Day 1 of the American College Sports Medicine Conference – 2017
Exercise is Medicine for Mental Illness: Developing Feasible and Effective Interventions for Real-world Clinical Settings
Stepping up the treatment of mental illness: feasibility and acceptability of a 12week exercise program for help-seeking youth with mood and anxiety disorders (Oscar Lederman, South Eastern Sydney Local Health District) Individuals both at risk for mental health issues or those who have experienced a first episode psychotic experience show lower fitness, decreased physical activity levels, and poorer sleep quality. Exercise physiologists in Australia are developing a program called headspace Active to develop a pragmatic physical activity program with the goal of embedding this program in standard mental health care practices. In regards to mental health issues, Lederman says that, “ We know that exercise works, but we want to know how to best implement these programs into the lives of these individuals in a real way.” Feasibility of maximal strength training in treatment of anorexia nervosa (Solfrid Bratland-Sanda, University College of Southeast Norway) When it comes to eating disorders, exercise is often seen as a “double-edged sword”. In patients with eating disorders, exercise can be used in an excessive and compulsive manner; however, it has also been shown to have therapeutic benefit when used as a part of treatment. Problems such as osteopenia and osteoporosis are common symptoms in patients with anorexia nervosa, and so strength training may be used as a way to prevent these bone-related issues. In a recent study, moderate strength training over a 16-week period (3, 60-minute sessions per week) in patients with AN was shown to both increase muscle strength and power as well as improve AN symptoms, especially as it related to dietary restraint.
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Post-traumatic stress disorder in emergency service workers: The role of physical activity (Simon Rosenbaum, UNSW Australia) When we think of post-traumatic stress disorder (PTSD), we think of veterans – those individuals who have experienced war. PTSD is also common in emergency workers, such as fire fighters, police, and paramedics. Physical activity interventions can be used as an effective means of decreasing post-traumatic stress disorder symptoms, especially when it comes to insomnia, depression, anxiety, and stress – with the largest improvements seen with depressive symptoms. In addition, physical activity can be used as way to help with functional recovery in patients with PTSD, with a major goal being of getting these individuals back to work. Integrating lifestyle interventions for people with treatment-resistant psychotic disorders – keeping the body in mind for people prescribed clozapine (Phillip Ward, UNSW Australia) Keeping the Body in Mind (KBIM) program is being developed as a way to make physical activity a part of routine care in the lives of individuals with severe mental illness (SMI). This means making the dietician and exercise physiologist an integral part of care and the treatment process. Patients with SMI are often taking clozapine, a 2nd generation anti-psychotic medication, and this often leads to weight gain (especially within the first 2 years of treatment), metabolic issues, and increased risk for cardiovascular disease. Recently, the KBIM program was shown to help to significantly decrease weight gain in patients with SMI who are taking anti-psychotic medications – Amazingly, 75% of participants did not experience clinically significant weight gain at the two year follow up. This in turn will help these patients to have a decreased risk for other chronic illnesses and improve their life expectancy.
