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Archive for the ‘Crossfit’ Category

Whither CrossFit: Sunday musings…

Sunday musings…

Oh my.

This morning my first outside interaction was a quick note from one of my sons: “CrossFit shit storm”. Though it has been several years since I have had any meaningful association with official CrossFit I did a quick perusal of social media and up popped the story. CrossFit founder and CEO Greg Glassman had replied to an Instagram post about the death of George Floyd and the public health implications of systemic racism with a rather flippant statement combining the two great mega-issues before us today: COVID-19 and the national unrest that has followed Mr. Floyd’s death at the hands of a police officer. Already under fire for not “adequately” publicly responding to the devastating economic effects of the corona virus lockdowns on CrossFit Affiliate gyms, Coach Glassman essentially ladled accelerant on the flames.

Like so many things “CrossFit” over the years, this episode has multiple layers that touch on much more than what we see on the surface. My own CrossFit journey began in 2005, a time in which CF was little more than a tiny underground movement with a equally tiny group of nearly underground fitness “rebels” fighting what felt like a righteous enemy in the entrenched fitness (and nutrition) community, led by a brash iconoclast who reveled in conflict. Conflict that he routinely initiated, mind you. While I have never been employed by CrossFit, Inc. in any manner I was certainly an “insider”, comfortable in the “halls” of CF HQ as well as in the spaces CrossFitters call Boxes, CrossFit Gyms. My role such as it may have been, was to speak as a friendly fellow traveler to those in the CF community. Kind of a “Goodwill Ambassador” to both insiders and outsiders alike.  It was a role that I created, one that was by turns encouraged and barely tolerated by Mr. Glassman and others in HQ, until it wasn’t. A few years ago it was time to step away.

It’s been quite awhile since “CrossFit” has been mentioned in Sunday musings or Random Thoughts. Why now? As a longtime participant and observer who now has literally nothing invested in anything CrossFit (with the exception of several life-long friendships made in my earliest years there) I thought I might add a bit of perspective to what is happening at the moment for the benefit of those who are relatively new to the movement and the business known collectively as CrossFit. In particular I am hopeful that this perspective will be helpful to my fellow physicians, especially those who have recently come to the CrossFit world as part of their personal battle on the front lines of healthcare, fighting one person at a time to keep their patients alive and healthy. Again please note that I am speaking for myself; I do not speak on behalf of CrossFit, Inc.

In order to begin to understand how to interpret this week’s events in the CrossFit world one must first understand and acknowledge that “CrossFit” is not an omnibus term that means or encompasses one single thing. Rather, CrossFit is and has always been three interrelated entities. It is first, and foremost, a fitness methodology. “Constantly varied functional movements performed at relatively high intensity” designed to enhance and increase fitness. “Fitness” in the CrossFit sense is further defined as “work capacity across broad time and modal domains”: how far can you move how much, how fast. Countless trees have been sacrificed and electrons unleashed in debating whether there is anything unique, or even new, about the first part, the methodology. I’ve long counted myself in the camp that the “how” of CrossFit the system is indeed different and new; very smart, kind and considerate people both agree and disagree with me on that, which is more than OK.

Defining fitness was arguably a true “first”, and in so doing Mr. Glassman created a platform of a sort. More than that, by defining fitness CrossFit created a way that fitness might be measured. The CrossFit “Curve” of fitness attributes theoretically gives us the opportunity to measure an individual’s level of fitness by calculating the “area under the curve”. While this has proven to be more challenging than originally thought, this measurement gave birth to the second of the three distinct entities under the CrossFit umbrella: The Sport of Fitness. If you can measure something you can turn it into a competition. With what can only be described as a barbecue at which a bunch of folks engaged in friendly games from the gym was born what we’ve come to know as The CrossFit Games (note: I foolishly turned down a personal invitation to attend, thereby missing what is arguably the most pure expression of the “CrossFit Community” before or since).

While my view of the Games and the “Gamesification” of CrossFit was originally quite contrarian (conventional stance: the Games did more to bring awareness to CF than anything before or since), it was clear to me that the emphasis on competition drove CF away from  what was clearly its early drive to improve health. Indeed, the loud introduction of the CrossFit definition of health (Fitness over time) was drowned out by all things “Games”. As far back as 2010 I publicly (here on my blog) and privately encouraged a re-dedication to the kind of fitness and health discussions and emphasis seen on the CrossFit Forum in the earlier days of CrossFit. The introduction of CrossFit for Health along with a seminar program specifically aimed at practicing physicians was a welcome pivot by CrossFit, Inc. back to its roots.

Which brings us to the third leg of the three-legged stool that is “CrossFit”: CrossFit, the business. CrossFit, Inc. is a combination of an educational business and an affiliate business in which independent gym owners pay a fee to use the “CrossFit” banner as a part of their brand. In return for a relatively modest fee (in comparison with franchise fees) a CrossFit affiliate is enabled to operate with rather minimal rules (in comparison with the franchise model) regarding the actual practice of “CrossFit” the fitness modality. CrossFit the business is a one-man shop when it comes to corporate direction. The face of CrossFit was, is, and will be Greg Glassman until such time as he decides otherwise.

Nothing that transpired this week is new or unique. Mr. Glassman marches to his own drum. More than that, once he has chosen his particular beat he pounds that drum loudly, regardless of how his audience responds. On occasion even his good intentions are drowned out by his drumming; it is often tone deaf and off-key, (if asked my bet is that he truly felt he was being supportive of protesters against racism). Many in the CrossFit universe feel that Mr. Glassman’s views on the national protests about racism and police brutality are flat-out wrong. Disappointment and anger are the public sentiments. A wish to separate from CrossFit expressed. This has happened before, albeit on issues much less global and at times when CrossFit was much tinier in all ways. Mr. Glassman is nothing if not consistent. When his views run counter to prevailing views he has typically doubled down rather than withdraw. I have never seen him back down, no matter how tiny the corner that he has backed into may become. Expecting anything different this week is as fruitful as expecting the sunrise to hold off because you got to bed a bit later than usual and need a few more hours of sleep.

