Laird Harrison

May 24, 2016

BOSTON — Exercise is medicine, according to a global initiative managed by the American College of Sports Medicine (ASCM), but getting the dosage right for each patient can be a challenge, attendees will hear at the upcoming ACSM 2016 Annual Meeting.

"We are very familiar with too little, but what happens at the other end of the spectrum — too much?" asked Liz Joy, MD, who is the meeting program chair.

That question will be answered in a featured clinical lecture that will be delivered by Paul Thompson, MD, from Hartford Hospital in Connecticut, entitled, Are There Clinical Cardiac Complications From Too Much Exercise?

People who participate in endurance sports can strain the right ventricles of their hearts, said Dr Thompson. Atrial fibrillation appears to be more common in lifelong endurance athletes. So does coronary calcification. And there is evidence of scarring as well.

Researchers have not yet figured out what behavior changes become risk factors for heart disease and what changes become healthy adaptations. But there are signs that some people are at greater risk from too much exercise than others. "They present with symptoms of disease more quickly and easily, younger in your life," said Dr Thompson. "I raise the possibility that there might actually be some genetic risk."

Sudden Death

A President's Lecture on strategies to prevent sudden death during athletic activity and controversies surrounding the issue will be delivered by Douglas Casa, PhD, from the Korey Stringer Institute at the University of Connecticut in Storrs.

Other presentations will look at strategies to reduce risks related to physical activity. One will be a randomized controlled trial of the Throwers Ten exercise program, which has been promoted as a way to prevent injury in baseball players and other overhead athletes, conducted by a team of researchers in Ankara, Turkey.

And one session will examine the use of internal measurement units — a class of wearable monitor — to determine how people move throughout the day. In addition to counting steps, these units can measure the angles of a person's anatomy and estimate the forces hitting their joints. Researchers say they hope the data can be used to improve individuals' biomechanics, allowing them to become more active with less pain and less risk for injury.

At ACSM meetings in general, there is buzz about the mobile monitoring of gait, said Irene Davis, PhD, from Harvard Medical School in Cambridge, Massachusetts, who was involved in some of the research being presented on the topic.

"We're starting to measure people outside, in their natural environment. You never know if people are trying to perform for us in the clinic," Dr Davis explained.

During a session on the latest research into sports concussion, there will be a presentation on a novel jugular compression collar that minimally restricts venous outflow to promote cerebral venous sinus engorgement, restricting the motion of the brain within the cranium, by researchers from Cincinnati Children's Hospital Medical Center.

But the risks related to exercise will not overshadow the benefits of exercise at the meeting.

"You get the most benefit from exercise when you go from doing nothing to doing something," Dr Thompson told Medscape Medical News. "You don't have to do all that much."

And many people are not even doing a little. Research on the benefits of standing at a desk while working or getting up and going for a short walk periodically will be presented by a team from the University of Pittsburgh.

Exercise Vital

Physicians play an important role in encouraging such movement, said Dr Joy. She said she believes that patient-reported exercise should be included in electronic health records. "We can't begin to counsel our patients on an individual level if we don't know how much physical activity they are doing."

The ACSM leadership will discuss its promotion of exercise "as a vital sign" in a conversation with US Surgeon General Vivek Murthy, MD, she reported.

There will also be a presentation on the effects of exercise on diverse aspects of health, and one on the comparative effects of cognitive behavioral therapy and exercise for the treatment for depression, conducted by researchers from the Karolinska Institute in Solna, Sweden.

The introduction of exercise at school to improve the behavior and academic performance of children will be examined in several presentations.

"I don't think there's controversy about whether they need it or not," said Dr Joy. Rather, the researchers will examine frequency, intensity, and duration within the institutional challenges posed by education systems. And they'll probe the mechanisms by which exercise can improve cognitive performance.

Three Keynote Lectures will touch on issues related to an overweight population. The economic costs of physical inactivity will be discussed by Michael Pratt, MD, from Emory University in Atlanta; how the relation between physics, physiology, and behavior affects body weight will be explored by Claude Bouchard, PhD, from the Pennington Biomedical Research Center in Baton Rouge, Louisiana; and a framework for appetite regulation will be proposed by John Blundell, PhD, from the University of Leeds in the United Kingdom.

"We're starting to get some granularity and specificity in terms of what types of patient benefit from what types of exercise, whether it's walking, more vigorous activity, strength training, or a combination of those activities," said Dr Joy. "What makes it so exciting for me is that I can translate those findings from the research into my clinical practice."

Dr Joy, Dr Thompson, and Dr Davis have disclosed no relevant financial relationships.

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