Exercise is Medicine for the Brain The state of our physical health and the role of exercise and organized sports in promoting mental health and treating mental illness (Robert Sallis, FACSM) Children exercise less as they get older, and during the adolescent years, the rates of individuals meeting the recommendations for exercise significantly drops off. 2
Regular physical activity in children and adolescents leads to better performance in school, increased levels of self-esteem and improved mental health, such as lower rates of ADHD, depression, and anxiety. Dr. Robert Sallis urges us that we need large scale exercise prescription initiative. The fitness industry needs to merge with the fitness industry. During his talk, he asked, “Why isn’t [fitness] a part of childhood that you can’t get out of – like math and science?” He believes that, “As physicians, we have responsibility to assess and prescribe physical activity.” The role of exercise and organized sports in academic performance and social development (Elizabeth Joy, FACSM) Physically active children are less likely to be obese, less likely to use illicit substances, less likely to develop mental health issues, less likely to have risky sex, more likely to go to college, and more likely to be physically active as adults (and the list goes on); however, only ~30% of children are meeting the recommended levels of physical activity. Unfortunately, most of the school day is spent sitting and physical education programs have been cut out of the curriculum in many school systems. There is no doubt that physical activity is good for the school-aged brain and in fact, physical fitness is positively associated with academic performance. In addition, physical activity and physical fitness help support positive psychosocial behaviors and social skills. The role of nutrition and brain health (Melinda Manore, FACSM) Diet is important for brain health throughout all stages of life. The Mediterranean diet and DASH diet have been shown to be especially important for brain health. These nutrient-rich diets are marked by increased whole grains, fruits, vegetables, legumes, nuts, and olive oil, and decreased dairy, poultry, red meats and sweets. These foods have increased levels of omega-3 fatty acids, polyphenols, vitamins (especially B-vitamins and antioxidants), zinc, and iodine. Diets such as these help decrease the risk of inflammation, insulin resistance, and other chronic diseases, and can help prevent cognitive decline, dementia, and Alzheimer’s disease. The role of exercise in treating traumatic brain injury and neurodegenerative diseases (Ross ZaFonte, Harvard University) Traumatic brain injury leads to a range of brain issues including increased brain inflammation, abnormality in neuronal functioning, and cellular death. In addition 3
TBI causes cognitive impairment and can lead to increased risk for neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease. Exercise can be helpful in treating symptoms of TBI as well as improving the brain anomalies associated with TBI; however, the timing of the exercise is very important. Waiting some period of time after TBI (21 days after injury in the rodent) is important to ensure a positive outcome. In patients with TBI, exercise can also help delay the onset or improve symptoms related to TBI-associated neurodegenerative diseases. This work has largely been informed by basic science, and more clinical trials are needed in humans to investigate the positive effect of exercise on patients with TBI.
Morris/Paffenbarger Exercise is Medicine Keynote Lecture Physical Activity and Cardiovascular Prevention (Dr. Mai-Lis Hellénius, Karolinska Institute) The main message: sedentary behavior is associated with poor cardiovascular health outcomes. Exercise is important and we need to get people active as it improves a range of cardiovascular health issues, such as improved blood pressures and decreased levels of triglycerides and cholesterol.
“Guidelines” for tomorrow at the American College Sports Medicine Conference 1. Avoid prolonged sitting. 2. Increase everyday activity. 3. Accumulate at least 10,000 steps per day. 4. Engage in light to moderate physical activity (exercise) for 30-60 minutes per day accumulated or at least five days per week. 5. Progressive resistance training 2-3 times per week, several major muscles, repetitions x8. 6. Remember, every step counts and it has to be fun! 4
Day 2 of the American College Sports Medicine Conference – 2017
Impacts of Exercise, the Gut Microbiome/Metabolome and Immunity on the Brain
Exercise or prebiotic diet increases stress resistance, modulate stress reactive neurocircuitry, and promote adaptive gut microorganisms (Monika Fleshner, University of Colorado Boulder) The gut is composed of bacteria called the gut microbiome. Recently, a link has been shown between the gut and the brain (called the gut-brain axis) – certain bacteria are linked to emotion and brain plasticity. It turns out that the gut microbiota is adaptive and can respond to our behaviors like the foods we eat and the physical activities we engage in. In rodents, early life exercise has been shown to change the gut microbiota in positive ways, altering both the diversity and amount of gut microbiota. These exercise-induced gut changes are related to positive changes in mood and provide stress-protective effects. You can read more about this here: http://fasttwitchgrandma.com/exercise-your-gut-microbiome/.
