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

Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health. In 2013, the National Heart, Lung, and Blood Institute (NHLBI) Advisory

http://kidneys.zaslavsky.com.ua/article/download/122220/118980

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000597

Context Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates. Objective To evaluate the relationship between gait speed and survival. Design, Setting, and Participants Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34 485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s. Main Outcome Measures Survival rates and life expectancy. Results There were 17 528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%-88.8%) and 10-year survival rate was 59.7% (95% CI, 46.5%-70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; P  Conclusion In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.

https://jamanetwork.com/journals/jama/articlepdf/644554/joc05171_50_58.pdf

Gait speed and survival in older adults.

Background The widespread application pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function attributable to the programs. This review updates that reported by Lacasse et al Lancet 1996; 748:1115-1119. Objectives To determine the impact of rehabilitation on health-related quality of life (QoL) and exercise capacity in patients with COPD. Search strategy The 14 randomized controlled trials (RCTs) included in the original meta-analysis were included. Additional RCTs were identified from the Cochrane Airways Group's registry of COPD RCTs using the strategy: [exp, lung diseases, obstructive] and [exp, rehabilitation or exp, exercise therapy] and [research design or longitudinal studies or evaluation study or randomized controlled trial]. Abstracts presented at American Thoracic Society 1980-2000, American College of Chest Physicians 1980-2000 and European Respiratory Society 1987-2000 were also searched. Selection criteria RCTs of rehabilitation in patients with COPD in which quality of life (QoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. Rehabilitation was defined as exercise training for at least 4 weeks with or without education and/or psychological support. Control groups received conventional community care without rehabilitation. Data collection and analysis Weighted mean differences (WMD) were calculated using a random-effects model. Missing data from the primary study reports were requested from the authors. Main results 23 RCTs met the inclusion criteria. Statistically significant improvements were found for all the outcomes. In three important domains of QoL (Chronic Respiratory Questionnaire scores for Dyspnea, Fatigue and Mastery), the effect was larger than the minimal clinically important difference of 0.5 units using this instrument. For example Dyspnoea score: WMD 0.98 units, 95% Confidence Interval (95% CI) 0.74 - 1.22 units; n=9 trials. For FEC and MEC, the effect was small and a little below the threshold of clinical significance for the 6- minute walking distance: WMD 49 m, 95% CI: 26 - 72 m; n=10 trials. Reviewer's conclusions Rehabilitation relieves dyspnea and fatigue and enhances patients' sense of control over their condition. These improvements are moderately large and clinically significant. The average improvement in exercise capacity was modest. Rehabilitation forms an important component of the management of COPD.

Pulmonary rehabilitation for chronic obstructive pulmonary disease

The original Physical Activity Readiness Questionnaire (PAR-Q) offers a safe preliminary screening of candidates for exercise testing and prescription, but it screens out what seems an excessive proportion of apparently healthy older adults. To reduce unnecessary exclusions, an expert committee established by Fitness Canada has now revised the questionnaire wording. The present study compares responses to the original and the revised PAR-Q questionnaire in 399 men and women attending 40 accredited fitness testing centres across Canada. The number of subjects screened out by the revised test decreased significantly (p < .05), from 68 to 48 of the 399 subjects. The change reflects in part the inclusion of individuals who had made an erroneous positive response to the original question regarding high blood pressure. There is no simple gold standard to provide an objective evaluation of the sensitivity and specificity of either questionnaire format, but the revised wording has apparently had the intended effect of reducing positive responses, particularly to the question regarding an elevation of blood pressure.

Revision of the Physical Activity Readiness Questionnaire (PAR-Q).

A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain.

Background and Purpose The purpose of this study was to examine the physical impairments and functional limitations of individuals with total knee arthroplasty (TKA), as compared with individuals with no diagnosed knee disease (control subjects) Subjects Twenty-nine individuals 1 year following TKA (13 women, 16 men) and 40 age- and gender-matched control subjects (18 women, 22 men) were assessed Methods Walking speed, stair-climbing ability, knee torque (in newton-meters), and total work performed during 15 repeated contractions were evaluated Results Walking speeds for men with TKA were 13% and 17% slower at normal and fast speeds, respectively Their stair-climbing ability was even more compromised (51% slower) Walking speeds for women with TKA were 17% and 18% slower at normal and fast speeds, respectively Similarly, their stair-climbing time was more compromised (43% slower) Men with TKA were 37% to 39% weaker and performed 36% to 37% less total work of their knee extensors compared with the control subjects Similarly, women with TKA had knee extensor strength deficits of 28% to 29% and performed 24% less total work Conclusion and Discussion One year after TKA, marked physical impairments and functional limitations persisted

