Sports Medicine Bulletin
May. 12, 2015

Active Voice: AHA Frames Guideline for Non-Physician Supervisors of Clinical Exercise Tests
By Jonathan N. Myers, Ph.D., FACSM, and William G. Herbert, Ph.D., FACSM
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Jonathan N. Myers, Ph.D., FACSM, completed his doctoral studies in exercise physiology at the University of Southern California. He is coordinator for the cardiology department's exercise laboratory at the Palo Alto VA Medical Center and is a clinical professor of medicine at Stanford University. Much of his work has focused on epidemiology studies that have demonstrated the importance of exercise tolerance and physical activity in modulating risk for cardiovascular events. Dr. Myers has authored or co-authored guidelines on exercise testing and related topics for numerous organizations, including ACSM, the American Heart Association and the American Thoracic Society.

William G. Herbert, Ph.D., FACSM, is professor emeritus in the Department of Human Nutrition, Foods and Exercise at Virginia Tech in Blacksburg. Much of his research and writing relates to exercise testing and physical activity interventions in coronary heart disease and obstructive sleep apnea, but he also has contributed to the literature on standards of care, legal issues and safety in adult exercise programs. He has been a member of the writing teams for several ACSM publications, including ACSM's Guidelines for Exercise Testing and Prescription, and chaired the Committee for Certification and Education, ACSM Clinical Exercise Physiology Practice Board and chief editor of SMB.

This commentary presents the authors' views on the above-titled American Heart Association Scientific Statement that was recently published in the journal Circulation. Dr. Myers chaired the multidisciplinary writing team and Dr. Herbert was a contributor.


The exercise test continues to have an important place in clinical medicine. Not only does the test help guide decisions regarding diagnosis and/or medical interventions, it remains valuable for evaluating the effects of therapies and setting exercise recommendations for patients. The knowledge and training required to properly conduct an exercise test are of central relevance to the clinical exercise physiologist. However, previously published guidelines on clinical competency for performing exercise testing have been directed toward physicians. If and when a non-physician should independently supervise a clinical exercise test and among which types of patients has remained uncertain. Early versions of exercise testing guidelines, beginning in the 1970s, recommended that a physician be available at all times to directly supervise an exercise test. This was due to the perceived risk associated with the test, particularly among patients with known disease. Since that time, surveys of event rates during exercise testing have consistently indicated that attendant serious events are extremely rare. In addition, significant changes in clinical practice patterns with exercise testing have continued to evolve over time. In contemporary exercise laboratories, physicians often provide supervision or oversight, but are less frequently present in the testing room. In fact, the majority of such tests today are administered by non-physicians (exercise physiologists, nurses, physical therapists or technicians)̶including those tests performed among high-risk patients. As these changes have evolved, ambiguity has arisen regarding the physician's role relative to the non-physician. While ACSM has provided the standard for certification programs for clinical exercise physiologists, there remains uncertainty regarding the cognitive and procedural skills necessary from both a practical and legal standpoint regarding who should supervise an exercise test in clinical settings.More

Don't Miss Special Mid-Day Sessions at ACSM Annual Meeting

  • Empowering Lives Through Sports: The Special Olympics and ACSM


  • This special mid-day session at the upcoming ACSM Annual Meeting in San Diego and will overview the extraordinary ability of the Special Olympics to empower and change lives on a massive scale in the United States and worldwide. The Special Olympics World Games will be in Los Angeles from July 25 through August 2, featuring 7,000 athletes from more than 177 countries. You will get an insider viewpoint of this upcoming amazing event. Plus, ACSM and Special Olympics are creating a partnership, and exciting news will be announced. Lastly, Dustin Plunkett, a remarkable Special Olympian and Special Olympics International Global Messenger will share his personal journey and how the Special Olympics empowered and forever influenced his life. This session will run from 11:45 a.m. – 12:45 p.m. PDT on Wednesday, May 27.

  • The Aspen Institute Initiative on Reimaging Youth Sports: Project Play and the Critical Role of Sports Medicine and Science


  • Join ESPN journalist and author Tom Farrey and a panel of ACSM youth sports experts such as John DiFori and Mike Bergeron on Friday, May 29 to discuss a once-in-a-generation opportunity to reimagine and enhance youth sports. This mid-day session will provide key insights into a truly transformative initiative called Project Play— for which Tom serves as executive director— that has been launched to make the youth sports experience more enjoyable, even safer and more inclusive. This session will provide an exceptional overview of the issues, strategies and opportunities for leadership and impact in a distinctive movement to make, at long last, key differences and changes that are needed. The special role of sports medicine and science will be underscored. ACSM has partnered with Aspen, Robert Wood Johnson Foundation, Nike and other leading organizations throughout the United States on the Project Play initiative. This session will run from 11:45 a.m. – 12:45 p.m. PDT on Friday, May 29.

    More information about both of these sessions will be available on-site at the ACSM Annual Meeting.More

    ACSM Leadership Meets with Surgeon General Last Friday

    ACSM President Carol Ewing Garber, Executive Vice President Jim Whitehead, and VP of Government Affairs Monte Ward met with U.S. Surgeon General Vivek Murthy last Friday. Murthy was commissioned as U.S. Surgeon General on April 22. The group continued discussions about the Surgeon General’s EveryBody Walk! Initiative, which seeks to explore the roles of walking and walkable communities as effective strategies to increase active living. For more information on the Surgeon General’s call to action on walking and to view additional resources about Every Body Walk!, click here.


