Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Posts Tagged ‘fitness’

Contentment, Complacency, and My Fitness Tracker

Where does being content end and being complacent begin? As an older athlete this question is just dogging me. The parallel question might be where is the line between being content and capitulating? These are both, of course, extensions of some of my recent thoughts on balancing the effects of relatively high intensity workouts with the countervailing effects on recovery, plus or minus injury.

There might be a more scientific answer to these, at least in so far as fitness is concerned, and it would come from of all places the fitness tracker world. As it turns out my latest tracker(s) have the ability to measure the beat-to-beat variation in heart rate (HRV). This measurement is a proxy for autonomic nervous system activity. A lower HRV means autonomic stress. If correlated with the previous day’s workout that would argue for either a lower intensity session or rest.

Is HRV ready for prime time? Well, world class endurance athletes and many professional athletes in other sports certainly think so. How about for us, the regular folks hoping to improve our fitness and along with that our health? Dunno. I’m impressed and frankly a little depressed to find that my HRV responded so classically to what was for me an intense WOD yesterday. For this to work one must have the discipline to dial it back if your HRV is low on a particular day (be content with your work), but also the discipline to ramp it up when your HRV is high (fight complacency and go to work).

In a busy life it is likely the second part that will prove the more difficult.

Of Tradewinds and Science

“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die.” –Max Planck

So very much of what we encounter as we seek any kind of guiding truth is not science at all, but strongly held opinion forcefully presented. Think about it for a moment. Think about a few of the really big issues orbiting the intellectuosphere. Climate change. Health. Fitness. The search for the cure for cancer. Heck, the decision on what to have for lunch. So many opinions…so much money…so little true science.

Even more than that, scientific truth is continually bludgeoned by the one-two punch of politics and commerce. True science has always been held hostage by those who have vested interests in what constitutes the prevailing truth at any given time. How many promising avenues of inquiry have been blocked, and how much time has been lost because of the failure to pursue additional lines of inquiry that ran counter to “consensus”? One need only think of inflammation in vascular disease or alternatives to “fat in the diet is unhealthy”, both squelched along with the careers and reputations of their proponents while the single consensus theory was pursued. Why? Alternate theories or parallel theories would siphon the spoils from those who fed at the consensus trough.

It’s quite tempting to hold that this is all relatively new, that it is a function of our highly developed Western societies. Tempting, but ultimately false. Has there ever been a time in recorded history when a new scientific truth has upended orthodoxy and there has NOT been an attempt by the entrenched to not only stop an new line of inquiry but also destroy those inquiring? Think Galileo. From where I sit it seems as if a substantial majority of truly disruptive new scientific truth has arisen from the ranks of those who stood aside the prevailing winds and charted their own course.

What does this mean for each of us as we sit in our own little boats and sail along? The trade winds of consensus are strong, and it seems the weaker the science behind them the stronger they blow. It’s fine to allow these to fill your sails, of course, for the majority of them do in fact propel us along a true course. The best course, however, may lie in the breezes that cross the trade winds. Those tiny little gusts that represent the true essence of real science–skepticism accompanied by inquiry, followed by proof–will ultimately propel us to the proper destination despite the power of the commerce attached to the trade winds.

Every now and again the Newport to Bermuda race is won by a rebel who went off alone and discovered a new truth about sailing. We should be open to the possibility of a new scientific truth in all parts of our lives, lest we find ourselves far behind, capsized in its wake.

Or worse yet gone, as Planck suggests, long before we ever had a chance to benefit.

CrossFit Programming and the CrossFit Open

CrossFit Open workout 17.2 will be announced tonight. This is a good time to reflect on the different aspects of CrossFit. There is a tension that exists between CrossFit, the strength and conditioning program and CrossFit, the Sport of Fitness.This tension is usually expressed in the guise of criticism of various versions of CrossFit programming. What’s very interesting is the lack of tension on this topic among the truly elite CrossFit athletes. If you look at their programming it looks like they are training to become…wait for it…really good at CrossFit.

Weird, huh?

What does that mean, anyway? Good at CrossFit? This is a perfect time for you to both re-read the seminal article “What is Fitness” in CFJ #2 and to recommend it to anyone who is either curious or unsure as to what constitutes CrossFit, and for the sake of this musings, CrossFit programming.

CrossFit is the pursuit of a broad, inclusive general fitness where fitness is defined as work capacity across broad time and modal domains. In the vernacular, CrossFit trains and tests us to move larger loads further over a longer period of time. In order to do this Coach has identified 10 Essential characteristics of Fitness as so defined, each of which needs to be equally expressed. Cardiovascular/Respiratory endurance; stamina; strength; flexibility; power; speed; coordination; agility; balance; accuracy.

Fitness as defined by CrossFit and Coach Glassman includes a precisely balanced degree of each of these 10 elements, with no one element being more of less important than any other. The CrossFit Games, and the athletes who take part, are simply an expression of the farthest right side reaches of the fitness Bell Curve. Look carefully and you will see that the events ask for equal competence in all 10 Elements; the athletes are simply better than the rest of us across the board. They get there because they do more work on all of the 10 Essential Elements.

