It’s really incredible what’s been said about our CrossFit on the information highways this week. The amount of opinion masquerading as fact-based advice is off the charts. Anyone’s who’s been around CrossFit for more than 2 years will realize that it’s just that part of the cycle, that time when CrossFit has reached another Tipping Point size-wise and has therefore come to the attention of another outwardly spiraling circle of “experts.” Trust me, it’s Groundhog Day in the gym, so to speak.

This is a wonderful opportunity to take a moment to reflect upon what CrossFit actually is, what it is not, and for whom CrossFit is appropriate. Let’s start with the last and work forward. CrossFit is appropriate for almost everyone. The group for whom it may not be really the best option is actually counter-intuitive: elite single sport athletes in highly skilled endeavors. Waaaiiiit at minute here, you might be saying. The highest-skilled elite athletes may NOT be the best CrossFit candidates, but the great unwashed masses of the obese, unfit,  and unhealthy ARE?! You bet, Bucky. That’s exactly what I’m saying. The .01% probably need to spend 100% of their time on their specialty, SPP or Specialty Physical Preparedness; CrossFit is GPP, General Physical Preparedness.

CrossFit is for the other 99.9%.

Why? How can that be? Well, that runs into what CrossFit is not, namely a dangerous, hyper-intense program that has a high injury rate, something too over-the-top for “regular” folks. Uh, uh. The real “dirty little secret” of CrossFit (if I may crib a rather recently famous phrase) is that scaling the stimulus and subbing in favor of more approachable movements is decidedly the norm in almost every setting where CrossFit is done. Technique. Then consistency. Then, and only then, intensity. Says so everywhere. Are there small pockets of CrossFit or CrossFitters who jump the gun and go straight to intensity? Sure. But that is hardly an indictment of the program, especially since the program and the company incessantly beat the drum: technique, then consistency, and only then intensity. The injury rate in CrossFit, if anyone cared to ask, is actually quite low, especially when you compare it with, say, running, where something ridiculous like 90% of runners suffer a running-related injury every year.

Which brings me to what it is that CrossFit can actually be said to be: the solution to the adverse effects of overabundance. A viable answer to the problems created by an unhealthy population. While the CrossFit Games have been an incredibly effective PR vehicle for the CrossFit Affiliates (which is also true, paradoxically, of all this silliness on the web right now!), they have confused a vocal segment of the opinionators about CrossFit and CrossFitters. Peek through the door of any CF Box and guess at who’s inside. Here’s a tip: it ain’t Jason and Miranda! It is, however, everyone else. What do you think they will be caught doing? Again, likely not what Jason and Miranda are doing that day! They will rather be doing approximately an hour’s worth of work, some of it skill-based, some of it directed toward some hole in their fitness, and almost certainly culminating in something that we would all recognize as a WOD. Look very closely, though, because if you do you will also see that there will be many subtle variations of that particular WOD going on, maybe as many subtle scalings as there are CrossFitters in the gym.

CrossFit is a highly customizable system built on the core principles elucidated in the Classic CrossFit Journal Issue no.2, “What is Fitness”, for which there is a link on the left side of the Main Page of CrossFit.com. A prescription for not only fitness but also health that includes a universally scalable program of exercise (with scaling options also offered under the “Start Here” tab on CrossFit.com) in combination with an easily followed guideline for nutrition, all geared to produce incremental and sustainable gains in 10 very specific physical domains. Following this “prescription” results in health, and when we combine this individual health with the wonders of the communities that have grown out of gatherings of CrossFitters we end up with something that could be called Wellness.

None of this is new. Nothing I’ve said here is unique or original. It does bear repeating, though, because you might be relatively new, and this latest round of “CrossFit is dangerous” or “CrossFit is only for people like Jason and Miranda” might actually be your first rodeo. It’s OK. Relax. It’s still technique, then consistency, and only then intensity. It’s still eat to support performance in the gym but not production of fat. Still learn and play new games. It’s still CrossFit.

CrossFit is still the answer.

Sunday musings (from the Games)…

1) Hall Pass. Yup. Got mine. The whole weekend to hang at the CrossFit Games. With “The Heir” and Lil’bingo. Yup.

2) Cyber-gym. Once upon a time in CrossFit land most of the people who did CrossFit congregated here, on the Main Page of CrossFit.com. This cyber-gym has since expanded, kinda like an Affiliate that got so big it needed a bigger space, and now it includes stuff like FB and Twitter. Many of us have forged a very cool kind of friendship or kinship through the shared suffering of CrossFit in this cyber-gym.