Physical Impairments and Functional Limitations: A Comparison of Individuals 1 Year After Total Knee Arthroplasty With Control Subjects

LIU, S., J. GOODMAN, R. NOLAN, S. LACOMBE, and S. G. THOMAS. Blood Pressure Responses to Acute and Chronic Exercise Are Related in Prehypertension. Med. Sci. Sports Exerc., Vol. 44, No. 9, pp. 1644–1652, 2012. Purpose: Aerobic exercise is recommended as a way to prevent hypertension. However, about 25% of individuals receive minimal antihypertensive benefits associated with chronic exercise training. Thus, we attempt to identify those ‘‘nonresponders’’ to chronic exercise on the basis of their blood pressure (BP) responses to acute exercise (single session). Our primary objective was to correlate the magnitude of BP decrease after acute exercise to the magnitude of BP reduction after chronic exercise. Our secondary objective was to examine the correlates of BP reduction after acute and chronic exercise. Methods: Seventeen prehypertensive (120 to 139/80 to 89 mm Hg) males and females (45–60 yr old) underwent acute exercise assessments before an 8-wk walking/jogging program (four times per week, 30 min per session, 65% maximum oxygen consumption). BP, hemodynamics, HR variability, and baroreflex sensitivity were assessed before and after acute exercise and chronic training. Results: BP was significantly reduced j7.2 T 1.2/j4.2 T 1.0 and j7.0 T 1.4/j5.2 T 1.2 mm Hg relative to baseline after acute (30 min at 65% maximum oxygen consumption) and chronic exercise, respectively (P G 0.01). The magnitude of change in systolic BP after acute exercise was strongly correlated with change in resting systolic BP after chronic training, r = 0.89, P G 0.01. A similar correlation was observed with diastolic BP, r = 0.75, P G 0.01. After acute exercise, significant reductions in total power (ms 2 ) and baroreflex sensitivity were observed in both sexes (P G 0.01). However, after chronic exercise, only men demonstrated a significant reduction in the low-frequency-to-high-frequency ratio (j36%), P G 0.01. Conclusions: The magnitude of the acute BPlowering with exercise may predict the extent of BP lowering after chronic training interventions in prehypertensive individuals.

Blood Pressure Responses to Acute and Chronic Exercise Are Related in Prehypertension

The physiology of Canadian National Judo Team members is described. These athletes differed widely in body size (height 157.4-187.7 cm; mass 56.5-100.8 kg). Aerobic fitness (treadmill) was high (VO2max = 4.49 I.min-1; 59.2 mL.kg-I.min-I), but relative VO2max decreased with increasing body mass. Elite judoka of other nations (Australia, 53.2; Poland, 59.0; Norway, 58.5) had comparable aerobic fitness. Significant (p less than 0.05) correlations between upper- (arm cranking, PWC170) versus lower-body aerobic fitness (r = 0.48), and upper- versus lower-body anaerobic power (r = 0.89) and capacity (r = 0.88) (Wingate) were observed. Peak power output (AnPP = 9.3 W.kg-I) and anaerobic capacity (AnCap = 260 J.kg-I) during arm cranking averaged 80% of leg-cranking values (AnPP = 13.7 W.kg-I; AnCap = 320 J.kg-I). Upper-body strength (bench press, one repetition, maximum = 100 kg) was also associated with upper-body anaerobic power (r = 0.72). Judoka exhibit a high degree of aerobic and anaerobic conditioning, and a pattern of total body fitness that is specifically required for their sport.

Scott G. Thomas

Papers

Revision of the Physical Activity Readiness Questionnaire (PAR-Q).

A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain.

Physical Impairments and Functional Limitations: A Comparison of Individuals 1 Year After Total Knee Arthroplasty With Control Subjects

Blood Pressure Responses to Acute and Chronic Exercise Are Related in Prehypertension

Physiological profiles of the Canadian National Judo Team.