Dixie Stanforth, Ph.D., FACSM, is a recently retired professor of instruction in the Department of Kinesiology and Health Education, The University of Texas at Austin. She developed and directed the Health Fitness Instructor, Community Health & Wellness, and Medical Fitness/Rehabilitation Specializations for undergraduates. She serves as a provost's teaching fellow emerita, is an associate editor for ACSM's Health & Fitness Journal®, and is a frequent presenter at ACSM's International Health & Fitness Summit and other national conferences. Erin Crownover, M.S., is a former collegiate basketball player who recently completed her master's degree in Exercise Physiology in the Department of Kinesiology and Health Education, The University of Texas at Austin. She is currently pursuing her Ph.D. at UT Austin in the Physical Culture and Sport Studies program. Erin is passionate about exercise and sport, especially racial and sex attitudes in sports history and early athletic training. Disclosure:The authors declare no conflict of interest and do not have any financial disclosures.

Dixie Stanforth, Ph.D., FACSM,is a professor of instruction, emerita in the Department of Kinesiology and Health Education, The University of Texas at Austin. She developed and directed the Health Fitness Instructor, Community Health & Wellness, and Medical Fitness/Rehabilitation Specializations for undergraduates. She serves as a provost's teaching fellow emerita, is an associate editor for ACSM's Health & Fitness Journal®and is a frequent presenter at ACSM's International Health & Fitness Summit and other national conferences. Erin Crownover, M.S.,is a former collegiate basketball player who recently completed her master's degree in Exercise Physiology in the Department of Kinesiology and Health Education, The University of Texas at Austin. She is currently pursuing her Ph.D. at UT Austin in the Physical Culture and Sport Studies program. Erin is passionate about exercise and sport, especially racial and gender attitudes in sports history and early athletic training. Disclosure:The authors declare no conflict of interest and do not have any financial disclosures.

