THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 8 - AUGUST 98
ACSM Makes Exercise Advice More Flexible: Fitness Recommendations Updated
Recent revisions to the American College of Sports Medicine (ACSM) exercise recommendations (1) for healthy adults may make it easier for patients to stick to an exercise routine, according to two experts who drafted the recommendations.
The guidelines, last revised in 1990, were presented in June at the ACSM meeting in Orlando by writing group chair Michael L. Pollock, PhD, who died 2 days after the presentation (see "Noteworthy," below). Pollock, who was an exercise physiologist at the University of Florida, commented on the new guidelines in a press release from the University of Florida. "These current guidelines include flexibility exercises and modifications to aerobic and weight training based on current research that will help the average person adhere to a fitness program," he said.
ACSM President-Elect Barry A. Franklin, PhD, part of the eight-member recommendation writing group, says the new document is based on 262 of the most meaningful recent research studies on health and exercise. Franklin is the director of the Cardiac Rehabilitation Program and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Michigan, and a professor of physiology at Wayne State University School of Medicine in Detroit. He says the group's report underwent extensive review before it was approved by the ACSM Board of Trustees. "The recommendations are based on the consensus of some of the best minds in the country," he says.
Aerobic exercise. One of the newest messages in the exercise recommendations is that exercise has an additive effect, says Franklin, who is also an editorial board member of The Physician and Sportsmedicine. Cardiovascular benefits gained in three 10-minute exercise bouts are almost the same as those from one 30-minute exercise bout. "My own perception," he says, "is that too many people are preoccupied with going to the gym. The new guidelines stress being active in daily living. People can get many of the health benefits of exercise without being in a formal exercise setting."
The exercise recommendations also clarify the dose of exercise needed to improve aerobic fitness, Franklin says. For sedentary or unfit persons, aerobic endurance exercise needs to be performed more than 2 days per week, at more than 40% to 50% of aerobic capacity, and for 10 minutes or longer, he says.
Franklin notes that physicians will see a new term—maximal oxygen uptake reserve—when they consult the new recommendations. "It's a function of heart rate reserve. The new terminology is preferred because it is incorrect to relate heart rate reserve to a level of metabolism that starts from zero rather than a resting level (ie, 1 MET). Franklin says other advantages include increased accuracy in the prescribed target heart rate and relative exercise intensity, and calculation of net caloric expenditure.
The recommendation states that people should perform aerobic exercise 3 to 5 days a week at 40% or 50% to 85% of maximum oxygen uptake reserve. The lower number applies to unfit individuals. Exercise should be done for 20 to 60 minutes; 10-minute bouts can be accumulated throughout the day. (See "Fitting in Fitness: Exercise Options for Busy People.")
Resistance training. A number of studies show that one set of 8 to 15 repetitions provides nearly the same strength and endurance increases as three sets, according to Franklin. "That's one of the most astounding things about these new recommendations," he says. Multiple sets produce only slightly greater benefits, he says.
Also new to the 1998 guidelines is recognition of the cardiovascular benefits of resistance training, Franklin says. Previously, it was thought that such training produced no cardiovascular benefits. But, according to Franklin, research shows that over time, resistance training reduces heart rate and blood pressure responses when lifting any given load. "Resistance training results in reduced stress on the heart, and yes, you can get that even with a one-set regimen," he says.
The recommendations state that people younger than 50 should work the major muscle groups 2 to 3 days a week with weight loads that allow 8 to 12 repetitions; those older than 50 are advised to perform with weight loads that allow 10 to 15 repetitions.
Flexibility training. For the first time, flexibility training has been added to the ACSM's exercise recommendations. According to Franklin, flexibility training decreases the potential for injury and improves physical function.
The stretching routine advised by the ACSM takes only a few minutes, Franklin says. The ACSM advises dynamic and static range-of-motion stretching of all the body's major muscle/tendon groups, 4 repetitions per muscle group, 2 to 3 days per week.
Fitness Clubs Urged To Do Cardiac Screening
Fitness clubs may soon be screening the cardiac health of their clients, if recommendations from the American Heart Association (AHA) and the American College of Sports Medicine (ACSM) are heeded. Club members identified as having risk factors may soon be handing their doctors medical release forms for clearance to work out.
The recommendations, released in June at the ACSM meeting in Orlando, were prompted by health, age, and exercise demographics, according to a press release from the AHA, based in Dallas. About one in four adult Americans has some form of cardiovascular disease, and during exercise people with heart disease are at 10 times higher risk of having a cardiac event than people who are disease free. The fastest-growing segment of health club members is people over age 34, an age when the risk of heart disease begins to rise, says Gary J. Balady, MD, in the AHA press release. Balady, a cardiologist and professor of medicine at Boston University School of Medicine, was the lead author of the recommendations. "Many Americans are surviving their heart attacks and are being told by their doctors to exercise more. So there may be more individuals showing up at health clubs who have heart disease," says Balady.
The recommendations contain screening, staffing, and emergency policies, along with a screening tool. "It's a very simple screen. It takes two minutes to complete, if that," Balady says. The report recommends adapted forms of two screening tools that are likely to identify persons at risk without inhibiting exercise participation: the Physical Activity Readiness Questionnaire (1), published in 1991, and a tool developed by the American Heart Association Wisconsin affiliate in 1989 (2). The recommendations, jointly published in AHA (3) and ACSM (4) journals, were developed with input from the International Health, Racquet, and Sportsclub Association (IHRSA), based in Boston.
