveys should be combined with regular measurement of physical fitness to study sedentary lifestyles, particularly in young people. This article presents a review of current physical fitness profiles of male children, adolescents and young adults, which hopefully initiates further studies in this relevant scientific field. In addition, the importance of physical fitness level is evaluated in relation to obesity and health. Collectively, studies examining physical fitness profiles of young men suggest a disturbing worldwide trend of decreased aerobic fitness and increased obesity. Continued efforts to foster improved physical fitness and healthy lifestyles should be encouraged to combat these trends. Such efforts should include frequent and objective assessment of physical fitness rather than solely relying on subjective assessment of physical activity.     

An estimate of physical activity prevalence in a large population-based cohort

PURPOSE: The purpose of this study was to describe the prevalence of self-reported moderate and vigorous physical activity (PA) among 40,261 native Californians in relation to age, gender, education, race/ethnicity, and self-reported disease risk factors. METHODS: Subjects, from the California Twin Program, completed a questionnaire that included three PA questions and were categorized by their level of PA: moderate and vigorous PA sufficient to meet CDC and ACSM guidelines. The relationship between demographic variables, chronic disease risk factors, and meeting the PA guidelines are reported. RESULTS: For moderate and vigorous PA, 22.3% and 37.4% of the total group reported meeting the guidelines respectively. Approximately one-half of all subjects met either duration or frequency criteria, but not both, for moderate and vigorous PA. Only 11.2% and 27.4% reported no moderate or vigorous PA, respectively. Significant age and education gradients existed for both moderate and vigorous PA. An inverse association was noted between both moderate and vigorous PA guidelines and prevalence of chronic disease risk factors. Both frequency and duration of PA were required to adequately characterize the association between PA and health outcomes. CONCLUSIONS: These data demonstrate 1) greater prevalence of sufficient moderate and vigorous PA and lower prevalence of sedentary behavior in this sample compared with adults nationwide, 2) a greater association between vigorous PA and improved health outcomes than was observed for moderate PA, 3) PA guidelines must focus on both frequency and duration of activity, and 4) age and education gradients in moderate and vigorous PA that could have implications for more effective targeting of guidelines to improve the PA prevalence of American adults.     

Self‐reported health‐enhancing physical activity recommendation adherence among 64,380 finnish adults

The Finnish recommendations for health‐enhancing physical activity (PA) for adults (≥18 years) recommend: (i) ≥150 minutes of moderate‐to‐vigorous‐intensity physical activity (MVPA) and (ii) activities that develop muscle strength and balance ≥2 days/week. However, adherence to these recommendations among the Finnish adults is currently unknown. This study reports on the self‐reported adherence to the PA recommendations and associations with sociodemographic factors among Finnish adults. Data were used from the Finnish “Regional Health and Well‐being Study.” In 2013‐2014, postal questionnaires were sent to 132,560 persons, with 69,032 responding (response rate =52.1%). The weighted proportions adhering to the: (i) MVPA recommendation, (ii) sufficient muscle‐strengthening activity (≥2 days/week), (iii) sufficient balance training (≥2 days/week), and (iv) Finnish health‐enhancing PA recommendations (Finnish recommendations) were calculated. Associations with sociodemographic variables (eg, age, education level, self‐rated health) were assessed using multiple logistic regression analyses. Of 69,032 respondents, 92.6% (n=64,380, response rate =48.6%, 18‐98 years) reported on their physical activity levels. A total of 31.2% (95% CI: 30.8%‐31.6%) met the aerobic MVPA recommendation, 17.2% (95% CI: 16.9%‐17.6%) reported sufficient muscle‐strengthening activity, 6.7% (95% CI: 6.4%‐6.9%) reported sufficient balance training, and 10.8% (95% CI: 10.5%‐11.1%) met the Finnish recommendations. In the adjusted analysis, those with poorer self‐rated health, older age, lower education levels, and those classified overweight or obese were independently associated with lower odds of meeting the Finnish recommendations. The vast majority of Finnish adults do not meet the full PA recommendations. Public health action is needed to increase PA in Finland.     

Is coronary artery calcium the key to assessment of cardiovascular risk in asymptomatic adults?

New recommendations put forth in the American College of Cardiology Foundation/American Heart Association (ACC/AHA) Guidelines for Assessment of Cardiovascular Risk in Asymptomatic Adults and the updated 2010 Appropriate Use Criteria for Cardiac Computed Tomography both reflect the unparalleled prognostic power of CAC scoring and it's unique ability to further refine current risk prediction models. The ACCF/AHA guidelines maintain the measurement of CAC is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk (10%-20% 10-year-risk) (IIa, Level of Evidence: B), low-to-intermediate risk (6%-10% 10-year-risk) (IIb, Level of Evidence: B), and in diabetics over age 40 (IIa, Level of Evidence: B). There now exists a large body of published evidence depicting the independent and incremental prognostic value of CAC scoring over Framingham risk score-based strategy alone, a feature unmatched by any other biomarker under investigation. Early detection of subclinical atherosclerosis through noninvasive assessment of CAC leads to more accurate risk stratification and a substantially higher net reclassification improvement (NRI) among intermediate-risk groups, deeming many patients newly eligible for lipid-lowering therapy and other preventative measures.     

