**Exercise Evaluation and Prescription**

Editors

**Cristina Cortis Andrea Fusco Carl Foster**

MDPI • Basel • Beijing • Wuhan • Barcelona • Belgrade • Manchester • Tokyo • Cluj • Tianjin


*Editorial Office* MDPI St. Alban-Anlage 66 4052 Basel, Switzerland

This is a reprint of articles from the Special Issue published online in the open access journal *Journal of Functional Morphology and Kinesiology* (ISSN 2411-5142) (available at: www.mdpi.com/ journal/jfmk/special issues/Exercise Evaluation).

For citation purposes, cite each article independently as indicated on the article page online and as indicated below:

LastName, A.A.; LastName, B.B.; LastName, C.C. Article Title. *Journal Name* **Year**, *Volume Number*, Page Range.

**ISBN 978-3-0365-1384-3 (Hbk) ISBN 978-3-0365-1383-6 (PDF)**

© 2021 by the authors. Articles in this book are Open Access and distributed under the Creative Commons Attribution (CC BY) license, which allows users to download, copy and build upon published articles, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications.

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### **Contents**



## **About the Editors**

#### **Cristina Cortis**

Cristina Cortis is currently Associate Professor in Sports Science at the Department of Human Sciences, Society and Health, at the University of Cassino and Lazio Meridionale, Italy. She obtained a Ph.D. degree in 2009 in Sport and Health Sciences at the University of Rome "Foro Italico", Italy. She was visiting researcher at the Human Performance Laboratory of the University of Wisconsin-La Crosse (USA) and University of Connecticut (USA). Prof. Dr. Cortis has been recognized as a Fellow of the American College of Sports Medicine in 2020.

#### **Andrea Fusco**

Andrea Fusco is currently a post-doc researcher and Lecturer in Sports Science at the Department of Human Sciences, Society and Health at the University of Cassino and Lazio Meridionale, Italy. He obtained a Ph.D. degree in the field of Sport and Health Sciences at the University of Cassino and Lazio Meridionale, Italy, receiving the title of Doctor Europaeus. He was also visiting researcher at the Human Performance Laboratory of the University of Wisconsin-La Crosse (USA) and Biomechanics Laboratory at the Department of Sport Science and Kinesiology of the University of Salzburg (Austria).

#### **Carl Foster**

Carl Foster is a Professor Emeritus in Exercise and Sports Science at the University of Wisconsin-La Crosse. He received his Ph.D. (1976) from the University of Texas at Austin. From 1977 to 1998, he was Professor of Medicine in the University of Wisconsin-Medical School at Sinai Samaritan Medical Center in Milwaukee, after which he moved to University of Wisconsin-La Crosse. He is a Fellow of the American College of Sports Medicine and the American Association of Cardiovascular and Pulmonary Rehabilitation, and has been President (2005-2006) and Treasurer (2015-2021) of the American College of Sports Medicine. He received the Citation Award from the American College of Sports Medicine (2009) and the ML Pollock Established Investigator Award from the American Association of Cardiovascular and Pulmonary Rehabilitation (2010). From 1989 to 2003 he was an Associate Editor of Medicine and Science in Sports and Exercise, and, from 2009 to 2013, he was Editor-in-Chief of the International Journal of Sports Physiology and Performance. From 1983 to 2002, he was the chair of the Sports Medicine and Sports Science Committee of U.S. Speed Skating.

### *Editorial* **Exercise Evaluation and Prescription**

**Carl Foster <sup>1</sup> , Cristina Cortis 2,\* and Andrea Fusco 2,\***


Ever since the farm boy, Milo of Crotone, lifted a growing bullock every day, to become the strongest man in the world, and six-time champion of the ancient Olympic Games, we have known about the principle of progression of exercise training. Probably earlier, but certainly by the early 19500 s, Matti Karvonen in Finland [1] taught us that there was a minimal intensity of exercise training necessary to provoke a training response. Thus, we learned that prescription of training was based on an evaluation of the potential exerciser, in order to pick an appropriate relative training intensity [2]. Evaluative procedures that are highly individually specific are critical. By the mid 1970's, several investigators demonstrated that various combinations of training frequency, intensity, type and training time (FITT) could produce predictable results in exercise capacity. This extensive body of knowledge is codified in documents like ACSM's Guidelines for Exercise Testing and Prescription, now in its' 10th edition [3].

Although training intensity and duration were originally based on the relative percent concept of Karvonen, more contemporary approaches have emphasized threshold-based prescription [4], and on simple psychophysiological approaches like rating of perceived exertion [5] and the Talk Test [6]. These latter approaches are somewhat evaluation independent in terms of prescribing the training load, but evaluation is still important in terms of assessing the outcomes of training.

Sometime in the intervening years, we learned about the concept of a "therapeutic window", the dynamic space between the good effects and bad side-effects, such as myocardial infarction, that come from exercise training programs. We also learned about the interplay between the fitness that increases with training and the fatigue (often a precursor to injury) that comes with the same training program. This interplay is the nucleus of the training impulse (TRIMP) concept of Banister [7], which essentially underpins monitoring training programs. Within this space lies the business of exercise prescription. In athletes, operating outside the therapeutic window is likely to cause injuries that interfere with the goals of the training program. If they cause an athlete to miss important competitions, they can be quite meaningful, but are rarely permanent or life threatening. However, given the social and financial importance of contemporary high-level sport, missing such competitions simply because athletes ignored common sense advice is unreasonable. In the ever-increasing population of older exercisers, or of patients where exercise is part of a rehabilitation program, side effects can be more severe, often life threatening, although predictable and manageable [8]. Thus, understanding the parameters of the therapeutic window is critical to successful prescription of training programs.

