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• W3045701140 abstract "We thank Thyfault and Bergouignan (2020) for their detailed and accurate summary of our STRUETH fitness and strength outcomes paper (Marsh et al. 2020), the sensible caveats they propose in interpreting our data and their helpful pointers to future studies. We particularly agree with their comments regarding the impacts of prolonged sitting/inactivity (Wheeler et al. 2019; Wheeler et al. 2020). We hope that our study starts a conversation about optimizing physiological and health benefit by individualizing exercise prescription. We agree with Thyfault and Bergouignan (2020) that our findings raise the question of whether population or individualized approaches should be favoured to optimize societal benefit. One size fits all approaches to exercise will have some benefit in some (maybe even most) individuals, but will fail for others who might have gained if alternative approaches were promoted, available and recommended. Our study is, in a way, a homage to the work of Dr Claude Bouchard, a pioneer who taught us all to think about genetics and exercise, as well as the fact that focusing on mean data can distract from important insights relating to variability in human physiological responsiveness. We purposefully utilized exercise interventions at the extremes of the modality continuum to illustrate that a range of responses can occur between individuals, even when matched interventions are applied, and that this may be modality specific. Note that we tried to avoid using the term ‘adverse’ response, which has perhaps distracted researchers from the germane issue: that just as for drug responses, exercise responses vary between people even when the ‘prescription’ is the same. It is true that we identified individuals who responded robustly to both forms of training, also some (a relatively small percentage) who were low responders to both, and many who were low responders to one form but responded well when switched to the alternative. What is perhaps overlooked is that we found low correlations in the magnitude of response to a given variable (say ) between the two forms of training. This raises some interesting issues around the specificity paradigm: perhaps it is possible for individuals to obtain some fitness gain from training focused on skeletal muscle adaptation, even if they do not gain from endurance training per se. Larger cross-over intervention trials will be necessary to answer this question. Our work with chronic disease patients (Maiorana et al. 2001; Green et al. 2004), in particular those with end-stage heart failure, has informed our approach to optimal and individualized prescription of exercise as a therapy for many years. For example, we developed novel combined modality interventions to target skeletal muscle as a typical locus of fatigue in these patients (Maiorana et al. 2000a; Maiorana et al. 2000b; Green et al. 2016). We undertake exercise training studies (even though they are difficult, time consuming and expensive) because we are well aware that cross-sectional findings pertaining to, for example, differences between trained and untrained individuals, can be easily misinterpreted if they are assumed to represent changes that occur as a result of training within individuals (Spence et al. 2011). The recent revisiting of the Morganroth hypothesis is a case in point (Naylor et al. 2008). The only way to really understand the effects of training, and for that matter the impacts of genetics on adaptation to training, is to train subjects and follow them longitudinally. We are advocates for twin studies in this regard because they can provide very useful insights into the age-old question of genes and environment (Hopper, 1992). The inclusion of dizygotic pairs has rarely been done, although it is an important control for the possibility that correlations between monozygotic pairs may be a result of environmental factors. There has been an excellent recent debate on the topic of trainability (eg for ) that includes consideration of the polygenicity, effect sizes and redundancy of genetic contribution to complex integrative physiological measures such as fitness and strength (Bouchard, 2019; Joyner, 2019). We would only add that the practically relevant issue for an individual wishing to enhance their function or health is whether training translates into meaningful phenotypic adaptation. There are many people in the exercise and health industry, as well as some in academic sport and exercise science, who are exercise evangelists. We are clear-eyed advocates for exercise benefit. Our study acknowledges that different outcomes are probable between individuals in the magnitude of benefit from any form of training. At the same time, most people will benefit in meaningful ways from bespoke prescription and that may mean changing the form of exercise undertaken. Exercise professionals who are trained to assess physiological adaptation and prescribe exercise have a better chance of helping individuals obtain optimal benefit in terms of fitness, strength and health, which, in turn, fosters long-term adherence. Exercise and physical activity have remarkable effects on the human body, on multiple organ systems, at subcellular to whole organism level. There has probably never been a more sedentary society than 21st Century Westerners and exercise and physical activity are arguably the ‘best buy’ for global health. ‘The world needs to get serious about physical activity. And that means money … for [research into] interventions … and especially the cost-effectiveness of interventions’ (Das & Horton, 2016). None. All authors contributed equally. None." @default.
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• W3045701140 date "2020-08-12" @default.
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• W3045701140 title "Exercise: One size does not fit all: authors’ response" @default.
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