Thursday, February 28, 2013

Don’t Skip Carbs


We all need energy in order to exercise and work out. Whether your goal is to lose weight, gain muscle, or train for a sport, everyone needs a certain amount of energy (Earle & Baechle, 2004). Carbohydrates represent the main energy source for our body. In addition, carbohydrates are necessary for complete metabolism of fatty acids, which helps prevent ketosis (a potential harmful condition). So when you see people cutting out carbs completely from their diet, they are not only depriving their body of energy to exercise (hence they are cranky), but they are also putting their body at risk for ketosis.

The body stores carbohydrates in the form of glycogen within the liver and muscles. The muscle glycogen storage represents the largest reserve, followed by liver storage, and a small percentage in the blood (McArdle, Katch & Katch, 2010).

Role of Carbs

  1.  Energy source: Main energy source for exercise
  2.  Protein sparer: Helps preserve our body’s protein tissue by not breaking it down for energy; a lack of glycogen stores causes the body to derive glucose from our amino acids (protein), which is not what we want
  3. Prevents ketosis: parts of carbohydrate breakdown assist in fat oxidation, which ultimately helps prevent accumulation of ketone bodies (ketosis)
  4. CNS fuel: our central nervous system needs a continuous stream of carbohydrate energy for proper functioning; it solely relies on carbohydrates for energy; a lack of this energy to the CNS can impair exercise performance and if sustained, can ultimately lead to unconsciousness and brain damage


How much?

The recommended intake for physically active individuals, according to exercise physiologists, should be around 60% of daily calories. For high intensity training, it is recommended to increase that percentage to about 70% of total calories (McArdle, Katch & Katch, 2010).

Scientific evidence has proven that a carbohydrate deficient diet depletes muscle and liver glycogen at a rapid pace. In addition, it impairs performance in short anaerobic exercise and prolonged intense aerobic exercise (McArdle, Katch & Katch, 2010).

What to eat?

-          Whole Grains (pasta, cereal, bread)
-          Vegetables (broccoli, asparagus, etc)
-          Fruits (oranges, berries, pears, etc)




Moral of this blog: Eat your carbs!

Ryan Benito
NSCA-CPT


References

McArdle, W. D., Katch , F. I., & Katch, V. L. (2010).Exercise physiology. (7th ed.). Baltimore, MD: Lippincott Williams & Wilkings.

Earle, R. W., & Baechle, T. R. (2004). Nsca's essentials of personal training. Champaign, IL: Human Kinetics.

Wednesday, February 27, 2013



THE MIGHTY EGG and CHD
 Myths and Facts
The egg, one of nature’s near perfect foods, has received negative attention in recent years and reductions in egg consumption have been widely recommended to lower blood cholesterol levels and prevent coronary artery disease (CHD). Taking a closer look however, many of the studies that were conducted did not find a  correlation with the cholesterol found in eggs to CHD. 
In these studies many factors were not taken into account, such as the levels of fats and saturated fats that the participants consumed on a daily basis. Let’s remember that all of these things; fats, saturated and unsaturated (along with salts and sugars), cholesterol including low density lipoprotein (bad cholesterol) and high density lipoprotein (good cholesterol) are all essential for our bodies.  They are all used to maintain the daily functions our bodies perform. The problems come from elevated levels of many of these in an individual’s daily diet.
The egg yolk though feared, actually contains an abundance of vitamins including the 4 essential fat soluble vitamins that help your body function, healthy fatty acids, all the essential amino acids required and various minerals.  Tossing out the egg yolk, means you lose 100% of the fat soluble vitamins contained in eggs. A,D,E,K and carotenoids. You may ask yourself what the fat soluble vitamins actually do, and the truth is they do much more than you can imagine. Fat soluble vitamins boost your immune system, reduce risk of cancer, keep your bones, teeth and skin healthy, support the thyroid gland, reduce the damaging effects of diabetes, and promote healthy growth in children to list but a few.
 