In this Celebrate Success! column, we are featuring the content written by Joe Sherlock for ACSM's Spotlight, a web site feature that shines a light on ACSM's outstanding members and certified professionals. Reading it, I was transported back to my first year in graduate school at the University of Arizona (1980), listening to a bold, brash, and brilliant guy sprawling in the front row and challenging the professor. The freight train that was Michael Joyner was making connections and asking questions that were so far beyond my understanding that I couldn't even follow the conversation…and was probably not even on the same tracks! To celebrate the success of Joyner, we start with Sherlock's overview of his career followed by some pithy advice shared by Joyner with me at ACSM's Annual Meeting. Our conversation was free-ranging from training to mentoring to chasm jumping and jam sessions. Hold onto your hats as you meet Joyner, a distance athlete and also a self-described “15 on the 10-point extrovert scale;” a brilliant scientist and strategic thinker, still challenging conventional wisdom and making change happen today. A MARATHON CAREER: MEET 2023 ACSM HONOR AWARD RECIPIENT (BY JOE SHERLOCK)Michael Joyner, M.D., FACSMSpeaking with Michael Joyner, one feels as if one is sprinting to catch hold of a freight train. Formidable in both intellect and presence, Joyner sets the pace of the conversation, and you immediately fall into the role of an adoring but perhaps subpar student. You daren't fall behind — not because you are afraid but because you are in awe. At the very least, you want to see where the damn train is going; it will doubtless be both an interesting destination and a thought-provoking journey along the way. Then a few minutes pass, and you find yourself keeping up after all. There's a steady ebb and flow to the conversation, one guided by Joyner's instinctive ability to pace. Things are moving at speed, but a tightly controlled velocity designed to give you just as much as you can handle. No more, but certainly no less. Fortunate, too, that Joyner's own biography offers some hope for the supposedly subpar student. More on this anon. Joyner, recipient of the 2023 Honor Award of the American College of Sports Medicine, is the Frank R. and Shari Caywood Professor of Anesthesiology as well as departmental vice chair for research at the Mayo Clinic in Rochester, MN. He′s received numerous awards and accolades, from the American Physiological Society's Lamport Award for Contributions to Cardiovascular Physiology (1993) to an honorary doctorate from McMaster University (2019). He has well more than 500 publications to his name. His Google h-index is more than 100, with upward of 39,000 citations. He’s contributed articles and op-eds to, among others, Outside Magazine and The New York Times. He’s shared airtime with then-Vice President Mike Pence for his work treating COVID-19 patients. EARLY DAYS But we start the conversation at the beginning, so to speak. I enquire as to how he got into exercise science, and he recalls a case of serendipity. It was 1977. He was 19 years old and contemplating dropping out of the University of Arizona to join the fire department: “I was the least prepared person ever to go to college,” Joyner says. “I did well on tests, but I was a terrible student.” In fact, Arizona was the third institution in which he'd enrolled, having beforehand tried his luck at both Earlham College and the Northern Arizona University, respectively. Really, the bright spot in his life was distance running — despite deep reservations about his place in the academic world, he was a solid walk-on U of A track and field athlete.Photos in this column are courtesy of Michael Joyner, M.D., FACSM; Shelly K. Roberts, R.N.; and the ACSM archives.In this providential case, he was competing in a weekend road race when, toward the end of the run, he found himself keeping pace with a young graduate student named Eddie Coyle. Coyle was working in the laboratory of the legendary Jack Wilmore, a future ACSM president (1978–9) and Honor Award winner (2006). Coyle asked the younger runner if he would be interested in becoming a subject in a human performance study headed by Pete Farrell, another grad student in Wilmore's laboratory. Joyner agreed. The study just so happened to be the pivotal “Plasma Lactate Accumulation and Distance Running Performance,” published in Medicine & Science in Sports & Exercise® in 1979. From there, Joyner's trajectory was set. “Jack started letting me come to Journal Club and started letting me participate,” Joyner recalls, “because for some reason he realized that maybe I had some ability. And Eddie was super, super supportive.” Later on in our discussion, Joyner shares, “I mean, I was barely 20 years old. The lightning bolt hit me and I said ‘I want to do this,’ right? And it was lucky because, you know, you didn't have the Internet. There was nobody telling you this was stupid, or that it wasn't possible, or that there would be some long and winding road.” Eventually, with a diploma fresh in hand, Joyner followed Coyle to Wash U in the summer of 1981 to work with John Holloszy (the 1987 recipient of the ACSM Honor Award) on a study examining athletic detraining. Joyner, who had been in peak condition for his recent track season at Arizona, signed on as one of seven subjects and took a — presumably irritating — 12 weeks off so they could see what exactly would happen when high-level athletes potatoed from 60 to 0. The research eventually led to the 1984 publication “Time Course of Loss of Adaptations after Stopping Prolonged Intense Endurance Training,” in the Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology. But by 1982, Joyner had been accepted by the U of A medical school, where he found himself compelled by anesthesiology, particularly how well its basic components fit into his previous exercise physiology experience. He would go on to pursue anesthesiology for his clinical residency. “The things you do in anesthesia — you think about breathing. You think about carbon dioxide. You think about oxygen. You think about blood pressure. You think about heart rate,” he says. “Those are the same things you think about during exercise.” A CAREER PROGRESSES We go on to discuss the anesthesiologist's role as the patient's temporary autonomic nervous system, maintaining homeostasis while the patient is undergoing the physiological challenge of surgery. As it relates to physiology: “We're studying how this system works, how it's affected by hypoxia, how it's affected by exercise, blood loss, a number of other things I'm interested in. And in clinical anesthesia, we're thinking about what happens when we turn the regulatory system off.” However, Joyner is quick to delineate the realms in which he operates. He completed a clinical residency with extra research training at Mayo, expecting to stay a few years and then return to Arizona. Instead, he remained in the Land of 10,000 Lakes. Joyner's current role at Mayo has him working as an anesthesiologist approximately 20% of the time. The rest is devoted to physiological research and teaching. “Most of what I do is study humans in a clinical research center who are exercising, who we're giving a different source of physiological challenges to,” he says, adding, “I'm an anesthesiologist thinking about physiology, but mostly what I am is a physiologist who also happens to be an anesthesiologist.” And his research has delved into a fair number of seemingly disparate questions, from the causes of fatigue in subjects with cerebral palsy to the physiology behind world records. Joyner is himself a 2:25 marathoner, and many may recognize him as the name behind the 1991 physiological model that proposed the possibility of a sub–2-hour marathon. Naturally unsatisfied by narrow lanes of inquiry, Joyner is also instinctively suspicious of reductionism. His 2015 Times op-ed “Moonshot’ Medicine Will Let Us Down,” presented doubts about the utility of precision medicine for the average person. The article caught the attention of Nigel Paneth, a pediatric epidemiologist at the University of Michigan, who reached out to Joyner via email. Together, they set up a network of researchers with varying fields of expertise but similar concerns about siloing in the scientific enterprise. “People who wanted to take a more broad-based, multifactorial view,” Joyner says. COVID-19 AND CONVALESCENT PLASMA Through another series of happenstances, one of the experts in their group was Arturo Casadevall, an immunologist and microbiologist at Johns Hopkins University. In the early stages of the COVID-19 pandemic, Casadevall penned an article for the Wall Street Journal in which he proposed, based on a doctor's inspired intervention during a 1934 measles outbreak, using the blood plasma of convalesced COVID-19 patients to treat those with an active infection. David Epstein, author of The Sports Gene, subsequently tweeted about the article. Joyner — who was at the 2020 Olympic Marathon trials to give a talk about his 2-hour marathon research — saw the tweet, sensed momentum, and immediately emailed Casadevall. Because of his anesthesia background, as well as some work he'd done with the U.S. Army, Joyner was familiar with the ins and outs of the nation's blood-banking system. He thought they had a good chance of actually making this thing happen. He and Casadevall, along with other colleagues, set up sister research protocols at Hopkins and Mayo. By March 2020, Peter Marks, director of the FDA's Center for Biologics Evaluation and Research, emailed Joyner about heading up an expanded access program for convalescent plasma. The effort treated more than 90,000 people early in the pandemic. As alluded to earlier, then-Vice President Mike Pence visited Mayo to hear Joyner's update on the project. The meeting was broadcast on multiple national networks. Of particular note, however, has been the effect of the plasma treatment on COVID-19 patients who also have leukemia or lymphoma. “We've had patients who've had COVID for 300 days,” Joyner says. “Immunocompromised patients. This isn't long COVID. These people have been actively infected, and they don't get horrible COVID because their immune system is suppressed.” We discuss the role of the inflammatory response, including cytokines. Then he floors me by saying, “So what happens is we've given these people a couple units of plasma and they get better right away.” We move along, but later in the conversation he offers a generalist's insight into the plasma program's success: “I think having a physiological perspective was helpful there,” he says, “as opposed to an infectious disease or microbiological or immunological perspective, just to be able to bring some outside thinking.” CURRENT AND FUTURE EFFORTS The convalescent plasma work is ongoing, but I ask about other irons he has in the fire. He rattles off a few ideas he and his teams are exploring, among them the effect of high altitude on exercise performance and working with people who are outliers on the continuum of physical health — particularly high-level athletes versus those with heart failure versus people who have left-shifted hemoglobin (i.e., those who possess a particular subset of hemoglobin that has a higher-than-average oxygen affinity). In this latter case, he's interested to know whether humans with said unique hemoglobin perform better at altitude than the average person. Certain animals that inhabit or travel through dizzying elevations, including some geese that overfly Mount Everest, have similarly configured hemoglobin. It seemed worth looking into. Preliminary results suggest they're onto something. He’s also interested in what information might be gleaned from large datasets in an increasingly wearable-focused medical and fitness world. This work, however, remains in a “precognitive” state. It's the second time he's used the word during our conversation, and the repetition is telling. Despite his rapid-fire conversational style, Joyner is a man who lets things work out organically, and in their own time. Or, rather, he doesn't needlessly rush things. One recalls once more that he is a long-distance runner. There are moments you should push and times to let the road simply roll on beneath your feet. Press on, reflect, regroup, stay in a holding pattern. Everything in its season. We'll get there. “I'm sure we'll make a lot of mistakes,” he says. “I'm sure there'll be some false starts. But I think that if you see the mountain peak 50 miles away, it looks pretty good.” This segment by Joe Sherlock was originally published on ACSM.org in May 2023: https://shorturl.at/flnXY. BE LIKE MIKE Capturing a conversation with Joyner is, as Sherlock discovered, an adventure. In attempting to describe his journey, Joyner says: “There's no fixed Monopoly board for your career…your career only makes sense when you look back. The catalytic person was Eddie Coyle who got me to be a subject in Pete Farrell's dissertation project and later recruited me to be a ‘detrainer’ at Washington University with Dr. Holloszy. Equally catalytic were the ‘enriched environments’ anchored by Jack Wilmore and my interactions with John Holloszy. Then along the way, people like Doug Seals, Roger Enoka, Jerry Dempsey, and Jim Hagberg influenced me. Plus, many good profs at the University of Arizona College of Medicine and then John Shepherd at Mayo. It has been a case of ‘when the student is ready the teacher appears,’ plus a collection of enriched environments.” Here are a few thoughts from Joyner which prompt personal reflection, whether you are on Boardwalk or Baltic: 1. Resist being pigeonholed: Joyner consistently uses training as a metaphor for life and personal growth. He is insistent that whatever “it” is, treat “it” like distance running: “Every day take a bite out of it and you're going to get better.” He sees no limits…only possibilities that are most fun and rewarding when explored with others who are willing to move out of their lanes and collaborate. 2. You can't leap a wide chasm in two jumps: Since his earliest days, he remembers deciding that if there was something he was interested in, he might as well “go for it.” His innate curiosity in everything was stoked by extensive reading, museum visits, and hanging out on the University of Arizona campus with his dad. He has a uniquely deep, wide-ranging historical perspective that enlarges his ability to see and frame the big issues in many disciplines. Whether you are talking exercise science, training methods, or epidemics and beyond, Joyner is fearless in suggesting new ideas, often grounded in some relatively obscure concept long forgotten or discarded (i.e., 1934 measles story mentioned previously). 3. Life is a continual intellectual jam session: And, he says, “look for themes and be willing to constantly improvise.” He sees this in the work he does in the laboratory where postdocs and young physicians are encouraged to work creatively within an existing theme or to develop a new line of research and make it their own. He describes the environment he has created by providing infrastructure and resources as a “Montessori school for adults” where asking great questions and “improv” rule, rather than traditional learning, which often prizes “getting the right answer.” 4. History doesn't repeat itself, but it does rhyme: Looking back to move forward has clearly added value to Joyner's career trajectory. He points to the historical richness of working with Wilmore at the University of Arizona, noting that Wilmore was trained by Steve Horvath, who worked with D.B. Dill at the Harvard Fatigue Lab. He stresses the need to “limit your ROI [return on investment] thinking” and to do things you are truly interested in. Are you curious about something? Love a particular topic? Use your energy there and it won't be wasted and you won't be bored or simply putting in your time. 5. Your career is not a zero sum game: Although he acknowledges that is how many people operate, he prefers a different equation. His goal is “not to cultivate like-minded people, but a network of people who also pursue excellence.” Known as an outstanding mentor, Joyner is quick to list and credit those who believed in him from his early days in the running boom of the late 70s (especially track coach Dave Murray) to many who supported him throughout his professional journey as mentioned throughout this column. He also highlights the value of “prementors” or those just a step or two ahead in the process. From his first journal club with Dr. Wilmore as an undergraduate student to his wide-ranging work at Mayo Clinic today, Joyner has lived what he describes as “a life of luck and timing where my curiosity was indulged.” As we finished our time together, Joyner spoke toward the future and the exciting new challenges and adventures he sees. He remembered a quote attributed to JFK, noting it might be apocryphal, but agreed it makes a good story ending for these days: “The Chinese use two brush strokes to write the word ‘crisis.’ One brush stroke stands for danger; the other for opportunity.” Although it is no surprise that Joyner would mention this rather esoteric quote, it reminded me of the description of the birth of the Harvard Fatigue Lab. In the 1989 D.B. Dill Lecture, Carleton Chapman (1) recognized the work of the five-man “Pacesetter” team who developed “…the concept of a laboratory devoted to human physiological research that was holistic rather than systems- or organ-oriented, that was strongly interdisciplinary, and that focused on measurements both at rest and under stressful conditions…” Chapman called the laboratory a “magnificent anomaly,” which is the perfect description of Joyner, both personally and professionally. We are grateful Joyner has embraced the opportunities available during his slice of history with characteristic curiosity and fearlessness…cheers to ACSM's 2023 Honor Award recipient! To read more about Dr. Joyner's accomplishments click here: https://shorturl.at/bdsMZ.