And so, whither CrossFit? It is not my place to suggest to CrossFit, Inc. how it should proceed. It never was. Nor is it my place to suggest to any of you who might read my drivel how you should respond to what comes from Mr. Glassman or CrossFit, Inc. CrossFit, and Mr. Glassman, will address the issue of systemic racism and associated mistreatment of Black Americans by a faction of the police force, or they won’t. Both are incomprehensible to me, a middle-aged white man who has acknowledged (and written) about a lifetime free of the concerns of racism and the likelihood of harm at the hands of a police officer. Like white bread I am of no particular distinction in the eyes of those who would judge one by how one looks. I am bland; I don’t register. I can not empathize, I can only be as sympathetic as possible. And so, like most of White America I struggle with how to actionably express my dismay at such things. To in some way give not lip service but be of real, actionable service in the hard work necessary to effect change here.

As for CrossFit, my views on the gamesification of CrossFit (not a great thing) and the recent pivot back to emphasizing health (a good thing) have been consistent over many years now. CrossFit, the methodology is still, when followed according to its original spirit and intent (and perhaps even better,  how it has evolved in the hands of several OG’s no longer affiliated with CF), the best overall fitness program I have encountered in a lifetime of fitness and athletics. This is the part that I do want to suggest. Constantly varied functional movements performed at relatively high intensity following the progression of form, then consistency, and then intensity, is still transformative, especially if it is accompanied by a diet low in processed foods and sugar, also encouraged by the CrossFit modality. This is separate, and separable, from the business of CrossFit and the public (and private) missives of the founder and CEO of CrossFit, Inc.

Understanding what “CrossFit” is will hopefully assist you in evaluating what it means to you and how you will choose to interact with all three of the very distinct entities that in combination constitute “CrossFit”. One can simultaneously, honorably, both do and disavow “CrossFit”.

I’ll see you next week…

St. bingo of the Sweaty Angel (ret.)

The Stages of Exuberance Sunday musings…1/13/19

1) Toddler. We are hosting the Man Cub for a few days as his parents prepare to move into a new house.

I. Am. Exhausted.

2) Strategy. Trample the wounded and hurdle the dead is neither a growth strategy nor is it a viable marketing tactic.

3) Snowpocalypse When I sit down to write I enjoy looking out over the lake as I wait for inspiration to sit down and chat. At the moment my view is blocked by 1/2″ of ice on all north facing windows at Casa Blanco.

The Ice Man cometh.

4) Irrational. Whenever a new technology or concept surfaces it is often met with irrational exuberance. Early adopters behave more like acolytes than simple adherents. Potential issues with the new idea are swept aside and those who propose that all is not so new or wonderful are labeled as too dense or simple to understand the brilliance of the new new thing. In a similar vein behavior by the creator of the new idea that would otherwise be a possible signal that all is not as it seems is either ignored or explained away without any real investigation. This particular phase is more intense and tends to last longer if it is associated with something that contravenes, and more so actively seeks to disrupt the status quo. A “cool kid” factor also magnifies the exuberance.

Rare is the new idea that does not then enter a phase one could call irrational dissaffectation in which both early adopters who become disillusioned and outsiders who become interested by the buzz created by the exuberance begin to look closely at not only the idea or product itself, but also at the behavior of both the “inventor” and the company that provides the service/product. The vehemence of this response is directly related to the buzz and fervor that exists among those who continue to be excited about the new thing. During this phase it is quite likely that there will continue to be newcomers to the technology who exhibit many, if not all of the characteristics of those people who claimed “first flag” discovery enthusiasm in the earliest days of adoption.

What comes next is either some degree of general acceptance of the new thing with a concomitant adoption into general use, or a slide into irrelevance as it becomes little more than a footnote in whatever historical space it inhabited.

As it happens both my professional life and a very large part of my non-professional activity each have a very significant player/thing that is entering this third phase. You may recall that I am an eye surgeon, in particular one who operates on the front of the eye. My expertise is in surgeries that both improve vision and liberate individuals from the need to wear glasses or contact lenses. In the LASIK world what was largely a PR battle between mechanical “flap makers” and those that created the LASIK flap using a laser was eventually won by the makers (and early users) of the laser. While I still feel that the introduction of the femtosecond laser to make a LASIK flap was a solution to a problem that had already been solved by 4th generation mechanical devices, the allure of an “all-laser LASIK” proved too powerful in the marketplace. Any “bad behavior” in the middle phase was marketing related. Even though it was more expensive, the laser won.

Cataract surgery also has a femtosecond laser entrant in the game. While the technology is actually quite stunning FLACS has never been shown to be more than slightly superior (if even that according to the most recent studies) to what it was developed to replace (the surgeon’s hands). Similar fear-mongering to the LASIK experience in the middle phase was buried in an avalanche of data reiterating the treasure trove of safety statistics and outstanding outcomes achieved with “traditional” surgery. Some really nice people got run over by some not so very nice people as companies were bought and sold. The most likely outcome as FLACS enters the third phase is that it becomes a niche procedure where hopefully the surgeons push back against industry in order to shield patients from predatory pricing; this laser is more expensive, and that has been its downfall.

