Sports Medicine Bulletin
Dec. 31, 2013

Active Voice: Barefoot Running - More than just Foot Strike?
By Janet S. Dufek, Ph.D., FACSM and Traci L. Delgado, SPT
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Dr. Janet Dufek is an associate professor and co-director of the Biomechanics Laboratory at the University of Nevada, Las Vegas. Her primary area of research focuses on lower extremity function and performer variability. As a runner, she is an advocate of “within-activity cross-training”.

Ms. Traci Delgado is nearing completion of her doctoral degree in physical therapy (DPT) at the University of Nevada, Las Vegas. She aspires to build her career in an outpatient setting where orthopedics and athletes are her primary focus.

This commentary presents Dr. Dufek’s and Ms. Delgado’s views on the topic of a research article which they and their colleagues published in the March 2013 issue of
Medicine and Science in Sports and Exercise®.

Injury prevention in the running community is paramount for sports medicine practitioners. As running fads populate, it is important to understand underlying biomechanical processes in order to provide appropriate intervention and rehabilitation therapies to minimize and recover from injury. One of the techniques utilized in the prevention of running injuries is to modify the gait pattern, with one particular contemporary trend increasing amongst runners, i.e., barefoot (or minimalist footwear) running. There is growing evidence to suggest that barefoot running results in changes in how you run (kinematics) as well as the forces (kinetics) associated with running.More

Active Voice: Why Should Pregnant Women Exercise?
By Lanay Mudd, Ph.D.
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Dr. Mudd is an assistant professor in the department of kinesiology at Michigan State University. With a background in both kinesiology and epidemiology, her research focuses on maternal and child health benefits of physical activity during pregnancy. In this commentary, Dr. Mudd, an ACSM member, presents her views associated with the research which she and her colleagues published in the February 2013 issue of Medicine and Science in Sports and Exercise® (MSSE).

“It’s six o’clock, so should I sit on the couch and watch some TV or fit in a quick walk before dinner?” For many pregnant women, the answer is automatic – “I’m tired and I’m pregnant. I deserve to relax. What’s on TV?” Yet, research conducted over the past 18 years indicates that the woman who laces up her sneakers instead, can expect a healthier pregnancy and a healthier baby.

In the past, most viewed pregnancy as a time to rest and gain weight in order to ensure a healthy delivery. The first physical activity guideline, published by the American College of Obstetricians and Gynecologists (ACOG) in 1985, even encouraged women to limit vigorous physical activity and keep their exercise heart rates below140 beats per minute. Unfortunately, while hundreds of studies have since shown benefits of physical activity during pregnancy and the guidelines have been subsequently updated many women and healthcare providers cling to this 140 limit. The most recent U.S. Dept. of Health & Human Services guidelines for physical activity during pregnancy state that women who are not already active should get at least 150 minutes per week of moderate intensity aerobic activity, and that those who are habitually more active may continue their normal routines provided they communicate openly with their healthcare provider. International guidelines in Canada, Denmark and Norway are similar.More

Active Voice: Is There a Relationship Between Vitamin D and Muscle Performance?
By Adam S. Grimaldi, Beth A. Parker, PhD, and Paul D. Thompson, MD, FACSM
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Adam S. Grimaldi, B.S., is a fourth-year medical student at the University of Connecticut School of Medicine in Farmington. He also is a research assistant to Drs. Parker and Thompson at Hartford Hospital in Connecticut.

Beth A. Parker, Ph.D., is an assistant professor of health sciences at University of Hartford and director of exercise physiology research at Hartford Hospital in Connecticut. She is a member of ACSM and her research focuses on age and sex differences in vascular function and cardiovascular responses to exercise. Dr. Parker is a principal or co-investigator on several projects involving the pleiotropic effects of statin therapy on skeletal muscle and cognition.

