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ACSM Position Stand: The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults
Abstract
ACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 d·wk-1, at less than 40-50% of V˙O2R, and for less than 10 min-1 is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations.
In the interpretation of this position stand, it must be recognized that the recommendations should be used in the context of participant's needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for the cardiorespiratory, muscular strength and endurance, and flexibility components of the program. An appropriate warm-up and cool-down period, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.
... This is important to note as stroke survivors may have low cardiorespiratory fitness [18,49,52]. Therefore, it may be valuable to prescribe physical activity intensity using a tailored approach based on cardiorespiratory fitness [7,53]. Some measures of relative physical activity intensity include rated perceived exertion and heart rate reserve [7]. ...
... The V3 framework [36], published by the Digital Medicine Society in 2020 and currently being revised as V3+ [37], provides guidelines for the Verification, Usability, Analytical, and Clinical Validation of digital devices to ensure they are "fit for purpose" in their intended contexts. The potential application in speech rehabilitation [51][52][53] and Parkinson's disease [58] has been previously described. This review focuses on using accelerometers to measure physical activity intensity in stroke survivors during acute inpatient rehabilitation. ...
Purpose of Review
Physical activity intensity is an underutilized biomarker in stroke rehabilitation, and current methods of measuring it—such as therapy time and self-reported exertion—have limited validity. Therefore, there is a need for more precise assessment tools. This review uses a novel framework to evaluate potential opportunities for using accelerometry to measure physical activity intensity during inpatient stroke rehabilitation.
Recent Findings
The recently developed V3 and V3 + frameworks outline key evaluation components applicable to accelerometer-based digital health technologies: verification ensures accurate motion data capture, usability validation assesses user-friendliness and effectiveness in real-world scenarios, analytical validation assesses measurement accuracy against reference standards, and clinical validation investigates the association between accelerometer data and pertinent stroke rehabilitation outcomes, such as long-term physical and cognitive function. Existing research suggests that accelerometry could be feasible for physical activity intensity characterization during inpatient stroke rehabilitation, but analytical and clinical validation research is limited. Furthermore, a standardized method should verify that accelerometers reliably capture the target range of physical activity intensities before use in inpatient stroke rehabilitation.
Summary
Despite promising evidence, further research is needed to delineate the potential utility of accelerometry for physical activity intensity characterization during inpatient stroke rehabilitation.
... Several biomarkers related to this adaptive process have been associated with a higher likelihood of developing mental disorders [22,176,177]. These biomarkers are influenced by various factors, including work-related stress [23,24,[178][179][180], early adverse life events [25][26][27], and unhealthy dietary patterns such as high caloric intake and obesity [28][29][30]181]. ...
... Benefits related to changes in mood and creativity may appear even after a single session [178]. The authors found that participation in school sports was a statistically significant predictor for milder depressive symptoms and better self-perceived mental health [179]. Physically active adolescents had higher self-esteem and life satisfaction, and a high level of physical activity was associated with a reduced likelihood of psychological distress among high school seniors [180]. ...
Mental health is an increasing topic of focus since more than 500 million people in the world suffer from depression and anxiety. In this multifactorial disorder, parameters such as inflammation, the state of the microbiota and, therefore, the patient’s nutrition are receiving more attention. In addition, food products are the source of many essential ingredients involved in the regulation of mental processes, including amino acids, neurotransmitters, vitamins, and others. For this reason, this narrative review was carried out with the aim of analyzing the role of nutrition in depression and anxiety disorders. To reach the review aim, a critical review was conducted utilizing both primary sources, such as scientific publications and secondary sources, such as bibliographic indexes, web pages, and databases. The search was conducted in PsychINFO, MedLine (Pubmed), Cochrane (Wiley), Embase, and CinAhl. The results show a direct relationship between what we eat and the state of our nervous system. The gut–brain axis is a complex system in which the intestinal microbiota communicates directly with our nervous system and provides it with neurotransmitters for its proper functioning. An imbalance in our microbiota due to poor nutrition will cause an inflammatory response that, if sustained over time and together with other factors, can lead to disorders such as anxiety and depression. Changes in the functions of the microbiota–gut–brain axis have been linked to several mental disorders. It is believed that the modulation of the microbiome composition may be an effective strategy for a new treatment of these disorders. Modifications in nutritional behaviors and the use of ergogenic components are presented as important non-pharmacological interventions in anxiety and depression prevention and treatment. It is desirable that the choice of nutritional and probiotic treatment in individual patients be based on the results of appropriate biochemical and microbiological tests.
