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.

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Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise

For decades, exercise has been considered a cornerstone of diabetes management, along with diet and medication. However, high-quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years. The present document summarizes the most clinically relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these. Our recently published technical review on physical activity/exercise and type 2 diabetes (1) includes greater detail on individual studies, on prevention of diabetes, and on the physiology of exercise.

The present statement focuses on type 2 diabetes. Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement. The levels of evidence used are defined by the ADA in ref. 2.

Two randomized trials each found that lifestyle interventions including ∼150 min/week of physical activity and diet-induced weight loss of 5–7% reduced the risk of progression from impaired glucose tolerance (IGT) to type 2 diabetes by 58% (3,4). A cluster-randomized trial found that diet alone, exercise alone, and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes (5). Therefore, there is firm and consistent evidence that programs of increased physical activity and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT.

Boule et al. (6) undertook a systematic review and meta-analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c (A1C) and body mass in people with type 2 diabetes. Postintervention A1C was significantly lower in exercise than control groups (7.65 vs. 8.31%, weighted mean difference −0.66%; P < 0.001). In contrast, postintervention body weight did not differ between the exercise and control groups. Meta-regression confirmed that the beneficial effect of exercise on A1C …

/pdf/physical-activity-exercise-and-type-2-diabetes-a-consensus-59ii81g069.pdf

Physical Activity/Exercise and Type 2 Diabetes A consensus statement from the American Diabetes Association

For decades, exercise has been considered a cornerstone of diabetes management, along with diet and medication. However, high-quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years. The last American Diabetes Association (ADA) technical review of exercise and type 2 diabetes (formerly known as non–insulin dependent diabetes) was published in 1990. The present work emphasizes the advances that have occurred since the last technical review was published.

Major developments since the 1990 technical review include: 

Based on this new evidence, we have refined the recommendations on the desired types, amounts, and intensities of aerobic physical activity for people with diabetes. Resistance training will now be recommended in a broader group of patients and at a broader range of intensity than done previously. There are other areas in which new evidence is lacking, but we feel that previous recommendations may have been more conservative than necessary. These areas include indications for exercise stress test before beginning an exercise program and precautions regarding …

https://care.diabetesjournals.org/content/diacare/27/10/2518.full.pdf

Physical activity/exercise and type 2 diabetes.

Low cardiorespiratory fitness and physical inactivity were found to be independent predictors of all-cause mortality in men with type 2 diabetes. Physicians should encourage patients with this dise...

Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes

Objective:  To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation. ...

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National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

OBJECTIVES: This study examined cross sectionally the physical activity patterns associated with low, moderate, and high levels of cardiorespiratory fitness. METHODS: Physical activity was assessed by questionnaire in a clinic population of 13,444 men and 3972 women 20 to 87 years of age. Estimated energy expenditure (kcal.wk-1) and volume (min.wk-1) of reported activities were calculated among individuals at low, moderate, and high fitness levels (assessed by maximal exercise tests). RESULTS: Average leisure time energy expenditures of 525 to 1650 kcal.wk-1 for men and 420 to 1260 kcal.wk-1 for women were associated with moderate to high levels of fitness. These levels of energy expenditure can be achieved with a brisk walk of approximately 30 minutes on most days of the week. In fact, men in the moderate and high fitness categories walked between 130 and 138 min.wk-1, and women in these categories walked between 148 and 167 min.wk-1. CONCLUSIONS: Most individuals should be able to achieve these physical...

Physical activity patterns associated with cardiorespiratory fitness and reduced mortality: the Aerobics Center Longitudinal Study.