When thinking about my non-professional activities over the last 12 or 13 years CrossFit is the obvious topic. In my entire life I have never been a part of anything quite so exciting as the first several years I spent in the CrossFit world. When I first found CF in 2005 there were about 100 gyms and maybe 5000 of us doing it on a regular basis. We were self-proclaimed fitness infidels, rising up against a cynical entrenched fitness orthodoxy and industry. Man, it was cool, and we were cool because of that. Not only did (does) it work if done properly, but we all had that same kind of first flag planted buzz you get when you discover something that becomes a phenomenon. Think being in your local in the 80’s and Nirvana is the house band kind of cool. It was like that.

CrossFit, too, is now in the earliest days of its own third phase. Having turned away from the strong (at least outward appearing) emphasis on CrossFit as sport, the company has pivoted back to something that sounds and feels more like what we all were doing prior to 2010 or so. Quite frankly I was personally too close to many of the primary personalities in phases 1 and 2 to objectively assess the players and how they played. Where CrossFit places its emphasis now is where I always felt it belonged, high intensity functional fitness as health rather than as sport. Which “laser” will CrossFit emulate as it leaves the stages of exuberance? What kind of laser company will CrossFit, Inc. be like if it, like the femtosecond laser, is proven to be only one among several ways to achieve the desired outcome in fitness and health?

In my day job phase three means a femtosecond laser for LASIK but not for cataract surgery. I am largely indifferent to the companies involved.

 

Don’t Exist, Live.

After my first foray into Spinning my back seized up. Pre-CrossFit this was a rather common occurrence, but it’s been some 10 years since my last episode and I’ve been feeling a little sorry for myself. For as long as I have been writing these little ditties I have exhorted (both of) you to get out and actively live your lives; don’t just exist.  More than that I have tried to impress upon anyone who would listen how important it is to have people to live for. People who truly care that you are living among them. What follows is a re-posting of one of the saddest, most powerful stories I’ve ever heard.

 

“Billy Ray (not his real name, of course) turned off his implantable defibrillator (ICD) yesterday. Billy Ray is 44.

In my day job I was asked to evaluate him for a problem in my specialty. I was told he was about to enter hospice care and assumed that he was much, much older and simply out of options. I admit that I was somewhat put out by the request, it being Saturday and the problem already well-controlled. Frankly, I thought it was a waste of my time, Billy Ray’s time, and whoever might read my report’s time, not to mention the unnecessary costs. I had a very pleasant visit with Billy Ray, reassured him that the problem for which I was called was resolving nicely, and left the room to write my report.

44 years old though. What was his fatal illness? What was sending him off to Hospice care? I bumped into his medical doc and couldn’t resist asking. Turns out that Billy Ray has a diseased heart that is on the brink of failing; without the ICD his heart will eventually beat without a rhythm and he will die. A classic indication for a heart transplant–why was Billy Ray not on a transplant list? Why, for Heaven’s sake, did he turn off his ICD?

There is a difference between being alive and having a life. It’s not the same to say that one is alive and that one is living. It turns out that Billy Ray suffered an injury at age 20 and has lived 24 years in unremitting, untreatable pain. Cut off before he even began he never married, has no children. Each day was so filled with the primal effort to stop the pain he had little left over for friendship.

Alive without a life. Alive without living. Billy Ray cried “Uncle”.

I have been haunted by this since I walked out of the hospital. How do you make this decision? Where do you turn? Billy Ray has made clear he has no one. Does a person in this situation become MORE religious or LESS? Rage against an unjust G0d or find comfort in the hope of an afterlife? Charles DeGaulle had a child with Down’s Syndrome. On her death at age 20 he said “now she is just like everyone else.” Is this what Billy Ray is thinking? That in death he will finally be the same as everyone else?

And what does this say about each of us in our lives? What does it say about the problems that we face, the things that might make us rage against some personal injustice? How might we see our various infirmities when cast in the shadow of a man who has lived more than half his life in constant pain, a man alone? The answer, of course, is obvious, eh?

The more subtle message is about people, having people. Having family, friends, people for whom one might choose to live. It’s very easy to understand the heroic efforts others make to survive in spite of the odds, despite the pain. Somewhere deep inside the will to live exists in the drive to live for others. The sadness I felt leaving the hospital and what haunts me is not so much Billy Ray’s decision but my complete and utter understanding of his decision.

Billy Ray gave lie to the heretofore truism that “no man is an island”.

Go out and build your bridges. Build the connections to others that will build your will to live. Live so that you will be alive for your others. Be alive so that your life will be more than something which hinges on nothing more than the switch that can be turned off. Live with and for others so that you, too, can understand not only Billy Ray but also those unnamed people who fight for every minute of a life.

Be more than alive. Live.”

 

Sitting here in the airport with Beth, headed home after celebrating our Anniversary with Lovely Daughter Megan and her Handsomedon Prince, somehow my back doesn’t feel all that bad anymore.

Sunday musings 9/2/18

Sunday musings…

1) Eschaton. A final stage in social evolution. Proposed by futurists in Silicon Valley as the inevitable.

Likely to be as accurate as Marx commenting on the steam turbine and electrification. (HT George Gilder).

2) Refurbish. Mrs. bingo and I own a refurbished 1971 runabout. It took 11 months to be  returned to us. At the moment it is a lovely piece of lawn art because our 1999 pier is in the middle of a refurbishment.

Yup. It’s been 11 months.

3) Air Show. Labor Day Weekend means it’s air show time in Cleveland. It’s nothing short of awe inspiring to see the majesty of our nations’s air power parade by the North Coast of the U.S. Two A-10’s casually floated by Casa Blanco on their way to the fairgrounds. They. Fly. So. Slowly.

Why do people choose to mess with us?