Keeping our adult patients healthy and active: the role of vaccines across the lifespan

The Centers for Disease Control and Prevention (CDC) recommend vaccinations from birth through adulthood for lifetime protection against many diseases and infections. Healthy, active adults need to be vaccinated for personal protection against infection as well as associated health benefits (eg, ability to maintain their daily activities). Immunization also reduces the risk of an individual transmitting infection to others, thereby conferring protection to his or her entire community. In the United States, influenza and pertussis (part of the trivalent Tdap) vaccines are recommended for every adult. There are other important vaccines for adults: the human papillomavirus (HPV) vaccine is recommended for every adult female aged up to 26 years, shingles vaccine is recommended for all adults aged ≥ 60 years, and pneumococcal vaccine is recommended based on age (all adults aged ≥ 65 years) and risk factors. Hepatitis A, hepatitis B, and meningococcal vaccines are recommended for adults with certain risk factors or conditions that increase their risk for serious complications (ie, there are no age-based recommendations for these vaccines in adults). Catch-up vaccination is also recommended for adults who have no evidence or proof of immunity to selected, traditionally childhood infections (ie, measles, mumps, rubella, and varicella). Despite the established safety and efficacy of vaccines for disease prevention, millions of adults who should be vaccinated are not, resulting in substantial and avoidable morbidity and mortality, as well as health care expenditures. It is incumbent on health care providers to raise awareness among their adult patients and encourage vaccination, thereby improving uptake among eligible adults. Routine vaccination into adulthood must be viewed as standard of care and an integral component of a comprehensive preventive care program.     

Physical activity and health in the elderly

Adults 65 years and older constitute the most rapidly growing segment of the US population. Sedentary lifestyle is a major risk factor for chronic disease and disability in the elderly. Physical activity levels among most older adults are insufficient to confer health benefits. This paper reviews recent evidence that physical activity and exercise training can positively modify the pathophysiology and outcomes of two leading causes of death and disability in the elderly: cardiovascular disease and fall-related injuries.     

Joint Position Statement: nutrition and athletic performance. American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada

It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of food and fluids, timing of intake, and supplement choices for optimal health and exercise performance. This position paper reviews the current scientific data related to the energy needs of athletes, assessment of body composition, strategies for weight change, the nutrient and fluid needs of athletes, special nutrient needs during training, the use of supplements and nutritional ergogenic aids, and the nutrition recommendations for vegetarian athletes. During times of high physical activity, energy and macronutrient needs-especially carbohydrate and protein intake-must be met in order to maintain body weight, replenish glycogen stores, and provide adequate protein for building and repair of tissue. Fat intake should be adequate to provide the essential fatty acids and fat-soluble vitamins, as well as to help provide adequate energy for weight maintenance. Overall, diets should provide moderate amounts of energy from fat (20% to 25% of energy); however, there appears to be no health or performance benefit to consuming a diet containing less than 15% of energy from fat. Body weight and composition can affect exercise performance, but should not be used as the sole criterion for sports performance; daily weigh-ins are discouraged. Consuming adequate food and fluid before, during, and after exercise can help maintain blood glucose during exercise, maximize exercise performance, and improve recovery time. Athletes should be well-hydrated before beginning to exercise; athletes should also drink enough fluid during and after exercise to balance fluid losses. Consumption of sport drinks containing carbohydrates and electrolytes during exercise will provide fuel for the muscles, help maintain blood glucose and the thirst mechanism, and decrease the risk of dehydration or hyponatremia. Athletes will not need vitamin and mineral supplements if adequate energy to maintain body weight is consumed from a variety of foods. However, supplements may be required by athletes who restrict energy intake, use severe weight-loss practices, eliminate one or more food groups from their diet, or consume high-carbohydrate diets with low micronutrient density. Nutritional ergogenic aids should be used with caution, and only after careful evaluation of the product for safety, efficacy, potency, and whether or not it is a banned or illegal substance. Nutrition advice, by a qualified nutrition expert, should only be provided after carefully reviewing the athlete's health, diet, supplement and drug use, and energy requirements.     

Exercise therapy – the public health message

Non‐communicable chronic diseases (NCDs), such as cardiovascular disease, diabetes, and cancer, are currently responsible for 65% of all deaths worldwide and are projected to cause over 75% of all deaths by 2030. A substantial accumulation of epidemiological and experimental evidence has established a causal relationship between NCDs and well‐known yet preventable risk factors (e.g., physical inactivity and obesity). Given that physical activity has both direct and indirect effects on the mortality and morbidity of NCDs via other risk factors (e.g., obesity, diabetes, and hypertension), it is now undeniable that sedentary lifestyles are one of the most significant public health problems of the 21st century. In 2007, the American College of Sports Medicine (ACSM) and American Medical Association (AMA) launched the Exercise is Medicine® (EIM) initiative in recognition of the fundamental importance of physical activity to health and well‐being. EIM is on the forefront of a global movement to reduce sedentary lifestyles, foster implementation of exercise counseling into clinical practice, and disseminate exercise therapy on a global scale. If the devastating human losses and financial burden of inactivity‐induced chronic disease are to be ameliorated, the wide‐ranging cost‐effective health benefits and financial feasibility of physical activity interventions must be appreciated and promoted.