Background The potential for prehabilitation programs to impact clinical outcomes is uncertain in abdominal cancer patients due to the short window of time to intervene and the weakened state of the patients. To improve the effectiveness of prehabilitation intervention, a multimodal sports science approach was implemented. Methods Prior to cancer-related surgery, 21 patients participated in a 4-week exercise and nutrition prehabilitation program comprised of blood flow restriction exercise (BFR) and a sports nutrition supplement. Retrospective data of 71 abdominal cancer patients who underwent usual preoperative care was used as a comparator control group (CON). At 90 days post-surgery, clinical outcomes were quantified. Results Prehabilitation was associated with a shorter length of hospital stay (P = .02) with 5.5 fewer days (4.7 ± 2.1 vs 10.2 ± 1.2 days in CON) and decreased incidence of any complications (P = .03). Prehabilitation was not related to incidence of serious complications (P = .17) or readmission rate (P = .59). The prehabilitation group recorded 58% more steps on day 5 after surgery (P = .043). Discussion A 4-week home-based prehabilitation program composed of BFR training and sports nutrition supplementation was effective in reducing postoperative complications and length of hospital stay in older patients with abdominal cancer. ClinicalTrials.gov Identifier: NCT04073381.

Dixie Stanforth, Ph.D., FACSM,is a Professor of Instruction in the Department of Kinesiology and Health Education, The University of Texas at Austin. She developed and directs the Health Fitness Instructor, Community Health & Wellness, and Medical Fitness/Rehabilitation Specializations for undergraduates. She serves as a provost's teaching fellow, is an associate editor for ACSM's Health & Fitness Journal®, and is a frequent presenter at ACSM's International Health & Fitness Summit and other national conferences. Erin Crownover, M.S.,is a former collegiate basketball player who recently completed her master's degree in Exercise Physiology in the Department of Kinesiology and Health Education, The University of Texas at Austin. She is currently pursuing her Ph.D. at UT Austin in the Physical Culture and Sport Studies program. Erin is passionate about exercise and sport, especially the intersection of exercise science with physical culture, sport history, sport economics, and sport/international relations. Disclosure:The authors declare no conflict of interest and do not have any financial disclosures.

Dixie Stanforth, Ph.D., FACSM,is a recently retired professor of instruction in the Department of Kinesiology and Health Education, The University of Texas at Austin. She developed and directed the Health Fitness Instructor, Community Health & Wellness, and Medical Fitness/Rehabilitation Specializations for undergraduates. She serves as a provost's teaching fellow emerita, is an associate editor for ACSM's Health & Fitness Journal®, and is a frequent presenter at ACSM's International Health & Fitness Summit and other national conferences. Erin Crownover, M.S.,is a former collegiate basketball player who recently completed her Master's degree in Exercise Physiology in the Department of Kinesiology and Health Education, The University of Texas at Austin. She is currently pursuing her Ph.D. at UT Austin in the Physical Culture and Sport Studies program. Erin is passionate about exercise and sport, especially the intersection of exercise science with physical culture, sport history, sport economics, and sport/international relations. Disclosure:The authors declare no conflict of interest and do not have any financial disclosures.

Dixie Stanforth, Ph.D., FACSM,is a professor of instruction in the Department of Kinesiology and Health Education, The University of Texas at Austin. She developed and directs the Health Fitness Instructor, Community Health and Wellness, and Medical Fitness/Rehabilitation Specializations for undergraduates. She serves as a provost's teaching fellow, is an associate editor for ACSM's Health & Fitness Journal®, and is a frequent presenter at ACSM's International Health & Fitness Summit and other national conferences. Erin Crownover, M.S.,is a former collegiate basketball player who recently completed her master's degree in Exercise Physiology in the Department of Kinesiology and Health Education, The University of Texas at Austin. She is currently pursuing her Ph.D. at UT Austin in the Physical Culture and Sport Studies program. Erin is passionate about exercise and sport, especially the intersection of exercise science with physical culture, sport history, sport economics, and sport/international relations. Disclosure:The authors declare no conflict of interest and do not have any financial disclosures.

Dixie Stanforth, Ph.D., FACSM, is a Professor of instruction in the Department of Kinesiology and Health Education, The University of Texas at Austin. She developed and directs the Health Fitness Instructor, Community Health & Wellness, and Medical Fitness/Rehabilitation Specializations for undergraduates. She serves as an associate editor for ACSM’s Health & Fitness Journal® and is a frequent presenter at ACSM’s International Health & Fitness Summit and other national conferences. Erin Crownover, M.S., is a former collegiate basketball player currently completing her master’s degree in Exercise Physiology in the Department of Kinesiology and Health Education, The University of Texas at Austin. She will be pursuing her Ph.D. at UT Austin in the Physical Culture and Sport Studies program starting in fall 2021. Erin is passionate about exercise and sport, especially the intersection of exercise science with physical culture, sport history, sport economics, and sport/international relations.

