The “Critical Point of Change”

Success truly is a habit, not a destination or static state.

I note this because we’re coming up on the New Year and people will invariably think that if they just really want something, that not only can they have it but they can keep it once they have it. This presupposes health and fitness are trinkets, items that once collected are kept in perfect order unless acted on by an outside force.

Here’s the thing: doing “nothing” once achieved *is* the outside force. What maintains health and fitness is not really wanting it, but wanting it just enough to regularly check in on it, in this case that means habits conducive to maintaining your earned health and fitness. What it is not, in spite what we might wish, is a “critical point of change,” a threshold that once crossed, changes the state of affairs permanently.

What do I mean? In the book Ubiquity, physicist and science journalist Mark Buchanan introduces the reader to the science of what he calls “historical physics”–the study of systems that are far from equilibrium and, as he puts it poised “on the knife edge of instability”. He describes a much-studied model of such catastrophe-prone systems, a simple sandpile. Build a sandpile by dropping one grain at a time on the now heap of sand grains. It will eventually reach a critical state at which a grain can either make the pile a bit taller or start an avalanche, small or large. Scientists experimenting with real and virtual sandpiles have observed several important regularities:

  1.  The time between avalanches is extremely variable, making it essentially impossible to predict when the next avalanche will occur.
  2.  The size of avalanches is also extremely variable, making it essentially impossible to predict whether the next avalanche will be tiny or huge.
  3.  A big avalanche doesn’t need a big cause; one grain can trigger a sandpile-flattening event.

While biological systems absolutely adhere to the laws of physics, human beings and their behavioral tendencies do not. The idea that, at some point, a switch is flipped and you are on good behavior autopilot is a fallacy. It gets easier, of course, approximating automatic, but if you slack off, backsliding is still very easy. This is why you build an environment that makes that backsliding hard (i.e. no junk food in the pantry) so when our fragile humanity kicks in, we’ve saved ourselves ahead of time.

To put it another way, when asked how long you have to do this, a trainer friend of mine put it succinctly:

Till you die, ma’am.

The Middle Way

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Health and vitality is the birthright of everyone on Earth. It’s not just the United States that is experience an obesity epidemic, and the health implications that come with it, but the rest of the world as well. Locally, this is a function of being the “Great Experiment,” where a melting pot society allows those to live however they choose. This means that one is free to follow, or ignore, cultural norms as they choose.

However, cultural norms have stood the test of time for a reason: they’re a directionally accurate answer to many of the societal problems encountered by a group. When it comes to health and vitality, long standing cultural norms are a constant reminder of the steps needed to keep healthy. I’ve discussed this a number of times in previous posts (here and here).

Most of us learned eating habits from our parents, who came of age in a TV Dinner/Fast Food nation that valued access and volume over quality and health. It’s no wonder we continue to get fatter!

In the absence of culture, you can pay to have someone do all the work for you. A personal chef controls the portions, food stuffs, and shopping, so you don’t have to think about that. Last I checked, none of my clients are in a position to afford such a luxury.

We’ve been trying to solve this dilemma at EE for a while now: how do you help people to learn how to eat better (not what to eat, necessarily) while making the information actionable without breaking the bank?

I had trouble putting it together until my last bit of graduate school, where my Health Education coursework introduced me to theories and frameworks that had already been used to create lifestyle habit change in the real world for things like smoking cessation, AIDS education, as well as alcohol reduction. By comparison, dietary habit changes should be quite doable!

So I’ve been referring to this as a “Middle Way”: all of the cultural and research-based lifestyle components that can get you lean and healthy without an obsession or an overly restrictive life bent to the will of your diet. Sounds good to me!

We’re calling it “Concierge Coaching” and here’s what you get:

  • Daily Content delivered and personalized just for you
  • Full Access to Exclusive Concierge Content
  • Only 10 minutes of reading 6 days per week
  • Actionable items to implement and practice
  • Weekly check-ins with your personal coach
  • A strong and effective community

The goal is the leverage all of the power and proven success of the health education foundation with a program delivered to you, that you can actually stick with. It’s a re-education program, not a diet. When you’re done, you should never have to “diet” again!

Sound interesting? Click here to find out more and inquire about getting on board.

 

It’s still about lifestyle, mostly.

I’ve examined a number of studies on how important lifestyle factors are in health and longevity. With this post I wanted to tie the threads together to get a big picture.

It’s easy to get hung up on tiny variables, on nerding out with the bleeding edge of science. I get it; I’ve been there. It makes it sounds really tough, like you have to time everything by an Atomic Circadian Clock. Really, this stuff isn’t that hard. If you’re on the bleeding edge of the BMI scale, you likely need some very specialized help. If you’re not, you don’t need daily mental masturbation about minutia that probably doesn’t make that much of a difference. Not in practice.

And that’s really it: things that can be done in the controlled lab environment are very rarely externally valid. Controlled meals and metabolic chambers? Nay. Metabolic carts and a perfectly timed bolus of amino acids? Nope. You get none of these, free-living human.

