Preview Of A New Definition Of Health
What follows is the draft of an article that Kathy Weesner and I submitted to the Crossfit Journal in the Spring of 2010. Consider it a preview, a “sneak peak” of a series of articles that I plan to post on Health.
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Two Crossfitting MD’s Look at Health
We figured it out! Coach gave his Crossfit definition of health about a year and a half ago and it’s taken us this long to figure it out. We thought we had it after a dinner at the 2009 Crossfit Games, but something still didn’t quite fit. There was something about “Fitness Over Time” that seemed incomplete. Health to a couple of doctors seemed as if it had to include something else, something other than just fitness as Crossfit defines it and a calendar.
Crossfit defines fitness as “Work Capacity Across Broad Time and Modal Domains”. With precision and accuracy we can chart or graph our fitness by looking at our power output in multiple domains against time; we can then compute our work capacity, the area under the curve.
[Insert classic CF Graph work capacity age 20 CF training guide]
Coach has declared that his ultimate mission is nothing less than to revolutionize healthcare, to produce healthier individuals who can lead more productive lives and live longer while doing so. Consistent with that goal, and certainly consistent with his development of Crossfit, Coach first had to come up with a definition of “health’. The Crossfit 3-D definition of health is “fitness over time; fitness over a lifetime”.
A little background is probably in order. We are two practicing doctors who happen to be relatively experienced Crossfitters. Kathy is a pediatric anesthesiologist, so she’s the smart one of this pair! Darrell is an ophthalmologist or eye surgeon. We did a little experiment after Coach started to talk about health. What, exactly, do physicians think is the definition of health? What does it mean to be healthy?
When we started to ask our colleagues this question we were almost universally disappointed in their responses. We surveyed newly minted physicians right out of training as well as those who have been practicing for over thirty years. Believe it or not, the most frequent answer we received when we asked doctors “what is your definition of health” was: “gee…I dunno…I never really thought about it.” Nuts, huh? Not so surprisingly, especially with an audience of American doctors, was the answer “health is simply the absence of disease.” All Crossfitters have heard Coach talk about the 95 year old man with absolutely no diseases on not one single medicine who can’t lift his ass off the toilet without help. No disease, but healthy?
The flip side of that is where we as doctors struggle with simply defining health as “fitness over a lifetime.” How about the 36 year old man with a 500 Lb. deadlift, a 5:00 mile, 50 pull-ups and a 2:30 “Fran” who drops dead from pancreatic cancer 3 months after posting all of those numbers? Was he “healthy” then? He surely was fit, at least using our Crossfit definition of fitness, but it’s hard to say that he was “healthy” because the volume under his life curve abruptly stopped increasing.
The beginning of the solution to our quandary did come from one of our surveyed doctors. Darrell was speaking in Florida and, as always, he asked the audience of physicians to define health. One of the docs at that meeting replied “unlimited potential, or life performance without any limits or potential limits.” BINGO! That’s the missing link–PROSPECITVE fitness, the potential to express fitness in the future.
The Crossfit 3-D definition of health is a LOOK-BACK, a retrospective evaluation of how healthy we have been. As such it is missing one of the key aspects of what health is more generally thought to include, the ability to make predictions about future life–in our case as Crossfitters about future levels of fitness. To truly invoke a three dimensional definition we need to include two more dimensions, two additional variables that affect our potential performance.
Interestingly, Crossfit already talks about one of these dimensions when Crossfit instructors discuss “wellness” at Level 1 Certifications. Wellness includes such widely discussed objective, observable, and measurable variables as blood pressure, cholesterol, %body weight fat, waist circumference and chest/weight ratios. Although we can agree that society as a whole is TOO focused on these variables, they do have some value in predicting future levels of fitness. We are confident that we can identify a validated “wellness scale” that scores this category based on these established markers.
[Insert Illness-Wellness-Fitness Arc pg 16 CF training guide]
The last variable, the third dimension of a comprehensive Crossfit definition of health is “well-being”– emotional and mental health. Although it is virtually impossible to establish a universally agreed upon definition, let’s call this the “happiness” metric. It’s impossible to maximize your fitness if you have some mental or emotional problem that becomes a barrier. We can certainly understand how named problems like depression, bipolar disease or severe pathologic anxiety can affect our fitness. In the same way our ability, or relative inability to handle both the chronic stress of everyday life and the acute episodes of stress we face can affect our fitness.
How do we measure something as amorphous as “well-being” or happiness? We could certainly use something like the inverse of the VAS or Visual Analogue Scale that anesthesiologists use with all of their patients to evaluate pain control in the post-op period. A better option would be something along the lines of the Quality of Life Indicator (http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAg511 ). This independently validated proprietary test fulfills our measurable, observable and repeatable Crossfit mandate.
We would like to propose a slight variation on the Crossfit 3-D definition of health by specifically naming two additional dimensions: traditional Wellness, and let’s call it “Well-Being”. We would further like to expand on Coach’s contention that increased fitness will drive all of our wellness measurements in a positive direction by saying that fitness, wellness, and happiness form a bi-directional “virtuous circle” that leads to health; any increase in each of the three elements will drive the others in a positive fashion leading to greater health.
In the end we think Coach has it more right than anyone else when he says that health is work capacity over time. By explicitly adding the pre-existing Crossfit definition and concept of Wellness to this definition, and then by going further and adding the concept of Well-Being we complete the full 3-D Crossfit Definition of Health. Health at any one point can be depicted by a sphere whose volume is determined by the interaction between Fitness, Wellness, and Well-Being.
Our conjecture (hypothesis?) is that the volume of the “Health Sphere”, perhaps combined with the volume trends over time, is a more accurate predictor of prospective fitness or work capacity in the future.