It is fitting to note that as we write this column, we represent two ends of the ACSM’s Health & Fitness Journal® (HFJ) continuum: Dixie as a seasoned professional has had the privilege to work with each of the editors, and Erin is just beginning her ACSM journey at the start of her Ph.D. program. Whether this is your first time to read the HFJ or if you have used the articles in your teaching for the past 25 years, we want to celebrate those behind the success, leading to outcomes like these: - Impact factor increased from 0.356 in 2015 to 1.364 in 2020. - Institutional subscriptions boomed 1,450% from 234 in 2004 to 3,630 in 2020. - Online presence began in 2004 with 34 k site visits and increased 1,076% to >400 K visits in 2020. - In 2020, the international reach was 57%, up from 10% in 2004. HFJ was birthed out of a desire to “bridge the gap” between science and practice, and that goal has been the driving force embraced by each editor. This focused approach created standards and identified non-negotiables that led to the solid and measurable growth described above. In addition, HFJ is widely accepted within academia and allied health professions as a reliable source for accessible and useful content. Current editors describe cornerstones that have been foundational to the Journal since its inception, including articles and information that are provided in an attractive yet scientific style and format; content that is intentionally diverse, inclusive, and welcoming to students and new professionals. Each of these elements have blended together to make the Journal unique by providing translational content that can be understood and applied by a wide variety of readers. The evolution of HFJ reflects those who have served as editor-in-chief over the past 25 years, each guiding their editorial boards and contributors to develop and share relevant and useful content. Their innovative approaches and willingness to grow with the industry have remained true to the ultimate goal of “bridging the gap.”LARRY GOLDING, Ph.D., FACSM: VISIONARY LEADER (EDITOR 1997–2004)The founding of HFJ is directly linked to the vision of Larry Golding and his identifying the need to “bridge the gap” between science and practice. Larry was an active ACSM member beginning in 1961, serving on numerous committees and the Board of Trustees. Although he fully embraced ACSM as the gold standard in science and clinical practice, Larry also recognized a growing need to provide professional practitioners with sound scientific information in a concise and readable format. Working extensively with students and young fitness professionals through his tenure at the University of Las Vegas and the YMCA, Larry became convinced that there was an immediate and growing need to translate the hard science, that is ACSM’s brand, into practical application for those working in the field. Pitching the idea to the Board of Trustees resulted in Larry being appointed as the founding editor-in-chief. He also was instrumental in the creation of ACSM’s Health & Fitness Summit as a natural educational pairing to provide scientific content in a way that attendees could “use” in their jobs. As chair of ACSM’s Health & Fitness Summit Program Committee for 12 years, Larry fostered the link between the high-quality articles in HFJ and the cutting-edge research and hot topics presented at the summit, all curated to answer the questions those in the field were actually asking. As he was stepping down from his editorial role in 2004, Larry described the exciting evolution of HFJ, reflecting years of hard work and dedication to excellence: “Seeing the Journal grow in both numbers of readers and in quality, seeing the number of advertisers grow, seeing the change from soliciting authors to getting unsolicited manuscripts, seeing ACSM’s Health & Fitness Summit & Exposition become an integral part of the Journal and become a major function of ACSM, seeing health and fitness professionals become members of ACSM, and getting to know some super people in the field of health and fitness have been just a few highlights of the past eight years” (1). Larry had a profound impact on generations of ACSM professionals and the fitness industry as an early adopter of the sentiment expressed by his colleague and friend Mary E. Sanders, Ph.D., FACSM: “More evidence-based practices are dependent upon more practice-based evidence.” As a champion for extending the reach of ACSM beyond the lab into what Avery Faigenbaum calls “useable science,” Larry’s legacy lives on through the Journal. As Jim Peterson, Ph.D., FACSM says: “Very few people understand both the science and the practical side … Larry was unique in that he thoroughly understood both … no Larry Golding, no HFJ or Summit.” We are thankful for Larry’s vision and legacy. EDWARD T. HOWLEY, Ph.D., FACSM: JOINING THE VIRTUAL WORLD (EDITOR 2005–2011)Following Larry Golding, Ed Howley brought a wealth of ACSM experience to HFJ, having served as president (2002–2003) and on the Board of Trustees, Administrative Council, and the Health & Fitness Summit Program Committee. As Larry passed the baton, he described Ed this way: “He is a scientist and publishes in scientific journals, but he is also a fitness practitioner and practices what he preaches.” Ed was uniquely qualified to blend science and practice and to begin building brand awareness of HFJ as a source that fitness professionals could use, as Walt Thompson, Ph.D., FACSM says, “on the floor, in the gym” (see Video 1, https://links.lww.com/FIT/A178). Under Ed’s leadership, there was significant growth and change, including transitioning from the days of snail mail and soliciting manuscripts from friends and family to establishing a virtual presence and receiving unsolicited manuscripts from all over the world (see Video 2, https://links.lww.com/FIT/A179). Ed led HFJ to adapt to how the rest of the world was presenting and sharing information, as well as connecting with a broader audience online. This adaptability transformed HFJ to a brand that is known for the unique position it holds within the health and fitness community. These features reflect the ongoing vision to provide relevant content to industry professionals in a recognized venue for practice-based articles grounded in science. In addition, Ed led the way to expanding the number of advertisers with improved “article level metrics,” including items such as how many times articles have been cited, tweeted, or blogged. Being open to change and growth is something Ed parallels in his own life. A dedicated runner for decades, he has adjusted to aging with a plan to stay physically active: his sport is now pickleball. Ed’s personal journey is reflected in that of HFJ and in his role as editor: “You have to be ready to change … and you have to be adaptable.” STEVEN J. KETEYIAN, Ph.D.: A THEME FOR CHANGING SEASONS (EDITOR 2012–2015)Steven Keteyian extended the growth of HFJ supported by his belief in the power of mentorship. A favorite memory of his involvement with the HFJ is helping others through the potentially arduous process of publication, particularly young professionals. He describes the process, both for himself and others, as both rewarding and challenging: “Helping work them along to nurture and mentor them in a column or article submission and to see them blossom and the writing improve right in front of our eyes all the way up to publication level” (see Video 3, https://links.lww.com/FIT/A180). He encourages everyone to seek a mentor, suggesting that there are many ways for mentorship to develop: “It does not always have to be active. See who you want to emulate … listen, watch, look at how people do things, etc. and then volunteer to write, help out in a lab, etc. That is how you connect” (see Video 4, https://links.lww.com/FIT/A181). As Steven thinks back over the past 25 years, he believes the strength of HFJ has been its ability to adapt to the changing world of health and fitness. He offers the following advice for readers: - Stay focused: Ask yourself “what lights your light bulb?” and do not waste professional energy on items not directly related to your goals and endeavors. He notes that sometimes saying “no” is the hardest but necessary response. - Nothing is wasted with a growth mindset: Learn from your experiences (especially failures) and take those with you on your next steps forward. “You can take some pauses along the way that will help you keep going forward” (see Video 5, https://links.lww.com/FIT/A182). With this focus on personal growth, Steven challenges students to be more inquisitive and HFJ to continue to recycle topics. He points out that one challenge for a practitioner-based journal is that there are always new readers who will benefit from foundational content. Steven initiated the move toward ongoing themed issues, beginning in 2014 and continuing today (see Box 1) reflecting this goal of purposeful recycling and updating to the most current content and guidelines. For instance, 2014 targeted the resurgence of high-intensity interval training (HIIT) combined with supportive historical research. In more recent years, themed issues continue to build on the groundwork of scientific evidence from both the past and present, focusing on behavioral change (2017), combating sedentary behavior (2019), and revisiting HIIT training for those with chronic conditions (2021). These themed issues have become a highlight for readers, consistently offering a deeper dive into current hot topics and translating both historical and ongoing research.Box 1. History of Themed Issues January/February 2005: Overweight and Obesity March/April 2014: Running Sept/Oct 2014: High-Intensity Interval Training Sept/Oct 2015: Weight Management Sept/Oct 2016: Resistance and Strength Training Sept/Oct 2017: Behavioral Change Sept/Oct 2018: Nutrition Sept/Oct 2019: Combating Sedentary Behavior Sept/Oct 2020: Refocusing Life Span to Health Span: Making Every Age Count Sept/Oct 2021: High-Intensity Interval Training and Chronic Conditions Box 2. ACSM Video Highlights Many of the 25-year celebration video interviews provided outstanding advice on how to succeed professionally and personally. Barry Franklin’s Top 10 list is below (see Video 7, https://links.lww.com/FIT/A184): Look for the good in people and situations Think about your goals constantly and write them down Get off your butt and take action to overcome inertia Be ferociously persistent Ask for things you want Improve your writing and speaking skills Partner with people who have skills, abilities, resources, etc., you do not have Develop excellent people skills Adopt a cause that is greater than yourself (your life will become a glorious adventure) Do not hesitate to help students; make the time — someone helped you BRAD ROY, Ph.D., FACSM: TOWARD A DYNAMIC FUTURE (EDITOR 2016–PRESENT)If you have ever wondered if there is a consistent “path” to follow to editor-in-chief, Brad’s story will convince you there is not. Beginning as a high school PE and cross-country coach, he completed graduate degrees, competed at the marathon distance, and has been the director of Logan Medical Fitness Center in Kalispell, Montana, for the past 26 years. Brad’s story includes a rich history of mentorship, all of whom encouraged him to be involved in ACSM, from his college track coach (Jim Crakes, Ph.D.) to John Boyer, M.D., and Fred Kasch, Ph.D., at San Diego State, to professional organizations affiliated with ACSM like the Medical Fitness Association (see Video 6, https://links.lww.com/FIT/A183). Out of that interdisciplinary connection came the opportunity to work collaboratively with ACSM, followed by his writing the Fitness Focus column for the HFJ, leading to Steven Keteyian inviting him to serve as associate editor-in-chief, which ultimately led to his current role. Brad is quick to credit the exceptional professionals associated with ACSM who have invested and believed in him over the years, and his advice to others includes “The key is to be involved, volunteer, and do not be afraid to interact and ask questions.” As he looks to the future, Brad offers the following direction for the HFJ: “My role as editor-in-chief is to help set a vision for the Journal and to facilitate all the excellent recommendations that are made to improve our content, presentation, and to keep the Journal practical and current for our readers. Maintaining the science to practice/practical application focus of the HFJ is extremely important … Our annual themed issue has been exceptional and provides an opportunity to provide expanded information on topics that are important to our industry and of current interest to our readers. Similarly, it has been exciting to see the progression of our annual trends survey to become a themed issue with growing international interest. I see the trends issue continuing to evolve over the next 3 to 5 years to provide additional international information and to add a consumer side to the survey comparisons as well.” “There are a lot of opportunities ahead in the digital world that we need to pursue. There also is the opportunity to integrate more with the Health & Fitness Summit and even the Annual Meeting, both of which offer tremendous educational sessions, some of which may lead to a feature article. Finally, we need to keep the topics current and applicable to our health and fitness professionals who are working directly with individuals, both clients and patients.” A YEAR TO REMEMBER HFJ continues to shrink the gap between science and practice by staying true to its original mission while responding to the changing needs of a diverse and dynamic industry. Never has this capacity been more essential than during the COVID-19 pandemic as we all adapted to living and working from home or were faced with significant restrictions at our jobs. Within the fitness industry, we have seen consumers shift toward home workouts guided by online professionals, regular walking/activity excursions with the family, increased use of fitness apps or videos, and even creative Zoom workouts maintaining group interaction with social distance. This behavior change has perhaps altered the fitness and wellness landscape forever, and the needs of HFJ readers will be different as well. We are pleased to report the strong foundation laid 25 years ago remains firm; we have seen the HFJ help bridge the gap we have all faced by providing a feeling of connection and support for one another with helpful and pertinent content. Cheers to the next 25 years!

