ACSM’S CERTIFIEDNEWSF O U R T H

Q U A R T E R

2 0 1 5•

V O L U M E

2 5 :I S S U E

42015 Recap andFuture Directions for
ACSM’s Certified News
Page 2

Managing Exercise inPatients with Diabetes:
Antihyperglycemic Medication
Review – Part 2
Page 3

Muscle Recovery From
Resistance Exercise
Page 4

Coaching News
Page 5

Effects of Low-Volume
High-Intensity IntervalTraining on Fitness
Page 6

Healthy Nutrition for
Cardiovascular Disease
Prevention and Treatment
Is High-Intensity IntervalTraining a “Magic Bullet” forthe Treatment of Obesity?
Page 8

LattaPictures/iStock/Thinkstock

Page 7

ACSM’S CERTIFIED NEWSCCRB Column

Fourth Quarter 2015 • Volume 25, Issue 4
In This Issue
2015 Recap and Future Directions for
ACSM’s Certified News....................................... Page 2
Managing Exercise in Patients with Diabetes:
Antihyperglycemic Medication Review – Part 2......... Page 3
Muscle Recovery From Resistance Exercise................. Page 4
Coaching News................................................... Page 5
Effects of Low-Volume High-Intensity
Interval Training on Fitness..................................... Page 6
Healthy Nutrition for Cardiovascular Disease
Prevention and Treatment....................................... Page 7
Is High-Intensity Interval Training a “Magic Bullet”
for the Treatment of Obesity?................................. Page 82015 Recap and Future
Directions for ACSM’sCertified News
By Dierdra Bycura, Ed.D., andYuri Feito, Ph.D., MPH, FACSM

Co-Editors

Dierdra Bycura, Ed.D.
Yuri Feito, Ph.D., FACSM
Committee on Certification
and Registry Boards Chair
William Simpson, Ph.D., FACSM
CCRB Publications Subcommittee Chair
Gregory Dwyer, Ph.D., FACSM

ACSM National Center Certified News Staff
National Director of Certification
and Registry Programs
Richard Cotton
Assistant Director of Certification
Traci Sue Rush
Certification Manager
Kela Webster
Creative Services Manager
David Brewer
Editorial Services
Lori Tish
Barbara Bennett

Editorial Board

Chris Berger, Ph.D., CSCS
Clinton Brawner, Ph.D., FACSM
James Churilla, Ph.D., MPH, FACSM
Ted Dreisinger, Ph.D., FACSM
Avery Faigenbaum, Ed.D., FACSM
Riggs Klika, Ph.D., FACSM
Tom LaFontaine, Ed.D., FACSM
Thomas Mahady, M.S.
Maria Urso, Ph.D.
David Verrill, M.S.
Stella Volpe, Ph.D., FACSM
Jan Wallace, Ph.D.

For More Certification Resources Contact the
ACSM Certification Resource Center
1-800-486-5643
Information for Subscribers

Correspondence Regarding Editorial Content
Should be Addressed to:
Certification & Registry Department
E-mail: certification@acsm.org
Tel.: (317) 637-9200, ext. 115.

For Back Issues and Author Guidelines Visit:
certification.acsm.org/certified-news

ACSM’s Certified News (ISSN# 1056-9677) is publishedquarterly by the American College of Sports Medicine
Committee on Certification and Registry Boards (CCRB). All
issues are published electronically and in print. The articles
published in ACSM’s Certified News have been carefully
reviewed, but have not been submitted for considerationas, and therefore are not, official pronouncements, policies,
statements, or opinions of ACSM. Information published in
ACSM’s Certified News is not necessarily the position of
the American College of Sports Medicine or the Committee
on Certification and Registry Boards. The purpose of the
publication is to provide continuing education materials to thecertified exercise and health professional and to inform these
individuals about activities of ACSM and their profession.
Information presented here is not intended to be information
supplemental to ACSM’s Guidelines for Exercise Testing and
Prescription or the established positions of ACSM. ACSM’sCertified News is copyrighted by the American Collegeof Sports Medicine. No portion(s) of the work(s) may be
reproduced without written consent from the publisher.
Permission to reproduce copies of articles for noncommercial
use may be obtained from the Certification Department.

As Yuri and I finish up our first year as co-editors of ACSM’s Certified News
(CN ), we’d like to take this opportunity to thank those who have given of
their time and expertise to author articles for CN. Your contributions havebenefited ACSM’s certified professionals internationally by providing relevant and applied content. Please see the table on page 9 for the topics and audiences reached (e.g.,clinical versus applied practitioner) over the last year.
Moving forward, we would like to focus on creating greater synergy between the readership’s interests and CN content. Even though prospective authors can turn to several
sources (e.g., current research literature, conference proceedings, trending topics fromapplied publications) to compose an article for submission, we believe the voice of thereadership is most valuable for CN ’s growth.
The collective voice of fitness professionals was most recently reported in The Worldwide Survey of Fitness Trends for 2016, written by Walter R. Thompson, Ph.D.,
FACSM, and published in ACSM’s Health & Fitness Journal®.1 This continued work(ten years running) was a culmination of survey results from fitness professionals
internationally commenting on health and fitness trends. In addition, at the conclusionof the article, four fitness professionals were asked to comment on the trends reported.
Their backgrounds were different with respect to levels of experience, employment typeand interests in the field. This offered varied perspective on the trends identified by thesurvey respondents.
Examining the trends reported in The Worldwide Survey of Fitness Trends, reviewing
insights from other professionals, and reflecting on our own practices might be aninteresting place to start a potential discussion of a possible topic to include in a futureissue of CN, which will have great appeal to other certified professionals around theworld.
That said, we want to hear from you! We are currently looking for contributors for upcoming issues of CN and would like to work with you to share your knowledge with allcertified professionals. In addition, we are in the process of creating electronic avenues
to communicate with certified professionals and would love to hear how you prefer tocommunicate with other professionals. Stay tuned! In the meantime, please don’t hesitate to contact either Yuri or me with content suggestions and article contributions!
2015 Recap and Future Directions (continued on page 9)

ACSM National Center
401 West Michigan St.
Indianapolis, IN
46202-3233
Tel.: (317) 637-9200 • Fax: (317) 634-7817©2015 American College of Sports Medicine.
ISSN # 1056-9677

2

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

Clinical Column

Managing Exercise in Patientswith Diabetes: Antihyperglycemic
Medication Review – Part 2
By Jeff Soukup, Ph.D.

I

n the first of this two-part series I provided a brief reviewof the classifications of antihyperglycemic medications thatare currently being used in the treatment of diabetes andmentioned that the major concern for exercise-induced hypoglycemia (EIH) comes when a medication increases the amount of
insulin within the system (either by exogenous administration or
by increasing pancreatic production) and disturbs theinsulin-glucagon balance.
In addition to insulin, medications that increase the opportunity
for EIH are collectively referred to as insulin secretagogues andinclude sulfonylureas, and meglitinides. While other antihyperglycemic medications also produce a glucose lowering effectduring exercise, they should leave the counter-regulatory system
intact so that hypoglycemia may be avoided. Under normal
physiologic conditions, the onset of exercise is accompanied bya sympathetic nervous system response which, by the action of
epinephrine, inhibits the release of insulin from the beta cellsof the pancreas. At the same time, epinephrine stimulates therelease of glucagon from the alpha cells of the pancreas whichthen acts on the liver to stimulate the release of glucose. The
net result is that the increasing muscular glucose uptake causedby exercise is carefully balanced with increased hepatic glucose output caused by glucagon, and the blood glucose levels
remain relatively stable as long as sufficient amounts of glucose
are available for release. Conversely, when there is an excessive
amount of insulin within the system that is not amenable to adequate down-regulation and glucagon release is inhibited (suchis the case when insulin or insulin secretagogues are taken),there is an opportunity for muscular glucose uptake to exceed
hepatic glucose output and result in a decrease in blood glucose.
Under these circumstances, the counter-regulatory system will
be overwhelmed and the possibility of hypoglycemia results.
When working with patients who inject insulin, it is importantto understand the characteristics of the insulin that is being injected along with the patient’s injection schedule. Regarding thecharacteristics of insulin, one must be aware of the onset, peaktime, and duration of the medicine being injected. The onset
refers to length of time following the injection before the insulinreaches the bloodstream and begins lowering blood glucose.
The peak time refers to the length of time during which theinsulin is at maximum strength and the duration is the length oftime that the insulin will continue to lower blood glucose levels.
There are four types of injectable insulin: rapid acting, regular or
short acting, intermediate acting, and long acting. Each of thesehas a different onset, peak time, and duration as outlined in thetable.2