 Conclusion
To avoid elevations in blood cholesterol and reduce CHD risk the public has been advised to consume no more than 300mg per day of cholesterol and limit consumption of eggs, which contain about 213mg of cholesterol per egg.  However eggs contain many nutrients besides cholesterol, including unsaturated fats, essential amino acids, folate and other B vitamins. In addition, consumption of eggs instead of carbohydrate-rich foods may raise high-density lipoprotein (HDL) cholesterol levels and decrease blood glycemic and insulinemic responses.
So unless you have a prior heart condition, there’s no need to dispose of the yolk, and as long as your diet is relatively clean and you stay away from processed and fast foods you have little to fear from the egg.

 Turo Gamez NSCA-CPT

were, b. f. JAMA Network | JAMA | A Prospective Study of Egg Consumptionand Risk of Cardiovascular Diseasein Men and Women. JAMA Network | JAMA | Home. Retrieved February 4, 2013, from http://jama.jamanetwork.com/article.aspx?articleid=189529
Baechle, T. R., & Earle, R. W. (2000). Nutrition Factors in Health and Performance. Essentials of strength training and conditioning (2nd ed., pp. (.,)). Champaign, Ill.: Human Kinetics. 
 

Sunday, February 24, 2013

Protein Intake: Past and Current Research

We have all seen the ads on TV and in magazines for protein powders, protein bars and other high protein drinks, advertised as essentials that everyone should add to their diet in order to have ripped abs and big muscles, but is that extra protein actually helping us out? Are our bodies utilizing all the protein we take in?

In a study performed in 2008 by Moore et al., it was found that muscle and albumin protein synthesis were maximally stimulated at a dose of 20 grams of protein following resistance exercise. Increasing doses of protein following resistance training were shown to have no further increase in mps or aps, and protein in excess of this amount was found to be lost to oxidation. In another study performed in 2009, focusing on young and elderly subjects, by Symons et al., a comparison of 30 grams of protein consumption and 90 grams was observed. In this study it was shown that the muscle protein synthesis was increased by 50% with a 30 gram does of protein and that no further increase in muscle protein synthesis was observed at higher doses. Based on the results from these two studies it has widely been accepted that no further benefit would be seen in a practical setting in which individuals were ingesting more than 20 to 30 grams of protein per meal. However, more recent studies have contradicted this widely held dogma.

While muscle protein synthesis does appear to reach its upper limits approaching 20-30 grams of protein, studies have shown that protein intake serves a larger role inside the body than just to build muscles. In a review written by Drs. Deutz and Wolfe, the two examine why this long held belief that individuals utilizing the 20-30 gram intake range per meal might be misguided. In their article, Wolfe and Deutz discuss the overall affect of protein ingestion as it relates to anabolism (the synthesis of complex molecules from simpler ones). In their article they explain that the anabolic response is measured as a function of both protein synthesis and breakdown and that projections of anabolism compared to protein intake have no maximal limit incontrast with the long held belief of ingesting at most 30 grams of protein per meal.

While these seperate indications for protein intake may be contradictory we can take away a few things from these observations. While earlier research performed by Moore et al. and Symons et al. show a maximal muscle protein synthesis at 20-30 grams of protein intake a meal, Wolfe and Deutsz suggest that this figure may not take into account a realistic view of metabolism of an individual in their daily life.

Remember that protein is not used just for muscle synthesis. It also plays vital roles in several other functions of your body. Consumption of protein has also been found to increase satiety. As with all diet changes, be sure to consult with a healthcare professional, especially if you have any pre-existing health conditions.

To Your Health,
Ryan Hasapes 

References
1.Deutz NE, Wolfe RR. Is there a maximal anabolic response to protein intake with a meal?. Clinical Nutrition. 2012 November 27

2.Symons TB, Sheffield-Moore M, Wolfe RR, Paddon-Jones D. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc. 2009 Sep;109(9):1582-6.

3.Moore DR, Robinson MJ, Fry JL, Tang JE, Glover EI, Wilkinson SB, Prior T, Tarnopolsky MA, Phillips SM. Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Am J Clin Nutr. 2009 Jan;89(1):161-8.

Saturday, January 26, 2013

Broccoli 101




We all remember as children having to finish our broccoli before we got to have our dessert. Well, Mom was definitely onto something. This natural superfood actually provides us with various incredible health benefits. There is much evidence that broccoli is superior and out ranks most other competing vegetables in nutritional value. 