... The average exercise duration was 81.3 ± 19.8 min. Mean and standard deviations for mean HR, peak HR, total steps, and mean METs estimated via accelerometry are reported in Table 2. (19). In this study, the mean HR of novice curlers was 106 BPM. ...
... The mean estimated MET value for the exercise session was 2.1 METs. This physical activity outcome would classify as "very light" to "light" depending on the age of the participant (19). Examples of activities that have moderate to low MET values (≤3.0 Mets) according to Ainsworth et al. 2000 include walking the dog, mild stretching, and picking fruits and vegetables. ...
... After the RWT, participants underwent a cool-down session lasting 5 min, which included slow walking and static stretching. The intensity of the walking was adjusted to meet the target heart rate range of 50-70% of maximum heart rate, as recommended by the American College of Sports Medicine [23,24]. . Blood pressure was categorized as normal (90/60-120/80 mmHg), pre-hypertension (121/81-139/89 mmHg), or hypertension (> 140/99 mmHg). ...
Non-communicable diseases (NCDs), including hypertension and cardiovascular diseases, are significant health concerns in Indonesia. Healthcare workers are particularly vulnerable due to occupational stress and physical inactivity. This study aimed to investigate the relationship between physical fitness and blood pressure among healthcare workers, particularly nurses in Indonesia.
A cross-sectional study was conducted from July to August 2023 at a hospital in Lampung Province. A total of 92 nurses volunteered to participate. Physical fitness was assessed using the Rockport Walking Test (RWT), and blood pressure was measured before and three minutes after the RWT. Body mass index (BMI) and demographic data were also collected. Paired t-tests were used to analyze changes in blood pressure.
Before the RWT, 78.3% of participants had normal blood pressure, increasing to 90.2% post-RWT. The mean decrease in blood pressure was 1.93 mmHg (p = 0.031). Despite 63.0% of participants having poor physical fitness, moderate physical activity, as measured by the RWT, was associated with improved cardiovascular outcomes.
This study found an association between physical fitness and blood pressure among healthcare workers, particularly nurses. While the cross-sectional design limits causal conclusions, the findings suggest that promoting physical activity could help manage blood pressure and reduce NCD risks in this critical workforce.
... Increasing PA is the most common modifiable risk factor for preventable chronic diseases and has been shown to directly prevent 8 out of 10 leading causes of mortality in the US [3,4]. Over the past few decades, many scientific societies and organizations have promoted physical activity and exercise recommendations for policy change or advocated for the clinical prescription of PA for disease prevention and treatment [5][6][7][8][9]. Because of these efforts, exercise prescription is considered a first-line therapy in the prevention and treatment for 26 chronic diseases [10]. ...
Introduction
Lifestyle changes are a powerful way to combat many chronic illnesses. However, education on appropriate instruction of physical activity appears to be insufficient among medical students. This manuscript highlights development, incorporation, and feedback of the Exercise is Medicine elective at the West Virginia School of Osteopathic Medicine.
Materials and Methods
Twenty-four medical students attended ten weekly sessions, each of which lasted 2 h and covered a different topic. Participants were selected based on previous experience with exercise-based medicine and their personal beliefs on incorporating it into clinical encounters. Outcomes were gathered using surveys consisting of the Likert Scale, rating, yes/no/maybe, and free text questions.
Results
Confidence in prescribing lifestyle changes increased ( p < 0.0001) from pre- to post-elective. Feelings of incorporating course material into practice increased ( p < 0.05) after the elective. Feelings that physicians could impact their patients’ physical activity did not change.
Conclusion
Implementation of the Exercise is Medicine elective was well received among students and increased student knowledge and confidence in prescribing lifestyle changes to a variety of patient populations.
... While exercise is recognized for its physical health benefits, its potential in mental health, particularly anxiety management and cognitive enhancement, is often overlooked [12][13][14]. Aerobic exercise and resistance training offer low-cost options for managing stress and improving cognitive task performance [15,16]. ...