The fact of the matter is that the leanest, longest-lived cultures on Earth aren’t accounting for any of that crap!

A quick rundown, shall we?

The Aladema Study

The Blue Zones studies attempted to tease out a defacto longevity formula from the longest lived cultures on Earth. I’ll talk more about them in a minute, but if you back the longevity train up a bit further, you’ll find a researcher by the name of Lester Breslow. In 1965, Breslow started a study in Alameda country, California that examined the health habits of 6,928 people, with an eye toward 7 health habits he deemed most important (which is why the study is referred to as the “Alameda 7″). Their behavior was examined over intervals of up to 20 years and the data was parsed with quantitative analysis (which at the time didn’t happen with longevity studies). As a result, Breslow found that a 45 year old who followed at least 6 of the 7 habits had a life expectancy 11 years longer than that of a person who followed 3 or fewer. And these were good, strong, functional years free of major disease or complication, because what does it matter that you live longer if you can’t do anything with it?

What were the habits? Here’s his original list of the Alameda 7:

  1. Avoiding Smoking
  2. Exercising regularly
  3. Maintaining a healthy body weight
  4. Sleeping 7 to 8 hours per night
  5. Limiting consumption of alcoholic drinks
  6. Eating Breakfast
  7. Avoiding snacking between meals.

…That’s it. You were expecting some sort of lifestyle calculus? Something only the “chosen few” could accomplish? There’s nothing sexy here and that’s the point: what is done consistently, albeit imperfectly, is what makes changes in the long term. Interventions require rigidity and high effort; lifestyles do not.

Don’t believe that this one study was enough? The good news is that the research has been followed and examined many times over the years. More recently, Dr. Jeff Housman (one of my graduate school professors) and colleague put together a review of the data that came from the study and subsequent reviews. Check this tidbit:

 The linear model supported previous findings, indicating regular exercise, limited alcohol consumption, abstinence from smoking, sleeping 7–8 hours a night, and maintenance of a healthy weight play an important role in promoting longevity and delaying illness and death.

So really the “Alameda 7″ is the “Alameda 5,” meaning that 1-5 on my list above are the big lifestyle “tricks” you need to attempt to do in order to set yourself up for a longer, stronger life.

So what happened to Lester Breslow? He died quietly in his home in 2012…at the age of 97. Maybe there’s something to this stuff after all?

Blue Zones

The main thrust of the Blue Zones starts with a study, known as the Danish Twin Study. This study followed 2872 Danish Twins born between 1870 and 1900. After all of these pairs had died, statistical analysis was performed and determined that ~25% of the variance in longevity can be attributed to genetic factors. Later studies give a slightly larger range, from a high of one-third to a low of 15%. So if we’re pessimistic, only one-third of our longevity is related to genetic factors, thus the remaining 70% is due to lifestyle. This was the thrust of the Alameda 7 study: follow some simple habits and you’ll gain quality years of life.

The book is based on the work of Michel Poulain, who identified a mountainous region of Sardinia where men lived longer than women, but both live longer than the rest of Sardinia. Fun fact: it’s a “Blue Zone” because that’s the color they used to identify the region. Really, take a look:

After the statistical analysis was found to be accurate, that there was in fact a positive longevity outcome, the search for more of these places around the world began.

So after digging and intense statistic analysis, these 5 zones have been confirmed:

bluezonesmap

From these 5 spots, the authors attempted to “tease out” a de facto longevity formula, which is this:

Now I won’t spend time unpacking those, but I would suggest that they’re directionally accurate and very similar to what was found in the Alameda 7 (5?) study. If you were able to follow the above list regularly, then you’d likely be in a good place to maximize your longevity free of chronic diseases.

I have some problems with the conclusions derived from the Blue Zones. Not enough to throw it out (it’s really a great piece of work) but to bring attention to things that I feel are worth reducing the importance of when compared to the authors of the book:

  1. It’s also noted that all of these groups are isolated, which means that there is a significant “Founder Effect” to consider. That is when a population splinters off from a larger population, thus reducing genetic variation. While the Blue Zones demonstrate a founder effect that selects for a genetic maximization of these good habits (e.g. phenotypic expression), other founder effects lead to things like the incredibly high rate of deafness on Martha’s Vineyard, leading to things Martha’s Vineyard Sign Language. Remember that while genes play a relatively small part of longevity, these populations may have the most important reduced genetic variation to maximize the longevity effects of their lifestyles.
  2. It’s hard to prove a negative. In the New York Times article about the Ikarian blue zone, Gary Taubes asks this question: “Are they doing something positive, or is it the absence of something negative?” So while they are eating more vegetables than your average American, they’re also eating very little white flour and sugar compared to your average American. If it’s not there, you can’t see its effect. What is being contributed to veggies might actually be the lack of sugar and flour. It’s especially hard to compare the lifestyle effect; again these are isolated populations. Would the lifestyle-credited longevity benefits remain if sugar and flour were added?
  3. Much of the book is hooked on the dietary component and emphasizes movement, though not “exercise.” Fine, but  a recent analysis showed that the variable that most correlated with the longevity of the Sardinia blue zone men was *drumroll*… physical activity.  Not training, but “pastoralism,” grade of the terrain, and, distance traveled to a place of work. Not magic legumes, not red wine, not cheese, not a super-secret workout…physical activity!

