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Personalizing Exercise Protocols Based on Genetics?



Earlier this week, I reviewed ‘The Cure For Everything‘ by Timothy Caulfied, who presented a rather devastating (some would say sobering) view of ‘personalized’ medicine based on genetic analyses. His take essentially is that little (if any) of the promise of genetics for complex conditions has panned out and little (if anything) is likely to pan out in the foreseeable future.

This is not because genes (or rather their expression and function) do not influence virtually all of human structural, metabolic, and perhaps even our behavioural characteristics. In fact it is the very fact that there are countless genes that impart these effects and generally do so in complex harmony (or disharmony) with countless environmental factors, which makes ‘predictive’ medicine at the personal level so iffy.

An example is a recent paper by Roth and colleagues published in Medicine and Science in Sports and Exercise that reviews the latest findings in genetics related to exercise, fitness and performance.

The paper focusses on the highest impact papers such as one that described physical activity levels as being significantly lower in patients with mitochondrial DNA mutations compared to controls (not really a surprise given that exercise is no fun without high-performing mitochondria).

Other studies found strong associations between sequence variation in the activin A receptor, type-1B (ACVR1B) gene and knee extensor strength, with rs2854464 emerging as a possible ‘marker’ of higher muscular strength.

Genetic data has also been associated with aerobic exercise training-induced improvements in maximal oxygen consumption, but no genetic variants derived from candidate transcripts were associated with trainability.

Finally, much of this paper looks at the fat mass and obesity-associated (FTO) gene, which has been associated with a modestly increased risk for obesity especially in sedentary individuals.

Based on these findings (and a few others), the authors rather enthusiastically conclude:

“…that a strong exercise genomics corpus of evidence would not only translate into powerful genomic predictors but would also have a major impact on exercise biology and exercise behavior research.”

This is where the authors lost me (and would likely have lost Caulfield). Undeniable, genetic studies represent an amazing feat of science and teach us much about human biology. But the idea that a genetic ‘test’ will somehow reliably predict ‘performance’, ‘fitness’, ‘training response’, or any other features, may at best be of interest to extreme athletes (e.g. not having the right genes may make the quest for Olympic Gold futile – so why bother?); their application or utility for population health or even that of my patients is far less clear.

Indeed, at some level, the idea of basing a specific treatment recommendation (e.g. a certain type of exercise) simply on the results of a laboratory test, may be the exact opposite of ‘personalized’ medicine, which to me, would be about considering environment, social and cultural background, beliefs, psychology, interests, and a 100 other ‘personal’ characteristics of each of my patients.

AMS
Freeman’s Village, Antigua

ResearchBlogging.orgRoth SM, Rankinen T, Hagberg JM, Loos RJ, Perusse L, Sarzynski MA, Wolfarth B, & Bouchard C (2012). Advances in Exercise, Fitness, and Performance Genomics in 2011. Medicine and science in sports and exercise PMID: 22330029

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7 Comments

  1. You’re right when you say that what people enjoy doing and the structure of their lives is going to have a lot to do with what kind and how much physical activity they incorporate.

    However, knowing about fitness-related hereditary predisposition might be helpful in some ways. People enjoy doing things that they’re good at. It could help people who have always thought of themselves as unathletic pinpoint potential strengths. Perhaps it’s difficult for them to build muscle but they have the potential to build up speed and stamina under the right circumstances. Perhaps they are never going to be exceptionally coordinated, but they have the potential to become very strong. It might help people identify things they might enjoy and excel at that they may not have thought of otherwise.

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  2. As an allied health professional I have participated in developing personal exercise programs for about 2200 people over the last 20 years. Genetically prescribed exercise is ridiculous.

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  3. Hi Dr Sharma. The future of health behavior and physical activity is anywhere but where these authors are focusing. Genomics meeting exercise sounds cool but won’t make it in real life situations.
    I ‘ve debated in the past with pro genomics bloggers and one of the Nutrigenomics chief scientist Dr Keith Grinaldi and it seems like they don’t (or don’t want to) understand how flawed is their perspective.
    You may like an article I ‘ve co-written with a molecular geneticist on the topic of nutrigenomics
    http://metavolismos.blogspot.com/2012/01/nutritional-genomics-exploring-evidence.html

    Congrats on your blog, some very interesting reads indeed

    Andreas

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  4. I must say I agree with Mavis McConnon.

    As someone who came to exercise relatively late in life, I’m certainly no natural athlete, but have been able to develop my fitness levels to a good degree. I have a genetic advantage with strength and endurance, but have had to work very hard to develop my coordination and agility.

    I think everyone should develop all aspects of their fitness to the best of their abiliy, focusing on those areas which need more work.

    Here’s where I disagree with DeeLeigh who said: Perhaps they are never going to be exceptionally coordinated, but they have the potential to become very strong. Instead of giving up because you’ll never be “exceptionally coordinated” what’s wrong with aiming to develop a reasonable level of coordination for you?

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  5. RedPanda, I didn’t mean to imply that people shouldn’t work on their weaknesses. However, knowing the difference between strengths and weaknesses is nice. Focusing on developing our talents while trying to reach a minimum level of competence at things that are important but that we have little aptitude for seems like the natural way to go. If we all spent our lives focusing on things for which we have little aptitude – just to prove something? so that we can feel that we’re perfect? – we wouldn’t accomplish much.

    The fact is, a lot of people who have one or two weaknesses when it comes to physical activity give up on physical activity entirely. If they knew that they had potential strengths as well, then maybe they’d be interested in developing them.

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  6. DeeLeigh, I have no idea how you gained the impression I was advocating that we should spend “our lives focusing on things for which we have little aptitude”.

    I think we’re essentially saying the same thing.

    I’ll reiterate that I think everyone should develop all aspects of their fitness to the best of their abiliy, focusing on those areas which need more work. People tend to avoid aspects of exercise for which they have little natural ability – hence the expression, “The best exercise for you is the one you’re NOT doing”.

    Even though I’ll never be exceptionally agile or coordinated, I worked hard to develop reasonable proficiency in those areas. I didn’t do this “just to prove something” or to “feel that I’m perfect”, but so that I could enjoy working out more and -importantly – be less likely to trip and fall.

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  7. I really see this as the start of a revolution “Genocise” (Genotype Anlysis based exercise) is likely in my opinion to be the start of many areas using genetics. It fits very much in line with Genetic based personalised medicine etc. I think in 10 years we’ll look back and wonder why every one did squats or sit ups when we can pin point the exercises that will truely benefit.

    Its an exciting time.

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