While we here, and most folks in Affiliate gyms, can assume agreement on the benefits of seeking Fitness as defined by CrossFit, this is not to say that either our definition of fitness or our particular way of seeking it (expressed through our CrossFit programming) is appropriate for every individual. Some people just like to run really long distances, while others are happiest when they lift really heavy stuff. Still others are interested only in the appearance of their body, and their entire fitness program is geared toward achieving a particular vision or visual. There is nothing inherently wrong with any of these desires, nor anything inherently wrong with the programming necessary to achieve these outcomes.

It just may not be CrossFit.

Because of this, the issue of programming is always on the table. Is there an optimal version of CrossFit programming? People take turns at supporting and denigrating the programming on the Main Page and in Affiliate gyms. For example, I think there are legitimate criticisms that can be leveled against gyms that do not emphasize proper movement. Countless efforts are made to “improve” on the model you see here on .com. Some of these alternatives make sense, while others IMO are not really alternative CrossFit programming but alternatives to CrossFit itself. Most of these, indeed most of the conversations in general, have to do with strength and strength training. Are you (is anyone) strong enough? Will CrossFit.com or another version of CrossFit make you strong enough?

The 10 Essential Elements found in CFJ #2, “What is Fitness”, are also posted on 030530 ( ironically on a day when heavy Deadlifts were prescribed). Pretty much all of the conversations noted about programming revolve around the premise that strength is somehow more important than other elements of fitness. Reasonable people can disagree on this point, but as a premise in discussing CrossFit the notion that strength is a, or the, primary element of fitness has no standing. There are 10 elements of Fitness, each no more and no less important than any other if we are seeking a broad, inclusive general physical preparedness that we call “fitness”. Full stop.

Whoa, wait a minute there Mr. bingo, aren’t you the guy who co-wrote an article called “Strong Medicine” introducing a programming alternative called “CrossFit Strength Bias”? Didn’t your home gym programming have supplemental strength training per CFSB principals since the time it opened? Isn’t that statement there just a bit, oh, duplicitous? Forked-typing?

Nope. Not at all. You see, if you read the original article you will see that CFSB is one way to address a DEFICIT in strength relative to the other 9 Essential Elements, not a program meant to gain strength at the EXPENSE of the other 9. As such it, like some others, is a program for the masses, for a CrossFitter who perceives a hole in his/her fitness that needs to be addressed, not at all unlike a CrossFitter who does supplemental work on balance or flexibility. Additional Element-specific work, be it strength or agility or whatnot, that drives continued balance and improvement in all 10 Elements is very much CrossFit. All versions of CFSB (I am now using the  newest protocol, v3.2) are designed to be one way to address this imbalance. There are others that you may enjoy more (Wendler, Westside, etc.), and just like having personal goals, there is nothing inherently wrong with another supplemental strength program as long as it works without the need to sacrifice other competencies.

Whether you are looking at members of a CrossFit Box or competitors at the CrossFit Games, CrossFit is outcome based. The outcome desired is a broad-based fitness comprised of equal quantities of each of the 10 Essential Elements. What goes into the left side of the hypothetical Black Box should produce Work Capacity Across Broad Time and Modal Domains if the Black Box is a CrossFit athlete of any type. An increase in your Deadlift brought about by concentrating on strength training at the expense of cardiovascular/respiratory endurance will be accompanied by a decrease in your 5K run time and vice versa. This may be precisely in line with your goals, but it is not CrossFit as defined by Coach Glassman and expressed at its limits by CrossFit Games athletes.

Programming for CrossFit should be aimed first and foremost at CrossFit outcomes. What you find on CrossFit.com, and what you should probably expect to find as the primary goal in an Affiliate gym, is programming that seeks to balance all 10 of the Essential Elements of Fitness, increasing all of them in an effort to produce increased work capacity across broad time and modal domains.

A demonstration of CrossFit programming will be available online tonight. It can be used as a workout or a test.

 

Musings on “Exercise as Medicine”

The “exercise is medicine” movement is kind of a confusing thing. On the one hand we in CrossFit are the uber example of how exercise as an independent variable can enhance health. On the other we have the “Big Sugar” industry funding research and promoting the notion that exercise is all that you need, that there is no effect of nutrition on health. Train your way out of any kind of diet, if you will. This has led to the toxic effect of “BS” industry money supporting academic research that is in effect little more than marketing for their products. (Visit TheRussells.CrossFit.com for details). Indeed, the soda industry in particular has come in for some very pointed criticism which includes being accused of acting like the tobacco industry ( https://blogs.scientificamerican.com/food-matters/if-soda-companies-don-t-want-to-be-treated-like-tobacco-companies-they-need-to-stop-acting-like-them/ ). Pretty harsh, but probably deserved.

Here’s the rub: exercise really is a medicine equivalent for a very large number of medical problems. Heck, if it were only to work for cardiovascular health and Type 2 diabetes it would be considered, or should be considered, a miracle treatment. Not only that, but exercise very well might work independently of diet. While exercise should not be used as an excuse to consume a poor, dangerous diet, you may actually be able to at least partly out-train a poor diet to at least some degree.

