Ca Highlights from American College of Sports Medicine Annual Meeting and World Congress on Exercise is Medicine ® 2015 Carol A. Harrison, M.Ed Senior.

ca

Highlights from American College of Sports Medicine Annual Meeting and World Congress on Exercise is Medicine® 2015

Carol A. Harrison, M.EdSenior Exercise Physiologist

http://en.wikipedia.org/wiki/File:ACSM_Logo_Horizontal.png

Highlighted Topics for Discussion

• ACSM Roundtable Pre-participation Exercise Screening Guidelines and Proposed Changes

• Current Research in Exercise Immunology

• Is it Time for Personalized Exercise Medicine?

• Wired for Health and Physical Activity

ACSM Roundtable Pre-participation Exercise Screening Guidelines and Proposed Changes

ACSM Roundtable convened in June 2014 to:• Safety of exercise• Identify those at risk for serious cardiac events during exercise• Review current literature• Update recommendations and discuss the need for change based on current

findings

What we know:• Exercise is relatively safe• Many health benefits• Cardiac events during exercise are rare• Adverse events usually preceded by signs and symptoms• Risk of cardiac event decreases with increased overall fitness


Current recommendations overly conservative resulting in:• Perceived barrier to starting an exercise program• Reluctance to advance exercise program when needed• Unnecessary burden on the healthcare system• Financial burden on individuals committed to starting an exercise

program

Roundtable participants from:• Risk assessment• Preventative cardiology• Public health• Exercise physiology• Geriatrics• Health and fitness


New evidence informed model for pre-participation screening based on:

• Current level of physical activity (exercise)• Presence of signs and symptoms or known cardiac, metabolic, or

renal disease• Desired level of intensity

Current evidence suggests that approach should be individualized.


1. CVD risk profile no longer part of the decision making process when deciding whether to refer for medical clearance or not. No longer classification of individual into a low, moderate or high risk category.

2. No longer making recommendation for a medical exam or exercise stress test. The recommendation is for medical clearance only. It is up to the healthcare provider to determine the necessity of these assessments based on patient records and current condition. Do they need it?

3. No longer automatically recommending those with pulmonary disease get medical clearance before exercising. Why? In itself, it does not increase risk for a cardiac event during exercise.

Again, presence of signs and symptoms critical in making assessment.


New guidelines released in MSSE November 2015

ACSM Guidelines for Exercise Testing and Prescription 10th edition to be released in 2017 (?)

Individuals looking to test for ACSM certification will be notified (on the certification website) when new guidelines take effect.

Highlights of Current Research in Exercise Immunology

The new sub-discipline in exercise physiology of exercise immunology emerged during the 1980’s.

Exercise immunology’s primary focus is on how exercise effects immune function and what are the consequences of that effect.

What are the mechanisms of the effect?

Does the timing of the exercise enhance or is it detrimental in the immune response?


Enhancing Virus and Tumor-specific Immunology with ExerciseRichard J. Simpson, Associate Professor, University of Houston, Houston, TX

Area of interest presented:• How does the immune system respond to a single bout of exercise.

• More specifically, how exercise can improve immune response to viruses and certain tumors.


We know that leucocytes increase dramatically in response to exercise.

There is an intensity dependent mobilization of total lymphocytes immediately post exercise followed by lymphocytopenia during the early stages of recovery ( J curve).

During exercise there tends to be a mobilization and high proliferation of lymphocytes( CD8+ T cell subtype called KLRG1, has previously encountered an antigen, has memory) in the peripheral blood flow.

The mechanism by which exercise elicits this response is mediated by catecholamines.

Catecholamine (epinephrine, norepinephrine) concentrations increase markedly during exercise.


Can this knowledge now be expanded to look a viral infections and cancer immunotherapy?

The cytomegalovirus (CMV) is a very prevalent herpes virus• CMV increases as we age• CMV is asymptomatic• In the immuno-compromised individual it can be fatal.• It can be mobilized with exercise as well as the viral specific and tumor

antigen specific T cells (KLRG1).


Exercise profile:• Cycling• Steady state at 10% about previously measured lactate threshold• Duration of 30 minutes

Exercised above lactate threshold to insure release of catecholamines.

Viral and tumor antigen specific T cells are increased in the blood compartment during this exercise.

Results:• Exercise had a dramatic effect on the expansion of the CMV viral

specific T cells observed in the blood.• Under non-exercise conditions, 21 days to grow same number of

immune cells observed after 8 days immediate post-exercise expansion.


How can this research now be expanded to cancer immunotherapy treatment?