BACKGROUND Complying with a prehabilitation program is difficult for patients who will undergo surgery, owing to transportation challenges and a limited intervention time window. Mobile health (mHealth) using smartphone apps has the potential to remove barriers and improve the effectiveness of prehabilitation. OBJECTIVE This study aimed to develop a mobile app as a tool for facilitating a multidisciplinary prehabilitation protocol involving blood flow restriction training and sport nutrition supplementation. METHODS The app was developed using “Appy Pie,” a noncoding app development platform. The development process included three stages: (1) determination of principles and requirements of the app through prehabilitation research team meetings; (2) app prototype design using the Appy Pie platform; and (3) app evaluation by clinicians and exercise and fitness specialists, technical professionals from Appy Pie, and non–team-member users. RESULTS We developed a prototype of the app with the core focus on a multidisciplinary prehabilitation program with accessory features to improve engagement and adherence to the mHealth intervention as well as research-focused features to evaluate the effects of the program on frailty status, health-related quality of life, and anxiety level among patients awaiting elective surgery. Evaluations by research members and random users (n=8) were consistently positive. CONCLUSIONS This mobile app has great potential for improving and evaluating the effectiveness of the multidisciplinary prehabilitation intervention in the format of mHealth in future.

Dixie Stanforth, Ph.D., FACSM,is a professor of instruction in the Department of Kinesiology and Health Education at The University of Texas at Austin. She developed and directs the Health Fitness Instructor, Community Health and Wellness, and Medical Fitness/Rehabilitation Specializations for undergraduates. She serves as an associate editor for ACSM’s Health & Fitness Journal® and is a frequent presenter at ACSM’s International Health & Fitness Summit and other national conferences. Jennifer Van Overdam, M.Ed., CHES,completed undergraduate and graduate work in the Department of Kinesiology and Health Education at The University of Texas at Austin. Her teaching experience focused on the basics of exercise programming and developing the communication skills needed in personal and group training. She works as a personal trainer and group fitness instructor at both private and corporate sites and as a program coordinator at the Center for Health Communication at UT Austin.

INTRODUCTION:The impact of prehabilitation remains controversial due to a short presurgical waiting period and the diminished capacity of the patient population. A strategy to augment and optimize the effectiveness of prehabilitations for abdominal cancer patients may be found in the unlikely field of sport science. We investigated the use of blood flow restriction training and sport nutrition supplementation to augment functional capacity and increase muscle strength in twenty-four abdominal cancer patients awaiting surgery. MATERIALS AND METHODS:The sport science-based program was comprised of blood flow restriction exercise 5 to 6 times per week and a daily sports nutrition supplement containing l-citrulline, creatine monohydrate, and whey protein. RESULTS:After 4 weeks of prehabilitation, 6-min walk test, timed up and go, short physical performance battery, 5-chair stand test and physical component score of quality of life were significantly improved (all p < 0.05). Total body and appendicular lean mass as assessed by dual energy X-ray absorptiometry increased by 0.73 ± 1.04 kg (p = 0.004) and 0.42 ± 0.64 kg (p = 0.006), respectively. Total body fat mass and trunk fat mass decreased (p = 0.004 and p = 0.021). There were no significant changes in hand grip strength, fear of falling, the mental component summary of quality of life, or fasting serum concentrations of myostatin, follistatin, and growth hormone. CONCLUSION:A multimodal prehabilitation program, which encompasses blood flow restriction training and sports nutrition supplements, is both feasible and effective in improving lean mass and physical function in abdominal cancer patients prior to surgery.

