ACSM Updates

A few months ago I covered the ACSM’s Health & Fitness Summit:

Well, the ACSM 52nd Annual Meeting is going on right now in Nashville. I’m not there, but I’m getting some updates and summaries of the presentations emailed to me by the ACSM. I thought I’d post them below for the heck of it.

For more info on the ACSM, check out the link below:

Here we go:


Most users concerned more with enhancing appearance than inappropriate dosages or adverse health effects

NASHVILLE, Tenn. - Major findings in a new survey of 500 steroid users reveal specific, alarming trends: most are non-athletes whose sole intention is to improve their physical appearance; users are taking larger doses than previously recorded; and even though nearly all admitted to adverse side effects, health concerns are not enough to deter their steroid use. The results of the survey were released today at the 52nd American College of Sports Medicine (ACSM) Annual Meeting in Nashville, Tenn.

The survey was conducted to identify current trends in steroid-taking habits. Researchers posted an anonymous, self-administered questionnaire to several message boards on Web sites popular among steroid users. While it is known the use of anabolic-androgenic steroids (AAS) among bodybuilders is widespread to increase muscle size and strength, information regarding self-administered AAS used non-medically to enhance athletic performance or improve physical appearance is sparse and poorly documented.

Of the 500 AAS users who participated in the survey, 78.4 percent (392/500) were non-competitive bodybuilders and non-athletes. Nearly 60 percent (298/500) reported using at least 1000mg of testosterone or its equivalent per week. The majority (99.2 percent or 496/500) of AAS users self-administer their injections, and up to 13 percent (65/500) report unsafe injection practices, such as re-using needles, sharing needles, and sharing multi-dose vials. In addition to using AAS, 25 percent of users admitted to also using growth hormone and insulin for anabolic effect. Finally, 99.2 percent (496/500) of users reported subjective side effects from AAS use.

“Clearly, the alarm is not ringing for the users who responded to our survey,” said Nick A. Evans, M.D., lead author for the study and physician at UCLA-Orthopaedic Hospital, Los Angeles. “They are not sensing or seeing the extremely dangerous game they are playing with these drugs. There are severe health risks associated with steroid use and abuse, but four out of five of our respondents report a greater desire to improve their physical appearance than to protect their health. Creating awareness among influencers like parents, coaches, trainers and health professionals may be a way to reach users and help them guide them back to safe health and fitness habits.”

Anabolic steroid use has been implicated in early heart disease, including sudden death, changes in blood cholesterol profile (increased LDL, lower HDL) resulting in increased risk of coronary artery disease, testicular atrophy, gynecomastia (abnormal enlargement of breasts in males), male pattern baldness, severe acne, premature closure of growth plates in adolescents, emotional disturbances, and other significant health risks.


Injuries, high-risk behaviors linked to infrequent usage

NASHVILLE, Tenn. - Teens who in-line skate, skateboard and snowboard underuse protective equipment designed to help prevent injuries and enhance safety in their “extreme” sports and activities. The study, presented today at the 52nd American College of Sports Medicine (ACSM) Annual Meeting in Nashville, Tenn., also showed an association between adolescents who use protective equipment and decreased high-risk health behaviors such as tobacco or alcohol use.

The study targeted adolescents, ages 13-18, at venues for extreme sports to determine reasons they did or did not wear personal protective equipment (PPE) and to identify possible factors that would influence more use. Additionally, researchers wanted to determine whether an association exists between high-risk behaviors and the use of PPE. Surveys were distributed at an indoor skate park, lakefront, a ski lodge, and a rural high school, and analyzed from August 2003 to March 2004.

From 333 surveys, adolescents reported they wore considerably less PPE than what is recommended by the American Academy of Pediatrics and American Academy of Orthopaedic Surgeons. In-line skaters wore the most PPE; snowboarders wore the least. The most common reasons adolescents wore PPE were parental influence, peer influence, and rule/requirement. Younger adolescents (13-15 year-olds) cited parents more frequently than older adolescents (16-18 year-olds) as a factor for PPE use.