Table 1: Injectable Insulin
Insulin Type
Rapid acting
Regular, short acting
Intermediate acting
Long acting

Onset
5-15 min30-60 min2-4 hours
2-10 hours

Peak Time		Duration
30-90 min		3-5 hours
2-3 hours		5-8 hours
4-10 hours		10-16 hours
6-16 hours		16-24 hours

Management of exercise in patients who take insulin requires
the clinician to be aware of the insulin type, timing of injection,
content and timing of meals, and in some cases, the insulin
injection site. Exercising when insulin is not at its peak, injecting
insulin into a non- or less-active muscle group, and exercising
one to two hours after a meal will reduce the likelihood of EIH.
If exercise is undertaken when the above can not be avoided,
then the clinician must be prepared to check blood glucose more
frequently and treat EIH with a fast-acting carbohydrate.
For more information on managing blood glucose during
exercise, the reader is referred to table 40-6 of the 7th edition of
ACSM’s Resource Manual for Guidelines for Exercise Testing and
Prescription.
The peak level and half-life of insulin secretagogues determine
the time of maximum blood glucose lowering effect and theduration of action, respectively. For sulfonylureas, the peak levels
range from one to four hours with most having peak levels of
two to four hours.1 For the meglitinides, the peak levels occur
earlier and range from one to two hours. The half-life of sulfonylureas ranges from 4-10 hours while the half-life of meglitinides is one to one and one half hours. Avoidance of EIH may
best be achieved by selecting exercise times that are not within
the peak level range of the specific medicine. However, these
medications are often taken prior to meals and if exercise is tobe undertaken one to two hours thereafter, it will occur during
peak level times. Once again, checking blood glucose levels
before, after and sometimes during exercise will provide the best
insight on how to manage the exercise session.
About the Author

Jeffrey Soukup received his Ph.D. in Human Performance from the University of Southern Mississippi in August 2003 after spending the previous 14
years working at Providence Hospital in Mobile, AL as a certified diabetes
educator and cardiopulmonary rehabilitation exercise physiologist.

Antihyperglycemic Medication Review (continued on page 10)

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 43

Fitness Column

Muscle Recovery From
Resistance Exercise
By Wayne Westcott, Ph.D.

W

Jupiterimages/Polka Dot/Thinkstock

hen a muscle experiences tissue microtrauma froma resistance training session, it initially becomes
weaker and gradually remodels to a slightly higher
level of strength. For example, in a classic and comprehensive
study by McLester and colleagues,4 ten previously trained
young men performed eight standard strength training exercisesfor three sets of ten repetitions each, using the 10-repetition
maximum (10RM) weight load. The mean number of repetitions performed across all of the exercises was 10.2 repetitions.
After a one-day (24-hour) recovery period the mean numberof repetitions completed was significantly lower than baseline,
at 8.4 repetitions. Following a two-day (48-hour) recovery
period the mean number of repetitions completed was almost
back to baseline, at 9.9 repetitions. After a three-day (72-hour)
recovery period the mean number of repetitions completed wassignificantly higher than baseline, at 11.2 repetitions. Following a four-day (96-hour) recovery period the mean number ofrepetitions completed remained at 11.2 repetitions.
The findings from this well-designed research study revealed
that a standard resistance training session, in which each exercise set is performed to momentary muscular failure, resulted inlowest strength levels one day after the weight workout, a returnto original strength levels two days after the weight workout,and highest strength levels three to four days after the weight
workout. These results suggested that full-body, moderate-volume, high-effort resistance training sessions should be followed
by 72 to 96 hours of recovery time for optimum strength
development. Two exercise sessions a week would therefore be arecommended training frequency for full-body weight workouts.
A split workout routine, such as chest and triceps exercises on
Mondays and Thursdays, upper back and biceps exercises on
Tuesdays and Fridays, leg and core exercises on Wednesdays andSaturdays, would likewise provide 72 to 96 hours of recovery
time between successive training sessions for given muscle
groups.
A study by Hackney and associates2 examined the increase in
resting energy expenditure following a full-body, high-volume,4

high-effort weight workout. A group of eight previously trained
subjects and a group of eight previously untrained subjects
both performed eight standard resistance exercises for eightsets of six repetitions each using the six-repetition maximum(6RM) weight load. The previously trained study participants
experienced a 7.9 percent average increase in resting energy
expenditure during the three-day (72-hour) period following
their strength training session. The previously untrained study
participants experienced a 9.2 percent average increase in restingenergy expenditure during the three-day (72-hour) period
following their strength training session. These results indicated that muscle remodeling processes were active for at least
three days after the full-body, high-volume, high-effort weight
workout.
Research by Heden and colleagues3 revealed similar results froma full-body, low-volume, high-effort strength training session.
Eight previously untrained young male participants performed
ten standard resistance exercises for one set of 10 repetitions
each using the 10RM weight load. Although the average completion time for this 10-set workout was just over 15 minutes,
the study subjects experienced a 5.2 percent average increase
in resting energy expenditure during the three-day (72-hour)
period following their strength training session. These results
revealed that even a relatively brief full-body weight workout,
performed at a high level of intensity, was associated with athree-day increase in resting energy expenditure to accommodate muscle remodeling processes.
Based on the three studies reviewed, it would appear that, ingeneral, muscles trained to temporary muscle failure requireat least 72 hours of recovery to rebuild/build higher levels ofstrength. If this is the case, should the American College ofSports Medicine1 revise its current strength training frequency
guideline that recommends two to three workouts a week withat least 48 hours of recovery for the exercised muscle groups?
Not necessarily. As demonstrated in a large-scale study,5 two or
three resistance exercise sessions per week may be equally effective for increasing muscle strength in beginning participants
who are training at a moderate effort level. In this study, morethan 1,600 previously untrained subjects performed the same
strength training program (10 standard weight stack machine
exercises, one set of 8 to12 repetitions each) one, two, or three
non-consecutive days a week, for a period of 10 weeks. The
once-weekly strength training group experienced a relatively
small lean weight (muscle) gain of 0.7 pounds. The two- andthree-weekly strength training groups experienced identicalincreases in lean weight (muscle) of 3.1 pounds, which was significantly greater than that attained by the single-session group.
Muscle Recovery (continued on page 10)

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

Coaching Column

Coaching Clients with Mild
Chronic Conditions
By Erika Jackson, MA, MCC and Margaret Moore (Coach Meg), MBAand your clients get motivated and jump onto the fitness bandwagon and stay there. Sometimes your passion may be energizing for your clients for a while, or they may engage to please youfor a while, but it doesn’t last if they don’t discover their own
passion and internal motivation. Sometimes your clients don’t
seem to be particularly motivated from the outset. They may
not bring a lot of passion to your time together. You are working
pretty hard to ignite, motivate, and excite them, while they are
just going through the motions; following directions.
What coaching inquiries might help you to be more successful
in generating client motivation?

Tell me about the fittest and healthiest time(s) inyour life.

Ammentorp Photography/iStock/ThinkstockThis article continues a valuable series for our Coaching News
column, exploring interesting and challenging client scenarios.
We describe a few strategies from our science-based coaching
toolbox to help you support your clients in engaging fully in a fit
lifestyle that allows them to thrive, whatever thriving means intheir lives.