4) Nest. My brother and sister-in-law are now officially empty nesters. Both children have graduated and are full employed. No one lives at home. Randall and Joanne chose to spend their first official trip with us. This is actually a pretty big deal; for 10 years they have spent literally 40 weekends per year following their boys’ collegiate teams. For 10 years I have waited for my bother, my best friend, to be free to hang with me again.

What’s the point? Simple. Sunday musings, indeed, all of my pabulum, is a luxury that I have taken for myself, and that all of you have gifted to me. It’s been a blast. A privilege. But it’s neither necessary nor is it mandatory. Here we are at 2042 and I am just now getting around to my laptop. I spent today doing pretty much exactly what I have exhorted each (both?) of you who read my stuff to do: spent my day in direct face-to-face contact with people I love, away from pretty much all forms of digital whatever. Arms length or closer, all day. We slept in while Mrs. bingo tended to her horses. We got a collective dousing from the Man Cub, who has apparently discovered how to turn on the back yard hose. The sunset over Lake Erie was epic.

I love writing for you, I really do. I hope that what I write occasionally gives you a moment to reflect on what it is we do and why. Today I just lived among my people. My whole day was spent with people I love who love me right back. I was busily in the act of loving and being loved all day long.

What a day!

I’ll see you next week…

–bingo

Sunday musings 8/26/18

Sunday musings…

1) Vicissitude. Fancy word for weather, especially if you need a particular weather pattern at any given moment.

2)) Hero. To be a hero one typically demonstrates courage in the face of personal danger, usually involving the selfless decision to put others before self. As a young man I find it hard to argue that this doesn’t describe John McCain. One could certainly disagree with the positions Mr. McCain took as a politician in the second phase of his life, but one would be hard pressed to argue that he hadn’t done enough in the service of his country over 60 some years.

RIP John McClain. Citizen. Patriot. Hero.

3) Health. CrossFit, Inc. has pivoted. Some among you will rejoice, for the direction that appears to be taken is in line with your own philosophy and goals. Those here who revel in the challenge of elite fitness will no doubt feel that this is a betrayal, a clear step backwards and toward mediocracy. I have a few friends who remain employed at CF, Inc. and they would doubtless like to hear me speak out in favor of this evolution. At the same time there are a few friends who are quite dear to me who would much rather I simply declare my days living in CF nation over and move on. CrossFit in all of its iterations has changed, and so, too, have I.

For many years I have written around this time of the year, just after the completion of the Games, about the peculiar and poorly understood triad that has comprised what we all know as “CrossFit”. It is a business, CrossFit, Inc., one that has as its charge the necessity to be self-perpetuating and to provide for the financial well-being of its owners. This should be self-evident, but over the years commentary has often come up that seeks to present CrossFit the business as some kind of public good. It is not, nor has it ever been. CrossFit, Inc. has succeeded over the years as a business, and in so doing it has made decisions that outsiders have both lauded and loathed. For many, how they interact with the company we call CrossFit is determined by who has been affected by these decisions and how. A pivot has occurred; you and I did not have a vote. CrossFit, Inc. will likely continue to prosper.

Second among the three traditional pillars of CrossFit is the Sport of Fitness. With the possible exception of aerobics competitions in the Denny Terrio age (the spandex!) and that old ABC series The Superstars (O.J. in a boat!), CrossFit likely deserved wears the mantle of the founders of fitness competition. Beginning with a friendly barbecue and leading up to a multi-day tiered competition shown on live network TV, there is no doubt that fitness competition is now here to stay. Early announcements suggest that the pivot will dramatically lower the direct involvement of CF in the competition season, but that CF will have the ultimate say at the highest level. No one you or I talk to has any real idea what this means, and supposition along those lines is wasted effort until we are all told exactly what CF has in mind by CF. The CrossFit Games have changed often over the years and they have changed again. Full stop.

Where most of us come in contact with CrossFit is in the third priority: fitness as a conduit to health. It surely seemed as if this was the least important of the three parts of CrossFit, at least until this past week, but it has always comprised the massively overwhelming majority of participants. Whether on CrossFit.com or in a local affiliate, almost everyone fell under this category;  most of those who thought they were part of the Sport of Fitness were fooling themselves at their own risk. With the creation of a CrossFit health movement and an L1 program for CrossFitting physicians, CrossFit, Inc. appears to be signaling that its public face will now be directed here. Note that I say “appears” because I am no more in the know about this than you or anyone else.

This is a good thing.  To de-emphasize the competitive aspects of CF is to re-emphasize the health aspects of CF that were outlined in “What is Fitness” in CFJ #2, the seminal thesis that brought so many of us here in the first place. I wish we could all go back and look at the threads on the old Message Board, 95% of which had to do with getting healthy. How will this affect the kind of CrossFit we see coming from CFHQ? Again, who knows. CVFMAHI has undergone countless lines of evolution outside of the direct umbrella of CrossFit. Individual trainers have gone out on their own and modified CrossFit in ways that reflect what they learned training people themselves (think James Fitzgerald, once known as OPT).  Entire movements with companies attached have been launched to provide clients with what they feel is a better way. A perfect example of this is The Brand X Method and the Martin family who are without a doubt the world leaders in youth fitness. Who will be right? Who will thrive?

Who knows?

In the end the entire conversation has changed over the last 10 years, and more people are sitting at the fitness table than ever. The line between healthcare and fitness continues to be a bright dividing line. Barriers continue to exist between the fitness world and both public health and public education. Will this pivot at CrossFit, Inc. start to blur those lines, or at least build bridges across them? Will we see some other organization, perhaps one that began within the CrossFit universe but now exists as a separate, growing galaxy like Brand X share the load or even take the lead?