Background: Anxiety affects over 280 million people worldwide and is linked to cognitive impairment and memory issues. University students are particularly vulnerable, with studies reporting daily anxiety in this group. Physical activity, on the other hand, has been shown to be effective in reducing stress and anxiety, which could improve cognitive function. This scoping review aims to map the literature on anxiety, academic performance, and physical activity, to identify associations between physical activity, anxiety symptoms, and their impact on academic performance in university students, as well as gaps in existing research. Methods:This scoping review was conducted following the PRISMA-ScR guidelines and the five-stage methodological framework proposed by Arksey and O'Malley for scoping reviews. The study encompassed a review of observational and experimental research, with searches conducted in the PubMed, Cochrane, Web of Science, and Scopus databases that met the eligibility criteria. The data obtained were analyzed using a descriptive-analytical approach, employing a common analytical framework to assess the impact of physical exercise on anxiety symptoms and academic performance. Results: A total of 362 records were identified across PubMed, Cochrane, Web of Science, and Scopus. After a full-text review, 27 studies met the inclusion criteria for this scoping review. Results suggests that interventions involving physical activity, exercise, or sports of varying intensity may reduce anxiety symptoms and improve academic performance. However, there is a notable lack of experimental research specifically targeting the effects of these interventions on anxiety and academic performance in university students. Conclusions: The evidence gathered indicates a potential positive association between exercise, sport, and physical activity interventions on anxiety reduction, with some evidence also pointing to improved
... Thus, among all the loading parameters, intensity is the most important parameter in exercise prescription as it is critical for bone strengthening. A consideration of different classification systems is required at the same time to monitor loading (8), making it necessary to combine resistance exercise recommendations (16), ground reaction force data (17), and perceived exertion ratings (18). ...
... В целом нагрузка при выполнении силовых тренировок, необходимая для улучшения мышечной силы и достижения роста скелетных мышц, должна составлять 65 % или более от максимального количества повторений. Силовые тренировки, составляющие менее 65-70 % от максимальной нагрузки, практически не приводят к увеличению мышечной силы и массы как у молодых, так и у пожилых людей [57]. ...
INTRODUCTION. The development of rehabilitation methods for patients with sarcopenia, a generalized age-associated loss of skeletal muscle mass and strength, is important, since sarcopenia leads to pronounced weakness, functional and motor disorders and an increased risk of death in the elderly. AIM. To analyze the prevalence, features of pathogenesis, diagnosis of secondary sarcopenia, including against the background of motor disorders due to stroke, as well as methods of treatment and medical rehabilitation of such patients. MAIN CONTENT. Among the secondary forms, sarcopenia is of the greatest clinical importance against the background of the consequences of acute cerebrovascular accident (ACA), due to muscular atrophy associated with paralysis and immobility, spasticity, inflammation and denervation of muscles, malnutrition and intestinal absorption of protein and vitamin D. Recent studies show that the prevalence of sarcopenia in stroke patients in emergency hospitals is 8.5–33.8 %, according to other data — more than 42 %. Muscle weakness after a stroke contributes to a decrease in physical functions and the development of disability, and sarcopenia leads to adverse outcomes 90 days after a stroke. According to the meta-analysis, which included 7 cohort studies with a total sample of 1,774 patients who underwent ACA, 27.1 % of them had sarcopenia. Moreover, the presence of sarcopenia negatively affected the clinical and functional outcomes of ACA, as well as the results of medical rehabilitation (odds ratio: 2.42, 95 % confidence interval: 1.76–3.33, p 0.001). CONCLUSION. Despite the prevalence and relevance of this pathology, rehabilitation programs for patients with sarcopenia against the background of the consequences of ACA have not been developed. Isolated foreign publications demonstrate the effectiveness of certain methods of physical therapy and electrical stimulation, but the evidence base for their effectiveness is low.
... If jogging was too hard, it could be alternated with brisk walking. The only requirement was to maintain heart rate within the range 55%-70 % of the age-predicted maximum heart rate (MHR), which is indicative of moderate intensity exercise according to the American College of Sports Medicine (Pollock et al., 1998). In line with the American College of Sports Medicine (ACSM) recommendations, age-predicted maximal HR (MHR) was estimated using the following equation: MHR = 206.9-0.67 × age (ACSM, 2010). ...