CONTINUING TO SERVEFor veterans Mike McKay and Justin Boflex Bohannon, serving their country did not stop when they left the military. Inspired by their own positive experience with fitness, both men decided to help other veterans reap the benefits of physical activity. For naval veteran McKay, this vision resulted in the creation of Heroes’ Movement, a national nonprofit organization that sponsors small group training sessions for veterans. Make A Vet Sweat, a Texas nonprofit founded by Army veteran Bohannon, covers the cost of membership with partner gyms. Both of these groups provide vets with the powerful tool of movement not only to improve physical health but also to empower them socially, mentally, and emotionally. As veterans work out in a small group community that often includes other ex-military, they become part of a unit again, promoting health along with personal connections and commitment. BACK IN THE FIGHT: MAKE A VET SWEAT Tired of losing more comrades at home to suicide than on deployment, Bohannon founded Make A Vet Sweat in 2015 as a way to support fellow veterans combating posttraumatic stress disorder (PTSD). Bohannon credits boxing, body building, and Orange Theory Fitness classes with helping him work through his own PTSD when he returned home. Strengthening his body was the key to rebuilding his identity and purpose, helping him to cope with survivor’s guilt that he found almost paralyzing. The creation of Make A Vet Sweat enabled Bohannon to be back in the fight — this time at home rather than overseas. To receive sponsorship from Make A Vet Sweat, veterans must first apply online. They can provide a list of local facilities or describe what their preferred physical activity entails in order for the Make A Vet Sweat team to find a good fit. Bohannon works with potential facilities to reach a discounted veteran’s rate of $100/month or less; 90% of the time, facilities agree to lower their prices to match this rate. Make A Vet Sweat will then fund a 3-month membership for veterans and spouses at locally owned facilities to maximize the advantages of the community atmosphere. Group exercise classes, like Zumba, yoga, and kickboxing, are encouraged for the same reason. Extended sponsorship is contingent upon consistency and participation. One way veterans and the Make A Vet Sweat team can track activity metrics is with the Make A Vet Sweat app. Made possible by funding from Returning the Favor podcast host Mike Rowe, vets can stay accountable to fitness goals and track personal progress. They also can view where other veterans are working out for potential social connections and team building. To date, Make A Vet Sweat has sponsored 434 memberships throughout Texas and continues to grow.From One Vet to Another: Heroes’ Movement Heroes’ Movement founder McKay began his career as a strength coach after his military service ended in 2001. Through his volunteer work at the local branch of the U.S. Department of Veterans Affairs (VA), McKay discovered that many veterans were unable to bridge the gap between the end of physical therapy and the return to full physical function. McKay realized that his identity as a vet partnered with his fitness background could be leveraged to assist other veterans. As a result, he began to train a group of veterans free of charge and over time received referrals from the American Legion. Eventually, the idea to create a nonprofit formed and Heroes’ Movement was officially born in June of 2015. Joining the Heroes’ Movement family as a veteran participant stems from individual inquiry or referrals from family and friends. After contact with a new veteran, McKay reaches out to local gyms in their area that have specific protocols in place. To become a Heroes’ Movement facility, approved gyms must guarantee five nonnegotiable elements for each training session, which are detailed in the sidebar. In addition, all gyms perform the Functional Movement Screen as a baseline for movement competency, which serves as the primary metric to track progress. Upon placement, Heroes’ Movement covers the cost of each training session.Success and expansion of the organization has been due to McKay’s existing relationships with different organizations and individuals. McKay credits his mentor, Mike Boyle, a renowned functional strength coach, with many of his gym connections as well as for the training protocols required in the small-group sessions. His long-standing volunteer work with the USA Patriots Amputee Softball Team has led to creating partnerships with local facilities for the players on the team. There are currently 50 participating facilities nationwide with more than 1,500 sponsored sessions a month. LEARNING THE NONPROFIT ROPES As nonprofit novices, both McKay and Bohannon encountered similar issues when creating their organizations: funding and recognition. For McKay, creating fundraising opportunities requires a large portion of his time, and knowing his audience is an important factor. In his experience, Facebook generates the most traction around charity fundraising for veterans and generally is the most popular social media site for older, vet-friendly users. Similarly, Bohannon has learned the value of appealing to donors to generate revenue. He has found that adapting to donor responses toward things like colors and logos on the Make A Vet Sweat web site positively affects donations and community involvement. Being open to change and listening to feedback goes a long way in generating funding as well as leading to both personal and professional growth. Entering the nonprofit sector can be intimidating. Both Bohannon and McKay recommend leaning in to the steep learning curve associated with starting a nonprofit by surrounding yourself with talented and committed individuals. In addition, there are numerous inspiring and helpful resources available for anyone on the verge of creating a nonprofit or simply starting a new venture. Find Your Why and Extreme Ownership were two influential books for Bohannon in creating Make A Vet Sweat. For those more interested in the strength and training principles found in Heroes’ Movement, McKay recommends Advances in Functional Training by Mike Boyle. He also recommends listening to the Strength Coach Podcast with Anthony Renna for those who want to keep up with the latest in the world of strength and conditioning. Regardless of the external resources that helped and inspired them along the way, both Bohannon’s and McKay’s success and strength lie in their inspirational drive and dedication to help fellow veterans. To learn more about these groups, check out the links provided in the Recommended Resources section.SHARE YOUR SUCCESS STORIES! We hope that you, too, will be inspired and work to bring about meaningful change in the realm of health and fitness wherever you are. We would love to hear how you are changing your world. Please send us your stories for publication consideration. If your story is selected for publication in ACSM’s Health & Fitness Journal®, we will contact you for additional information. To submit, simply e-mail the following to [email protected]: A Word file with: Your story Lessons learned Advice Your contact information (name, affiliation, mailing address, phone number, and e-mail address) Requirement for Heroes’ Movement partner gyms: Posttraumatic stress and traumatic brain injury training guidelines required for Heroes’ Movement partner gyms: Breath work before every session. Diaphragmatic breathing, such as the 7-4-7 method, enables better control of the parasympathetic system and can improve the stress response. Proper breathing is the first thing vets are taught by their medical team at the VA to help them in a time of stress and every training session aims to reinforce this practice. Achieving mastery of movement. Programming functional movements promotes mastery of essential patterns that veterans may need to relearn after discharge from service and/or physical therapy. The goal is to minimize frustration and promote success; thus, the progression curve may be slower but still designed to promote overload with safe and effective movements. Avoiding high-intensity exercise early on in sessions. Strengthening and supporting the mind-body connection is a huge goal in Heroes’ Movement training sessions. Beginning with low-intensity exercise ensures competency, success, increased self-confidence, and most of all, reduced injury risk. A noncompetitive environment. Rather than competition during small-group training sessions, participants focus on personal or team competency to build a supportive community. As McKay states, “We are putting vets back together, not beating them down with exercise.” Having a quiet area to gather and recover. Veterans who may be triggered during a workout must have a separate area to regroup. What may trigger a veteran is unknown and is often unique to the individual. If triggered, there needs to be a known spot for them to safely recover.