Adventists & Mormons: It was never about meat

Going back to my whine about isolating small variables and attempting control them, remember that our bodies aren’t these time-dependent output machines. That is, an input will not always give you the same output, in the same amount of time…there’s a constellation of variables all in flux that affect the final outcome.

This is the problem with any self experiment: humans tracking inputs into our biology leaves all sorts to be desired…the margin of error is just too much for any sort of meaningful information to be derived:

nancy-qs

We’re not machines; if we were, we could expect a given input to yield a linear, time-consistent response. X volume of powder A yields Y response in Z minutes. But it doesn’t and we don’t. Not only are we not machines, but some of the greatest advances in phlebotomy and proteomics research have come when we get the human element out of the way, mostly for the “unreliable/distractions/kittens” element mentioned above.  Examples:

So just live all Dionysian and  attempt to not control anything? No, but you must understand that the inputs are signals…they are stimuli. The stimuli is directionally accurate and dose-dependent. Further, the dose will have varying outcomes depending on the state of your physiological milieu at the moment of input. You can be sure ingesting protein will lead to new amino acids being available for protein synthesis, but the standard deviation of the response will vary depending on a variety of factors that you can never hope to control.

Further, the body is directionally set by the stimuli…it doesn’t care nearly as much by the context of delivery as much as by the quality of the content. This is especially true in the “paleo” community, with the idea that “Caveman X was on the savanna, therefore only could lift heavy rocks and get thorns in their ass when they screwed. I must mimic this for maximum health!” Here’s the thing:

The body doesn’t care about concepts; it only cares about stimuli.

The SAID principle (specific adaptation to imposed demand) referred to the type, quantity, and frequency of a stimuli. So while our hunter-gatherer ancestors trained their posterior chain by hauling an animal, we might dead lift or use a good lumbar extension. The stimuli is similar, no hauling required. The mismatch was never “We’re not hauling bison out of a ditch and eating mongongo nuts”; it was “we’re never exerting to a sufficient intensity while eating lots of processed garbage.” You mimic the stimuli while reducing the risks.

Why mention all of that? Well I think the above is largely the root of why people get hung up on a single dietary variable like meat (for instance). Never mind that so many studies lump meat in with, say, “fatty” foods like potato chips and ice cream (really!); the food stuffs are just one variable in a larger picture, going back to the title of this post. If the totality of the lifestyle is in order, the inputs hold less weight because the whole spinning plate is much more balanced.

Example: Seventh Day Adventists are often credited for their longevity, which is always reduced to diet. However, the most thorough studies never claim it’s just the diet: they’re always looking at the total lifestyle to draw their conclusions.

Similarly, studies that look at a similar population (California Mormons & California Adventists) show similar improvements in longevity due to the totality of the lifestyle:

  • Adventists: 7.28 years in men and by 4.42 years in women from age 30
  • Mormons: 9.8 years in men and by 5.6 years in women from age 25

Now it’s important to note that this isn’t a comparison between groups…or rather, it’s between one religion and the average Californian of the same age. And the statistics used in each study may be slightly different (like which inputs & variables they found most valuable, etc. I have no interest in unpacking them). The point is that if a single variable, meat, was a keystone/linchpin/cornerstone in the longevity equation, then the statistics should indicate some change. And since it’s often cited as “the” culprit, the statistic should jump out and punch you in the face, the same way cancer rates in those who smoke isn’t a tiny statistical anomaly.

Here’s the point: all of the nerding out in service of the big picture, the lifestyle, is great. A regular sanding of the details leads to a better overall picture. However, nerding out in order to replace the big picture is a fools errand, a big distraction that keeps one focused on a “big secret” that simply doesn’t exist.

251505_10151024760092405_1633409149_nSkyler Tanner is an Efficient Exercise Master Trainer and holds his MS in Exercise Science.  He enjoys teaching others about the power of proper exercise and how it positively affects functional mobility and the biomarkers of aging.

Dynapenia: The Real Problem With Not Resistance Training

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At Efficient Exercise, we use the term “Sarcopenia” when discussing why new clients should endeavor into resistance training. This is Latin for “poverty of the flesh,” which really means age and/or inactivity-related losses in muscle mass. This was thought to be a primary driver of things like osteoporosis and obesity, even associating the term “sarcopenic obesity.”

However, this implies a sufficiency issue: just have enough muscle mass and you’re insured against many of the future losses that come with simply having the muscle. However, this did not explain why people of varying levels of muscle mass were experiencing these symptoms with prolonged inactivity. This is a bit like how skinny people can be “obese” as far as visceral fat to lean body mass ratio. There’s  a hormonal milieu that can only be accounted for through the lens of use rather than presence.

