Random Thoughts from a Restless Mind

“[True] innovators are on the edge of the inside.” Friar Richard Rohr

I once wrote that “if you’re not living on the edge you’re taking up too much space.” This is a bit different. Effective innovators and those who are early extenders of their ideas cannot be so far outside of present orthodoxy that their innovation is ignored, however correct they may (turn out to) be. An innovation or discovery that is too radical to even be examined might be shelved simply for being too far outside the inside, thereby denying countless individuals its benefit. Incrementalism occurs in the middle, but innovation that scales happens just barely inside the border.

Think about my fitness program, CrossFit. What would likely have been the result if step one had been the spectacle of the CrossFit Games, ca. 2017? We all know the answer to that: Constantly varied functional movement at relatively high intensity (CVFMHI)  would have been deemed ludicrous for all but the elite athletes we are seeing perform in the East and South Regionals this weekend, rather than a legitimate option as we seek a public health solution to the well-being of a broader population. The sentinel signal of the innovation was initially ever so slightly inside the outer boundary of the fitness/health orthodoxy: train consistently using irreducible full-body exercises at higher intensity utilizing proper movement patterns. Others have noted the importance and effectiveness of interval training, notably Michael Joyner, M.D, at the Mayo Clinic. While a sense of the importance of the glycolytic energy pathway existed before CrossFit, it took an innovator far enough outside the middle to realize its potential and make it the primary focus of a program.

The world of my day job is also populated by innovators who were just radical enough to nearly become outcasts. I always think of the great Charles Kelman, M.D., the inventor of what we now know as phacoemulsification. When Dr. Kelman began his research on using high frequency ultrasound to dissolve a cataract through an incision roughly 15-20% the size of what was then typical, no one could fathom why that would even matter. Fast forward to our present day ability to remove a cataract through a 2mm incision. Because of that first innovation I can now replace a cataract with an implant that allows someone to see both near and far with no glasses. Imagine!

Once true innovation occurs it moves inward, but a next wave of innovators lurks near the edge. Like so many benign Salieri’s to Mozart they build upon the original innovation within their own, smaller zones. This is no less disruptive than that original innovation; it simply occurs in a different part of the world. Shortly after CrossFit erupted in the general fitness world a second wave was brought by innovators in youth fitness by Jeff and Mikki Martin of Ramona California. Their program is now known as The Brand X Method and they lecture on their evolved programs for youth fitness all over the world. In a similar fashion Brian McKenzie, an ultra runner looking for a way to train more efficiently and with fewer injuries, used the principals of CrossFit as applied to endurance training in what was originally known as “CrossFit Endurance”. B Mack is also continuing to push the envelope in his PowerSpeedEndurance program.* It was only the growing acceptance of the original innovation that prevented these next-wave innovators from being OUTSIDE the edge of their particular parts of the fitness world.

The logical extension of CFVMHI, what we are witnessing each weekend as The CrossFit Games season is upon us, has long since passed me by. It turns out that for me all I’ve needed was an early update to the original inspiration (classic, early vintage CrossFit.com with CrossFit Strength Bias v3.3 layered on); more and more actually brings me less of everything. Others who I am quite fond of have had a different journey. One of my daughters-in-law is doing a modified CrossFit Endurance protocol for example, and is winning her age group in 5K races while pushing my granddaughter “The Nugget” in a race stroller. My grandson “The Man Cub” will doubtless train using the Brand X principles that have evolved from the original CrossFit Kids program. My friend Julie continues to push the limits of human everything as she competes on a CrossFit Games team while developing new medical paradigms, all before graduating from med school here in Cleveland. Unlike yours truly, more and more brings Julie more and more. Innovators in the world of eye care similarly bring us new techniques from the edges of our world, the latest being the once unthinkable ability to treat floaters with a laser.

CrossFit is now firmly established as both a system and a business. Small incision cataract surgery using ultrasound is the standard of care. We would do well to remember that time when this was not at all the case, a time when only one innovator sat just inside the outer edge. What is to come in any number of other areas–medicine, finance, digital, what have you–will come from the same place. Some of us caught on to CrossFit really early. Wouldn’t it be great to be out near the edge and catch something like that right in the beginning again?

*To my knowledge neither the Martins nor Mr. MacKenzie are presently associated with CrossFit, Inc.

Health should be defined along the lines of individual human potential. An actionable definition would go something like “the ability to live at the limits of your fullest potential without any encumbrance now or in a foreseeable future”. Fitness as defined by Greg Glassman and CrossFit–work capacity across broad time and modal domains–should therefore be seen as “applied health”. As such, since fitness at any given time is an accurate measurement of one’s functional ability, our variable ‘F’ should have the heaviest weighting in our Health Index.