People who don't know their cholesterol level or blood pressure are encouraged to consult a physician about their heart disease risk. The recommendations say that club members with known risk factors who don't obtain a medical evaluation can be excluded from participation "to the extent permitted by law." "Our purpose," Balady says, "is not to set up barriers, but to bridge the gap between the physician, the patient, and the health club."
John D. Cantwell, MD, a cardiologist at Cardiology of Georgia, PC, and clinical professor of medicine at Morehouse School of Medicine, both in Atlanta, lauds the recommendations and says he hopes health clubs adopt them. "The recommendations are a gold standard against which we can measure the quality of such centers," says Cantwell, who is an editorial board member of The Physician and Sportsmedicine. "The guidelines will enhance communication between patients, physicians, and the health club staff. At present, such communication is rather haphazard."
Cantwell says he wishes that the recommendations advised health clubs to install automated external defibrillators. He says a defibrillator might have saved the life of a 46-year-old patient who suffered a cardiac arrest while playing racquetball at a fitness center last year. "Based on the literature and my 25 years as a cardiac rehabilitation program director, the single most effective measure in an exercise-related cardiac arrest is prompt defibrillation," he says. "If the airlines can do it, so can fitness centers." Balady says the group did not recommend defibrillators because the rate of heart attack emergencies at health clubs is not known, and that most clubs have access to emergency services.
Health clubs that don't comply with the screening recommendations may increase their liability risks, says David Herbert, a specialist in the legal aspects of sports medicine who is a senior partner at Herbert, Benson, & Scott in Canton, Ohio, and an editorial board member of The Physician and Sportsmedicine. Herbert says strong wording in the statement, such as the word "must" in the screening and emergency planning sections, might sway courts to see the recommendations more as standards than as recommendations. Legal complications may arise for health clubs, Herbert says, because the ACSM publishes its own separate recommendations (5), which are not as strong as the AHA-ACSM statement.
Will the liability risks drive up the cost of joining a club, posing a barrier to activity? Not likely, says Herbert. Cathy Masterson McNeil, spokesperson for the IHRSA, agrees. "We're not overly concerned about that," she says. "Cardiac screening is a reality that has to be dealt with. The older, baby boomer profile of people joining health clubs now is very different than it was 10 years ago when new members were young and healthy and didn't need cardiac screening," she says. "We view the recommendations as being based on sound principles. They will be useful for clubs that serve the deconditioned market."
Running to Fight Leukemia
In the early morning of summer's first day, 20,000 runners jammed the San Diego streets for the first ever Rock 'n' Roll Marathon. Though Kenyans dominated the finish line, the editorial staff of The Physician and Sportsmedicine counted on our own senior editor from Minneapolis, Bob Roos, to uphold our sportive image. And that he did, by completing the course and, in the process, raising over $3,600 for the Leukemia Society of America through its Team in Training program.
The program. Roos, 47, joined the Twin Cities Team in Training in February. The Leukemia Society's program offered him individual coaching and group training. In return, Roos agreed to raise at least $3,000 for leukemia research and financial aid to patients.
By June, Roos had progressed from 10 to 21 miles on biweekly group runs, managed several ailments, including an ankle sprain and a muscle strain, and was primed for his first marathon.
The race. Unfortunately, the 7:30 am start was delayed 40 minutes, and Roos and thousands of well-hydrated runners stood in satellite lines or judiciously improvised. Once the gun sounded, the first half went well, as rock bands stationed every mile thumped a running rhythm. But soon Roos felt the effects of his previous day's visit to the San Diego Zoo. "About mile 17 or so I hit the wall," he said. "I had burned just about every molecule of glycogen, and I had to walk quite a bit the last several miles."
The payoff. Roos finished in just under 5 hours, and though far from first in this race, he and the 6,000 members of the Team in Training created a significant first of their own, raising over $15.6 million for the Leukemia Society of America, reportedly the largest single charity fund-raiser connected with a sports event.
Michael L. Pollock, PhD, a renowned expert on exercise and health, died of a cerebral aneurysm on June 5 at age 61, according to a press release from the University of Florida in Gainesville. Pollock was director of the University of Florida Center for Exercise Science. He collapsed while attending the annual meeting of the American College of Sports Medicine (ACSM) in Orlando, where earlier in the week he had presented new national exercise guidelines (see "ACSM Makes Exercise Advice More Flexible," above) and research on resistance training.
In his prolific career, Pollock wrote 230 articles and three books on physiology, physical fitness, cardiac rehabilitation, and sports medicine. He was president of the ACSM from 1982 to 1983 and served on the ACSM exercise guidelines committee from 1972 until his death. He was a consultant to the President's Council on Physical Fitness and Sports from 1972 to 1989.
Barry A. Franklin, PhD, ACSM president-elect, knew Pollock well and served with him on many committees. Pollock's tireless pursuit of the optimal frequency, intensity, duration, and modes of exercise training provided the cornerstone of exercise prescription as we know it today, says Franklin, who is an editorial board member of The Physician and Sportsmedicine. "His research influenced literally millions of adults in the US and abroad—he helped patients help themselves," he says. "He truly made a difference, and his legacy will continue through his publications and by the countless students and colleagues that he touched over the years—I was one of them."
Pollock is survived by his wife, Rhonda, son Jonathan, and daughters Lauren and Elisa, all of whom live in Gainesville.
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