It’s especially cool to actually meet these folks in real life. For real…like shake hands and hug kinda real. At the CF Kids Teen Challenge I met the near-OG who once upon a time went by “Cougar” around here along with a half dozen other women who’ve met the same way. Very cool pic floating around FB as proof.

Full frontal hugs had by all.

3) Vetted. Bumped into Kelly Starret. You know, budding author about to be published (do look for his book, out in early 2013). We got to chatting about our community and the word he used to describe it was “vetted”.

“I know everything about you once I know you are a CrossFitter. I know who you are. I know who you hang out with. I know the kinds of choices you make, good choices. I already know we will be friends. You’ve been vetted, simply by telling me you are a CrossFitter.”

I really like that word and all it stands for in this context. There is an assumption of good will extended from all CrossFitters to all CrossFitters. We are not surprised in the least when we meet yet another really nice person with a great story. Astonished yes, but no longer surprised. Like today when an honest-to-goodness real-life American hero spent 20 minutes talking with my boys after just having met them, sharing words of encouragement and inspiration (you and your fiance know who you are–thank you).

Indeed, I like that word and how Kelly used it so much I think I’ll buy him a dinner at a place called “Lola”!

4) Community. I’ve been reading Allison Belger’s book “The Power of Community” in which she dissects the CrossFit Community from the perspective of both a CrossFitter and a psychologist. I’m reading and re-reading parts so I’m not going through it all that quickly–I’m enjoying savoring the gems and jewels I’ve been finding there, and I’m sure that I will share more than several of those once I’ve mined it fully.

Every anecdote so far elicits a knowing nod. I struggled a bit with the question of “why”but I think I’ve figured it out. You know, as in why does CrossFit create such a strong community? Again and again, on a micro (Affiliate gym) and macro (the CrossFit Games gathering) level.

The science is cool: it turns out that we as creatures are probably wired for community, wired to become a part of a community. What it takes for this pre-wired state to become operational is some trigger or stimulus. The most exciting applied neuroscience now extent is in the realm of my day job where the brain part of the vision system can actually be made to change, to get better, if the stimulus that causes maximal activity in a neural pathway is repeatedly applied.

Ah… now we’re getting somewhere. Our stimulus is the willful acceptance of discomfort, and more so the shared experience of that discomfort in an effort to better ourselves. There is obviously something about this particular stimulus that fits right into that pre-wiring for the creation of a community. Dr. Belger’s book not only gave me an expanded vocabulary to describe our community, what our CrossFit community looks like, but it also helped me answer the the question of “why” it happens.

Whether in the cyber-gym or a Box, the stimulus for community lies in the willingness to pay the price to move beyond your perception of what is possible; once having done so one seeks others willing to do the same.

Having found them one always seems to be at home.

I’ll see you next week…

Posted by bingo at July 14, 2012 10:30 PM

The most dangerous man in American health care is Greg Glassman. That’s right, the man who will make the biggest difference in making our country healthier, and thereby reducing the cost of providing health care, is a fitness trainer from Santa Cruz California. And you have no idea who he is.

That’s okay, though; you’re in good company. There are lots of really important, really influential people in American healthcare who have never heard of Greg Glassman. Donald Berwick, head of the Centers for Medicare and Medicaid Services? Not a clue. Toby Cosgrove, CEO of the vaunted Cleveland clinic foundation? Nope, never heard of him. So it goes, as well, for the presidents and executive vice presidents of all the various and sundry medical “letter” organizations like the AMA, the American Association of ophthalmology, and the like. The man who might hold the key to economic healthcare salvation is not even a blip on the margins of the healthcare establishment’s radar screens.

So what’s the big deal? Why is Greg Glassman the most dangerous man in American healthcare? There are two reasons, actually. First, he is right. Glassman has identified not only the most fundamental and foundational problem with the health of Americans, but he has also discovered, defined, and implemented the solution. Americans are not fit. There is an appalling lack of physical fitness in the populace. Fat and slow, or skinny–fat and weak, we are a nation of the unfit. What Science Daily calls “frailty” in an article linking a lack of fitness to poor health outcomes (ScienceDaily.com/releases/2011/04/110426122948.htm), Glassman calls decrepitude. Skinny or fat, how healthy can you be if you can’t get yourself out of a chair without assistance?