The only constant in CrossFit in the years that I’ve been here is change. Change brings with it opportunity. My prediction: this turns out pretty well for CrossFit. The fitness world is much, much bigger than it was 10 years ago. One would do well to listen very carefully when CrossFit directly addresses this pivot publicly. This will also turn our pretty well for people who may have been part of the CrossFit world but are no longer associated with any of the 3 parts of CrossFit outlined above. One would also be well-advised to closely watch the direction taken by the Martins and others in the fitness world as well. There will be many benefits that come from that one, big original idea. They will come from many places.

After all the Theory of Relativity was simply the on ramp to what we now know as Quantum Physics. The highway of fitness progress is now fed by a growing number of on ramps that come from many directions.

I’ll see you next week…

–bingo

Sunday musings 8/19/18

Sunday musings…

1) Bollocks. Testicles. Who knew? The whole kerfuffle over the Sex Pistols album title makes a ton more sense now.

2) Directed. “Use as directed.” I’m not sure who is more surprised. Mothers when their offspring open up some something or other and just fly into using it (and it works), or said offspring when they fail to check the directions and whatever it is they opened doesn’t work.

For the record this is also a problem in areas that are a bit less trivial than a tiny drone received as a birthday gift. Like medicine.

3) Knots. “Miles per hour plus the glamour of the open sea.” –Mark Childress.

Not terrifically accurate, but who’s gonna argue with that little bit of poetry?

4) Despair.  Why is it that so-called “great literature” always ends in despair? The boy never gets the girl and vice versa. Every family is rendered asunder whether or not they deserve that particular fate. Why?

Lettie Teague wrote about her summer reading, all of her books centered in some way around wine as a pivotal character. Upon reading the headline I was excited to have some fun, happy reading for a change. Yah. About that. Even the consumption of epic wines was spoiled by the despair that prompted the binge or that which ensued.

Jeez. Winston Churchill managed to help save the world when he drank. How come no one can write literature with a happy ending?

5) Change. Inspired by by near lifelong friend Bob.

I watch the ripples change their size
But never leave the stream
Of warm impermanence
And so the days float through my eyes
But still the days seem the same.  –David Bowie

Grand baby birthdays. Siblings and their offspring passing milestones. 40th high school reunions. There is no escaping the passing of time. Along with the ebbs and flows there has been but one, single constant: change. Each day seems so much like the one just passed, and yet a glance ever so slightly further back brings an awfully quick reality check. Change has been afoot. “You haven’t changed” is such a lovely thing to hear, yet it, too, cannot withstand even a passing glance in the mirror.

There is nothing new or even remotely weighty about noting change. What is significant, though, is the importance of both acknowledging and accepting change, however disruptive it may be physically or emotionally. One must be able to see change and react accordingly, no matter how difficult it may be for either an individual or for those who may be highly interested spectators. I think of my good friends from California, true pioneers in both the CrossFit movement and subsequently independently in the larger fitness world. They have looked at how their world, their lives have changed, and they have accepted the need to change as well. For them it begins with the closing of a beloved, iconic gym which is rightly famous worldwide, the loss of which has been met with an international tsunami of tears. Yet they have seen the change and have accepted that the time had come.

Some changes are so disruptive that they turn lives upside down even when you know they are on the way. Our friends Bob and Kathy begin the journey toward an empty nest as their only child begins his senior year in high school. So, too, my brother and sister-in-law must adapt to the changes brought by college graduation and their sons’ retirement from competitive sports. No longer will Randall and Joanne plan each week around their boys’ games. My sisters and their husbands are soon to follow. Will those changes be any less impactful given foreknowledge?

Someone, I’m not sure if they like me or not, once asked at what age I would choose to be frozen if such a thing was possible. How old would you choose to be, with all of the attributes of that age but no prospect of any further growth or development? It’s an impossible question, a cruel koan which cannot be solved. How can one possibly choose between the youthful feet attached to the running shoes that are so joyfully and maddeningly soaked by your child and the archless soles doused by a grandchild? Which is better, to have the agility to dance away from your son’s aim lest your shoes be ruined, or to happily submit to the realization that the laughter of your grandson is more than worth the fact that you can no longer save the shoes regardless.

Besides, the shoes have changed, too. They’re waterproof now.

Changes are happy and sad, big and small. We lose parents and friends. Special places like our friends’ gym close taking with them any chance they may change us for the better. Heck, it looks like I’ll be changing hips sometime soon, a change I for some reason thought I’d be the only one to escape. It makes me sad to hear parents tell a child “don’t change; stay like this forever” because that is one wish that will never be granted. Nor should it. After all, there is only one way to assure that change will never come.

I am not done changing
Out on the run, changing
I may be old and I may be young
But I am not done changing   –John Mayer

Change is life. To change is to be alive. Embracing change is to live.

I’ll see you next week…

–bingo

Sunday musings 8/12/18

Sunday musings…

1) Krispies. All of my snaps and crackles now have pops.

2) Relevant. “Who wants to be relevant? It just takes a lot of work.” –Andie MacDowell

In this day of social media driving said relevance I think Ms. MacDowell is spot on. When relevance is measured by something as ephemeral and lacking in any type of substance as retweets and follows, her take is prescient.

True relevance is substantive. Or should be.

3)  Games. What are we to make of the massive gap between the top 5 men and women and everyone else? What is it that separates them so completely from the rest of the very best? Is it just me or is this fundamentally different from all of the other truly individual athletic sports?

4) Summer. For anyone with school-aged kids summer if officially over. August 1st has come and gone, the CrossFit Games are over, and football camps are open all across America. Heck, school starts in parts of Ohio on Wednesday, and didn’t I see kids heading to school last week on FB?