In 2009 a study was published in the International Journal of Epidemiology (http://m.ije.oxfordjournals.org/content/39/1/197.full) examining the effect of aerobic exercise on longevity (hat tip to Michael Joyner, MD at Mayo). Mind you, the study was enrolled prior to the creation of the CrossFit fitness program (completed in 2003), so the definition of fitness (aerobic health) will be viewed as incomplete by CrossFitters since it includes only aerobic fitness. In addition, what is defined as an unhealthy diet would only partially pass muster here; we would agree that simple carbohydrates (sugars) are unhealthy, but there is a plethora of more recent data that strongly suggests that red meat and healthy fat do not render a diet worrisome in the least.

A careful reading of the study revealed a couple of nuggets that should not surprise even a little bit. Eating the unhealthiest diet was associated with a 40% increase in all-cause mortality in comparison with the healthiest diet. Those who ate that worst diet and reported that they did moderate or greater levels of exercise had a 13.5% decrease in mortality. That group of bad eaters who exercised and were proven on a modified cardiac stress test to actually have greater aerobic fitness levels had a 55% decrease in mortality. Let that sink in for a minute: people who ate a shitty diet who exercised to the degree that they were fit by the testing criteria in the study were half as likely to die in any period than those who were unfit.

Boom.

Frankly, I don’t care who funded this study. Eating a shitty diet that is high in sugar increases your risk of death by 40%. Proof. Exercise that produces improved fitness, even fitness that I would view as partial or incomplete, reduces all-cause mortality in people who eat a diet high in sugar by more than half. Proof. Yeah, sure, I get that this could be used to justify or excuse eating that way, but the reality has always been that most people don’t exercise at all. Nada. Bupkis. Those who do certainly don’t achieve much in the way of any kind of fitness because they don’t exercise effectively—saying you exercise only got you a 15% decrease in mortality, after all. These results only apply if you get fitness results, and let’s face it, working hard at exercise is not the default setting in the developed world. By comparison eating better is a breeze.

Studies such as this one are mint, man. Especially to people like me, people who follow the CrossFit Rx and other programs that ask you to work hard. It’s exercise AND nutrition. Says so in the study. Sure, we can pick at this one if we want, like I did above, but my bid is that we use studies such as this one as talking points to prove that our worldview is the gold standard by which all public health initiatives ought to be compared. We can turn the cynical “exercise is medicine” campaign of “BS” on its head and use their own data against them. Eat like a CrossFitter (protein, nuts and seeds, little starch, no sugar). Exercise like a CrossFitter (functional movements performed at relatively high intensity). Seek ever-higher levels of fitness (work capacity across broad time and modal domains) like we do.

“Exercise is medicine” is just fine as long as we continue to call BS on “BS”. Health requires both exercise AND nutrition. People who are fit, especially physicians, are just the right people to tell that story.

 

“Lift”, Fitness, and the CrossFit Games

Here we are, a couple of weeks away from the CrossFit Games. Getting pretty exciting, huh? Sadly, once again, due to an illness in my extended family, I will not be able to attend the Games in person this year. Last year turned out to be our last with my Dad. This year we are spending as much time as we can with Beth’s Dad. No need to feel sorry for me, though. I think I’ve made it to 8 of the Games, each time as a guest of Greg Glassman who is a most gracious host. I’ll  surf over to the Games site and check out all the different ways to watch our annual extravaganza from home. Maybe this is the event that finally pushes me to get that new, “big ass” TV I’ve been planning to buy for…oh…3 years now.

Tuesday’s Wall Street Journal has a book review on “Lift” by Daniel Kunitz, a history of fitness. According to the review, Kunitz is very complimentary of CrossFit and Coach Glassman. Interestingly, the author of the review is a gentleman named Michael Shermer. His personal fitness journey sounds remarkably like that of so many of us in the CrossFit community. Indeed, he even references both “What is Fitness?” and the Ten Essential Characteristics of Fitness. Shermer’s discussion of fitness, sport, and training brought me back to thoughts I have had about fitness as sport.

There is a tension that exists between CrossFit, the strength and conditioning program and CrossFit, the Sport of Fitness.This tension is usually expressed in the guise of criticism of various versions of CrossFit programming. What’s very interesting is the lack of tension on this topic among the truly elite CrossFit athletes. If you look at their programming it looks like they are training to become…wait for it…really good at CrossFit.

Weird, huh?

What does that mean, anyway? Good at CrossFit? Follow Mr. Kunitz’s lead. This is a perfect time for you to both re-read the seminal article “What is Fitness” in CFJ #2 and to recommend it to anyone who is either curious or unsure as to what constitutes CrossFit, and for the sake of this musings, CrossFit programming.