Influences of Physical Activity/Exercise on Cognitive Health Across the Lifespan Fit body, fit brain: effects of exercise on neurocognitive function in older adults (Kirk Erickson, University of Pittsburgh) Older individuals who participate in a regular physical activity program show increased cognitive function, increase brain volume, and a decreased risk for cognitive decline and brain atrophy. Two regions of the brain that seem particularly amenable to physical activity are the hippocampus and prefrontal cortex, with fitness level positively associated with the size of these two brain regions. Dr. Kirk Erickson concludes that, “1) Exercise has widespread effects on the brain. 2) Moderate intensity exercise several days a week is sufficient for 5
improving brain health. 3) Starting to exercise in late life is not futile: even those who are sedentary can improve function.” Exercise in the fight against Alzheimer’s and Dementia (Jeffrey Burns, University of Kansas Alzheimer’s Disease Center) Increased physical activity is associated with decreased cognitive decline both in health individuals as those with Alzheimer’s disease (AD). In rodent studies that use AD models, exercise decreases the pathophysiology of the disease. Human studies, exercise has been shown to decrease rates of cognitive decline in patients with AD. In patients with AD, higher aerobic fitness is associated with less brain atrophy, and 6 months of aerobic exercise helps to protect brain volume and function. Dr. Jeffrey Burns says, “What’s good for the heart is good for the brain.” He also notes that more is always better because cognitive gains are positively correlated with fitness gains.
Exercise Psychology Physical Activity Beliefs in Middle-aged, Weight-challenged Women with Sedentary Jobs (Mary Yoke, Indiana University) For many weight-challenged individuals, there are many barriers to getting involved in physical activity. If we are going to meet the needs of individuals who are physically inactive and weight challenged, we need to talk with them and brainstorm with these individuals to ask them about how we can get them physically active. What are the barriers? Recent research is showing that for these individuals, high-intensity, challenging exercises often result in discouragement, drop-out, and feelings of hopelessness. Therefore, we may need to change the focus to more pleasurable activities such as light intensity activity, standing more, or moving while sitting. Body-heart-brain Interaction On Exercise: Effects Of Intensity On Inhibitory Control, Affect, Autonomic Cardiac Function And Brain Oxygenation (Weslley Quirino Alves da Silva, Federal University of Rio Grande do Norte) Different exercise intensities are associated with different levels of pleasurable sensations. In general, at high intensity exercises, the pleasurable nature of exercise decreases. When you look at sympathetic activity increases, cognitive function (inhibitory control) In a study One study examined heart rate 6
variability, blood flow in the prefrontal cortex, as participants cycled past their ventilatory threshold. They found that participants experienced the exercise session as pleasurable until the ventilatory threshold was reached. After this point, mood significantly decreases, cognitive function was impaired, and this was associated with significantly increased sympathetic activity (as assessed by heart rate variability), and significantly decreased oxygenation in the prefrontal cortex. Associations Between Mother’s And Children’s Moderate-to-vigorous Activity And Sedentary Time In The Family Context (MinKyoung Song, Oregon Health and Science University) The literature is unclear whether maternal physical activity behavior relates to the child’s physical activity behavior. Song and colleagues recently found that both MVPA and ST in mothers and their children are directly related. That is, the more mom’s are physically active (or sedentary), the more their children will be as well. I Feel Good! – Physical Activity and Quality of Life (Eszter Füzéki. Goethe University Frankfurt) PA can lead to meaningful increases in quality of life in various populations. However, based on the literature, it is difficult to prescribe a specific dose of exercise. What exercise intensity and frequency is the best to improve quality of life? Segar and colleagues (2011) have shown that, “[Individuals] with quality of life as a superordinate goal, exercise 15-34% more than those with weight/appearance, current health or healthy aging goals.” Physicians and healthcare professionals need to be aware that increased physical activity may not be the main goal for all people engaging in an exercise program. Rather, improvements in mental well being and quality of life may be at the forefront of why people participate in exercise.