Paul D. Thompson, M.D., FACSM, is director of cardiology at Hartford Hospital and professor of medicine at University of Connecticut. He is a past-president of ACSM and has presented invited keynote lectures at the ACSM annual meetings, such as the D.B. Dill Lecture. He has authored more than 200 scientific articles on such topics as exercise training and heart disease and sudden death during exercise. Dr. Thompson’s current research, funded by the National Institutes of Health, examines the effects of statins on muscle strength and aerobic performance.

This commentary presents perspectives from Mr. Grimaldi, Dr. Parker, and Dr. Thompson relative to issues central to their cross-sectional study that appears in the January 2013 issue of ACSM’s
Medicine and Science in Sports and Exercise® (MSSE).

In recent years, Vitamin D has become a topic of great discussion. Evidence shows that its biologic role goes beyond bone metabolism and calcium homeostasis. For example, elevated concentrations of serum 25-hydroxy vitamin D (25(OH)D) have been shown to be associated with improved cardiovascular outcomes, enhanced immune function, and reductions in cancer risk. Additionally, 25(OH)D levels have been linked to skeletal muscle performance through our historical understanding that long-term vitamin D deficiency can produce a myopathy. In recent years, multiple studies have shown mixed results in favor of a direct relationship between 25(OH)D and muscle performance. Even more recently, low vitamin D levels have been associated with increased non-specific skeletal muscle complaints by patients in primary care practices. This becomes clinically important for those patients located in cold-temperate climates during winter months when vitamin D levels are lowest.More

Active Voice: The AMA Says Obesity is a Disease; Now We Need to Inform Them How to Best Treat It
By Robert Sallis, M.D.
Robert E. Sallis, M.D., FACSM, is a past president of ACSM and chair of the Exercise is Medicine Task Force. He originated the EIM concept and has been its leading advocate from the beginning. Dr. Sallis earned an M.D. from Texas A&M University and completed his residency in family medicine at Kaiser Permanente Medical Center in Fontana, CA. He has continued his medical career with Kaiser and now co-directs their sports medicine fellowship training program. Dr. Sallis is the founding editor-in-chief of ACSM's Current Sports Medicine Reports journal. Exercise Is Medicine was launched in partnership with the AMA, and continues to work with AMA to find solutions to the obesity epidemic.

Viewpoints presented in SMB commentaries reflect author opinions and not necessarily the positions or policies of ACSM
.

My first reaction to hearing that the AMA had voted to classify obesity as a disease last month was a positive one. That was until I heard the excited comments from those who will profit most from the increased use (and payment for) bariatric surgery and weight loss drugs. Right away these individuals and organizations began campaigns to gain more reimbursement for their treatments of this newfound disease. My concern is that pushing the same old overpriced treatments on patients is more likely to benefit the wallets of surgeon’s and pharmaceutical companies than the health of Americans. There must be a better way to deal with this newly labeled disease called obesity.More

Active Voice: Does Vitamin D Have a Role in Preventing Sarcopenia?
By Caitlin Mason, Ph.D.
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Dr. Mason is a postdoctoral research fellow at the Fred Hutchinson Cancer Research Center in Seattle, WA. With a background in epidemiology, her research focuses primarily on understanding the mechanisms that link nutrition, exercise, and body composition to chronic disease risk, including cancer.

This commentary presents Dr. Mason’s views associated with a research article she and her colleagues published in the April, 2013 issue of ACSM's
Medicine and Science in Sports and Exercise® (MSSE).

Lifestyle changes leading to modest weight loss of 5-10% are generally sufficient to yield significant improvements in a variety of chronic disease risk factors and are widely recommended. During weight loss, however, a higher ratio of muscle-to-fat mass is lost in older compared to younger adults. Thus, the potential for muscle loss is sometimes a deterrent to prescribed weight loss for overweight and obese older adults, particularly those with or at risk of sarcopenia. More

Active Voice: Exercise or Calorie Restriction to Lower Blood Triglycerides Levels?
By Labros S. Sidossis, Ph.D., and Elena Bellou, Ph.D.
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Labros Sidossis, Ph.D., is professor of medicine and nutrition and metabolism at the University of Texas Medical Branch (UTMB), Galveston, USA. A member of ACSM, he is Director of Obesity Research at the Sealy Center on Aging at UTMB. Dr. Sidossis also is Professor in the Department of Nutrition and Dietetics, Harokopio University, Athens, Greece. His research interests include obesity and lipid metabolism, lifestyle interventions to promote health and brown adipose tissue metabolism.