CrossFit is the pursuit of a broad, inclusive general fitness where fitness is defined as work capacity across broad time and modal domains. In the vernacular, CrossFit trains and tests us to move larger loads further over a longer period of time. In order to do this Coach Glassman has identified 10 Essential characteristics of Fitness as so defined and noted in the book review, each of which needs to be equally expressed. Cardiovascular/Respiratory endurance; stamina; strength; flexibility; power; speed; coordination; agility; balance; accuracy.

Fitness as defined by CrossFit and Greg Glassman includes a precisely balanced degree of each of these 10 elements, with no one element being more of less important than any other. The CrossFit Games, and the athletes who take part, are simply an expression of the farthest right side reaches of the fitness Bell Curve. Look carefully and you will see that the events ask for equal competence in all 10 Elements; the athletes are simply better than the rest of us across the board. They get there because they do more work on all of the 10 Essential Elements.

While we here, and most folks in CrossFit Affiliate gyms, can assume agreement on the benefits of seeking Fitness as defined by CrossFit, this is not to say that either our definition of fitness or our particular way of seeking it (expressed through our CrossFit programming) is appropriate for every individual. Some people just like to run really long distances, while others are happiest when they lift really heavy stuff. Still others are interested only in the appearance of their body, and their entire fitness program is geared toward achieving a particular vision or visual. There is nothing inherently wrong with any of these desires, nor anything inherently wrong with the programming necessary to achieve these outcomes.

It just may not be CrossFit.

Because of this, the issue of programming is always on the table, especially during the Crossfit Games season that starts with the CrossFit Open and culminates in the spectacle in Carson, CA. Is there an optimal version of CrossFit programming? People take turns at supporting and denigrating the programming on the Main Page and in various CrossFit Affiliate gyms. Countless efforts are made to “improve” on the model you see on what we call “.com”. Some of these alternatives make sense, while others IMO are not really alternative CrossFit programming but alternatives to CrossFit itself. Most of these, indeed most of the conversations in general, have to do with strength and strength training. Are you (is anyone) strong enough? Will CrossFit.com or another version of CrossFit make you strong enough?

The 10 Essential Elements found in CFJ #2, “What is Fitness”, are also posted on Workout  030530 ( ironically on a day when heavy Deadlifts were prescribed). Pretty much all of the conversations noted about programming revolve around the premise that strength is somehow more important than other elements of fitness. Reasonable people can disagree on this point, but as a premise in discussing CrossFit the notion that strength is a, or the, primary element of fitness has no standing. There are 10 elements of Fitness, each no more and no less important than any other if we are seeking a broad, inclusive general physical preparedness that we call “fitness”. Full stop.

Whoa, wait a minute there pal, aren’t you the guy who co-wrote an article called “Strong Medicine” introducing a programming alternative called “CrossFit Strength Bias”? Hasn’t your home gym programming had supplemental strength training per CFSB principals since it opened? Isn’t that statement there just a bit, oh, duplicitous? Forked-typing?

Nope. Not at all. You see, if you read the original article you will see that CFSB is one way to address a DEFICIT in strength relative to the other 9 Essential Elements, not a program meant to gain strength at the EXPENSE of the other 9. As such it, like some others, is a program for the masses, a CrossFitter who perceives a hole in his/her fitness that needs to be addressed, not at all unlike a CrossFitter who does supplemental work on balance or flexibility. Additional Element-specific work, be it strength or agility or whatnot, that drives continued balance and improvement in all 10 Elements is very much CrossFit. All versions of CFSB (I am now using v3.2) are designed to be one way to address this imbalance. There are others that you may enjoy more (Wendler, Westside, Conjugate, etc.), and just like having personal goals, there is nothing inherently wrong with another supplemental strength program as long as it works without the need to sacrifice other competencies.

Whether you are looking at members of a CrossFit Box or competitors at the CrossFit Games, CrossFit is outcome based. The outcome desired is a broad-based fitness comprised of equal quantities of each of the 10 Essential Elements. What goes into the left side of the hypothetical Black Box should produce Work Capacity Across Broad Time and Modal Domains if the Black Box is a CrossFit athlete of any type. An increase in your Deadlift brought about by concentrating on strength training at the expense of cardiovascular/respiratory endurance will be accompanied by a decrease in your 5K run time and vice versa. This may be precisely in line with your goals, but it is not CrossFit as defined by Coach Glassman and expressed at its limits by Games athletes.

Programming for CrossFit should be aimed first and foremost at CrossFit outcomes. For most people, ever increasing fitness as described and defined by CrossFit results in increased health. What you find on CrossFit.com, and what you should probably expect to find as the primary goal in a CrossFit Affiliate gym, is programming that seeks to balance all 10 of the Essential Elements of Fitness, doing extra work in a lagging domain, and increasing all of them in an effort to produce increased work capacity across broad time and modal domains.

A demonstration of CrossFit programming will be available in a couple of weeks online and on ESPN. We call it the CrossFit Games. While I won’t be able to accept my invitation to visit my CrossFit friends and see it in person, rest assured that I will be glued to my (hopefully big ass) TV and watching nonetheless.