Let us begin our discussion of Fitness by reviewing and dispelling several myths and misconceptions about the interrelation between health and fitness. First, is it really necessary to review all of the data which now stares us in the face as far as the importance of exercise in health? By the same token, it should be clear to any sentient being that not only is what we eat important (although we must concede that this may differ across populations) but how much?  Simple carbohydrates, manufactured substances meant to cheaply replace real food, harmful (trans-) fats–it doesn’t matter what KIND of nutrition plan you follow, these are all BAD. As I write this I am recovering from surgery and I am not able to exercise. Does anyone believe that I will NOT gain useless weight if I maintain my pre-operative food intake? This part isn’t rocket science, folks. Coach Glassman says it as well as anyone: “Eat [protein] and vegetables, nuts and seeds, some fruit, little starch, and no sugar. Keep intake to levels that will support exercise but not body fat.”

Next up is the canard that fitness is simply being able to do something for a very long time. This view, promulgated and propagated by the likes of Outside Magazine and others, is not only insufficient but has been shown to be false as well. In the last couple of years there have been a number of very important studies showing a degradation of heart function in so-called “Ultra” athletes in any area. Decreased cardiac output and an increase in cardiac arrhythmias such as atrial fibrillation have been shown to be caused by excess endurance training. Endurance as the sole defining characteristic of fitness is as incomplete as would be strength. One need only look at the life expectancy of the strongest humans on record to see that strength in and of itself is not sufficient to produce health.

The question of what constitutes fitness is one that has been answered, at least insofar as health is concerned. It is not enough to be able to run or bike or swim long distances if you cannot also lift heavy things, including your own body. In the same vein one is not truly fit if one can deadlift or squat 3X his or her own bodyweight but cannot run a mile in under 15:00. One must have some measure of BOTH. As such the inescapable conclusion is that Greg Glassman is correct when he says that fitness equals work capacity across broad time and modal domains. You must be able to lift heavy things over a short distance when necessary, but also possess the ability to carry lighter things a longer way for a longer time as well. While I am not naive enough to expect that this will be accepted without spirited debate, when it comes to any measurements of health now available, all arguments to the contrary are not supportable. Glassman has won this battle.

As an aside, this should once and for all put to rest the myth of the “healthy obese”. What good is it to be happy, ‘W’ off the charts, with a stratospheric ‘M’ because all of your bloodwork is perfect, to go with your BP of 120/70, if your joints will cave under pressure decades sooner than they need to? You simply cannot escape the reality that health requires physical fitness.

If fitness can be described as “applied health”, it stands to reason that it will have the greatest contribution to our eventual Health Index. As such it is especially important that our chosen tests meet the criteria outlined in Part 1, that the measurement be as broadly accessible in all ways as possible. In the purest sense we would be able to measure an individual’s “work capacity”, the totality of his or her expression of fitness as measured by many tests covering different loads, distances traveled, and time. In CrossFit we talk of this as the “area under the curve” of a graph that records Power (lbs-ft. per second) on the X axis and Time (in minutes) on the Y. In a perfect world this would be part of every individuals ongoing pursuit of health, but alas, even in the CrossFit world where a very committed everyone records everything, this has proven to be problematic. In designing a series of tests to be applied to the broadest possible swath of humanity this ideal must yield to a more pragmatic approach.

What, then, should we measure, and how? Let us first propose a couple of general characteristics of the tasks in our test and then see what fits the bill. We should test an individual’s ability to move from one place to another under their own power–running is a fundamental human trait and should be part of our evaluation. Likewise, the ability to pick something up off the ground is a pretty basic, everyday movement and would qualify as our test of strength. Lastly, in the U.S. we have a storied heritage from the 1960’s, The Presidential Council Fitness Challenge (PCFC), in which candidates are tested on their ability to perform calisthenic exercises for both speed and endurance. It would be fitting to include something that evokes this historical element.

Once again I anticipate a vigorous debate about the particular elements we include. I’ll go first. We can reward both speed and endurance by starting with a timed run in which the result is distance traveled. The most common example of this comes from athletic programs and the military: a 12:00 timed run for distance. We live in the U.S.; the unit is yards. Pick up something heavy? Sure sounds like a deadlift to me. Any deadlift you wish, standard or sumo, will do. My bias is that a lifting belt is just fine, but except in very special circumstances (e.g. one-armed subject) I would say that straps to help you grip the bar are not a good idea, especially for the very inexperienced subject.

After giving considerable thought to the exercises and format in the original PCFC I think we should simplify the test while at the same time bringing it into the modern fitness world. In the PCFC one sought a maximum number of reps in 2:00 of pull-ups, 2:00 of sit-ups, and 2:00 of push-ups. What exactly are we testing with sit-ups that reflects true fitness? I would favor swapping out sit-ups for air squats. With a nod to CrossFit and Greg Glassman’s outsized contributions to this discussion, let’s use the format made famous by the CrossFit WOD “Cindy” with a small adjustment. To test our subject’s ability to perform bodyweight movements and move quickly, repeats of the triplet of 5 pull-ups, 10 push-ups, and 15 air squats in 6:00, counting as our result the total number of repitions achieved.

There you have it. A definition of “Health” and “Healthy”. The introduction of the three variables that go into the measurement of “Health”: traditional medical values ‘M’, emotional well-being ‘W’, and Fitness ‘F’. Next I will address how we will value each of these measures, and then ultimately how they will be combined to give us a meaningful, actionable health measurement ‘H’.