Whether it’s folding towels at the front desk of a gym or shadowing physical therapy sessions, many of us remember our first real-world experience in the health and wellness field. These experiences often spring from degree-required internships during college. For undergraduates in the exercise science and health promotion program at Cabrini University, a Catholic liberal arts university in Pennsylvania, internships not only give students a taste of reality but also require a project rooted in social justice. This requirement stems from Cabrini’s core curriculum sequence called Justice Matters, which aligns with Cabrini’s mission statement to prepare students to become engaged citizens of the world through a commitment to social justice. JUSTICE AT THE CORE The Justice Matters core curriculum was approved in 2008 and implemented the following school year. The centerpiece of the curriculum involves three developmentally linked courses called “Engagements with the Common Good.” Embedded with Catholic Social Teaching concepts (see Sidebar), these courses emphasize self-reflection, engagement with the community, and understanding the root causes of injustice. Through this course work, each student learns how to connect the theory and practice of social justice to their specific major. According to Dr. Maria Elena Hallion, chair of the Health and Exercise Sciences (HES) Department, skills developed from this curriculum not only advance students’ future professional careers but also enhance their capacity to give back to their communities. The final requirement of the Justice Matters curriculum is a senior capstone, in which students are encouraged to integrate components of social justice with their personal and career goals. To better align with the Justice Matters curriculum, the HES Department modified degree requirements in 2012 when the first round of students who started the core curriculum as freshmen became seniors. Previous senior capstones encompassed traditional health and fitness projects that related to curriculum or services offered by internship sites. Since 2012, students completing an internship have had the choice of focusing their culminating project on either research or social justice.Sidebar Principles of Catholic Social Teaching Life and dignity of the human person Call to family, community, and participation Rights and responsibilities Option for the poor and vulnerable The dignity of work and the rights of workers Solidarity Care for God’s creation Link for more information:https://www.cabrini.edu/about/departments/wolfington-center/who-are-we/catholic-social-teaching/principles-of-catholic-social-teaching.PROJECT REQUIREMENTS Students complete a minimum of three internship site interviews at university-approved sites. With assistance from Dr. Anjuli Gairola (current internship coordinator), students finalize their placement. Popular internship sites include rehabilitation and fitness centers, hospitals, and sports performance programs. During the initial weeks of internship work, students begin the development of their social justice project. The selection of the social justice project stems from students’ interests and passions, such as issues surrounding food inequalities, the environment, poverty, health disparities, etc. Although students often work closely with internship staff to brainstorm project ideas, they are encouraged to think through different project ideas before starting their internship to be better prepared to discuss options with their site. Along with planning the project, students are solely responsible for implementing and assessing effectiveness. The main goal of the project is to enhance students’ time management skills, organization, creativity, leadership, and collaboration, while connecting back to the social justice principles they have learned in previous course work. Thus, there is no requirement that projects relate directly to exercise science content or be internship site specific. However, students still need to be educated about the cause and advocate for the agency at their internship site with their internship manager’s support and collaboration. This connection not only leads to increased awareness of specific social justice issues at the internship site but also often results in a lasting relationship between the site and the student-chosen organization. Previous projects range from awareness campaigns to fundraising efforts for local entities such as the Delaware Riverkeeper Network and national organizations like Soles 4 Souls and the Special Olympics. Students who still want to complete a traditional health-related project can pair it alongside the social justice project. For example, a former student at a physical therapy site organized a shoe drive to send to a partner organization (Amigos for Christ) in Nicaragua and created a foot health brochure for patients, with information regarding injury prevention and how to select proper footwear. At the end of each semester, students present their social justice project and internship experience at the Senior Internship Presentations. NEW PROJECT, NEW CHALLENGES Like any other successful program, the HES social justice project encountered challenges during implementation. First, Dr. Hallion (former internship coordinator) had to clarify what a “social justice”–based project meant as many students were not sure what was expected of them. Initial strategies to clarify and guide students are now built into the learning process. For example, group brainstorming activities and reflection exercises on previous course work help guide students toward greater clarity in developing project ideas. Veering away from traditional projects like personal training or health education activities was a difficult concept for students not only to grasp but also to gain buy-in from some internship supervisors. It was initially difficult for students to articulate their project requirements when some internship supervisors did not understand what “social justice” meant. Some needed a clear-cut definition of “social justice” from faculty themselves to better support student interns. Over time, as internship sites have received repeat Cabrini interns, they have needed less clarification and assistance from HES faculty. Because students are required to develop the social justice project themselves, from drafting program development to creating evaluation outcome measures, some need additional coaching on how to outline project requirements for their internship supervisors. Additional one-on-one meetings with faculty are always available for students to enhance the learning experience by building their confidence for completing the process. Requiring students to write a one-page summary of their social justice project to archive and share also has improved the program, as future students can use them to help develop their ideas.LIVE AND SHARE THE MISSION Students’ enthusiasm, passion, and commitment to their social justice projects have far exceeded faculty expectations. For them, this project requirement showcases students’ ability to live and share Cabrini’s mission to address social justice issues in the community. Dr. Hallion and Dr. Gairola recommend that other undergraduate programs consider internship projects as opportunities to do work beyond the application of exercise/health-related content because responsibilities at intern sites inherently include those activities. This enables students to work on a project they truly care about and results in a product they can expand upon in graduate school essays, cover letters, and job interviews. Although not all universities have a major focus on social justice like Cabrini University, choosing another value linked to a university’s vision or mission statement can help students develop similar social projects to connect to a larger purpose. SHARE YOUR SUCCESS STORIES! We hope that you, too, will be inspired and work to bring about meaningful change in the realm of health and fitness wherever you are. We would love to hear how you are changing your world. Please send us your stories for publication consideration. If your story is selected for publication in ACSM’s Health & Fitness Journal®, we will contact you for additional information. To submit, simply e-mail the following to [email protected]: A Word file with Your story Lessons learned Advice Your contact information (name, affiliation, mailing address, phone number, and e-mail address)

