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

Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.

Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association.

BACKGROUND: Individuals with the metabolic syndrome are 3 times more likely to die of heart disease than healthy counterparts. Exercise training reduces several of the symptoms of the syndrome, but ...

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Aerobic Interval Training Versus Continuous Moderate Exercise as a Treatment for the Metabolic Syndrome: A Pilot Study

High-intensity interval training (HIT), in a variety of forms, is today one of the most effective means of improving cardiorespiratory and metabolic function and, in turn, the physical performance of athletes. HIT involves repeated short-to-long bouts of rather high-intensity exercise interspersed with recovery periods. For team and racquet sport players, the inclusion of sprints and all-out efforts into HIT programmes has also been shown to be an effective practice. It is believed that an optimal stimulus to elicit both maximal cardiovascular and peripheral adaptations is one where athletes spend at least several minutes per session in their 'red zone,' which generally means reaching at least 90% of their maximal oxygen uptake (VO2max). While use of HIT is not the only approach to improve physiological parameters and performance, there has been a growth in interest by the sport science community for characterizing training protocols that allow athletes to maintain long periods of time above 90% of VO2max (T@VO2max). In addition to T@VO2max, other physiological variables should also be considered to fully characterize the training stimulus when programming HIT, including cardiovascular work, anaerobic glycolytic energy contribution and acute neuromuscular load and musculoskeletal strain. Prescription for HIT consists of the manipulation of up to nine variables, which include the work interval intensity and duration, relief interval intensity and duration, exercise modality, number of repetitions, number of series, as well as the between-series recovery duration and intensity. The manipulation of any of these variables can affect the acute physiological responses to HIT. This article is Part I of a subsequent II-part review and will discuss the different aspects of HIT programming, from work/relief interval manipulation to the selection of exercise mode, using different examples of training cycles from different sports, with continued reference to T@VO2max and cardiovascular responses. Additional programming and periodization considerations will also be discussed with respect to other variables such as anaerobic glycolytic system contribution (as inferred from blood lactate accumulation), neuromuscular load and musculoskeletal strain (Part II).

High-intensity interval training, solutions to the programming puzzle: Part I: cardiopulmonary emphasis.

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2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease.

HELGERUD, J., K. HKYDAL, E. WANG, T. KARLSEN, P. BERG, M. BJERKAAS, T. SIMONSEN, C. HELGESEN, N. HJORTH, R. BACH, and J. HOFF. Aerobic High-Intensity Intervals Improve VO2max More Than Moderate Training. Med. Sci. Sports Exerc., Vol. 39, No. 4, pp. 665-671, 2007. Purpose: The present study compared the effects of aerobic endurance training at different intensities and with different methods matched for total work and frequency. Responses in maximal oxygen uptake (VO2max), stroke volume of the heart (SV), blood volume, lactate threshold (LT), and running economy (CR) were examined. Methods: Forty healthy, nonsmoking, moderately trained male subjects were randomly assigned to one of four groups:1) long slow distance (70% maximal heart rate; HRmax); 2) lactate threshold (85% HRmax); 3) 15/15 interval running (15 s of running at 90-95% HRmax followed by 15 s of active resting at 70% HRmax); and 4) 4 4 min of interval running (4 min of running at 90-95% HRmax followed by 3 min of active restingat 70% HRmax). All four training protocols resulted in similar total oxygen consumption and were performed 3 dIwk j1 for 8 wk. Results: High-intensity aerobic interval training resulted in significantly increased VO2max compared with long slow distanceandlactate-thresholdtrainingintensities(P G 0.01). The percentage increases for the 15/15 and 4 4 min groups were 5.5 and 7.2%, respectively, reflecting increases in VO2max from 60.5 to 64.4 mLIkg j1 Imin j1 and 55.5 to 60.4 mLIkg j1 Imin j1 . SV increased significantly by approximately 10% after interval training (P G 0.05). Conclusions: High-aerobic intensity endurance interval training is significantly more effective than performing the same total work at either lactate threshold or at 70% HRmax, in improving VO2max. The changes in VO2max correspond with changes in SV, indicating a close link between the two. Key Words: LACTATE THRESHOLD, AEROBIC POWER, 4 4-MIN INTERVALS, 15/15 TRAINING, STROKE VOLUME, BLOOD VOLUME

Aerobic high-intensity intervals improve VO2max more than moderate training.

The purpose of the present study was to investigate the effect of maximal strength training on cycling economy (CE) at 70% of maximal oxygen consumption (Vo2max), work efficiency in cycling at 70% Vo2max, and time to exhaustion at maximal aerobic power. Responses in 1 repetition maximum (1RM) and rate of force development (RFD) in half-squats, Vo2max, CE, work efficiency, and time to exhaustion at maximal aerobic power were examined. Sixteen competitive road cyclists (12 men and 4 women) were randomly assigned into either an intervention or a control group. Thirteen (10 men and 3 women) cyclists completed the study. The intervention group (7 men and 1 woman) performed half-squats, 4 sets of 4 repetitions maximum, 3 times per week for 8 weeks, as a supplement to their normal endurance training. The control group continued their normal endurance training during the same period. The intervention manifested significant (p < 0.05) improvements in 1RM (14.2%), RFD (16.7%), CE (4.8%), work efficiency (4.7%), and time to exhaustion at pre-intervention maximal aerobic power (17.2%). No changes were found in Vo2max or body weight. The control group exhibited an improvement in work efficiency (1.4%), but this improvement was significantly (p < 0.05) smaller than that in the intervention group. No changes from pre- to postvalues in any of the other parameters were apparent in the control group. In conclusion, maximal strength training for 8 weeks improved CE and efficiency and increased time to exhaustion at maximal aerobic power among competitive road cyclists, without change in maximal oxygen uptake, cadence, or body weight. Based on the results from the present study, we advise cyclists to include maximal strength training in their training programs.

Marius Bjerkaas

Papers

Aerobic high-intensity intervals improve VO2max more than moderate training.

Maximal Strength Training Improves Cycling Economy in Competitive Cyclists