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Day 3 of the American College Sports Medicine Conference – 2017
Neurobiological Effects of Physical Activity
Exercise and neurodegeneration; potential therapeutic role for FNDC5/irisin (Christiane Wrann, Massachusetts General Hospital, and Harvard Medical School) We know that exercise improves cognitive functioning, but why? Recent research has discovered that exercise increases a protein in the muscle known as FNDC5 (fibronectin type III domain-containing protein 5). FNDC5 is in turn secreted into the blood as irisin. The increase in these exercise-induced factors causes an increase in brain-derived neurotrophic factor (BDNF) in the hippocampus. As BDNF is like the miracle-grow of the brain, this then leads to increases in hippocampal neurogenesis (or new neurons in the brain). These things underlie why exercise improves our brain functioning. Can athletic blood cure Alzheimer’s disease in vitro? (Nathan Scrimgeour, Norwegian University of Science and Technology) There is an experimental technique called parabiosis where you connect the blood systems of two rodents. In what is called heterochronic parabiosis, you can connect a young rodent to an old rodent – the blood from a young mouse has been shown to have rejuvenate effects on the old mouse. In these experiments, the old mice show enhanced structural improvements in the brain, increased neurogenesis, improved neuronal function, and increased cognition. The long-term goal is to use this method in humans, giving patients with Alzheimer’s or Parkinson’s disease blood transfusions from young, healthy individuals. In a recent study, it was shown that cells in culture that were exposed to proteins associated with Alzheimer’s disease (amyloid beta and tumor necrosis factor alpha) start to shrivel and die. However, when these cells are then exposed to blood from humans that just exercised, the cells show decreased levels of atrophy and enhanced viability.
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Exercise and Neuroplasticity (Henriette van Praag, National Institute on Aging/National Institute of Health) Exercise improves spatial learning and memory and pattern separation abilities in rodents; that is, exercise improves hippocampal functioning. These exercise-induced improvements are thought to be related to the fact that exercise increased levels of new neurons in the hippocampus. New research has shown that exercise also changes the local circuitry of the hippocampus. Running reorganizes the circuitry of the hippocampus such that there is significantly increased input from both the brain stem and entorhinal cortex (both lateral and medial components). Excitingly, exercise expands the interconnected nature of brain cells. Work from the van Praag lab is showing that these brain changes may be connected to what is happening directly at the level of the muscle. Aging, Exercise, and Brain Plasticity (Kirk Erickson, University of Pittsburgh) In aging individuals, there is huge inter-individual variability in the rates of cognitive decline and brain atrophy, but why? What factors explain this type of variability? Physical activity may be one key factor. Increased levels of physical activity and higher levels of fitness have been shown to be positively associated with cognitive function and brain volume, especially in areas of the hippocampus and prefrontal cortex. In addition, exercise training enhances cognitive functioning and increases brain volume. In a seminal study, 1 year of physical activity (brisk walking) was shown to increase hippocampal volume by 2% (Erickson et al., 2011). However, there is a large degree of variability in how much individuals respond to physical activity both in terms of cognitive functioning and brain volume. Many moderating factors exist including diet, engagement in intellectual stimulation, gender, age, genetic status, hormone therapy use, omega-3 intake, baseline fitness level…the list goes on. Future studies will need to investigate exactly how these other factors influence the beneficial effects of exercise on the brain and behavior.