STRENGTH REDEFINEDThe term “strength” in the fitness industry generally evokes an image of someone or something that is strong and able to lift heavy weight or withstand external forces. If you ask Jeremy Shore, founder of the nonprofit Strength to Serve, strength is “the capacity and/or potential for effective and meaningful action.” His nonprofit Strength to Serve enables exercisers to fulfill their capacity for true strength by using their physical abilities to give back to the community. “Effective and meaningful action” can take the shape of providing physical labor and/or expertise in physical fitness when helping others — unique volunteer skillsets that are developed in the gym but often overlooked outside it. Shore’s vision of Strength to Serve began in 2004 when he was working as a personal trainer at a boutique gym in Dallas, Texas. Despite the joy associated with training others, he felt dissatisfied with the “do this, get fit, repeat” culture within the exercise world. How could he reframe fitness as something that goes way beyond the traditional purpose of losing weight and preventing disease? The answer kept coming back to one simple phrase: “strength to serve.” For Shore, the phrase embodied how he wanted fitness to function in all areas of his life, from the personal to the professional to the spiritual. Not yet transformed into a full-fledged vision, this phrase stuck with Shore and continued to expand after a move to New York City. While there, Shore joined different groups, such as the Entrepreneurial Initiative, where he connected with a wide range of individuals all desiring to create an industry-wide cultural shift in their unique spheres of influence. Rather than targeting personal gain, they wanted to shift to an others-oriented focus to maximize using their skills to benefit others. Collaborating with these groups fortified Shore’s resolve to make the concept of “strength to serve” a career cornerstone. A CALL TO SERVICE Strength to Serve shifted from a personal north star into a not-for-profit organization in 2012, two years after Shore moved back to Texas. A friend at Google asked Shore if his “strength to serve” idea could be integrated to help with a company event. With Shore’s connections and organizational skills, Google bikes were shipped to Austin for a tech company relay competition, resulting in a fun and interactive series. Although benefit events like this allow exercisers to use their physical abilities to participate, often generating funding for important causes, Shore knew he wanted to provide direct services for community organizations in need. As a sponsored athlete and brand contributor for Reebok, Shore decided to use this relationship to create the first Strength to Serve service event in Boston, MA, in 2015. He partnered with Brookview, a nonprofit group that helps homeless mothers get off the streets. Strength to Serve brought in 50 local Reebok fitness professionals to transform an empty field into a functional recreational area for mothers and their children. Leveraging the strength and endurance of these fitness professionals resulted in 3 hours of transformative work that the landscaping crew said would have taken them 3 months … and probably would never have happened without Strength to Serve. Another early, large-scale service event took place in San Diego, CA, in 2016 with Urban Street Angels, an organization that provides resources for homeless youth. Strength to Serve reached out to local gyms and equipment partners like Dynamax and Matrix Fitness for equipment donations and brought in local trainers to teach free classes at the youth transitional center. A similar service project took place that same year in Phoenix, AZ, with MentorKids USA when Strength to Serve brought in local fitness pros to help restore a playground and community garden for this after-school youth mentoring program. These events were incredibly successful and created lasting ties within the local community. Most of the volunteers who served during these initial big projects have stayed connected with the organizations and continue to provide practical assistance that capitalizes on their physical capabilities and/or fitness expertise. One example of this relational connectedness is ActivLab Phoenix: this group has remained partnered with MentorKids USA as their primary support for any project in need of strong hands and backs.Until 2018, Strength to Serve partnered to serve other nonprofits by connecting them with local individuals and/or gyms interested in making a difference. The more physically challenging the work, the better, as volunteers are often more highly trained than the average person who raises their hand to help. Increased volunteer interest has recently caused Strength to Serve to transition its focus toward becoming a dynamic database platform that directly matches gyms/individuals with vetted service organizations in their local community. There are currently 13 cities included in the nonprofit database (see Sidebar/Callout Box 3). On their site, individuals interested in volunteering can view different local volunteer opportunities to use their strength to serve in practical ways. The database allows volunteers to select the type of service they are interested in, the area of town they live in, and the days of the week they are available to serve. A selection of potential nonprofit options is then generated based on these criteria. After choosing a specific nonprofit, the web site connects them directly with the organization’s volunteer coordinator to complete the sign-up process. With a small donation, gym owners also can have unlimited access to this database by becoming a Champion Gym Partner. Having a Champion Gym Partner label makes facilities stand out, as it is a unique opportunity to build community among members, creating a powerful source of motivation for them to build strength for something bigger than themselves. Champion Gym Partners receive a monthly report of volunteer sign-ups, allowing them to see where passions and needs exist in their community. They also receive assistance from the Strength to Serve team regarding marketing to their members and organizing the actual service events. Passionate gyms have even helped build their city volunteer databases, serving with not only physical but also relational strength. Nonprofit organizations apply to be included in the database by filling out an application outlining their volunteer needs, current opportunities, and volunteer onboarding process. STRENGTH THAT MATTERSStrength to Serve encourages fitness professionals and gyms to partner with local organizations in hopes that these connections will endure rather than result in a one-and-done event. Shore believes that service events like the Urban Street Angels partnership are scalable and reproducible in any city. The main idea is to be a blessing, not a burden, to organizations. Rather than picking an organization and putting pressure on them to find or create an event, Shore encourages offering to perform tasks that require being physically active/fit, like landscaping, moving material, etc. Although these tasks may not directly bring revenue to the organization, they are still essential for daily operations and successful long-term function and are often a financial challenge for nonprofits. Regardless of whether or not someone is directly involved, Shore hopes that the idea behind Strength to Serve will inspire others to consider the potential being physically fit offers — a benefit not only for personal health but also as a mechanism for service to others. To Shore, the simple act of giving back provides spiritual and emotional health and growth, and Strength to Serve is an outlet that provides just that. Much like the Strength to Serve logo made of overlapping shields, we are made stronger by sharing our strength to serve one another, creating a life of significance and positive change.Recommended resources: Seeking inspiration? Below are a few of the resources Shore credits with guiding him toward the development of Strength to Serve: Strength to Love by Martin Luther King Jr. Every Good Endeavor by Tim Keller Just Courage by Gary Haugen Strong and Weak, Playing God, and Culture Making by Andy Crouch Want to volunteer? Interested in learning more about the volunteer opportunities with Strength to Serve? Learn more about becoming a Champion Partner: https://strengthtoserve.com/ Sample Champion Gym Serve Page: http://strengthtoserve.strengthtoserve.orgCurrent Strength to Serve cities: Orlando, FL Tampa, FL Springfield, IL Norman, OK Oklahoma City, OK Tulsa, OK Nashville, TN Austin, TX Brenham, TX Dallas, TX San Antonio, TX Temple, TX Waco, TX Coming soon: San Diego, CA Washington, DC Chicago, IL

Complex surgery for abdominal cancer often leads to postoperative complications that may prevent post-surgical rehabilitation in old, frail, or malnourished patients. Prehabilitation is an emerging alternative strategy that has the potential to speed recovery and may be analogous to athletic preparations for gameday. For optimal physiological improvement to occur in a limited time period prior to the surgery, cancer patients undergoing prehabilitation interventions must work closer to their maximal physiological capacity (albeit a very low level) in a manner similar to that of competitive athletes. PURPOSE: To determine the effect of a 4-week sports science-based prehabilitation program on spontaneous physical activity in cancer patients who undergo major abdominal surgery. METHODS: Twenty-two cancer patients (63±11 years) who underwent major abdominal surgery were studied. Fourteen patients participated in a 4-week exercise and nutrition prehabilitation program prior to abdominal surgery. The sport-science based program comprised of an interdisciplinary approach, including blood flow restriction exercise and a daily sports nutrition supplement containing L-citrulline, creatine monohydrate, and whey protein. The remaining 8 patients served as controls. Physical activity of both groups was monitored for 5 days after surgery. Accelerometers were used to quantify number of steps, energy expenditure, and sedentary time. RESULTS: The prehabilitation group recorded 47.4% more total steps for 5 days after abdominal surgery than the control group (16,032±5,194 vs.10,877±5,182 total steps/5 days, p=0.037). The prehabilitation group had a greater amount of total energy expenditure than the control group (5,555±3,400 vs. 2,971±1,572 total kcal/5 days, p=0.028). There was no significant difference in total sedentary time between the two groups (5,064±597 vs. 5,414±514 min/5 days). CONCLUSIONS: This prehabilitation program composed of cutting-edge sports science practices significantly improved spontaneous physical activity after major surgery in older patients with abdominal cancers.