Sorry, that’s all wrong. School is meant to start after Labor Day. Too much work too soon for kids who aren’t taking part in feeding a family.

5) Screening. It appears that I am a health tracker recidivist. Why? Well, it certainly has nothing to do with the truly actionable nature off the information a tracker gives me, because to date only heart rate variability (HRV) has any value and at that it appears only in elite athletes. No, I’m just having some fun with mine, playing around to see if my little n=1 studies might come up with something that might move my needle for some reason or other.

That, and they are fun to write about.

Screening for health risks is potentially a big deal, the across the board lack of success thus far notwithstanding. The most recent best example of that coin is an article published this month in the NEJM on cardiac testing of elite soccer players in England. Performed at age 16 between 1996 and 2006 the screenings were undertaken to see if an EKG and Echocardiogram could predict cardiac events that led to early death in athletes who compete in sports with “strenuous exertion”. In all more than 11,000 athletes were tested, the vast majority of whom were declared healthy.

1 in 266 were found to have an underlying, silent abnormality that put them at risk for sudden cardiac arrest. Most of these were Hypertrophic Obstructive Cardiomyopathy (HOCM), the same entity that was responsible for the tragic death of Boston Celtic Reggie Lewis. 2/3 of those who were found to be at risk had surgical procedures which allowed them to safely return to play; it appears that they are all alive and well. Of the originally screens players 8 did in fact die from cardiac arrest, but here’s the kicker: only 2 of those 8 were assesses as being at risk. The other 6 went through the screening and passed. Overall the results equal a risk of 6.8 deaths per 100,000 athletes.

What does this mean in the greater context of health screening? In general the problem with health screening of all kinds (remember, I am in the midst of a classic American cardiac health risk screening process at the moment) is the combination of inaccuracy as noted above, coupled with a fraught cost/benefit ratio in almost all instances. Believe it or not, though, the cost of screening relative to the accuracy and ultimate effect may be the lesser of the problems inherent in screening. Two of the athletes screened and found to be at risk refused to give up soccer and were among the cardiac deaths. You might ask if they were mad to have continued to play, but I would counter that it is quite likely that all they had as a means to provide was soccer; to not play was to choose to go hungry. Imagine an inner city kid destined to be a Lottery Pick in the NBA screened and told they could no longer play the game that would surely set them up financially for life on their rookie contract alone?

Not to mention the deep psychological issues inherent in being told that you are no longer the one, single thing that you have self-identified since early childhood. That’s rough.

One of the very first diseases one used to learn about in med school was Huntington’s Chorea, an inherited disease in which the afflicted exhibit violent, uncontrollable movements (chorea) before eventually dying a rather unpleasant death  (any med students here? Is that still true?) Why? Well, partly because it’s such an interesting tale, equal parts detective story (the original cluster is in a tiny town in England) and history lesson (many of the townsfolk in England emigrated to Salem and were on the wrong end of the Salem witch trials). What makes this interesting in the context of screening is that Huntington’s Chorea is the first disease for which a single gene defect was identified, making it possible to screen with 100% accuracy to determine if you, like Woodie Guthrie and his siblings, would be so afflicted.

Would you want to know? Remember, even in this age of SPLCR technology there is still no cure for Huntington’s. Is there a difference between this and the cardiac risk of HOCM in athletes? How about the rather mundane and ridiculously common risk associate with elevated serum lipids? Given that there are things one can do to mitigate the risks in the latter one should probably answer “yes”, there is a difference. But emotionally, on an individual level, is there? That’s a really hard question to answer. I personally know families with Huntington’s and HOCM. Some family members get tested as a matter of course. Others, for any number of reasons, choose not to do so. In your life you know dozens of people who really need to be screened for diabetes and cardiac risk from elevated serum lipids who prefer the relative comfort of ignorance.

Who is to say who’s right?

In the end this is a question that is going to become more and more common as testing becomes both easier and less expensive. We are soon to see a lab test for HOCM which will be less expensive than an EKG/echocardiogram and more accurate to boot. The calculation will change as well because on the heels of this test is the likely approval of a gene therapy that will reverse the abnormality and presumably remove the risk. For some reason Huntington’s Chorea has defied this happy ending, but it has to be just a matter of time before it, too, is curable. Before any universal agreement is reached on screenings in general you can depend on tons of controversy which each new development. I shudder to think of the coming shit show that will be wrist-worn trackers that can detect afib in real time.

Who knows what kind of mischief I will manage to get into with my little HRV monitor?

I predict I’ll see you next week…

 

–bingo

 

DNA Always Wins

DNA always wins.

In the fitness world, and sometimes even at that tiny intersection where fitness and health or healthcare cross paths, there is a recurring theme: you can’t out-train a bad diet. For whatever it’s worth, I think that’s true. Having said so there is a dangling little assumption that hangs off the back end of our axiom, that if you are fit and follow an evidence-based nutrition program that you will inevitably be healthy. Indeed, every worthwhile fitness program I’ve ever encountered pretty much says just that. “Fitness in 100 Words” on CrossFit.com was my first exposure to this as a mission statement. Loads of folks from the substantive (The Brand X Method) to the frivolous (The Biggest Loser) support this logic as the foundation of health-based fitness. For the most part it is true, and for most people the combination of general physical fitness and solid nutritional strategy results in health.

Except, you know, the whole Jim Fixx thing.

For all of you puppies and kittens out there Jim Fixx was the original running guru in the United States, the author of The Joy Of Running. You could make a case that only the late, great Jack Lalanne was a more influential historical figure when it comes to promoting health through exercise in the U.S. Jim Fixx was responsible for the surge in interest in running as both exercise and as sport, and his writing launched an era in which U.S. runners were competitive on the international stage in ALL distances from the mile all the way to the marathon.

