b y L e n K r ^ v I t z , P h D

(TC QUIZ 2:PAGE 82

From 1998 to 2011ACSM Publishes -Updated Exercise^Guidelines ~ "^Updates that help you tohelp your clients.

Garber, C.E., et al. 2011. Quantity andquality of exercise for developing andmaintaining cardiorespiratory, muscu-loskeletal, and neuromotor fitness in ap-parently healthy adults: Guidance forprescribing exercise. Medicine & Sciencein Sports & Exercise, 43 (7), ¡334-59.

The new American College of SportsMedicine (ACSM) Position Stand paperon exercise quantity and quality is an up-date of the 1998 ACSM document on thistopic. The new paper cites over 400 pub-lications from scientific reviews, epi-demiological studies, clinical studies,meta-analyses, consensus statements andevidence-based guidelines.

The purpose of this ACSM PositionStand is to present evidence-based direc-

' tion to health and fitness professionals ondeveloping individualized exercise train-ing programs for apparently healthyadults of all ages (Garber et al. 2011).Competent exercise and health profes-sionals can also use these guidelines for

..people with some chronic health prob-lems or disabilities, incorporating modi-fications appropriate to these clients'physical function and health status.

Helpfully, Garber and colleagueshave clarified common misunderstand-

Figure 1. Health Benefits of Cardiorespiratory,Resistance, Flexibility and Neuromotor Exercise

decreased risk of developingcoronary heart disease (CHD)

improved insulinsensitivity

reduced chance ofdeveioping osteoarthritis

improved HDL-C

prevention or reversalof osteoporosis

improvement indepressivedisorders

reduced riskof falling

decreased risk of developingtype 2 diabetes and

metabolic syndrome

improvedcholesterol profile

reduced depressionand anxiety

improved blood pressure(when eievated)

increased bone mass

improved body composition

reduction in CHD markers

higher levels of weli-being, quality of life, cognitive function and energy

decreased risk of developing functional limitations

Improved balance, agility, gait and coordination

decreased risk of having a stroke

decreased risk of developingcolon and breast cancer

Source: Garber et al. 2011.

18 October 2011 Fitness Journal

ings regarding frequently used fitnessterminology (see the sidebar "ExerciseTerminology Clarified").

One of the most compelling sectionsof the paper is a fact-based review of thenumerous health benefits (see Figure 1)conferred by a comprehensive exerciseprogram of resistance, cardiorespiratory,flexibility and neuromotor exercise.Equally impressive is ACSM s statementthat "engaging in regular exercise and re-ducing sedentary behavior is vital for thehealth of adults."

Cardiorespiratory ExerciseDesign GuidelinesIt is important to note that Garber et al.(2011) state that the minimum level ofcardiorespiratory fitness required forhealth benefits may be different for menthan it is for women and different forolder adults than it is for younger ones.Garber and colleagues also note thatsedentary behavior (e.g., sitting at a desk-top workstation, watching TV, surfing theInternet) is associated with depression,higher coronary heart disease, increasedwaist circumference, elevated blood pres-sure, depressed lipoprotein lipase activity(leading to higher levels of circulatingblood triglycérides) and elevated bloodglucose, insulin and cholesterol.

The authors state that daily physicalactivity, exercise and standing movementduring the day can help diminish theseunfavorable biological effects. The guide-lines recommend progressive increases instep counts of >2,000 steps (when using apedometer), to attain a daily step count ofat least 7,000 steps. The new cardiorespi-ratory exercise recommendations areshown in Table 1.

Resistance ExerciseDesign GuidelinesHigher levels of muscular fitness are as-sociated with reduced risk of all causes ofdisease, improved cardiometabolic health(a construct that includes a group of riskfactors that are indicators of a person'soverall risk for type 2 diabetes, stroke andcardiovascular disease) and reduced riskof developing functional limitations. Infact, Garber and colleagues state in the newACSM Position Stand that resistance exer-cise may be an effective intervention in thetreatment of metabolic syndrome. Very

Table 1. CardiorespiratoryExercise Recommendations

Variable

frequency

intensity

time

type

pattern

progression

Evidence-Based Recommendation

>5 days/week for moderate-intensity* exercise or >3 days/week for vigorous-intensity** exercise, or >3-5 days/week for a combination of both

moderate and/or vigorous (for apparently healthy adults)

30-60 minutes at a moderate intensity or 20-60 minutes at a vigorousintensity, or a combination of both

purposeful, continuous, rhythmic exercise involving the body's majormuscle groups

one continuous exercise session per day or multiple sessions of>10 minutes to accumulate the desired duration

intensity, duration and frequency progressed gradually until desiredgoal is attained

'Moderate-intensity exercise is fairly light to somewhat hard, equivalent to 12-13 on the rating-of-perceived-exertion (RPE) scale.