Discomfort and lack of perceived need were the factors reported most often for lack of use. Sustaining or witnessing an accident was the most common reason cited that would convince adolescents in all three sports to wear PPE. However, almost half of adolescents in each sport reported that nothing would convince them to wear protective gear. Younger adolescents wore more PPE than older adolescents. A strong association was seen between PPE use in the three sports and helmet use when bicycling, but no association was seen between PPE use and seatbelt use. In-line skaters and skateboarders who tend to wear helmets were less likely to report tobacco usage. In addition, skateboarders who wore helmets more often reported less alcohol use. Adolescents reported low levels of substance use in the study; this was also the most common topic they reported their physician had discussed with them.
“Teenagers often have a sense of invincibility, which carries over to their sports and leisure pursuits,” said Erica L. Kroncke, M.D., lead author. “Active kids are generally healthy kids, but lack of protective gear in high-risk sports can have an adverse effect on health, in terms of injuries and other patterns of behavior. Parents of young adolescents can have a significant positive influence in promoting equipment use for these ‘extreme’ young athletes.”

Experts suggest several interventions could increase compliance with PPE and lead to decreased injuries in the future, including requirements for equipment usage instituted in public areas, reinforcement of safety equipment by parents and peers, manufacturing of more comfortable protective gear, and adolescent education. As the results demonstrate a link between protective equipment use and decreased high-risk health behaviors in adolescents, researchers hope that awareness of the study will have a positive influence.


Finding and sticking with what works may be the secret to better golf

NASHVILLE, Tenn. – Popular golfing magazines, books and videos often stress the importance of proper weight shift and tempo during the golf swing as critical to successful golfing. Yet there has been little scientific research to support these concepts. Results of a recent study of weightshift and golf swing tempo indicate these elements may not be as important to success in the game as previously thought.

The research was presented today at the 52nd American College of Sports Medicine (ACSM) Annual Meeting in Nashville, Tenn. The study looked at 28 college age athletes who had qualified for the National Collegiate Athletic Association’s National Tournament in 2003. Participants were divided into three groups based on their average competitive golf scores in 2002. Nine golfers were in the top group, seven in the middle group, and 12 in the bottom group.

Researchers found that the top golfers demonstrated the most consistency in their weight shift and tempo when 15 swings were measured. The golfers in the least proficient group had the greatest variance in their tempo and weight shift.

“In the best golfers, we saw significantly less variation in lateral movement, which is movement of the hips side to side,” said Bert H. Jacobson, Ed.D., FACSM, lead author. “We also noted that even among the golfers who had greater lateral movement of their hips, if they were consistent in that movement, they tended to hit the ball better than others in their skill group who were less consistent.”

Jacobson also noted that a faster swing (swing tempo) was not a significant characteristic of the better golfers. In fact, the researchers measured slower swings among some of the best golfers studied. The best golfers, though, were consistent in their swing tempo.

“What stands out is that even among the elite golfers, being consistent in how they hit the ball seemed to be a stronger indicator that they would hit the ball well than if they displayed a perfect form.”

“For the average golfer, this means people need to figure out what they are doing that is working for them, and then to try to be consistent with that form. Often, people take golf lessons and get overly concerned about their stance, how they are holding the club, where their elbows are, and how fast they swing the club,” said Jacobson. “What they really need to figure out is what is working best for them, and then attempt to repeat those movements as closely as possible, even if their form is highly unorthodox. Reproducibility is the key.”


Strength, body composition significantly improved in new study

NASHVILLE, Tenn. – A supervised, progressive resistance training program significantly increased strength and resulted in favorable body composition changes in overweight and obese children. Results add to the support of resistance training programs for youth, which can be part of a comprehensive health-enhancement strategy for all boys and girls, including those with a disinterest in physical activity. The study was presented today at the 52nd American College of Sports Medicine (ACSM) Annual Meeting in Nashville, Tenn.

With the dramatic increase in childhood obesity and inactivity in the past decade, this study was designed to determine the value of resistance training programs for a group of obese children, particularly its effect on strength and body composition.

“Parents and coaches who are concerned about the safety of resistance training for kids, and even young athletes, should know that it is a safe and effective activity for this age group, provided it is well designed and supervised,” said Chris M. Holian, lead author of the study. “For some, this type of training for kids is a question. Should they or shouldn’t they? There’s no doubt resistance training offers great benefits for kids when performed correctly. But, no competitive or maximal weightlifting and powerlifting for kids.”

A small group of young children between the ages of 7 and 11 was randomly selected to participate in a 10-week (3 times/wk) program or in a control (no training) program. Each child possessed a Body Mass Index higher than the 95 percentile for age and gender.