At EE, we’ve always focused on maintaining muscle mass through aging, but it’s become increasingly clear that what matters most about muscle is the use rather than the amount. It makes sense that the focus was on sufficient muscle mass, as we were unable to measure any element of the tissue that communicated with the rest of the body…they were merely motors. Now we understand that muscle is in fact our largest endocrine organ, releasing hormones and signaling agents called myokines that communicate with the rest of the body to set the thermostat, so to speak, regarding the importance of muscle tissue and how it should be treated by the rest of the body.

Let me explain.

Go back to my first paragraph and the term “sarcopenic obesity.” The literature on this topic is totally interesting and the first thing that jumps out is that both muscle and fat tissue are very active endocrine tissues.  The second thing that stands out is that these endocrine actions are almost in direct opposition to each other, like colonies in competition for energy resources. This is different than the old “auto-regulation” model that the body would partition based on substrate and availability, like when the muscles were replete with nutrients, the fat was a dump for whatever was left. This is now turning out to be incorrect.

In this review of sarcopenic obesity, researchers lay out all of the signalling mechanisms that fat and muscle use to facilitate endocrine communication. If you wrote down all of the mediators and their effects in separate columns labeled “muscle” and “fat” you’d see that they’re in competition.  Age seems to dictate which tissue has the competitive advantage. When you are young, muscle has the competitive advantage over adipose tissue and the advantage slowly shifts toward fat as the years go by, largely because you pass childbearing years and your Darwinian Fitness reduces (or “evolution stops giving a damn” to quote evolutionary biologist Michael Rose). As you lose muscle, the signalling from fat mass becomes greater, begetting more fat mass, increasing the signal further as muscle continues to whither and reduce their signalling.

So the signalling from fat mass is largely due to the volume of fat mass. However, it turns out that muscle signalling is not due to the presence of the tissue itself (a sufficiency), but rather from the use of said tissue. This means that is actually a reduction in muscle quality, which means less strength, than correlates more with aging than merely having enough muscle tissue. The term for this is dynapenia which literally means “poverty of power.”  It is the loss of strength which reduces the quality of our contractions, which reduces the signalling for resources, which reduces the partitioning of nutrients to muscle tissue and increases the partitioning toward fat mass, which begets more fat mass. A recent literature review demonstrates that strength is lost more rapidly than mass as we age. Considering it’s the very strength that would, for example, help prevent a fall or maintain balance through aging, this fact of rapid loss is especially important.

Strength precedes the signal and the signal is in proportion to the use of said strength. If you’re using a high intensity of effort on a regular basis, you’ve set the stage to maintain your strength, muscle tissue, and tip the balance toward lean mass instead of fat mass as we age.

Iatrogenesis: A Response From Dr. Phillip Alexander

In the January 27th post entitled, “Small Health Habits Make a Big Difference,” I laid out the 10 leading causes of death in the United States according to the CDC. I recently received a response from Dr. Philip Alexander on this very topic:

Skyler…on the CDC’s own website, they freely admit that the list of the Top 10 Leading Causes of Death always leave out the real #3 cause. I’ve added it below. Sometimes hospitals can be very dangerous places!

 

  • Heart disease: 597,689
  • Cancer: 574,743

 

The medical profession: 225,000

Non-error drug adverse events 106,000

Medication errors in hospitals 7,000

Other errors in hospitals 20,000

Unnecessary surgery 12,000

Hospital-acquired infections 80,000

 

  • Chronic lower respiratory diseases: 138,080
  • Stroke (cerebrovascular diseases): 129,476
  • Accidents (unintentional injuries): 120,859
  • Alzheimer’s disease: 83,494
  • Diabetes: 69,071
  • Nephritis, nephrotic syndrome, and nephrosis: 50,476
  • Influenza and Pneumonia: 50,097
  • Intentional self-harm (suicide): 38,364

 

Incidentally, in 1990 Alzheimer’s Disease wasn’t even in the top 20. In 1999 it was #7, in 2004 it was #6, and is now #5. Medicare says that by 2020 50% of the long-term facility beds in the US will be Alzheimer’s Disease. It’s 50% now. All the others are stable or slightly improving (as in the graph below), but with a frightening increase in Alzheimer’s.

It’s all lifestyle, and we know how it happens and how to prevent it.

Disease Changes

So we’ve learned two things: 1) Dr. Alexander never does anything halfway and, 2) treatment is a serious killer. What Dr. Alexander is talking about is called Iatrogenesis, which is where harm comes from the healer. The human body is incredibly complex, as discussions with my physician clients always elucidates. Historically we’ve take a statistical approach to treatment and treatment methods, that is a clinical trial shows that X percent of patients respond to Y treatment, and side effects were less than the benefit, so the treatment is viable. No clinical trial, no matter how huge, can account for the ever growing number of patients physicians are seeing, especially as boomers age into Medicare. There will be somebody who, because of their unique makeup, responds exceedingly poorly to a treatment and becomes part of the statistic above.