Elena Bellou, Ph.D. is clinical dietitian and post-doctoral fellow in the Department of Nutrition and Dietetics, Harokopio University, Athens. Her scientific interests relate to the regulation of human lipid metabolism, particularly effects of lifestyle interventions on lipoprotein triglyceride kinetics.

In this commentary, Dr. Sidossis and Dr. Bellou present their views related to the research report which they and their colleagues published in the March 2013 issue of
Medicine and Science in Sports and Exercise® (MSSE).

Lifestyle changes are the first line of therapy for metabolic abnormalities such as hypertriglyceridemia, or elevated triglycerides. Exercise is particularly efficient in improving the lipid profile in humans; even a single bout of exercise can acutely decrease the blood triglyceride concentration. However, for this to work, exercise should result in a negative energy balance. When food is increased to compensate for the energy lost during exercise, the hypotriglyceridemic effect of exercise is lost.More

Active Voice: Commentary on Doping in Sports
By Gary I. Wadler, M.D., FACSM
Viewpoints presented in SMB commentaries reflect the opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Gary I. Wadler, M.D., FACSM, FACP, FCP, FACPM, chairs ACSM’s Communications and Public Information Committee. He is a clinical associate professor of medicine at Hofstra North Shore-LIJ Schools of Medicine and past chairman of the World Anti-Doping Agency’s Prohibited List Committee.

The Lance Armstrong scandal sits among the most high-profile, unprecedented doping scandals in United States sports history.

The evolving story is about more than understanding the complexities of banned substances, drug testing and prosecutions. The real story is about the regrettable messages that this scandal sends to our youth who seek nothing more than fair and ethical competition.

It is more than the tragic story of a gifted athlete—Lance Armstrong—who finally has admitted to his use of a variety of performance-enhancing drugs and methods. It is more than his accepting a lifetime suspension in cycling, losing numerous records including seven Tour de France titles and countless millions in prize money, and apologizing to his family and fans.

In years past, doping may have gone unnoticed by many. But now we are witnessing the evolution of a new world order in elite sports, one committed to fair play and ethical values; one whose troubled roots can be found in what was for 30 years a dysfunctional system of inadequate drug control.More

Active Voice: Personal Trainers as Professionals
By Richard T. Cotton, M.A.
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Richard Cotton is ACSM’s National Director of Certification and Registry Programs. He has worked in the health and fitness industry for more than 30 years. Cotton earned a B.A. in education from Wayne State University, Detroit, and an M.A. in exercise science from San Diego State University. He holds ACSM certifications as Preventive and Rehabilitative Program DirectorSM and ACSM Exercise Specialist®. He frequently serves as an expert source on behalf of ACSM in print, broadcast and Web-based media
.

While Frank Bruni’s July 27 column in the New York Times, "Our Pulchritudinous Priesthood," may accurately reflect some personal trainers in the industry, I’d like to highlight some of the recent steps ACSM has taken to further solidify professional education and certification for fitness professionals.As the American College of Sports Medicine’s national director of certification, I know the process by which we have certified thousands of highly qualified exercise professionals who, each day, make a significant difference in their clients’ health. A standard of best practices does exist for personal trainers in the fitness industry, and most of ACSM's certifications require a bachelor’s degree in exercise science or kinesiology at minimum — and we certify up to the Ph.D. level. When selecting trainers, the best criteria to use are their education, certification and training background, not whether they themselves appear to be fit.More

Active Voice: Resistance Training in Healthy Older Adults — Do We Need to Supplement Dietary Protein?
By Lex B. Verdijk, Ph.D. and Luc J.C. van Loon, Ph.D.
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Dr. Verdijk is a researcher and Assistant Professor at the Department of Human Movement Sciences at Maastricht University Medical Centre+, the Netherlands. His research focuses on the role of exercise and nutrition in the regulation of skeletal muscle mass and function, with special interest in the aging human.