Broccoli has it all, containing calcium, fiber, vitamins A, K and C, protein, fiber, and much more. The amount of vitamin C that broccoli contains is more than that of even oranges (CNN Health, 2000). Its fiber content has been shown to lower cholesterol and help the process of digestion along. It also houses various anti-inflammatory and detoxifying nutrients as well as antioxidants. This vegetable has been shown to prevent colon cancer and stroke while decreasing the risk for cataracts and improving vision, containing carotenoids such as lutein and zeaxanthin. Broccoli has also been shown to promote healthy skin and skin repair. It is well equipped with cancer fighting agents such as isothiocyanates that promote other cancer battling phase 2 enzymes. These enzymes act as neutralizers for potentially cancerous substances, keeping them from infecting healthy cells (CNN Health, 2000). In addition, broccoli also contains a miracle organic sulfur called Sulforaphane that promotes better vision, lowers blood pressure to decrease the risk for hypertension, and protects against cancer causing tumors and stomach bacteria that can lead to ulcers (Mercola, 2012).

For all you calorie counters out there, this is a great go-to snack or addition to any meal with only 34 calories per 100 grams (Cline, 2012). 

How to buy broccoli:
  • look for tightly packed heads
  • heads should be a dark green color
  • stalks should be smooth and firm
  • stay away from discolored heads containing any open or yellowing buds as well as those that feel mushy or soft

Ways to prepare broccoli:
  • Raw
  • Microwaved
  • Steamed
  • Stir Fried
  • Boiled

All in all, broccoli is one of the most nutritious foods you can consume and one of the biggest favors you can do for your body. Now that you have the 411 on this almighty vegetable, its time to get your broccoli on and try out different ways to eat this super food and see which is your favorite.

Kimi Ma
ACE - CPT



References

Cline, J. (October, 2012). Food Focus: Broccoli. IDEA Fitness Journal

Mercola, Dr. (2012, September 23). Mounting Evidence Pegs Broccoli as One of Nature's Most Health-Promoting Foods, Tackling Hypertension, Cancer, and More. Mercola.com.  Retrieved January 26, 2012 from http://articles.mercola.com/sites/articles/archive/2012/09/23/broccoli-health-benefits.aspx

Wilcox, J. (2012, July 1). Health Benefits of Broccoli. Forbes. Retrieved January 26, 2012 from http://www.forbes.com/sites/juliewilcox/2012/07/01/health-benefits-of-broccoli/

Broccoli Beats Most Other Veggies in Health Benefits (2000, April, 17). CNN Health. Retrieved January 26, 2012 from http://articles.cnn.com/2000-04-13/health/broccoli.benefits.wmd_1_brassica-chemoprotection-laboratory-broccoli-isothiocyanates?_s=PM:FOOD

Thursday, January 17, 2013

High Intensity Interval Training (HIIT) alternates low & high intensity activities. Example: alternate 30sec sprinting with 60sec jogging for 10-30mins. Spinning & Tabata are other popular forms of Interval Training.
But is HIIT really more efficient to lose fat than steady state cardio? In this post you'll get a comparison between both in terms of fat loss.

How Cardio Helps Fat Loss.
To lose fat you need a caloric deficit. Either by eating less calories or by burning more calories or both. Here's how HIIT & steady state cardio help you create this caloric deficit:
  • Burn Calories. Your body uses the food you eat as fuel for cardio. The more & higher intensity cardio you do, the more calories you'll burn.
  • Increase Metabolic Rate. Your body burns more calories at rest during the hours post cardio. This is the post-workout afterburn or EPOC.
  • Eat More. Cardio allows you eat more while having a caloric deficit. This can prevent starvation with lighter males/females.
There are more ways that cardio can help fat loss, but they don't matter within the context of this post. What matters is that you need a caloric deficit to lose fat (and you can do this without cardio, through dieting & lifting alone).

How Much Calories Does Cardio Burn?
Everything depends on the intensity at which you do cardio, and how long you do it. Here are some estimates:
  • Low Intensity. Less than 65% of your max heart rate. Walking burns only 5kcal/min. That's why it's not efficient for fat loss.
  • Moderate Intensity. 65-85% of your max heart rate. Steady state cardio at moderate intensity on the elliptical trainer burns about 10kcal/min.
  • High Intensity. +85% of your max heart rate. Sprints burn 15kcal/min. But most people can't sustain this kind of intensity for long.
These are estimates. The best way to find out how much you burn is using the bodybugg. And people who've used it, found that HIIT burns about the same or less calories than steady state cardio. 2 reasons:
  • Average intensity is the same since HIIT alternates between high & low intensities (sprints then jogging). So you end up burning 10kcal/min.
  • Most people never get the most out of HIIT because they aren't pushing themselves hard enough. Meaning: never until their muscles burn.