However, there is also the patient side of the equation, expecting the physician to “Do Something” when they see them. This is made worse by social ranking systems like Yelp where a patient can boil a physician’s ability down to a 5 star rating system based on one visit. If you’re in a position where you’re effectively arguing with a patient who expects to be prescribed something, you may very well just write the most benign script available and move onto the next patient in your overcrowded day. That’s “Murica for you: give me drugs or I’ll have your head on Yelp.

The human body is not beholden to our temporal expectations as much as we’d like it to be. What may take weeks we want in days, and this leads to some of the ill-advised treatment that results in harm above. To quote my friend Doug McGuff:

My favorite mantra is….”Don’t just do something, stand there!”. We must always be cautious about intervening when mother nature is not taking her course as fast as we would like it. The greater your sense of urgency to act, the more you should wait.

This is not to say that you should do nothing, but that you should understand that not everything has a clean, linear treatment or recovery process and sometimes waiting is the most prudent course of action. That’s why they call it the “art and science of medicine,” folks.

251505_10151024760092405_1633409149_nSkyler Tanner is an Efficient Exercise Master Trainer and holds his MS in Exercise Science.  He enjoys teaching others about the power of proper exercise and how it positively affects functional mobility and the biomarkers of aging.

 

Health and Longevity: The Most Impactful Changes Are The Simplest

During this year’s PaleoFX conference, I had the opportunity to eat and shoot the shit with one Ben Greenfield. More importantly, I had the opportunity to do the same with his wife, Jessa. Great people, super passionate about helping people improve their lives and health, and a lot of fun to be around when fish skins are part of the menu.

Ben knows a LOT about the human body. He’s also part of a small cohort of people I know who have willingly had needle biopsies done just to see how many mitochondria their muscle tissue has added as a result of being in chronic ketosis (Ben has, if I recall correctly, triple the mitochondria in his muscle tissue as your average bear). He considers himself an “ancestral athlete” but doesn’t attempt to live in a cave or only train body weight because of it. He sums this up in his article: “The 10 Rules of the Ancestral Athlete.” Note, there are likely some borderline Not Safe For Work photos on that website. However, the article is great and is a long form version of something Doug McGuff likes to say:

Fred Flintstone diet with a George Jetson workout.

Ben has done a LOT of experimentation to push the limits of health and performance, much in the same way any Olympic athlete does building up to the Olympics every four years. However, Ben is curious about the outcome, as his paycheck isn’t nearly as large for all the noodling he’s wont to do. Truth be told, we’re all nerds about this stuff, but the reality is that very little of the nerding amounts to any significant improvements in health and longevity over getting the simple stuff done, consistently. Take a look below, where I plot the time/effect interval for a variety of health marker improvements that result from exercise:

Exercise per week

The curves are fairly steep: doing enough, regularly, leads to the largest changes in health outcomes. After that, it’s a lot of mental masturbation for a paltry change in outcomes. In numbers above, you have to train 350% more per week to achieve 28% more result over what 1 hour each week gets you. If you’re an Olympic athlete looking for performance, that’s worth it. But if you’re not, that’ s a waste of time, especially when you factor in all of the wear and tear that comes with that effort.

Ben even admits as much in the article. He talks about how his wife is very laissez-faire about her training and how much better it is for health:

I’m not arguing that there’s no value to rigidity, self-control, knowledge, and self-discipline, but I suspect that if we both stay on the same path, my wife will probably outlive me and have a higher quality of life in the process.

If you didn’t read the article, the context is that Jessa trains when she feels like it, eats real food when she’s hungry, and doesn’t stress about it. But she does these small things regularly with big result. She’s in great shape.

It’s the simple changes that result in the biggest health outcomes long term. This is why restrictive diets are an abject failure in the research world, why so many people hate “training,” and why this country is in really poor condition. It’s also why those who did the simple habits regularly in the Alameda 7 Study or the Blue Zones are those living the longest.

Simple is not easy, but it’s a whole mess easier than making things really complicated not much more gain.

 

251505_10151024760092405_1633409149_nSkyler Tanner is an Efficient Exercise Master Trainer and holds his MS in Exercise Science.  He enjoys teaching others about the power of proper exercise and how it positively affects functional mobility and the biomarkers of aging.

The Elderly Need More Exercise? Yes And No.

stephen-jepson

 

An interesting discussion over at Doug McGuff’s message board regarding exercise and aging. This comment was of interest:

I suggest that the sedentary elderly require more exercise, not less. I am one such. A few minutes a week is not going to do it for sarcopenia or anything else. If I train once a week I cannot maintain my condition, strength,metabolic benefit, motivation or momentum. Nor can you if the rest of the time you are inactive.

