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      Precision exercise medicine: understanding exercise response variability

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          Abstract

          There is evidence from human twin and family studies as well as mouse and rat selection experiments that there are considerable interindividual differences in the response of cardiorespiratory fitness (CRF) and other cardiometabolic traits to a given exercise programme dose. We developed this consensus statement on exercise response variability following a symposium dedicated to this topic. There is strong evidence from both animal and human studies that exercise training doses lead to variable responses. A genetic component contributes to exercise training response variability.

          In this consensus statement, we (1) briefly review the literature on exercise response variability and the various sources of variations in CRF response to an exercise programme, (2) introduce the key research designs and corresponding statistical models with an emphasis on randomised controlled designs with or without multiple pretests and post-tests, crossover designs and repeated measures designs, (3) discuss advantages and disadvantages of multiple methods of categorising exercise response levels—a topic that is of particular interest for personalised exercise medicine and (4) outline approaches that may identify determinants and modifiers of CRF exercise response. We also summarise gaps in knowledge and recommend future research to better understand exercise response variability.

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          Most cited references56

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          Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association

          In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]
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            Individual differences in response to regular physical activity.

            The purpose of this review was to address the question of interindividual variation in responsiveness to regular exercise training and to define the contributions of age, sex, race, and pretraining phenotype level to this variability. A literature review was conducted of the studies reporting interindividual variation in responsiveness to standardized and controlled exercise-training programs, and included an analysis of the contribution of age, sex, race, and initial phenotype values to the heterogeneity in VO(2max), high-density lipoprotein (HDL)-C and submaximal exercise, heart rate (HR), and systolic blood pressure (SBP) training responses in subjects from the HERITAGE Family Study. Several studies have shown marked individual differences in responsiveness to exercise training. For example, VO(2max) responses to standardized training programs have ranged from almost no gain up to 100% increase in large groups of sedentary individuals. A similar pattern of heterogeneity has been observed for other phenotypes. Data from the HERITAGE Family Study show that age, sex, and race have little impact on interindividual differences in training responses. On the other hand, the initial level of a phenotype is a major determinant of training response for some traits, such as submaximal exercise heart rate and blood pressure (BP) but has only a minor effect on others (e.g., VO(2max), HDL-C). The contribution of familial factors (shared environment and genetic factors) is supported by data on significant familial aggregation of training response phenotypes. There is strong evidence for considerable heterogeneity in the responsiveness to regular physical activity. Age, sex, and ethnic origin are not major determinants of human responses to regular physical activity, whereas the pretraining level of a phenotype has a considerable impact in some cases. Familial factors also contribute significantly to variability in training response.
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              Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women.

              To quantify the relation of cardiorespiratory fitness to cardiovascular disease (CVD) mortality and to all-cause mortality within strata of other personal characteristics that predispose to early mortality. DESIGN--Observational cohort study. We calculated CVD and all-cause death rates for low (least fit 20%), moderate (next 40%), and high (most fit 40%) fitness categories by strata of smoking habit, cholesterol level, blood pressure, and health status. Preventive medicine clinic. Participants were 25341 men and 7080 women who completed preventive medical examinations, including a maximal exercise test. Cardiovascular disease and all-cause mortality. There were 601 deaths during 211996 man-years of follow-up, and 89 deaths during 52982 woman-years of follow-up. Independent predictors of mortality among men, with adjusted relative risks (RRs) and 95% confidence intervals (CIs), were low fitness (RR, 1.52;95% CI, 1.28-1.82), smoking (RR, 1.65; 95% CI, 1.39-1.97), abnormal electrocardiogram (RR, 1.64;95% CI, 1.34-2.01), chronic illness (RR, 1.63;95% CI, 1.37-1.95), increased cholesterol level (RR, 1.34; 95% CI, 1.13-1.59), and elevated systolic blood pressure (RR, 1.34; 95% CI, 1.13-1.59). The only statistically significant independent predictors of mortality in women were low fitness (RR, 2.10; 95% Cl, 1.36-3.21) and smoking (RR, 1.99; 95% Cl, 1.25-3.17). Inverse gradients were seen for mortality across fitness categories within strata of other mortality predictors for both sexes. Fit persons with any combination of smoking, elevated blood pressure, or elevated cholesterol level had lower adjusted death rates than low-fit persons with none of these characteristics. Low fitness is an important precursor of mortality. The protective effect of fitness held for smokers and nonsmokers, those with and without elevated cholesterol levels or elevated blood pressure, and unhealthy and healthy persons. Moderate fitness seems to protect against the influence of these other predictors on mortality. Physicians should encourage sedentary patients to become physically active and thereby reduce the risk of premature mortality.
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                Author and article information

                Journal
                Br J Sports Med
                Br J Sports Med
                bjsports
                bjsm
                British Journal of Sports Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0306-3674
                1473-0480
                September 2019
                12 March 2019
                : 53
                : 18
                : 1141-1153
                Affiliations
                [1 ] departmentSchool of Kinesiology and Health Studies , Queen’s University , Kingston, Ontario, Canada
                [2 ] departmentTranslational Research Institute for Metabolism and Diabetes , Florida Hospital , Orlando, Florida, USA
                [3 ] departmentDepartment of Physiology and Pharmacology , University of Toledo College of Medicine and Life Sciences , Toledo, Ohio, USA
                [4 ] departmentDepartment of Exercise Science , University of South Carolina , Columbia, South Carolina, USA
                [5 ] departmentDivision of Geriatric Medicine , University of Colorado Anschutz Medical Campus , Aurora, Colorado, USA
                [6 ] departmentInterventional Resources , Pennington Biomedical Research Center , Baton Rouge, Louisiana, USA
                [7 ] departmentSchool of Kinesiology , Louisiana State University , Baton Rouge, Louisiana, USA
                [8 ] departmentDepartment of Kinesiology , Indiana University , Bloomington, Indiana, USA
                [9 ] departmentDepartment of Physical Education , University of Campinas (UNICAMP), Campinas , São Paulo, Brazil
                [10 ] Pennington Biomedical Research Center , Baton Rouge, Louisiana, USA
                [11 ] departmentJohn S Mcilhenny Skeletal Muscle Physiology Laboratory , Pennington Biomedical Research Center , Baton Rouge, Louisiana, USA
                [12 ] Kingston General Health Research Institute, Kingston Health Sciences Centre , Kingston, Ontario, Canada
                [13 ] departmentEconomics and Sociology of Sport , Saarland University , Saarbrücken, Saarland, Germany
                [14 ] departmentCollege of Sport and Exercise Science , Victoria University , Melbourne, Victoria, Australia
                [15 ] departmentHuman Genomics Laboratory , Pennington Biomedical Research Center , Baton Rouge, Louisiana, USA
                Author notes
                [Correspondence to ] Dr Claude Bouchard, Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808, USA; claude.bouchard@ 123456pbrc.edu
                Author information
                http://orcid.org/0000-0002-0048-491X
                Article
                bjsports-2018-100328
                10.1136/bjsports-2018-100328
                6818669
                30862704
                9f537e14-3e1a-4767-976c-8537c2c41a51
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 1 February 2019
                Categories
                Consensus Statement
                1506
                2314
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                Sports medicine
                exercise testing
                Sports medicine
                exercise testing

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