• Use of immediate post-exercise cells may dramatically reduce time for donor immune cell expansion.

• Given the fact that these exercise cells are highly cytotoxic, can this method cause an increase in the incidence of graft versus host disease after stem cell transplant? Still investigating.

• Evidence has shown that it is fairly safe for healthy donors to exercise through apheresis thus increasing time for gathering and expansion of donor immune cells.

Highlights of Research in Research in Exercise Immunology

Exercise, Colitis, and the Gut MicrobiomeJeffrey A. Woods, Professor, University of Illinois, Urbana, IL.

Present in the gut we have: • Feces• Microbiota (several bacterial species, some harmful, some not).• Epithelial cells with short half lives • Stem cells that mature into epithelial cells, etc.• Immune cells• These cells are combined by barrier tight structure layers

There can be a breach between cell layers separating micro-organisms and an entering in of cells where they should not be, thus causing a pro-inflammatory state and an immune response.


How does exercise effect the gut?

Physical activity in the form of regular exercise can protect against colon cancer to the tune of a 25 to 30% reduction in colon cancer mortality.

Problems arise with the presence of chronic and/or excessive inflammation leading to many pathologies including ulcerative colitis (UC) which can lead to colon cancer.

Can regular exercise alter inappropriate information in chronic and/or excessive inflammation and improve the consequences associated with pathological inflammation?


Can exercise attenuate ulcerative colitis (UC) in mouse?

• Forced treadmill running 6 weeks as opposed to a sedentary mouse control

• Dextran sulphate sodium (DSS) applied 2% in water as opposed to water only group.

• DSS disrupts the gut barrier function initiating inflammation in mice.

Exercised 6 weeks, 5 days weekly, 40 minutes a day, for a total of 30 exercise sessions.

This type of treadmill training has been shown to decrease inflammation in adipose tissue.


Results:• Forced treadmill running induced mortality and morbidity.

exacerbating the inflammatory response in DSS treated mice.• Water-fed only mice did not experience exaggerated inflammatory

response.• Forced treadmill running perceived as excessively stressful. Proven by

examination of adrenal gland (hypertrophy during excessive stress) and thymus gland (atrophy during excessive stress).

Is all exercise the same? Can excessive stress “nullify” the potential protective benefits of exercise?

• Procedure repeated using voluntary wheel running.

Results:• No deaths, little to no diarrhea, weight loss minimal.


Conclusions?• There are apparent benefits to wheel running as opposed to forced

treadmill running.

• Cytokine expression examined in the distal colon of wheel runners (TNFα, IL-6). Wheel running attenuates the inflammatory response in the distal colon suggesting protection against DSS induced colitis.

• Adrenal and thymus glands examined in wheel runners. No difference in normal weight observed suggesting that the mice did not perceive wheel running as stressful.

• Exercise mode and circumstances under which it is undertaken appear to make a difference in the potential benefits derived.


Further study from a microbiome view:

• Voluntary and forced exercise may alter the community structure of the gut microbiota

• Voluntary and forced exercise can alter the bacteria taxa that may be implicated in the pathogenesis of UC.

• Increased concentration of gram negative (pathogenic) bacteria seen in forced treadmill runners as opposed to wheel runners.

• May be correlated changes in the gut microbiota that can account for the responses to DSS treatment between forced (stressful) treadmill running and voluntary wheel running. What are they specifically?

• Exercise can be used to reduce inflammation associated with chronic inflammation in irritable bowel disease.

Is it Time for Personalized Exercise Medicine ?

Evidence Supporting Inter-individual Response to Cardiorespiratory Fitness in Response to Exercise DoseTim Church, Pennington Biomedical Research Institute, Baton Rouge, LA.

What we have believed:• Every 1 MET increase in activity is associated with a 13% reduction

in risk for all cause mortality.• Every 1 MET increase in activity is associated with a 15% reduction

in cardiovascular disease (CVD) mortality.What we now observe:• Fitness is relative. • Potential benefits associated with beginning fitness level.• Moderate to high fitness, 1 MET increase offers no benefit• Low fitness, 1 MET increase 20-30% improvement in all cause

mortality, 20-30% reduction in CVD risk.

Is it Time for Personalized Exercise Medicine?

Highlighted Dose Response to Exercise in Women (DREW) studyCooper Institute, yr. 2001-2006)

Investigated the effects of different volumes of exercise training on CRF and SBPVolume defined as total energy expenditure per week (kcal/kg/week or kkw)• 464 women• BMI 25-43• SBP 120-159.9 mmHG• Exercised at 50% of peak VO2

• Cycle ergometer and treadmill• 6 month intervention• Randomized to non-exercise, 4 kkw, 8 kkw, 12 kkw

Is it Time for Personalized Exercise?