Here was my response to this statement:

And I disagree; I think the elderly need more activity, not exercise. Further, the health education research is clear: in the elderly, physical activity and self-efficacy track side by side. The more confident a person is in their abilities, the more physically active they are; the more physically active they are, the more confident they are in their abilities.

If you make a person stronger in your studio, they’re more confident in their ability to do other activities. This is what Doug talks about when he says people want to move more after training for a number of months. Get strong and you’ll get more active relative to your starting lifestyle.

I’ll even make it a nice soundbite: have you ever heard the phrase “a stronger athlete is a better athlete?” The same is true of human beings throughout aging, that is a stronger human is a better (more active, more healthy, more resistant to cancer/metabolic disease/disability) human. (Emphasis mine…just now!)

There is a nugget of wisdom in there that I want people to pay attention to: “relative to your starting lifestyle.” If a person is doing zip and they start a once per week strength training routine that then leads them to take leisurely strolls because they enjoy it, they’re going to do a whole lot better for themselves compared to where they started as far as disease prevention and injury risk reduction. If you had a crazy triathelte at the same advanced age add the same dose of exercise, it wouldn’t make much of a difference. There’s a survivorship bias discussion that will be addressed another time, but here’s my advice: don’t take advice from an endurance athlete who has been training “all of their life” as the gospel…there’s more at play than just hard work!

I digress; elderly individuals should look at their training as an upside-down oil funnel: the widest, part is going to be activity that is very low in intensity but very high in frequency. It seems this is where one can start making a semantic argument that this too is “exercise.” However, it’s really just being a good human animal and setting a functional path: if you move a certain way today, you’ve got a good chance of moving that way tomorrow. The middle part of the funnel is going to be mobility work as maintaining joint free range of motion is paramount for maintaining activity levels. When looking at barriers to exercise, the less mobile people are, the larger their barriers to exercising become. For example, those with mobility limitations cite “poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise…”. Performing joint mobility work for 10-20 minutes a day, hell even starting at 5 minutes per day, when mobility is still pretty good will go a long way to maintaining mobility, which maintains activity levels and exercise efficacy. Finally, the tip of the funnel is exercise training, preferably of a high intensity nature. Muscle is the most plastic tissue in the body, the largest endocrine organ we have, and creating a sufficient degree of demand will improve all aspects of a person’s physiology. By its nature, it cannot be sustained for very long and requires a prolonged recovery period. That’s fine, as it means more time for the activities the person would rather be doing, which is going to set the table for continuing to do the activities until the day they die. All good stuff!

So no, the elderly do not need more exercise; they need just enough exercise to produce a body that feels good doing lots of physical activity that a person would rather be doing. Maybe this advice will produce a few more Stephen Jepsons in the world and how cool would that be?

251505_10151024760092405_1633409149_nSkyler Tanner is an Efficient Exercise Master Trainer and holds his MS in Exercise Science.  He enjoys teaching others about the power of proper exercise and how it positively affects functional mobility and the biomarkers of aging.

Integrating What We Do With Other Activities

This past weekend at the PaleoFX conference, I had a number of conversations with people who were curious as to how we incorporate what

we do at Efficient Exercise with other activities. They were having a hard time rectifying how such a small amount of exercise could benefit their activity.

Specificity

There first thing I explained was simply that we at EE don’t want them to be “good” at working out. Not that we don’t want them to get better but that we want them to do only well enough to benefit the activity that they’d rather be doing. For endurance athletes, this means that they really only need one workout per week with us. The trick is that they need to replace one of their training days with our workout: you can’t just add the strength training on top of a loaded endurance schedule. Studies showthat the combination of strength and endurance only works if some of the endurance activity is replaced with strength work. It’s also been shown from the same studies that this strength work reduces injury potential and improves oxygen consumption.

So how might that look in practice? My friend Patrick Diver has combined an approach similar to ours with his cycling. In this interview, he explained the schedule he used when competing at the highest levels (Florida Pro I/II criterium championship):

  • Monday:   Off
  • Tuesday:  Intervals on bike + short HIT session
  • Wednesday:  Training Race
  • Thursday: Off
  • Friday: Off
  • Saturday:  Race
  • Sunday:  2.5 hour fast group ride

Total weekly hours: 5-7

Welcome to the gun show.

 

So if you know any cyclists who compete, they’ll scoff at this amount of training but it was an intelligent application of leveraging the highest quality hours that produce the best result.

What about other activities? It’s pretty in vogue to focus on moving naturally, attempting to apply how humans may have moved and build a workout around it. This sort of activity is a lot of fun and that’s part of my point: you should be doing things you like doing more often with less injures. That’s what resistance training like what we do at EE can provide. Back to my point, how do we mesh the two? Again, Patrick’s answer is more succinct than I could provide:

My take on it goes like this:  do a (high quality strength) session once a week to cover your bases, and then go jump, roll, fight, climb, cycle or whatever else that seems like fun to you.