 

–bingo

Sunday musings 2/28/16

Sunday musings…

1) Sleep 1. 9 hours of solid sleep last night. While I don’t recommend major surgery as a means to more sleep, still, that was nice.

2) Sleep 2. Over the New Year’s weekend I changed my nutrition strategy. After 10 years as a strict Zoner I am now using what I consider to be a version the Zone (Macro) in a timed fashion. I’ll expand on this another time, but one of the main reasons to have done this is to improve my sleep, both quantitatively and qualitatively. I think it’s better, sleep that is, except for the effect of…

3) Sleep 3. …alcohol. Seriously, is there a weirder substance out there? On a macro level, drink too much and your life expectancy is lower, too little and ditto. Drink juuuuust enough and you live longer. Except the sleep thing. Alcohol messes with your sleep.

Still working on that particular sleep hack. Let me get back to you on that one.

4) Sleep 4. Man, lots of sleep apparently lost by Affiliate gym owners over 16.1, eh? It appears that the WOD has a couple of, ahem, logistical challenges when it comes to running it in a Box. Apparently there are a whole lotta boxes (boxen?) out there built like the classic big-city shotgun apartments of yore: long and narrow. As a partner in an Affiliate who writes most of the programming, I certainly understand the need to take architecture into account when designing the local version of our international kick.

Here’s one man’s take on it: I love 16.1. I think it’s everything we’ve come to know and love about CrossFit, both in a CrossFit Affiliate and in garage gyms and big box commercial gyms the world over. It’s a classic triplet with three easily scaleable movements utilizing one of the most time-tested formats in our quiver, the AMRAP 20:00. It’s inclusive; very few people will drop out of the Open because of these movements and these loads. Indeed, Mrs. bingo’s observation was spot on: “I’m proud of CF tonight; those two regular folks could be from our gym.” Frankly, if you’re looking to criticize (and I’m not, at least not here), you could very well quibble with the fact that it’s taken so many years to get a longish WOD programmed for the Open. At that, it’s more a quibble for folks outside of CrossFit who still think fitness equals long, slow, runs or rides.

The CrossFit Open is our annual “Big Tent” event, one in which we all gather both literally and figuratively to celebrate our shared experience. It can be a challenge for the Affiliate owner, and neither gym members nor HQ should dismiss this. But the Open is ours. All of ours. The Regionals and the Games are for the professionals and the wanna-be professionals, as near to what we do in the gym as Rory McElroy is to Joe Sixpack at the local Muni. When I recover rest assured that I will do all 5 Open WODs so that I, too, can be under the Big Tent that is the Open.

I imagine I’ll sleep pretty well after each one, too.

5) Sleep 5. I’m pretty sure no one at HQ is losing any sleep over this, but I wonder if maybe someone should. In the WSJ this week was an article about the buying habits of different types of gym members. The results of that part of the study were so predictable, reinforced stereotypes so completely that they were comical. My only surprise was that CrossFitters paid more for monthly dues than any other group including boutique cycling gym and yoga studios, but that turns out to be because those members don’t use their boutiques as often as we use our Boxes.

We spend less on pretty much everything else we buy than everyone else. Oh, except fitness clothes that is. Time for a big, fat “thank you” from Reebok right about here; CrossFit gear has sold at a rate 4 TIMES the internal Reebok/Adidas predictions. No matter what you think about the CF/Reebok deal, it looks like CF is underpaid. Of note is that we spend less on food than athletes in other genres, both at the grocery store and out to eat. Funny, that. The assumption is that eating healthier is more expensive, that it must take up a greater percentage of your finances. I’m going with that would make Coach sleep better, except he probably already knew that. Plus, I’m not sure Coach ever sleeps, anyway.

Here’s the part where someone, sometime should probably be losing some sleep: only 13% of CrossFit Newbies who sign up and pay in January are still paying for CrossFit in December. Whoa. This “fall off the cliff” decline was seen in pretty much every group of gym members over their first year, so it’s not just CrossFit. Again, not surprisingly, the big commercial gyms with a low-price business model that actually seeks non-attendance saw the lowest drop-off in membership after 12 months.

13% though. What does this say? What does it mean to the Affiliate owners and by extension to CrossFit, Inc.? We all, Affiliate owners and members alike, tend to think more about the people who are there in the gym every day and every month, working hard on their health and on being the kind of people we would remember. For me that 13% number is a punch-in-the-nose red flag that those nagging feelings about folks who drift away are real. It’s a big ol’ wake-up call about the constant need to attract new members to the gym to replace that 87% who for whatever reason just drift away. Man…13%.

Coach told my boys “[it's] easy, and it’s fun!” Lil’bingo and The Heir (and for that matter Mrs. bingo) would certainly agree that the 13% who stay real DO make it fun. Those folks who are there in your class every day, 3 on/1 off, cheering you on whether you PR or end up DFL…yah, that’s all kinds of fun. But it ain’t easy, at least it hasn’t been for quite a few years now. There’s nothing easy about replacing that 87%, and knowing that the number is that high doesn’t make it any easier, either. The professional trainer seems to need a bunch of sales professional in them according to these numbers, and as far as I can see that’s not really on anyone’s radar screens. Lots of really smart, dedicated folks who run Affiliates are up nights thinking about this. I used to be comforted by the fact that CrossFit has about a 2% penetration in the fitness market, that growth could come for everyone by moving into that 98%. This new number bugs me, though. 13% stay.

