EDITORIAL
Exercise Nonresponders: Genetic Curse, Poor
Compliance, or Improper Prescription?
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V̇O2max needs no definition for the readers of Exercise and
Sport Sciences Reviews (ESSR) because it is a, if not the, most fre-
quently used abbreviation in exercise physiology. It is a measure
of cardiorespiratory fitness for exercise professionals, a gauge for
endurance capacity and potential for coaches and athletes, and
an index of cardiovascular disease risk for clinical scientists.
When V̇O2max is used as a measure of exercise training response,
considerable variabilities exist in the individual responses. Some
subjects respond with substantial improvements whereas gains
are either minimal or nonexistent in others. This latter group
has been labeled as exercise nonresponders. Much of this variabil-
ity has been attributed to a variety of factors including a poor
compliance/adherence to exercise program and a genetic predis-
position to a specific type of exercise training stimuli. In the cur-
rent issue of ESSR, Joyner and Lundby (1) argue that trainability
depends largely on the dose of exercise training and that genetic
predispositions may not be as important as we previously thought.
Would the notion of nonresponders that we excuse some individ-
uals as a “genetic curse” be a misnomer or a phenomenon that
depends on the context
Arguably, one of the most strenuous exercise training studies
to date was conducted by Hickson et al. (2) back in 1970s. The
participants, mainly graduate students and postdocs, ran contin-
uously as fast as possible for 30 min or longer 3 d a week (equiv-
alent to running 5- to 10-km races every other day) and cycled
six 5-min-long intervals at the intensity to reach V̇O2max in
5 min (equivalent to performing six V̇O2max tests in row) on
alternate days. One open day (i.e., nontraining day) of the
week was devoted for V̇O2max tests resulting in no rest day in
a week. The average increase in V̇O2max after 10 wk was ap-
proximately 40%. There was no nonresponder because even
the lowest responder achieved an 18% increase in V̇O2max.
Several studies since then have demonstrated that increasing
exercise intensity or dose abolished nonresponders in previously
sedentary adults (1). Would individuals who failed to respond
to one type of exercise training be able to obtain sufficient gains
when a different type of training was prescribed? In a recent
Authors for this section are recruited by Commentary Editor: Russell R. Pate, Ph.D.,
FACSM, Department of Exercise Science, University of South Carolina, Columbia, SC
29208 (E-mail: rpate@mailbox.sc.edu).
0091-6331/4603/137
Exercise and Sport Sciences Reviews
DOI: 10.1249/JES.0000000000000156
Copyright © 2018 by the American College of Sports Medicine
137
Copyright © 2018 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
randomized crossover exercise intervention study (3), all
the participants responded to exercise when they were exposed
to both endurance and sprint interval training protocols. More
interestingly, improvements in V̇O2max, or a lack thereof, for a
specific individual after endurance training did not predict the
improvements in V̇O2max after sprint interval training.
These results suggest that the vast majority, if not all, of exer-
cise participants may be able to gain the benefits from exercise
training protocols as long as the exercise stimuli are appropriate
and sufficient. Clearly, there is no single exercise training rou-
tine that works for everyone. As a number of exercise guidelines
remind us, exercise prescription needs to be diversified (as in
cross-training) and individually tailored to optimally improve
function and maximize adaptations. The concept of nonre-
sponders to medical treatments is highly prevalent in the clini-
cal literature because “resistance hypertension” and “vaccine
failure” are a few examples to designate small groups of patients
who are resistant to the treatments. Exercise training is unique
and distinct in that the dose of the treatment strategies can be
increased and altered without much regard to toxicities, adverse
effects, and complications. Even if V̇O2max is unresponsive to
exercise training in some populations, other benefits from
regular exercise are innumerable. Even breaking up sitting
or sedentary time confers cardiometabolic benefits (4). Exercise
is clearly medicine!
Hirofumi Tanaka
Department of Kinesiology and Health Education
The University of Texas
Austin, TX
References
1. Joyner MJ, Lundby C. Concepts about VO2max and trainability are context
dependent. Ex. Sport Sci. Rev. 2018; 46:138–43.
2. Hickson RC, Bomze HA, Holloszy JO. Linear increase in aerobic power in-
duced by a strenuous program of endurance exercise. J. Appl. Physiol. Respir.
Environ. Exerc. Physiol. 1977; 42:372–6.
3. Bonafiglia JT, Rotundo MP, Whittall JP, Scribbans TD, Graham RB, Gurd
BJ. Inter-individual variability in the adaptive responses to endurance and
sprint interval training: a randomized crossover study. PLoS One. 2016; 11:
e0167790.
4. Benatti FB, Ried-Larsen M. The effects of breaking up prolonged sitting time:
a review of experimental studies. Med. Sci. Sports Exerc. 2015; 47:2053–61.