Remember, unless you have a specific performance goal that pertains to the gym, you don’t have to spend much time there to get the benefits to health and vitality. This is also true if you’re attempting to improve the performance of other activities. The gym only improves the baseline strength of the muscles involved; you’ve got to use them in the activity to maximally transfer that raw strength.

It’s really that simple.

Lifestyle Habits: “The Blue Zones”

Back in my Alameda 7 post, I made reference to “The Blue Zones,” which is a demographic study of areas of the world where people live measurably longer periods of time.The Blue Zones idea and suggested conclusions (more on that in a moment) were vaulted into the consciousness of health-minded folks largely due to Dr. Oz and an entire episode on Oprah outlining the 4 Blue Zones that had been discovered at that time (there are now 5).

I’ll give a brief rundown of the gist, outline these zones, list the found similarities in how these groups live, and offer some criticism as to the conclusions drawn.

 

Origins

The main thrust of the Blue Zones starts with a study, known as the Danish Twin Study. This study followed 2872 Danish Twins born between 1870 and 1900. After all of these pairs had died, statistical analysis was performed and determined that ~25% of the variance in longevity can be attributed to genetic factors. Later studies give a slightly larger range, from a high of one-third to a low of 15%. So if we’re pessimistic, only one-third of our longevity is related to genetic factors, thus the remaining 70% is due to lifestyle. This was the thrust of the Alameda 7 study: follow some simple habits and you’ll gain quality years of life.

The book is based on the work of Michel Poulain, who identified a mountainous region of Sardinia where men lived longer than women, but both live longer than the rest of Sardinia. Fun fact: it’s a “Blue Zone” because that’s the color they used to identify the region. Really, take a look:

After the statistical analysis was found to be accurate, that there was in fact a positive longevity outcome, the search for more of these places around the world began. Many Don Quixote-types claim that their area of the world has a positive outcome on longevity. My wife even spent a year in one of these places: Vilcabamba, Ecuador.  In her own words, “The guy who probably convinced the gringos that you lived forever there was my host father. He was a fantastic story teller.” I mean it’s a gorgeous place, but no longevity advantage has been found:

The Five Blue Zones

So after digging and intense statistic analysis, these 5 zones have been confirmed:

bluezonesmap

From these 5 spots, the authors attempted to “tease out” a de facto longevity formula, which is this:

Now I won’t spend time unpacking those, but I would suggest that they’re directionally accurate and very similar to what was found in the Alameda 7 study. If you were able to follow the above list regularly, then you’d likely be in a good place to maximize your longevity free of chronic diseases.

Criticism

I have some problems with the conclusions derived from the Blue Zones. Not enough to throw it out (it’s really a great piece of work) but to bring attention to things that I feel are worth reducing the importance of when compared to the authors of the book:

  1. The book goes on about all of the exercise of a decent intensity that these people are doing, but then concludes that if you “move naturally” you don’t need to exercise. They’re not talking Movnat-style exercise, but maintaining a high level of physical activity through gardening, walking, or “inconveniencing yourself.” This is great stuff, mind you, but the audience of the books needs to be considered. I learned in graduate school how if a researcher is not on top of a person, they’d count walking to the mailbox as “10 minutes of moderate intensity physical activity.” For Americans, I feel there needs to be some sort of intervention of activity to demonstrate meaning of “moderate physical activity” while also addressing the musculoskeletal imbalances these people have. It’s not like I’m talking out of my ass here: I’ve made a career of this because it’s so common. Eventually, when you’re in better shape, you want to move more, like you can’t sit still. This isn’t accounted for: the conclusion ignores the cause of why these people move so much, which is that they’re already healthy and fit. It’s the same reason all the fat people on the “Biggest Loser” are forced to move a ton. Correlation and causation are flipped.
  2. It’s also noted that all of these groups are isolated, which means that there is a significant “Founder Effect” to consider. That is when a population splinters off from a larger population, thus reducing genetic variation. While the Blue Zones demonstrate a founder effect that selects for a genetic maximization of these good habits (e.g. phenotypic expression), other founder effects lead to things like the incredibly high rate of deafness on Martha’s Vineyard, leading to things Martha’s Vineyard Sign Language. Remember that while genes play a relatively small part of longevity, these populations may have the most important reduced genetic variation to maximize the longevity effects of their lifestyles.
  3. It’s hard to prove a negative. In the New York Times article about the Ikarian blue zone, Gary Taubes asks this question: “Are they doing something positive, or is it the absence of something negative?” So while they are eating more vegetables than your average American, they’re also eating very little white flour and sugar compared to your average American. If it’s not there, you can’t see its effect. What is being contributed to veggies might actually be the lack of sugar and flour. It’s especially hard to compare the lifestyle effect; again these are isolated populations. Would the lifestyle-credited longevity benefits remain if sugar and flour were added?

I like this book. I have a dog-eared copy that I’m sure I’ll have to replace at some point because I read it so much. I’m on board with the lifestyle habits that maximize longevity but I like to remind people that, due to a variety of factors, these habits may simply be what maximizes longevity in these populations due to their genetic makeup. Take these habits on and you’ll significantly improve the quality of your life, just don’t expect to live to 110 because some of those in the Blue Zones have.