EPOC.
Then there's HIIT's biggest selling point: EPOC. According to this study HIIT has an EPOC of 14% vs 7% with steady state cardio. So if 30mins of HIIT burns as much as 30mins steady state cardio, that's 342kcal vs 321kcal.
Do 30mins HIIT 3x/week (which is a lot) and you'll burn 252kcal per month extra from EPOC. Since you need to burn 3500kcal to lose 1lb fat this is insignificant. But again, these numbers are estimates. Use the bodybugg for proof.
So in theory HIIT will burn more than steady state cardio through EPOC, but not as much as people usually think.

Cardio Duration.
The longer you do cardio, the more total calories you'll burn. You must be in really good shape to handle 30mins HIIT while anyone can do 45mins moderate intensity steady state cardio. Compare calories burned:
  • 30mins HIIT: burns 324kcal (incl 14% EPOC)
  • 45mins steady state cardio: burns 481kcal (incl 7% EPOC)
So you'll burn 628kcal/month more if you do 3x45mins steady state cardio than if you'd do 3x30mins HIIT. But people usually do 20mins HIIT. This would burn 228kcal incl EPOC or 3036kcal/month less. Which is almost 1lb of fat.

Cardio Frequency.
20mins of HIIT 3x/week is hard to recover from because it's high intensity. You will stall if you do StrongLifts 5x5 + HIIT 3x/week. But you can easily do steady state cardio 4x/week without issues.
4x45mins steady state cardio per week burns 7696kcal/month or +2lbs of fat. 3x20mins of HIIT only burns 2736kcal/month. So HIIT burns less total calories, is harder physically & mentally and causes stalling by messing with recovery.
Again: don't believe me. Get the bodybugg and do the test. Compare how many calories you burn with HIIT vs steady state cardio. Then decide what is most efficient knowing that burning more calories matters most to lose fat.

Should You Never Do HIIT?
No. HIIT has benefits: it takes less time, is more fun and more things I won't get into here. Did I write that you won't lose fat if you do HIIT? No, you will. But less than you might think.
My point is that for fat loss burning calories matters. Steady state cardio burns more calories and with less effort. Here are 5 quick cardio tips to lose fat:
  1. Don't do HIIT if you do StrongLifts 5x5. Your legs will never get enough recovery. Do steady state cardio only. Up to 4x45mins/week.
  2. Don't do HIIT if you're a beginner with zero fitness levels. This would be like starting with 220lbs on Squats. Build base fitness levels first.
  3. If you lack time to do 4x45mins/week steady state cardio, do 3x30mins. This burns about as many as calories as 3x30mins HIIT does.
  4. If you lack time to do 3x30mins/week steady state cardio, focus on diet & strength. You'll lose fat, but slower. Accept it.
  5. If you get bored of the steady state cardio: get over it. It's meant to be effective, not fun. Really. Once you've got body fat down you can quit it.
And the reason why Shaun T and his max interval training are so popular is because it exceeds the traditional HIIT 30mins. Also it is for more overall fitness rather than just fat lose. I personally do insanity from time to time and I think it is one of the best workouts out there to date. For one afterwards you are pooring in sweat and then you just have a feeling of accomplishment set in. So to each there own, however im gonna conclude with if you just want to loose fat then stick with steady state cardio, but if you want to build muscle along with lose some fat and have a little more fun, then HIIT or Insanity is the path for you.

-William Perdue
 Personal Trainer
 Marine

Thursday, November 29, 2012

Type 2 Diabetes

Current Research Surrounding Development of Type 2 Diabetes

     As the number of adults with type 2 diabetes has steadily climbed, increasing by 49% in the years 1991 to 2000, as reported by the centers for disease control and prevention, it’s important that we learn of the risk factors and lifestyle choices that can contribute to our chances for developing this chronic disease. Type 2 diabetes is believed to be caused primarily by a tolerance build up of the body to insulin, and is also linked to impairment of cells of the pancreas to produce insulin. Dramatic complications such as kidney disease, blindness, and damage to the extremities possibly leading to amputation, along with an increased risk for heart attack and stroke are associated with the disease.