This volume presents several papers, written from the perspective of optimizing training programs by better understanding the purpose and process of evaluating exercise capacity either in order to better prescribe exercise training or to better understand the outcome of exercise training programs. A total of 14 papers were published, including nine original articles, two viewpoints, two brief reports, and a review, focusing on healthy and sport population (soccer, off-road running, archery, dance, and pilot cadets) and

**Citation:** Foster, C.; Cortis, C.; Fusco, A. Exercise Evaluation and Prescription. *J. Funct. Morphol. Kinesiol.* **2021**, *6*, 31. https://doi.org/ 10.3390/jfmk6010031

Received: 3 March 2021 Accepted: 19 March 2021 Published: 23 March 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

diseases (type II diabetes, overweight, obese, breast cancer survivors, multiple sclerosis, and COVID-19 patients).

In order to carefully adjust training intensity and duration prescription, Foster et al. [9] suggested the utility of "translating" exercise test responses into the workload during exercise training. In particular, in sedentary individuals beginning an exercise program or in patients during rehabilitation, this approach may yield useful estimates of exercise intensity and contribute to both the safety and efficacy of exercise therapy. Accordingly, to implement physical interventions effectively, it is essential to provide an appropriate exercise and training prescription terminology. Therefore, Gronwald et al. [10] provided a new and clearer definition of the terms dose and response in the context of exercise and training prescription, suggesting that the dose of physical exercise and/or physical training should be operationalized by specific markers of internal load and modifying the exercise prescription by carefully adjusting the external load.

Individualized and supervised training FITT prescription are particularly important for specific clinical populations and in particular situations such as the health-related consequences of COVID-19. In fact, Pippi et al. [11] with the C.U.R.I.A.Mo. Centre Experience showed the effectiveness and the importance of a supervised Nordic walk program to improve body weight control, body composition parameters, muscular flexibility and maximal oxygen uptake levels in obese adults with and without type 2 diabetes. Furthermore, Campa et al. [12] showed that a supervised high frequency resistance training program resulted in greater benefits for weight loss, cardiometabolic risk factors and handgrip strength than a training program with a session once a week in overweight and obese women. Additionally, the lack of significant associations between activity pacing and fatigue or physical activity found by Abonie et al. [13] suggests that people with multiple sclerosis which may benefit from targeted interventions to manage fatigue and optimize engagement in physical activity. Mascherini et al. [14] demonstrated that an exercise prescription program produces mid-term improvements in body composition, physical fitness and health-related quality of life of breast cancer survivors while adjuvant therapy slows down the effectiveness of an exercise program in the loss of fat mass. Individualization and personalization are also the key terms of the review proposed by Maugeri and Musumeci [15]. Accordingly, they provided a detailed review of the literature aiming to summarize updated evidence on the beneficial effects of adapted physical activity, based on personalized and tailor-made exercise, in preventing, treating, and counteracting the consequences of COVID-19.

The dose–response relationship proposed by Gronwald et al. [10] depends on a multitude of factors, such as internal and external load, and influencing factors. Within the influencing factors, nutrition, hydration, anthropometrics, environment, sport specific circumstances and ability have been highlighted. Results from Magee et al. [16] demonstrated a continued need for sport nutrition education interventions to be part of regular team activities, recommended to help athletes understand their advanced dietary requirements, provide strategies to meet dietary recommendations and avoid low energy availability. Investigating the effect of dehydration on archery performance, subjective feelings and heart rate response, the study from Savvides et al. [17] reported that, despite the induced psychological and physiological strain, archery performance over 72 arrows was not affected by dehydration. Specific bioelectrical impedance vector analysis references for the start of the season period, through which the physical condition achieved after the preparation microcycle in soccer can be assessed, have been provided by Bongiovanni et al. [18]. Thanks to findings from Petri et al. [19], national and international federations will be able to perform regular body composition assessments using skinfold measurements in soccer referees. Rojas-Valverde et al. [20] showed that data related to impacts could better explain the cumulative mechanical kidney trauma during mountain running, suggesting technology to better understand how the number and magnitude of the g-forces involved in off-road running could potentially affect kidney function. Video observation and motor imagery training did not improve reaction time when compared to controls, but Sirico et al. [21] suggested it as a

useful training strategy in individuals who need to simultaneously develop a fast response to different types of stimuli like pilot cadets. Finally, dance participation and experience proved to not influence balance and motor control in the sixth ballet position although resulting in better balance outcomes while standing in the first ballet position, suggesting identifying specific training adaptations and injury risk in varying foot positions [22].

Given the great success of the present Special Issue, we already launched a second edition, and we do hope to receive contributions focusing on the use of either laboratory or field evaluations to generate training advice in patients, healthy people, and athletes.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**