If this is indeed the case we will have further cemented the primacy of Crossfit’s definition of physical fitness. By combining our measurement for fitness with similar metrics for medical wellness and happiness Crossfit will have created the first truly measurable, observable, repeatable, and ACTIONABLE comprehensive definition of health.
So, time to begin our Crossfit conquest of healthcare!
(NB: Graphs and figures to be added)
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I will address all three categories and then expand on the unified definition of health in upcoming posts.
Tags: Crossfit, fitness, health, healthcare, healthcare reform
This entry was posted on Friday, November 26th, 2010 at 2:43 pm and is filed under Crossfit, Health Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
November 27th, 2010 at 11:46 am
Our ability to earn and retain money plays a significant role in the quality of our lives. Savings and investment greatly directly effect how we spend our later years. But perhaps more important is our ability to earn and
retain physical health. To the poor, we can transfer money; we can provide Social Security, food stamps, and welfare. But to the physically impoverished, we can provide very little. If you can’t pay your rent, your rent can be paid for you. However, if and when you become sufficiently
infirm, no one, not your doctor, your friends, your family, or your government can bail you out. If your body can’t pay the physical cost of a broken hip or a bout of pneumonia or cancer, you die. The physical equivalent of bouncing a check is death.
Work capacity is the physical equivalent of money. It may not be enough to cover all of lifes surprise “expences,” but without it, you’re poor and always a step away from bankruptcy.
November 27th, 2010 at 12:16 pm
In economics, the wealth of an individual, company, or nation, is defined as the total value of assets minus liabilities. Wealth is a simple concept, because money is easy to quantify. For most of us what matters most is not our current wealth but our potential wealth. This is why we go into debt to fund our education. We believe that with the asset of an education, we can more than pay off liability of its cost. We take on mortgages and business loans for the same reason. Those of us who lack money, credit, or immediate earning potential often rely on monetary transfers from government, friends, or family.
Money has value because it allows us to buy things we cannot produce for ourselves. It can be stored and spent in the future. But much of what makes our lives worthwhile has little to do with money. Money matters, but not only money matters. We know this, but we often ignore it.
While most people plan for their financial future, they give little thought to their physical future. They rarely think about their steadily declining fitness, their increasing physical poverty. They simply become less active, avoiding the stairs and anything else that becomes physically demanding. They behave like people who are slowly adjusting to a lower standard of living, but rather than cutting back on spending, they cut back on moving.
For those of us without trust funds, achieving economic security in old age is fairly straightforward: During early adulthood, learn a skill and/or get an education. Spend most of our lives working, earning, and saving. Retire with a nest egg that will allow us to draw funds in our old age. On the other hand, most people treat their bodies exactly like trust funds. Born with a certain level of physical strength, as they age, they simply allow life (and lifestyle) to draw down the balance, until it’s nearly all gone. They then spend their final years living physical equivalent of “hand to mouth.” It doesn’t have to be this way. Just as old age doesn’t need to be a time of economic poverty, it also doesn’t need to be a time of physical poverty.
People understand money, in part because money is easily quantified. Fitness is not so straightforward. For most people, fitness is a mystery; they simply observe that as they age, they seem to have less of it. Steadily declining fitness is accepted in a way that steadily declining wealth is not. (CrossFit.com is perhaps first to provide the clear quantitative definition of fitness as “work capacity,” the ability to apply a force over a distance, and to do so in multiple ways for varying lengths of time.)
Our ability to earn and retain money plays a significant role in the quality of our lives. Savings and investment greatly directly effect how we spend our later years. But perhaps more important is our ability to earn and retain physical health. To the poor, we can transfer money; we can provide Social Security, food stamps, and welfare. But to the physically impoverished, we can provide very little. If you can’t pay your rent, your rent can be paid for you. However, if and when you become sufficiently infirm, no one, not your doctor, your friends, your family, or your government can bail you out. If your body can’t pay the physical cost of a broken hip or a bout of pneumonia or cancer, you die. The physical equivalent of bouncing a check is death.
The person whose physical work capacity is confined to short durations and relatively few alternatives (e.g., only walking and only for short distances) is the physical equivalent of the person who can only do economic work in low-skill minimum-wage jobs. Depending on the individual’s age and potential, this may be far less than he or she desires or is capable of. For the person in need of income, working a minimum-wage job is preferable to unemployment, but typically it is not preferable to working a higher paid job. At the very least, most people would like to have the option of how and where they work. However, as people age, they often accept that walking is about the best they can do in the way of exercise. (And certainly walking is preferable to not!)
But as they grow older and weaker, people tend to not even walk much; they drop out of the physical aspects of life in a way that the under skilled and underemployed often drop out of the workforce. They become the equivalent of discouraged workers. But instead of economically living off of welfare, unemployment, or others, they simply live off of what is left of their body’s “trust fund.”
To be sure, there are significant differences between how we can invest financially and how we can invest physically. For one thing, it is possible to accumulate wealth during early or mid life; to then passively invest wealth; and finally to draw down wealth later in life. With the important exception of sleep, there is no equivalent of passively investing in our bodies. Fitness demands a lifetime of consistent work that can only be done by and for the individual. Unlike our spending, which typically tends to decline as we age, the ongoing “rent” payments demanded by life steadily increase, becoming the greatest as we near the end.
In essence, we spend our lives running the equivalent of a physical balance sheet. On the asset side is the body with which we have been endowed and the contributions we make through exercise, nutrition, and sleep. On the debit side are the ongoing, increasing, and often-unpredictable charges made by life and lifestyle. We live for as long as we maintain a positive physical net worth. It pays to start investing and to keep investing.