Results:• Absolute VO2 (L/min) increased in exercise group overall compared to control group

by 4.2% (4kkw), 6.0% (8kkw), 8.2% (12kkw). • No significant change in SBP• Control group decreased (-1.7%)

There was significant individual variability in response across all exercise groups. Some responded well while others responded poorly or not at all. • 4kkw 46% nonresponders • 8kkw 24% nonresponders• 12kkw 19% nonresponders

The smaller the exercise volume the greater the number of nonresponders. But high numbers of nonresponders seen at all 3 dosage levels.Add resistance training? Add interval training? Personalize mode to match likelihood of response?


Robert Ross, ProfessorQueen’s University, Kingston, ON, Canada

• Individual response to exercise has been neglected.• We should focus on the dynamic interaction between intensity and

volume.• High Amount High Intensity appears to achieve favorable CRF in

all subjects, but still in varying degrees.• If we are going to fix the amount of exercise and alter intensity,

multiple assessments of CRF ( every 4 to 6 weeks) must be done and the training program adjusted in response to the physiological changes in the individual.

• It is possible to do exercise of varying amounts and intensities and see no results.


Claude Bouchard, ProfessorPennington Biomedical Research Institute, Baton Rouge, LA.

What would personalized exercise medicine do?

• Treat that person as a unique biological entity.

• Understand individual’s unique makeup so we can possibly predict how they will respond, risk for cardiac event, risk for joint and/or skeletal muscle injury.

• Tailor the exercise to the person and not the group.

Is it Time for Personalized Exercise Medicine?

Claude Bouchard, ProfessorPennington Biomedical Research Institute, Baton Rouge, LA.

What is needed for successful personalized exercise?

What we need are diagnostic tools to achieve personalized medicine.

How do we develop diagnostics?• Gene expression profiling• Genomic markers powerful in contribution to diagnostics• Metabolic profiling• Need large and powerful studies (of the pharmaceutical type) which may

not be likely because they depend on tissue not generally used for diagnostic purposes (muscle and adipose tissue). Very expensive.

Wired for Health and Physical Activity

Edward Melanson, ProfessorUniversity of Colorado, Denver, CO.

Estimating Energy Expenditure using Body Worn Direct Calorimetry Device

Nutrients + O2 → ATP + Heat + CO2 + H2O (simple energy expenditure equation)

Indirect calorimetry (what we presently use in our physiology labs): Heat and gas exchange (CO2 exhaled in relation to O2 consumed) is directly proportionate to energy expenditure.

Direct calorimetry is the measurement of the actual heat produced by an individual in a small closed chamber.

Metalogics® has developed the Personal Calorie Meter (PCM) for direct measurement of energy expenditure (calories burned).


DirectCAL™ Technology•Direct Calorimetry •Validation Studies

DirectCAL™ directly measure all the calories your body burns. It does this by accurately

measuring the heat that is generated by your body. As seen in the illustration below, the patented sensor measures all four forms of heat that flows from your body (heat flux), including heat flows from conduction, convection, radiation and evaporation.

http://www.metalogicscorp.com/directcal-technology

http://www.metalogicscorp.com/direct-calorimetry

http://www.metalogicscorp.com/validation-studies


The sensing band measures all forms of heat generated by your body. Data is transmitted wirelessly from the armband to the portable read-out so you know instantly the amount of calories you are burning.


Advantages of PCM:• They are sensitive to activities not detected by activity monitors. Ex: Accelerometers cannot measure resistance training efforts.• They provide immediate results.• They can easily be hidden under clothing.• May possibly be used to personalize exercise prescription.

Disadvantages of PCM:• Wearing heavy clothing may skew output.• Sleeping under heavy covering may produce erroneous output.• Obesity• Not accurate over brief periods of time as the heat is lost.

Highlights from American College of Sports Medicine Annual Meeting and World Congress on Exercise is Medicine® 2015

Many thanks to the Center for Energy Balance in Cancer Prevention and Survivorship

Ca Highlights from American College of Sports Medicine Annual Meeting and World Congress on Exercise is Medicine ® 2015 Carol A. Harrison, M.Ed Senior.

Documents

exercise testing

safety of exercise

exercise program reluctance

personalized exercise

exercise stress test

acsm guidelines

preparticipation screening

acsm certification