Strength was examined in a one-repetition series for the leg press, leg curl, chest press, overhead press, biceps curl, front pulldown, and seated rows. Changes in body composition were measured by total body scans. As expected, the resistance training group showed significant increases in strength throughout the series of weight exercises. Additionally, those in the program gained more lean muscle.

“Kids can start with some basic resistance training concepts that don’t require expensive equipment or a gym membership,” said Holian. “For example, using the body’s own resistance to do sit-ups, push-ups, pull-ups and other exercises is a good way to start. Kids who really want to try a program should find a trainer to help them design a well-rounded program, which should include other activities besides resistance training, like running, walking or cycling.”


NASHVILLE, Tenn. – The metabolic syndrome, a dangerous cluster of risk factors previously seen in adults and adolescents, is now appearing in elementary school-aged children. The findings, presented today at the 52nd American College of Sports Medicine (ACSM) Annual Meeting in Nashville, are the first to emerge from a three-year physical activity intervention and study to determine the prevalence of the condition in young children.

The metabolic syndrome has become a prevalent condition in North America, affecting nearly a quarter of U.S. men and women. An individual with the metabolic syndrome has three or more of the following factors: high blood pressure, high blood glucose, high plasma triglycerides, low HDL cholesterol, and high waist circumference. The metabolic syndrome is considered a precursor for Type 2 diabetes, coronary artery disease, and premature mortality.

Three hundred seventy-five second- and third-grade boys and girls were assessed to determine the prevalence of the metabolic syndrome and its related components in this age group. Researchers developed metabolic syndrome screening protocol for the children, defined as the presence of three or more of the following components: 1) central obesity (high waist circumference); 2) elevated triglyceride concentrations; 3) low HDL (good) cholesterol; 4) elevated blood pressure; or 5) elevated fasting glucose levels.

Five percent of both boys and girls were identified as having the metabolic syndrome. Half of the children had no components, and 45 percent had one or two components, with elevated blood pressure being the most common. Although the prevalence is low in this population, researchers say the results show the need for early prevention since components of the metabolic syndrome track into adulthood.

“The prevalence of metabolic syndrome dramatically increased among children who were overweight, with one in five overweight children having the condition,” said Katrina D. DuBose, Ph.D., lead author. “To help manage this, children need to participate in more physical activity and choose healthier foods to eat. Parents and teachers can help by encouraging children to be more active both inside and outside of school.”

Previous studies have indicated physical activity is an effective way to lower some of the risk factors common in metabolic syndrome. In one study of more than 600 adults classified as having the metabolic syndrome, nearly a third resolved their symptoms after exercise training.

I have some more study summaries involving the effects of pilates and yoga on old broads, but I’ll skip those for this audience!

I’ll post more later if I get some interesting ones.

Great stuff, Chris; thanks for sharing those. I wanted to make it to ACSM this year, but it just didn’t work out. With that said, here’s a list of presentations from our lab. I’m sure I could dig up some abstracts if any of them really catch someone’s eye.

Plasma Fibrinogen Alters Postexercise Hypotension

Testosterone And Androgen Receptor Responses To Resistance Exercise: Effects Of L-carnitine Supplementation

Body Composition Changes During A Competitive Season In Men?s Soccer At The American Collegiate Level

Chronic Alcohol Intake And Resistance Training On Skeletal Muscle Androgen Receptor Protein Content In Rats

Testosterone And Androgen Receptor Responses To Resistance Exercise: Effects Of L-carnitine Supplementation

Influence Of Vicoprofen? On Endogenous Opioid Peptides Following Exercise-induced Muscle Damage

CortitrolTM supplementation reduces serum cortisol responses to physical stress

Acute Effects Of Exercise Velocity In Resistance Exercise (I was a study subject for this one!)

Effect Of Muscle Oxygenation During Resistance Exercise On Lipid Peroxidation

Effect of Maximal Oxygen Consumption and body fat percent on thermoregulatory responses during a 4-hour march

Effect Of Gender On Lipid Mobilization And Lipolytic Hormones During And After Prolonged Submaximal Exercise

Influence Of Catecholamines On Muscle Force Production Capabilities

Incidence and Degree of Dehydration and Attitudes Regarding Hydration in Children in Summer Football Camps

Fluid Ingestion Attenuates The Decline In Vo2max Associated With Cardiovascular Drift

Effect Of Interval Versus Continuous Training On Measures Of Health-related Fitness

[quote]Eric Cressey wrote:
. I’m sure I could dig up some abstracts if any of them really catch someone’s eye.