     Current theories surrounding accruement of insulin tolerance and decreased insulin production by cells of the pancreas all deal heavily with obesity, fatty acids released by adipocytes (fat cells), smoking, diet and exercise levels, along with some genetic links as well.

     Current research examining adipocytes (fat cells) has created a mainstream shift among researchers, where previously it was thought that adipocytes did little more than store fats; it has now been shown that these fat cells actually release a variety of hormone-like substances which affect other tissues. Several of these proteins and substances exist, such as leptin, an appetite suppressing factor, resistin, a substance which counteracts the effects of insulin, suggesting that the substance actually contributes to insulin tolerance. Another protein, known as adipopectin, increases the effects of insulin, but in obese individuals has been found to have decreased production.

     The review, Obesity and Free Fatty Acids (FFA) written by Dr. Guenther Boden from Temple University School of Medicine in Philadelphia, examines the link between free fatty acids in several possible pathways which contribute to insulin resistance. In his paper Dr. Boden cites evidence that “plasma FFA levels are elevated in most obese individuals,” that “raising plasma FFA levels increases insulin resistance” and “lowering of FFA improves insulin resistance,” qualifying FFAs as a physiological link between insulin resistance and obesity.

     In studies performed by Drs. Boden and Chen, it was found that acutely raising plasma FFA reduced insulin stimulated glucose uptake in all individuals tested, without any correlation to age or gender. Furthermore, Dr. Boden cites a study, performed by R. Rizza and others, which shows evidence that physiological elevations of FFA inhibit insulin suppression of hepatic glucose production (glucose production of the liver), resulting in an increase of glucose production in the liver.

     Though current information about pathways involved in the development of diabetes has been vastly expanded, there is still no 100% effective treatment for type 2 diabetes. Current advances in the field have opened up several new possibilities for treatment in the future. The best way to treat diabetes is to prevent yourselves from developing it. Exercise and a healthy diet have been shown to be a major contributor to individuals at high risk for type 2 diabetes. WebMD’s entry on Type 2 Diabetes Prevention, suggests screening for type 2 diabetes at age 30 among people at risk, i.e. those with a family history of diabetes or those who are overweight. WebMD cites a study performed by the Harvard School of Public Health, saying that the study showed that “regular exercise – at least 30 minutes a day, five days a week – and an improved diet that’s low in fat and high in fiber significantly helped with type 2 diabetes prevention.”

     So now that you have a little background info about diabetes, it’s time to start doing your part to prevent diabetes: Inform your friends and family about the importance of regular exercise and a healty lifestyle in preventing diabetes and make sure that you are using your Bronco Fitness Center membership to help combat this debilitating disease!

 
References
Arterburn, D., Bogart, A. et al. A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass. OBES SURG, Sppringer Science+Business Media. (2012). Clinical Research.

Bluher, S., Mantzoros,C. The Role of Leptin in Regulating Neuroendocrine Function in Humans. The Journal of Nutrition. (2004). Vol 134: 2469S-2474S.

Boden, G. Obesity and Free Fatty Acids (FFA). Endocrinol Metab Clin North Am. 2008. Vol 37(3): 635-ix)

Boden, G., Shulman, G. Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and β-cell dysfunction. European journal of clinical Investigaion. 2002. Vol 32(3):14-23.

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

Marx, J. Unraveling the Causes of Diabetes. Science. 2002. Vol 296:686-9.

Saltiel,A. New Perspectives into the molecular Pathogenesis and Treatment of Type 2 Diabetes. Cell. 2001. Vol 104:617-629.

What Can Stretching Do for Me?