**Vigorous exercise is somewhat hard to very hard, equivalent to 14-17 on the RPE scale.

Table 2. Resistance Exercise Recommendations

Variable

frequency

intensity(strength)

intensity(endurance)

intensity(power)

repititions

sets

rest

Evidence-Based Recommendation

major muscle groups: 2-3 days/week with 48-hour rest betweensessions for muscle groups

40%-50% of one-repetition maximum (I-RM), or very light to light load,for novice older-adult exercisers and novice sedentary adults

60%-70% of 1 -RM, or moderate to hard load, for novice to intermediateadult exercisers

>80% of 1 -RM, or hard to very hard load, for experienced welghtlifters

<50% of 1 -RM, or light to moderate load

20%-50% of 1 -RM, or extremely light to light load, for older adults

10-15 repetitions to improve strength in novice, middle-aged andolder-adult exercisers

8-12 repetitions to improve strength and power in most adults15-20 repetitions to improve muscular endurance in most adults

single-set training for novice and older adults2-4 sets to improve strength and power in most adults<2 sets for muscular endurance

2-3 minutes of rest between sets in multiple-set training

October 2011 IDEA Fitness Journal 19

important, they state that the bone-load-ing stress of resistance exercise may pre-vent, slow and even reverse the losses ofbone mineral and bone mass that occurwith osteoporosis.

Program designs should target opposingmuscle groups of the chest, shoulders, back,hips, legs, trunk and arms. Clients shouldperform all exercises with a purposeful, con-trolled, full range of motion. See Table 2 fornew resistance exercise guidelines.

Exercise TerminologyClarified

The terms physical activity, exercise,

piiysicai fitness and piiysical function

are closely related and interchanged

frequently, yet have discrete meanings.

The new ACSM Position Stand (2011 )

distinguishes these terms with the fol-

lowing definitions:

• Physical fitness: the ability to carry

out daily tasks with vigor and alert-

ness, without undue fatigue and

with ample energy to enjoy [leisure]

pursuits and to meet unforeseen

emergencies. Physical fitness is

operationalized as [a set of] measur-

able health- and skill-related attributes

that include cardiorespiratory fitness,

muscular strength and endurance,

body composition and flexibility, bal-

ance, agility, reaction time and power.

• Exercise: physical activity that is

planned, structured and repetitive,

and [that] has as a final or interme-

diate objective the improvement or

maintenance of physical fitness.

• Physical activity: a bodily move-

ment produced by skeletal muscles

that results in energy expenditure

above resting (basal) levels. Physical

activity broadly encompasses exer-

cise, sports and physical activities

done as part of daily living, occupation,

leisure and active transportation.

• Physical function: the capacity of

an individual to carry out the physical

activities of daily living. Physical

function reflects motor function

and control, physical fitness and

habitual physical activity, and is an

independent predictor of functional

independence, disability, morbidity

and mortality.

Variable

frequency

intensity

time

PNF

stretches

pattern

volume

Evidence-Based Recommendation

major muscle groups: >2-3 days/week of stretching; greater gains

will be attained if done daily

to the point of slight discomfort or a feeling of tightness in the muscle

30-60 seconds of static-stretching holds for older adults

10-30 seconds of static-stretching holds for most adults

3-6 seconds of muscle contraction at 20%-75% of maximum intensity,

followed by 10-30 seconds of assisted stretch

2-4 repetitions of each stretch

a total of 60 seconds of stretching time per target muscle group for

any stretching method utilized

Table 4. Neuromotor Exercise Recommendations

Variable

frequency

intensity

time

type

volume

Evidence-Based Recommendation

>2-3 days/week

not determined at this time

>20-30 minutes/day may be needed

exercises that improve balance, agility, coordination and gait, particularly

for older adults needing to improve/maintain physical function and to

prevent falls

optimal volume of repetitions and sets not yet known

October 2011 IDEA Fitness Journal

Flexibility ExerciseDesign GuidelinesGarber et al. 2011 recommend that flexi-bility programs (including static, dynamicand proprioceptive neuromuscular facili-tation [PNF] methods) should be designedspecifically to meet the needs and demandsof each individual's lifestyle. For mostadults, flexibility training will improve bal-ance and postural stability. The relationshipbetween flexibility and a reduction of mus-culoskeletal injury has not been substanti-ated in the literature. Flexibility exerciseguidelines are shown in Table 3.

Neuromotor ExerciseDesign GuidelinesNeuromotor exercise (i.e., functional exer-cise) training is advantageous as part of anall-inclusive exercise program for adults,especially older persons. This type of train-ing can improve balance, agility, musclestrength, gait and coordination, and canalso reduce the risk of falls. Garber and col-leagues conclude that more research isneeded to clarify the specific health-relatedchanges resulting from functional fitnesstraining and to determine the effectivenessof different exercise types and amounts. SeeTable 4 for recommendations.

FinalThoughtsOne of the most impressive evidence-basedstatements in the new ACSM PositionStand is that leadership from well-trainedfitness professionals will meaningfullyenhance the exercise experience of adults,especially those who are novice exercisers.The fact that a position statement with over400 cited references highlights the impor-tance of skilled exercise professionals is atrue measure of how much we as a profes-sion have grown in the last decade. •

Len Kravitz, PhD, is the program coordina-tor of exercise science and a researcher at theUniversity of New Mexico, Albuquerque,where he has won the Outstanding Teacherof the Year award. He was honored with theCan-Fit-Pro Lifetime Achievement Awardin 2008 and received the 2010 AquaticExercise Association Global Award.

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