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Bracko, Michael R. Ed.D., FACSM

doi: 10.1249/FIT.0b013e318184a1f8

Fixed Versus Free-Form Resistance Training; Medical Students Understand the Importance of Physical Activity; Walking Reduces Diabetic, Hypertensive, and Cholesterol Medication Use.

Michael R. Bracko, Ed.D., FACSM, is an exercise physiologist and director of the Institute for Hockey Research and the Occupational Performance Institute in Calgary, Canada. He is an associate editor for ACSM's Health & Fitness Journal®and works in three areas: 1) sports physiology, where he conducts research on the performance characteristics of female ice hockey players, teaches high performance skating, and serves as physiologist for the University of Alberta Women's Hockey Team and the U.S. Men's Deaf Olympic Ice Hockey Team; 2) the health and fitness industry, by contributing to fitness magazines, consulting, presenting at health and fitness meetings such as the ACSM's Health & Fitness Summit & Exposition; and 3) as an occupational physiologist, in the areas of back injury prevention, ergonomics, workstation stretching, and prework warm-up.

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This study compared the effect of training with fixed versus free-form resistance with 30 previously sedentary subjects. There were an equal number of male and female subjects, with an average age of 49 years. Fixed-form training had a set range of motion that the user could not change. Free-form training allowed multiple planes of motion including free weights.

Subjects were tested on the following parameters: frequency of headaches, joint pain, and a timed one-leg BOSU® balance test before and after training.

There were three groups: control, free form, and fixed form. The free-form group performed four leg exercises, six body exercises, and two torso exercises. The fixed-form group performed four leg exercises, seven upper body exercises, and two torso exercises. Each group performed one set of 8 to 12 repetition maximum, twice/week for 16 weeks.

Results showed that the free-form and fixed-form groups improved starting and ending total resistance. However, the free-form group improved 115% compared with 57% by the fixed-form group. Frequency of headaches dropped in both groups by 50%, which the author hypothesized was caused by stress and tension reduction from regular exercise. Joint pain increased by 111% in the fixed-form group and decreased by 30% in the free-form group. On the one-leg BOSU balance test, the fixed-form group improved their balance by 49%, whereas the free-form group improved by 245%. The author indicates that this is probably because the free-form group was trained on stable and unstable surfaces. This is important because it may translate into better balance during activities of daily living that may help prevent falls in older adults. The author concluded that using free-form resistance training for older beginning exercisers may be of more benefit than the traditional fixed-form weight training. There does seem to be a trend in the fitness industry to use more nontraditional forms of exercise. In addition, exercise equipment manufacturers are designing more exciting and unique equipment to keep people motivated to exercise, which is great news for all of us (1).



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In this interesting study, affectionately called "Healthy Doc = Healthy Patient," the researchers surveyed U.S. medical students from 16 medical schools during 4 years. The survey asked questions about health-related attitudes and practices as they relate to factors that predict relevance and frequency of physical activity counseling of patients. Demographics of subjects including: age, school size, National Institutes of Health research ranking, private/public school balance, underrepresented minorities (blacks, Hispanics, and Native Americans), sex, and geographic distribution. The study had an 80.3% (n = 2,316) response rate during the 4 years.

The survey asked medical students about their exercise habits relating to frequency and duration of minimal, moderate, and strenuous exercise as defined by previous research. A measure was created based on whether students met the U.S. Centers for Disease Control (CDC) Physical Activity (PA) recommendation (engage in either vigorous activity for at least 20 minutes, 3 days/week, or at least 30 minutes of moderate activity, 5 days/week).

The study had two primary outcomes of interest: perceived relevance of counseling in the student's intended practice and self-reported frequency of counseling a "typical general medicine patient." The results are interesting and varied, with 61% of students exercising according to the CDC PA recommendations. African American students reported the lowest adherence to exercise, whereas Hispanic students had the highest adherence. Students who endeavored to specialize in primary care had the lowest exercise levels, with students wanting to subspecialize having the highest levels. When students reported less stress and fewer days of "bad mental health," they had higher adherence to the CDC PA recommendations.

Positive attitudes about their school and their classmates indicated that students were more likely to get appropriate exercise. In addition, exercising with classmates helped students meet the exercise guidelines. Students were more likely to get appropriate exercise when they agreed with the statements, "In order to effectively encourage a patient, a physician also must adhere to a health lifestyle," "I will be able to provide more credible and effective counseling if I exercise and stay fit," and "Medical school faculty members should set a good example by practicing a healthy lifestyle."



The authors conclude that it is important to provide programs relating to physical activity and health to increase the number of medical students who get regular physical activity. As a result, this help may increase the likelihood of physicians counseling patients about exercise and its role in disease prevention. This is good news for health and fitness professionals because it might also increase the likelihood of a program of referrals from physicians for exercise prescriptions (2).

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This study investigated the relationships of walking distance, frequency, and intensity to the use of antidiabetic, antihypertensive, and low-density lipoprotein (LDL) cholesterol-lowering medications. Participants were selected from a Walking Magazine subscriber list. There were 32,683 female subjects and 8,112 male subjects who provided complete data for the survey. Average age for female subjects was 50.4, and that for male subjects was 61.1. Survey respondents were 91.7% white, 3.7% black, 2.5% Hispanic, 1.2% Asian, and 0.9% Native American. Nine hundred nineteen women and 599 men were taking medications for diabetes, 4,668 women and 2,349 men were taking medications for high blood pressure, and 2,388 women and 1,741 men were taking medications for high LDL cholesterol.

Walking distance was the usual weekly walking distance during the year of the survey. Walking intensity was measured based on the response to the survey question: "During your usual walk, how many minutes does it take for you to walk 1 mile?" Walking frequency was determined by how many walks the participant took during each week that was more than 10 minutes in length. The longest walk per week also was measured. The survey also asked about height, weight, demographics, age, diet, aspirin use, current and past cigarette use, alcohol use, history of myocardial infarctions, cancer, and medication use for blood pressure, thyroid condition, cholesterol level, and diabetes.

The results indicated that weekly walking distance, longest walk, and walking intensity were all associated with declines in antidiabetic, antihypertensive, and LDL cholesterol-lowering medications. Participants who walked faster (>2.1 m/second versus <1.2 m/second) reduced their medication use by 40% to 68% compared with those who walked slower. Walking frequency did not affect medication use. But the longest usual weekly walk was a better discriminator of medication reduction than total cumulative walking distance per week, especially in men. These results are exciting as they relate to counseling our clients about the benefits of walking and prescribing walking to improve health and reducing medication use (3).

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1. Spennewyn, K. Strength outcomes in fixed versus free-form resistance equipment. Journal of Strength and Conditioning Research 22(1):75-81, 2008.
2. Frank, E., E. Tong, F. Lobelo, et al. Physical activity levels and counseling practices of U.S. medical students. Medicine & Science in Sports & Exercise® 40(3):413-421, 2008.
3. Williams, P.T. Reduced diabetic, hypertensive, and cholesterol medication use with walking. Medicine & Science in Sports & Exercise® 40(3):433-443, 2008.
© 2008 American College of Sports Medicine