This randomized controlled trial investigated the impact of a brief session of group-based running on feelings of energy and fatigue, comparing exercise in a local nature reserve versus an outdoor built environment, and a sedentary control condition. Sixty-six physically active university students participated, with 56 providing full data for each time point. Consistent with previous research, participants in both exercise groups reported significantly increased energy and decreased fatigue compared to those in the sedentary control group. However, the type of outdoor environment did not significantly influence the magnitude of improvements. Contrary to expectations, there was no significant difference in energy enhancement or fatigue mitigation between participants who jogged in a local nature reserve versus those who jogged on a cinder track in an urbanized area. The study discusses potential reasons for this, including seasonal variations in forest volatile organic compounds (FVOCs) concentrations, which may impact the psychological effects associated with forest environments. Further research is needed to better understand the complex relationship between exercise, environment, and feelings of energy/feelings of fatigue.
A coletânea abrange diversos temas, entre eles: as concepções da imagem corporal entre praticantes e instrutores de musculação, fisiculturistas e estudantes de Educação Física na região metropolitana de Salvador; a atividade física como fator de proteção para co-morbidades cardiovasculares em mulheres obesas; prevalência e fatores associados à inatividade física em adultos na cidade de Lauro de Freitas-BA, entre outros.
In brief: In this study shoes, floor types, and individual physical differences were evaluated for their effects on aerobic dance injuries. The injury frequency was 75.9% for instructors and 43.3% for students. The shin was the most common site of injury in both groups. Overall, 60% of the injuries in the student group and 52% of injuries in the instructor group occurred below the knee. Most injuries were not debilitating, and few required medical treatment. The authors concluded that resilient but stable floor surfaces, proper shoes, and moderating the frequency of participation can prevent injuries in aerobic dance.
The reproductive dysfunctions seen with exercise are reviewed. The three salient problems discussed are delayed menarche, secondary amenorrhea, and cycle dysfunction (including shortened luteal or prolonged follicular phases). These problems are probably multifactorial in origin and are not caused by exercise alone. The multiple physiologic changes seen in pregnancy are influenced by an exercise load. No long-term effects of exercise in pregnancy have been documented, although areas of concern are reviewed.
Obese women (140–180% of ideal body weight) were studied on a metabolic ward during 1 wk of maintenance feeding, followed by 5 wk of 800 kcal/d (liquid formula diet). Five subjects participated in a supervised program of daily aerobic exercise and three subjects remained sedentary. Total weight loss was not different between exercising and nonexercising subjects but significantly more of the weight loss came from fat and less from fat-free mass in the exercising subjects. Resting metabolic rate (RMR) declined similarly in both groups (approximately 20%), even though exercising subjects were in greater negative energy balance due to the added energy cost of exercise. In summary, results from this controlled inpatient study indicate that exercise is beneficial when coupled with food restriction because it favors loss of body fat and preserves fat-free mass.
We conducted a 12-wk resistance training program in elderly women [mean age 69 +/- 1.0 (SE) yr] to determine whether increases in muscle strength are associated with changes in cross-sectional fiber area of the vastus lateralis muscle. Twenty-seven healthy women were randomly assigned to either a control or exercise group. The program was satisfactorily completed and adequate biopsy material obtained from 6 controls and 13 exercisers. After initial testing of baseline maximal strength, exercisers began a training regimen consisting of seven exercises that stressed primary muscle groups of the lower extremities. No active intervention was prescribed for the controls. Increases in muscle strength of the exercising subjects were significant compared with baseline values (28-115%) in all muscle groups. No significant strength changes were observed in the controls. Cross-sectional area of type II muscle fibers significantly increased in the exercisers (20.1 +/- 6.8%, P = 0.02) compared with baseline. In contrast, no significant change in type II fiber area was observed in the controls. No significant changes in type I fiber area were found in either group. We conclude that a program of resistance exercise can be safely carried out by elderly women, such a program significantly increases muscle strength, and such gains are due, at least in part, to muscle hypertrophy.