As it turns out Jim Fixx may also be the single most influential non-medical individual in the history of the cholesterol theory of heart disease. You see, Fixx had hereditary hyperlipidemia. Despite his epic running history he was found one day in his running shorts at the side of the road, dead from a massive heart attack. Blood work at the time of his autopsy revealed a cholesterol of 750 or something like that, as well as other elevated serum lipids. His healthy diet, his outsized VO2 Max, and his prodigious training schedule were no match for his DNA. He died with epic fitness numbers, a single-digit bodyweight fat %, and coronary arteries that were so clogged red blood cells had to pass single-file. You can trace many of the USDA dietary guidelines and literally billions of dollars in research to the death of Jim Fixx.

Why bring up Jim Fixx now, in 2018, when we know that hyperlipidemia is a significant part of the cardiac risk story, albeit not the whole story? Well, we should harken back to the beginning of my thoughts: DNA always wins. While you can reduce your health risks by adopting a healthy, evidence-based diet and couple that with an exercise program that produces a comprehensive degree of fitness, you cannot escape genetics. Why at this particular moment? Yours truly just got all of his lab work back and despite 13+ years of a clean Zone diet and varying degrees of devotion to functional fitness, most of my serum lipid numbers have continued on their ever-upward march and have now reached a level where they simply must be addressed by modern medicine.

To do else wise would be madness.

I must confess that this is deeply disappointing. Quite frankly it feels like failure. At 58 I am relatively lean and strong, albeit a bit under-trained in the aerobic domain. Why didn’t this inoculate me from the need to take medication to lower my LDL? In the last couple of days I have chatted with my docs locally (both of whom are close friends who care about me) as well as really significant, nationally recognized experts in the science of health and cardiac risk mitigation. There is a consensus; nay, the voting was unanimous across the board. Don’t be stupid. Continue my program of fitness and nutrition and take the meds. We’ve now moved on the the minutia of choosing which one, a not-trivial discussion to be sure, but one that is less than earth-moving, you know?

Some years ago while proposing a unified theory of health on my personal blog I received an advance copy of Coach Greg Glassman’s definition: if fitness is WCABTMD then health is Fitness Over Time. As a physician and scientist I readily saw the value of this concept. However, I also saw and pointed out the deficiencies inherent in such a narrow definition. For example, any definition of health must explicitly address mental health. Over the years I have championed the term “well-being” and have suggested several metrics that can be used to measure this state of mental and emotional health. Mind you, I was openly mocked at the time for this, here and elsewhere. If you have followed the conversation in the CrossFit world since you will see an evolution of thought along this line, though. “Well-being” has been openly discussed in various ways as an integral part of health in most medical, health, and fitness communities. I like to think I played a small role in that.

I wrote before, then, and subsequently over the years that any definition of health must be more than a snapshot of how “healthy” you may be at any given moment. You may have a 2.5X body weight deadlift and squat, run a sub 5:00 mile and do “Fran” in under 3:00, but can you truly be declared “healthy” if you also harbor a malignant tumor in your gut or are running around with an LDL of 175? Like it or not, any comprehensive definition of health must be able to provide some degree of probability that you will remain healthy in the future. It must have some predictive value. Traditional health metrics–blood pressure, lipid levels, family history, etc.–added to a measurement of fitness and well-being do just that.

In practice such a value has proven elusive for a number of reasons, none the leasts of which is the difficulty in designing a truly measurable variable for fitness that would be accessible to the masses. Once such a measure exists the rest is just math, right? It will be necessary to determine the relative value of our three variables–fitness, well-being, and risk predictors–and then plug them into a formula to kick out something that we might call “True Health”. While this is still “pie-in-the-sky” stuff I am convinced that it is only a matter of time before it is a reality. To do my part I have tried to enlist new “partners” like my brother-in-law Pete, the cardiology savant, and others.

But for now there are lessons to be learned from Jim Fixx, and yes, once again there is a teachable moment in my little epiphany and “Sunday musings” this week. You can’t out-train a poor diet. A healthy diet of any type combined with a program of functional fitness meant to produce general physical preparedness that includes both strength and metabolic conditioning is the optimal strategy. Even here, though, you cannot escape genetics. DNA always wins. Good, bad, or in between, your DNA talks to you in the language of traditional health risk metrics.

Your DNA doesn’t care how fast you can run a mile or how much you can bench. I start my new meds tomorrow.

 

Sunday musings 6/3/18: 40th Reunion Thoughts

2018 is the year of my 40th high school reunions (we moved after my freshman year so I have two). It’s a nice time to return to one of my frequent themes, identity. Who are you when you are all alone, just you and the mirror? Who are you when you are in any particular group of people? Do you feel that there is more confluence between those versions of you than not? How much confluence do you think there is between who you think you are and who it is that those around you think you are? As this is my 40th year away from my classmates, have you evolved from who you thought you were and who your classmates thought you were over the years?

First a couple of disclaimers. One should not be all that too terribly concerned about the thoughts of others since this gives all too much power to individuals who may not have your best interests at heart. Sorry, but our world is altogether too filled with people who will opt to climb over your downtrodden psychological carcass if you allow them to do so. Also, there is no reason for you to ossify as an individual at any stage of your life. Indeed, if you haven’t evolved since high school you’re probably doing it wrong.