Eventually, someone might have to lose some sleep over this.

I’ll see you next week…

–bingo

Measuring Health Part 4: Fitness ‘F’

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 date 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’.

 

Comet CrossFit/CrossFit Bingo: End of an Era

Everything changes. Sometimes change means that something comes to an end. So it is with the White family’s CrossFit Affiliate. It’s a CrossFit story for sure, but it’s really more of a family story, actually. While it is surely sad–I’m certainly sad–it’s actually quite a nice story, and the ending is really very OK.

Randy gave college a try in the fall and winter of 2010 at the same school where Megan was a junior. After 2 trimesters it became very clear to him that he wasn’t really ready for a traditional college path, and that his journey would start another way. Randy and I hit up a CrossFit L1 at Rogue (my 4th, Randy’s 2nd), and then Beth and I packed him off to Brand X for a 3 month internship with the Martin Family and theCrossFit Kids team. He and I had done our original CFK cert in January 2010 as part of my 50th birthday gift from Beth: a Dad/Son Kids’ cert and surfing camp! That summer he spent his weekdays in Ramona coaching both kids and adults and his weekends traveling from London to Australia spreading the word about CrossFit and CrossFit Kids. He came home ready to begin his career as a CrossFit gym owner. When the application for Comet CrossFit was accepted by HQ he became the youngest Affiliate owner in North America.

While this was going on Dan was in his senior year in college, coming into his own big-time as student after a couple years of, oh, let’s call it intellectual wanderlust, making the Dean’s list to close out his days at DU. Home he came as a sorta/kinda pre-med grad, albeit one who managed to make it through college without taking physics, Continuing on the pre-med course would mean 2 years of classes and applications BEFORE starting the 8-12 years of medical training. Pretty daunting. He asked if maybe his brother could use some help in launching and running Comet, and thus was formed the Affiliate ownership team universally known in greater Cleveland as “The Boys”.

Those were heady times in the CrossFit Affiliate world. When Coach Glassman met the boys he was thrilled about their plans, telling them “it’s fun, and it’s easy!” Comet would be the 3rd CrossFit gym to announce its opening on the west side of Cleveland. In what can only be considered quaint now, The Boys insisted that their gym be located far enough away from CrossFit Cleveland and Coca CrossFit that there would be no way that anyone would consider them in competition with the first 2 gyms; athletes would choose their gym based on geography. This quite righteous and honorable decision made their row all the harder to sow because they chose a location far outside the reaches of their parents’ considerable contact list, but it also ensured that their successes would be built solely by their own efforts.

Comet CrossFit opened for business on Monday, October 11, 2011, with programming based on CrossFit.com and the original CrossFit Strength Bias article in the CFJ. The first WOD started out with 5 sets of Front Squats aiming for a 3-rep max, followed by 4 Rounds for Time of Run 400M/15 HSPU/15PU. Since that time Comet (and CF Bingo) have followed the classic training patterns outlined in “What is Fitness?” and on the pages of CrossFit.com, a traditional General Physical Preparedness gym with a modest strength bias. Literally hundreds of athletes have come through, coached by The Boys and eventually by their parents as well.

In time it became clear that Dan was destined for something else. He came home one day armed with a rather impressive score on an LSAT prep test asking for parental support to apply to law school. Off he went to THE Ohio State University, along with the bride he met at Comet CrossFit ( Brittany herself an accomplished CrossFitter and coach in her own right!). After 2 years of running an Affiliate now named CrossFit Bingo on his own, Randy has also come to the conclusion that he, too, is destined for something else. Randy will join his fiancé Katelyn as a full-time student, he to become a physical therapist.

And so it is time to wind down our CrossFit gym. Comet/Bingo has been an amazing experience for our whole family. We have among us more than a dozen certifications (Randy, Beth, and I are all L2, for example). Megan became a CrossFitter when she and her husband moved to South Carolina, like everyone else we/you know, finding a group of best friends in her new Box. The White family gym afforded both of our boys the time to grow that each needed in order to discover the next path they needed to take, while at the same time giving them the priceless experience of making people better. Indeed, no fewer than 3 neighboring gyms were spawned from Comet/Bingo. For Beth and I, well, we not only got the precious gift of being able to give our boys this opportunity, but we were also able to spend countless hours with them–right there WITH them–enjoying the adventure.

We leave behind our beloved gym, and we say “see you later” to our many member friends. We are not leaving CrossFit by any stretch of imagination. Both Randy and I will have little garage gyms at our homes, a literal and figurative return to an even more classic CrossFit (al la CFJ #10) than our gym. The White family is eternally grateful to CrossFit, CrossFit Kids, the Martin Family and the CrossFit community both in greater Cleveland and abroad for the love and kindness extended to us over the years. Randy, Dan, Beth and I are especially thankful for the support and friendship extended to us by Coach and the Glassman family over not only the 5 year life of Comet CrossFit and CrossFit Bingo, but also the entirety of the CrossFit experience that began with that fateful November day in 2005 when I picked up a Men’s Journal and read about this crazy new fitness thing out of Santa Cruz created by Coach.

