Random Thoughts from a Restless Mind

Sunday musings…

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

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

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

True relevance is substantive. Or should be.

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

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

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

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

That, and they are fun to write about.

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

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

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

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

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

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

Who is to say who’s right?

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

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

I predict I’ll see you next week…

–bingo

Hi. My name’s Darrell and I buy activity trackers.

Like most everyone else, I’m sure, it started off innocently enough. For me it was the Nike Fuel Band. Man…was that fun! Looking back it really didn’t do all that much to be honest. As far as I can tell all it really did was tell me how many steps I did, and maybe there was some other kind of movement it tracked. Heck, Nike made all kinds of a big deal out of the “social aspect” of the Fuel Band. How I could follow groups and compete to see who got how much Fuel and I never even did any of that.

It was the fireworks that got me, I think. When you made your Fuel goal, whatever that even meant, your band erupted into fireworks.

Thinking back that might have been enough. A Fuel Band, daily fireworks, and I might have stopped right there. Ah, but as is so often the case when you are an early adopter, my Fuel Band was not really a ready for prime time grown up product. It broke less than a year after I put it on for the first time. But me? I was hooked. I imagined all kinds of cool stuff you could do with a REAL tracker. A tracker that could measure something real and meaningful like…wait for it…WORK. I’m a CrossFitter after all. WCABTMD is my ultimate goal. Of course I’d want to track my work done.

So began my quest. The research wasn’t quite as in depth, my dive not as deep as my initial jump into CrossFit so long ago. Imagine how long it took to get through a few pages of CrossFit.com or the original CrossFitKids.com with a dial-up or early stage cable modem. No, this was a high speed/high churn journey. Next up was a Garmin Vivofit which taught me that I should care about sleep. Not just sleep of course, but the measurement of my sleep. Who knew? Years ago I’d researched sleep and I knew I should be getting some multiple of 90 minutes (cycles) each night, but now I could measure that, too.

Naturally the VivoFit was inadequate: no points for a PU. So, too, the Jawbone Up came up short. I gave some thought to the Athos wearable garment sensors, but my craving for measurements wasn’t deep enough to prompt me to buy something that only told me when and to what degree a particular muscle group was firing (although it would have been a cool way to dial in my deadlift and squat technique).

Over time it became clear that the entire fitness tracking industry was just one big shill for the endurance community. All of them were dedicated to measuring your aerobic activity. Period. [Note to Coach Glassman, and everyone in the functional fitness community: if you want growth in your part of the fitness world get a viable tracker of work capacity on the Apple Watch] I had great hopes for the Mio Slice and the BioStrap because you could dial in specific exercises and get activity credit when you did them, not just when you were running, biking, or rowing. Alas, although they were light years ahead of my beloved little Fuel Band they, too, were not ready for prime time. It was comical to see what they decided I was doing when I exercised.

Although my disappointment was painful I was in too deep to just give up. Surely, science would step in with something more meaningful than how many steps I got each day. Enter Heart Rate Variability as a proxy for autonomic nervous system health, ergo fitness. Could this be it? My BioStrap was now matched against both a Zoom HRV and a program on my phone that used the camera to measure HRV. The science was great.

The data was meaningless.

Now desperate I turned off everything except my alarm clock and my cheap little $15 Casio with a stopwatch. Yes, you read that right: I went cold turkey. I hit the pillow and woke up without any kind of measure other than “did you sleep well, dear?” from my wife Beth. 3-2-1-Go, start the stopwatch on my cheapo watch and go as fast and as hard as I could. Sweat angels instead of rushing to check my numbers. No plugging my results into Strava or Beyond the Whiteboard or anything else. It was hard. I couldn’t tell whether the shakes were from the WOD or from trying not to reach for my BioStrap and my phone.

But I made it through. I did give a thought to buying an iPhone when I saw it could do a one-lead EKG (an EKG on your wrist!), but I managed to resist. Recovery is hard, especially if you can’t watch your heart rate go down. No, no, no, I meant it’s hard to not want to put on one of my trackers. You know, just to check. The urge is getting weaker each time I go to the gym now, so I think I’m in the clear. It’ll be tough if something comes out that can really tell me what work I’ve done, what the area is under my curve, but I guess I’ll have to deal with that if it ever actually happens. For now I am free of activity trackers of any and all kinds.

Although I really do miss those Fuel Band fireworks.

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.