Over the years I admit that I have not made much of an effort to remain in contact with the vast majority of my classmates in either of my childhood towns. I could certainly lay the blame for that on my Dad who held that true friendships were rare and the effort to stay in touch with acquaintances too arduous for the ROI. The truth is more that I’ve always done the deepest dive possible into whatever ocean of opportunity I happened to be sailing on at any given moment; those oceans have always been rather distant from the shores of my youth. It was simply too hard and too time consuming to maintain a large number of close contacts behind as I was ever looking ahead. Looking back there is no way to know if this was the best strategy. Like my Dad, though, I have tried to be the best friend I could be to those who were with me at any given time.

Today Facebook has made it rather easy to re-forge ties, however delicate the fibers may be. These tiny, tenuous connections have me very curious about my childhood mates in both towns. Much to the surprise (and amusement) of my family I have found myself moving all kinds of the chess pieces of my life so that I might attend both reunions. Who will I meet when I do? With the exception of a very few people I still do chat with, so many years have passed that literally everyone I see will be someone I am pretty much meeting for the first time.

40 years is a lot of years of growth and change.

Who will my classmates be meeting when they see me for the first time in at least 30 years (I went to one school’s 10th)? Judging by a post on our Reunion FB page in which a classmate unearthed some commentary about our class from graduation day I will be largely unrecognizable. You see (and this gets back to who you think you are and who others see you as being) what I once thought of as self-assurance and confidence came across (to some people at least) as self-centeredness and arrogance. This is not really a revelation mind you, nor is the re-appearnace of this item from Graduation Day distressing. I’ve long held that I was an arrogant putz when I was a young man, although that may have been a part of whatever successes I may have accrued over the years; I pretty much always assumed I was gonna turn out OK.

What does bother me though, at least the me of the last 20 or so years, is the possibility (probability?) that my younger self may have run roughshod over people who didn’t deserve anything rough out of me at all. That does make me sad, frankly. You see, a large part of my own personal development, the ongoing changes to the person I try to see in the mirror (and project for any and all to see in me) is a foundation of kindness in all that I do and in all that I am. It’s hard–no, impossible– to be good at all times, and I’m not sure at all that you can be truly kind always and everywhere. But you can try, and it is in the trying that I have evolved over the years.

Who will my classmates remember as they think about our upcoming reunions? Will our memories of the children we were be so strong that we will be prevented from seeing the adults we have become? Regardless it’s been an interesting part of the journey to be reminded of who people thought I was so long ago and to peruse the pages of each intervening “Yearbook” as I’ve gone from cocky teenage jock to whatever it is I am today.

Wow. 40 years.

Fitness or Sport? A Proper Place For High Intensity Training

The CrossFit Games Regionals were on ESPN yesterday afternoon. What? Wait. No? No, I guess you’re right. It wasn’t ESPN, was it. As it turns out the Games have shifted over to CBS Sports. Totally missed that memo. Of course, I only surf to the Games site once or twice a week anymore so I can be forgiven. Thankfully I was marooned at home with nothing left on either my Honey-Do list or my own Wish List, and ESPNU was all kinds of messed up so I couldn’t watch the D1 Lacrosse quarterfinals. Surfboring around cable I stumbled on the Regionals and received my annual reminder about what CrossFit is and who is supposed to do it.

In short the CrossFit Games as exhibited in this year’s Regionals is to CrossFit as the Indy 500 is to your daily commute: almost everyone needs to do the latter, but almost no one can, or should, do the former.

You could certainly say that I am treading on thin ice by proclaiming that you and I have no business doing anything but gawking at Regionals athletes doing full-on Regionals WODs here on .com. Fine. Here is why I feel this way; the incessant urge to emulate Games-level athletes and to turn every CrossFit WOD into a training session for competition risks the undoing of what makes CrossFit (and other high-intensity offshoots) a potential solution (or integral part of an irreducible Rx, to coin a phrase) in solving the population health problem in Western societies. It really could be as easy as eating fewer processed carbohydrates, being stronger, and training at relatively high intensity for periods of time in the 8-20:00 range. Stronger and leaner with greater aerobic capacity is all pretty much any of us needs.

Everyone who has ever owned a Box or coached a CrossFit class has seen the danger of extending the “you vs. you” competition outward into the “Sport of Fitness (TM)”. Clients who leave a gym because the trainer refuses to teach them how to do a CTB butterfly PU when they can barely do a single dead hang PU. Fledgling CrossFitters who insist on rebounding box jumps instead of stepping down because their times suffer when they do. “Linda” or “Diane” done As Rx’d with rounded lower backs, chins held high because, you know, you gotta Rx the Open WODs if you want to go to the Games. It’s really hard to exaggerate how disheartening it is to listen to a client say they are leaving a gym because they don’t feel like you are the best fit for them. Then you look at their data and discover that they are down 15% BW fat, have doubled their 1RM Deadlift, can now do “Fran” Rx’d in half the time they first did it with an empty bar and a green band, all injury-free.

Form, then consistency, then and only then intensity. This is what you need for fitness. The siren song of competition is strong, especially during our Games season. Shout out to those trainers, both within the CrossFit business universe and out, who continue to hue to this orthodoxy. Functional movements, irreducible exercises performed properly at a level of intensity that is high for an individual, coupled with a diet that is designed to fuel performance in the gym and in life is what we 99.9%’ers need. Distilling this prescription into a measurable and repeatable program is the essential genius of CrossFit. That some of us get to do it as part of a community is that much better; friendships formed through shared experiences, especially shared strife (and what is “Fran” if not shared strife), are also an integral part of being healthy.

After my (ca. 2006) WOD I sat down with some left-over steak and a handful of nuts to see how Dani Horan was doing in the East. A little sore and energized, the only thing that was missing was another CrossFitter there to join me in watching the spectacle.

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