Chronic Alcohol Intake And Resistance Training On Skeletal Muscle Androgen Receptor Protein Content In Rats

Effect Of Interval Versus Continuous Training On Measures Of Health-related Fitness[/quote]

EC I’d be interested in both of these abstracts if you could find them

I’d like to hear about this!

[quote]Eric Cressey wrote:
Acute Effects Of Exercise Velocity In Resistance Exercise (I was a study subject for this one!)

You know, I like the ACSM, but they sure do have a knack for spending 3 years on studies a PE teacher could tell you off the top of his or her head.

Eric, I’d appreciate seeing the abstract for the alcohol study on rats and the L-carnitine studies.



It would be great/cool if you could dig some of that stuff up! I’d really like to read:

Testosterone And Androgen Receptor Responses To Resistance Exercise: Effects Of L-carnitine Supplementation and Acute Effects Of Exercise Velocity In Resistance Exercise



[quote]RoadWarrior wrote:

It would be great/cool if you could dig some of that stuff up! I’d really like to read:

Testosterone And Androgen Receptor Responses To Resistance Exercise: Effects Of L-carnitine Supplementation and Acute Effects Of Exercise Velocity In Resistance Exercise




Check this L-carnitine study out:

[quote]buffalokilla wrote:
You know, I like the ACSM, but they sure do have a knack for spending 3 years on studies a PE teacher could tell you off the top of his or her head.

I agree that some studies have a definite “duh” component, but in fairness to the ACSM, they’re not necessarily doing these studies, the studies are just being presented at their conference. (But they do offer some research grants.)

Is that correct, Cressey?

[quote]Chris Shugart wrote:
I agree that some studies have a definite “duh” component, but in fairness to the ACSM, they’re not necessarily doing these studies, the studies are just being presented at their conference. (But they do offer some research grants.)

Is that correct, Cressey? [/quote]

Right on the money, Chris. It’s pretty funny, especially when you get to the undergraduate investigator presentations on the regional level. Most of them are survey-type studies that show that exercise is good for you, or having soda machines in school is a bad thing! When I’ve written up the NEACSM conference the past two years, I’ve had to restrain myself from including these abstracts just so that I can crack a few jokes.

But you’re right; what gets presented is out of the ACSM’s hands…sort of. Many of the ACSM higher-ups are prominent faculty members at the institutions making the most presentations. Our department alone has four FACSM’s (ACSM Fellows), and physical therapy here has another. They have control over what they study to some extent (e.g. master’s theses, doctoral dissertations), but it also comes down to where they can get funding. Research is expensive and grants are hard to come by. The money might come from NIH or corporations.

I don’t believe that the ACSM research grant fund is all that large; most of their grants are given in the form of scholarships to students at various levels, to my knowledge. Don’t quote me on that one, though; I’d have to look into it further.

[quote]gdm wrote:

Check this L-carnitine study out:

Good find. There have actually been several studies along these lines examining L-carnitine’s role in a variety of different realms (plus another that looked at dose-response).

More reports coming in…


U.S. Army looks at how some soldiers are trying to lose weight

While many Americans are concerned about weight control for health or appearance, some U.S. Army personnel have an added motivation to shed excess pounds. Carrying excess fat could result in a job loss. Unfortunately, the approaches some soldiers use to keep their weight in check may compromise both their overall health and their military preparedness. A study of weight loss strategies of American soldiers is being presented today at the American College of Sports Medicine’s 52nd Annual Meeting in Nashville, Tenn.

Researchers at the U.S. Army Research Institute of Environmental Medicine in Natick, MA studied 1,435 soldiers (1,212 men and 223 women) who had been referred to Womack Army Medical Center, Fort Bragg, NC, for weight control counseling. The men were an average of 33 pounds heavier than the Army’s maximum weight-for-height guidelines, and the women were an average of 35 pounds over weight. Study participants completed a survey of their dieting practices.

