Garber, C.E., et al. 2011. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine & Science in Sports & Exercise, 43 (7), 1334–59.

The new American College of Sports Medicine (ACSM) Position Stand paper on exercise quantity and quality is an update of the 1998 ACSM document on this topic. The new paper cites over 400 publications from scientific reviews, epidemiological studies, clinical studies, meta-analyses, consensus statements and evidence-based guidelines.

The purpose of this ACSM Position Stand is to present evidence-based direction to health and fitness professionals on developing individualized exercise training programs for apparently healthy adults of all ages (Garber et al. 2011). Competent exercise and health professionals can also use these guidelines for people with some chronic health problems or disabilities, incorporating modifications appropriate to these clients’ physical function and health status.

Helpfully, Garber and colleagues have clarified common misunderstandings regarding frequently used fitness terminology (see the sidebar “Exercise Terminology Clarified”).

One of the most compelling sections of the paper is a fact-based review of the numerous health benefits (see Figure 1) conferred by a comprehensive exercise program of resistance, cardiorespiratory, flexibility and neuromotor exercise. Equally impressive is ACSM’s statement that “engaging in regular exercise and reducing sedentary behavior is vital for the health of adults.”

Cardiorespiratory Exercise Design Guidelines

It is important to note that Garber et al. (2011) state that the minimum level of cardiorespiratory fitness required for health benefits may be different for men than it is for women and different for older adults than it is for younger ones. Garber and colleagues also note that sedentary behavior (e.g., sitting at a desktop workstation, watching TV, surfing the Internet) is associated with depression, higher coronary heart disease, increased waist circumference, elevated blood pressure, depressed lipoprotein lipase activity (leading to higher levels of circulating blood triglycerides) and elevated blood glucose, insulin and cholesterol.

The authors state that daily physical activity, exercise and standing movement during the day can help diminish these unfavorable biological effects. The guidelines recommend progressive increases in step counts of ≥2,000 steps (when using a pedometer), to attain a daily step count of at least 7,000 steps. The new cardiorespiratory exercise recommendations are shown in Table 1.

Resistance Exercise Design Guidelines

Higher levels of muscular fitness are associated with reduced risk of all causes of disease, improved cardiometabolic health (a construct that includes a group of risk factors that are indicators of a person’s overall risk for type 2 diabetes, stroke and cardiovascular disease) and reduced risk of developing functional limitations. In fact, Garber and colleagues state in the new ACSM Position Stand that resistance exercise may be an effective intervention in the treatment of metabolic syndrome. Very important, they state that the bone-loading stress of resistance exercise may prevent, slow and even reverse the losses of bone mineral and bone mass that occur with osteoporosis.

Program designs should target opposing muscle groups of the chest, shoulders, back, hips, legs, trunk and arms. Clients should perform all exercises with a purposeful, controlled, full range of motion. See Table 2 for new resistance exercise guidelines.

Flexibility Exercise Design Guidelines

Garber et al. 2011 recommend that flexibility programs (including static, dynamic and proprioceptive neuromuscular facilitation [PNF] methods) should be designed specifically to meet the needs and demands of each individual’s lifestyle. For most adults, flexibility training will improve balance and postural stability. The relationship between flexibility and a reduction of musculoskeletal injury has not been substantiated in the literature. Flexibility exercise guidelines are shown in Table 3.

Neuromotor Exercise Design Guidelines

Neuromotor exercise (i.e., functional exercise) training is advantageous as part of an all-inclusive exercise program for adults, especially older persons. This type of training can improve balance, agility, muscle strength, gait and coordination, and can also reduce the risk of falls. Garber and colleagues conclude that more research is needed to clarify the specific health-related changes resulting from functional fitness training and to determine the effectiveness of different exercise types and amounts. See Table 4 for recommendations.

Final Thoughts

One of the most impressive evidence-based statements in the new ACSM Position Stand is that leadership from well-trained fitness professionals will meaningfully enhance the exercise experience of adults, especially those who are novice exercisers. The fact that a position statement with over 400 cited references highlights the importance of skilled exercise professionals is a true measure of how much we as a profession have grown in the last decade.

Figure 1. Health Benefits of Cardiorespiratory, Resistance, Flexibility and Neuromotor Exercise

Source: Garber et al. 2011.

Table 1. CardiorespiratoryExercise Recommendations

Table 2. Resistance Exercise Recommendations

Table 3. Flexibility Exercise Recommendations

Exercise Terminology Clarified

The terms physical activity, exercise, physical fitness and physical function are closely related and interchanged frequently, yet have discrete meanings. The new ACSM Position Stand (2011) distinguishes these terms with the following definitions:

  • Physical fitness: the ability to carry out daily tasks with vigor and alertness, without undue fatigue and with ample energy to enjoy [leisure] pursuits and to meet unforeseen emergencies. Physical fitness is operationalized as [a set of] measurable health- and skill-related attributes that include cardiorespiratory fitness, muscular strength and endurance, body composition and flexibility, balance, agility, reaction time and power.
  • Exercise: physical activity that is planned, structured and repetitive, and [that] has as a final or intermediate objective the improvement or maintenance of physical fitness.
  • Physical activity: a bodily movement produced by skeletal muscles that results in energy expenditure above resting (basal) levels. Physical activity broadly encompasses exercise, sports and physical activities done as part of daily living, occupation, leisure and active transportation.
  • Physical function: the capacity of an individual to carry out the physical activities of daily living. Physical function reflects motor function and control, physical fitness and habitual physical activity, and is an independent predictor of functional independence, disability, morbidity and mortality.
Table 4. Neuromotor Exercise Recommendations

Len Kravitz, PhD

Len Kravitz, PhD is a professor and program coordinator of exercise science at the University of New Mexico where he recently received the Presidential Award of Distinction and the Outstanding Teacher of the Year award. In addition to being a 2016 inductee into the National Fitness Hall of Fame, Dr. Kravitz was awarded the Fitness Educator of the Year by the American Council on Exercise. Just recently, ACSM honored him with writing the 'Paper of the Year' for the ACSM Health and Fitness Journal.

1 Comment

  1. Timothy Neff on February 1, 2021 at 9:28 pm

    Are these recommendations for repetitions and endurance times appropriate for a man of my age (64) I’m moderately out of shape , but have no medical restrictions .

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