Client Scenario: How do I support a client with amild chronic condition (e.g., diabetes or asthma)and few symptoms, in being motivated to leadan active lifestyle to prevent the development of
more life-altering chronic symptoms?
You likely entered this field because you have a natural passion
for health and fitness and the connection between the two. You
feel called to help people improve their health conditions andquality of life through exercise and hopefully delay, minimize,or avoid the consequences of a serious medical event. You wantyour enthusiasm to spill over to your clients. You have a strong,internal motivational urge to move your body and you want tohelp others discover that strong urge. You encourage, educate,and sometimes cheerlead with enthusiasm to inspire engagement in a fitness lifestyle.

Your passion is a wonderful trait—believing in the power ofhealth-giving lifestyles, believing people can get fit and gethealthier through a fit lifestyle. It’s invigorating to feel thispassion. You are grateful for the work you get to do. While yourpassion is energizing for your relationship with clients, making
it clear that you want to help them, your passion may not always
elicit their passion and motivation. Sometimes you are successful

Let’s start by digging up, unpacking, and appreciating yourclient’s past and best experiences with being healthy and fit. Askthese questions:• W hat happened to generate these times for you?
• W hat did you learn?
• W hat did good health and fitness contribute?
• W hat was the impact on your energy, sleeping, stress, mental
productivity, creativity, and other life aspects?
This appreciative inquiry allows clients to reconnect with a positive past in order to ignite possibilities for a positive future.

Describe someone you know and admire who
has a chronic condition and has turned it into an
opportunity to get more fit and healthier.

Most human behavior is learned through modeling; from birth
we are attuned to the models in our lives for behaviors for everything from walking to conducting ourselves in social settings.
We take our cues from role models and, when they are effective,
can adopt the “If he can do it, I can do it!” attitude as a result.
There is an important distinction to make here, however. Behavior change is better influenced by role models than by inspirations. An inspiration seems untouchable. Like an Olympian,or an astronaut, or even you as a fitness expert, success of theserole models is so far out of reach that it inspires awe, but notconfidence. The success of inspirational role models may seemtoo unlikely for us to believe that we could do it too.
A role model is one or more persons with whom we feel a kinship. We see similarities in their character, in their stories and intheir struggles. We see their humanity, along with their success.
In other words, we can see ourselves in our role models, andtherefore, our true potential to be like them.
Coaching News (continued on page 11)

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

5

Health & Fitness Feature

Effects of Low-Volume HighIntensity Interval Training
on Fitness
By Edward Davila, MS, and Leah Vogel, BS
Learning Objectives

1. To understand what low-volume high-intensity interval
training is.
2. To describe the acute and chronic physiologic adaptations
induced by low-volume high-intensity interval training.
3. To understand why low-volume high-intensity interval training may be a useful strategy to promote exercise adherence
and health.
4. To have a better understanding on how to prescribe lowvolume high-intensity interval training.

Engaging in regular physical activity (PA) is a welldocumented strategy to reduce disease risk, improve
cardiorespiratory fitness (CRF), improve quality of life
(QOL), and reduce risk of certain cancers (e.g., colon, breast).11,3
Not only can regular PA induce positive physical health benefits,
it also can lead to improvements in depression/anxiety, enhanced
feelings of energy and well-being, and improved cognitive function.3 However, despite the overwhelming and rapidly expanding body of literature to support the use of regular PA to prevent
and/or reverse chronic disease and premature death, most adults
fail to meet the minimum recommended guidelines.4
Many studies report that the most common reason for not exercising is “lack of time.”4 In response to this commonly reported
barrier, research on exercise prescription strategies that yield
similar health benefits to continuous endurance-based exercise
with minimal time commitments have become exceedingly
popular.4 Moreover, these low time-commitment interventions,which generally consist of low-volume high-intensity exercise
intervals, have led to as good, if not greater physiologic adaptations when compared to a more contemporary moderate-intensity continuous exercise training (MCT) approach.

High-Intensity Interval Training

High-intensity interval training (HIIT) has gained considerable
attention as a promising, “time-efficient” exercise prescription
strategy in a variety of populations. Typically, HIIT protocols
involve a series of repeated bouts of higher intensity exercise
interspersed with shorter periods of low-to-moderate intensity
recovery periods.7,1 Both acute and chronic effects of HIIT havebeen documented (Table 1).
High-intensity interval training has been shown to improveanaerobic and aerobic capacity, increase skeletal muscle capacity
for fatty acid oxidation and glycolyic enzyme content, improve
insulin sensitivity and acutely impact hormonal response.1
Further, after a single bout, HIIT has been shown to lead to6enhanced cardiac vagal modulation and decreased number ofpremature ventricular contractions which, in turn, decreases thelikelihood of potentially lethal ventricular dysrhythmias.6
Table 1. Acute and Chronic Responses of HIIT
Acute

Chronic

h Heart Rateh Cortisol
h Catecholamines
h Growth Hormone
h Plasma Lactate
h Plasma Glucose
h Glycerolh Cardiac Vagal Modulationi PCr, ATP, Glycogen StoreshAerobic Capacity
hAnaerobic Capacity
hInsulin Sensitivity
hSkeletal Muscle Capacity for Fatty

Acid Oxidation and Glycolyic Enzyme
Content

NOTE: PCr = Phosphocreatine; ATP = Adenosine Triphosphate

Low-volume high-intensity interval training protocols are safe
and time-efficient strategies that have been used in both healthy
and chronic diseased populations.2,9 In fact, interval exercise
training has been shown to create superior improvements in
CRF compared with MCT in patients with cardiovasculardisease (CVD) and also has been demonstrated as superior
to MCT in reversing risk factors of metabolic syndrome.8,10
Further, research shows that after a short-term HIIT intervention of two weeks, insulin sensitivity increased by 25 percent at
24 hours following the HIIT intervention but had returned tobaseline 72 hours post-exercise.1
In healthy populations, the intermittent method of HIIT allows
for less fatigue due to the frequent periods of lower intensity
exercise or rest. Consequently, this leads to a greater physical effort during the high-intensity exercise interval.7 For example, inathletes the greatest improvements in peak oxygen consumption(VO2) are demonstrated when high-intensity exercise training(i.e., 90 to 100 percent HRR) is integrated into the training
program.12
In addition, HIIT has been shown to repeatedly stress the adenosine triphosphate phosphocreatine (ATP-PC) and glycolysis
energy systems, which increases the energy capacity of skeletal
muscles and has even been shown to induce skeletal muscle
remodeling towards a more oxidative phenotype.7,5 As a result,
HIIT has been shown to lead to improved exercise capacity,
lower lactate accumulation, increased capacity for whole-bodyand skeletal muscle lipid oxidation and to cause increases inperoxisome-proliferator activated receptor g coactivator (PGC)
Interval Training (continued on page 12)

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

Clinical Highlight

Healthy Nutrition for
Cardiovascular Disease
Prevention and Treatment
By Lyndsey M. Hornbuckle, Ph.D., RD

appropriately managed, reductions in CVD and CVD risk often
follow. In addition, the article will review dietary “helpers” that,when consumed as recommended, serve as a form of defense
against particular contributors to CVD.