We’ve all heard it, “Stretching improves flexibility”, but why do I need to be flexible? Being flexible won’t make me stronger, faster, or lose weight, so why should I do it? There are various benefits to stretching that are complementary to any exercise program. Unfortunately, this is an area that is often overlooked and skipped in most work out routines. Stretching allows for a greater range of motion (ROM). Flexibility is an indicator of areas that are tight, limiting the range of motion at a particular joint or joints (Bryant & Green, 2010). When ROM is limited, one cannot fully extend to their full potential. This can be a risk for injury because you may be in a situation where you stretch beyond what you are capable of and possibly pull a muscle. For example, when attempting to reach for something that is beyond your range of flexibility, you may end up compromising that particular muscle and injure it instead. This is seen in various exercises and sports such  as soccer, football, and basketball. A common area that is pulled in these sports is the groin and thigh muscles. Conditioning these muscles and making them more flexible will make them less prone to future injury. Not only does stretching benefit exercise, but it will also allow you to go through daily functioning with greater ease. Whether it is bending over, pulling a door open, or even reaching something off of a high shelf, improved flexibility will make all of these motions effortless.
  
There are various types of stretching that include: static, proprioceptive neuromuscular facilitation, and dynamic. 

1. Static stretching is holding any stretch at the greatest point of tension for anywhere from 15 to 60 seconds (ACSM, 2010). Since this kind of stretching is held in longer bouts, it should be done after a normal exercise routine when the muscles are warm to avoid injury. 
2. Proprioceptive neuromuscular facilitation is the combination of holding a stretch for about 10 to 30 seconds and relaxing the stretch for 6 seconds and continuing to alternate this cycle (ACSM, 2010).
3. Dynamic stretching, also known as ballistic stretching, is short repetitive stretches only lasting for a couple of seconds (ACSM, 2010). This is usually done before a work out to help warm up the muscles while also stretching them out. This type of stretching before exercise carries less risk than static stretching because you are not holding a “cold muscle” in a deep stretch for an extended amount of time.  

Finally, stretching is also a relaxing exercise that gives you time during your day to unwind and focus on yourself. It is calming, feels amazing, and just does your body all kinds of good. Enjoy stretching because it is like a treat for your muscles.

Here are some stretches to try:

Quadricep Stretch 

  
Begin with standing on one leg, and then reach with one or both hands to grab hold of the other leg, bending it as close to your body and towards the Glutes as possible. Hold this stretch for about 10 to 30 seconds then alternate to the other leg. Remember to keep a good posture while holding this stretch. You may choose to place one hand on a wall or piece of furniture to help keep balance.

Hamstring Stretch

Stand with one leg in front of the other and bend the back most leg while keeping the front leg straight. Shift your body weight towards the bent knee and tilt your hips forward and Glutes backwards, while maintaining a flat back. Place your hands on your thighs for support. Hold this stretch for about 10 to 30 seconds then alternate to the other leg.

Calf Stretch


Begin facing a wall, standing a couple feet away from it, then place one leg in front of the other maintaining a flat back on both feet flat on the floor. Lean forward and press your hands on the wall bending the front leg and keeping your back leg straight. You should feel a nice stretch in the calf of the straight leg. The farther you position yourself away from the wall, the deeper the stretch becomes. Hold this stretch for about 10 to 30 seconds then alternate to the other leg.

Neck Stretch


Begin by sitting or standing on the floor, either way is perfectly fine. Then slowly start to pull your neck towards the left shoulder and extend the opposite arm downwards. You should feel a deep stretch on the right side of the neck. Hold this stretch for about 10 to 30 seconds then alternate to the other side.

Low Back Stretch

Child’s Pose. Lie face down on the floor and bend the knees and hips toward the back of the room. Stretch your arms out straight above the head keep the palms of your hands and forehead flat on the floor. You should feel nice and relaxed in this pose with a stretch in the low back muscles. Hold this stretch for about 10 to 30 seconds.

Arm/ Shoulder Stretch


Extend one arm straight across the body while using the other to hold it in place and create a deeper stretch. Hold this stretch for about 10 to 30 seconds and then alternate to the other arm.


Kimi Ma
ACE-CPT

References

Bryant, C., & Green, D. (2010). ACE Personal Trainer Manual: The Ultimate Resource for Fitness Professionals (4th Edition). San Deigo: American Council on Exercise

American College of Sports Medicine (2010). ACSM’s Guidelines for Exercise Testing and Prescription (8th Edition). Philadelphia: Wolters Kluwer/Lippincott Wiliams & Wilkins