    (L to R: ACSM EVP Jim Whitehead, U.S. Surgeon General Vivek Murthy,
    ACSM President Carol Ewing Garber, ACSM VP Government Affairs Monte Ward)
    More

    Regional Chapter News: NEACSM Spring Meeting Recap

    The New England Chapter of ACSM (NEACSM) held its annual spring meeting on March 26, themed “Celebrating Excellence and Leadership in Exercise Science and Sports Medicine: Past, Present, Future” at Central Connecticut State University (CCSU) in New Britain, Conn. Regarding the theme, one interesting historical item to note regarding a special connection with CCSU is that a founder and leader of ACSM, Dr. Josephine Rathbone, began her career there in the early 1920s. She worked in health and physical education at what was then known as the Normal School. The Normal School is now known as Central Connecticut State University and the department name has changed to Physical Education and Human Performance. At this, their most recent spring meeting which is almost 100 years later, five current or past presidents of ACSM shared personal insights on their professional work and leadership experiences. Presenters at the meeting included current ACSM President Carol Ewing Garber, Ph.D., FACSM; ACSM Past President Janet Walberg Rankin, Ph.D., FACSM; President-elect Lawrence E. Armstrong, Ph.D., FACSM; Robert C. Cantu, M.D., FACSM; and Russell R. Pate, Ph.D., FACSM. For more information, please contact the NEACSM chapter.

    More

    Don't Miss Free Online Content from ACSM's Health & Fitness Journal®

    Check out the two free featured articles from the May/June 2015 issue of ACSM's Health & Fitness Journal® at www.acsm-healthfitness.org.

    Several articles in this issue are available free of charge until June 23, including these two features: "The Role of Exercise in Preventing Falls Among Older Adults," by Debra J. Rose, Ph.D., FNAK and the Worksite Health Promotion column, "LifeWorks@TURCK: A Best Practice Case Study on Workplace Well-being Program Design," by Nico P. Pronk, Ph.D., FACSM, FAWHP; David Lagerstrom; and Jane Haws, R.N., MBA.More

    NHLBI Seeks Feedback on Strategic Direction

    The National Heart, Lung and Blood Institute (NHLBI) is currently accepting comments on the possibility of establishing a permanent exercise study section within their organization. Please click here if you are interested in voting. You will need to register to vote if you do not already have an account. The deadline to submit comments is May 15.More

    One Year Later: Reflecting on Former ACSM President Jack Boyer's Passing

    John L. "Jack" Boyer, M.D., FACSM, president of ACSM from 1977 to 1978, passed away almost one year ago on May 31, 2014. His notable career included serving as medical director of the Adult Fitness and Exercise Physiology Laboratory at San Diego State University (SDSU). Working with Fred Kasch, Ph.D., FACSM, he conducted groundbreaking research that proved the important role exercise and fitness plays in heart disease prevention and rehabilitation of cardiovascular diseases. Dr. Boyer also taught courses in the graduate school at SDSU. He was appointed to the President's Council on Fitness and Sports in 1970 until 1974. Dr. Boyer loved sports, snow skiing, hiking, golf and especially horseback riding.

    "In remembrance as we approach the first anniversary of Jack Boyer’s passing on May 31, the American College of Sports Medicine honors this extraordinary person and professional, who both was inspired by and contributed to new discoveries and care about the role of exercise and physical activity in preventing heart disease and in rehabilitating cardiovascular diseases. He was a remarkably poised learner, teacher, colleague, and practitioner. ACSM was especially honored to have Jack serve the college and the field as president in 1977-1978. He is missed but his legacy truly lives on."

    God bless and warm memories to all,
    Jim Whitehead, CEO, American College of Sports Medicine

    Dr. Boyer's obituary can be viewed here. More

    How to Safely Use a Treadmill (It's Not As Easy As You Think)
    The Washington Post
    It's a pretty straightforward piece of equipment and you've been walking and running for how many years now? I mean, how difficult can it be to try a treadmill for the first time?

    As my colleague Michael E. Miller points out in this excellent post, more than 460,000 people found out about the dangers the hard way when they suffered injuries related to exercise equipment, according to data for 2012. About 32,000 people were hospitalized or dead on arrival after those accidents and, according to one study, 66 percent of gym injuries involve treadmills. The tragic death of Dave Goldberg, CEO of SurveyMonkey and husband of Facebook exec Sheryl Sandberg, is the exclamation point at the end of this warning.

    So if you're on vacation, as Goldberg was, and get a hankering to jump on the treadmill, or you're a novice starting an exercise program, here are some great tips on how to use the treadmill safely. They come from exercise physiologist Mike Bracko of Calgary, Alberta, who wrote the American College of Sports Medicine's guide on treadmills. (The guide covers home treadmills but the lessons apply in the gym as well.) More

    An Unexpected Death Rattles the Fitness Community
    The New York Times
    The recent death of the tech executive Dave Goldberg, reportedly during a treadmill workout on a vacation, has saddened and rattled the fitness community. The death of Mr. Goldberg, the chief executive of SurveyMonkey and husband of Sheryl Sandberg of Facebook, has left many people wondering if the exercise itself might have triggered a serious health event. Was it a heart attack? Another health problem? An unfortunate accident?

    While the circumstances surrounding Mr. Goldberg's death are not fully known, the science on exercise and sudden death is both comforting and troubling. Someone who exercises has a much lower risk of dying from heart disease than someone who doesn't. At the same time, it's also true that during exercise, a person has a slightly higher risk of having a heart attack than when he or she is just sitting quietly in a chair.

    To learn more about the relationship between exercise and heart risk, I spoke with two experts on the topic: Dr. Michael Blaha, the director of clinical research at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Medicine in Baltimore, and Dr. Paul D. Thompson, the chief of cardiology at Hartford Hospital in Connecticut. Here are edited excerpts from our conversation. More