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

The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: Section 1 briefly reviews the structural and functional changes that characterize normal human aging, Section 2 considers the extent to which exercise and physical activity can influence the aging process, and Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults. Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises. The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans. All older adults should engage in regular physical activity and avoid an inactive lifestyle.

Exercise and physical activity for older adults

In order to stimulate further adaptation toward specific training goals, progressive resistance training (RT) protocols are necessary The optimal characteristics of strength-specific programs include the use of concentric (CON), eccentric (ECC), and isometric muscle actions and the performance of bilateral and unilateral single- and multiple-joint exercises In addition, it is recommended that strength programs sequence exercises to optimize the preservation of exercise intensity (large before small muscle group exercises, multiple-joint exercises before single-joint exercises, and higher-intensity before lower-intensity exercises) For novice (untrained individuals with no RT experience or who have not trained for several years) training, it is recommended that loads correspond to a repetition range of an 8-12 repetition maximum (RM) For intermediate (individuals with approximately 6 months of consistent RT experience) to advanced (individuals with years of RT experience) training, it is recommended that individuals use a wider loading range from 1 to 12 RM in a periodized fashion with eventual emphasis on heavy loading (1-6 RM) using 3- to 5-min rest periods between sets performed at a moderate contraction velocity (1-2 s CON; 1-2 s ECC) When training at a specific RM load, it is recommended that 2-10% increase in load be applied when the individual can perform the current workload for one to two repetitions over the desired number The recommendation for training frequency is 2-3 d·wk -1 for novice training, 3-4 d·wk -1 for intermediate training, and 4-5 d·wk -1 for advanced training Similar program designs are recommended for hypertrophy training with respect to exercise selection and frequency For loading, it is recommended that loads corresponding to 1-12 RM be used in periodized fashion with emphasis on the 6-12 RM zone using 1- to 2-min rest periods between sets at a moderate velocity Higher volume, multiple-set programs are recommended for maximizing hypertrophy Progression in power training entails two general loading strategies: 1) strength training and 2) use of light loads (0-60% of 1 RM for lower body exercises; 30-60% of 1 RM for upper body exercises) performed at a fast contraction velocity with 3-5 min of rest between sets for multiple sets per exercise (three to five sets) It is also recommended that emphasis be placed on multiple-joint exercises especially those involving the total body For local muscular endurance training, it is recommended that light to moderate loads (40-60% of 1 RM) be performed for high repetitions (>15) using short rest periods (<90 s) In the interpretation of this position stand as with prior ones, recommendations should be applied in context and should be contingent upon an individual's target goals, physical capacity, and training status

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Progression Models in Resistance Training for Healthy Adults

SUMMARYACSM 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 chr

http://myweb.facstaff.wwu.edu/chalmers/pdfs/acsm position stand - quantity and quality of exercise.pdf

ACSM Position Stand: The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults

In order to stimulate further adaptation toward a specific training goal(s), progression in the type of resistance training protocol used is necessary. The optimal characteristics of strength-specific programs include the use of both concentric and eccentric muscle actions and the performance of both single- and multiple-joint exercises. It is also recommended that the strength program sequence exercises to optimize the quality of the exercise intensity (large before small muscle group exercises, multiple-joint exercises before single-joint exercises, and higher intensity before lower intensity exercises). For initial resistances, it is recommended that loads corresponding to 8-12 repetition maximum (RM) be used in novice training. For intermediate to advanced training, it is recommended that individuals use a wider loading range, from 1-12 RM in a periodized fashion, with eventual emphasis on heavy loading (1-6 RM) using at least 3-min rest periods between sets performed at a moderate contraction velocity (1-2 s concentric, 1-2 s eccentric). When training at a specific RM load, it is recommended that 2-10% increase in load be applied when the individual can perform the current workload for one to two repetitions over the desired number. The recommendation for training frequency is 2-3 d x wk(-1) for novice and intermediate training and 4-5 d x wk(-1) for advanced training. Similar program designs are recommended for hypertrophy training with respect to exercise selection and frequency. For loading, it is recommended that loads corresponding to 1-12 RM be used in periodized fashion, with emphasis on the 6-12 RM zone using 1- to 2-min rest periods between sets at a moderate velocity. Higher volume, multiple-set programs are recommended for maximizing hypertrophy. Progression in power training entails two general loading strategies: 1) strength training, and 2) use of light loads (30-60% of 1 RM) performed at a fast contraction velocity with 2-3 min of rest between sets for multiple sets per exercise. It is also recommended that emphasis be placed on multiple-joint exercises, especially those involving the total body. For local muscular endurance training, it is recommended that light to moderate loads (40-60% of 1 RM) be performed for high repetitions (> 15) using short rest periods (< 90 s). In the interpretation of this position stand, as with prior ones, the recommendations should be viewed in context of the individual's target goals, physical capacity, and training status.

American College of Sports Medicine Position Stand. Progression Models in Resistance Training for Healthy Adults

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.