Highlight of the Day: An informal chat with Mr. Michael Phelps, the most decorated Olympian of all time! When asked how he did it he said, “It’s not rocket science – I get in the water and train.” Of course, this training is supported by the best trainers in the world 9
alongside exercise physiologists regulating all aspects of nutrition, supplementation, and recovery. Michael’s overall message for us: “Don’t be afraid to dream”
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Day 4 of the American College Sports Medicine Conference – 2017
Join the #IMove-MENT
ACSM / SBM Co-Sponsored Symposium: Exercise as an Integrative Approach to the Management oF Chronic Pain and Addiction Psychobiology of pain and exercise in chronic musculoskeletal pain (Dane Cook, University of Wisconsin) In patients with chronic pain issues, exercise may exacerbate fatigue, pain, and cognitive impairment often seen in these patients. However, acute exercise is not always associated with a worsening of pain and fatigue. For example, moderate intensity exercise can strengthen pain modulatory function in patients with fibromyalgia; that is, exercise increases activity in brain regions that inhibit the pain that we feel. Chronic pain can actually be seen at the level of the brain. Compared to healthy Gulf War veterans, Gulf War veterans with chronic muscle pain show widespread reductions in white matter integrity, with these brain impairments being associated with the level of chronic pain symptoms. Physical activity level, however, have been shown to modulate this effect, with higher physical activity levels corresponding to better brain health. Treating patient pain through exercise (Marie Hoeger Bement, Marquette University) Abnormal pain modulation is a shared characteristic of many chronic pain patients. Exercise can be helpful in the treatment of chronic pain. In fact, the majority of review 11
studies conclude that prolonged or chronic exercise results in pain relief. Many individuals with chronic pain do not engage in a regular physical activity programs, and some report that exercise increases their pain. This initial increase in pain, however, does not mean that chronic exercise won’t help with prolonged pain relief. Dr. Bement says, “Hurt does not equal harm. If you haven’t been exercising, it is natural that exercise may hurt.” This plays into the idea that pain inhibits pain. If exercise causes minimal levels of pain, the brain may engage pain modulatory circuits to inhibit the pain experienced by chronic pain patients. CDC’s Vision for Increasing Physical Activity Across the Nation: Looking Behind the Curtain (Janet Fulton, Ruth Petersen, & Susan Carlson, Center for Disease Control) Only 50% of adults in the United States meet the requirements for physical activity, and $117 billion in annual healthcare costs are associated with inadequate physical activity (Carlson et al., 2014). This is a serious issue, and the Center for Disease Control is making a call for action to get people more active. Their long-term goal is to increase the number of youth and adults who increase their level of physical activity. In their program, which they call “Active People, Healthy Nation”, they focus on 5 areas of development. These are: 1. To deliver physical activity programs that work; 2. To mobilize physical activity partners; 3. To message active lifestyles; 4. To train leaders for action; 5. To develop technologies, tools, and data that matter.
Highlight of the Day: 2017 ACSM Annual Meeting Gisolfi 5K Fun Run and Walk Today I ran my first race ever as part of the 2017 American College of Sports Medicine conference – and I did it at 6 am and 5,280 feet (1 mile) above sea level! 12
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Day 5 of the American College Sports Medicine Conference – 2017
Female Elite Athletes: The Impact of Participation in Competitive Sports Fitness athletes- the healthy body image idea: how are they doing? (Therese Methisen, The Norwegian School of Sport Sciences) Body image is important for the female fitness athletes. Around 3 to 4 months prior to competition, many fitness athletes begin to diet. This produces a variety of changes in body composition such as a decrease in body weight, resting metabolic rate, and fat mass, and an increase in lean body mass. However, 1-month post-competition, all of these changes return to baseline levels. This “body ideal” is not realistic or sustainable and leads to a significantly decreased bone mineral density. In addition, these ideals lead to increased feelings of depression, disordered eating and often times, eating disorders. Is it appropriate to manipulate body composition in young athletes to meet sport specific requirements for performance? (Ina Garthe, The Norwegian Olympic and Paralympic Committee and Confederation of Sport) It is not recommended for young athletes to diet to lose weight, but we know that such methods are being used in youth athletes and promoted by coaches. Youth athletes are those individuals who compete in sports and are between the ages of 12 to 18 years. Unlike adult athletes, they are going through a unique time period – puberty. During this time, the body goes through many changes and as such, youth athletes require special training and dietary. In this population, dieting starts at an early age (12.6-14.0 years). These restrictive eating and weight manipulation methods may lead to many negative outcomes including, “compulsive and excessive training, dissatisfaction with the body, low self-esteem, insomnia, reduced coping skills, and increased risk of 14