Culprit: SodiumCudra/iStock/Thinkstock

ardiovascular disease (CVD), sometimes referred tosimply as heart disease, affects approximately 83.6 million Americans (more than one-third of the population)and is a leading cause of morbidity and mortality in the UnitedStates.4 CVD encompasses multiple issues that can occur inthe heart and/or blood vessels that are often linked to atherosclerosis. Atherosclerosis is a condition that results from theaccumulation of plaque in the artery walls, ultimately narrowing those arteries and restricting blood flow in the body. If a
blood clot forms in the restricted artery, a myocardial infarction(also known as a heart attack) or a stroke can occur, resulting
in permanent damage to the cardiac muscle or brain cells.1 In
serious cases, either event can result in death. Congestive heart
failure, cardiac arrhythmias, and problems relating to the valvesof the heart are additional conditions that are considered typesof CVD.1
Survivors of myocardial infarctions and strokes, as well as
individuals diagnosed with CVD and conditions linked to CVDsuch as atherosclerosis, hypertension, and diabetes, are often
advised by their health care professionals to make immediate
lifestyle changes and to maintain these changes in order tominimize future risk of a cardiac event. The American Heart
Association has identified dietary improvement as a criticalchange necessary in the strategy to prevent CVD risk.6 This article will review major dietary “culprits” that contribute to CVD
and strategies to reduce each of them. When these culprits are

Hypertension, or high blood pressure, is commonly linked to
CVD and has been shown to be the leading cause of CVD
worldwide.5 In general, research has shown that as sodium
intake increases, blood pressure increases.6 Although sodium
is an essential nutrient, most individuals only need it in small
quantities. The majority of Americans consume an excess of
sodium because it is found in large quantities in processedand preserved foods (canned items, frozen meals, etc.), which
are widely available in the United States. Studies show that a
reduction in sodium intake can both prevent hypertension andassist in blood pressure control,6 as well as reduce myocardial
infarctions, strokes, and the annual number of deaths from any
cause.2 The United States Departments of Agriculture (USDA)
and Health and Human Services (HHS) recommend 2,300
mg/day of sodium (the amount found in one teaspoon of tablesalt) as the tolerable upper intake level for adults, with 1,500
mg/day considered the adequate intake. The adequate intake isparticularly recommended for individuals 51 years of age andolder, African-Americans, and those who are already diagnosed
with hypertension. Interestingly, recent data has shown that the
average intake for Americans two years of age and older is 3,400
mg/day.11
The Dietary Approaches to Stop Hypertension (DASH) dietis a well-established eating plan that emphasizes the abundantconsumption of fresh fruits, fresh vegetables, whole grains, andlow-fat dairy products as a way to naturally reduce sodium andtotal fat consumption without specific restrictions. The DASH
eating pattern is often the go-to line of dietary defense against
hypertension, because adherence to the DASH diet has been
linked to decreases in both systolic and diastolic blood pressure7 and lower CVD and stroke risk.8 Patients and clients can“DASH” to control or lower their blood pressure by consuming
the following:• two to three servings/day of low-fat/nonfat milk or dairy
products• four to five servings/day of fruit (preferably fresh)• four to five servings/day of vegetables (preferably fresh andseasoned without salt)
Healthy Nutrition (continued on page 13)

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

7

Wellness Highlight

Is High-Intensity Interval Traininga “Magic Bullet” for the Treatmentof Obesity?
By Emily J. Sauers, Ph.D.

making an exercise session less than 30 minutes. Recent studies
have determined that HIIT improves cardiovascular functioning by reducing heart rate and increasing stroke volume duringsubmaximal exercise bouts.9 Demonstrated improvements inmetabolic functioning include improved insulin sensitivity
independent of weight loss.6 Aerobic capacity has consistently
been shown to increase in response to HIIT.3,9 Many of thedemonstrated benefits of HIIT address concerns for an obese
population. However, in terms of weight loss and improved
comorbidities, is HIIT truly an effective exercise protocol for anobese individual?

Objectives

monkeybusinessimages/iStock/Thinkstock

1. D efine high-intensity interval training.
2. I dentify why high-intensity interval training is an appealing
mode of exercise to many.
3. I dentify health-related benefits to high-intensity interval
training as they relate to obesity.
4. I dentify limitations to using high-intensity interval training
as a method to aid in weight loss.

Over the years, it has become evident that the majority ofadults in the United States do not meet current physical activity guidelines4 of 150 minutes of moderateintensity exercise per week.1 A clear link exists between physicalactivity status and obesity, as well as cardiovascular and metabolic disorders. With obesity rates in the United States at 34.9%4, it
is clear that health-related professionals have a duty to increase
activity and reduce obesity in the majority of adults.

A leading reason reported by many adults for not participating
in exercise programs is a perceived lack of time. High-intensity interval training, or HIIT, has sparked optimism in many
because it is perceived as a time-efficient method to increase
cardiorespiratory fitness levels and induce weight loss. In fact,
HIIT has become such a popular concept that it is ranked
second among ACSM’s Top Fitness Trends for 2015.6 HIIT
involves short duration, high-intensity exercise followed by a
low-intensity (active) or passive recovery; typical ratios for work
to recovery are from 1:2 to 1:5. This cycle is repeated typicallybetween four and eight times in a single workout, typically8

A study by Sijie compared the effects of 12 weeks of HIIT
training with moderate intensity continuous training (MICT)in overweight young women. Following a ten minute warm up,the. HIIT group completed 5x3 minute intervals at 85 percent
V. O2 max, with three minute active recoveries at 50 percent
VO2 max. The MICT group completed a similar ten-minute.
warm-up and completed 40 minutes at 50 percent VO2 max. Allsessions were completed on an outdoor track. The researcher
found that, compared to MICT, HIIT produced greater improvement of body fat, waist-to-hip
ratio, resting heart rate, left.
ventricular ejection fraction, VO2 max, and ventilatory threshold.7
While this seems promising, the aforementioned protocols were
not isocaloric. Therefore, it has not been demonstrated as areliable method in determining if the effects seen were due to ahigher stimulus in the HIIT group or if they may be attributed
to the difference in training protocol. This brings up a common
concern found in much of the literature; it is often difficult tocompare protocols that have substantial differences between
the stimulus and overall caloric expenditure. This is especially important concerning a population whose primary goal isweight loss. The aforementioned study utilized an outdoor
track to complete all exercise sessions. While this mode does
provide some difficulty when conducting investigative studies(effort, motivation, collection of data, etc.), a real-world modeof exercise is being utilized which is certainly applicable to anobese population.
A study by Lunt recruited middle-aged obese men and women
who were randomized into the following exercise groups:
low-intensity walking (WALK), aerobic interval training (AIT),and maximal volitional intensity training (MVIT). The WALK
group completed 33 minutes of walking at 65-75 percent of
HRmax. The AIT group completed four minutes of jogging at
Magic Bullet (continued on page 14)

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

2015 Recap and Future Directions (continued from page 2)
Table 1: ACSM’s Certified News 2015
2015 First Quarter [2015, Vol 25 (1)]AuthorTitle
CCRB Column
Bill Simpson, Ph.D., FACSM	ACSM Certification – Progress for ACSM Certifications: 2015 and Beyond
Clinical Column
Jeff Soukup, Ph.D., ACSM CES	Understanding Pacemaker Settings – Part 1
Health & Fitness Column
Wayne L. Westcott, Ph.D.
Selection of Strength Training Exercises
Coaching News	Erika Jackson, M.A., MCC,
Health Coaching and Cultural Sensitivity
Margaret Moore (Coach Meg), MBA
Tips & Tools
Penelope Dianne Steen	Customer Service for the Certified Professional
Clinical Feature	Jenna Brinks, M.S.,
Enhanced External Counterpulsation
Anne Davis, RN, andBarry A. Franklin, Ph.D., FACSM
H&F Article	Nicholas T. Lionetti, B.S., andBody Weight and Suspension
Julie B. Wagaman, B.S.
Exercise for the Older Adult
Wellness Feature	Joanne Duncan-Carnesciali,
A Primer in HbA1c and Advanced
M.S., RCEP
Glycation End Products
2015 Second Quarter [2015, Vol 25 (2)]CCRB Column
Katie Feltman	It Takes a Village—Looking Ahead to 2017
Clinical Column
Jeff Soukup, Ph.D., ACSM CES	Understanding Pacemaker Settings – Part 2
Health & Fitness Column
Wayne L. Westcott, Ph.D. 	Resistance Training for Older Adults and Elderly Individuals
Coaching News	Erika Jackson, M.A., MCC andNCCHWC National Health Wellness
Margaret Moore (Coach Meg),
Coaching Cert Launch in 2016
MBA
Tips & Tools	Peter Ronai, M.S., ACSM RCEP,
Online Tips and Tools for
CES, PD, CSCS-D, FACSM
Exercise Professionals
Clinical Highlight	Nicole M. Hafner, M.S., RCEP,
HFS; Paul M. Gallo, Ed.D., ATC,
CES, HFS, CSCS