251505_10151024760092405_1633409149_nSkyler Tanner is an Efficient Exercise Master Trainer and holds his MS in Exercise Science.  He enjoys teaching others about the power of proper exercise and how it positively affects functional mobility and the biomarkers of aging.

 

 

Habit Formation: The 21 Day Folklore

How long does it take to form a new habit? If you’re like most people, the answer you will say without thinking is “21 days.” This time frame is built into the zeitgeist of our culture, though I’m not sure where it comes from insofar as experimental evidence. Let’s explore this a bit and see where the science takes us.

Willpower is rocket fuel

Changing habits does require some amount of willpower, especially early in the process. In attempting to change habits, many of my clients lament their “lack of willpower” if they are unable to adopt a new habit in 3 or 4 minutes…that’s sarcasm folks, but it’s basically an extension of what I covered in this blog post about giving yourself time to adopt a new habit. However, there is a grain of truth in that so much of our daily habits are on autopilot, totally free of rational inputs beyond process initiation. While some of you will be set to argue this with me, imagine you had to rationally work out every step of the process to get out of bed, get showered, and get yourself to work every morning. The fact that you’re both A) still gainfully employed and B) not mentally exhausted by 8:30am tells me that the vast majority of this process was free of serious deliberation of the alternatives…once in motion you stayed in motion. This is because there things are your habits and, like Newton said, objects in motion tend to stay in motion. Yes he was talking physics but it’s not too far off the mark regarding how we work with habits.

So changing a habit requires new processes, which requires deviations from autopilot, which requires willpower. The thing about willpower is that it is a finite resource: you can very easily use it up. There’s even a cool name for it: ego depletion. Further, there aren’t different silos that have X amount of willpower for different types of tasks. There’s one big pool that you fish out of and then when it’s all gone for the day, you’re more likely to throw caution to the wind with any tempting thing that crosses your path. Hence willpower is great for getting things started, rocket fuel, but it is not to be relied upon for maintenance of long term habits.

Twenty-one Days is a Myth

So if we’re going to gain a new habit, willpower will be used early on until the habit becomes a more integrated part of our routine, where less and less willpower are required to put things in motion, which at that point can be considered a habit. So how long does a habit take to form? As noted above, there is a cultural idea that a habit takes 21 days to form with daily practice. However, the research available doesn’t support that conclusion as absolute. Rather, the complexity of the habit desired determines the length of time to integrate said habit into your daily routine. From a recent study on habits, we have some clues as to what defines complex habits and their integration. The study had 96 individuals take on various habits and log their progress into an internet tracking site. They also tracked out automatic the behavior felt, known as “automaticity.”

So how long did it take? On average, across the participants who provided enough data, it took 66 days until a habit was formed. The complexity (or perceived complexity) determined how long a habit would take to be acquired. People who resolved to drink a glass of water after breakfast were up to maximum automaticity after about 20 days, while those trying to eat a piece of fruit with lunch took at least twice as long to turn it into a habit. And relevant to you, dear readers, the exercise habit proved very tricky. The study provided a “50 sit-ups after morning coffee,” habit, which still was not a habit after 84 days for one participant. However, something simpler like “Walking for 10 minutes after breakfast”  turned into a habit after 50 days for another participant. I’d suggest this is because we are built to walk as human beings, but doing situps is not a requirement for daily living.

Break the Habit Down

So you can see, depending on the complexity of the habit, it can be 12 weeks or more before the habit has stuck. So how do we go from where we are to where we want to be? Like eating a 30 ounce porterhouse, we do this one bite at a time:

  1. Determine the outcome you’d like to achieve and the main habit you’d need to achieve said outcome.
  2. Break the habit down into parts. There parts need to be specific.
  3. Focus on the simplest part of the habit until you have achieved automaticity before moving onto the next part.

So instead of one big habit, you have many small habits. So while the overall habit might take a long time, the feedback of integrating smaller habits creates a foundation to build on toward larger habits. An example would be instead of “I’m going to stop eating all junkfood and eat more vegetables” as a habit, you’d break that down into a few separate habits that are specific and actionable like “I’m going to eat 3 servings of leafy greens each day,” or, “I’m going to limit myself to one snack per day at 3pm in the afternoon.” From there, determine which seems least difficult to accomplish and do only that habit until automaticity sets in. That way, each part might only take 20 days and the success of completion will further move you as the complexity increases. You gain self-efficacy, which means you’re more likely to keep up your efforts and succeed.

So 21 days isn’t set in stone, but if you break a habit down, you might only need to spend that much time on every component, and that’s the secret to habit integration over time.

251505_10151024760092405_1633409149_nSkyler Tanner is an Efficient Exercise Master Trainer and holds his MS in Exercise Science.  He enjoys teaching others about the power of proper exercise and how it positively affects functional mobility and the biomarkers of aging.

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