disordered eating and eating disorders.” In youth athletes, these issues present as, “reduced energy or ability to recover, decreased concentration, mood swings, reduced social activities, and avoidance of eating situations.” Because of these prevalent issues in youth athletes, the focus needs to shift! Rather than dieting, the focus needs to be on performance and health enhancement, optimization of nutrient intake and food habits, and improving knowledge and skills. Educated role models for these youth athletes will be integral to this new approach. Menstrual dysfunction – potential impact on performance (Anna Melin, University of Copenhagen) 50% of female athletes report that menses affects their performance. Women experience changes in a range of hormones throughout the monthly cycle; these hormones regulate metabolic, cardiovascular, respiratory, and musculoskeletal systems, and so it is no surprise that these hormonal changes affect athletic performance. In addition, several menstrual dysfunction issues exist such as polycystic ovarian syndrome and functional hypothalamic amenorrhea. These issues may be cause low energy states and are associated with, “increased muscle fatigue, decreased recovery rate of muscles, decreased blood flow and aerobic substrate utilization, decrease pulmonary oxygen uptake, decreased glycogen stores, increased risk for low bone muscle density and musculoskeletal injury, and changes in cognitive functions like reaction time, which are important for sports.” Pregnancy and postpartum in international and Olympic level athletes: what do we know? (Jorunn Sundgot-Borgen, The Norwegian School of Sport Sciences) Previous research has shown that exercising at 90% or above of VO2 max during pregnancy, may be dangerous for the fetus. Therefore, pregnant elite athletes have two questions, “How much exercise can I do, and when can I compete?” Sundgot-Borgen and colleagues examined 35 elite athletes who were Olympic medalists and world champions in the areas of endurance, ball game, technical, esthetic, and power sports. When asked about pregnancy and motherhood in relation to sports, one of the participants said, “[I have ] no problem with training, competing, and being a mother, but not sleeping is a problem”. Overall, in this group of pregnant elite athletes, there was no problem with fertility, risk of miscarriage or preterm birth. In addition, fetal growth was normal, most continue to train as usual until the 3rd trimester, and most return to ordinary training with 3-6 months after birth. 15
Presidential Lecture: No Sweat: The Surprising Science Behind Lasting Motivation and Sustained Physical Activity (Michelle Segar, University of Michigan) • Check out Dr. Segar’s book, “No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness” • Check out her motivational work@michellesegar.com • Segar’s guiding question is, “Why don’t most people prioritize and sustain physically active lives?” We’ve taught people to focus on distant goals such as weight loss, getting fit, disease prevention, and better health, and 75% of individuals report exercising for these reasons. People may start an exercise program, but then they quit. Dr. Segar calls this the “binocular problem” – they are focused on the long-term goals and because they don’t see effects immediately, they quit. She says, “There is a gap between people’s values and behaviors – what people intend to do is very different than what they actually do.” The real question is, what determines sustainable behavior? Research shows that it is affect, rather than logical or reason, that motivates people in the now. Immediate feelings outweigh the future value, and affect powerfully and predictably influences decision making. Therefore, we must hone this research to get people to exercise in a sustained way. Dr. Segal is trying to get people to exercise by changing the focus from the long-term goal of overall health to the immediate goal of feeling good. She proposes 3 strategies that we can use to get people motivated to exercise for the long term: • Reframe the “why”: Focus on the immediate feel good effects of exercise rather than losing weight and other long-term health goals • Use positive affective forecasting: Tell people to expect that they will feel good – research has shown that if people expect that they will feel good, they will! • Give permission: Give people permission to move in ways that feel good. What type of exercise do you love to do? Anything is better than nothing, and research is showing that even low-intensity exercise can be beneficial for the body and mind!
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Highlight of the Day: An informal discussion with Dr. Michelle Segar from the University of Michigan, Dr. Martin Gabala from McMaster University, and Gretchen Reynolds from the New York Times!
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