The Evidence-Based Effects ofResistance Training on Sarcopenia in Older Adults

H&F Feature
Lyndsey Hornbuckle, Ph.D., RD	Nutritional and Lifestyle Strategies for Diabetes Prevention and Management
Wellness Spotlight	The article listed was notincluded in 2015-2
2015 Third Quarter [2015, Vol 25 (3)]
CCRB Column	Ben Thompson, Ph.D., FACSM,
Who is an Exercise Physiologist?
ACSM EP-C	 Clinical Column
Jeff Soukup, Ph.D., ACSM CES	Managing Exercise in Patients with Diabetes: Part One – Antihyperglycemic
Medication Review
Health & Fitness Column
Wayne L. Westcott, Ph.D.
The Up and the Down: Concentric and Eccentric Muscle Actions
Coaching News	Erika Jackson, M.A., MCC andHelping Clients Thrive
Margaret Moore (Coach Meg), MBA
Online Tips and Tools for Exercise Professionals: Human Kinetics Webinars
Tips & Tools	Peter Ronai, M.S., ACSM RCEP,
CES, PD, CSCS-D, FACSM
Clinical Highlight
Chris Repka, Ph.D.
Physiological Benefits of Exercise in Cancer Patients
H&F Feature
Jim White, Ph.D., CCEP, CSCS	Returning to the Wild: Tailoring Exercise Programs for an Outdoorsperson Diagnosed with Chronic Disease
Wellness Spotlight
Carol Michaels
Mindful Exercise Programming for the Cancer Patient
2015 Fourth Quarter [2015, Vol 25 (4)]CCRB Column	Dierdra Bycura, Ph.D., and Yuri Feito,
Ph.D., FACSM
Clinical Column
Jeff Soukup, Ph.D., ACSM CES
Health & Fitness Column
Wayne L. Westcott, Ph.D.
Coaching News	Erika Jackson, M.A., MCC andMargaret Moore (Coach Meg), MBA
Tips & Tools	The article listed was notincluded in 2015-4
Clinical Feature
Lyndsey Hornbuckle, Ph.D., RD
H&F Article	Edward Davila, M.S., ACSM-RCEP,
EP-C and Leah Vogel, BS, ACSM-EP-C
Wellness Feature
Emily J. Sauers, Ph.D., CES

2015 Recap and Future Directions for ACSM’s Certified News
Exercise-induced Hypoglycemia: Medications and Timing
Muscle Recovery From Resistance Exercise
Coaching Clients with Mild Chronic Conditions

Healthy Nutrition for Cardiovascular Disease Prevention and Treatment
Effects of Low-volume High-Intensity Interval Training on Fitness
Is High-Intensity Interval Training a Magic Bullet for the Treatment of Obesity?

About the Authors

Dierdra Bycura, Ed.D., ACSM EP-C, CPT is anassistant professor of Fitness Wellness in thedepartment of Health Sciences at Northern Arizona
University and a member of the CCRB and
sub-publications committee.

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

Yuri Feito, Ph.D., MPH, FACSM is an assistantprofessor of exercise science at Kennesaw State
University and a member of the CCRB and the Exam
Review Committee.

9Antihyperglycemic Medication Review (continued from page 3)
References

1. L ebovitz H. Insulin secretagogues: sulfonylureas, rapaglinide, and nateglinide. In: Lebovitz H, editor. Therapy for Diabetes Mellitus and Related
Disorders. 5th ed., Alexandria (VA): American Diabetes Association; 2009.
222-234 p.
2. S
 kyler J. Insulin treatment. In: Lebovitz H, editor. Therapy for Diabetes
Mellitus and Related Disorders. 5th ed. Alexandria (VA): American Diabetes Association; 2009. 273-289 p.

Suggested Readings

1. C olberg S. Exercise prescription for patients with diabetes. In: Swain
DP, editor. ACSM’s Resource Manual for Guidelines for Exercise Testing
and Prescription. 7th ed. Baltimore (MD): Lippincott, Williams andWilkins;2013. 661-681 p.
2. I nzucchi SE, Bergenstal RM, Buse JB, et al. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach. Position Statement of the American Diabetes Association and European Association for
the Study of Diabetes. Diabetes Care. 2012;35(6):1364-1379.

Muscle Recovery (continued from page 4)
These research results suggested that two and three non-consecutive strength training sessions per week may produce similar
rates of muscle development in beginning exercisers who are not
performing high-volume or high-intensity workouts.

Summary

Studies show that high-volume and/or high-intensity resistancetraining sessions may require at least 72 hours of recovery time
for optimum muscle remodeling and strength development.
However, beginning exercisers who perform low-volume andmoderate-intensity resistance training appear to attain similar
gains in lean (muscle) weight with two or three weekly
workouts.

References

1. A
 merican College of Sports Medicine. ACSM’s Guidelines for Exercise
Testing and Prescription. 9th ed. Philadelphia (PA): Lippincott, Williams &Wilkins; 2014. 181 p.
2. H
 ackney KJ, Engels HJ, Gretebeck RJ. Resting energy expenditure anddelayed-onset muscle soreness after full-body resistance training with an
eccentric concentration. J. Strength Cond Res. 2008;22(5):1602-1609.
3. H
 eden T, Lox C, Rose P, et al. One-set resistance training elevates energy
expenditure for 72 hours similar to three sets. Eur J App Physiol. 2011;
111:477-484.
4. M
 cLester J, Bishop P, Smith J, et al. A series of studies – a practical protocol for testing muscular endurance recovery. J Strength Cond. Res. 2003;
17(2):259-273.
5. Westcott WL, Winett RA, Annesi JJ, et al. Prescribing physical activity:
Applying the ACSM protocols for exercise type, intensity, and duration
across 3 training frequencies. Phys Sportsmed. 2009; 2(37):51-58.

About the Author

Wayne L. Westcott, Ph.D., is a professor of Exercise
Science at Quincy College (MA) and is an active
member of the New England Chapter of theAmerican College of Sports Medicine.

www.onlinelearning-acsm.org

Complete ACSM’s Certified News Selftests at ACSM ceOnlineSM –Your Resource
for Online Continuing Education!

ACSM ceOnline Benefits:
Affordable
4 ACSM CECs for as little as $20!
Flexible• Completely accessible online: 24/7/365• Self-paced: Start and stop per your schedule
Convenient
Track CECs earned from outside agencies
Instant• Instant notifications• Immediate access to content including course materials,
tests, certificates and receipts.

10

ACSM Alliance members: to access the member
discount code, log in to your ACSM account at
www.acsm.org. Click “View My Benefits” and then clickon the ACSM ceOnline logo on the right. You also may
email membership@acsm.org for the discount code andfor additional questions/comments regarding ACSM
ceOnline, please contact onlinelearning@acsm.org.
Look for ACSM’s 2015 Health & Fitness Summit
CEC Videos!
Don’t delay… log on today atwww.onlinelearning-acsm.org!

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

Coaching News (continued from page 5)

What are the most important reasons for you to
get more fit and healthier?

Humans generally struggle to change behavior if the goodreasons to change don’t clearly outweigh the good reasons to notchange. In today’s world where we often feel overwhelmed andhave no time to pause and reflect more deeply, our self-awareness may be shallow. Have your client develop a list of all of thegood things that would likely happen if she or he was to get
more fit and healthier. Get out of sales and into fishing, as motivational interviewing trainer Robert Rhode says. Dig deeper
with these questions:• W hat else would happen?
• W hat would that be like?
• W hat would you be like?
• W hat is good about that?”