Somewhere around 2001 Greg Glassman co–founded a fitness system which he dubbed “Crossfit”(http://www.crossfit.com). He offered  the first actionable definition of fitness ever created: work capacity across broad time and modal domains. How much stuff can you move, how far, how quickly. It’s not enough to be strong, you must also be able to travel long distances. By the same token, it’s not enough to be able to travel long distances if you are not strong enough to lift your own body. This definition led to a measurement of fitness, power output or work.

To achieve this level of fitness Crossett offers the equivalent of a prescription. Exercise should consist of “constantly varied, high intensity, functional movements.” Intensity is the key. Fitness gains are not only magnified but are achieved in the most efficient manner when the exercise is performed at relatively high intensity. Functional movements include fitness standards like running, swimming and biking, but also weight training using major lifts like the deadlift, the clean, and the squat. Crossfit has returned those staples of gym classes in the 60’s, pull-ups, push-ups, and squats, to a prominence not seen since the days of Kennedy’s Presidential Council on Fitness.

Caloric intake matters; you can’t out train a bad diet or a bad lifestyle. Crossfit’s dietary prescription is quite simple: “eat meats and vegetables, nuts and seeds, some fruit, little starch and no sugar. Keep intake to levels that will support exercise but NOT BODY FAT.” Crossfit preaches the merits of both quantity and quality when if comes to food. Carbohydrates with a low glycemic index, protein containing all essential amino acids, AND FAT are all essential to producing physical fitness. Food should be seen as fuel and should be measured as such. Even the highest quality foods consumed in the most balanced proportions will produce increased body fat and decreased fitness if taken in too high volume

A funny thing happened on the way to revolutionizing the fitness industry. In addition to increased strength, increased endurance, and decreased body fat, which translated into a dramatically fewer inches and lower dress sizes, it seemed as if everyone who did Crossfit became healthier. Lower cholesterol. Lower resting heart rates. Decreased blood pressure. Elevated moods. It looked like a move away from decrepitude and frailty was actually a move TOWARD health. Toward WELLNESS.  A scientist at heart, Glassman digested this information and in 2008 made the following statement: fitness is a proxy for health. Indeed, Glassman declared that fitness EQUALS health. In this, Greg Glassman is right, or at least more right than not. At a minimum, fitness is the foundation upon which health is built. A healthy nation is one that need not expend countless $Billions on curing diseases that could be prevented by becoming fit. This is the first reason why he is the most dangerous man in American health care.

The second reason is that he doesn’t care.

Greg Glassman is like the little boy standing at the side of the road watching the naked emperor parade by who declares “the Emperor has no clothes!” He is standing there watching a parade of the fat and the weak and he is saying “hey look…they can’t get their butt off the throne!” It’s uncomfortable to hear someone say that, but he doesn’t care; it needs to be said. The standard dietary dogma of high carbohydrate, low-fat diets with little or no meat? A straight ticket to decrepitude! He doesn’t care that statements like that make all of the Oz’s and Pritiken’s sputter and squirm. When asked once upon a time how to gain weight for a movie role Glassman famously responded: “ easy…non–fat frozen yogurt.” It’s no different with exercise. Walking and other low-intensity exercises? Better than nothing, but only almost. Cue the howls of the Jillians and the Jakes, and every glossy, muscly, fitnessy magazine editor in the English speaking world. Glassman is right, and he doesn’t care.

Greg Glassman has looked at what is wrong with the health of Americans and he is willing to say what that is and say it out loud. He is willing to say that we as a people are unfit, and that this is the primary cause underlying our lack of health, and our accelerating need to spend money to cure disease. He is willing to say that the vast majority of the advice that we have received to fix this is flat out wrong, whether it comes from the government or the cover of Fitness Magazine. He is willing to say the the road to economic salvation in American Healthcare leads through the gym, the grocery store, and the kitchen, not to or through something as meaningless as an “Accountable Healthcare Organization” (whatever that may be). Although he is convinced that he is right he is presently spending gobs of his own money studying the effects of the Crossfit prescription on the health of regular people.

Yup, Greg Glassman is right, and he doesn’t care that all of the so–called experts in healthcare don’t know who he is yet, or that they wouldn’t agree with him if they did. Judging by what’s going on in the physical fitness world right now as Crossfit grows 30% PER MONTH, I’d say that makes Greg Glassman the most dangerous man in American healthcare.

Better learn how to spell his name.

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.