While some soldiers had attempted to lose weight by reducing the amount of food they ate, increasing their physical activity, or adding more fruits and vegetables to their diet, other strategies tended to be less healthy. Some 71 percent of respondents reported skipping meals to reduce weight, and 31 percent reported fasting. Other weight loss methods included the use of ‘fat burner’ medication by 55 percent of those in the study. Thirty-six percent indicated the use of appetite suppressants, and 21 percent said they used laxatives to reduce weight. Another 55 percent admitted to using a rubber sauna suit.

Weight management is a significant issue in the Army. Researchers noted that in 2003 the Department of Defense separated more than 3,000 military personnel for failure to meet standards for body fat.

“The focus of the Army Weight Control Program is keeping people healthy and fit,” said Col. Gaston P. Bathalon, Ph.D., R.D. “A major concern is that some of the weight loss behaviors we identified in the study could negatively impact health as well as performance.”

Among primary factors contributing to weight gain among the soldiers were medical issues such as injury or illness that restricted activity, deployment, and change in duty station that resulted in less physical activity.

Bathalon explained that the study also gained insight into the types of resources soldiers identified that would be helpful to them in weight reduction and control. These included support such as structured gym workouts and sessions with a personal trainer or dietitian. Personal weight management workbooks, Internet and PDA-based programs, weight loss medications, having a weight loss partner, and the availability of more low-fat/low-calorie foods in dining facilities also were identified.

“There are certain weight loss tools that work well for some, but not all people trying to manage their body weight. We need to find or develop programs and tools that meet individual needs based on lifestyles and preferences,” said Bathalon.

According to Bathalon, the Army is collaborating with Pennington Biomedical Research Center in Baton Rouge, LA to develop a Web-based interactive weight reduction program that is designed specifically for Army personnel. “The program will be designed to address military standards, and focus on Army needs,” he said.

Bathalon said that about one-third of the soldiers who participated in the weight loss survey indicated they would be interested in using a Web-based weight loss program.


Two-year study shows lifestyle-related chronic illness begins early

As the prevalence of overweight and obesity increases among American children, signs of risk for chronic diseases such as type 2 diabetes and cardiovascular diseases?previously thought of as adult disorders?are on the rise among youth. Results of research that looked at body weight, fat distribution and physical fitness among 83 high school students in Colorado were presented today at the 52nd American College of Sports Medicine (ACSM) Annual Meeting in Nashville, Tenn.

“We wanted to look at children ages 13 to 18 in this study,” said Teresa A. Sharp, Ph.D., lead researcher. “A number of studies have evaluated the relationship between obesity, fat distribution, and risk of chronic disease in adults, but few studies have examined these issues in children.”

According to the Centers for Disease Control and Prevention (CDC), 16 percent of children age six to 19 are considered overweight. In this study, the majority of participants were overweight?most had close to 30 percent body fat. Sharp points out that a healthy body fat percent for boys is 19 to 20 percent, and for girls about 23 percent.

Seventy-two percent of the children in the study were Hispanic and 21 percent were Caucasian. The study focused on Hispanic children because as adults they are particularly prone to develop type 2 diabetes and cardiovascular disease.

What Sharp and her colleagues found was that during the two-year period of the study, as weight, waist circumference, and body mass index (BMI) of the young people increased, their risk for chronic diseases also increased. Researchers were able to measure increases in the total cholesterol and triglycerides, and a decrease in HDL (good) cholesterol as the study participants became more overweight. This indicated they were at increased risk for cardiovascular disease. Researchers also saw increases in fasting glucose and insulin level-risk factors for type 2 diabetes.

“What surprises me is that two years is not a long period, yet we are seeing disease risk indicators for adult diseases in these kids,” said Sharp. “We have been seeing an increase in childhood obesity, and now we are starting to see the health implications that the obesity epidemic is causing. These kids are obviously now at risk for adult diseases, primarily due to obesity.”

The study also looked at changes in fitness level over the two-year period, and while most of the children became less fit over the two-year period, this was not significantly related to an increase in chronic disease risk.

The researchers indicate that it is imperative that public health professionals address the issue of increasing weight among youth, or be faced with a generation of individuals who will have to live with lifestyle-related chronic diseases as they enter young adulthood.

Note the end of this one and the so-called “million dollar question.” I think any T-Nation regular could win that million bucks! The deal is, no one in the general population wants to hear the answer.