What source of motivation will help you most in
moments of planning and decisions, choosing
between a healthy and less healthy option?

Jupiterimages/Stockbyte/Thinkstock

What are you most passionate about? What do
you treasure most in your life?

Health and fitness is not the end goal for most people, it’s themeans to the end that people most desire. Ask these questions:• W hat are you passionate about in your life?
• W hat do you treasure most?
• W hat do you most enjoy, or look forward to?
• W hat do you most want to have happen in your future?
Watch for your clients’ eyes to sparkle, faces to light up, when
they discuss what makes life most worth living. This is theenergy of their life force, the energy needed to power up positivechange.

How might a higher level of health and fitness
help you live a life you treasure?

Now is an opportunity for your clients to connect the dots
between their best experience of being fit and healthy and how
greater fitness might enable them to have more of what they
love most or more of what they want most for the future. After
fully exploring the positive side, you might also ask:
• W hat would your life be like if your medical condition got
more serious?
• How would it impact the things you are most passionate about
or care most about?”Your clients are faced daily with dozens of decisions that impact
their fitness and health: Take the stairs or not? Eat the apple andnot the cookie; and on and on. Ask your client to explore andprioritize his or her most potent source or sources of motivation,
the ones that are most likely to generate a health-giving choice
when brought to mind in the moment of making a plan ordecision. Your client’s greatest kind of motivation is the one thatworks best and reliably in the many moments of daily life when
she or he plans and makes decisions. Then explore: How could
you break out of automatic pilot and notice that this is one ofthose health-generating moments, and bring your best motivation, summon a good intention into mind just as the moment ofchoice arrives?
Onward and upward…
About the Authors

Erika Jackson, MA, MCC, is the vice president ofTraining and Operations of Wellcoaches Corporation,a strategic partner of ACSM, widely recognized as
setting a gold standard for professional coaches inhealth care and wellness. Wellcoaches has trained morethan 9,000 health professionals as coaches in 45
countries. With Margaret Moore, she co-authored the
ACSM-endorsed Lippincott, Williams & Wilkins
Coaching Psychology Manual, the first coaching
textbook in health care, now in its 2nd edition.
Margaret Moore (Coach Meg), MBA, is the founderand CEO of Wellcoaches Corporation, She isco-director of the Institute of Coaching, at McLean
Hospital, an affiliate of Harvard Medical School andco-directs the annual Coaching in Leadership &Healthcare Conference offered by Harvard Medical
School. She is a faculty member of Harvard University
Extension School, teaching coaching psychology. She
is also the author of the Harvard Health Book
published by Harlequin: Organize Your Mind, Organize Your Life.

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

11

Interval Training (continued from page 6)-1a, which is an intensity-dependent regulator of mitochondrial
biogenesis.5,13
Moreover, acute low-volume Wingate-based HIIT has beenshown to induce increases in PGC-1a several fold whenmeasured three hours post-exercise, which is comparable withincreases observed following a bout of continuous endurance-based exercise training.5
Furthermore, due to the intermittent nature of HIIT, thisexercise strategy permits stroke volume (SV) to reach higher
levels repeatedly during a bout of HIIT as opposed to one time
during a bout of MCT.7 As a result, these repeated bouts of highcardiac stress may result in improvements in maximal SV.7 Thus,
HIIT has the potential to improve exercise capacity throughboth centrally and peripherally mediated mechanisms.

High-Intensity Interval Training Protocols

Depending on the interval training protocol prescribed, thesubsequent effects of interval training stimulus can vary. To date,there is no standardized approach to prescribing this type of exercise training. In fact, many different HIIT protocols have beenutilized in the literature ranging from 2 to 15 weeks. The protocol most commonly used in research has been the Wingate test
(30 s of all-out sprint).1 This protocol consists of 30 s of all-out
sprint intervals repeated four to six times interspersed by four
minute recovery periods.1 This Wingate protocol amounts toapproximately three to four minutes of exercise per session andis typically performed three times a week for two to six weeks.1
However, due to the high intensity of this protocol, it may not
be suitable for individuals not accustomed to exercising at thisintensity. In response to this, other less intense HIIT protocols
have been evaluated. In 2011, Boutcher summarized the effects
of different HIIT protocols on fitness, insulin resistance, fatloss, and skeletal muscle adaptations.5 Table 2 highlights a few
examples of the reviewed protocols.
Table 2. Examples of Evidence-Based Low-Volume
HIIT Protocols*Mode
Intervals
Reps
CE (WM) 30 s sprints
3-4 of cycle		sprints per		sessionCE	8 s sprint
60 8 s sprints
followed by
12 s low
intensity
cycling for
20 minCE	15 s cycle
4-6sprint followed 30 s sprints
by 15 s of low
intensity cycling
for 20 min

Frequency
3x/wk for 2-6wks

Summary

Considerable evidence supports the use of low-volume HIIT
as a safe, effective, and time-efficient strategy for inducing
favorable central and peripheral physiologic adaptations. Given
that the most commonly reported barrier preventing individuals from engaging in regular PA is “lack of time,” the natureof low-volume HIIT may be an attractive method for fitness
professionals prescribing exercise training for fitness improvements and weight loss. However, the optimal intensity, length,
and work-rest ratio with consequent adaptations still needs tobe evaluated. Furthermore, nearly all published protocols utilize
a cycle ergometer. As such, less is known about the impact ofusing other exercise modalities (e.g., rowing, stair climbing) withHIIT training.
Regardless, HIIT to promote regular PA appears to be a viable
solution to overcome the “lack of time” barrier. Moreover, theutilization of HIIT has been shown to induce similar, if notsuperior, adaptations in healthy and diseased populations whencompared to contemporary MCT. Ultimately, an appropriately prescribed and supervised HIIT intervention may assist inpromoting PA compliance, improving fitness, and improving
overall quality of life.
About the Authors

Edward Davila, MS, ACSM-RCEP, EP-C, is the
director of fitness at the Ridge Athletic Clubs inBozeman, MT. He is also a clinical exercise
physiologist in the Department of Cardiac andPulmonary Rehabilitation at Bozeman Deaconess
Heart Center and serves as an instructor at Montana
State University. Edward is an ACSM Registered
Clinical Exercise Physiologist and Certified Exercise
Physiologist.

EffortAll-out

Leah Vogel, BS, ACSM EP-C, is a fitness professionalat the Ridge Athletic Clubs in Bozeman, MT who
specializes in training postmenopausal women, older
adults, and women who are strength-focused. Leah is
an ACSM Certified Exercise Physiologist.

45 sessions in 15wks All-out

6 sessions in 2 wks

All-out

NOTE: * = Boucher, 2011; CE = Cycle Ergometer; WM = Wingate Method

Although the less intense HIIT example protocols in Table 2
consist of lower sprint times during the work bouts and allow
for more recovery, they all still require maximum efforts during
the work phases (i.e., all-out). Albeit in cardiac patients, Keteyian7 has reported using a moderate-intensity interval training(MIIT) method consisting of four work bouts lasting four to12

five minutes at 70-80 percent heart rate reserve (HHR) separated by three minutes recovery bouts at 60-70 percent HRR.7
Theoretically, utilizing MIIT in a non-cardiac population
may be an effective strategy to improve exercise tolerance andprogress to using HIIT, particularly in a sedentary and obese
population.

References

1. B
 outcher SH. High-intensity intermittent exercise and fat loss. Journal of
Obesity. 2011. Available from: http://dx.doi.org/10.1155/2011/868305
2. C
 urrie KD, Dubberley JB, McKelvie RS, MacDonald MJ. Low-volume,
high-intensity interval training in patients with CAD. Med Sci Sports
Exerc. 2013;45(8):1436-1442.
3. G arber CE, Blissmer B, Deschennes MR, et al. Quantity and quality of
exercise for developing and maintain cardiorespiratory, musculoskeletal,
and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exer. 2011;43(7):1334-1359.
4. G
 ibala MJ, McGee SL. Metabolic adaptations to short-term high-intensity interval training: a little pain for a lot of gain? Exerc Sports Sci Rev.
2008;36(2):58-63.