This study compared simultaneous whole body washdown (WBW) and regional skin surface (REG) sweat collections to generate regression equations to predict WBW sweat Na+ concentration ([Na+]) and K+ concentration ([K+]) from single- and five-site REG sweat patch collections. Athletes (10 men, 10 women) cycled in a plastic chamber for 90 min in the heat. Before exercise, the subject and bike were washed with deionized water. After the onset of sweating, sterile patches were attached to the forearm, back, chest, forehead, and thigh and removed on saturation. After exercise, the subject and bike were washed with ammonium sulfate solution to collect all sweat electrolyte loss and determine the volume of unevaporated sweat. All individual patch sites and five-site REG (weighted for local sweat rate and body surface area) were significantly (P = 0.000) correlated with WBW sweat [Na+]. The equation for predicting WBW sweat [Na+] from five-site REG was y = 0.68x + 0.44 [r = 0.97, intraclass correlation coefficient (...

https://www.physiology.org/doi/pdf/10.1152/japplphysiol.00197.2009

Comparison of regional patch collection vs. whole body washdown for measuring sweat sodium and potassium loss during exercise

This observational study was designed to determine whether football players with a history of heat cramps have elevated fluid and sodium losses during training. During a “two-a-day” training camp, five Division I collegiate football players (20.2 ± 1.6 y, 113 ± 20 kg) with history of heat cramps (C) were matched (weight, age, race and position) with a cohort of teammates (19.6 ± 0.6 y, 110 ± 20 kg) who had never cramped (NC). Change in body weight (adjusted by fluid intake) determined gross sweat loss. Sweat samples (forearm patch) were analyzed for sodium and potassium concentrations. Adlibitum fluid intake was measured by recording pre- and post-practice bottle weights. Average sweat sodium loss for a 2.5-h practice was projected at 5.1 ± 2.3 g (C) vs. 2.2 ± 1.7 g (NC). When averaged across two practices within the day, fluid intake was similar between groups (C: 2.6 ± 0.8 L vs. NC: 2.8 ± 0.7 L), as was gross sweat loss (C: 4.0 ± 1.1 L vs. NC: 3.5 ± 1.6 L). There was wide variability in the fluid defici...

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Sweat and Sodium Losses in NCAA Football Players: A Precursor to Heat Cramps?

This study investigated the relationship between runners' perceptions of fluid needs and drinking behavior under conditions of compensable heat stress (ambient temperature = 20.5 +/- 0.7 degrees C, 68.9 degrees F; relative humidity = 76.6%). Eighteen experienced runners (15 men, 40.5 +/- 2.5 y, and 3 women, 42 +/- 2.3 y) were given ad libitum access to a sports drink (6% carbohydrate-electrolyte solution) at Miles 2, 4, 6, and 8. After the run (75.5 +/- 8.0 min), subjects completed questionnaires that required them to estimate their individual fluid intake and sweat loss. Dehydration averaged 1.9% +/- 0.8% of initial body weight (a mean sweat loss of 21.6 +/- 5.1 mL.kg-1.h-1). Subjects replaced only 30.5% +/- 18.1% of sweat loss and underestimated their sweat loss by 42.5% +/- 36.6% (P <or= 0.001). Subjects' self-estimations of fluid intake (5.2 +/- 3.2 mL.kg-1.h-1) were not significantly different from actual fluid intake (6.1 +/- 3.4 mL.kg-1.h-1) and were significantly correlated (r = 0.63, P = 0.005). The data indicate that even under favorable conditions, experienced runners voluntarily dehydrate (P <or= 0.001), possibly because they are unable to accurately estimate sweat loss and consequently cannot subjectively judge how much fluid to ingest to prevent dehydration. This conclusion suggests that runners should not depend on self-assessment to maintain adequate hydration, underscores the need for runners to enhance their ability to self-assess sweat losses, and suggests that a predetermined regimen of fluid ingestion might be necessary if they wish to maintain more optimal hydration.

https://secure.footprint.net/gatorade/prd/gssiweb/pdf/20071221222945730.pdf

Voluntary dehydration in runners despite favorable conditions for fluid intake

The purpose of this study was to establish normative data for regional sweat sodium concentration ([Na+]) and whole-body sweating rate in athletes. Data from 506 athletes (367 adults, 139 youth; 40...

John R. Stofan

Papers

Physical activity patterns associated with cardiorespiratory fitness and reduced mortality: the Aerobics Center Longitudinal Study.

Comparison of regional patch collection vs. whole body washdown for measuring sweat sodium and potassium loss during exercise

Sweat and Sodium Losses in NCAA Football Players: A Precursor to Heat Cramps?

Voluntary dehydration in runners despite favorable conditions for fluid intake

Normative data for regional sweat sodium concentration and whole-body sweating rate in athletes