Aerobic exercise yields greater fitness, but is harder to maintain
Moderate intensity physical activity such as walking may be helpful in maintaining weight loss for some, according to research presented today at the 52nd American College of Sports Medicine (ACSM) Annual Meeting in Nashville, Tenn. Study subjects who engaged in high-intensity aerobic exercise lost no more weight than “lifestyle activity” participants, and were less likely to maintain their fitness improvements a year later.

The four-year study, funded by the National Institutes of Health, involved 104 women and 20 men who were 15-50 pounds overweight?bordering on obesity. All followed a low-fat, moderately restricted diet for four months, choosing from among options allowed by dietary guidelines.

Participants were randomly placed into one of three exercise groups and engaged in:

  • Traditional aerobic exercise, (40-minute sessions, four days a week);

  • Short-bouts aerobic exercise (10-minute sessions, four times daily, four days a week), or

  • Lifestyle activity, accumulating at least 30 minutes of moderate-intensity physical activity each day.

Those engaging in traditional aerobic exercise made greater gains in fitness than the other groups, but all three groups saw similar weight-loss results.

Following the four-month program, participants were monitored for an additional 12 months. All groups were encouraged to keep up their activity levels but were also allowed to pursue activity or exercise of their choice.

“If your goal is fitness, then traditional aerobic exercise may offer the best return,” said study coordinator Shawn Franckowiak. "If you’re looking for weight loss or health benefits such as controlling blood pressure, cholesterol or diabetes, then the novel approaches we tested may be a promising alternative to traditional exercise.

“Interestingly,” said Franckowiak. “When we allowed people to engage in their own choice of activity after treatment, those in the lifestyle activity group tended to maintain their fitness better than aerobics participants. We also learned that, in the short run, weight loss does not appear to be compromised when engaging in novel exercise routines such as lifestyle activity or short-bout aerobic exercise.”

Franckowiak hypothesized that a lifestyle program may offer opportunities to fit physical activity into a busy schedule. He said there is much more to be learned about weight loss and fitness. “This is the tip of the iceberg. We’re looking at data showing what the individuals may have done during the year.” It is possible, he said, that lifestyle activity serves as a gateway to other traditional forms of exercise.

While much research has been done on how to lose weight, the subject of how to maintain weight loss is of continuing interest - ask any dieter. “That,” said Franckowiak, “is the million-dollar question we’re trying to answer.”

Although far from hardcore, I really like these “step” approaches for otherwise sedentary people. This is good stuff for your mom or fat older sister, although hopefully later they’ll see the value of weight training and a more intense approach.


Small steps may be best path to fitness

Small, achievable goals may be more effective in helping sedentary adults maintain fitness programs than more challenging goals. Results of a study of sedentary adults who set varying levels of fitness goals for an eight-week period were presented today at the 52nd American College of Sports Medicine (ACSM) Annual Meeting in Nashville, Tenn.

Seventy-eight people were involved in the study: 48 women and 30 men, ranging in age from 30 to 58. All were inactive when they began the study. At the start of the research project, participants wore pedometers to measure the number of steps they took each day. This gave researchers a baseline number for each participant, which was an average of 5,510 steps per day. The people in the study were then randomly assigned to one of two groups. One group was given a goal of 10,000 steps a day. The other group was given a goal of increasing the number of daily steps by 2,500 over their baseline. A control group was also measured at the start of the study, but not given a goal to increase steps.

At the end of the eight-week study, both groups with goals to increase steps showed significant improvement in daily activity, as compared to the control group, which had no significant increase in activity. Those who set a goal of 10,000 steps per day averaged an increase of 3,036 steps over their baseline. Those with a goal of adding 2,500 steps had an increase of 2,879 steps each day.

“What’s most interesting is 42.3 percent of the people who set the smaller goal, increasing steps by 2,500, were able to stick to their goal on four out of seven days in the eight-week study,” said Mark Davis, M.Ph., lead researcher. “Only 15.4 percent of those who had a goal of taking 10,000 steps per day met this goal on four days out of seven in the study period.”

Davis points out that the goal of taking 10,000 steps a day is widely promoted as a measure of moderate physical activity. With the growing popularity of pedometers, many people use this 10,000 step number as a goal.

“Based on our study results, smaller goals, such as increasing daily steps by 2,500 steps at a time, might in fact be a more effective way to help people not only reach a desired physical activity goal, but also stick with it.”