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

5. G
 ibala MJ, Little JP, MacDonald MJ, Hawley JA. Physiological adaptations to low-volume, high-intensity interval training in health and disease.
J Physiol. 2012;591(5):1077-1084.
6. G uiraud T, Labrunee M, Gaucher-Cazalis K, et al. High-intensity interval
exercise improves vagal tone and decreases arrhythmias in chronic heart
failure. Med Sci Sports Exerc. 2013;45(10):1861-1867.
7. K
 eteyian SJ. High intensity interval training in patients with cardiovascular disease: a brief review of physiologic adaptation and suggestions for
future research. J Clin Exerc Physiol. 2013;2(1):13-19.
8. R
 ognmo Ø, Hetland E, Helgerud J, Hoff J, Slørdahl SA. High intensity
aerobic interval exercise is superior to moderate intensity exercise forincreasing aerobic capacity in patients with coronary artery disease. Eur J
Cardiovasc Prev Rehabil. 2004;11:216-222.
9. R
 ognmo Ø, Moholdt T, Bakken H, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients.
Circulation. 2012;126:1436-1440.

10. Tjønna AE, Lee SJ, Rognmo Ø, et al. Aerobic interval training versus
continuous moderate exercise as a treatment for the metabolic syndrome.
Circulation. 2008;118:346-354.
11. U
 .S. Department of Health and Human Services. (USDHHS). 2008
Physical activity guidelines for Americans. Washington, DC: Healthier
US Gov. 2008.
12. Warburton DER, McKenzie DC, Haykowsky MJ, et al. Effectivenessof high-intensity interval training for the rehabilitation of patients withcoronary artery disease. Am J Cardiol. 2005;95:1080-1084.
13. Wu Z, Puigserver P, Andersson U, et al. Mechanisms controlling mitochondrial biogenesis and respiration through the thermogenic coactivator
PGC-1. Cell. 1999;98:115-124.

Healthy Nutrition (continued from page 7)• seven to eight servings/day of whole grains (whole wheat
breads and pastas, brown rice, etc.)• two servings/day or less of lean meat, fish, or poultry (three oz.
of cooked meat = one serving)• four to five servings/week of nuts, seeds, and dried beans

Helper: Fiber

Dietary fiber is a non-digestible form of carbohydrate that isfound naturally in plants.11 Dietary fiber intake is importantbecause it has been associated with lower risk of CVD10 andmore favorable CVD-related health issues, including abdominal obesity, hypertension, blood lipids, metabolic syndrome (acollection of several CVD risk factors), and stroke.3,9,11 Bothforms of dietary fiber (insoluble and soluble) play a role inoverall health, yet soluble fiber is of particular importance when
considering the health of the heart and blood vessels. Insoluble
fiber is considered dietary “roughage” that cannot be dissolvedin water and promotes regularity in the gastrointestinal system.
However, soluble fiber forms a thick gel during digestion
because it is soluble in water. This type of fiber reduces the riseof blood lipids and slows the emptying of the stomach, which
encourages a feeling of fullness and can have a positive effect onweight control.10 The Dietary Guidelines for Americans recommends a dietary fiber consumption of 25 g/day for women and
38 g/day for men. The majority of Americans do not consume
enough daily fiber, with a more typical daily intake being 15 g/day.11 Remind patients and clients to actively seek out a coupleof these great sources of dietary fiber each day:• Beans, peas, and lentils• Fresh fruits and vegetables• W hole grains• Bran products• Nuts• Cereals

Culprit: Saturated and Trans Fats

Dietary fat is present in many animal and plant sources. Because
fat does have positive physiological effects (assists with the absorption of fat-soluble vitamins, concentrated source of energy,
internal insulation, etc.), it is recommended that adults consume
approximately 20-35 percent of their total daily calories fromfat sources. However, high intakes of saturated and trans fat areassociated with elevated blood lipids, including total cholesterol
and low-density lipoproteins, which are risk factors for CVD.6,11
Note that these types of fats can be identified by their solid

structure when at room temperature (such as butter, some typesof margarine, and the visible fat on meats). To reduce CVD
risk, the American Heart Association suggests that less thanseven percent of total caloric intake come from saturated fat, lessthan one percent come from trans fat, and less than 300 mg ofcholesterol be consumed daily.6

Helper: Omega-3 Fats

Fats on the opposite end of the spectrum are omega-3 fats
which have been linked to a reduction in cardiac deaths in individuals with and without CVD.6,11 Incorporating food sourcesof omega-3 fats and other unsaturated fats like vegetable oils
also may help displace some of the more harmful fat sources inthe diet mentioned above. Although the average United States
intake of seafood overall is approximately 3.5 ounces/week,
approximately eight ounces/week of a seafood species high inomega-3 fats is the recommendation for cardiac benefit11. Someseafood varieties that are high in omega-3 fats include:• Salmon• Anchovies• Sardines• Tuna• Trout• O ysters

Culprit: Alcohol

Approximately half of United States adults are regular drinkers,11 which include women who consume one drink per day
and men who consume two drinks per day. Although moderate
alcohol intake has been linked to a reduced risk of CVD and alower number of cardiovascular events, drinking in excess has
no benefit, and in fact increases the risk of hypertension, stroke,
and type 2 diabetes.11 For this reason, the American Heart Association recommends that if you do choose to consume alcohol,
it should be done so in moderation. Specifically, the following
parameters should be applied:• No more than one drink per day for women or two drinks per
day for men, ideally done so with meals• Note: one drink is defined as 1.5 fluid ounces (about one shot)of 80 proof liquor, four fluid ounces of wine, or 12 fluid ouncesof beer6
The dietary suggestions presented in this article can likely bemost helpful if utilized to formulate prevention tactics in order
Healthy Nutrition (continued on page 14)

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

13

Healthy Nutrition (continued from page 13)
to coach patients and clients into a healthy lifestyle before a cardiac event or clinical diagnosis related to CVD occurs. Individuals also should keep in mind that a general balance of caloric
intake and physical activity will help them achieve and/or maintain an appropriate body weight, which also can reduce CVD
risk. However, as an exercise professional, be aware that it is
only appropriate to give general parameters for healthy eating. If
a patient or client requires specific diet evaluation or therapy, it
is critical to refer them to a registered and licensed dietitian who
has obtained the clinical training to provide a diet prescription.
This is the safest option for both the exercise professional (froma liability standpoint) and the patient or client, who deserves
specialized treatment from a professional specifically trained
to provide diet therapy. This is particularly important whenworking with a clinical population where food-drug interactions
must be considered. Qualified diet professionals in your area canbe located through the Academy of Nutrition and Dietetics5
website at www.eatright.org. Incorporating diet professionals
into your practice will only enhance your patient’s or client’s
health benefits and/or training results, allowing everyone to obtain the common goal of achieving optimal health and wellness
for the individual of interest. So bring on the teamwork!
About the Author

Lyndsey M. Hornbuckle, Ph.D., RD, is currently an assistant professor
in Exercise Science at Kennesaw State University in Kennesaw, GA. Dr.
Hornbuckle earned her Ph.D. in Exercise Physiology from Florida State
University and completed her Dietetic Internship at the Yale-New Haven
Hospital in New Haven, CT. She is also a certified Group Exercise Instructor and Personal Fitness Trainer.