Seven endurance exercise-trained subjects were studied 12, 21, 56, and 84 days after cessation of training. Maximal O2 uptake (VO2 max) declined 7% (P less than 0.05) during the first 21 days of inactivity and stabilized after 56 days at a level 16% (P less than 0.05) below the initial trained value. After 84 days of detraining the experimental subjects still had a higher VO2 max than did eight sedentary control subjects who had never trained (50.8 vs. 43.3 ml X kg-1 X min-1), due primarily to a larger arterial-mixed venous O2 (a-vO2) difference. Stroke volume (SV) during exercise was high initially and declined during the early detraining period to a level not different from control. Skeletal muscle capillarization did not decline with inactivity and remained 50% above (P less than 0.05) sedentary control. Citrate synthase and succinate dehydrogenase activities in muscle declined with a half-time of 12 days and stabilized at levels 50% above sedentary control (P less than 0.05). The initial decline in VO2 max was related to a reduced SV and the later decline to a reduced a-vO2 difference. Muscle capillarization and oxidative enzyme activity remained above sedentary levels and this may help explain why a-vO2 difference and VO2 max after 84 days of detraining were still higher than in untrained subjects.
To determine the minimum duration of exercise for improving the aerobic capacity of patients with coronary heart disease (CHD), 23 female patients with CHD and/or hypertension, aged 52.8±8.7 years, were studied. After pre-testing, all the patients were conditioned for 4 months in order to elicit improvements in their aerobic capacity and other healthrelated factors. Duration and contents of daily activities were recorded by each patient. After 4 months, oxygen uptake at lactate threshold (VO2LT) and VO2peak were increased significantly from 12.9±2.6 to 16.0±3.4ml/kg/min and from 18.5±4.2 to 22.3±5.6ml/kg/min, respectively. Duration of exercise conditioning for the 4 months averaged 23.8±12.2min per day, ranging from 4.6 to 49.7min. Correlational analyses were applied in order to determine the extent to which the improvement in aerobic capacity was associated with the individual mean duration of exercise conditioning. As a result, changes in VO2LT and VO2peak correlated significantly with the exercise duration (Pearson's r=0.51, Spearman's rho=0.47 for VO2LT; Spearman's rho=0.58 for VO2peak) . Both VO2LT and VO2peak tended to improve markedly when daliy exercise duration was 20 min or longer. Furthermore, it was shown that the improvement in aerobic capacity remained almost the same within a range of exercise duration of 20 to 60min. We suggest that the minimum exercise duration for improving the aerobic capacity of cardiac patients is 20 to 30min per day or 140min or more per week.
Twenty-nine men participated in a study designed to evaluate the effectiveness of using ratings of perceived exertion (RPE) in the prescription and regulation of exercise intensity. A secondary purpose of the study was to evaluate the efficacy of the training heart rate (THR) method for regulating exercise intensity by comparing subject-regulated intensity (i.e., THR) with directly recorded electrocardiograms (ECG). The subjects were randomly assigned to one of three groups: group 1 (THR), group 2 (RPE), and group 3 (no prescription). Group 1 had a THR range equivalent to 60% to 70% of their maximal oxygen uptake (VO2 max) and was trained to use the palpation technique and to exercise at intensities within their THR range. Group 2 was trained to maintain a prescribed level of exercise intensity solely by monitoring their RPE. Group 3 served as a control group and was instructed to exercise as they would if they were on their own. A series of six submaximal treadmill exercise sessions was then conducted. The first two sessions provided time for practicing the palpation method of HR determination and RPE techniques; the last four served as experimental sessions during which HRs were recorded every minute by ECG to determine the accuracy of each of the three methods. The study showed that the exercise intensity was maintained within the individualized THR ranges with 55.3% accuracy for group 1 (THR), 48.5% for group 2 (RPE), and 24.5% for group 3 (no prescription). The finding that THR resulted in only a 55.3% accuracy was unexpected, as this is currently the accepted standard for regulating intensity of exercise. Thus the 48.5% accuracy achieved by the RPE method can be considered quite good.
Circuit weight training (CWT) can improve cardiorespiratory endurance, body composition, and strength, and sessions only take 25 to 30 minutes. Studies reviewed in this article showed that CWT increased aerobic capacity about 5%, compared with 15% to 25% in other aerobic exercise programs. Lean body mass increased 1 to 3.2 kg and fat decreased 0.8% to 2.9%. Strength improved 7% to 32%. Energy costs of CWT were similar to jogging at 5 mph. The authors conclude that improvements in strength and V̇O2 max depend on work performed, not the equipment used. Although CWT does not develop high levels of aerobic fitness, it can help maintain fitness.