Everything changes, and sometimes change means loss. I am so very, very proud of my boys and what they created and accomplished. I loved being with them, and my darling Beth, in their gym, and I will miss seeing my little guy, no longer little, almost every day for 5 years. Doing CrossFit in a CrossFit gym is a very special thing, all the more special when you have a hand in running that gym. We will all, each of us, miss the experience of helping our fellow CrossFitters become better. Beth and I are so very proud of what our boys did and how they did it. We are excited to see what they will do on these new journeys, journeys made possible because they owned a CrossFit gym.

I will miss our CrossFit gym, my CrossFit gym, immensely, but I continue to be comforted by the fact that I will see you all on CrossFit.com next week…

–bingo

Measuring Health Part 1: Rationale, Definitions and Background

In 2010 I had a bit of an epiphany. At the time I was a bit over 4 years into my CrossFit journey. It became painfully obvious that the genius that Greg Glassman had applied to physical fitness–a definition of fitness that invited measurement, and in turn the critical evaluation of the efficacy of different fitness programs–was nowhere to be seen in the fields of health and medicine. Indeed, an informal survey carried out in person by my friend Dr. Kathy Weesner and I made it clear that the majority of physicians couldn’t come up with an actionable definition for health despite the fact that we are charged as professionals with helping our patients become “healthy”.

At around this time Coach Glassman published a theory that health was precisely defined as “fitness over time”. In CrossFit Fitness is work capacity across broad time and modal domains. Fitness over years could be depicted as a 3-dimensional graph with axes time, work, and years. As I thought about his thesis, that a backward looking view of an individual’s fitness as defined by CrossFit was a proxy for health, I found myself with the feeling that the definition was intriguing but incomplete. In response I took it upon myself to develop a broader definition of health, one in which fitness was a primary, but not the sole marker or metric. That April I submitted a draft of my definition of health along with a new, broader base of proposed tests that would generate the data that could be used to measure an individual’s health. Over the years it has become clear that Greg and I are more in agreement than not, but a key CrossFit employee at the time had a fundamental disagreement with my thesis, and consequently the article was rejected by the CrossFit Journal. I published my draft here on Random Thoughts later that year.

For almost 6 years I have been mulling this over, threatening to return to the problem of defining and then measuring health in much the same way that Coach Glassman defined and then measured fitness. The quest was derailed by all of the usual time sinks of mid-life. In a humorous irony, the majority of my real, true free time was consumed by the task of helping my sons run their CrossFit Affiliate gym. It is time, now, for me to finish what I started in 2010 if for no other reason than to establish the provenance of the theory.

In order to effectively address any issue whatsoever it is first necessary to have a clear understanding of the definition of terms that may be important to the discussion. I made a similar statement in one of my earliest posts on the importance of understanding the difference between health, healthcare delivery (medicine), and healthcare finance. Here again I fall back on the genius of Greg Glassman: just as one cannot evaluate either fitness or fitness programs without first defining what it is that you are discussing when you say “fitness”, one must first have a definition of “health” before one can begin to measure it. What exactly is “health”? What does it mean to be healthy?

Let’s return for a moment to the physician survey that Dr. Weesner and I did in early 2010. During face-to-face meetings we asked groups of physician colleagues to give us their definition of “health” or “healthy”. The majority of the answers couldn’t have been less inspiring or more disappointing. Indeed, the most common answer was “I don’t know”! Not very comforting, that. The second most common answer was as anticipated: health is the absence of disease. In our American medical system of “disease care” this is an understandable response, of course, but as the basis for the development of a true measurement of “health” it is obvious on its face that this definition has never translated into any actionable metric. Why? Well for one it fails entirely to take into account the very real importance of “fitness”, the expression of health. More specifically, like fitness as a proxy for health, “absence of disease” also fails to address a key requirement for any measurement of health: there is no forward-looking predictive value to simply stating that you have no disease today.

A measurable, actionable definition of health is one that takes into account the degree that disease is present or absent at any given time. It must address physical fitness; to be without a named disease but to be unable to walk up a flight of stairs should not ever be construed as “healthy”. Of equal importance to these factors, any definition of “health” that will generate a meaningful metric must have a predictive value. Your Health Value should provide some measurement of your future likelihood of being disease free and fit. Our little survey of our physician peers did produce just such definitions. Given these requirements I propose that the following are actionable definitions that can be used in healthcare to create measurements in precisely the same way that Greg Glassman’s definition of fitness is used in that realm:

HEALTH: The state in which no infirmity of any kind suppresses, or has the possibility of suppressing the ability to express the full extant of an individual’s potential capacities.

HEALTHY: Able to perform in all ways at the farthest limits of one’s potential capabilities.