Magic Bullet (continued from page 8)85-95 percent of HRmax with three minutes of active recovery
at 65-75 percent HRmax. The MVIT group completed 30
seconds of all-out exercise with four minutes of low-intensity
recovery. All sessions took place in a local park three times per
week for 12 weeks. The investigators determined there wereno significant differences
after training between groups in.
body mass index, VO2 max, waist circumference, body fat, bloodpressure, insulin resistance, or high density lipoproteins. There
was a greater decline in total cholesterol and a trend toward
lower triglycerides in the WALK group, but that was attributed to a reduced energy intake in that group.2 This study is ofparticular interest because it has clear applications. Compliancewith this study was a clear limitation. The WALK group shouldhave (in theory) exercised 144 minutes/week but exercised 166
minutes. The AIT group should have exercise 120 minutes/
week but actually exercised 74 minutes/week. The MVIT groupshould have exercised 90 minutes/week but only exercised 45
minutes/week.2 This study illustrates what may be a larger issue
than simply the effectiveness of HIIT on weight loss. A bigger
challenge to practitioners appears to be increasing complianceand the amount of time spent in exercise every week.

14

References

1. A
 merican Heart Association. What is cardiovascular disease? [cited 2014
Oct 1]. Available from: http://www.heart.org/HEARTORG/Caregiver/
Resources/WhatisCardiovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp.
2. B
 ibbins-Domingo K, Chertow GM, Coxson PG, et al. Projected effectof dietary salt reductions on future cardiovascular disease. N Engl J Med.
2010;362(7):590-9.
3. F
 ujii H, Iwase M, Ohkuma T, et al. Impact of dietary fiber intake on
glycemic control, cardiovascular risk factors and chronic kidney diseasein Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes
Registry. Nutrition Journal. 2013;12(159):1-8.
4. G
 o AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke
statistics–2014 update: a report from the American Heart Association.
Circulation. 2014;129(3):399-410.
5. K
 earney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He
J. Global burden of hypertension: analysis of worldwide data. Lancet.
2005;365(9455):217-23.
6. L
 ichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006. Circulation. 2006;114(1):82-96.
7. S
 aneei P, Salehi-Abargouei A, Esmaillzadeh A, Azadbakht L. Influenceof Dietary Approaches to Stop Hypertension (DASH) diet on bloodpressure: a systematic review and meta-analysis on randomized controlled
trials. Nutr Metab Cardiovasc Dis. 2014:Epub ahead of print.
8. S truijk EA, May AA, Wezenbeek NLW, et al. Adherence to dietaryguidelines and cardiovascular disease risk in EPIC-NL cohort. Int J Cardiol. 2014;176(2):354-9.
9. Threapleton DE, Greenwood DC, Evans CEL, et al. Dietary fiber intake
and risk of first stroke: a systematic review and meta-analysis. Stroke.
2013;44(5):1360-8.
10. Threapleton DE, Greenwood DC, Evans CEL, et al. Dietary fibre intake
and risk of cardiovascular disease: systematic review and meta-analysis.
BMJ. 2013;347(f6879):1-12.
11. U
 .S. Department of Health and Human Services and U.S. Departmentof Agriculture. Dietary Guidelines for Americans, 2010. Washington, D.C.:
U.S. Government Printing Office; 2010.

Perhaps the most reasonable method is to eliminate the notionthat HIIT is a “magic bullet” approach to weight loss. Instead,
it may be more reasonable to combine both continuous aerobic
exercise and HIIT when designing exercise prescriptions totarget weight loss. A study by Roxburgh assessed this idea
in overweight/obese moderate-risk men and women. In thisstudy, participants attended five exercise sessions per week for
12 weeks. Those in the continuous, moderate intensity group(CMIET) completed 15 minutes on a cycle ergometer and 15
minutes walking on a treadmill at 45-60 percent heart rate reserve. A second group completed four days of continuous moderate-intensity exercise and one day of HIIT (CMIET+HITT).
The continuous training bouts were the same as the CMIET
group. The HIIT
. day consisted of 8-12 60-second intervals
at 100 percent VO2 max with 150 seconds of active recovery on
a treadmill. Roxburgh found that the inclusion of HIIT did
not yield any clinically significant differences in physiologicalmeasures when compared to the CMIET group, despite similarenergy expenditure.6 However, what is interesting to note isthat the compliance for continuous exercise sessions was 87.5
and 86.5 percent in the CMIET+HIIT group and CMIET
group respectively. The HIIT training session had 100 percent

ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 4

compliance.6 Granted, sample size is a primary limitation in thisinvestigation, but the compliance to HIIT in an overweight/
obese group is encouraging. For effective weight loss, ACSM
recommends individuals exercise most, if not all, days of theweek.1 It seems that adding variety through HIIT may encourage participants to meet these requirements more so than justcontinuous exercise training.
While the health benefits of HIIT are clear, discretion must
be used in applying this training method to the obese population. This is an interesting tactic in theory, but a good amountof research is still needed to determine appropriate protocols
and modes for the obese population. While it appears that
exclusive HIIT may not elicit the direct weight loss benefits
that are commonly cited in popular media, clear benefits to theobese population do exist. Indirectly, weight loss success may
be increased simply by increasing the amount of time spent inphysical activity. Adding variety and enhancing compliance is an
important component to exercising among the obese population. This understated benefit may in fact be one of the key
benefits of HIIT in this population.
About the Author

Emily Sauers, Ph.D., ACSM CEP, is an assistantprofessor in the department of Exercise Science at East
Stroudsburg University in East Stroudsburg, PA.
Emily serves on the Research Committee for
Mid-Atlantic ACSM and is a committee member on
the SHI-Women’s Health Committee for ACSM.

References

1. A
 merican College of Sports Medicine. ACSM’s Guidelines for Exercise
Testing and Prescription. 9th ed. Baltimore (MD): Lippincott Williams &Wilkins;2013.
2. L
 unt H, Draper N, Marshall HC, et al. High intensity interval training
in a real world setting: a randomized controlled feasibility study in overweight inactive adults, measuring change in maximal oxygen uptake. PLoS
One. 2014;9(1):1-11.
3. N
 ybo L, Sundstrup E, Jakobsen MD, et al. High-intensity training versus
traditional exercise interventions for promoting health. Med Sci Sports
Exerc. 2010;42(10):1951-1958.
4. O
 gden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood andadult obesity in the United States, 2011-2012. JAMA. 2013;311(8):806814.
5. R
 ichards JC, Johnson TK, Kuzma JN, et al. Short-term sprint interval training increases insulin sensitivity in healthy adults but does notaffect the thermogenic response to b-adrenergic stimulation. J Physiol.
2010;588(15):2961-2972.
6. R oxburgh BH, Nolan PB, Weatherwax RM, Dalleck LC. Is moderateintensity exercise training combined with high intensity interval training
more effective at improving cardiorespiratory fitness than moderate exercise training alone? J Sports Sci Med. 2014;13(3):702-707.
7. S
 ijie T, Hainai Y, Fengying Y, Jianxiong W. High intensity interval
exercise training in overweight young women. J Sports Med Phys Fit.
2012;52(3): 255-262.
8. Thompson WR. Worldwide survey of fitness trends for 2015: What’s
driving the market. ACSMs Health Fit J®. 2014;18(6):8-17.
9. Trilk JL, Singhal A, Bigelman KA, Cureton KJ. Effect of sprint interval
training on circulatory function during exercise in sedentary, overweight/
obese women. Eur J Appl Phys. 2011;111(8): 1591-1597.

March 29-April 1, 2016

Register Today! Hilton Orlando Lake Buena Vista
Orlando, Florida

In its twentieth year, the ACSM Health & Fitness Summit & Expo continues to celebrate and share innovations inscience and practice with industry professionals—like yourself—who seek to be the best!
Your professional development and information needs are top priority! Not only will you earn CECs you need torenew your ACSM certification, you’ll leave the conference with practical ideas and applications supported by credible,
evidence-based information, and ACSM’s trusted brand.

SEE YOU IN ORLANDO!
www.acsmsummit.org
ACSM’S CERTIFIED NEWS • FOURTH QUARTER 2015 • VOLUME 25: ISSUE 415

ACSM’s Certified News
ISSN # 1056-9677
401 West Michigan Street
Indianapolis, IN 46202-3233 USA