Dr. van Loon is a Professor of Physiology of Exercise at the Department of Human Movement Sciences, Maastricht University Medical Centre+, the Netherlands. An ACSM member, Dr. van Loon leads the M3 Research Unit at Maastricht University. The main fields of investigation in his research unit include human skeletal muscle metabolism, exercise metabolism, sports nutrition, adaptation to endurance and resistance type exercise training, and the use of combined physical activity and/or dietary (lifestyle) interventions to improve health and/or functional performance in chronic metabolic disease (obesity and type 2 diabetes) and aging.

This commentary presents Dr. Verdijk’s and Dr. van Loon’s views on the topic of a research article which they and their colleagues published in the March 2013 issue of Medicine and Science in Sports and Exercise®, "Protein supplementation during resistance-type exercise training in the elderly."


Muscle mass, strength, and function progressively decline with increasing age. This process has been termed "sarcopenia", and ultimately results in physical disability, loss of independence, and reduced quality of life. Since both decreased physical activity and inadequate food intake play a key role in the development of sarcopenia, exercise and/or nutritional interventions are considered important tools in its treatment. Resistance type exercise training is currently regarded as the most effective intervention strategy to counteract loss of muscle mass and function with aging. Although several studies have suggested that protein supplementation may be of additional benefit, there is no clear evidence that elderly should combine resistance training with protein supplementation to optimize the effects of exercise. Inconclusive findings are likely caused by differences in the populations studied, the amount, type, and timing of supplements, and duration of the intervention programs.More

Active Voice: Strength Training Lowers Risk of Impaired Glucose Metabolism at the Population Level
By Karl Minges, M.P.H., and David Dunstan, Ph.D.
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

Karl Minges is a doctoral student at Yale University Graduate School of Arts & Sciences. His research interests broadly relate to diabetes and cardiovascular disease and the role of health behaviors in preventing overweight/obesity. Mr. Minges completed the present work with the support of a U.S. Fulbright Scholarship administered by the Australian-American Fulbright Commission.

Professor Dunstan is an Australian Research Council Future Fellow and heads the Physical Activity Laboratory at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia. He is an ACSM member whose research focuses on the role of physical activity and sedentary behavior in the prevention and management of chronic diseases.

This commentary presents perspectives from Mr. Minges and Dr. Dunstan’s relative to issues central to their cross-sectional study that appears in the February 2013 issue of ACSM’s
Medicine and Science in Sports and Exercise® (MSSE).

Increasing rates of type 2 diabetes (T2D) have global public health implications; furthermore, about 1 in 3 adults are afflicted with the precursor to T2D – impaired glucose metabolism (IGM). Thus, they are at risk of developing T2D and associated cardiovascular complications.

Participation in regular physical activity has a key role in managing insulin resistance in those who have T2D and in preventing the development of T2D in those with IGM. Traditionally, engagement in aerobic activity has been the exercise modality championed for the prevention and management of T2D. However, there is a plethora of studies to show that strength training (ST) – resistance exercise – not only leads to improved glycemic control, but also provides a means to maintain functional capacity and prevent and manage other health impairments. Indeed, several leading organizations, including ACSM, endorse ST exercise as an integral component of adults' daily physical activity – recommending a frequency of ST of at least twice per week for those with and without T2D. Further, Braith and Stewart, in their 2006 research review, have suggested that training objectives may be accomplished in about 40 minutes of ST per week. More