With these definitions we can move on to developing a “health metric”, one that can not only assess our present degree of health, but can also predict to some degree our ability to remain healthy. I believe this metric has three component parts: physical fitness as defined by CrossFit, well-being or emotional health, and a factor that addresses traditional or standard medical factors such as blood pressure, cholesterol, genetics and the like. Furthermore, I predict that these three variables are as evident and as logical for “health” as Coach Glassman’s definition is for fitness.

One can have an otherworldly degree of fitness as defined by CrossFit, but what good is it to have a 500 pound deadlift and the ability to run a 4:00 mile if your physical achievement is driven by self-loathing? By the same token, in addition to having a normal result in every conceivable medical test your countenance is as sunny as an 8 year old on vacation, your disposition so Zen-like that the Dali Lama himself wishes he were as happy and serene, but you can’t walk a mile. This surely cannot equal healthy. You are a world-champion long-distance runner, and yet you drop dead from a heart attack, unaware that you have a cholesterol of 800. Fit for sure, but hardly healthy. Fitness, well being, and modern health metrics all have a role in an actionable Health Measurement. Vigorous debate will be necessary to parse the relative weight given to each of these factors, but as I first proposed and wrote in April 2010,all three are clearly necessary components.

In short order I will offer follow-up posts that delve more deeply into each of these three components. I will include suggestions for what and how to measure them. I will conclude with a re-statement of my proposal for a single measurement of health with my suggestion as to the relative weight of the three variables, hopefully inciting the above-mentioned vigorous debate. By doing so I wish to document the originality and timeline of my proposal, acknowledge the intellectual debt owed to Greg Glassman for inspiring me, and reassert my contention that healthcare cannot reach its fullest potential without first agreeing on both a definition of health and how to measure it.

 

 

 

Fitness as Health Marker

The human body as a machine is an endless source of fascination. Designed at this point in evolution primarily as a vehicle to carry a brain, our bodies can withstand famine, thirst, and physical stress beyond what our brains can imagine. When one part starts to fail we have a series of “fail-safe” backups in many cases that allow us to carry on. Interestingly, the greatest harm to our “vehicles” is actually excess (gluttony) and lack of physical stress (sloth).

Kinda Biblical, eh?

There is a complex daisy chain of effects that can ever be traced back to a cause when our bodies begin to break down. My own musculoskeletal system is failing me miserably, and it has taken the eventual unavoidable breakdown of one of those fail-safe mechanisms for me to finally figure out the original cause. Last month’s programming with its emphasis on our core was the last straw.

For the better part of a year I have struggled on and off with progressively worse failures of accessory muscles for mid-line stabilization. The posterior chain (gluteus maximus, hamstring, erector spinae) precisely balances your anterior chain (rectus abdominus) in maintaining a rigid core so that you can do, well, everything. Progressive movement failures in the gym (massive retrograde numbers in lifts, need for major scaling of loads) has now given way to rather plebeian challenges: spasms of the gluteus medius, priformis, and obturator (not to mention that rat bastard the extensor fascia lata) which sometimes drop me in the simplest of movements.

My initial reaction, of course, was to address what must be a weakness in these accessory muscles due to inattention. Surely this would be all that I needed to return me to my previous level of physical prowess. Naturally, since these “failures” were actually the fail-safes going down, accessory work on these muscles only worsened the problem by OVER-working the already overburdened.

How, then, did I figure it out? Well, as I noted, the chariot that rolls along carrying our brain is ever set to do its job, and eventually it sends up a signal when all of the backup systems failed. A tiny little dull ache appeared in my lower abs, an annoyance that escalated to Def-con 1 whenever I braced my anterior chain for any task whatsoever. There was no difference between a back squat or a “bear in the woods” squat–I could not use my abs to secure my midline, and guarding against the pain had shifted that burden to all of those little helper muscles.

A tiny little tear born in an area of inherited weakness turned out to be the cause. My friend the general surgeon describes the defect as “a dime with aspirations of becoming a quarter.” A half-dozen really smart folks had failed to see it, all of them equally fascinated by the epic failure of my Piriformae. And so it is that I will engage the knife as I seek relief on behalf of my accessory warriors such that they may return to their proper roles behind the front line of the midline stabilization battle.

What’s the point of all this sharing you ask? It’s pretty simple, really. Very basic. Each one of us is, or should be, engaging the CrossFit prescription of strength and metabolic conditioning aligned with proper nutrition in the pursuit of better daily function. Better, clearer thought. Stronger, leaner, faster bodies. In order to do so it is necessary that we are ever aware of those bodies, ever vigilant in our pursuit. CrossFit provides us a metric that allows us to monitor the machine that transports our brain. My performance began to suffer. I stalled, then backed up. Measurable and observable that I was failing at repeatable. To discover the root cause I eventually used the degree and manner of those failures to work back to the source. I think fitness as we describe it is best seen as a real-time marker for health. CrossFit approached properly is the thinking athlete’s fitness program, the inquisitive athletes health monitor.

Now to be fixed and resume my quest.