From working out to eating right, knowing how to best live a healthy lifestyle can become confusing. The long-term health landscape continues to change as research into integrative medicine and genomic function evolves. Even as Americans strive to live healthier and achieve greater fitness, there is much that is still unknown about how our bodies benefit from a lifestyle of physical fitness.

Still, exercise remains a critical element to long-term health, allowing us to alter our physical fitness levels, says nursing researcher David Boley. “Exercise is a specific type of activity that is done for the express purpose of improving our functional abilities and reducing limitations; it’s how we how we maximize our potential for a healthy life,” says Boley, a doctoral student at the Johns Hopkins University School of Nursing.

Boley, who will be working this fall as an Intramural Research Fellow at the National Institutes of Health, became interested in exercise training for health-related fitness after his father suffered a heart attack at the age of 54. Boley later became a personal trainer and now, as an Advanced Practice Nurse, is focusing his research on the role of exercise in long-term health maintenance and improvement.

To Boley, America’s obsession with weight loss often overlooks the important role of muscles, specifically building and conditioning the lean skeletal muscles that support movement and boost metabolism. Maintaining both the quantity and quality of muscle fibers is a critical piece of long-term health, and that can only be achieved through regular, intentional, exercise. With that in mind, Boley has a couple principals that he recommends when incorporating exercise.

First, there are countless types of exercise a person can do. “There are numerous scientific studies demonstrating that the benefits of exercise can be achieved through a lot of different activities,” Boley says. From bodybuilding to Pilates to simple calisthenics, exercise can vary widely, and some forms might be more appropriate than others for certain individuals. Further, any type of exercise can be adapted to account for limitations such as age or physical disability.

Second, exercise for long-term health should focus on muscle strengthening. “Whatever it is, it should have some components that challenge the strength of the muscles in your body,” Boley says. “Bodies are made to move, and muscles are responsible for moving the joints that make that happen.” Where running, biking and other cardiovascular exercises benefit the circulatory system, it’s important to also work-out with weights or resistance , Boley says. “We have a tendency to focus too much on aerobic exercise,” he says, adding that evidence shows that resistance exercises alter the cellular structure of muscle in a way that aerobic exercise doesn’t. In his research, Boley hopes to improve scientific understanding of how those changes improve the symptoms of common, chronic diseases.

Finally, exercise requires an element of regularity, Boley says. Although more research is needed into the relative benefits of longer versus shorter bouts of exercise, exercise should be performed at regular intervals to maintain muscle quality. Once a regular routine of strength-training exercise has been established, the regimen can be adapted and altered as a person’s fitness level improves. “Fitness requires constant revision,” Boley notes. “As you become more fit, you can maintain that level, or you can make adjustments to reach a higher level or fitness. The very fist step, though, is to establish the habit of doing one thing on a regular basis.”

Earlier this month, I had the opportunity to attend a meeting of one of the Institutional Review Boards (IRB) at the Johns Hopkins Hospital. The IRB welcomes visitors, however there are few things to consider when planning a visit. First, it’s a good idea to go with a faculty member. My advisor is a member of the IRB I visited and was able to facilitate the visit easily. Second, because space is limited anyone wishing to observe a session needs to make arrangements in advance. Shortly after I arrived the receptionist announced the arrival of 2 students from the School of Public Health. Since the chairperson had not been contacted by the students, they were denied access. What a waste of time! Finally, upon arrival be prepared to sign a confidentiality agreement. In addition to hearing or seeing protected health information, you may also be exposed to protocols submitted by a colleague! If you can orchestrate a visit and are comfortable with the “what happens in the IRB meeting stays in the IRB meeting” requirement, it’s a rewarding experience where you can truly see how history influences our modern approaches to scientific inquiry.

Meeting Their Charge

In accordance with the Johns Hopkins Medicine’s website (http://irb.jhmi.edu/GeneralInformation/index.html), which explains the function of the the institutional review board, common criticisms of the reviewed protocols involved

• Lack of assurance that the subject’s rights and welfare were going to be adequately protected
• The inclusiveness of the protocol and the ability of its sampling plan and recruitment strategy to meet the stated goals
• Appropriateness and adequacy of the informed consent documents and process

The particular IRB I observed was chock-full of experienced professional from several disciplines who were able to quickly identify potential problems in the areas listed above. Additionally, this IRB was critical of the collaborative nature of the protocols as well as the differentiation of true research from non-research proposals. I thought that was great, since it added another dimension to the review that went beyond a simple checklist approach to the review. Not only did they cover the essential elements of their charge, but they were also acting to ensure that quality work would be done.

An Historical but Progressive Context

In the context of the readings we’ve completed over the course of this semester, these main criticisms are classic – protect from harm, ensure access and equitability, obtain consent from an informed patient, etc. But, in a progression of that historical context, the IRB I visited critically reviewed the protocols for elements not necessarily included in their charge. For example, they frequently posed the question “Is it research?” I don’t recall reading about the role of the IRB in making such distinctions, but it certainly seemed appropriate considering that some protocols were really “quality improvement projects.” In light of the workloads that IRBs routinely deal with, such a basic question can help to easily dispatch some protocols while focusing in those with more intricate or complex designs.

Paradigm of Oversight

After reflecting on the article by Emanuel & Grady (2006), I would have to say that, in that particular session, the board members were generally guided by more of a “participant access” paradigm. However, as previously mentioned, there were additional perspectives influencing the process. The result is, perhaps, more of a hybrid model. A hybrid model that protects rights of informed participants, ensures equitable access, improves research quality and recognizes the importance of communities.  I thought the consideration of  ”important communities” was especially interesting because the IRB was not only concerned about the community of participants, but also that of the scientists! I observed this expanded view of community during the review of a certain protocol that involved the use of samples from a tissue bank. While the protocol was strong the PI failed to demonstrate that the scientists responsible for the establishment and management of the tissue bank had agreed to allow the PI to access and use samples. The protocol was suspended until the PI could provide evidence of healthy collaboration with the tissue bank scientists.

Expectations and Surprises

As expected, the IRB session I attended was very well organized and methodical. The board members were from a wide representation of disciplines and experience levels which created an impressive “group intelligence.” I was surprised by the amount of “ancillary support” provided in the form of an IT representative who not only projected resource documents but was also able to retrieve additional materials if needed. Finally, the group that I observed had an informal policy of “extra vigilance.” Through this approach they also performed a sort of “grant review” and frequently, even if a protocol was approved, made recommendations to the PI that would strengthen the study.

Conclusion

I enjoyed visiting the IRB. All of the members were welcoming, professional. Plus, they were gracious with their offering of coffee and danishes! Although they showed much kindness during my visit, I doubt they’d be as friendly if there were reviewing my proposal. I feel pretty secure in saying that If I were to submit my dissertation research study proposal to this committee today, it would be quickly and summarily dismissed with one criticism – “Mr. Boley, prior to your resubmission, please at the very least, have a clear purpose!