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.

/pdf/quantity-and-quality-of-exercise-for-developing-and-1fohxlhqop.pdf

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.

pdf/importance-of-assessing-cardiorespiratory-fitness-in-v407bkh4h5.pdf

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.

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.

High-intensity interval training (HIT) is a well-known, time-efficient training method for improving cardiorespiratory and metabolic function and, in turn, physical performance in athletes. HIT involves repeated short (<45 s) to long (2–4 min) bouts of rather high-intensity exercise interspersed with recovery periods (refer to the previously published first part of this review). While athletes have used ‘classical’ HIT formats for nearly a century (e.g. repetitions of 30 s of exercise interspersed with 30 s of rest, or 2–4-min interval repetitions ran at high but still submaximal intensities), there is today a surge of research interest focused on examining the effects of short sprints and all-out efforts, both in the field and in the laboratory. Prescription of HIT consists of the manipulation of at least nine variables (e.g. work interval intensity and duration, relief interval intensity and duration, exercise modality, number of repetitions, number of series, between-series recovery duration and intensity); any of which has a likely effect on the acute physiological response. Manipulating HIT appropriately is important, not only with respect to the expected middle- to long-term physiological and performance adaptations, but also to maximize daily and/or weekly training periodization. Cardiopulmonary responses are typically the first variables to consider when programming HIT (refer to Part I). However, anaerobic glycolytic energy contribution and neuromuscular load should also be considered to maximize the training outcome. Contrasting HIT formats that elicit similar (and maximal) cardiorespiratory responses have been associated with distinctly different anaerobic energy contributions. The high locomotor speed/power requirements of HIT (i.e. ≥95 % of the minimal velocity/power that elicits maximal oxygen uptake [v/p
 $$ \dot{V} $$
 O2max] to 100 % of maximal sprinting speed or power) and the accumulation of high-training volumes at high-exercise intensity (runners can cover up to 6–8 km at v
 $$ \dot{V} $$
 O2max per session) can cause significant strain on the neuromuscular/musculoskeletal system. For athletes training twice a day, and/or in team sport players training a number of metabolic and neuromuscular systems within a weekly microcycle, this added physiological strain should be considered in light of the other physical and technical/tactical sessions, so as to avoid overload and optimize adaptation (i.e. maximize a given training stimulus and minimize musculoskeletal pain and/or injury risk). In this part of the review, the different aspects of HIT programming are discussed, from work/relief interval manipulation to HIT periodization, using different examples of training cycles from different sports, with continued reference to the cardiorespiratory adaptations outlined in Part I, as well as to anaerobic glycolytic contribution and neuromuscular/musculoskeletal load.

High-Intensity Interval Training, Solutions to the Programming Puzzle

The present review addresses the physiological demands during recreational football training and the effects on central health variables that influence the risk of life-style diseases of young and middle-aged men. Recent studies have established that recreational football, carried out as small-sided games can be characterized as having a high aerobic component with mean heart rates of 80-85% of maximum heart rate, which is similar to values observed for elite football players. In addition, the training includes multiple high-speed runs, sprints, turns, jumps and tackles, which provide a high impact on muscles and bones. Recreational football training in untrained men results in marked improvements in maximum aerobic power, blood pressure, muscle capillarization and intermittent exercise performance, and those effects are similar to interval training and more pronounced than moderate-intensity continuous running and strength training. Further, recreational football training enhances fat oxidation during exercise and results in a higher fat loss than interval training and strength training, and results in marked muscle hypertrophy and elevates bone mass, more than interval and continuous running. Taken together, recreational football appears to effectively stimulate musculoskeletal, metabolic and cardiovascular adaptations of importance for health and thereby reduces the risk of developing life-style diseases.

Recreational football as a health promoting activity: a topical review.

The maximal oxygen uptake (V-dotO(2max)) is considered an important physiological determinant of middle- and long-distance running performance. Little information exists in the scientific literature relating to the most effective training intensity for the enhancement of V-dotO(2max) in well trained distance runners. Training intensities of 40-50% V-dotO(2max) can increase V-dotO(2max) substantially in untrained individuals. The minimum training intensity that elicits the enhancement of V-dotO(2max) is highly dependent on the initial V-dotO(2max), however, and well trained distance runners probably need to train at relative high percentages of V-dotO(2max) to elicit further increments. Some authors have suggested that training at 70-80% V-dotO(2max) is optimal. Many studies have investigated the maximum amount of time runners can maintain 95-100% V-dotO(2max) with the assertion that this intensity is optimal in enhancing V-dotO(2max). Presently, there have been no well controlled training studies to support this premise. Myocardial morphological changes that increase maximal stroke volume, increased capillarisation of skeletal muscle, increased myoglobin concentration, and increased oxidative capacity of type II skeletal muscle fibres are adaptations associated with the enhancement of V-dotO(2max). The strength of stimuli that elicit adaptation is exercise intensity dependent up to V-dotO(2max), indicating that training at or near V-dotO(2max) may be the most effective intensity to enhance V-dotO(2max) in well trained distance runners. Lower training intensities may induce similar adaptation because the physiological stress can be imposed for longer periods. This is probably only true for moderately trained runners, however, because all cardiorespiratory adaptations elicited by submaximal training have probably already been elicited in distance runners competing at a relatively high level.Well trained distance runners have been reported to reach a plateau in V-dotO(2max) enhancement; however, many studies have demonstrated that the V-dotO(2max) of well trained runners can be enhanced when training protocols known to elicit 95-100% V-dotO(2max) are included in their training programmes. This supports the premise that high-intensity training may be effective or even necessary for well trained distance runners to enhance V-dotO(2max). However, the efficacy of optimised protocols for enhancing V-dotO(2max) needs to be established with well controlled studies in which they are compared with protocols involving other training intensities typically used by distance runners to enhance V-dotO(2max).

Is there an optimal training intensity for enhancing the maximal oxygen uptake of distance runners?: empirical research findings, current opinions, physiological rationale and practical recommendations.

Aim. Many previous studies have examined the time limit at which an individual can maintain V.O2max (Tlim V.O2max) during high-intensity continuous and intermittent runs to exhaustion. The main purpose of the present study was to examine the effects of employing different criteria used in previous investigations during Tlim V.O2max evaluation. Methods. Seven moderately trained competitive runners completed 2 running tests to exhaustion, during which metabolic data was obtained from breath-by-breath gas analysis. The 1st test was an incremental test to evaluate V.O2max and the minimal running velocity at which V.O2max was elicited (v V.O2max). The 2nd test was a continuous single velocity test at v V.O2max from which the time to attain V.O2max (TA V.O2max) and Tlim V.O2max were subsequently evaluated. Time at V.O2max was evaluated employing 6 specific criteria. Intra-individual differences in Tlim V.O2max values due to applying the different criteria were analysed using a one-way ANOVA, with significant differences between pairs identified using Tukey’s HSD posthoc test. Significance was set at p<0.05. Results. A one-way ANOVA demonstrated that significant differences (F=4.03, p=0.005) existed between Tlim V.O2max values generated by employing the six different criteria. Conclusion. The present study provides support that employing different criteria in the evaluation of Tlim V.O2max, such as those used in previous investigations, leads to significantly different Tlim V.O2max values. However, the practical implications of these measurement differences require further investigation.

Criteria and other methodological considerations in the evaluation of time at V.O2max.

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Is there an optimal training intensity for enhancing the maximal oxygen uptake of distance runners?: empirical research findings, current opinions, physiological rationale and practical recommendations.

Criteria and other methodological considerations in the evaluation of time at V.O2max.