Muscle hypertrophy response to resistance training in older women

Because of the influence of cardiorespiratory fitness on functional independence, quality of life, and cardiovascular disease and all-cause mortality, tremendous interest has been directed towards describing the age-related change in maximal oxygen consumption (VO(2max)). Current evidence supports a 10% per decade decline in VO(2max) in men and women regardless of activity level. High-intensity exercise may reduce this loss by up to 50% in young and middle-aged men, but not older men, if maintained long term. Middle-aged and older women do not appear to be able to reduce loss rates in VO(2max) to less than 10% per decade, which may be related to estrogen status. However, maintaining high-intensity training seems limited to approximately one decade at best and to a select few individuals. While the factors limiting the ability to maintain high-intensity training are not completely known, aging most likely plays a role as studies have demonstrated that training maintenance becomes more difficult with advancing age. Age-related loss of VO(2max) seems to occur in a non-linear fashion in association with declines in physical activity. In sedentary individuals, this non-linear decline generally occurs during the twenties and thirties whereas athletic individuals demonstrate a non-linear decline upon decreasing or ceasing training. Non-linear loss rates are also demonstrated in individuals over the age of 70 years. The decline in VO(2max) seems to be due to both central and peripheral adaptations, primarily reductions in maximal heart rate (HR(max)) and lean body mass (LBM). Exercise training does not influence declines in HR(max), while LBM can be maintained to some degree by exercise. Recommendations for exercise training should include aerobic activities utilising guidelines established by the American College of Sports Medicine for improving CV fitness and health, as well as strength training activities for enhancing LBM.

Rate and mechanism of maximal oxygen consumption decline with aging: implications for exercise training.

We evaluated the relationship of body composition, maximal aerobic capacity (VO2max), and muscle strength to bone mineral density in 91 healthy men and women, age 61-84 years. Lean body mass was estimated from two independent measures of fat mass, bioelectrical impedance and skinfold thickness. VO2max was determined by treadmill ergometry with direct measurement of oxygen consumption. Grip and back strength were measured by isometric dynamometry. Mineral density of lumbar spine and midradius were measured by dual- and single-photon absorptiometry. Men had significantly greater lean mass, muscle strength, aerobic capacity, and bone density than women. In women, grip strength correlated with forearm and spine density (r = 0.37, r = 0.28, p less than 0.05). In men, grip strength correlated with forearm density (r = 0.47, p less than 0.05), and back strength was significantly correlated with both spine (r = 0.46, p less than 0.01) and forearm density (r = 0.46, p less than 0.01). In women, neither forearm nor spine density correlated significantly with aerobic capacity. In men, midradius density did not correlate significantly with oxygen consumption, but the simple correlation between spine density and VO2max was significant (r = 0.41, p less than 0.05). Back strength and VO2max were significantly related in men (r = 0.47, p less than 0.01). By stepwise multiple regression, back strength emerged as the most robust predictor of spine mineral, accounting for 19% of the variation in bone density. Addition of VO2max to the regression did not add significant predictive value. However, when VO2max was expressed per kilogram lean body mass, both back strength and VO2max contributed significantly to the prediction of spine density in men, and the coefficient of determination R2 increased to 0.30. We conclude that body mass and grip strength, but not aerobic capacity, significantly predict bone density in elderly women. In elderly men, back strength is a more robust predictor of axial bone density than traditional expressions of aerobic capacity, but VO2max per kilogram lean mass and back strength both make significant contributions to the prediction of spine mineral density. The applicability of these results to younger men and women is uncertain.

Relationship of body composition, muscle strength, and aerobic capacity to bone mineral density in older men and women.

Muscle Hypertrophy Response To Resistance Training in Older Women

We tested the hypothesis that the expansion of satellite cell numbers, 24 h after maximal eccentric knee extensor exercise, is blunted in older men. Muscle biopsies were obtained from the vastus lateralis of 10 young (23-35 years) and 9 older (60-75 years) men. Satellite cells were identified immunohistochemically using an antibody to neural cell adhesion molecule. After 92 maximal eccentric contractions, the mean number of satellite cells per muscle fiber increased to a greater extent among the young men (141%; P < 0.001) than older men (51%; P = 0.002) from preexercise levels. Similar results were obtained when satellite cells were expressed as a proportion of all sublaminar nuclei. We conclude that a single bout of maximal eccentric exercise increases satellite cell numbers in both age groups, with a significantly greater response among the young men. These data suggest that age-related changes in satellite cell recruitment may contribute to muscle regeneration deficits among the elderly.

Robert A. Wiswell

Papers

Muscle hypertrophy response to resistance training in older women

Rate and mechanism of maximal oxygen consumption decline with aging: implications for exercise training.

Relationship of body composition, muscle strength, and aerobic capacity to bone mineral density in older men and women.

Muscle Hypertrophy Response To Resistance Training in Older Women

Satellite cell numbers in young and older men 24 hours after eccentric exercise